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Fujishima N, Komiya K, Matsunaga N, Usagawa Y, Yamasue M, Hashinaga K, Umeki K, Nureki SI, Ando M, Matsunaga T, Kadota JI. A Pitfall of Treatment with Tosufloxacin for Pneumonia That Might Be Lung Tuberculosis. Intern Med 2019; 58:263-266. [PMID: 30643085 PMCID: PMC6378169 DOI: 10.2169/internalmedicine.1369-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Tosufloxacin, which is not used to treat Mycobacterium tuberculosis, is a fluoroquinolone recommended for pneumonia when the possibility of tuberculosis infection cannot be excluded. In the present case, symptoms and chest infiltrative shadow initially improved by tosufloxacin. Therefore, we regarded this patient as having general pneumonia and did not perform follow-up chest X-ray until the infiltrates had completely disappeared. However, a few weeks later, the symptoms and the infiltrates had worsened, so M. tuberculosis was isolated from the patient's sputum. This case suggests that patients suspected of having pulmonary tuberculosis should be monitored carefully, even if antibiotics without antituberculous activity are initially effective.
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MESH Headings
- Aged, 80 and over
- Diagnosis, Differential
- Fluoroquinolones/administration & dosage
- Fluoroquinolones/adverse effects
- Fluoroquinolones/therapeutic use
- Humans
- Male
- Mycobacterium tuberculosis/isolation & purification
- Naphthyridines/administration & dosage
- Naphthyridines/adverse effects
- Naphthyridines/therapeutic use
- Pneumonia, Bacterial/complications
- Pneumonia, Bacterial/diagnosis
- Pneumonia, Bacterial/diagnostic imaging
- Pneumonia, Bacterial/drug therapy
- Sputum/microbiology
- Tomography, X-Ray Computed
- Tuberculosis, Pulmonary/complications
- Tuberculosis, Pulmonary/diagnosis
- Tuberculosis, Pulmonary/diagnostic imaging
- Tuberculosis, Pulmonary/drug therapy
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Affiliation(s)
- Nobuhiro Fujishima
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Japan
- Internal Medicine, Matsunaga Cardiovascular Hospital, Japan
| | - Kosaku Komiya
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Japan
| | | | - Yuko Usagawa
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Japan
| | - Mari Yamasue
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Japan
| | - Kazuhiko Hashinaga
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Japan
| | - Kenji Umeki
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Japan
| | - Shin-Ichi Nureki
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Japan
| | - Masaru Ando
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Japan
| | | | - Jun-Ichi Kadota
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Japan
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Ishikawa S, Igari H, Yamagishi K, Takayanagi S, Yamagishi F. Microorganisms isolated at admission and treatment outcome in sputum smear-positive pulmonary tuberculosis. J Infect Chemother 2018; 25:45-49. [PMID: 30414723 DOI: 10.1016/j.jiac.2018.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 10/03/2018] [Accepted: 10/10/2018] [Indexed: 10/27/2022]
Abstract
Cured or completed cases in newly diagnosed sputum smear-positive pulmonary tuberculosis (TB) is 47.7% in Japan in 2016. Aging of TB patients and their underlying conditions could affect treatment outcome. We analyzed the association between the isolation of microorganisms from sputum at admission and the 180-day mortality rate of the sputum smear-positive pulmonary TB patients in Chiba-East Hospital in Japan. Total subjects were 761 (median age: 63 years). Sputum test for microorganisms was conducted in 708 patients. Microorganisms other than the normal oral flora were isolated in 128 cases (18.1%). Details of the isolated microorganisms were as follows: methicillin-resistant Staphylococcus aureus 23 cases, Klebsiella pneumoniae 17 cases, Pseudomonas aeruginosa 16 cases. Mortality was significantly elevated in the patients with those microorganisms than the others (39.8% vs. 10.2%) (P < 0.01). Fifty-one of 128 patients with those microorganisms died, and 10 of them died of infectious disease, which is the most frequent cause of deaths. The factors associated with the isolation of those microorganisms were as follows: respiratory failure (adjusted odds ratio (aOR):2.5 [95% confidence interval (CI) 1.3-4.7]), performance status 3 or 4 (aOR:2.9 [95% CI 1.6-5.4]), serum albumin <3.0 mg/dL (aOR:2.1 [95% CI 1.3-3.6], age of 65 years or older (aOR:2.0 [95% CI 1.2-3.4]). Those strains were isolated from one of sixth patients. Patients with those microorganisms did not always develop infectious diseases; however, treatment outcomes were poor, with higher mortality. The isolations of microorganisms were associated with various underlying conditions, leading to death. Thus, attention should be paid to TB patients with the above factors.
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Affiliation(s)
- Satoru Ishikawa
- National Hospital Organization Chiba-East Hospital, Department of Respiratory Medicine, 673 Nitona-cho, Chuoh-ku, Chiba 260-8712, Japan; Japan Community Health Care Organization Funabashi Central Hospital, Department of Internal Medicine, 6-13-10 Kaijin, Funabashi, Chiba 273-8556, Japan.
| | - Hidetoshi Igari
- National Hospital Organization Chiba-East Hospital, Department of Respiratory Medicine, 673 Nitona-cho, Chuoh-ku, Chiba 260-8712, Japan; Chiba University Hospital, Division of Infection Control and Treatment, 1-8-1 Inohana, Chuoh-ku, Chiba 260-8677, Japan
| | - Kazutaka Yamagishi
- National Hospital Organization Chiba-East Hospital, Department of Respiratory Medicine, 673 Nitona-cho, Chuoh-ku, Chiba 260-8712, Japan; Chiba University Hospital, Division of Infection Control and Treatment, 1-8-1 Inohana, Chuoh-ku, Chiba 260-8677, Japan
| | - Shin Takayanagi
- National Hospital Organization Chiba-East Hospital, Department of Respiratory Medicine, 673 Nitona-cho, Chuoh-ku, Chiba 260-8712, Japan; Chiba University Hospital, Division of Infection Control and Treatment, 1-8-1 Inohana, Chuoh-ku, Chiba 260-8677, Japan
| | - Fumio Yamagishi
- National Hospital Organization Chiba-East Hospital, Department of Respiratory Medicine, 673 Nitona-cho, Chuoh-ku, Chiba 260-8712, Japan
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