Case Of Atypical Mycobacterial Infection Research Articles

Hepatitis B Virus Reactivation and Mycobacterial Infections Associated With Ustekinumab: A Retrospective Study of an International Pharmacovigilance Database.

Background: Reports were recently published on hepatitis B virus reactivation (HBVr), tuberculosis (TB), and atypical mycobacterial infection (AMI) in patients with ustekinumab treatment. However, the literature is limited to case reports and series. The study was aimed to investigate their relationships by using an extensive population-based database. Methods: Using the United States Food and Drug Administration Adverse Event Reporting System (FAERS) database, we collected all cases of HBVr, TB, and AMI between 1 January 2009 and 30 September 2021, for ustekinumab and other drugs. Disproportionality was analyzed using the reporting odds ratio (ROR), which was considered significant when the lower limit of the 95% confidence interval (95% CI) was >1. Results: Of the 18,760,438 adverse cases reported to FAERS for all drugs, 56,581 cases had been exposed to ustekinumab. Adverse events of HBVr, TB, and AMI were reported in 21, 210, and 20 cases, respectively. The ROR for HBVr with ustekinumab was 2.33 (95% CI, 1.52–3.58), for TB was 5.09 (95% CI, 4.44–5.84), and for AMI was 2.09 (95% CI, 1.35–3.24). In the ustekinumab exposure group, no death occurred in patients with HBVr, but one patient experienced life-threatening liver failure. For those with TB, 24 cases experienced hospitalization and 2 deaths occurred. No death occurred in patients with AMI but eight experienced hospitalization. Conclusion: We identified positive signals between ustekinumab exposure and HBVr, TB, and AMI in FAERS. Although these complications are rare, clinicians using ustekinumab should be aware of the risks.

Mycobacterial infections due to PD-1 and PD-L1 checkpoint inhibitors

BackgroundImmune checkpoint inhibitors that block programmed cell death-1 (PD-1) and programmed cell death ligand-1 (PD-L1) have improved outcomes for many cancer subtypes but do exhibit toxicity, in the form of immune-related adverse events.ObjectiveThe aim of this study was to investigate the emerging toxicities of PD-1 and PD-L1 inhibitors including acute or reactivation of tuberculosis (TB) and atypical mycobacterial infection (AMI).MethodsThis study was completed as a retrospective review using the US Food and Drug Administration Adverse Events Reporting System (FAERS) for incidence of TB and AMI due to PD-1 and PD-L1 inhibitors compared with other FDA (Food and Drug Administration) approved drugs. The statistical methods included disproportionality signal analysis using the reporting OR (ROR) to compare cases. The 95% Wald CI was reported to assess the precision of the ROR.ResultsOut of the 10 146 481 adverse events (AEs) reported to FAERS for all drugs between 1 January 2015 and 31 March 2020, 73 886 AEs were due to the five FDA approved PD-1/PD-L1 inhibitors. Seventy-two cases of TB were due to PD-1/PD-L1 inhibitors. Specifically, 45 cases (62.5%) due to nivolumab, 18 (25%) due to pembrolizumab, 5 (7%) due to atezolizumab and 4 (5.5%) due to durvalumab. There were 13 cases of AMI: 9 (69.3%) due to nivolumab, 2 (15.3%) due to pembrolizumab and 1 (7.7%) each due to durvalumab and atezolizumab. Avelumab was not attributed to any AE of TB or AMI. From analysis of the FAERS database, the calculated ROR for TB due to PD-1/PD-L1 inhibitors was 1.79 (95% CI, 1.42 to 2.26) (p<0.0001) and for AMI was 5.49 (95% CI, 3.15 to 9.55) (p<0.0001).ConclusionPD-1/PD-L1 inhibitors used in the treatment of cancer subtypes is associated with increased TB and AMI risk. Although this complication is rare, clinicians using PD-1/PD-L1 inhibitors should be aware of the risks.

Atypical mycobacterial infections following laparoscopic surgery

Three cases of atypical mycobacterial infection were encountered following laparoscopic surgery at the Colombo North Teaching Hospital over a period of eighteen months from September 2014 to April 2016. The patients presented with port site infections and sinus tract formation three to four weeks after laparoscopic surgery performed in the same operating theatre. These cases were clinically suspected as atypical mycobacterial infection. The Ziehl Neelsen stain showed acid fast bacilli with atypical morphology and cultures grew mycobacteria other than tuberculosis (MOTT). Histology of tissues showed chronic granulomatous inflammation. The infections resolved with surgical intervention and long term antibiotic therapy. Erroneous practice of disinfection of laparoscopic instruments with formaldehyde was thought to be the cause of these infections. No cases were reported after implementing protocols for proper cleaning and disinfection of laparoscopes.

非定型抗酸菌感染空洞の内腔面を気管支鏡で観察し得た 2 症例

非定型抗酸菌感染空洞の内腔面を気管支鏡で観察し得た 2 症例

Le syndrome de Lady Windermere : données cliniques, bactériologiques et évolutives

Described by Reich and Johnson in 1992 [2], the Lady Windermere syndrome occurs exclusively in non-smoking women over the age of 60 years, without significant pre-existing pulmonary disease. It comprises bronchial dilatation, typically in the middle lobe and lingula, together with secondary infection by atypical mycobacteria (Mycobacterium avium in the first cases). Among the 17 cases of atypical mycobacterial infection that we have seen in the past 14 years, there were seven cases of this syndrome. It was associated with cough, sputum, sometimes haemoptysis, febrile episodes and deterioration of general health. The diagnostic criteria and treatment were defined by the American Thoracic Society. The pathophysiological hypothesis proposed by Reich and Johnson was that voluntary suppression of the cough led to congestion of the bronchi and secondary infection with atypical mycobacteria. Currently it is thought more likely that the following factors are involved: progressive increase in dilatation of small bronchi, delayed diagnosis, morphological abnormalities of the thorax, hormonal factors, immune deficiency, genetic neutrophil dysfunction, and even heterozygous forms of cystic fibrosis.

Complications of laparoscopic inguinal herniorrhaphy including one case of atypical mycobacterial infection

Although laparoscopic inguinal herniorrhaphy is considered safe, several complications may occur. This study aimed to evaluate the complications observed in 780 laparoscopic inguinal herniorrhaphies at the authors' hospital. All the patients who underwent laparoscopic inguinal herniorrhaphy at the authors' hospital during a period of 11 years were enrolled retrospectively in this study. Patient demographics, operative data, and intra- and postoperative complications were evaluated. A total of 569 patients underwent 780 laparoscopic inguinal herniorrhaphies. The male-to-female ratio was 8.8 to 1, and the mean age was 54.8 ± 15.7 years. Hernia recurrence was recognized in 14 patients (2.5%). Intra- and postoperative complications were diagnosed in 28 (4.9%) and 35 (6.2%) patients respectively. There was no mortality. The most common intraoperative complication was extensive subcutaneous emphysema. Two patients with extensive subcutaneous emphysema had cardiac arrhythmia. Small bowel perforation and bladder perforation occurred in one patient each. One patient had extensive preperitoneal infection caused by Mycobacterium massiliense, which required mesh removal, tissue debridement, and prolonged antibiotic therapy. Although the mortality rate is low, potentially life-threatening complications such as small bowel and bladder perforation may be experienced by patients subjected to laparoscopic herniorrhaphy.