Publications by authors named "Jae-Joon Yim"

235 Publications

A systematic review and meta-analysis of regional risk factors for critical outcomes of COVID-19 during early phase of the pandemic.

Sci Rep 2021 05 7;11(1):9784. Epub 2021 May 7.

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.

The mortality rates of COVID-19 vary across the globe. While some risk factors for poor prognosis of the disease are known, regional differences are suspected. We reviewed the risk factors for critical outcomes of COVID-19 according to the location of the infected patients, from various literature databases from January 1 through June 8, 2020. Candidate variables to predict the outcome included patient demographics, underlying medical conditions, symptoms, and laboratory findings. The risk factors in the overall population included sex, age, and all inspected underlying medical conditions. Symptoms of dyspnea, anorexia, dizziness, fatigue, and certain laboratory findings were also indicators of the critical outcome. Underlying respiratory disease was associated higher risk of the critical outcome in studies from Asia and Europe, but not North America. Underlying hepatic disease was associated with a higher risk of the critical outcome from Europe, but not from Asia and North America. Symptoms of vomiting, anorexia, dizziness, and fatigue were significantly associated with the critical outcome in studies from Asia, but not from Europe and North America. Hemoglobin and platelet count affected patients differently in Asia compared to those in Europe and North America. Such regional discrepancies should be considered when treating patients with COVID-19.
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http://dx.doi.org/10.1038/s41598-021-89182-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8105319PMC
May 2021

Reintroduction of Antituberculous Drugs in Patients with Antituberculous Drug-Related Drug Reaction with Eosinophilia and Systemic Symptoms.

J Allergy Clin Immunol Pract 2021 Apr 16. Epub 2021 Apr 16.

Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea. Electronic address:

Background: Patients who suffered drug reaction with eosinophilia and systemic symptom (DRESS) during the treatment of tuberculosis (TB) commonly experience multidrug hypersensitivity reactions resulting in limited anti-TB drug choices. Therefore, reintroduction based on a desensitization protocol may be an option to resume anti-TB medication.

Objective: To evaluate the outcomes and safety of resuming anti-TB drugs according to reintroduction methods in patients with anti-TB drug-related DRESS.

Methods: A retrospective cohort of patients who had experienced anti-TB drug-related severe cutaneous adverse reactions from 2011 to 2017 was established from separate 5 institutions.

Results: Anti-TB medication was resumed in 27 of 29 patients with anti-TB drug-related DRESS through complete changing regimen (n = 9), reintroduction by a graded challenge (n = 5), or reintroduction using a desensitization protocol (n = 13). Nine patients completely changed their anti-TB regimen to second-line TB drugs, but only 1 (11.1%) succeeded in maintaining new anti-TB drugs. The other 8 failed to take drugs due to the occurrence of hypersensitivity reactions to the newly introduced anti-TB drugs. Two (40.0%) of 5 patients who underwent graded rechallenges successfully completed anti-TB drugs, whereas 3 (60%) failed to resume anti-TB drugs due to the recurrence of hypersensitivity reactions. In 13 patients who resumed anti-TB drugs using a desensitization protocol, no one who underwent desensitization developed recurrence of DRESS; 11 (84.6%) eventually completed anti-TB treatment and 2 eventually failed to complete anti-TB treatment due to late-onset itching and drug-induced liver injury.

Conclusions: Resuming anti-TB medication based on desensitization protocols may be a safe and effective option for those with anti-TB drug-related DRESS.
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http://dx.doi.org/10.1016/j.jaip.2021.03.054DOI Listing
April 2021

Outcomes of multidrug-resistant tuberculosis treated with bedaquiline or delamanid.

Clin Infect Dis 2021 Apr 10. Epub 2021 Apr 10.

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.

Background: Since September 1, 2016, bedaquiline and delamanid have been administered for treatment of patients with multidrug-resistant/rifampicin-resistant tuberculosis after the official approval in South Korea. This study aimed to assess and compare the final treatment outcomes of patients who received bedaquiline with those of patients who received delamanid.

Methods: This is a nationwide cohort study of patients with multidrug-resistant/rifampicin-resistant tuberculosis in whom bedaquiline or delamanid was administered from September 1, 2016, to February 28, 2018, after receiving the official approval in South Korea. Patients were classified into the bedaquiline and delamanid group according to the first used drug. We evaluated and compared the final treatment outcomes between the groups.

Results: During the study period, 284 patients with multidrug-resistant/rifampicin-resistant tuberculosis were approved to use bedaquiline or delamanid and 260 were included in the final analysis; 119 (45.8%) and 141 patients (54.2%) were classified into bedaquiline and delamanid groups, respectively. Among them, 30 patients (11.5%) exhibited additional resistance to second-line injectable drugs, 94 patients (36.2%) had additional resistance to fluoroquinolones, and 37 patients (14.2%) had resistance to both drugs. The overall treatment success rate was 79.2%. Initiation of bedaquiline rather than delamanid was not associated with treatment success (adjusted odds ratio = 0.671, 95% confidence interval = 0.350-1.285). Frequencies of adverse events were not significantly different between the two groups.

Conclusions: Initial choice of bedaquiline or delamanid did not make any significant difference in the final treatment outcome or the frequencies of adverse events among patients with multidrug-resistant/rifampicin-resistant tuberculosis.
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http://dx.doi.org/10.1093/cid/ciab304DOI Listing
April 2021

Determination of Clinical Characteristics of -Derived Species by Reanalysis of Isolates Formerly Reported as .

Ann Lab Med 2021 Sep;41(5):463-468

Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea.

Background: Seven genotypic subtypes of were recently demonstrated to represent distinct species based on phylogenomic analysis. sensu stricto (formerly known as subtype 1) is most frequently associated with human diseases; only a few studies have compared the diverse clinical characteristics of subtypes, including their drug susceptibilities. We determined the actual incidence of infections caused by each subtype of and identified their clinical characteristics.

Methods: We subtyped isolates identified as over the last 10 years at a tertiary care hospital. Percent identity score of stored sequencing data was calculated using curated reference sequences of all subtypes. Clinical characteristics were compared between those classified as subtype 1 and other subtypes. Student's -test, Wilcoxon rank-sum test, and Fisher's exact test were used for comparisons.

Results: Overall, 21.7% of the isolates were identified as species distinct from . The proportion of patients with subtype 1 infection who received treatment was significantly higher than that of patients with other subtype infections (55.3% vs. 7.7%, =0.003). Only patients with subtype 1 infection received surgical treatment. Non-subtype 1 isolates showed a higher frequency of resistance to ciprofloxacin and trimethoprim/sulfamethoxazole.

Conclusions: Non-subtype 1 isolates should be separately identified in routine clinical laboratory tests for appropriate treatment selection.
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http://dx.doi.org/10.3343/alm.2021.41.5.463DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8041593PMC
September 2021

Clinical Implications of Size of Cavities in Patients With Nontuberculous Mycobacterial Pulmonary Disease: A Single-Center Cohort Study.

Open Forum Infect Dis 2021 Mar 24;8(3):ofab087. Epub 2021 Feb 24.

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.

Background: The presence of cavities is associated with unfavorable prognosis in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD). However, little is known about the characteristics of such cavities and their impact on clinical outcomes. The aim of this study was to investigate the size of cavities and their implications on treatment outcomes and mortality in patients with NTM-PD.

Methods: We included patients diagnosed with NTM-PD at Seoul National University Hospital between January 1, 2007, and December 31, 2018. We measured the size of cavities on chest computed tomography scans performed at the time of diagnosis and used multivariable logistic regression and Cox proportional hazards regression analysis to investigate the impact of these measurements on treatment outcomes and mortality.

Results: The study cohort comprised 421 patients (noncavitary, n = 329; cavitary, n = 92) with NTM-PD. During a median follow-up period of 49 months, 118 (35.9%) of the 329 patients with noncavitary and 64 (69.6%) of the 92 patients with cavitary NTM-PD received antibiotic treatment. Cavities >2 cm were associated with worse treatment outcomes (adjusted odds ratio, 0.41; 95% CI, 0.17-0.96) and higher mortality (adjusted hazard ratio, 2.52; 95% CI, 1.09-5.84), while there was no difference in treatment outcomes or mortality between patients with cavities ≤2 cm and patients with noncavitary NTM-PD.

Conclusions: Clinical outcomes are different according to the size of cavities in patients with cavitary NTM-PD; thus, the measurement of the size of cavities could help in making clinical decisions.
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http://dx.doi.org/10.1093/ofid/ofab087DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7990513PMC
March 2021

Prediction of 1-year treatment outcome using early sputum culture conversion status in Mycobacterium abscessus pulmonary disease.

J Glob Antimicrob Resist 2021 Mar 21;25:117-118. Epub 2021 Mar 21.

Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea. Electronic address:

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http://dx.doi.org/10.1016/j.jgar.2021.03.006DOI Listing
March 2021

Efficacy of Health Coaching and an Electronic Health Management Program: Randomized Controlled Trial.

J Gen Intern Med 2021 Mar 5. Epub 2021 Mar 5.

Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea.

Background: For chronic disease management, self-management strategies are essential to achieve sustained improvement.

Objective: Our study evaluated the efficacy of health coaching and a self-management strategy-based electronic program on self-management strategies for patients with osteoporosis, chronic respiratory disease, or arthritis.

Design: Three-arm randomized controlled trial, pilot study PARTICIPANTS: Fifty-four participants INTERVENTIONS: The first intervention group (n = 53) received a self-management strategy-based electronic program and 12 weeks of health coaching (20 sessions). The second intervention group received the information and communications technology (ICT) program; the control group received usual care and an educational booklet about self-management of chronic diseases.

Main Measures: The primary outcome was the difference in the change of the mean of self-management strategy scores. Secondary outcomes included depression (PHQ-9), physical activity (Godin Leisure Exercise Questionnaire), and health habit maintenance (transtheoretical model) after 12 weeks in the program.

Key Results: The combination of health coaching and ICT was superior to control group (change 18.5 vs. - 2.6, adjusted difference = 24.5, p < 0.001); however, the ICT alone group was not superior to the control group (change 8.0 vs. - 2.6, adjusted difference = 8.0, p = 0.156). As a result of evaluating the change in the percentage of people with positive stage changes in the transtheoretical model of health habits, regular exercise (p = 0.008), a balanced diet (p = 0.005), helping others (p = 0.001), and living with loved ones (p = 0.038) showed significant differences. There was no significant difference in the changes in percentage of patients with depressive symptoms in comparison with control group; however, there was in comparison with control group among groups (p = 0.033). Compared to the control group, the proportion of patients who achieved an exercise amount of 12.5 MET or higher was significantly higher (p = 0.028) in the health coaching and ICT group.

Conclusions: The combination of ICT + health coaching led to improvement in self-management as well as in increasing exercise, and several healthy behaviors.

Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03294057.
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http://dx.doi.org/10.1007/s11606-021-06671-2DOI Listing
March 2021

Establishing a Patient-centered Longitudinal Integrated Clerkship: Early Results from a Single Institution.

J Korean Med Sci 2020 Dec 28;35(50):e419. Epub 2020 Dec 28.

Office of Medical Education, Seoul National University College of Medicine, Seoul, Korea.

Background: Longitudinal integrated clerkships (LICs) have been adopted by medical schools to overcome the limitations of traditional block clerkship rotations and to promote continuity of care. In 2018, Seoul National University College of Medicine introduced a patient-centered LIC program as part of a new curriculum in parallel with traditional block rotation clerkships. The purpose of this study was to present the patient-centered LIC program and to investigate its educational effects.

Methods: In 2018 and 2019, a total of 298 third-year medical students participated in the LIC program. We divided the students into groups of eight, which were organized into corresponding discussion classes. Throughout the academic year, students followed up patients by interviewing them at the hospital or reviewing their electric medical records. Discussion classes on set topics were held seven times per year with facilitators and clinical faculites. Students completed a course evaluation questionnaire at the end of the academic year. The questionnaire included 22 items measured on a 5-point scale and two open-ended questions asking about the benefits and limitations of the program. The items covered three domains: student experience, satisfaction, and self-assessment. Final reflective essays were collected as both student assessments and data for qualitative analysis.

Results: During the study period, the overall experience of the students improved. We increased the number of faculty members and patients and decreased the number of students in each discussion class. We also provided additional feedback through an e-portfolio. Students' satisfaction changed positively. Compared to the rotational clerkship, students answered that the LIC provided additional help in learning the two core competencies. During the first 2 years of the program, the percentage of students who answered that the program was more helpful than the rotational clerkship increased from 23.7% to 46.4% for continuity of care ( < 0.001), and from 20.5% to 50.7% for patient-centered care ( < 0.001).

Conclusion: Our patient-centered LIC, in parallel with traditional block rotation clerkships, had a positive effect on students' experience of continuity of care and patient-centered care.
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http://dx.doi.org/10.3346/jkms.2020.35.e419DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7769701PMC
December 2020

Reply to van Deun and Decroo.

Clin Infect Dis 2020 Dec 20. Epub 2020 Dec 20.

Montreal Chest Institute & McGill International TB Centre, Montreal, Quebec, Canada.

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http://dx.doi.org/10.1093/cid/ciaa1875DOI Listing
December 2020

How medical education survives and evolves during COVID-19: Our experience and future direction.

PLoS One 2020 18;15(12):e0243958. Epub 2020 Dec 18.

Office of Medical Education, Seoul National University College of Medicine, Seoul, South Korea.

Background: Due to the outbreak of coronavirus disease 2019 (COVID-19), school openings were postponed worldwide as a way to stop its spread. Most classes are moving online, and this includes medical school classes. The authors present their experience of running such online classes with offline clinical clerkship under pandemic conditions, and also present data on student satisfaction, academic performance, and preference.

Methods: The medical school changed every first-year to fourth-year course to an online format except the clinical clerkship, clinical skills training, and basic laboratory classes such as anatomy lab sessions. Online courses were pre-recorded video lectures or live-streamed using video communication software. At the end of each course, students and professors were asked to report their satisfaction with the online course and comment on it. The authors also compared students' academic performance before and after the introduction of online courses.

Results: A total of 69.7% (318/456) of students and 35.2% (44/125) of professors answered the questionnaire. Students were generally satisfied with the online course and 62.2% of them preferred the online course to the offline course. The majority (84.3%) of the students wanted to maintain the online course after the end of COVID-19. In contrast, just 13.6% of professors preferred online lectures and half (52.3%) wanted to go back to the offline course. With the introduction of online classes, students' academic achievement did not change significantly in four subjects, but decreased in two subjects.

Conclusions: The inevitable transformation of medical education caused by COVID-19 is still ongoing. As the safety of students and the training of competent physicians are the responsibilities of medical schools, further research into how future physicians will be educated is needed.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0243958PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7748283PMC
January 2021

Amikacin Liposome Inhalation Suspension for MAC Lung Disease: A 12-Month Open-Label Extension Study.

Ann Am Thorac Soc 2020 Dec 16. Epub 2020 Dec 16.

The University of Texas Health Science Center at Tyler, 12341, Medicine, Tyler, Texas, United States.

Rationale: Patients with refractory Mycobacterium avium complex (MAC) lung disease have limited treatment options. In the CONVERT study, amikacin liposome inhalation suspension (ALIS) added to guideline-based therapy (GBT) increased culture conversion rates vs GBT alone by Month 6. Limited data are available regarding >6-month treatment in a refractory population.

Objectives: Evaluate 12-month safety, tolerability, and efficacy of ALIS+GBT.

Methods: Adults with refractory MAC lung disease not achieving culture conversion by CONVERT Month 6 could enroll in this open-label extension (INS-312) to receive 590 mg once-daily ALIS+GBT for 12 months. Two cohorts enrolled: the "ALIS-naive" cohort included patients randomized to GBT alone in CONVERT, and the "prior-ALIS" cohort included those randomized to ALIS+GBT in CONVERT. Safety and tolerability of ALIS over 12 months (primary endpoint) and culture conversion by Months 6 and 12 were assessed.

Results: In the ALIS-naive cohort, 83.3% of patients (n=75/90) experienced respiratory treatment-emergent adverse events (TEAEs), and 35.6% (n=32) had serious TEAEs; 26.7% (n=24) achieved culture conversion by Month 6 and 33.3% (n=30) by Month 12. In the prior-ALIS cohort, 46.6% of patients (n=34/73) experienced respiratory TEAEs, and 27.4% (n=20) had serious TEAEs; 9.6% (n=7) achieved culture conversion by Month 6 (≤14 months ALIS exposure) and 13.7% (n=10) by Month 12 (≤20 months ALIS exposure). Nephrotoxicity-related TEAEs and measured hearing decline were infrequent in both cohorts.

Conclusions: In up to 20 months of ALIS use, respiratory TEAEs were common, nephrotoxicity and hearing decline were infrequent, and culture conversion continued beyond 6 months of therapy. Clinical trial registered with www.clinicaltrials.gov (NCT02628600).
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http://dx.doi.org/10.1513/AnnalsATS.202008-925OCDOI Listing
December 2020

New-onset nontuberculous mycobacterial pulmonary disease in bronchiectasis: tracking the clinical and radiographic changes.

BMC Pulm Med 2020 Nov 10;20(1):293. Epub 2020 Nov 10.

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, South Korea.

Background: The close association between bronchiectasis and nontuberculous mycobacterial pulmonary disease (NTM-PD) is well-known. However, the clinical impact of subsequent new-onset NTM-PD in bronchiectasis patients has not been elucidated. The aim of this study is to investigate the clinical courses and radiographic changes of patients with bronchiectasis in whom NTM-PD subsequently developed.

Methods: A total of 221 patients with bronchiectasis who had participated in a non-NTM bronchiectasis cohort between July 1st 2011 and August 31st 2019 at Seoul National University Hospital were included in this study. The data of patients in whom NTM-PD developed during this observation period were analyzed; specifically, changes in the Bronchiectasis Severity Index (BSI) and lesions on computerized tomography (CT) scan of the chest arising during the observation period.

Results: During the observation period, NTM was isolated from 35 patients. A total of 31 patients (14.0%) satisfied the diagnostic criteria of NTM-PD. The median time from enrollment in the cohort to the development of subsequent NTM-PD was 37 months (Interquartile range [IQR], 18-78 months). Mycobacterium avium complex was the most common pathogen (80.6%). Twelve patients underwent antibiotic treatment for NTM-PD with a median interval of 20 months (IQR, 13-30) from the time of NTM-PD diagnosis. When NTM-PD developed, the severity and extent of bronchiectasis, cellular bronchiolitis, and the extent of nodules worsened on CT scans, while BSI did not change.

Conclusions: NTM-PD can develop in previously negative bronchiectasis patients. It is associated with worsening radiographic lesions. Active screening of non-NTM bronchiectasis patients for new-onset NTM infection should be considered, especially if radiographic findings worsen. The BSI is not a reliable predictor of new-onset NTM-PD.

Trial Registration: This study was performed at Seoul National University Hospital ( NCT01616745 ).
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http://dx.doi.org/10.1186/s12890-020-01331-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7653824PMC
November 2020

Aminoglycosides and Capreomycin in the Treatment of Multidrug-resistant Tuberculosis: Individual Patient Data Meta-analysis of 12 030 Patients From 25 Countries, 2009-2016.

Clin Infect Dis 2020 Oct 30. Epub 2020 Oct 30.

Montreal Chest Institute and McGill International Tuberculosis Centre, Montreal, Quebec, Canada.

Background: As new drugs are developed for multidrug-resistant tuberculosis (MDR-TB), the role of currently used drugs must be reevaluated.

Methods: We combined individual-level data on patients with pulmonary MDR-TB published during 2009-2016 from 25 countries. We compared patients receiving each of the injectable drugs and those receiving no injectable drugs. Analyses were based on patients whose isolates were susceptible to the drug they received. Using random-effects logistic regression with propensity score matching, we estimated the effect of each agent in terms of standardized treatment outcomes.

Results: More patients received kanamycin (n = 4330) and capreomycin (n = 2401) than amikacin (n = 2275) or streptomycin (n = 1554), opposite to their apparent effectiveness. Compared with kanamycin, amikacin was associated with 6 more cures per 100 patients (95% confidence interval [CI], 4-8), while streptomycin was associated with 7 (95% CI, 5-8) more cures and 5 (95% CI, 4-7) fewer deaths per 100 patients. Compared with capreomycin, amikacin was associated with 9 (95% CI, 6-11) more cures and 5 (95% CI, 2-8) fewer deaths per 100 patients, while streptomycin was associated with 10 (95% CI, 8-13) more cures and 10 (95% CI, 7-12) fewer deaths per 100 patients treated. In contrast to amikacin and streptomycin, patients treated with kanamycin or capreomycin did not fare better than patients treated with no injectable drugs.

Conclusions: When aminoglycosides are used to treat MDR-TB and drug susceptibility test results support their use, streptomycin and amikacin, not kanamycin or capreomycin, are the drugs of choice.
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http://dx.doi.org/10.1093/cid/ciaa621DOI Listing
October 2020

Genome-wide association study of non-tuberculous mycobacterial pulmonary disease.

Thorax 2020 Oct 28. Epub 2020 Oct 28.

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)

Background: The prevalence of non-tuberculous mycobacterial pulmonary disease (NTM-PD) is increasing in South Korea and many parts of the world. However, the genetic factors underlying susceptibility to this disease remain elusive.

Methods: To identify genetic variants in patients with NTM-PD, we performed a genome-wide association study with 403 Korean patients with NTM-PD and 306 healthy controls from the Healthy Twin Study, Korea cohort. Candidate variants from the discovery cohort were subsequently validated in an independent cohort. The Genotype-Tissue Expression (GTEx) database was used to identify expression quantitative trait loci (eQTL) and to conduct Mendelian randomisation (MR).

Results: We identified a putatively significant locus on chromosome 7p13, rs849177 (OR, 2.34; 95% CI, 1.71 to 3.21; p=1.36×10), as the candidate genetic variant associated with NTM-PD susceptibility. Its association was subsequently replicated and the combined p value was 4.92×10. The eQTL analysis showed that a risk allele at rs849177 was associated with lower expression levels of , a proapoptotic gene. In the MR analysis, a causal effect of on NTM-PD development was identified (β, -4.627; 95% CI, -8.768 to -0.486; p=0.029).

Conclusions: The 7p13 genetic variant might be associated with susceptibility to NTM-PD in the Korean population by altering the expression level of .
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http://dx.doi.org/10.1136/thoraxjnl-2019-214430DOI Listing
October 2020

Concurrent use of bedaquiline and delamanid for the treatment of fluoroquinolone-resistant multidrug-resistant tuberculosis: a nationwide cohort study in South Korea.

Eur Respir J 2021 Mar 4;57(3). Epub 2021 Mar 4.

Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea

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http://dx.doi.org/10.1183/13993003.03026-2020DOI Listing
March 2021

Management of drug toxicity in M. avium complex pulmonary disease - an expert panel survey.

Clin Infect Dis 2020 Sep 10. Epub 2020 Sep 10.

Division of Pulmonary and Critical Care Medicine, Seoul National University College of Medicine, Seoul, South Korea.

Adverse events are frequent in NTM pulmonary disease treatment, but evidence to support their management is scarce. An expert panel survey on management of adverse events shows consistent opinions on management of hepatoxicity, ocular toxicity, ototoxicity, tinnitus and GI upset. These opinions can provide assistance in individual patient management decisions.
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http://dx.doi.org/10.1093/cid/ciaa1361DOI Listing
September 2020

Impact of Molecular Drug Susceptibility Testing on the Time to Multidrug-resistant Tuberculosis Treatment Initiation.

J Korean Med Sci 2020 Sep 7;35(35):e284. Epub 2020 Sep 7.

Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Background: The purpose of this study was to evaluate the current status and trends in the coverage of molecular drug susceptibility testing (mDST), and the impact of mDST on the time to multidrug-resistant tuberculosis (MDR-TB) treatment initiation in Korea.

Methods: We included confirmed rifampin-resistant (RR)/MDR-TB patients who submitted application forms for novel drug uses to the National TB Expert Review Committee from September 1, 2016 to November 30, 2019. We retrospectively reviewed their medical records.

Results: Of the 621 MDR/RR-TB patients, mDST was performed in 442 (71.2%); Xpert MTB/RIF (Xpert) alone in 109 (17.6%), MTBDR line probe assay (LPA) alone in 199 (32.0%), and both Xpert and LPA in 134 (21.6%) patients. The coverage rate of mDST has gradually increased to 70% in 2015, 50.7% in 2016, 67.9% in 2017, 75.2% in 2018, and 79.4% in 2019 ( for trend < 0.001). Median time to MDR-TB treatment initiation was 35 days (interquartile range 0-72), which has gradually decreased during the study period ( < 0.001). Independent predictors of shorter time to MDR-TB treatment initiation were retreatment case (adjusted hazard ratio [aHR], 1.30; 95% confidence interval [CI], 1.10-1.54), Xpert testing (aHR, 2.42; 95% CI, 2.03-2.88), and LPA testing (aHR, 1.83; 95% CI, 1.55-2.16). Transfer to another healthcare facility was inversely related to shorter time to treatment initiation (aHR, 0.74; 95% CI, 0.63-0.88).

Conclusion: mDST coverage is gradually increasing and contributes to reducing the time to MDR-TB treatment initiation. Further efforts are needed to achieve universal access to mDST and to properly integrate mDST into routine clinical practice.
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http://dx.doi.org/10.3346/jkms.2020.35.e284DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7476798PMC
September 2020

Impact of body mass index on development of nontuberculous mycobacterial pulmonary disease.

Eur Respir J 2021 Feb 4;57(2). Epub 2021 Feb 4.

Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.

The incidence and prevalence of nontuberculous mycobacterial pulmonary disease (NTM-PD) have been increasing worldwide. The risk of NTM-PD may be higher in undernourished populations. In this study, we tried to elucidate the impact of body mass index (BMI) and its change on development of NTM-PD.We performed a retrospective cohort study including South Koreans aged >40 years who underwent biennial National Health Insurance System (NHIS) health check-ups in both 2005 and 2009 or 2006 and 2010. We monitored eligible individuals from the study initiation date (NHIS health check-up date in 2009 or 2010) until the diagnosis of NTM-PD or until December 31, 2017. Enroled individuals were classified based on BMI at initiation date. By calculating hazard ratios, we compared NTM-PD incidence per 100000 person-years by BMI group and by BMI change.A total of 5670229 individuals were included in the final analysis. Compared with the BMI <18.5 kg·m group, the incidence of NTM-PD gradually decreased with increased BMI (adjusted hazard ratio 0.38, 95% confidence interval (CI) 0.35-0.42 for BMI 18.5-22.9; 0.17, 95% CI 0.15-0.19 for BMI 23-24.9; 0.1, 95% CI 0.09-0.11 for BMI 25-29.9; and 0.1, 95% CI 0.07-0.13 for BMI ≥30). A BMI decrease of ≥1 kg·m over 4 years increased the incidence of NTM-PD (adjusted hazard ratio 1.08, 95% CI 1.01-1.16) whereas a BMI increase of ≥1 kg·m decreased the incidence of NTM-PD (adjusted hazard ratio 0.77, 95% CI 0.71-0.83).In conclusion, BMI was inversely related to development of NTM-PD and weight loss increased the risk of NTM-PD.
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http://dx.doi.org/10.1183/13993003.00454-2020DOI Listing
February 2021

BACES Score for Predicting Mortality in Nontuberculous Mycobacterial Pulmonary Disease.

Am J Respir Crit Care Med 2021 01;203(2):230-236

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and.

Because the prognosis of nontuberculous mycobacterial pulmonary disease varies, a scoring system predicting mortality is needed. We aimed to develop a novel scoring system to predict mortality among patients with nontuberculous mycobacterial pulmonary disease. We included patients age ≥20 years with newly diagnosed nontuberculous mycobacterial pulmonary disease, with , , subsp. , or subsp. . Cox proportional hazards models were used to identify predictors of mortality in a derivation cohort, and a scoring system was developed. It was validated in an independent prospective cohort. A total 1,181 and 377 patients were included in the derivation and validation cohorts, respectively. In the final model, body mass index <18.5 kg/m (1 point), age ≥65 years (1 point), presence of cavity (1 point), elevated erythrocyte sedimentation rate (1 point), and male sex (1 point) were selected as predictors for mortality. We named this novel scoring system BACES (body mass index, age, cavity, erythrocyte sedimentation rate, and sex). Harrell's C-index for the BACES score was 0.812 (95% confidence interval, 0.786-0.837) in the derivation cohort and 0.854 (95% confidence interval, 0.797-0.911) in the validation cohort, indicating excellent discrimination performance. The estimated 5-year risk of mortality was 1.2% with BACES score 0 and 82.9% with BACES score 5. We developed the BACES score, which could accurately predict mortality among patients with nontuberculous mycobacterial pulmonary disease caused by , , subsp. , or subsp. .
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http://dx.doi.org/10.1164/rccm.202004-1418OCDOI Listing
January 2021

Minimal Inhibitory Concentration of Clofazimine Among Clinical Isolates of Nontuberculous Mycobacteria and Its Impact on Treatment Outcome.

Chest 2021 Feb 24;159(2):517-523. Epub 2020 Jul 24.

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea. Electronic address:

Background: Clofazimine has been regarded as a promising agent for the treatment of nontuberculous mycobacteria pulmonary disease (NTM-PD). However, its overall effectiveness in vitro and in the clinic remains unknown.

Research Question: What is the minimal inhibitory concentration (MIC) of clofazimine in clinical isolates and the association between MICs and treatment outcome?

Study Design And Methods: MICs for clofazimine were measured in clinical isolates from NTM-PD patients who participated in a prospective study at Seoul National University Hospital. The MIC was determined by using the broth microdilution concentration method. Correlation between MIC and conversion to negative of sputum culture with clofazimine was determined.

Results: Of a total 189 isolates, 133 strains were Mycobacterium avium complex (MAC) and 40 strains were M abscessus. Although the clofazimine MICs for MAC ranged from 0.031 mg/L to 8 mg/L, the values obtained for M abscessus ranged from 0.031 mg/L to 16 mg/L. Of 20 patients who were treated with a regimen including clofazimine, eight achieved negative conversion of sputum culture. All patients with isolates exhibiting clofazimine MIC values ≤ 0.25 mg/L achieved culture conversion. The likelihood of culture conversion in patients with MIC value ≤ 0.25 mg/L was much higher than that of patients with MIC value > 0.5 mg/L (OR, 39.3; P = .021).

Interpretation: The MICs of clofazimine varied widely in clinical isolates from patients with NTM-PD. Negative conversion of sputum culture with clofazimine use was associated with a lower MIC value. Clofazimine use could be considered in patients with NTM-PD when the MIC value is ≤ 0.25 mg/L.

Trial Registry: ClinicalTrials.gov; No.: NCT01616745; URL: www.clinicaltrials.gov.
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http://dx.doi.org/10.1016/j.chest.2020.07.040DOI Listing
February 2021

Effect of COVID-19 on Tuberculosis Notification, South Korea.

Emerg Infect Dis 2020 Oct 16;26(10):2506-2508. Epub 2020 Jul 16.

After South Korea raised its infectious disease alert to the highest level in response to coronavirus disease emergence, tuberculosis notification during the first 18 weeks of 2020 decreased significantly from the same period for each year during 2015-2019. Adequate measures to diagnose, control, and prevent tuberculosis need to be maintained.
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http://dx.doi.org/10.3201/eid2610.202782DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7510739PMC
October 2020

Evolution of Interferon-Gamma Release Assay Results and Submillisievert Chest CT Findings among Close Contacts of Active Pulmonary Tuberculosis Patients.

Tuberc Respir Dis (Seoul) 2020 Oct 9;83(4):283-288. Epub 2020 Jul 9.

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

Background: Latent tuberculosis (TB) infection among TB contacts is diagnosed using plain chest radiography and interferon-gamma release assays (IGRAs). However, plain chest radiographs often miss active TB, and the results of IGRA could fluctuate over time. The purpose of this study was to elucidate changes in the results of the serial IGRAs and in the findings of the serial submillisievert chest computed tomography (CT) scans among the close contacts of active pulmonary TB patients.

Methods: Patients age 20 or older with active pulmonary TB and their close contacts were invited to participate in this study. Two types of IGRA (QuantiFERON-TB Gold In-Tube assay [QFT-GIT] and the T-SPOT.TB test [T-SPOT]) and submillisievert chest CT scanning were performed at baseline and at 3 and 12 months after enrollment.

Results: In total, 19 close contacts participated in this study. One was diagnosed with active pulmonary TB and was excluded from further analysis. At baseline, four of 18 contacts (22.2%) showed positive results for QFT-GIT and T-SPOT; there were no discordant results. During the follow-up, transient and permanent positive or negative conversions and discordant results between the two types of IGRAs were observed in some patients. Among the 17 contacts who underwent submillisievert chest CT scanning, calcified nodules were identified in seven (41.2%), noncalcified nodules in 14 (82.4%), and bronchiectasis in four (23.5%). Some nodules disappeared over time.

Conclusion: The results of the QFT-GIT and T-SPOT assays and the CT images may change during 1 year of observation of close contacts of the active TB patients.
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http://dx.doi.org/10.4046/trd.2020.0038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7515678PMC
October 2020

Interim treatment outcomes in multidrug-resistant tuberculosis patients treated sequentially with bedaquiline and delamanid.

Int J Infect Dis 2020 Sep 5;98:478-485. Epub 2020 Jul 5.

Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. Electronic address:

Objectives: The objective of this study was to evaluate the efficacy and safety of the sequential use of bedaquiline (Bdq) and delamanid (Dlm) in patients with multidrug-resistant tuberculosis (MDR-TB) and limited treatment options.

Methods: This study evaluated 74 MDR-TB patients treated between March 2016 and December 2018 with Bdq followed by Dlm (n = 22), or vice versa (n= 52), combined with optimized background regimens.

Results: The mean age of the participants was 49.0 ± 15.8 years. Fifty-one (68.9%) of the participants were male. Fluoroquinolone resistance was identified in 54 (72.9%) patients, including 20 (27.0%) with extensively drug-resistant TB. Of the 47 (63.5%) patients with positive cultures at the commencement of the first new drug, culture conversion occurred in 44 (93.6%). The interim treatment outcome after 12 months was favourable in 68/74 patients (91.9%). Twenty-four weeks of treatment were completed in 137 of 148 episodes of new drug use (92.3%). Regarding the 11 early discontinuation events, six patients stopped using a new drug due to adverse drug reactions that were not life-threatening, including one (1.4%) who stopped Bdq due to QT-prolongation.

Conclusions: Sequential use of the two new drugs appears to be an effective and safe option for MDR-TB patients with few treatment options.
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http://dx.doi.org/10.1016/j.ijid.2020.07.001DOI Listing
September 2020

Changes in treatment for multidrug-resistant tuberculosis according to national income.

Eur Respir J 2020 11 5;56(5). Epub 2020 Nov 5.

Dept of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Seoul National University College of Medicine, Seoul, South Korea.

The aim of this study was to analyse temporal changes in treatments for and outcomes of multidrug-resistant (MDR)/rifampin-resistant (RR)-tuberculosis (TB) in the context of national economic status.We analysed data collected by the Collaborative Group for the Meta-Analysis of Individual Patient Data in MDR-TB Treatment on MDR/RR-TB patients from 37 countries. The data were stratified by three national income levels (low-/lower-middle, upper-middle and high) and grouped by time of treatment initiation (2001-2003, 2004-2006, 2007-2009, 2010-2012 and 2013-2015). Temporal trends over the study period were analysed. The probability of treatment success in different income groups over time was calculated using generalised linear mixed models with random effects.In total, 9036 patients were included in the analysis. Over the study period, use of group A drugs (levofloxacin/moxifloxacin, bedaquiline and linezolid) recommended by the World Health Organization increased and treatment outcomes improved in all income groups. Between 2001-2003 and 2013-2015, treatment success rates increased from 60% to 78% in low-/lower-middle-income countries, from 40% to 67% in upper-middle-income countries, and from 73% to 81% in high-income countries. In earlier years, the probability of treatment success in upper-middle-income countries was lower than that in low-/lower-middle-income countries, but no difference was observed after 2010. However, high-income countries had persistently higher probability of treatment success compared to upper-middle income countries.Improved treatment outcomes and greater uptake of group A drugs were observed over time for patients with MDR/RR-TB at all income levels. However, treatment outcomes are still unsatisfactory, especially in upper-middle-income countries.
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http://dx.doi.org/10.1183/13993003.01394-2020DOI Listing
November 2020

Interim treatment outcomes in multidrug-resistant tuberculosis using bedaquiline and/or delamanid in South Korea.

Respir Med 2020 06 8;167:105956. Epub 2020 Apr 8.

Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. Electronic address:

Purpose: The Korea Centers for Disease Control & Prevention has implemented a review process for the approval of new drugs used to treat patients with multidrug-resistant tuberculosis (MDR-TB) since September 2016. Therefore, this study aimed to evaluate the efficacy and safety of these new drugs bedaquiline (Bdq) and delamanid (Dlm).

Methods: A total of 318 patients with MDR-TB were reviewed by the committee from September 2016 to February 2018; 282 (88.7%) of them were treated with the new drugs (Bdq, 107 patients; Dlm, 108 patients; and both concurrently or sequentially, 67 patients) and retrospectively evaluated. Culture conversion rates, interim treatment outcomes at 12 months, and predictors of unfavorable outcomes were analyzed. Treatment efficacy was also compared between Bdq and Dlm.

Results: The mean age of the patients was 49.3 years, and 197 (69.9%) were male. Three patients were HIV seropositive and 151 (53.5%) were quinolone resistant. The culture conversion rates at 2 and 6 months were 57.4% (81/141) and 89.4% (126/141), respectively. A favorable outcome at 12 months was achieved in 84.8% of patients (239/282). Differences in the culture conversion rate or interim treatment outcomes were not statistically significant among the drug susceptibility test patterns or new drugs used. Multivariable analysis showed that age >60 years and body mass index of <18.5 kg/m were significant risk factors for unfavorable outcomes at 12 months.

Conclusions: The use of new drugs resulted in satisfactory interim treatment results, without significant differences between them.
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http://dx.doi.org/10.1016/j.rmed.2020.105956DOI Listing
June 2020

Longitudinal changes in health-related quality of life according to clinical course among patients with non-tuberculous mycobacterial pulmonary disease: a prospective cohort study.

BMC Pulm Med 2020 May 7;20(1):126. Epub 2020 May 7.

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, South Korea.

Background: Improvement in health-related quality of life (HRQL) has been suggested as an alternative treatment goal of non-tuberculous mycobacterial pulmonary disease (NTM-PD). This study was performed to elucidate the longitudinal changes in HRQL using St. George's Respiratory Questionnaire (SGRQ) among patients with NTM-PD according to their clinical course.

Methods: Patients with NTM-PD who participated in Seoul National University Hospital's prospective NTM cohort were screened. Participants for whom the SGRQ score was estimated with the one-year interval for ≥ three times were included. The longitudinal trends of the SGRQ score were assessed. The impact of the clinical course on the change in the SGRQ score was elucidated using multilevel mixed-effects linear regression with a repeated-measures model.

Results: In total, 114 patients were analyzed. During the median 5-year observation period, 53 patients started anti-mycobacterial treatment and 61 patients were observed without treatment. Among the treated patients, 24 (45.2%) achieved microbiological cure. Patients who required treatment eventually had worsening SGRQ scores with time compared with patients who could be observed without treatment (P < 0.001). In cured patients, the SGRQ score decreased from 33.9 at baseline to 20.8 at 1 year post-treatment (P < 0.001), 21.3 at 2 years (P < 0.001), and 17.6 at 3 years (P < 0.001). The SGRQ scores also decreased for 2 years of treatment in patients with NTM-PD that could not be cured, although this decrease did not last for 3 years of treatment.

Conclusion: Worsening HRQL scores were associated with the initiation of treatment and, in turn, treatment improved HRQL scores of patients with NTM-PD.

Trial Registration: This study was registered to the ClinicalTrials.gov (Identifier: NCT01616745 / registration date: June 12, 2012). The protocol was retrospectively registered.
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http://dx.doi.org/10.1186/s12890-020-1165-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7203799PMC
May 2020

Whole genome sequencing of Nontuberculous Mycobacterium (NTM) isolates from sputum specimens of co-habiting patients with NTM pulmonary disease and NTM isolates from their environment.

BMC Genomics 2020 Apr 23;21(1):322. Epub 2020 Apr 23.

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.

Background: Nontuberculous mycobacterium (NTM) species are ubiquitous microorganisms. NTM pulmonary disease (NTM-PD) is thought to be caused not by human-to-human transmission but by independent environmental acquisition. However, recent studies using next-generation sequencing (NGS) have reported trans-continental spread of Mycobacterium abscessus among patients with cystic fibrosis.

Results: We investigated NTM genomes through NGS to examine transmission patterns in three pairs of co-habiting patients with NTM-PD who were suspected of patient-to-patient transmission. Three pairs of patients with NTM-PD co-habiting for at least 15 years were enrolled: a mother and a daughter with M. avium-PD, a couple with M. intracellulare-PD, and a second couple, one of whom was infected with M. intracellulare and the other of whom was infected with M. abscessus. Whole genome sequencing was performed using patients' NTM isolates as well as environmental specimens. Genetic distances were estimated based on single nucleotide polymorphisms (SNPs). By comparison with the genetic distances among 78 publicly available NTM genomes, NTM isolates derived from the two pairs of patients infected with the same NTM species were not closely related to each other. In phylogenetic analysis, the NTM isolates from patients with M. avium-PD clustered with isolates from different environmental sources.

Conclusions: In conclusion, considering the genetic distances between NTM strains, the likelihood of patient-to-patient transmission in pairs of co-habiting NTM-PD patients without overt immune deficiency is minimal.
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http://dx.doi.org/10.1186/s12864-020-6738-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7181514PMC
April 2020

Clustered micronodules as predominant manifestation on CT: A sign of active but indolently evolving pulmonary tuberculosis.

PLoS One 2020 17;15(4):e0231537. Epub 2020 Apr 17.

Department of Pathology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.

Objective: To investigate the prevalence, patient characteristics, and natural history of clustered micronodules (CMs) in active pulmonary tuberculosis.

Materials And Methods: From January 2013 through July 2018, 833 consecutive patients with bacteriologically or polymerase chain reaction-proven active pulmonary tuberculosis were retrospectively evaluated. CMs were defined as a localized aggregation of multiple dense discrete micronodules, which primarily distributed around small airways distal to the level of the segmental bronchus: small airways surrounded by CMs maintained luminal patency and the CMs might coalesce into a larger nodule. The patients were dichotomized according to whether the predominant computed tomography (CT) abnormalities were CMs. We analyzed radiologic and pathologic findings in patients whose predominant diagnostic CT abnormalities were CMs, along with those of incidental pre-diagnostic CT scans, if available. Chi-square, McNemar, Student t-test and Wilcoxon-signed rank test were performed.

Results: CMs were the predominant CT abnormality in 2.6% of the patients (22/833, 95% CI, 1.8-4.0%) with less sputum smear-positivity (4.8% vs 31.0%; p = .010) and a similar proportion of immunocompromised status (40.9% vs 46.0%; p = .637) than those without having CMs as the predominant CT abnormality. The time interval for minimal radiologic progression was 6.4 months. The extent of CMs increased with disease progression, frequently accompanied by consolidation and small airway wall thickening. Pathologically, smaller CMs were non-caseating granulomas confined to the peribronchiolar interstitium, whereas larger CMs were caseating granulomas involving lung parenchyma. Two of the five patients with a pre-diagnostic CT scan obtained more than 50 months pre-diagnosis showed an incipient stage of CMs, in which they were small peribronchiolar nodules.

Conclusion: Active pulmonary tuberculosis manifested predominantly as CMs in 2.6% of patients, with scarce of acid-fast bacilli smear-positivity and no association with impaired host immunity. CMs indolently progressed, accompanied by consolidation and small airway wall thickening, and originated from small nodules.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0231537PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7164656PMC
July 2020

The Role of Chest Imaging in Patient Management During the COVID-19 Pandemic: A Multinational Consensus Statement From the Fleischner Society.

Chest 2020 07 7;158(1):106-116. Epub 2020 Apr 7.

Department of Radiology, Stanford University School of Medicine, Stanford, CA.

With more than 900,000 confirmed cases worldwide and nearly 50,000 deaths during the first 3 months of 2020, the coronavirus disease 2019 (COVID-19) pandemic has emerged as an unprecedented health care crisis. The spread of COVID-19 has been heterogeneous, resulting in some regions having sporadic transmission and relatively few hospitalized patients with COVID-19 and others having community transmission that has led to overwhelming numbers of severe cases. For these regions, health care delivery has been disrupted and compromised by critical resource constraints in diagnostic testing, hospital beds, ventilators, and health care workers who have fallen ill to the virus exacerbated by shortages of personal protective equipment. Although mild cases mimic common upper respiratory viral infections, respiratory dysfunction becomes the principal source of morbidity and mortality as the disease advances. Thoracic imaging with chest radiography and CT are key tools for pulmonary disease diagnosis and management, but their role in the management of COVID-19 has not been considered within the multivariable context of the severity of respiratory disease, pretest probability, risk factors for disease progression, and critical resource constraints. To address this deficit, a multidisciplinary panel comprised principally of radiologists and pulmonologists from 10 countries with experience managing patients with COVID-19 across a spectrum of health care environments evaluated the utility of imaging within three scenarios representing varying risk factors, community conditions, and resource constraints. Fourteen key questions, corresponding to 11 decision points within the three scenarios and three additional clinical situations, were rated by the panel based on the anticipated value of the information that thoracic imaging would be expected to provide. The results were aggregated, resulting in five main and three additional recommendations intended to guide medical practitioners in the use of chest radiography and CT in the management of COVID-19.
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http://dx.doi.org/10.1016/j.chest.2020.04.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7138384PMC
July 2020

The Role of Chest Imaging in Patient Management during the COVID-19 Pandemic: A Multinational Consensus Statement from the Fleischner Society.

Radiology 2020 07 7;296(1):172-180. Epub 2020 Apr 7.

From the Department of Radiology, Duke University School of Medicine, Box 3808, Durham, NC 27705 (G.D.R.); Department of Medicine, University of British Columbia, Vancouver, Canada (C.J.R.); Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (L.B.H.); Department of Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy (N.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); Division of Pulmonary, Critical Care & Sleep Medicine, Lenox Hill Hospital, New York, NY (S.R.); Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center, New York, NY (N.W.S.); 1st Anesthesia and Intensive Care Unit, University Hospital of Parma, Parma, Italy (A.V.); Division of Pulmonary and Critical Medicine, Seoul National University College of Medicine, Seoul, South Korea (J.J.Y.); Department of Emergency Medicine, The Medical College of Wisconsin School of Medicine, Milwaukee, Wis (I.B.K.M.); Director, Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, NC (D.J.A.); Medical Director of Pathology and Clinical Laboratory Medicine, Stanford University Medical Center, Stanford, Calif (C.K.); Department of Radiology, University of Missouri, Columbia, Mo (T.A.); Department of Paediatrics and Paediatric Respirology, Royal Brompton Hospital, London, England (A.B.); Department of Radiology, Royal Brompton & Harefield NHS Foundation Trust, London, England (S.R.D.); National Heart and Lung Institute, Imperial College, London, England (S.R.D.); Department of Radiology, David Geffen School of Medline at University of California Los Angeles, Los Angeles, Calif (J.G.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Respiratory and Intensive Care Medicine, Université Paris-Saclay, Hôpital Bicêtre, Le Kremlin-Bicêtre, France (M.H.); Department of Pathology, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan (Y.I.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (H.U.K.); Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Sichuan, China (F.L.); Respiratory Institute, Cleveland Clinic, Cleveland,Ohio (P.J.M.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (M.P.); Department of Thoracic Imaging-Hospital Calmette, University Centre of Lille, Lille, France (M.R.J.); Divisionof Pulmonary Medicine, Università Cattolica del Sacro Cuore, Rome, Italy (L.R.); Department of Radiology and Nuclear Medicine, Meander Medical Centre, Amersfoort, the Netherlands (C.M.S.P.); Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan (N.T.); Department of Pulmonary Medicine, Royal Brompton Hospital, London, England (A.U.W.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.N.L.).

With more than 900 000 confirmed cases worldwide and nearly 50 000 deaths during the first 3 months of 2020, the coronavirus disease 2019 (COVID-19) pandemic has emerged as an unprecedented health care crisis. The spread of COVID-19 has been heterogeneous, resulting in some regions having sporadic transmission and relatively few hospitalized patients with COVID-19 and others having community transmission that has led to overwhelming numbers of severe cases. For these regions, health care delivery has been disrupted and compromised by critical resource constraints in diagnostic testing, hospital beds, ventilators, and health care workers who have fallen ill to the virus exacerbated by shortages of personal protective equipment. Although mild cases mimic common upper respiratory viral infections, respiratory dysfunction becomes the principal source of morbidity and mortality as the disease advances. Thoracic imaging with chest radiography and CT are key tools for pulmonary disease diagnosis and management, but their role in the management of COVID-19 has not been considered within the multivariable context of the severity of respiratory disease, pretest probability, risk factors for disease progression, and critical resource constraints. To address this deficit, a multidisciplinary panel comprised principally of radiologists and pulmonologists from 10 countries with experience managing patients with COVID-19 across a spectrum of health care environments evaluated the utility of imaging within three scenarios representing varying risk factors, community conditions, and resource constraints. Fourteen key questions, corresponding to 11 decision points within the three scenarios and three additional clinical situations, were rated by the panel based on the anticipated value of the information that thoracic imaging would be expected to provide. The results were aggregated, resulting in five main and three additional recommendations intended to guide medical practitioners in the use of chest radiography and CT in the management of COVID-19.
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http://dx.doi.org/10.1148/radiol.2020201365DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233395PMC
July 2020