Seiko Soeda

The utility of galactomannan antigen in the bronchial washing and serum for diagnosing pulmonary aspergillosis

BACKGROUND The diagnosis of pulmonary aspergillosis is difficult because the sensitivity of the conventional methods for the detection of Aspergillus such as culture and cytology, is poor. To improve the sensitivity for Aspergillus detection, the detection of galactomannan antigen has been investigated. The serum galactomannan (GM) antigen has been recognized to be a useful tool for the diagnosis of invasive pulmonary aspergillosis. However, the utility of the galactomannan antigen for the diagnosis of pulmonary aspergillosis other than invasive pulmonary aspergillosis (IPA) has been unclear. METHODS The GM antigen using serum and bronchial washing (BW) using bronchofiberscopy for the diagnosis of pulmonary aspergillosis other than IPA were measured. RESULTS In 45 enrolled patients, 7 patients had pulmonary aspergillosis, 5 of these patients had chronic necrotizing pulmonary aspergillosis and 2 patients had allergic bronchopulmonary aspergillosis. The area under the receiver operating characteristic (ROC) curve was 0.89 for the BW GM antigen detection test, and 0.41 for the serum GM antigen detection test, suggesting that the BW GM antigen detection test exhibits a better diagnostic performance than the serum GM antigen detection test. The BW GM antigen detection test had a sensitivity of 85.7% and a specificity of 76.3% at a cut-off level of ≥0.5, which was the optimal cut-off level obtained by the ROC curve. CONCLUSION The BW GM antigen detection test is thought to be a promising test for the diagnosis of pulmonary aspergillosis other than IPA.

Histological types and localizations of lung cancers in patients with combined pulmonary fibrosis and emphysema

Most patients with combined pulmonary fibrosis and emphysema (CPFE) are males, and heavy smokers. CPFE is more prevalent than fibrosis in patients with lung cancer, and patients with CPFE usually have a poor prognosis. This study reviewed the differences in the prevalence of lung cancer among patients with normal, fibrosis, emphysema and CPFE via chest computed tomography (CT), and the relationship between histopathology and the localizations of lung cancer.

Menthol-Flavored Cigarettes: Potentially a Strong Trigger of Acute Eosinophilic Pneumonia

Menthol-flavored cigarettes recently have received significant attention. Lower quit rates and higher relapse rates of smoking in people who smoke menthol-flavored cigarettes have been demonstrated. Additional disadvantages of menthol cigarettes also might exist. We present a lesson learned from a case we experienced: Menthol cigarette smoking might be a stronger trigger of acute eosinophilic pneumonia compared with nonflavored cigarette smoking. A 19-year-old man visited our hospital with a 3-day history of dry cough, dyspnea, and high fever. He had been completely healthy until the appearance of these symptoms. He had started smoking menthol cigarettes approximately 1 month before his visit to our hospital. He had no history of lung disease. He had no obvious history of occupational dust inhalation or illegal drug use. When he visited our outpatient department, his oxygen saturation was 88% while breathing room air. His temperature was 38.8 C. His complete blood count and blood chemistry findings were unremarkable, except for elevations in white blood cell count (14,900/mL), C-reactive protein (11.45 mg/dL), serum surfactant protein-D (259 ng/mL), and immunoglobulin-E (437 IU/mL). Chest x-ray and computed tomography scan showed patchy shadows and infiltration in both lungs and thickening of interlobular septa (Figure, A, B). Bronchoalveolar lavage findings showed marked elevation of eosinophils (total cell count 12.7 10/mL, eosinophils 67.6%) (Figure, C). The bronchoalveolar lavage eosinophil elevation, typical radiologic findings, and clinical history of symptom onset after initiation of cigarette smoking suggested a diagnosis of acute eosinophilic pneumonia. Systemic corticosteroid therapy resulted in resolution of his symptoms and radiologic findings (Figure, D). The patient was advised to stop smoking, but continued to smoke nonflavored cigarettes against the advice.