Two cases of pyelonephritis with bacteremia by Staphylococcus epidermidis in male patients with nephrolithiasis: Case reports and a literature review.

BACKGROUND: Staphylococcus epidermidis is a common cause of health care-associated bacteremia, especially in patients with an indwelling medical device. However, S. epidermidis is an uncommon causative organism in catheter-associated urinary tract infection, and rare pyelonephritis without any indwelling urinary device. To our knowledge, there are few cases reported of bacteremia secondary to urinary tract infection. We report two cases of pyelonephritis with bacteremia by S. epidermidis in male patients with unilateral nephrolithiasis and review prior case reports. CASE PRESENTATION: Case 1: 74-year-old man with a history of diabetes and overactive bladder had fever and pyuria with a right nephrolithiasis on abdominal CT scan. Case 2: 79-year-old man with a history of diabetes and post-myocardial infarction status had fever with a left nephrolithiasis on abdominal CT scan. In both cases, both the urine culture collected at ureteral stenting and blood culture were positive for S. epidermidis. We initiated intravenous antibiotics in these patients in addition to ureteral stenting. CONCLUSIONS: S. epidermidis is acknowledged as an uncommon pathogen that can cause bacteremia secondary to pyelonephritis without an indwelling urinary device. Clinicians should consider the possibility of pyelonephritis due to S. epidermidis if the pathogen is identified in blood and urine in patients with nephrolithiasis.

Cervical abscess caused by Mycobacterium tilburgii in a patient carrying anti-interferon gamma autoantibody: A case report and literature review.

Mycobacterium tilburgii, a nonculturable mycobacterium, is an important nontuberculous mycobacterium that occasionally causes serious infections in patients with cellular immune deficiencies. Due to its nonculturable nature, information about its drug susceptibility is not available, and data about its clinical response to antimycobacterial treatment remains insufficient. Here, we report a case of a patient who presented with neck swelling and was finally diagnosed with cervical abscess caused by M. tilburgii carrying anti-interferon gamma autoantibodies using a molecular method. The relevant literature was reviewed in the context of epidemiological and clinical data on M. tilburgii infections. In this report, 15 patients were reported to be infected with M. tilburgii. Almost all patients had a cellular immune deficiency and presented with disseminated infections. Multiple refractory or relapse cases that often required prolonged antimycobacterial treatment have been reported, although a few fatal cases have also been reported. In conclusion, M. tilburgii is an important pathogen in patients with cellular immune deficiency. Physicians should thoroughly investigate cellular immune deficiency, including adult-onset immune deficiency with anti-interferon gamma autoantibodies, in patients with M. tilburgii infection.

[Fecal microbiota transplantation for refractory Clostridioides difficile infection with Crohn's disease in an allogeneic bone marrow transplant recipient].

We report a case of a 15-year-old girl who developed refractory Clostridioides difficile infection (CDI) after allogeneic bone marrow transplantation (BMT). She was treated successfully with fecal microbiota transplantation (FMT). The patient who had aplastic anemia underwent allogeneic BMT from an HLA 1-locus-mismatched unrelated donor. Four months later, she developed gastrointestinal graft-versus-host disease (GVHD), and immunosuppressive treatment improved the GVHD. However, she developed CDI 5 months after BMT and experienced recurrence after that. Fifteen months after transplant, CDI relapsed despite discontinuation of immunosuppressive treatment; thus, she underwent FMT. Colonoscopy at the time of FMT revealed round aphthae, mainly in the ileocecum, and colonic biopsy revealed inflammatory cell infiltration and noncaseating epithelioid granuloma, which fulfilled the diagnostic criteria for Crohn's disease. Following FMT for CDI, she was treated with enteric budesonide and intravenous methotrexate for Crohn's disease. These interventions resulted in a marked improvement in both CDI and Crohn's disease. Twenty-eight months after FMT, both CDI and Crohn's disease remained in remission with oral mesalamine monotherapy.

Epidemiological trends of imported infectious diseases in Japan: Analysis of imported 2-year infectious disease registry data.

INTRODUCTION: The epidemiology of infectious diseases in Japan remains undefined despite the increasing tourism. GeoSentinel, an epidemiological surveillance system for reporting imported infectious diseases, has only two participating facilities in Japan. Although the number of infectious diseases is reported by the National Institute of Infectious Diseases, there is no detailed clinical information about these cases. Therefore, we established J-RIDA (Japan Registry for Infectious Diseases from Abroad) to clarify the status of imported infectious diseases in Japan and provide detailed information. METHODS: J-RIDA was started as a registry of imported infectious diseases. Case registration began in October 2017. Between October 2017 and September 2019, 15 medical institutions participated in this clinical study. The registry collected information about the patient's age, sex, nationality, chief complaint, consultation date, date of onset, whether visit was made to a travel clinic before travel, blood test results (if samples were collected), travel history, and final diagnosis. RESULTS: Of the 3046 cases included in this study, 46.7% to Southeast Asia, 13.0% to Africa, 13.7% to East Asia, 11.5% to South Asia, 7.5% to Europe, 3.8% to Central and South America, 4.6% to North America, 3.9% to Oceania, and 2.8% to Central and west Asia. More than 85% of chief complaints were fever and general symptoms, gastrointestinal symptoms, respiratory symptoms, or dermatologic problems. The most common diseases were travelers' diarrhea, animal bite, upper respiratory infection, influenza, and dengue fever. CONCLUSIONS: We summarized two-year cases registered in Japan's imported infectious disease registry. These results will significantly contribute to the epidemiology in Japan.

Imported and locally transmitted mild SARS-CoV-2 pneumonia cases in Japan.

Here, we describe two mild SARS-CoV-2 pneumonia cases. One was imported from Wuhan, and the other was locally transmitted in Japan without recent travel to China. In both cases, lower respiratory tract symptoms were observed first, and high fever progressed in about one week. The laboratory findings revealed normal WBC and CRP despite apparent lung infiltrations, and typical observations on CT imaging were important diagnostic clues. In the domestic endemic situation, a comprehensive evaluation of the clinical course, and laboratory and radiological findings was required for diagnosis.

Bejel, a Nonvenereal Treponematosis, among Men Who Have Sex with Men, Japan.

Bejel, an endemic treponematosis caused by infection with Treponema pallidum subspecies endemicum, has not been reported in eastern Asia and the Pacific region. We report local spread of bejel among men who have sex with men in Japan. Spread was complicated by venereal syphilis.

[Evaluation of a Newly Developed Campylobacter Antigen Detection Kit for Patients with Enteritis].

The newly developed rapid diagnostic test (RDT, DK14-CA1, Denka Seiken Co., Ltd.) to detect Campylobacter antigen was evaluated using fecal specimens of patients with enteritis. The RDT is an immunochromatographic assay using colored latex and can detect Campylobacter antigen (C. jejuni and C. coli) from patients' stool samples within 15 minutes. A total of 227 stool samples obtained from patients with enteritis were examined and the results were compared with conventional culture methods. Overall sensitivity, specificity, accuracy and positive predictive value (PPV) were 75.6%, 98.6%, 89.9% and 97.0% respectively. Among 53 severe cases defined with their clinical findings, sensitivity, specificity, accuracy and PPV were 82.1%, 100%, 90.6% and 100% respectively. Mean time to obtain the result with the RDT was 7 minutes whereas the culture method took 2.2 days. This study revealed the usefulness of the newly developed RDT as a rapid detection tool for Campylobacter antigen. Although the RDT has a little lower sensitivity compared with culture method, the simple and rapid test can contribute to treatment decisions for patients with enteritis and can be used at the patient's bedside and in outpatient clinics.

Multicenter retrospective study of cefmetazole and flomoxef for treatment of extended-spectrum-ß-lactamase-producing Escherichia coli bacteremia.

The efficacy of cefmetazole and flomoxef (CF) for the treatment of patients with extended-spectrum ß-lactamase-producing Escherichia coli (ESBL-EC) bacteremia (ESBL-CF group) was compared with that of carbapenem treatment for ESBL-EC patients (ESBL-carbapenem group) and with that of CF treatment in patients with non-ESBL-EC bacteremia (non-ESBL-CF group). Adult patients treated for E. coli bacteremia in four hospitals were retrospectively evaluated. The 30-day mortality rates in patients belonging to the ESBL-CF, ESBL-carbapenem, and non-ESBL-CF groups were compared as 2 (empirical and definitive therapy) cohorts. The adjusted hazard ratios (aHRs) for mortality were calculated using Cox regression models with weighting according to the inverse probability of propensity scores for receiving CF or carbapenem treatment. The empirical-therapy cohort included 104 patients (ESBL-CF, 26; ESBL-carbapenem, 45; non-ESBL-CF, 33), and the definitive-therapy cohort included 133 patients (ESBL-CF, 59; ESBL-carbapenem, 54; non-ESBL-CF, 20). The crude 30-day mortality rates for patients in the ESBL-CF, ESBL-carbapenem, and non-ESBL-CF groups were, respectively, 7.7%, 8.9%, and 3.0% in the empirical-therapy cohort and 5.1%, 9.3%, and 5.0% in the definitve-therapy cohort. In patients without hematological malignancy and neutropenia, CF treatment for ESBL-EC patients was not associated with mortality compared with carbapenem treatment (empirical-therapy cohort: aHR, 0.87; 95% confidence interval [CI], 0.11 to 6.52; definitive therapy cohort: aHR, 1.04; CI, 0.24 to 4.49). CF therapy may represent an effective alternative to carbapenem treatment for patients with ESBL-EC bacteremia for empirical and definitive therapy in adult patients who do not have hematological malignancy and neutropenia.

[The first case report of Ross River virus disease in a Japanese patient who returned from Australia].

A 31-year-old Japanese female had stayed in Australia from January to May 2013. She presented with a sudden onset of left ankle and right knee arthralgia in March but neither fever nor rash was present. As her arthralgia persisted, she visited our hospital upon her return to Japan in May. When she came to our hospital, she complained of left ankle and right knee pain, but no arthritis findings. Laboratory findings were also within normal ranges. Ross River virus (RRV) antibody levels were examined as she was suspected of having contracted the disease in Australia. RRV IgG antibody and IgM antibody were positive, and the patient was confirmed as a case of acute RRV disease. RRV disease is endemic in Australia, but there are no prior reports of the disease in Japan. This is the first case of RRV disease confirmed in Japan. Typical symptoms of RRV disease include arthralgia, fever, and rash. Our patient had only arthralgia. With the increase in the number of travelers and length of stay in RRV endemic regions, health care providers need to consider the disease in their differential diagnosis, among returning travelers with arthralgia, fever, rash and a travel history to RRV-endemic regions.

A case of amebic colitis and liver abscesses that occurred after treatment of coronavirus disease 2019 with dexamethasone.

Entamoeba histolytica infections, which can be asymptomatic, are endemic to developing countries; traveling to such countries is a risk factor for contracting these infections. A 65-year-old Japanese man was hospitalized for coronavirus disease 2019 (COVID-19)-associated respiratory distress, and was treated with remdesivir, dexamethasone, and oxygen supplementation. Although his respiratory condition improved and the oxygen support was discontinued, he developed a fever, severe abdominal pain, and diarrhea on day 13 of hospitalization. Fifteen years ago, he was hospitalized for diarrhea of an unknown origin in Suzhou, China, and had a history of passing loose stools for 1 year. Contrast-enhanced abdominal and pelvic computed tomography revealed liver abscesses in both lobes and intestinal edema from the ascending colon to the descending colon. The abscesses were suspected to be amebic based on the characteristics of the drained abscess fluid. The patient was treated with cefotaxime and metronidazole, and his temperature declined and abdominal pain improved. A culture analysis of abscess fluid yielded negative findings; however, polymerase chain reaction analyses of abscess and stool samples were positive for Entamoeba histolytica. We speculated that the patient was infected with Entamoeba histolytica while in China, and that the corticosteroid usage for COVID-19 had exacerbated the infection. Clinicians should be aware that corticosteroid treatments can lead to recurrent invasive amebiasis in asymptomatic amebic carriers.

[Epidemiological analysis and clinical study of pediatric human metapneumovirus detected in patients with acute respiratory infection].

We detected and isolated human metapneumovirus (HMPV) and isolated another respiratory virus in pharyngeal swab specimens from 502 pediatric patients with acute respiratory infection, seen at 3 Kyoto City sentinel hospitals from January to December 2011. Our prospective study detected 43 positive HMPV cases (8.6%). Phylogenetic analysis showed that subgroup A2 was most common, followed by B1 and B2, and that A1 was not detected. HMPV was detected mostly in specimens from patients less than 3 years old, and positive HMPV was identified most in spring, peaking in March. Our clinical study showed that positive HMPV patients had fever above 38 degrees (86%) and cough (65%). Among the 30 whose chest radiography was examined, radiological findings were recognized in 18 cases. We found inflammatory infiltrative shadows around the bronchus and peribronchus near the hilum of the lung. Lobar pneumonia and diffuse infiltrative shadows coinciding with peripheral alveolar involvement were not recognized. No difference affecting illness severity was seen among subgroups, viral isolation results, or mixed coxsackie virus or influenza virus infection. In hospitalization, mean disease lasted significantly longer in those with lower respiratory tract symptoms at first'examination than in those without such symptoms. We detected HMPV RNA in pharyngeal swabs and stool specimens from patients admitted to the hospital for rhabdomyolysis.

Two Cases of Kikuchi Disease Presenting with Aseptic Meningitis and Encephalitis.

Kikuchi disease, also called histiocytic necrotizing lymphadenitis, is an idiopathic and generally self-limiting disease affecting young adults and children. Kikuchi disease does not commonly manifest neurological complications at its initial presentation. We herein report two cases of Kikuchi disease that initially presented with aseptic meningitis and encephalitis rather than the more common signs of lymphadenopathy, rash, and arthritis. A 15-year-old boy presented with aseptic meningitis with an extremely high intracranial pressure. A 28-year-old man presented with dysesthesia of the right lower extremity, coinciding with abnormal magnetic resonance imaging findings. In both cases, painful cervical lymphadenopathy was observed following the central nervous system symptoms. Both patients improved after treatment with steroids. Kikuchi disease occasionally affects the central nervous system, to which lymphadenitis may be observed subsequently. A repeated, careful physical examination of the cervical lymph nodes may be helpful for the diagnosis.

Non-typhoidal Salmonella bacteremia in COVID-19 with recrudescence of fever after corticosteroid discontinuation: A case report.

It is challenging for clinicians to determine the cause of occurrence of fever in COVID-19 patients after corticosteroid discontinuation. Blood cultures help us distinguish between secondary infections and rebound phenomena. We report a case of non-typhoidal Salmonella bacteremia in a 34-year-old male COVID-19 patient who developed fever after discontinuing corticosteroids.

Putative Novel Species of Genus Capnocytophaga, Capnocytophaga stomatis Bacteremia in a Patient with Multiple Myeloma after Direct Contact with a Cat.

Capnocytophaga species are among the typical zoonotic pathogens causing infections following direct contact with animals. Recently, a putative novel species of zoonotic Capnocytophaga, Capnocytophaga stomatis, was reported. We herein report the first case of bacteremia caused by C. stomatis. A woman in her 80s with multiple myeloma who was receiving bortezomib and dexamethasone therapy was admitted to our hospital with a 2-day history of a fever and right calf redness. She was often licked by her cat. On a blood culture, thin, Gram-negative rods were detected, which were identified as C. stomatis by whole-genome sequencing. The patient was successfully treated with ampicillin-sulbactam treatment. Our case highlights the pathogenic potential of the putative novel Capnocytophaga, C. stomatis, in immunocompromised hosts.

Oral Antibiotic Transition in Patients with Bacteremia with a Urinary Source Due to Extended-Spectrum ß-Lactamase-Producing Escherichia coli.

Transitioning from intravenous to oral antibiotic therapy for Escherichia coli bacteremia could reduce the length of hospital stay and drug costs without compromising efficacy. Despite the expansion of extended-spectrum ß-lactamase (ESBL)-producing E. coli, limited data are available regarding the effectiveness of switching to oral antibiotic therapy in patients with bacteremia caused by this organism. To compare clinical outcomes between oral transition therapy and intravenous therapy in patients with bacteremia due to ESBL-producing E. coli with a urinary source, we conducted a retrospective cohort study at 3 Japanese hospitals. The effects were estimated by Cox hazard analysis using propensity scores. Among 996 patients with bacteremia due to E. coli, 73 were included in the study. In the adjusted analysis weighted by propensity scores including 26 patients in the oral switch group and 47 in the intravenous group, oral transition did not increase the risk of treatment failure within 60 days (adjusted hazard ratio 0.86, 95% confidence interval 0.18-4.10), whereas the length of hospital stay was shorter in the oral switch group than in the intravenous group (median, 12 days vs. 19 days, P = 0.04). Intravenous-to-oral transition may be an effective treatment option that shortens the hospital stay.

Comparison of 12 Molecular Detection Assays for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2).

Molecular testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the mainstay for accurate diagnosis of the infection, but the diagnostic performances of available assays have not been defined. We compared 12 molecular diagnostic assays, including 8 commercial kits using 155 respiratory samples (65 nasopharyngeal swabs, 45 oropharyngeal swabs, and 45 sputum) collected at two Japanese hospitals. Sixty-eight samples were positive for more than one assay and one genetic locus, and were defined as true-positive samples. All the assays showed a specificity of 100% (95% CI, 95.8%-100%). The N2 assay kit of the US Centers for Disease Control and Prevention and the N2 assay of the Japanese National Institute of Infectious Disease (NIID) were the most sensitive assays with 100% sensitivity (95% CI, 94.7-100), followed by the Centers for Disease Control and Prevention N1 kit, E assay by Corman, and Japanese National Institute of Infectious Disease N2 assay multiplex with internal control reactions. These assays are reliable as first-line molecular assays in laboratories when combined with appropriate internal control reactions.

[Case of imported scrub typhus contracted in Myanmar].

Scrub typhus is widespread in rural south and southeastern Asia and the western Pacific. The scrub typhus incidence is the highest among vector-borne diseases in Japan, but imported cases are extremely rare. A 49-year-old man admitted for persistent fever, headache, and rash after returning from Myanmar had been exposed to mosquito and tick bites while doing a 12-day forest inventory in Myanmar. On admission, he had a generalized maculopapular rash but no apparent eschars characteristic of scrub typhus. Blood examination and abdominal ultrasonography showed elevated liver enzymes, thrombocytopenia, and hepatosplenomegaly. Repeated blood smears and blood cultures were negative for malaria infection and bacteremia. Dengue fever was denied by both PCR and serology. The patient deteriorated on the ninth day and suffered complications of rhabdomyolysis, pneumonia, and enteritis. Based on a tentative diagnosis of typhoid fever or rickettiosis, we administratered ceftriaxone and minocycline, which dramatically reduced clinical signs and symptoms. After discharge on day 19, immunofluorescence assay showed significantly increased antibodies for Orienta tsutsugamushi serotype Gilliam, first discovered in Myanmar. All serological results were negative for other rickettioses, leptospirosis and Q fever. Given the many travelers from Japan visiting endemic scrub typhus areas, we must recognize cases of imported scrub typhus among those travelers with fever and rash returning from endemic areas.

[A case of bacteremia and suppurative vertebral osteomyelitis/discitis due to Shewanella algae occurring after raw-fish consumption].

Shewanella algae is an aquatic gram-negative bacterium, rarely recovered from human clinical samples. Case reports of human Shewanella infection are, however, slowly increasing, and a Shewanella infection outbreak was reported at a South Korean hospital. We report the case of an 89-year-old man admitted for back pain and fever after eating raw marine fish. Sulbactam/cefoperazone was started under a tentative diagnosis of gall bladder inflammation with gallstones based on ultrasonographic findings. His persistent back pain, however, necessitated vertebral magnetic resonance imaging (MRI), which showed thoracic vertebral osteomyelitis and discitis. Two sets of blood culture on admission yielded a gram-negative bacillus identified as "Shewanella putrefaciens" by automated identification. Ceftriaxone administration for 3 weeks followed by oral levofloxcin for 5 weeks cured the vertebral osteomyelitis and discitis. 16S rRNA sequence analysis showed that "S. putrefacien" was, in fact, S. algae-incorrectly detected because semi-automated and automated identification did not include S. algae in their database. It should thus be kept in mind that consuming raw-fish may cause Shewanella bacteremia and osteomyelitis in patients with hepatobiliary disease and that genetic analysis is required to precisely determine the occurrence of Shewanella spp.

Wheezing illness caused by respiratory syncytial virus and other agents.

BACKGROUND: Respiratory syncytial virus (RSV) and other pathogenic agents cause lower respiratory infection with wheezing in infants (wheezing illness in infancy). Wheezing illness in infancy due to RSV can be life-threatening and can induce recurrent wheezing; but these events can also be produced by infection by other pathogenic agents. Thus, whether RSV induces more severe wheezing illness in infancy remains poorly understood. METHODS: Infants with an initial wheezing illness were divided into an RSV-positive group and an RSV-negative group and the differences in disease severity, intensity of acute symptoms, and susceptibility to recurrent wheezing, between these two groups, were investigated. RESULTS: The RSV-positive group accounted for 57.4% of the infants. The infants in the RSV-positive group were significantly younger than those in the RSV-negative group. Other background parameters, gender and family history, were not significantly different. There were no significant differences in indicators of severity (hospitalization periods, periods of persistent wheezing and requirement of oxygen supplementation) between the two groups. CONCLUSION: Wheezing illness in infancy caused by RSV is more common in younger infants, but it is not more severe than that caused by other pathogenic agents.