Diagnosis of Pulmonary Tuberculosis: Recent Advances and Diagnostic Algorithms

Ryu, Yon Ju The Korean Academy of Tuberculosis and Respiratory 2015 Tuberculosis and Respiratory Diseases Vol.78 No.2

Pulmonary tuberculosis (TB) persists as a great public health problem in Korea. Increases in the overall age of the population and the rise of drug-resistant TB have reinforced the need for rapid diagnostic improvements and new modalities to detect TB and drug-resistant TB, as well as to improve TB control. Standard guidelines and recent advances for diagnosing pulmonary TB are summarized in this article. An early and accurate diagnosis of pulmonary TB should be established using chest X-ray, sputum microscopy, culture in both liquid and solid media, and nucleic acid amplification. Chest computed tomography, histopathological examination of biopsy samples, and new molecular diagnostic tests can be used for earlier and improved diagnoses, especially in patients with smear-negative pulmonary TB or clinically-diagnosed TB and drug-resistant TB.

REVIEW : Diagnosis and Treatment of Nontuberculous Mycobacterial Lung Disease: Clinicians` Perspectives

( Yon Ju Ryu ),( Won Jung Koh ),( Charles L. Daley ) 대한결핵 및 호흡기학회 2016 Tuberculosis and Respiratory Diseases Vol.79 No.2

Nontuberculous mycobacteria (NTM) are emerging pathogens that affect both immunocompromised and immunocompetent patients. The incidence and prevalence of NTM lung disease are increasing worldwide and rapidly becoming a major public health problem. For the diagnosis of NTM lung disease, patients suspected to have NTM lung disease are required to meet all clinical and microbiologic criteria. The development of molecular methods allows the characterization of new species and NTM identification at a subspecies level. Even after the identification of NTM species from respiratory specimens, clinicians should consider the clinical significance of such findings. Besides the limited options, treatment is lengthy and varies by species, and therefore a challenge. Treatment may be complicated by potential toxicity with discouraging outcomes. The decision to start treatment for NTM lung disease is not easy and requires careful individualized analysis of risks and benefits. Clinicians should be alert to those unique aspects of NTM lung disease concerning diagnosis with advanced molecular methods and treatment with limited options. Current recommendations and recent advances for diagnosis and treatment of NTM lung disease are summarized in this article.

Diagnosis and Treatment of Nontuberculous Mycobacterial Lung Disease: Clinicians' Perspectives

Ryu, Yon Ju,Koh, Won-Jung,Daley, Charles L. The Korean Academy of Tuberculosis and Respiratory 2016 Tuberculosis and Respiratory Diseases Vol.79 No.2

Nontuberculous mycobacteria (NTM) are emerging pathogens that affect both immunocompromised and immunocompetent patients. The incidence and prevalence of NTM lung disease are increasing worldwide and rapidly becoming a major public health problem. For the diagnosis of NTM lung disease, patients suspected to have NTM lung disease are required to meet all clinical and microbiologic criteria. The development of molecular methods allows the characterization of new species and NTM identification at a subspecies level. Even after the identification of NTM species from respiratory specimens, clinicians should consider the clinical significance of such findings. Besides the limited options, treatment is lengthy and varies by species, and therefore a challenge. Treatment may be complicated by potential toxicity with discouraging outcomes. The decision to start treatment for NTM lung disease is not easy and requires careful individualized analysis of risks and benefits. Clinicians should be alert to those unique aspects of NTM lung disease concerning diagnosis with advanced molecular methods and treatment with limited options. Current recommendations and recent advances for diagnosis and treatment of NTM lung disease are summarized in this article.

Prevalence of Depression and Anxiety in Outpatients with Chronic Airway Lung Disease

( Yon Ju Ryu ),( Eun Mi Chun ),( Jin Hwa Lee ),( Jung Hyun Chang ) 대한내과학회 2010 The Korean Journal of Internal Medicine Vol.25 No.1

Background/Aims: Patients with chronic airway lung diseases often experience depression and anxiety, but little information is available regarding Koreans with these conditions. We thus assessed depression and anxiety in Korean patients with chronic airway lung diseases. Methods: The degree of depression and anxiety in 84 outpatients with chronic obstructive pulmonary disease (COPD), 37 with asthma, 33 with bronchiectasis, and 73 healthy controls were evaluated by the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI). Results: The patients with COPD and bronchiectasis had higher BDI scores and were more likely than controls to experience depression ([COPD, 17; range, 0 to 42; prevalence, 55%], [bronchiectasis, 16; range, 3 to 51; prevalence, 55%], [controls, 13; range, 0 to 31; prevalence, 30%], p<0.05). The state-anxiety scores of the patients were higher than those of the controls, but only the bronchiectasis group demonstrated a higher frequency of state-anxiety compared with the controls (39 vs. 16%, patients vs. controls, p=0.015). Among all patients, 22% presented with concomitant depression and state-anxiety, and 25% demonstrated depression and trait-anxiety. Depression was positively correlated with both state-anxiety (r=0.644) and trait-anxiety (r=0.597, p<0.0001). Irrespective of individual diagnosis, post-bronchodilator FEV1 (odds ratio [OR], 0.972; p=0.027) and smoking history (OR, 3.894; p=0.018) were independent risk factors for depression in patients with chronic airway lung diseases. Conclusions: Chronic airway lung diseases are associated with depression and/or anxiety, particularly in those with a higher airflow limitation and/or history of smoking. (Korean J Intern Med 2010;25:51-57)

Bronchoalveolar lavage in fibrotic idiopathic interstitial pneumonias

Ju Ryu, Yon,Pyo Chung, Man,Han, Joungho,Kim, Tae Sung,Lee, Kyung Soo,Chun, Eun-Mi,Kyung, Sun Young,Jeong, Sung Hwan,Colby, Thomas V.,Kim, Hojoong,Kwon, O. Jung Bailliere Tindall,in association with the British 2007 Respiratory medicine Vol.101 No.3

<P><B>Summary</B></P><P>The purpose of this study was to assess the role of bronchoalveolar lavage (BAL) in differentiating usual interstitial peumonia (UIP) from non-specific interstitial pneumonia (NSIP) and in predicting the prognosis in fibrotic idiopathic interstitial pneumonia (IIP). A retrospective review of 122 patients (age 58±8 years, 70 male) with UIP (n=87) and NSIP (n=35) was carried out. Prior to surgical lung biopsy, all of them underwent BAL and high-resolution-computed tomography (HRCT) of the chest. Neutrophil count in BAL fluid was higher in UIP (7.0%) than NSIP (3.0%) (P=0.027). In contrast, BAL lymphocyte count was significantly higher in NSIP (29.0%) than UIP (5.5%) (P<0.0001). In 62 patients whose HRCT findings were atypical for UIP, BAL lymphocytosis was more frequently observed in NSIP (20/33) than UIP (4/29) (P<0.001) and the absence of BAL lymphocytosis suggested a diagnosis of UIP rather than NSIP (odds ratio 12.7, P<0.001). Pathologic diagnosis of NSIP was the only independent factor predicting a longer survival of our patients (median follow-up 21 months) (hazard ratio (HR) 0.035, P=0.005). When NSIP was not included in the survival analysis, higher BAL lymphocyte count was the only independent predictor of a longer survival (HR 0.909, P=0.029). BAL is an useful non-invasive tool in fibrotic IIP, not only for excluding a variety of specific non-IIP diseases but also for narrowing the differential diagnosis and predicting the prognosis in the absence of the histopathologic diagnosis.</P>

Prognostic factors in pulmonary tuberculosis requiring mechanical ventilation for acute respiratory failure

RYU, Yon Ju,KOH, Won-Jung,KANG, Eun Hae,SUH, Gee Young,CHUNG, Man Pyo,KIM, Hojoong,KWON, O Jung Blackwell Publishing Asia 2007 RESPIROLOGY Vol.12 No.3

<P>Background and objective: </P><P>The prognosis in patients with pulmonary tuberculosis and acute respiratory failure requiring mechanical ventilation is believed to be poor. The aim of this study was to identify factors contributing to in-hospital mortality in these patients.</P><P>Methods: </P><P>The medical records of 32 patients with active pulmonary tuberculosis as a primary cause of acute respiratory failure requiring mechanical ventilation in the medical intensive care unit (ICU) of a tertiary referral hospital over a 10-year period were reviewed retrospectively, and predictors of mortality were assessed.</P><P>Results: </P><P>The patients’ median age was 69 years (range 25–88 years). The median length of intensive care unit stay was 11 days (range 2–88 days), and the median duration of mechanical ventilation was 9 days (range 2–86 days). Overall in-hospital mortality was 59% (19/32). Independent predictive factors of in-hospital mortality included tuberculous-destroyed lungs (hazard ratio 6.61, 95% CI: 1.21–36.04, <I>P</I> = 0.029), Acute Physiology and Chronic Health Evaluation II scores ≥20 (hazard ratio 4.90, 95% CI: 1.43–16.80, <I>P</I> = 0.012) and sepsis (hazard ratio 5.84, 95% CI: 1.63–20.95, <I>P</I> = 0.007).</P><P>Conclusion: </P><P>Acute respiratory failure caused by pulmonary tuberculosis necessitating mechanical ventilation has a high mortality rate and poor prognosis, particularly in patients with tuberculous-destroyed lungs, high Acute Physiology and Chronic Health Evaluation II scores and sepsis.</P>

REVIEWS : Diagnosis of Pulmonary Tuberculosis: Recent Advances and Diagnostic Algorithms

( Yon Ju Ryu ) 대한결핵 및 호흡기학회 2015 Tuberculosis and Respiratory Diseases Vol.78 No.2

Pulmonary tuberculosis (TB) persists as a great public health problem in Korea. Increases in the overall age of the population and the rise of drug-resistant TB have reinforced the need for rapid diagnostic improvements and new modalities to detect TB and drug-resistant TB, as well as to improve TB control. Standard guidelines and recent advances for diagnosing pulmonary TB are summarized in this article. An early and accurate diagnosis of pulmonary TB should be established using chest X-ray, sputum microscopy, culture in both liquid and solid media, and nucleic acid amplification. Chest computed tomography, histopathological examination of biopsy samples, and new molecular diagnostic tests can be used for earlier and improved diagnoses, especially in patients with smear-negative pulmonary TB or clinically-diagnosed TB and drug-resistant TB.

65세 이상 노인 환자에서 흉부외 수술 후 폐 합병증의 발생률 및 예측인자

류연주 ( Yon Ju Ryu ),박지영 ( Ji Young Park ),백수정 ( Su Jung Baik ),이진화 ( Jin Hwa Lee ),천은미 ( Eun Mee Cheon ),장중현 ( Jung Hyun Chang ) 대한내과학회 2004 대한내과학회지 Vol.67 No.1

배경: 최근 노인 환자의 수술 빈도가 증가함에 따라, 수술 후 폐 합병증이 수술 후 이환과 사망의 중요한 원인이 되고 있다. 방법: 전신 마취 하에 흉부외 수술을 받은 65세 이상의 환자 206명을 대상으로 수술 후 폐 합병증의 발생률과 예측인자를 후향적으로 조사하였다. 수술 후 폐 합병증은 수술 후에 새로 발생한 무기폐, 폐렴, 폐색전증, 급성호흡부전으로 정의하였다. 결과:수술 후 폐 합병증의 발생률이 13.6%(28/266)이었다. 수술 후 폐 합병 Background: As number of the older patients for general elective surgery is increasing, postoperative pulmonary complications in the elderly are common and are a significant source of morbidity and mortality. Methods: We retrospectively evaluated the inci

양성 기도협착질환에서 실리콘 기도스텐트의 임상경험 - Dumon 스텐트와 Natural 스텐트의 비교 -

류연주 ( Yon Ju Ryu ),유창민 ( Chang Min Yu ),최재철 ( Jae Chul Choi ),권용수 ( Yong Soo Kwon ),김호중 ( Ho Joong Kim ),김진국 ( Jhin Gook Kim ),서수원 ( Soo Won Suh ) 대한결핵 및 호흡기학회 2005 Tuberculosis and Respiratory Diseases Vol.59 No.1

만성폐쇄성폐질환 환자에서 우울과 불안심리 평가

류연주 ( Yon Ju Ryu ),천은미 ( Eun Mi Chun ),심윤수 ( Yun Su Sim ),이진화 ( Jin Hwa Lee ) 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.62 No.1

연구배경: 만성폐쇄성폐질환(chronic obstructive pulmonary disease, COPD) 환자군에서 우울증 및 불안장애의 유병률이 높고, 이는 치료경과 및 사망률에도 영향을 주는 것으로 알려져 있다. 저자들은 국내 연구가 미비한 COPD환자들의 우울과 불안심리에 대한 평가를 하고자 하였다. 방법: 2005년 9월부터 2006년 8월까지 이화의료원 호흡기내과에서 외래치료 중인 72명의 COPD환자와 정상 대조군 50명에서 Beck Depression Inventory (BDI)와 State-Trait Anxiety Inventory (STAI)로 설문조사를 시행하였고, 임상기록을 분석하였다. 결과: 1) 연령과 체질량지수, 혈청 알부민 수치는 환자군과 대조군간의 유의한 차이를 보이지 않았다(p>0.05). 우울심리는 BDI점수가 환자군 16(0-37), 대조군 12(1-30)으로 환자군에서 유의하게 높았고(p=0.001), 21점 이상의 우울집단은 환자군이 36%로 대조군 6%에 비해 많았다(p<0.0001). 환자군에서는 경증군 18%(4/22), 중등증군 30%(6/20), 중증군 52%(13/25), 심한 중증군 60%(3/5)로 중증일수록 빈도가 높았다(p=0.008). 2) 불안심리는 환자군에서 SAI점수 44(20-67), TAI점수 47(20-66)로 각각 대조군 39(26-65), 44(33-90)보다 유의하게 높았다(p=0.005, p=0.022). 환자군에서 BDI와 STAI점수는 상관관계를 보였고(p<0.001), 우울집단에서 불안점수가 유의하게 높았다. 3) COPD환자군에서 우울집단은 비우울집단보다 체질량지수, 기관지확장제후 FEV1의 예측치가 유의하게 낮았고, 현재 흡연자의 비율과 중증도, STAI점수가 유의하게 높았다(p<0.05). 4) 연령과 성별을 통제한 다변량 로지스틱 회귀분석상 95% 신뢰구간으로 비차비는 체질량지수 0.9(p=0.311), 현재 흡연자 3.2(p=0.051), 중증군이상 3.9로(p=0.027), 중증이상의 중증도가 유일한 우울증 발생의 독립적 위험요인이었다. 결론: COPD환자군에서 우울증과 불안심리가 흔하게 관찰되며, 체질량지수, 폐기능, 현재 흡연력이 우울관련 요인으로 특히 중증도가 높을수록 우울증과 불안장애의 관리가 필요함을 보여주었다. Background: Patients with chronic obstructive pulmonary disease (COPD) have often been reported to suffer from depression and anxiety possibly due to the exacerbation, hospitalization and mortality of COPD. However, scarce data are available in Korea. This study assessed degree of depression and anxiety, and evaluated the factors associated with depressive symptoms in COPD. Methods: The cross-sectional data on the lung function measurements, smoking behavior, body mass index (BMI), age, gender, depressive symptoms using Beck Depression Inventory (BDI) and anxiety using the State-Trait Anxiety Inventory (STAI) were evaluated in 72 outpatients with COPD and 50 controls without underling lung diseases from September, 2005 to October, 2006 in the Ewha medical center. Results: 1) The age, body mass index (BMI) and serum albumin levels were similar in the patients and controls. The BDI scores (16(0-37) vs. 12(1-30), p=0.001) and the prevalence of depression (36% vs. 6%, p<0.0001) were higher in the COPD patients than in the controls. In the COPD group, the prevalence of depression increased with increasing GOLD stage (p=0.008). The prevalence was 18%(4/22), in mild cases, 30%(6/20) in moderate cases, 52%(13/25) in severe cases and 60%(3/5) in very severe cases. 2) The SAI and TAI scores were higher in the COPD patients (44(20-67) and 47(20-66)) than in the healthy controls (39(26-65) and 44(33-90)). There were a significant correlation between the depression and anxiety scores (p<0.001). 3) A lower BMI, lower postbronchodilator FEV1, current smoking behavior and severity of COPD were univariately associated with the depressive group in COPD, 4) while multivariate logistic analysis revealed only the severe-to-very severe group (OR 3.9, 95% CI 1.2 to 12.9) to be independently associated with depressive symptoms. Conclusion: COPD is strongly associated with depression and anxiety. Therfore, screening for psychological problems in COPD patients is essential, particularly in patients with severe-to-very severe COPD. (Tuberc Respir Dis 2007; 62: 11-18)