Mycobaterium avium complex infection is a type of nontuberculous mycobacterial (NTM) infections h... more Mycobaterium avium complex infection is a type of nontuberculous mycobacterial (NTM) infections have been reported often occurred in elderly, white, thin and principally nonsmoking women. It has been postulated that such disease in woman is related to the way they cough. They often cough quietly and covertly, thereby the clearance of sputum is suppressed. In this study, we hypothesized that NTM subjects may have decreased cough sensitivity as measured by a higher threshold for inducing cough and the Urge-to-Cough compared to controls. Female, white and elderly NTM and control subjects were recruited in the study. Four concentrations of capsaicin (50, 100, 200, 500 uM) plus placebo (0 uM capsaicin) were presented to the subject three times each in a blinded-randomized block order. Each capsaicin presentation was separated approximately 1 min. At the end of each capsaicin presentation, subjects were asked to rate their Urge-to-Cough using the modified Borg scale from 1 (no Urge-to-Cough) to 10 (maximum Urge...
Text: COPD patients often experience gaps in knowledge and access to care for many reasons. Both ... more Text: COPD patients often experience gaps in knowledge and access to care for many reasons. Both the latest iteration of the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (the “GOLD recommendations”) and the NHLBI COPD National Action Plan call for enhanced care coordination and patient education leading to improved self-efficacy, in an attempt to close these gaps. However, little evidence currently exists to demonstrate the impact these programs have on quality of life, psychosocial metrics, or other patient-centered functional outcomes. The WMU School of Medicine has integrated a respiratory therapist/COPD educator directly into their urban primary care clinic to act as a consultation resource, a patient educator/navigator, and care facilitator. As this clinic also serves as a resident physician training program, the presence of a “COPD clinic” on premises has the potential to be a demonstration model for the development of ...
BackgroundThe American Thoracic Society (ATS)/Infectious Diseases Society of America (IDSA) Commu... more BackgroundThe American Thoracic Society (ATS)/Infectious Diseases Society of America (IDSA) Community-acquired Pneumonia (CAP) guidelines were developed using systematic reviews to inform every recommendation, as suggested by the Institute of Medicine Standards for Trustworthy Guidelines. Recent studies suggest that an expert consensus-based approach, called the Convergence of Opinion on Recommendations and Evidence (CORE) process, can produce recommendations that are concordant with recommendations informed by systematic reviews.PurposeThe goal of the study was to evaluate the efficacy of the CORE process had it been used to develop the ATS/IDSA CAP guidelines.MethodsExperts in CAP who were not on the guideline panel and had no knowledge of the guideline’s systematic reviews or recommendations were recruited to participate in the CORE process, addressing the same questions asked by the guideline panel. Recommendations derived from the CORE process were compared to the guideline rec...
AIRE deficiency causes a characteristic pattern of pulmonary immunopathology that is responsive t... more AIRE deficiency causes a characteristic pattern of pulmonary immunopathology that is responsive to T and B lymphocyte–directed immunomodulation.
We used an amoeba model to study the intracellular growth and cytotoxicity of clinical strains of... more We used an amoeba model to study the intracellular growth and cytotoxicity of clinical strains of Mycobacteriumabscessus subsp. massiliense (Mabsm) isolated from 2 patients (one with cystic fibrosis, the other one with idiopathic bronchiectasis) during the early (smooth colonies) and late stage (rough colonies) of chronic pulmonary infection. Acanthamoeba castellanii were infected with Mabsm (MOI 100) and samples collected every 24 h for 72 h. Results showed Mabsm is able to survive in trophozoites and persist in cysts for at least 7 days. Late Mabsm demonstrated higher cytotoxicity toward A. castellanii when compared to early strains. A. castellanii is a useful in vitro host model to study infection of Mabsm clinical isolates.
The treatment of infections caused by nontuberculous mycobacteria (NTM) is challenging because mu... more The treatment of infections caused by nontuberculous mycobacteria (NTM) is challenging because multidrug regimens with limited efficacy and considerable toxicity are required. Current treatment of NTM is largely empiric. None of the NTM drugs were specifically developed for the treatment of NTM; the rationale for their use was often extrapolated from the treatment of tuberculosis. This article reviews key features of the drugs that are most commonly used for NTM infections, and provides monitoring parameters. With this information, clinicians can make the most of the limited options available. Considerable research is needed to optimize the treatment of NTM.
Objectives. To report a probable interaction between rifampin and carbamazepine, likely leading t... more Objectives. To report a probable interaction between rifampin and carbamazepine, likely leading to a seizure, and to review conflicting reports regarding this interaction. Case Summary. A 55-year-old female was treated with carbamazepine 200 mg 3 times daily for grand mal seizures, with excellent control. A 6-hour postdose carbamazepine concentration was 10.7 µg/mL (therapeutic range = 4-10 µg/mL). After she was diagnosed with pulmonary Mycobacterium avium complex, she received rifampin 300 mg twice daily, ethambutol 800 mg daily, and clarithromycin 500 mg twice daily. At first clinic visit, rifampin was changed to 600 mg daily, and clarithromycin was replaced with azithromycin 250 mg daily. A 4-hour postdose carbamazepine concentration was 7.1 µg/mL. Two weeks later, the patient experienced a seizure (no carbamazepine concentration reported at that time), but admitted to missing doses of carbamazepine. After experiencing 2 more seizures, the patient stopped taking rifampin. Subsequ...
Mycobaterium avium complex infection is a type of nontuberculous mycobacterial (NTM) infections h... more Mycobaterium avium complex infection is a type of nontuberculous mycobacterial (NTM) infections have been reported often occurred in elderly, white, thin and principally nonsmoking women. It has been postulated that such disease in woman is related to the way they cough. They often cough quietly and covertly, thereby the clearance of sputum is suppressed. In this study, we hypothesized that NTM subjects may have decreased cough sensitivity as measured by a higher threshold for inducing cough and the Urge-to-Cough compared to controls. Female, white and elderly NTM and control subjects were recruited in the study. Four concentrations of capsaicin (50, 100, 200, 500 uM) plus placebo (0 uM capsaicin) were presented to the subject three times each in a blinded-randomized block order. Each capsaicin presentation was separated approximately 1 min. At the end of each capsaicin presentation, subjects were asked to rate their Urge-to-Cough using the modified Borg scale from 1 (no Urge-to-Cough) to 10 (maximum Urge...
Text: COPD patients often experience gaps in knowledge and access to care for many reasons. Both ... more Text: COPD patients often experience gaps in knowledge and access to care for many reasons. Both the latest iteration of the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (the “GOLD recommendations”) and the NHLBI COPD National Action Plan call for enhanced care coordination and patient education leading to improved self-efficacy, in an attempt to close these gaps. However, little evidence currently exists to demonstrate the impact these programs have on quality of life, psychosocial metrics, or other patient-centered functional outcomes. The WMU School of Medicine has integrated a respiratory therapist/COPD educator directly into their urban primary care clinic to act as a consultation resource, a patient educator/navigator, and care facilitator. As this clinic also serves as a resident physician training program, the presence of a “COPD clinic” on premises has the potential to be a demonstration model for the development of ...
BackgroundThe American Thoracic Society (ATS)/Infectious Diseases Society of America (IDSA) Commu... more BackgroundThe American Thoracic Society (ATS)/Infectious Diseases Society of America (IDSA) Community-acquired Pneumonia (CAP) guidelines were developed using systematic reviews to inform every recommendation, as suggested by the Institute of Medicine Standards for Trustworthy Guidelines. Recent studies suggest that an expert consensus-based approach, called the Convergence of Opinion on Recommendations and Evidence (CORE) process, can produce recommendations that are concordant with recommendations informed by systematic reviews.PurposeThe goal of the study was to evaluate the efficacy of the CORE process had it been used to develop the ATS/IDSA CAP guidelines.MethodsExperts in CAP who were not on the guideline panel and had no knowledge of the guideline’s systematic reviews or recommendations were recruited to participate in the CORE process, addressing the same questions asked by the guideline panel. Recommendations derived from the CORE process were compared to the guideline rec...
AIRE deficiency causes a characteristic pattern of pulmonary immunopathology that is responsive t... more AIRE deficiency causes a characteristic pattern of pulmonary immunopathology that is responsive to T and B lymphocyte–directed immunomodulation.
We used an amoeba model to study the intracellular growth and cytotoxicity of clinical strains of... more We used an amoeba model to study the intracellular growth and cytotoxicity of clinical strains of Mycobacteriumabscessus subsp. massiliense (Mabsm) isolated from 2 patients (one with cystic fibrosis, the other one with idiopathic bronchiectasis) during the early (smooth colonies) and late stage (rough colonies) of chronic pulmonary infection. Acanthamoeba castellanii were infected with Mabsm (MOI 100) and samples collected every 24 h for 72 h. Results showed Mabsm is able to survive in trophozoites and persist in cysts for at least 7 days. Late Mabsm demonstrated higher cytotoxicity toward A. castellanii when compared to early strains. A. castellanii is a useful in vitro host model to study infection of Mabsm clinical isolates.
The treatment of infections caused by nontuberculous mycobacteria (NTM) is challenging because mu... more The treatment of infections caused by nontuberculous mycobacteria (NTM) is challenging because multidrug regimens with limited efficacy and considerable toxicity are required. Current treatment of NTM is largely empiric. None of the NTM drugs were specifically developed for the treatment of NTM; the rationale for their use was often extrapolated from the treatment of tuberculosis. This article reviews key features of the drugs that are most commonly used for NTM infections, and provides monitoring parameters. With this information, clinicians can make the most of the limited options available. Considerable research is needed to optimize the treatment of NTM.
Objectives. To report a probable interaction between rifampin and carbamazepine, likely leading t... more Objectives. To report a probable interaction between rifampin and carbamazepine, likely leading to a seizure, and to review conflicting reports regarding this interaction. Case Summary. A 55-year-old female was treated with carbamazepine 200 mg 3 times daily for grand mal seizures, with excellent control. A 6-hour postdose carbamazepine concentration was 10.7 µg/mL (therapeutic range = 4-10 µg/mL). After she was diagnosed with pulmonary Mycobacterium avium complex, she received rifampin 300 mg twice daily, ethambutol 800 mg daily, and clarithromycin 500 mg twice daily. At first clinic visit, rifampin was changed to 600 mg daily, and clarithromycin was replaced with azithromycin 250 mg daily. A 4-hour postdose carbamazepine concentration was 7.1 µg/mL. Two weeks later, the patient experienced a seizure (no carbamazepine concentration reported at that time), but admitted to missing doses of carbamazepine. After experiencing 2 more seizures, the patient stopped taking rifampin. Subsequ...
Uploads
Papers by Kevin Fennelly