A Mycobacterium abscessus infection complicated with lipoid pneumonia]

A 64-year-old man was admitted to our hospital because of productive cough and fever. Chest radiography on admission revealed air space consolidation in the right middle and lower lung fields and ground-glass opacity in the left middle lung field. He had been constipated for several years and had taken mineral oil for about a year. Sputum smears demonstrated acid bacilli, and cultures disclosed Mycobacterium abscessus. The transbronchial lung biopsy specimen showed granulomatous inflammation and numerous lipoid-laden macrophages in the alveolar spaces. Mycobacteria were present within the mineral oil and lipid-laden macrophages. It is likely that the mineral oil increased the pathogenicity of the mycobacteria.     

A case of lung infection due to Mycobacterium abscessus (M. abscessus) complicated with primary macroamylasemia]

We report a case of lung infection due to Mycobacterium abscessus (M. abscessus), complicated with primary macroamylasemia. A 76-year-old man was admitted to our hospital in August 2002 because of bloody sputum and an abnormal shadow found on chest radiography. The patient had had pulmonary tuberculosis from 1998 to 2000. He was found to be antacid bacillus-positive (Gaffky 5) on examination of the sputum in August 2002, but after hospitalization was negative for tuberculosis bacillus on sputum examination by the PCR method. We had suspected the presence of non-tuberculous mycobacterial disease since the patient's admission, and had started a regime of three drugs: clarithromycin, rifampicin, and ethambutol. The bacteria were identified as M. abscessus in a later sputum culture examination. It was noticed that the blood amylase level was high, and the disease was diagnosed as primary macroamylasemia. Such a case of lung infection due to M. abscessus complicated with macroamylasemia has rarely been reported in Japan.     

An autopsy case of Mycobacterium abscessus pulmonary infection complicated with rheumatoid arthritis

We present the case of a 70-year-old man diagnosed with Mycobacterium abscessus pulmonary infection complicated with rheumatoid arthritis who was treated with corticosteroids. He died despite treatment according to the recommended regimen of imipenem, clarithromycin, and amikacin. Autopsy revealed granulomatous lesions throughout the bilateral lungs. We conclude that M. abscessus infection may have a fatal outcome because of the drug resistance of the pathogen. This case suggests that rheumatoid arthritis might be a risk factor for M. abscessus pulmonary infection, but further studies are necessary for clarification.     

A case of lung infection due to Mycobacterium abscessus]

We report a case of lung infection due to Mycobacterium abscessus (M. abscessus). A 60 year-old woman was admitted to our hospital because of an abnormal shadow found on chest radiography and a bloody sputum. Chest radiography revealed infiltrative and linear shadows in the middle and lower fields of both lungs. The sputum smears were negative for acid-fast bacilli, but sputum culture was positive. Rapidly growing mycobacteria were detected. The patient was treated with clarithromycin. Since M. abscessus was identified from repeated cultures of the sputa, the patient was treated with Imipenem/Cilastatin and Amikacin for four weeks, during which the chest radiography improved. After discharge, the treatment with clarithromycin and minocycline was continued for ten months, and the chest radiography improved further. Our treatment for M. abscessus may be a useful choice for drug treatment of such cases.     

A case of bronchial ulcer due to infection by Mycobacterium abscessus]

We present a rare case of tracheobronchitis caused by Mycobacterium abscessus. The patient was a 79-year-old man with a previous history of tuberculosis. For smear examinations, he repeatedly expectorated many acid-fast bacilli. Bronchoscopic examination revealed the presence of ulceration on the lower end of the trachea and extending to the right main bronchus. Mycobacterial cultures were used to grow Mycobacterium abscessus. Following an antimicrobial regimen of clarithromycin, amikacin, and cefoxitin, the patient exhibited marked improvement. After initial multidrug therapy, the patient was placed on clarithromycin for 10 months. No relapse has occurred to date.     

Mycobacterium abscessus pulmonary infection complicated with vertebral osteomyelitis in a heart transplant recipient: case report and literature review

Infections produced by Mycobacterium abscessus are emerging in immunosuppressed patients, such as solid organ transplant recipients. We report the first case, to our knowledge, of a vertebral osteomyelitis caused by M. abscessus in a heart transplant recipient, and review the risk factors, manifestations, and therapeutic approaches to this uncommon disease.     

A case of Pasteurella multocida subsp. multocida complicated with diabetes mellitus]

We report a case of sepsis who died caused by Pasteurella multocida subsp. multocide sepsis. A 68-year-old male was admitted to Azusawa Hospital because of disturbance of consciousness. He had been suffering from diabetes mellitus combined with gangrene, but received no treatment. The patient died 24 h after hospitalization, and Pasteurella multocida subsp. multocida was isolated from his blood. Laboratory tests showed that CRP; 5+ WBC; 15,400/microliters, TP; 5.2 g/dl. Although Pasteurella multicida subsp. multocida seemed to cause mild infection in healthy subjects, it can cause severe systemic illnesses such as sepsis and meningitis in compromised hosts. It should be considered that the contact with pets will increase the incidence of systemic severe infection with this agents.     

Mycobacterium abscessus pulmonary infection presenting as a solitary pulmonary nodule

Nontuberculous mycobacterial pulmonary infection is a rare cause of a solitary pulmonary nodule. All previously reported cases were caused by Mycobacterium avium complex, and a solitary pulmonary nodule caused by other NTM species has been very rarely reported. We describe the first case of Mycobacterium abscessus infection presenting as a solitary pulmonary nodule in a 51-year-old asymptomatic adult patient.     

糖尿病水疱病一例

患者 ,女性 ,38岁。糖尿病史 7年 ,平素服用消渴丸 ,饮食控制不佳 ,体重呈渐进性下降。入院前 7d进食过量后出现上腹痛 ,恶心 ,呕吐胃内容物 ,静脉输入生理盐水和能量合剂后腹痛减轻。入院 2 d前突发全身散在水疱 ,神志不清。查体 :T36℃ ,P10 8次 / min,R2 0次 / min,Bp90 / 6     

新型冠状病毒肺炎合并糖尿病的相关问题

笔者针对新型冠状病毒肺炎(COVID-19)合并糖尿病的热点问题进行分析。通过目前的证据并未显示COVID-19患者较普通人群糖尿病比例更高。长期高血糖对人体免疫系统的不利影响使糖尿病患者更容易发生各种感染,但对于COVID-19这一疾病,无论是总体患者还是重症患者,COVID-19患者合并糖尿病比例与同年龄段普通人群接近。对于血糖的管理,需要根据COVID-19患者病情临床分型,分别制定血糖治疗方案和控制目标。     

Two cases of pulmonary infection by Mycobacterium abscessus in which drug susceptibility testing results conflicted with clinical courses]

We encountered two cases of pulmonary infection by Mycobacterium abscessus (M. abscessus). [Case 1] A 66-year-old man who had been treated for non-tuberculous mycobacterium in the past was admitted because of productive cough. His chest X-ray film showed cavitation and direct microscopy of sputum revealed positive acid-fast bacilli (AFB). He was given rifampicin (RFP), ethambutol (EB), and clarythromycin (CAM), and then his symptoms and radiographic findings improved. [Case 2] A 74-year-old man with multiple myeloma as an underlying disease was admitted because of a cavitation found on chest radiography and a positive result for AFB in his sputum. Standard antituberculous drug therapy with isoniazid (INH), RFP, EB, and pyradinamide (PZA) was initiated and then the chest radiographic findings improved. As M. abscessus was isolated two weeks after the induction of therapy, the therapeutic regimen was changed to another combination therapy consisting of EB, clarithromycin (CAM) and ciprofloxacin (CPFX), and then his symptoms and radiographic findings were further improved. In both cases, the bacilli found in their sputum were identified as M. abscessus by DNA hybridization. They were completely resistant to all anti-tuberculosis agents and many antibiotics with a high value of MIC. However, their symptoms, radiographic abnormalities and the results of sputum examination improved following chemotherapy. The results obtained by MIC measurement were inconsistent with the clinical outcomes. The measurement of the MIC value of antibiotics do not necessarily predict its therapeutic effect.     

糖尿病合并肺部感染151例临床分析

目的分析糖尿病伴肺部感染的临床特点，探讨其治疗策略。方法对151例糖尿病伴肺部感染患者临床相关因素（性别、年龄、病程、血糖、并发症、痰菌等）和治疗效果进行回顾性分析。结果糖尿病伴肺部感染的发生率为26．35％，其发生与年龄、病程、血糖高低及同时存在的糖尿病其他并发症有密切关系（P〈0．05或0．01），而与性别无关；肺部感染类型以急性气管-支气管炎为主（占39．07％），其次为肺炎、慢性支气管炎、肺结核等。肺部感染以革兰阴性杆菌为主。151例中痊愈和显效106例（占70．19％），死亡19例（12．58％）。结论定期行胸部X线检查，控制血糖，预防和治疗糖尿病并发症，有效抗生素应用是防治本病的关键。     

A case of Mycobacterium intracellulare infection complicated by immotile cilia syndrome]

A 25-year-old woman with a history of immotile cilia syndrome (ICS) was admitted to our hospital with dyspnea. Chest roentgenography revealed dense infiltrates in both lower lung fields in addition to bronchiectasis and small nodular opacities, which had been observed previously. Transbronchial lung biopsy demonstrated evidence of non-caseating epithelioid cell granuloma. Sputum specimens were examined, and isolates were identified as Mycobacterium intracellulare. The patient was given antituberculous therapy and clarithromycin, which induced clinical improvement. It is well known that bronchial mucociliary transport is severely impaired in patients with ICS. However, to our knowledge, cases of M. intracellulare infection complicated by ICS have not been reported in Japan. We must pay close attention to the concurrence of these diseases.     

Mycobacterium abscessus pulmonary infection during hepatitis C treatment with telaprevir,peginterferon and ribavirin

The first generation protease inhibitors has been the mainstay of hepatitis C treatment for the last couple of years, showing marked improvement in sustained virological response, but also increased side effects. Infection has emerged as a common complication of telaprevir and boceprevir in combination with peginterferon and ribavirin, usually caused by common pathogens. We present the case of a 65 years old man who developed a Mycobacterium abscessus pulmonary infection during treatment with telaprevir, peginterferon and ribavirin. The patient was successfully treated with amikacin, imipenem and chlarithro-mycin. The present case is relevant for increasing awareness for recognition of opportunistic infections and particularly nontuberculous mycobacterial infections in patients receiving triple therapy for chronic hepatitis C, especially in cirrhotic subjects who develop significant lymphopenia.