The saw-tooth sign as a clinical clue for intrathoracic central airway obstruction

BACKGROUND: The saw-tooth sign was first described by Sanders et al in patients with obstructive sleep apnea syndrome as one cause of extrathoracic central airway obstruction. The mechanism of the saw-tooth sign has not been conclusively clarified. The sign has also been described in various extrathoracic central airway diseases, such as in burn victims with thermal injury to the upper airways, Parkinson’s disease, tracheobronchomalacia, laryngeal dyskinesia, and pedunculated tumors of the upper airway. CASE PRESENTATION: A 61-year-old man was referred to our hospital with a two-month history of persistent dry cough and dyspnea. He was diagnosed with lung cancer located in an intrathoracic central airway, which was accompanied by the saw-tooth sign on flow-volume loops. This peculiar sign repeatedly improved and deteriorated, in accordance with the waxing and waning of central airway stenosis by anti-cancer treatments. CONCLUSION: This report suggests that the so-called saw-tooth sign may be found even in intrathoracic central airway obstruction due to lung cancer

Nationwide surveillance of bacterial respiratory pathogens conducted by the surveillance committee of Japanese Society of Chemotherapy, the Japanese Association for Infectious Diseases, and the Japanese Society for Clinical Microbiology in 2010: General view of the pathogens\u27 antibacterial susceptibility

The nationwide surveillance on antimicrobial susceptibility of bacterial respiratory pathogens from patients in Japan, was conducted by Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases and Japanese Society for Clinical Microbiology in 2010.The isolates were collected from clinical specimens obtained from well-diagnosed adult patients with respiratory tract infections during the period from January and April 2010 by three societies. Antimicrobial susceptibility testing was conducted at the central reference laboratory according to the method recommended by Clinical and Laboratory Standard Institutes using maximum 45 antibacterial agents.Susceptibility testing was evaluable with 954 strains (206 Staphylococcus aureus, 189 Streptococcus pneumoniae, 4 Streptococcus pyogenes, 182 Haemophilus influenzae, 74 Moraxella catarrhalis, 139 Klebsiella pneumoniae and 160 Pseudomonas aeruginosa). Ratio of methicillin-resistant S.aureus was as high as 50.5%, and those of penicillin-intermediate and -resistant S.pneumoniae were 1.1% and 0.0%, respectively. Among H.influenzae, 17.6% of them were found to be β-lactamase-non-producing ampicillin (ABPC)-intermediately resistant, 33.5% to be β-lactamase-non-producing ABPC-resistant and 11.0% to be β-lactamase-producing ABPC-resistant strains. Extended spectrum β-lactamase-producing K.pneumoniae and multi-drug resistant P.aeruginosa with metallo β-lactamase were 2.9% and 0.6%, respectively.Continuous national surveillance of antimicrobial susceptibility of respiratory pathogens is crucial in order to monitor changing patterns of susceptibility and to be able to update treatment recommendations on a regular basis

Diagnostic clue for pleural metastasis of malignant melanoma

This case demonstrated the importance of recognition of melanin pigments in pleural effusion as a diagnostic tool for metastasis of malignant melanoma

Editorial: Mycoplasma pneumoniae Clinical Manifestations, Microbiology, and Immunology

Mycoplasma pneumoniae (Mp) is a major human pathogen that causes both upper and lower respiratory infections, and is one of the leading causes of community acquired pneumonia (CAP), accounting for 11–15% of CAP throughout the world. Additionally it is known to induce an inflammatory process which depends on several mechanisms such as virulence of Mp (lipoproteins, community acquired respiratory distress syndrome (CARDS) toxin, oxidative products) and host defenses (cellular immunity and humoral immunity). Although it is a common pathogen, the pathogenesis for Mp infections is not yet fully understood. From the clinical point of view, since the pioneer studies in the 1960s and 1970s on the clinical presentation of Mp associated disease, the diagnostics approaches have changed dramatically leading to a better understanding of the clinical presentation and new issues have emerged - such as antibiotics resistance. The purpose of this Frontiers ebook is to thoroughly review and discuss the clinical presentation in view of the improved diagnostics, microbiological and immunological analysis of Mp infections, with focus on the history of Mp, clinical features of disease, bacterial structure of Mp and mechanism of gliding, clinical and laboratory diagnostics, the role of lipoproteins and Toll-like receptor, CARDS toxin, subtyping of Mp isolates and genome analysis, macrolide resistance and treatment