Language：English   Publisher：Medical Mycology  

Breakthrough candidemia (BrC) is a significant problem in immunocompromised patients, particularly those with hematological disorders. To assess the characteristics of BrC in patients with hematologic disease treated with novel antifungal agents, we collected clinical and microbiological information on said patients from 2009 to 2020 in our institution. Forty cases were identified, of which 29 (72.5%) received hematopoietic stem cell transplant (HSCT)-related therapy. At BrC onset, the most administered class of antifungal agents were echinocandins, administered to 70% of patients. Candida guilliermondii complex was the most frequently isolated species (32.5%), followed by C. parapsilosis (30%). These two isolates were echinocandin-susceptible in vitro but had naturally occurring FKS gene polymorphisms that reduced echinocandin susceptibility. Frequent isolation of these echinocandin-reduced-susceptible strains in BrC may be associated with the widespread use of echinocandins. In this study, the 30-day crude mortality rate in the group receiving HSCT-related therapy was significantly higher than in the group not receiving it (55.2% versus 18.2%, P =. 0297). Most patients affected by C. guilliermondii complex BrC (92.3%) received HSCT-related therapy and had a 30-day mortality rate of 53.8%; despite treatment administration, 3 of 13 patients had persistent candidemia. Based on our results, C. guilliermondii complex BrC is a potentially fatal condition in patients receiving HSCT-related therapy with echinocandin administration.

DOI： 10.1093/mmy/myad056

Web of Science

Scopus

PubMed

Language：English   Publisher：Modern Rheumatology Case Reports  

A 53-year-old man with adult-onset Still’s disease developed severe streptococcal toxic shock syndrome (STSS) due to Streptococcus dysgalactiae subsp. equisimilis (SDSE), following retroperitoneal panniculitis. He was receiving tocilizumab (TCZ), an interleukin-6 receptor inhibitor. The modifying effect of TCZ on the immune response and the pathophysiology of SDSE infection may have led to retroperitoneal panniculitis and atypical STSS with delayed shock and flare of soft tissue inflammation.

DOI： 10.1093/mrcr/rxae001

Web of Science

Scopus

PubMed

Language：Japanese   Publisher：日本臨床寄生虫学会  

寄生虫による脳炎が疑われる検体からのDNA抽出およびPCR用プライマーについて解説を行った。これらの手法を用いることで、寄生虫による脳炎をより効率的に検出できる可能性が示唆された。

Language：English   Publisher：International Medical Case Reports Journal  

Platypnea-orthodeoxia syndrome (POS) is a rare disorder associated with coronavirus disease 2019 (COVID-19) pneu-monia. However, POS may be underdiagnosed. We report the case of a 59-year-old female patient with POS complicated by pulmonary embolism in COVID-19. Imaging revealed ground-glass opacities predominantly in the lower lobes and a pulmonary embolus in the right upper lobe. She was diagnosed with POS due to marked postural discrepancies between supine and upright oxygen saturations and blood oxygenation. Intracardiac shunt, one of the etiologies of POS, was not detected by bubble contrast echocardiography, and postural de-saturation gradually improved with methylprednisolone and edoxaban administration. In our literature review, only 3 of the 16 patients with POS associated with COVID-19 had cardiac shunting, suggesting that moderate to severe COVID-19 causes POS without cardiac shunts. COVID-19-associated vasculopathy and lower lung lesion predominance in COVID-19 pneumonia may cause ventilation-perfusion mismatch due to gravitational shunting of blood into the poorly ventilated lower lungs in the upright position, which may ultimately cause POS. Hypoxemia impedes rehabilitation, whereas early initiation of supine positioning in bed, with knowledge of the pathophysiology of POS, may have a positive effect.

DOI： 10.2147/IMCRJ.S402537

Web of Science

Scopus

PubMed

Language：English   Publisher：Auris Nasus Larynx  

Rapidly growing mycobacteria rarely causes parotitis. We report a rare case of Mycobacteroides abscessus subspecies abscessus (MAB) parotitis in a previously healthy 26-year-old woman. She presented to the previous hospital with a swelling over the right parotid region, and a computed tomography scan revealed multiple abscesses in the swollen parotid gland. Histopathology showed granulomatous inflammation with acid-fast bacilli; however, a subsequent culture failed to isolate mycobacterium. Despite repeated antibiotic therapy and multiple surgical interventions including partial incision and drainage of the abscesses, the parotitis did not resolved. At six months after presentation, she was referred to our institute. We performed enlarged resection of the necrotic tissue and abscesses, and the sample cultivated after homogenization was positive for mycobacterium. The isolate was finally identified as MAB. She underwent long-term postoperative antibiotic therapy for MAB, with a favorable outcome. To the best of our knowledge, this is the first case of MAB parotitis where the subspecies has been identified. MAB is much more intractable than the other subspecies. We highlight the importance of the correct identification of MAB, which leads to the appropriate treatment.

DOI： 10.1016/j.anl.2020.11.005

Scopus

PubMed

Event date： 2014.6

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：福岡   Country：Japan  

Event date： 2006.9 - 2011.9

Venue：San Francisco   Country：United States  

Event date： 2012.2

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：福岡   Country：Japan  

背景と目的:以前当院で使用していたトキシン検出キットは、Toxin Aのみの検出だったため、Toxin A-B+株を見逃し、診断できなかった可能性がある。そこで、Toxin A-B+株の分離状況を調べ、その疫学的解析も行った。
方法：2008年10月から2009年8月の間に当院で便から分離保存していたC. difficile (CD) 53株を用い、PCR法によるToxin遺伝子検索とリボタイピングによる分子疫学的解析を行った。Toxin A-B+株分離患者に対してはCD関連下痢症（CDAD）の臨床的診断と疫学調査を行った。
結果: Toxin A-B+株は53株中10株6症例で、そのうち5症例は臨床的にはCDADであるものの、実際にはCDADと診断されず未治療であった。また、A-B+10株（6症例）中9株（5症例）でリボタイピングの泳動パターンが一致し、同一株と推測された。院内伝播が疑われたが、5症例において診療科や病室は一致しなかった。6例中4例が大腸内視鏡検査を受けていたが同一時期ではなく、関連性は不明であった。
考察: CDトキシン陰性という結果のみでCDADと診断されず、接触予防策が行われずCDが院内伝播している可能性が示唆された。また、下痢患者では、原因検索のため大腸内視鏡を施行することが多く、キットによりCDトキシン偽陰性の症例では特に注意が必要である。現在は、トキシンAとBを両方測定可能になったことで、診断上に有用性があり、さらに医療関連感染対策にも有意義と考える。