Pulmonary inflammatory pseudotumor due to Coxiella burnetii. Case report and literature review.

A 58-year-old man was admitted because of respiratory failure, episodic fever with chilling, cough, malaise, fatigue, myalgia and weight loss lasting for at least one month. Chest x-rays and CT scan of the chest showed bilateral pulmonary consolidations in upper lobes, the left lower lobe, and mediastinal lymphadenopathy. Bronchoscopy with cytology was unremarkable. A needle CT-guided lung biopsy documented an inflammatory pseudotumor, lymphoplasmacytic type. Serology showed high titer antibodies to phase II Coxiella burnetii infection. Therapy with doxycycline and hydroxychloroquine for three months led to a complete resolution of symptoms and radiological findings, and a marked decrease in titers to Q fever.

Cytological and histological diagnosis of lung cancer in Sardinia and Italy in the 1990s.

BACKGROUND: Up to 30-50% of all lung cancer cases remain without cyto-histological characterisation. The aim of our study was to evaluate retrospectively the proportion of histological and/or cytological diagnosis in patients with lung cancer in Sardinia. METHODS: Data was gathered by consulting the hospital registers and case notes of individual patients released from hospital with a diagnosis of Lung Cancer at all medical centres throughout Sardinia. In gathering patients' data, we focused our attention on cytological and histological procedures through which allowed the lung cancer was diagnosed. Cancer Registries data was utilised to compare our data with national and Sassari province data. RESULTS: From 1991 to 1996 there was a total of 3146 lung cancer patients registered in Sardinia. 1902 patients (60.5%) had a histological diagnosis, 142 patients (4.5%) a cytological diagnosis while in 1102 patients (35%) the diagnosis was performed without any pathological validation. CONCLUSIONS: Our study has shown that lung cancer diagnosis is supported by pathological verification in 65% of cases while in remaining 35% of patients the diagnosis is based only on clinical and radiological reports. In Italy data from Cancer Registries report the percentage of cytohistological diagnosis to be 70% with the percentage of cytological diagnosis being higher than in Sardinia.

Epidemiology of lung cancer in Sardinia, Italy, from 1980 to 1996.

SETTING: Bronchial carcinoma is the most common cause of death among all malignant tumours. Despite a progressive increase, many Italian regions--ours included--do not have a Regional Cancer Registry. OBJECTIVE: To assess lung cancer incidence and mortality rates in Sardinia during the period 1980-1996. METHODS: Data were gathered by consulting hospital registers and the case notes of individual patients released from hospital with a diagnosis of bronchial carcinoma at all Sardinian medical centres between 1980 and 1996. RESULTS: A total of 7734 patients with lung cancer were registered in Sardinia between 1980 and 1996. Data showed a steady increase in lung cancer incidence rates over the years (from 22.3/100000 in 1980 to 34.5 in 1996). The same increase was evident in mortality rates (from 25.7/100000 in 1980 to 42.9 in 1996). The increase in mortality rates was higher in women (+146%) than in men (+59.5%). CONCLUSIONS: Results show a slow but steady increase in lung cancer incidence and mortality rates in Sardinia. The high number of smokers among lung cancer patients seems to indicate that anti-smoking campaigns need to be more effective in Sardinia.

Epidemiology of tuberculosis in Sardinia: a comparison of two data-gathering methods.

SETTING: A complete surveillance system for tuberculosis should be able to guarantee constant updating of incidence and provide useful data on a variety of problems related to tuberculosis such as drug resistance, co-infection with the human immunodeficiency virus (HIV), the geographic origin of patients, and mycobacterial species. OBJECTIVE AND DESIGN: To assess the completeness of the surveillance system currently operating in Sardinia, cases seen by all medical centres between 1987 and 1995 were compared with those notified to Sardinian Public Health Services for the same period. RESULTS: Each year, on average 39% of cases seen in Sardinia are notified; 646 (40%) of the 1591 patients notified during the study period were never seen by regional medical centres. An analysis of the results shows that from 1992 the decline recorded in incidence rates in previous years ceased: 1992 (26/100,000), 1993 (25/100,000), 1994 (28/100,000), and 1995 (24/100,000). CONCLUSIONS: The current surveillance system in Sardinia is inadequate for performing an accurate epidemiological survey of the disease. Epidemiological analysis based solely on notification can provide neither reliable incidence rates nor useful information concerning many aspects of tuberculosis.

Microbiological diagnosis of tuberculosis: a comparison of old and new methods.

The aim of our study was to evaluate the diagnostic value of various methods widely used in microbiological diagnosis of tuberculosis: direct smear examination for acid-fast bacilli, cultural identification in Lowestein-Jensen (L-J) medium, the radiometric BACTEC 460 system, and Polymerase Chain Reaction (PCR). Three hundred and ninety-three clinical samples of sputum (375), gastric aspirate (3), pleural fluid (12) and urine (3) were taken from 125 patients hospitalized at our Institute for suspected pulmonary tuberculosis, between January 1995 and June 1997. On completion of diagnosis, 35 were found to be affected by active tuberculosis (30 pulmonary, 4 pleural and 1 urinary) and 90 by other non-tubercular diseases (pneumonia, lung cancer, non-tubercular pleural effusion, etc.). In our study, direct smear examination for acid-smear bacilli gave diagnostic value results of 88% and positive predictive value of 91.67%. Cultural identification in L-J and BACTEC 460 TB radiometric system media resulted in diagnostic values of 96.80% and 94.40%, respectively, and positive predictive values of 100% for both of them. Finally, One-Tube Nested-PCR, a variant which uses specific primers for the IS6110 insertion sequence specific for Mycobacterium tuberculosis, gave us 88.80% (91.43% sensitivity and 87.78% specificity) diagnostic value results, and 74.42% (11 false-positives) positive predictive value. On the basis of our results, we can affirm that PCR is a good method for microbiological diagnosis of tuberculosis, given its high sensitivity and specificity and unparalleled rapidity. However, the high number of false-positives that we found suggests that results obtained should be confirmed with BACTEC, which considerably reduces the time required for identification, and makes it possible to carry out an antibiotic assay rapidly.

Serodiagnosis and follow up of patients with pulmonary tuberculosis by enzyme-linked immunosorbent assay.

A new ELISA assay based on antigen A60 from M. bovis BCG was used to quantitate specific anti-mycobacterial antibodies in 250 sera from 133 subjects: 90 tuberculosis cases and 43 controls. Controls were all negative, suggesting the specificity of this assay. In subjects with secondary pulmonary tuberculosis, a correlation was observed between the anti-mycobacterial antibody titer and culture positivity. In fact, positive ELISA assays were found in 88.8% of patients with positive cultures for M. tuberculosis and in 45% of culture-negative tuberculosis patients under therapy. According to our results the A60 ELISA assay is useful in monitoring the efficacy of anti-mycobacterial drugs. In pulmonary tuberculosis cases with positive cultures for M. tuberculosis higher levels of specific anti-mycobacterial IgGs were found after therapy.