Clinical features of chronic summer-type hypersensitivity pneumonitis and proposition of diagnostic criteria.
- 作者列表："Onishi Y","Kawamura T","Higashino T","Kagami R","Hirata N","Miyake K
BACKGROUND:Trichosporon asahii (T. asahii) causes chronic summer-type hypersensitivity pneumonitis (C-SHP); however, little is known about the clinical features of this condition. We aimed to elucidate the clinical features of C-SHP and propose practical diagnostic criteria for C-SHP based on the presence of serum anti-T. asahii antibody (TaAb). METHODS:Patients diagnosed with C-SHP and idiopathic pulmonary fibrosis (IPF) between January 2010 and May 2017 were reviewed retrospectively. Clinical findings were compared between the two groups. Criteria for C-SHP were proposed on the basis of significant characteristics and applied to the development and validation cohorts. RESULTS:Thirty-one patients with C-SHP and 26 with TaAb-negative IPF were identified. C-SHP patients were more likely to live in wooden houses; their serum Krebs von den Lungen-6 (KL-6) and serum surfactant protein-D (SP-D) levels were higher than those of IPF patients. C-SHP patients were more likely to have subpleural consolidation, micronodules, and extensive ground-glass opacification on high-resolution computed tomography (HRCT). The following 3 items were considered to have diagnostic value: I) TaAb positivity; II) an HRCT pattern consistent with chronic hypersensitivity pneumonitis, including mosaic attenuation or micronodules; and III) elevated serum biomarker levels (KL-6 > 1500 U/mL or SP-D > 250 ng/mL). We defined cases satisfying I) and II) as "probable C-SHP" and those satisfying all 3 criteria as "confident clinical diagnosis of C-SHP". The areas under the receiver-operating curve were 0.965 and 0.993 in the development and validation cohorts, respectively, which suggested that these criteria had good discriminative ability in clinical evaluations. CONCLUSIONS:Clinical features could be useful for distinguishing C-SHP from IPF and other etiologies of ILDs.
背景: 毛孢子菌asahii (T. asahii) 引起慢性夏季型过敏性肺炎 (C-SHP); 然而，对这种情况的临床特征知之甚少。我们旨在阐明C-SHP的临床特征，并根据血清抗asahii抗体 (TaAb) 的存在提出C-SHP的实用诊断标准。 方法: 回顾性分析2010年1月至2017年5月间诊断为C-SHP和特发性肺纤维化 (IPF) 的患者。比较两组患者的临床表现。根据重要特征提出了c-shp的标准，并将其应用于开发和验证队列。 结果: 发现31例C-SHP患者和26例TaAb阴性IPF患者。C-SHP患者更倾向于居住在木屋中; 其血清Krebs von den Lungen-6 (KL-6) 和血清表面活性蛋白-D (sp-d) 水平高于IPF患者。C-SHP患者在高分辨率计算机断层扫描 (HRCT) 中更容易出现胸膜下实变、微小结节和广泛的磨玻璃浑浊。以下3项被认为具有诊断价值: I) TaAb阳性; II) 符合慢性过敏性肺炎的HRCT模式，包括镶嵌衰减或微小结节; 和III) 血清生物标志物水平升高 (KL-6 > 1500 U/mL或sp-d> 250 ng/mL)。我们将满足I) 和II) 的病例定义为 “可能的C-SHP”，满足所有3个标准的病例定义为 “C-SHP的可靠临床诊断”。在开发和验证队列中，受试者工作曲线下面积分别为0.965和0.993，这表明这些标准在临床评价中具有良好的判别能力。 结论: 临床特征有助于鉴别C-SHP与IPF及其他病因。
METHODS::There is emerging evidence for the role of posaconazole in the management of Aspergillus-related cystic fibrosis (CF) lung disease. The tolerability and efficacy of posaconazole in paediatric CF is not well established. We report a prospective study over a fifty-three month period evaluating the safety, tolerability, and efficacy of posaconazole in pediatric CF. Fourteen children (seven males, median age 13 years, range 3-17 years) received a total of twenty-three courses of posaconazole (13 oral suspension and 10 tablet formulation). Of these patient episodes, nine received posaconazole for emerging or active allergic bronchopulmonary aspergillosis (ABPA) and two required a combination of posaconazole and systemic corticosteroids for difficult-to-treat ABPA. A subgroup of patients (n = 12) with persistent isolates of Aspergillus fumigatus, in the absence of serological markers of ABPA, received posaconazole monotherapy for pulmonary exacerbations not responding to conventional broad-spectrum antibiotic treatment. Posaconazole levels, full blood count, electrolytes, and liver function were monitored on day 7 of treatment and then monthly. Posaconazole was well tolerated in all but three patients. Therapeutic plasma levels >1 mg/l were achieved in all receiving the tablet formulation in comparison to 60% on the liquid preparation. There was a modest but significant improvement in FEV1 (% predicted) demonstrated for the cohort as a whole (p = 0.015) following posaconazole therapy. Posaconazole is well tolerated in children as young as six years old, improvements in lung function are observed, and therapeutic plasma levels are readily achieved in patients taking the tablet formulation and in adherent patients taking the liquid formulation.
METHODS::The relationship between the cellular immune response during Trichuris trichiura infection and asthma has not yet been established. In this study, the cytokines interleukin (IL)-2, IL-4, IL-6, IL-10, TNF-α, IFN-γ and IL-17A were evaluated in asthmatic children harboring T. trichiura. For this assessment, asthmatic and non-asthmatic children (ISAAC questionnaire) were submitted to parasitological tests and blood samples were cultured (mitogen stimulation) for cytokine measurements in the supernatant. Asthma frequencies were similar in infected and uninfected children, but IL-4, IL-6, TNF-α and IL-10 levels were high in the infected asthmatic children. Additionally, infected non-asthmatic children exhibited high levels of these cytokines in relation to uninfected non-asthmatic children; however, cytokine levels were lower when compared with infected and asthmatic children. Therefore, T. trichiura infection positively modulated the pro- and anti-inflammatory cytokines in asthmatic children, but a background of asthma seemed to narrow the production of cytokines induced by this helminth.
METHODS::In a recent meta-analysis, we found that atopic diseases, like asthma and allergic rhinitis, occur more frequently prior to the onset of attention-deficit/hyperactivity disorder (ADHD). Our aim was to determine the temporal order of the association between daily fluctuations in atopic disease symptoms and in ADHD symptoms in individual participants. In this observational study among 21 participants, age 7-16 years, we performed a replicated time-series analysis of symptom fluctuations in asthma and/or allergic rhinitis and ADHD. Data were collected through parents who filled in a daily online questionnaire during up to 50 days. In each individual, we investigated the temporal order of fluctuations in atopic disease symptoms and ADHD symptoms using a vector autoregressive (VAR) model while using sleep problems and medication use as covariates. For 16 out of 21 participants, we constructed a VAR model. For a majority of the participants, significant associations were detected between atopic disease symptoms and ADHD symptoms. The results were heterogeneous; the direction, sign, and timing of the relationship between ADHD, atopy, sleep problems, and medication use varied between individuals. This study provides additional evidence that the symptom expression of atopy and ADHD are related. However, the connection between both diseases in children is found to be heterogeneous within our study population.