A case of asthma revealed to be a much rarer condition

Key message Asthma is one of the most common diseases. However, in patients with refractory asthma, chest imaging assessment should be performed, bearing in mind the possibility of other diseases

A case of allergic bronchopulmonary mycosis: 3D‐CT Findings led to successful multidisciplinary treatment with dupilumab and cryoprobe

Abstract The present case involved a 78‐year‐old woman with repeated recurrences of allergic bronchopulmonary mycosis (ABPM) who presented to our outpatient clinic with a chief complaint of dyspnoea with respiratory failure. Computed tomography (CT) of the chest showed atelectasis of the lower lobes due to mucus plugs. Blood and biochemical tests showed a high peripheral blood eosinophil count (1330/μL) and elevated immunoglobulin E (15,041 IU/mL; normal, < 361 IU/mL). Recurrent ABPM was diagnosed. The patient also showed chronic lower respiratory tract infection associated with Mycobacterium avium complex and Pseudomonas aeruginosa. First, we removed the mucus plug with a cryoprobe to avoid administering corticosteroids. However, subsequent 3‐dimensional CT showed residual mucus plugs, so we administered dupilumab as an additional treatment. After initiating dupilumab, mucus plugs disappeared and respiratory failure resolved. We were able to implement multidisciplinary treatment that did not rely on corticosteroids

Risk factors for drug-resistant pathogens in immunocompetent patients with pneumonia: Evaluation of PES pathogens

AbstractRationaleThe new acronym, PES pathogens (Pseudomonas aeruginosa, Enterobacteriaceae extended-spectrum beta-lactamase-positive, and methicillin-resistant Staphylococcus aureus), was recently proposed to identify drug-resistant pathogens associated with community-acquired pneumonia.ObjectivesTo evaluate the risk factors for antimicrobial-resistant pathogens in immunocompetent patients with pneumonia and to validate the role of PES pathogens.MethodsA retrospective analysis of a prospective observational study of immunocompetent patients with pneumonia between March 2009 and June 2015 was conducted. We clarified the risk factors for PES pathogens.ResultsOf the total 1559 patients, an etiological diagnosis was made in 705 (45.2%) patients. PES pathogens were identified in 51 (7.2%) patients, with 53 PES pathogens (P. aeruginosa, 34; ESBL-positive Enterobacteriaceae, 6; and MRSA, 13). Patients with PES pathogens had tendencies toward initial treatment failure, readmission within 30 days, and a prolonged hospital stay. Using multivariate analysis, female sex (adjusted odds ratio [AOR] 1.998, 95% confidence interval [CI] 1.047–3.810), admission within 90 days (AOR 2.827, 95% CI 1.250–6.397), poor performance status (AOR 2.380, 95% CI 1.047–5.413), and enteral feeding (AOR 5.808, 95% CI 1.813–18.613) were independent risk factors for infection with PES pathogens. The area under the receiver operating characteristics curve for the risk factors was 0.66 (95% CI 0.577–0.744).ConclusionsWe believe the definition of PES pathogens is an appropriate description of drug-resistant pathogens associated with pneumonia in immunocompetent patients. The frequency of PES pathogens is quite low. However, recognition is critical because they can cause refractory pneumonia and different antimicrobial treatment is required

Species habitat associations in an old-growth beech forest community organised by landslide disturbances

<p>In order to understand the processes that govern tree species’ spatial associations with habitats in landslide-affected forest communities, we investigated the habitat associations of six major tree species in an old-growth beech forest community located on a steep flank slope where landslides had occurred. All stems ≥ 5cm in diameter at breast height were mapped on a 1.14 ha polygonal plot and the topographic conditions (slope inclination and convexity), canopy state, and forest floor vegetation (i.e. dwarf bamboo and fern cover) were assessed. Most stems of <i>Fagus crenata</i> and <i>Acer japonicum</i> as well as many stems of <i>Magnolia obovata</i> belonging to the canopy layer were located on sites with low fern cover, whereas many stems of <i>M. obovata</i> below the canopy layer were associated with sites having high dwarf bamboo cover. The locations of the two <i>Acer</i> species belonging to the canopy and lowest layers coincided with sites having convex topography. Stems of <i>Aesculus turbinata</i> below the canopy layer were generally found on sites with gentle slopes, whereas most stems of <i>Quercus crispula</i> coincided with steeply sloping sites. While the results demonstrate that steep slopes created as landslide headscarps provide suitable habitats for species with less shade tolerance, it should be noted that there were few consistent patterns of habitat association across the layers. Our results suggest that unpredictable sporadic landslide disturbances with varying intensities and spatial scales, and their recursiveness, are at least partly responsible for habitat association patterns observed in the forest community.</p

Serological and morphological prognostic factors in patients with interstitial pneumonia with autoimmune features

Abstract Background To identify the prognostic factors for survival in patients with interstitial pneumonia with autoimmune features (IPAF) who meet the serological domain of the IPAF criteria. Methods We retrospectively analysed 99 IPAF patients who met the serological domain and were hospitalised at the Respiratory Medicine Unit of Kurashiki Central Hospital from 1999 to 2015. The high-resolution computed tomography findings were usual interstitial pneumonia (UIP; n = 1), non-specific interstitial pneumonia (NSIP; n = 63), NSIP with organizing pneumonia (OP) overlap (n = 15), and OP (n = 20). One patient who had radiological UIP pattern, and met the serological and clinical domains was excluded. The clinical characteristics, radiological findings, administered therapy, and prognosis of the remaining 98 IPAF patients who met the serological and morphological domains were analysed. Results The median age of the 98 IPAF patients was 68 years, and 41 (41.8%) of them were men. Twelve (12.2%) of the 98 IPAF patients developed other characteristics and were diagnosed with connective tissue disease (CTD) later during the median follow-up of 4.5 years. Univariate Cox analysis revealed systemic sclerosis (SSc)-specific and SSc-associated antibodies (ANA nucleolar pattern, ANA centromere pattern, anti-ribonucleoprotein and anti-Scl-70) positive IPAF, radiological NSIP pattern, bronchoalveolar lavage fluid lymphocytes >15%, and age as significant prognostic factors for survival. Multivariate Cox analysis revealed radiological NSIP pattern (hazard ratio [HR], 4.48; 95% confidence interval [CI], 1.28–15.77, p = 0.02) and age (HR, 1.07; 95% CI, 1.02–1.11, p = 0.01) were significantly associated with worse survival. Conclusions We confirmed that radiological NSIP pattern and age are poor prognostic factors for the survival of IPAF patients. This study suggested that the autoantibodies that are highly specific for certain connective tissue diseases might be less important for the prognosis of IPAF compared with the radiological-pathological patterns. The relatively high proportion of IPAF patients who developed CTD later suggests the importance of careful observation for evolution to CTD in IPAF