Clinical Features of Mycoplasma pneumoniae Pneumonia

Clinical features in ninety-two cases of mycoplasmal pneumonia during the past seven years, which are fourty-one percent of 226 primary atypical pneumonia cases in this study, are reported. Occurrence of the illness was closely retated to age of the patients; it was generally higher in patients under thirty years of age at all seasons. The main clinical symptoms were cough, fever, rales, sputum, headache and sore throat. However, these common symptoms recognized in a variety of respiratory diseases were not particular to the diagnosis of mycoplasmal pneumonia, and it was often difficult to differentiate from pulmonary tuberculosis, chronic pneumonitis or bronchiectasis. Although a roentgenographic pattern characteristic of mycoplasmal pneumonia could not be recognized, the majority showed a "homogenous" or "flocculent" appearance. Therefore, the appropriate laboratory studies for isolation of the agents and/or the related serological tests have much importance to the diagnosis of this disease. The treatment with erythromycin seemed to be more effective than other antibiotics when using chest roentgenographic resolution, as the parameter of response

Three Cases of Renal Infarction : Special Reference to Etiology, CT findings and Therapy

Three cases of renal infarction are presented. Case 1 presented left renal infarction associated with mild mitral stenosis, moderate degree of mitral regurgitation (MR) and tricuspid regurgitation (TR). A small thrombus was detected in the posterior wall of the left atrium and left auricle. Case 2 presented right renal infarction complicated with hypertrophic cardiomyopathy (HCM) associated with severe TR and mild MR. Case 3 presented multiple infarction of the left kidney without any complication. Renal infarction in two cases was possibly induced by small clots in the atrium or blood stream, which might had been driven from atrial fibrillation

An Autopsy Case of Carcinosarcoma of the Esophagus

A case of carcinosarcoma, a rare polypoid tumor of the esophagus is presented. The characteristic gross and microscopic features as well as a discussion of the histogenesis of the sarcomatous elements are presented by microscopic, immunohistochemical and electron micronscopic examinations. Immunohistochemically, keratin and EMA (epithelial membrane antigen) were demonstrated in the islands of squamous cell carcinoma within the sarcomatous elements and in the carcinoma in situ at the border of normal mucosa. Vimentin, desmin, actin, myoglobin, factor VIII, S-100 protein, NSE, neuraminidase were not demonstrated in both the carcinomatous and the sarcomatous elements except for a positive reactivity to a-1-antichymotrypsin in the sarcomatous elements at part. It is suggested that the sarcomatous elements are of epithelial origin based on the facts as follows : 1 transition from overlying epithelium or carcinomatous islands to sarcomatous elements existent ; 2 some small tubules were formed within the sarcomatous elements, which showed transition into the sarcomatous elements ; and 3 a part of the sarcomatous elements revealed either positive or weak reactivity to keratin and EMA. Further, weak reactivity to keratin and EMA in the more anaplastic lesion may reflect the lack of tonofilaments and desmosomes in the ultrastructural findings

Partial lung resection of supernumerary tracheal bronchus combined with pulmonary artery sling in an adult: report of a case

An adult case of pulmonary resection for repeated infections in a supernumerary tracheal bronchus combined with a pulmonary artery sling is reported. A 33-year-old woman with a pulmonary artery sling was referred for recurrent lung infections. Chest computed tomography showed the left pulmonary artery arising from the right pulmonary artery and coursing posterior to the trachea. The lung parenchyma connected to the tracheal bronchus showed dense opacity and traction bronchiectasis. Partial pulmonary resection was performed with an ultrasonically activated scalpel after the tracheal bronchus was auto-sutured. The patient\u27s postoperative course was uneventful, and she is now in good condition

Comparison of rapid immunochromatographic assays using sputum and urine for Streptococcus pneumoniae detection in adult patients with respiratory tract infection

Aim: Streptococcus pneumoniae is the most frequently detected bacterium in pneumonia. RAPIRUN Streptococcus pneumoniae (RAPIRUN) using sputum and BinaxNow Streptococcus pneumoniae (BinaxNow) using urine have been used as rapid diagnostic methods for S. pneumoniae detection in Japan; however, their correlation with quantitative culture tests has not been well evaluated.Methods: A prospective study was conducted on adult patients with respiratory tract infections whose sputum and urine samples were available in six hospitals. Sputum and urine samples were tested at each site, and quantitative sputum cultures were performed. The performance of RAPIRUN and BinaxNow was compared in cases in which quantitative culture showed S. pneumoniae.Results: A total of 192 patients were analyzed. Of these, 167 were diagnosed with pneumonia (87.0%) including 161 of community-acquired pneumonia. Of the 192 cases, 86 (44.8%) were culture-proven for S. pneumoniae. There were 83 and 57 RAPIRUN- and BinaxNow-positive cases, respectively. The sensitivity and specificity of RAPIRUN were 84.9% and 90.6%, respectively, and those of BinaxNOW were 55.8% and 91.5%, respectively, indicating that RAPIRUN was significantly superior in sensitivity (p < 0.0001) with almost equal specificity (p = 0.317). Positive and negative percent agreements of both tests were 59.3% (κ, 0.114 [95% CI, 0.053–0.281]) and 99.1% (κ, 0.942 [95% CI, 0.830–1]), respectively, indicating they were well matched in specificity but not in sensitivity. The positivity rate of RAPIRUN increased with an increase in the number of bacteria (p< 0.0001) but not BinaxNow (p = 0.275).Conclusion: In adult patients with respiratory tract infections in whom sputum collection is feasible, RAPIRUN will increase the diagnostic efficacy of S. pneumoniae infection

Clinical features, risk factors and treatment of fulminant Mycoplasma pneumoniae pneumonia: A review of the Japanese literature

Mycoplasma pneumoniae (MP) is one of the most common causes of community-acquired pneumonia in children and young adults. Although MP sometimes causes self-limiting pneumonia, severe and fulminant cases with hypoxia occur, but their clinical features have rarely been reported. This study aimed to reveal the clinical manifestations, risk factors, and treatment of fulminant MP pneumonia (MPP). Using PubMed and abstracts from the proceedings of several domestic Japanese academic societies, we reviewed the Japanese and English literature for cases of fulminant or severe MPP reported in Japan. All clinical information such as sex, age, underlying diseases, clinical symptoms, clinical course, laboratory and radiological findings, and treatment was collected and analyzed. In total, 52 fulminant MPP cases were reported between September, 1979 and February, 2010. The dominant population of fulminant MPP was young adults without severe underlying diseases. Cough (97.3%), fever (100.0%), and dyspnea (83.3%) with diffuse abnormal findings in radiological examinations were noted. Antibiotics without antimycoplasmal activity were used in 32 cases (61.5%) as initial treatment prior to the onset of hypoxia. Anti-mycoplasmal drugs were appropriately used in 41 cases (78.8%) after onset of respiratory failure with steroids (23 cases, 45.1%) and effective. The majority of patients improved within 3-5 days after steroid administration. There were only 2 fatal cases. Although this small retrospective study did not reveal the apparent risk factors of fulminant MPP, initial inappropriate use of antibiotics may be a risk factor, and early administration of appropriate anti-mycoplasmal drugs with steroids as a cellular immune suppressor is required

A case of splenic abscess during treatment of interstitial pneumonia.

We experienced a case of a 76-year-old man who developed a splenic abscess while undergoing treatment for interstitial pneumonia. Splenic abscess-like abnormal intensities were accidentally found by the chest computed-tomography (CT) examinations 3 weeks after the initiation of corticosteroids and immunosuppressive treatment for interstitial pneumonia. An ultrasonography-guided percutaneous aspiration test resulted in the isolation of methicillin-resistant Staphylococcus aureus (MRSA). Since colonized MRSA had been detected intermittently from sputum after admission and the patient risked bloodstream infection from an indwelling central venous catheter and intubation, we suspected that the organism colonized in the airway had spread into the bloodstream via these devices. Although CT-guided percutaneous drainage followed by postoperative antibiotic therapy are normally required for the treatment of splenic abscess, the patient was successfully treated by the administration of vancomycin without drainage