Cellulitis caused by Roseomonas mucosa in a child: a case report.

BACKGROUND: Roseomonas mucosa (R. mucosa) is a pink-pigmented, Gram-negative short rod bacterium. It is isolated from moist environments and skin, resistant to multiple drugs, including broad-spectrum cephalosporins, and a rare cause of infection with limited reports. R. mucosa mostly causes catheter-related bloodstream infections, with even fewer reports of skin and soft tissue infections. CASE PRESENTATION: A 10-year-old boy received topical steroid treatment for sebum-deficient eczema. A few days before the visit, he was bitten by an insect on the front of his right lower leg and scratched it due to itching. The day before the visit, redness, swelling, and mild pain in the same area were observed. Based on his symptoms, he was diagnosed with cellulitis. He was treated with sulfamethoxazole/trimethoprim, and his symptoms improved. Pus culture revealed R. mucosa. CONCLUSIONS: We report a rare case of cellulitis caused by R. mucosa. Infections caused by rare organisms that cause opportunistic infections, such as R. mucosa, should be considered in patients with compromised skin barrier function and regular topical steroid use. Gram stain detection of organisms other than Gram-positive cocci should be considered.

Sepsis following acute pyelonephritis caused by Trueperella bernardiae: a case report and literature review.

BACKGROUND: Trueperella bernardiae is a coryneform, gram-positive bacterium that is a commensal of the skin and upper respiratory tract. It is treated as a contaminant and rarely causes infections. Blood, urine, and abscesses have been previously reported as the most common sites of infection. Infections caused by T. bernardiae are rarely reported in bedridden very old patients with reduced activities of daily living (ADL). In this report, we describe a case of sepsis due to acute pyelonephritis caused by T. bernardiae in a very old patient with impaired ADL. CASE PRESENTATION: A 94-year-old woman had a home visit from her local physician. She was bedridden and used diapers. On the day of admission, she presented with fever and dyspnea and was admitted with a diagnosis of sepsis associated with acute pyelonephritis. T. bernardiae was detected in blood and urine cultures; furthermore, multiple bacteria were detected in a urine culture. She was treated with ampicillin/sulbactam 3 g every 12 h on the day of admission. The fever was controlled, and inhaled oxygen 1 L/min via a nasal cannula was administered for dyspnea until hospitalization day 2. On hospitalization day 2, her fever resolved to 36 °C. Antimicrobials were de-escalated and changed to cephazolin and then to cephalexin on hospitalization days 9 and 16, respectively, and were continued until day 22. On hospitalization day 28, the urinary tract infection flared up; however, her fever resolved by hospitalization day 38 after the re-administration of antimicrobial agents. She was discharged on hospitalization day 60. CONCLUSIONS: We encountered a rare case of sepsis following acute pyelonephritis caused by T. bernardiae infection. When bedridden, diaper-using, very old patients present with urinary tract infections caused by multiple bacteria, the presence of rare opportunistic organisms, such as T. bernardiae, should be considered.

Minor Electrocardiographic ST-T Change and Risk of Stroke in the General Japanese Population.

BACKGROUND: Minor ST-T changes are frequently observed on the electrocardiogram (ECG), but the risk of stroke associated with such changes is unclear.Methods and Results:In 10,642 subjects from the Japanese general population, we evaluated minor and major ST-T changes (major ST depression ≥0.1 mV) on ECGs obtained at annual health examinations. At baseline, minor ST-T changes were found in 10.7% of the subjects and 0.5% had major ST-T changes. Minor ST-T changes were associated with older age, female gender, higher systolic blood pressure, presence of hyperlipidemia, and use of antihypertensive medication. There were 375 stroke events during the follow-up period (128.7±28.1 months). In all subjects, minor ST-T changes (HR, 2.10; 95% CI: 1.57-2.81) and major ST-T changes (HR, 8.64; 95% CI: 4.44-16.82) were associated with an increased risk of stroke, but the stroke risk associated with minor ST-T changes had borderline significance after adjustment for conventional risk factors (P=0.055). In subgroup analysis, the risk of stroke was significantly associated with minor ST-T changes in subjects who had hyperlipidemia (HR, 1.75; 95% CI: 1.15-2.67) compared to those without hyperlipidemia (HR, 1.01; 95% CI: 0.64-1.59; P for interaction=0.016), even after adjustment for ECG-diagnosed left ventricular hypertrophy. CONCLUSIONS: Minor ST-T changes were particularly associated with a higher risk of stroke in subjects with hyperlipidemia and this association was independent of electrocardiographic left ventricular hypertrophy.

An In Vitro Assay for Sonothrombolysis Based on the Spectrophotometric Measurement of Clot Thickness.

OBJECTIVES: For improved thrombolysis therapy based on ultrasound irradiation, researchers and practitioners would strongly benefit from an easy and efficient in vitro assay system of thrombolysis activity involving irradiated ultrasound. For the present study, we designed a new in vitro sonothrombolysis assay system using a sheet-type clot. METHODS: We designed a cell for clot assay, and we confirmed that this clot cell did not significantly intervene in the acoustic field. Using human plasma, we made a sheet-type clot in the cell. Clot thicknesses at 100 points along 4 directions were measured photometrically at a rate of approximately 4 points/s. RESULTS: The sonothrombolysis effects at 13 levels of ultrasonic intensity were obtained with only one sheet-type clot. With this method, we used a clinically oriented probe at 0.7 and 0.3 W/cm2 to confirm that sonothrombolysis took place. CONCLUSIONS: We successfully established a new, easy, and efficient method for conducting in vitro sonothrombolysis assays. This method involves little intervention of either ultrasound reflection or standing waves in the clot cell. We believe that this new assay method is very useful for fundamental analyses of ultrasound's thrombolysis effects.

Brown crusts on infant owing to contact dermatitis associated with ethanol disinfection.

A 2-year-old girl developed dermatitis with atypical brown crusts after ethanol disinfection. Since many Oriental people have genetically reduced acetaldehyde dehydrogenase type 2 (ALDH2) activity, ethanol disinfection causes acetaldehyde to accumulate in the skin, resulting in dermatitis.

Recurrence of unilateral angioedema of the tongue: A case report.

BACKGROUND: Angioedema is a disorder characterized by edema of the face, lips, tongue, and extremities due to increased vascular permeability. Angioedema of the tongue usually occurs bilaterally, and the incidence of unilateral angioedema of the tongue is rare. This study reports a rare case of unilateral angioedema of the tongue with no identifiable cause and repeated recurrence even after discontinuation of an angiotensin-converting enzyme inhibitor. CASE SUMMARY: The patient was a 65-year-old woman with pre-existing hypertension and hyperlipidemia and had been receiving 20 mg/d of lisinopril. She was diagnosed with angioedema due to unilateral swelling of the tongue. No airway obstruction was observed, and the symptoms improved following the administration of 0.3 mg of epinephrine intramuscularly and 125 mg of methylprednisolone intravenously. Although lisinopril was discontinued, unilateral angioedema of the tongue continued to recur every 2-5 mo, with the symptoms improving following the administration of prednisolone and an antihistamine. Daily oral administration of 500 mg of tranexamic acid after dinner prevented the recurrence of angioedema. CONCLUSION: Careful monitoring and identification of the underlying mechanism play a crucial role in the treatment of angioedema.

Prevalence and genotype/subtype distribution of hepatitis E virus (HEV) among wild boars in Japan: Identification of a genotype 5 HEV strain.

To further investigate the prevalence of hepatitis E virus (HEV) infection and characterize HEV genomes among Japanese wild boars (Sus scrofa leucomystax), 1880 boars captured in 17 prefectures in Japan from 2013 to 2019 were studied. Overall, anti-HEV IgG was detected in 8.9 % and HEV RNA was detected in 3.9 % of boars, which was comparable with our previous studies during 2003-2013 (10.3 % and 3.5 %, respectively). Among 74 boar HEV strains obtained from infected boars in the present study, 50 (68 %) were classified into genotype 3 (3a and 3b), 23 (31 %) were classified into genotype 4 (4i), and the remaining strain (wbJGF_19-1) was classified into genotype 5. The wbGF_19-1 strain shared 92.7 % identity over the entire genome with the prototype genotype 5 strain (JBOAR135-Shiz09). The identification of the second genotype 5 HEV strain in a place that is located only 100 km from the site at which JBOAR135-Shiz09 was identified, suggests that genotype 5 HEV circulates within a relatively close range in Japan. Genetically similar HEV strains forming a clade were identified from wild boars living in each area during the observation period of 11-13 years, although the nucleotide sequence changed gradually, accounting for up to 3.4-3.6 % within the 412-nucleotide ORF2 sequence. Eight groups of boars with a cluster of HEV infections were observed, consisting of two, three or four infected offspring, presumably born to the same mother or offspring with their mother. These results suggest that wild boars continue to be important reservoirs for HEV infection in humans in Japan.

Tissue Inhibitor of Matrix Metalloproteinase 1 Increases With Ageing and Can Be Associated With Stroke　- Nested Case-Control Study.

Background: Increase of collagen in the extracellular matrix occurs with ageing. We investigated whether a collagen marker, tissue inhibitor of matrix metalloproteinase 1 (TIMP-1), was associated with risk of stroke. Methods and Results: In a nested case-control study of 953 subjects from the general population, we evaluated determinants of TIMP-1 level and stroke risk. Mean subject age was 65.7±8.6 years (53.0% men); TIMP-1 was 72.4±28.2 pg/mL in the control group and 75.3±30.9 pg/mL in the stroke group. The relationship between TIMP-1 quartile and stroke was J-curved. Subjects in the highest TIMP-1 quartile (≥89 ng/mL) had a significantly higher OR of stroke (59-72 ng/mL; OR, 1.90; 95% CI: 1.09-3.31, P=0.023) than those in the second TIMP-1 quartile, and this tended toward significance even after adjusting for confounding factors (P=0.059). Elevation of serum TIMP-1 became more marked after age 65 years. On multiple linear regression analysis, significant determinants of TIMP-1 were older age (B=0.21 per 1 year; 95% CI: 0.52-1.07, P<0.001) and higher systolic blood pressure (SBP; B=0.19 per 1 mmHg, 95% CI: 0.08-0.42, P=0.004). Conclusions: TIMP-1 increased with ageing and with SBP, and can be associated with stroke.

The mixed trunsored model with applications to SARS.

The trunsored model, which is a new incomplete data model regarded as a unified model of the censored and truncated models in lifetime analysis, can not only estimate the ratio of the fragile population to the mixed fragile and durable populations or the cured and fatal mixed populations, but also test a hypothesis that the ratio is equal to a prescribed value with ease. Since SARS showed a severe case fatality ratio, our concern is to know such a case fatality ratio as soon as possible after a similar outbreak begins. The epidemiological determinants of spread of SARS can be dealt with as the probabilistic growth curve models, and the parameter estimation procedure for the probabilistic growth curve models may similarly be treated as the lifetime analysis. Thus, we try to do the parameter estimation to the SARS cases for the infected cases, fatal cases, and cured cases here, as we usually do it in the lifetime analysis. Using the truncated data models to the infected and fatal cases with some censoring time, we may estimate the total (or final) numbers of the patients and deaths, and the case fatality ratio may be estimated by these two numbers. We may also estimate the case fatality ratio using the numbers of the patients and recoveries, but this estimate differs from that using the numbers of the patients and deaths, especially when the censoring time is located at early stages. To circumvent this inconsistency, we propose a mixed trunsored model, an extension of the trunsored model, which can use the data of the patients, deaths, and recoveries simultaneously. The estimate of the case fatality ratio and its confidence interval are easily obtained in a numerical sense. This paper mainly treats the case in Hong Kong. The estimated epidemiological determinants of spread of SARS, fitted to the infected, fatal, and cured cases in Hong Kong, could be the logistic distribution function among the logistic, log-normal, gamma, and Weibull models. Using the proposed method, it would be appropriate that the SARS case fatality ratio is roughly estimated to be 17% in Hong Kong. Worldwide, it is roughly estimated to be about 12-18%, if we consider the safety side without the Chinese case. Unlike the questionably small confidence intervals for the case fatality ratio using the truncated models, the case fatality ratio in the proposed model provides a reasonable confidence interval.

Diagnostic accuracy of cardiac markers for myocardial damage after radiofrequency catheter ablation.

AIMS: This study compares serum markers of myocardial damage incurred during radiofrequency catheter ablation (RFCA). METHODS AND RESULTS: Blood was sampled from 34 patients with atrial flutter (n = 16), atrioventricular nodal reentrant tachycardia (AVNRT; n = 13), and Wolff-Parkinson-White syndrome (WPW; n = 5) to measure creatine kinase MB subfraction (CK-MB), human heart-type fatty acid protein (h-FABP), and cardiac troponin T (cTnT) values at baseline and after RFCA. The controls comprised 12 patients without significant elevation of all myocardial markers during electrophysiological study (EPS) without RFCA. h-FABP values did not elevate significantly, whereas CK-MB and cTnT demonstrated significant change after RFCA (P < 0.001). Neither peak h-FABP nor CK-MB correlated with following RFCA parameters: delivery duration, number of RFCA discharges, and cumulative RFCA energy. In contrast, correlations were significant between mean peak values of cTnT and these RFCA parameters (all P < 0.05). The sensitivity (71.6%) and specificity (35.6%) of h-FABP were inferior to those of cTnT (93.3% and 89.8%, respectively). CONCLUSION: h-FABP is an insensitive and less specific marker of myocardial damage in RFCA much along the lines of CK-MB and when compared with the proven accuracy of cTnT.

Cardiac mortality of premature ventricular complexes in healthy people in Japan.

BACKGROUND AND PURPOSE: Premature ventricular complexes (PVCs) are frequently encountered in healthy people. But the association between PVCs and cardiac events is not well established in Japan. We investigated the association of PVCs and cardiac deaths in people without cardiovascular disease in the Jichi Medical School (JMS) Cohort study. METHODS AND SUBJECTS: We conducted a prospective cohort study in 12 districts in Japan as part of the JMS cohort study. Baseline data were obtained between April 1992 and July 1995. We excluded subjects who had myocardial infarction and stroke and those who had not received 12-lead electrocardiograms. Cox's proportional hazard model was used to calculate the hazard ratios (HRs) of cardiovascular mortality of subjects with PVCs, using subjects without PVCs as reference. RESULTS: A total of 11,158 participants (4333 males and 6825 females) were analyzed. Participants were followed for an average of 11.9 years. PVCs were present in 1.4% of men and 1.1% of women. There were 92 cardiac deaths (47 males and 45 females) during the follow-up period. In crude cardiovascular mortality, HRs (95% confidence interval [CI]) were 5.29 (1.64-17.0) in males and 2.14 (0.29-15.5) in females. Age-adjusted HRs were 3.73 (1.16-12.0) and 0.98 (0.13-7.21), respectively. After further adjustment for body mass index, systolic blood pressure, total cholesterol level, high-density lipoprotein-cholesterol, and blood glucose, HRs were 3.98 (1.21-13.0) and 0.95 (0.13-7.11), respectively. CONCLUSIONS: We conclude that PVCs are a predictive factor for cardiac death in men without structural heart disease.