Haemophilus influenzaeによる気道感染軽快後,気管支洗浄液中好酸球数増加が顕性化したABPAの1例  [in Japanese] A Case of Allergic Bronchopulmonary Aspergillosis Demonstrating Marked Eosinophilia in Bronchial Lavage Fluid After Antibiotic Therapy for Bronchitis Due to Haemophilus Influenzae  [in Japanese]

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Author(s)

    • 田中 徹 Tanaka Toru
    • 独立行政法人国立病院機構茨城東病院内科診療部呼吸器内科 Department of Respiratory Medicine, National Hospital Organization Ibarakihigashi National Hospital
    • 蛸井 浩行 Takoi Hiroyuki
    • 独立行政法人国立病院機構茨城東病院内科診療部呼吸器内科 Department of Respiratory Medicine, National Hospital Organization Ibarakihigashi National Hospital
    • 林 士元 Lin Shin-yuan
    • 独立行政法人国立病院機構茨城東病院内科診療部呼吸器内科 Department of Respiratory Medicine, National Hospital Organization Ibarakihigashi National Hospital
    • 谷田貝 洋平 Yatagai Yohei
    • 独立行政法人国立病院機構茨城東病院内科診療部呼吸器内科 Department of Respiratory Medicine, National Hospital Organization Ibarakihigashi National Hospital
    • 関根 朗雅 Sekine Akimasa
    • 独立行政法人国立病院機構茨城東病院内科診療部呼吸器内科 Department of Respiratory Medicine, National Hospital Organization Ibarakihigashi National Hospital
    • 梅津 泰洋 Umetsu Yasuhiro
    • 独立行政法人国立病院機構茨城東病院臨床研究部 Department of Clinical Research, National Hospital Organization Ibarakihigashi National Hospital
    • 林原 賢治 Hayashihara Kenji
    • 独立行政法人国立病院機構茨城東病院内科診療部呼吸器内科 Department of Respiratory Medicine, National Hospital Organization Ibarakihigashi National Hospital
    • 斎藤 武文 Saito Takefumi
    • 独立行政法人国立病院機構茨城東病院内科診療部呼吸器内科 Department of Respiratory Medicine, National Hospital Organization Ibarakihigashi National Hospital

Abstract

背景.アレルギー性気管支肺アスペルギルス症(ABPA)に細菌感染を合併した際の病態に対する理解は十分でない.症例.74歳男性,気管支喘息合併COPD.発熱,膿性痰,呼吸困難が出現.喀痰細菌検査からH.influenzae感染と診断し,ガレノキサシン(Garenoxacin;GRNX)の投与により改善した.治療前の喀痰白血球分画は好中球99%・好酸球1%であった.感染軽決後,好酸球20%と推移した.左下葉に浸潤影が残存するため気管支鏡検査を実施し,洗浄液の白血球分画は好酸球50%と,一層の好酸球増加が認められた.洗浄液の培養からAspergillus fumigatusが検出され,ABPAの診断に至った.結論.ABPAに細菌が重複感染した際,Th1/Th2細胞型炎症の不均衡(Th1>Th2)が生じ,ABPAの病態がマスクされることがあり,同病態診断の注意点である.

Background. It is not sufficient to clearly identify allergic bronchopulmonary aspergillosis (ABPA) complicated by bacterial infection. Case. A 74-year-old man with a previous history of bronchial asthma and chronic obstructive pulmonary disease (COPD) presented with fever, purulent sputum and dyspnea. He was given a diagnosis of Haemophilus influenzae infection based on a sputum examination, and treated with garenoxacin mesilate hydrate (GRNX). Before antibiotic therapy, a differential leukocyte count from a sputum smear showed 99% neutrophils and 1% eosinophils. After his bacterial infection was resolved, eosinophils in his sputum increased to 20%. We performed bronchoscopy and bronchial lavage to examine the remaining consolidation of the left lower lung. A differential leukocyte count in his bronchial lavage revealed an increase in eosinophils to 50%. Aspergillus fumigatus was cultured in bronchial lavage fluid, and we diagnosed ABPA. Conclusion. When ABPA is complicated by bacterial infection, the clinical characteristics of ABPA are often masked due to an imbalance of Th1/Th2 inflammation (Th1>Th2). Therefore, care must be taken in diagnosing of ABPA complicated by bacterial infection.

Journal

  • The Journal of the Japan Society for Respiratory Endoscopy

    The Journal of the Japan Society for Respiratory Endoscopy 33(6), 491-495, 2011

    The Japan Society for Respiratory Endoscopy

References:  7

Codes

  • NII Article ID (NAID)
    110008896969
  • NII NACSIS-CAT ID (NCID)
    AN00357687
  • Text Lang
    JPN
  • Article Type
    NOT
  • ISSN
    0287-2137
  • Data Source
    CJP  NII-ELS  J-STAGE 
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