Epidemiology and Clinical Features of Pulmonary Nontuberculous Mycobacteriosis in Nagasaki, Japan

Background and Objectives: Recent reports indicate that the incidence of nontuberculous mycobacterial-lung disease (NTM-LD) is increasing. This study aimed to investigate the epidemiology and clinical features of NTM-LD patients in Nagasaki prefecture, Japan to identify the negative prognostic factors for NTM-LD in Japan. Methods: The medical records of patients newly diagnosed with NTM-LD in eleven hospitals in Nagasaki prefecture between January 2001 and February 2010 were reviewed. Data regarding the annual population of each region and the incidence of all forms of tuberculosis were collected to assess geographic variations in NTM-LD incidence, isolates, and radiological features. Results: A total 975 patients were diagnosed with NTM-LD. The incidence increased over the study period and reached 11.0 and 10.1 per 100,000 population in 2008 and 2009, respectively. M. intracellulare was the most common pathogen in the southern region, and M. avium most common in other regions. The most common radiographic pattern was the nodular-bronchiectatic pattern. Age >60 years, body mass index <18.5 kg/m2, underlying lung disease, and cavitary pattern were the negative prognostic factors at the 1-year follow-up. Conclusions: The incidence of NTM-LD has been increasing in Nagasaki prefecture. The isolates and radiographic features of patients vary markedly by region

Interstitial Lung Disease Induced by Pazopanib Treatment

Although pneumothorax has been reported to be a major pulmonary adverse event in patients treated with pazopanib, a multikinase inhibitor, drug-induced interstitial lung disease (DILD) has not been reported. A 74-year-old Japanese man who received pazopanib for the treatment of femoral leiomyosarcoma and lung metastasis presented with dyspnea and fatigue. He had mild interstitial pneumonia when pazopanib treatment was initiated. Chest computed tomography revealed progressive bilateral ground-glass opacity (GGO) and traction bronchiectasis. We diagnosed DILD due to pazopanib. The patient’s pazopanib treatment was interrupted and a steroid was administered. The symptoms and GGO were improved with treatment. Physicians should be aware of DILD due to pazopanib in patients with pre-existing interstitial lung disease

Isolates detected in 975 NTM-LD patients.

<p>MAC, <i>Mycobacterium avium-intracellulare</i> complex; PMI, polymicrobial infection</p><p>*Identified using 16S rRNA.</p><p>Isolates detected in 975 NTM-LD patients.</p

Geographic variation in radiographic patterns in NTM-LD patients.

<p>Four patients were residents of another prefecture. NB, nodular-bronchiectatic pattern; CAV, cavitary pattern.</p

Flowchart of patient selection.

<p>Flowchart of patient selection.</p

Isolates detected in NTM-LD patients between 2001 and 2009 in Nagasaki, Japan.

<p>RGM, rapid growing mycobacteria.</p

Geographic variation in isolates detected in NTM-LD patients.

<p>Nine patients were residents of another prefecture. Map was obtained from the Geospatial Information Authority of Japan (<a href="http://www.gsi.go.jp/ENGLISH/index.html" target="_blank">http://www.gsi.go.jp/ENGLISH/index.html</a>). MAC, <i>Mycobacterium avium-intracellulare</i> complex.</p

Characteristics and 1-year prognosis of NTM-LD patients.

<p>BMI, body mass index; CRP, C-reactive protein; CAM, clarithromycin; CAV, cavitary pattern on chest radiographs.</p><p>*Includes history of tuberculosis, chronic obstructive pulmonary disease, lung cancer, interstitial lung disease, asthma, and silicosis.</p><p>Characteristics and 1-year prognosis of NTM-LD patients.</p

A high α1-antitrypsin/interleukin-10 ratio predicts bacterial pneumonia in adults with community-acquired pneumonia: a prospective cohort study

Abstract Background Current microbiological tests fail to identify the causative microorganism in more than half of all pneumonia cases. We explored biomarkers that could be used for differentiating between bacterial and viral pneumonia in patients with community-acquired pneumonia (CAP). Methods In this prospective cohort study conducted in Japan, data obtained from adult patients with bacterial pneumonia, including bacterial and viral coinfections (bacterial pneumonia [BP] group), and purely viral pneumonia (VP group) at diagnosis were analyzed using multivariate logistic regression analysis to identify predictors of bacterial pneumonia. Furthermore, a decision tree was developed using the predictors. Results A total of 210 patients were analyzed. The BP and VP groups comprised 108 and 18 patients, respectively. The other 84 patients had no identified causative microorganism. The two groups shared similar characteristics, including disease severity; however, a significant difference (p < 0.05) was observed between the two groups regarding sputum type; sputum volume score; neutrophil counts; and serum levels of interleukin (IL)-8, IL-10, and α1-antitrypsin (AAT). Sputum volume score (p < 0.001), IL-10 (p < 0.001), and AAT (p = 0.008) were ultimately identified as predictors of BP. The area under the curve for these three variables on the receiver operating characteristic (ROC) curve was 0.927 (95% confidence interval [CI]: 0.881–0.974). The ROC curve for sputum volume score and an AAT/IL-10 ratio showed a diagnostic cutoff of 1 + and 65, respectively. Logistic regression analysis using dichotomized variables at the cutoff values showed that the odds ratios for the diagnosis of BP were 10.4 (95% CI: 2.2–50.2) for sputum volume score (absence vs. presence) and 19.8 (95% CI: 4.7–83.2) for AAT/IL-10 ratio (< 65 vs. ≥ 65). Conclusions Considering that obtaining a definitive etiologic diagnosis with the current testing methods is difficult and time consuming, a decision tree with two predictors, namely sputum volume and the AAT/IL-10 ratio, can be useful in predicting BP among patients diagnosed with CAP and facilitating the appropriate use of antibiotics. Trial registration UMIN000034673 registered on November 29, 2018