Auto-brewery syndrome caused by oral fungi and periodontal disease bacteria.

BACKGROUND: Auto-brewery syndrome (ABS) is often caused by fungi in the intestinal tract. We describe a rare case of alcohol production by Candida albicans and periodontal disease bacteria in the oral cavity. CASE PRESENTATION: A man aged in his 60s had a car accident, and alcohol was detected on his breath. At the time, he exhibited alcohol overdose seizures with no alcohol consumption. We carried out a gastrointestinal endoscopy, detected esophageal candidiasis, and diagnosed ABS. His seizures continued despite using miconazole oral gel. Significant tooth decay, periodontal disease, and high C. albicans levels were observed in his oral cavity. Alcohol production was confirmed from periodontal bacteria and C. albicans cultures and alcohol-degrading enzyme functions were poor. Dental treatment and antifungal drugs reduced seizures, and improved his fatty liver. CONCLUSION: Alcohol can be produced by microorganisms in healthy individuals. Therefore, blood alcohol levels and alcohol-degrading enzyme functions should be examined in patients with unexplained liver dysfunction.

Use of Direct Hemoperfusion with Polymyxin B-Immobilized Fiber for the Treatment of Septic Shock Complicated with Lemierre Syndrome Caused by Fusobacterium necrophorum.

We report a case of septic shock treated with PMX-DHP that was complicated with Lemierre syndrome caused by Fusobacterium necrophorum. The patient was a 31-year-old man who was initially diagnosed with influenza. He received treatment; however, because his symptoms gradually worsened, he was transported to our hospital 10 days following his diagnosis. His initial examination revealed symptoms of respiratory distress and an altered level of consciousness. Based on laboratory and imaging results, it became clear that he suffered from septic shock of unknown etiology, disseminated intravascular coagulation, and acute renal and respiratory failure. We initiated treatment with vasopressors, an antibacterial agent, immunoglobulins as well as an appropriate ventilator management; however, his unstable circulatory condition continued. As soon as PMX-DHP was initiated, 2 days following admission to the ICU, his circulatory instability normalized. F. necrophorum was ultimately detected after a culture examination, and contrast-enhanced computed tomography revealed a jugular vein thrombus, which led to the diagnosis of Lemierre syndrome. The patient's condition gradually improved, and he was discharged from the ICU after 19 days.

Empiric Antibiotic Therapy for Severe Sepsis and Septic Shock.

BACKGROUND: A retrospective study was conducted to investigate the validity and the effectiveness of early empiric antibiotic and de-escalation therapy for the treatment of severe sepsis and septic shock patients in the intensive care unit (ICU). METHODS: Patients admitted to the ICU at Chiba University Hospital from January 1, 2010, to December 31, 2012, for the treatment of severe sepsis or septic shock were selected for analysis. RESULTS: One-hundred and ten patients were enrolled for the analysis. Carbapenems were selected most frequently (57.3%), followed by cephalosporins (22.7%), and penicillins (21.8%). Empiric antibiotic therapy was appropriate for 85 (77.3%) patients. Mortality rates for patients with inappropriate empiric therapy was 36.8%, whereas mortality rates for patients with appropriate empiric therapy was 17.5%. Among the patients with appropriate empiric antibiotic administration, de-escalation was associated with lower mortality rates of 5.0% for severe sepsis and 9.7% for septic shock patients. The mortality rates for the no de-escalation group were 19.0% and 35.7%, respectively. CONCLUSION: Empiric antibiotic therapy was acceptable for severe sepsis and septic shock patients treated in the ICU. The appropriate selection of empiric antibiotics was related to a greater rate of de-escalation and better survival. The risk of multi-drug-resistant bacterial infections was not as high as expected, but will need further attention in the future.

Experimental Research on Stimulation of Wound Healing by n-3 Fatty Acids.

UNLABELLED: Objexctive. The objective of this study was to investigate the wound healing effects of n-3 fatty acids and to identify factors that stimulate wound healing. MATERIALS AND METHODS: Four-week-old male Wistar rats were subjected to full-thickness skin wounds and assigned to 3 experimental diet groups (an n-3 fatty acid-fortified diet, a diet with a 1:3 ratio of n-3 to n-6 fatty acids, and an n-6 fatty acid-fortified diet). Intergroup comparisons were conducted for the changes in wound areas, the number of days to wound healing, and blood cytokines, blood hydroxyproline, and blood chemistry test values on the day before and after wound healing. RESULTS: The number of days to wound healing in the n-3/n-6 fatty acid group (18.4 ± 1.8 days) was significantly shorter than in the n-3 fatty acid-fortified diet (21.6 ± 1.6 days) and n-6 fatty acid-fortified diet groups (21.9 ± 1.8 days). This suggests that the n-3/n-6 fatty acid diet stimulates wound healing (P < 0.05). Changes in wound area, however, were not significantly different. The n-3 fatty acid-fortified diet was found to have potent immunopotentiating and anti-inflammatory effects in the group receiving this diet, as evidenced by total blood lymphocyte count and plasma levels of interleukin-1 beta (IL-1ß) and sialic acid on day 1 after wounding. The plasma hydroxyproline concentrations noted in the groups with a diet containing n-3 fatty acids indicate that this fatty acid type stimulates wound healing. CONCLUSIONS: Findings suggest that n-3 fatty acids have anti-inflammatory and immunopotentiating effects, and are beneficial in the wound healing process, particularly during early inflammation. .