[The Effect of Intravenous Gamma-globulin Reagents on the Measurement Results of (1➔3)-ß-D-glucan].

Serum (1→3) beta-D-glucan (BG) measurement is a useful test for systemic mycoses, and often used. On the other hand, various factors, including administration of intravenous immunoglobulins (IVIG) may cause false-positives. In the present study, we measured BG concentration of seven IVIG preparations with three lots respectively. BG levels varied with individual IVIG preparations (<3.0 - >300 pg/mL), and contamination from manufacturing processes was suspected. With serum BG concentration of clinical specimens obtained in Niigata University Medical & Dental Hospital, the difference between before and after administration of IVIG were calculated. The false-positive rate of BG due to IVIG administration was 9.8 %, and the positive predective value was reduced to 37.5%. Above all, administration of IVIG can complicate the BG test's interpretation, and caution is required.

Analysis of the influenza A (H1N1) 2009 pandemic infection in Japanese asthmatic patients: using a questionnaire-based survey.

BACKGROUND: Influenza infection is known to be an exacerbating factor in the control of asthma, therfore its prevention is critical in managing asthma. The aim of this study was to investigate the influenza A H1N1 2009 pandemic virus (H1N1 pdm09) infection in adult asthmatic patients. METHODS: Data were obtained from a questionnaire-based survey of asthmatic patients conducted from September to October 2010 in Niigata Prefecture. Patient background, H1N1 pdm09 infection, vaccination status, and asthma exacerbation due to influenza infection were analyzed. RESULTS: In total, 2,555 cases were analyzed. The incidence of the infection was 6.7% (95% confidence interval [CI]: 5.7-7.6), and the rate of vaccination was 63.9% (95% CI: 62.1-65.8). The odds ratio (OR) for vaccination against the infection among adult patients and younger patients (≤ the median age) were 0.61 (95% CI: 0.45-0.84) and 0.62 (95% CI: 0.42-0.90), respectively. However, OR among the older patient (> median age) were 1.38 (95%CI: 0.66-2.89). The rate of infection-induced asthma exacerbation was 23.2% (95% CI: 18.6-29.6), and the OR for vaccination against the infection-induced asthma exacerbation was 1.42 (95% CI: 0.69-2.92). CONCLUSIONS: The effectiveness of the vaccination against the H1N1 pdm09 virus was confirmed during the first pandemic season, but it was limited. Further investigation on H1N1 pdm09 virus infection in asthmatics will be required.

[Results of antifungal susceptibility testing of Candida species and trends of antifungal use in Niigata university medical and dental hospital].

The accuracy of antifungal susceptibility testing is important for the clinical management of patients with serious infections due to fungus. Our primary objective was to analyze the results of antifungal susceptibility testing of Candida species performed at Niigata University Medical and Dental Hospital and usage of antifungal agents. Antifungal susceptibility testing was performed by the CLSI M27-A2 method. Yeast-like fungi were isolated from 6% of 6,730 samples. All isolates were Candida species, i.e., C. albicans (50%), C. parapsilosis (28%), C. guilliermondii (9%), C. krusei (5%), C. glabrata (4%), and C. tropicalis (4%). The results of the minimum inhibitory concentration that inhibits 90% of the strain tested (MIC90) were 1 microg/mL for fluconazole, 0.5 microg/mL for miconazole, 0.06 microg/mL for itoraconazole, < or = 0.03 microg/mL for micafungin, respectively. The results of non-albicans species were 32 microg/mL for fluconazole, 8 microg/mL for miconazole, 0.5 microg/mL for itoraconazole, 1 microg/mL for micafungin, respectively. All Candida species were susceptible to the available antifungal agents, except C. krusei that was resistant to fluconazole. Thus, antifungal susceptibility varies greatly according to fungal species. The accuracy of identification of the fungus and antifungal susceptibility would contribute to the proper management of patients with serious fungal infections.

[Case of central neurosarcoidosis with panhypopituitalism].

A 63-year-old man was admitted because of dizziness, polydipsia, polyuria, and diminished libido. His brain MRI showed swelling of the pituitary gland. Because of panhypopituitarism suggested by hormonal examination, hydrocortisone, desmopressin and levothyroxine sodium were started as hormone replacement therapy. He was given a clinical diagnosis of central neurosarcoidosis with panhypopituitarism because of the presence of an abnormal lung shadow, positive gallium scintigram in bilateral hilar lymph nodes, negative tuberculin skin test, lymphocytosis and a high CD4/8 ratio in bronchoalveolar lavage fluid. After prednisolone therapy, his lung shadow and pituitary swelling reduced significantly. Anti-diuretic hormones and anterior pituitary hormones tended to increase, and his urine volume also decreased. This case suggested that endocrinological abnormalities in central neurosarcoidosis might be improved by prednisolone therapy even if the initiation of treatment is delayed.