[Successful treatment of Legionella pneumonia with moxifloxacin in a hemodialysis patient].

Moxifloxacin, a recent, new quinolone agent, has superior pharmacokinetics and appears to be safe for patients with renal failure, as it is mainly excreted in the bile. The case of a hemodialysis patient with Legionella pneumonia who was successfully treated with moxifloxacin is reported. A 76-year-old woman, who had been on hemodialysis for chronic renal failure secondary to diabetic nephropathy, visited her hospital with a cough and fever. Pneumonia was diagnosed, and intravenous administration of cefotiam hydrochloride was begun, but her respiratory condition deteriorated. She was transferred to our hospital with dyspnea. A chest radiograph showed consolidation in both lung fields and cardiomegaly. A urinary antigen test for Legionella was positive. Legionella pneumonia with heart failure was diagnosed and she was started on 400 mg a day moxifloxacin. Her clinical condition improved. Moxifloxacin appears to be useful in the treatment of Legionella pneumonia in patients with renal failure.

[Successful macrolide therapy for recurrent pneumococcal pneumonia in a man with X-linked agammaglobulinemia].

A 55-year-old man, who had not suffered from any severe or recurrent bacterial infections previously, visited our hospital because of symptoms of fever, cough, sputum, and otorrhea. Chest X-ray and computed tomography demonstrated infiltrates in the right middle lobe and lingula. Pneumococcal pneumonia and tympanitis were diagnosed based on the isolation of Streptococcus pneumoniae from sputum and otorrhea specimens. A peripheral blood analysis showed a remarkable reduction in serum IgG level and the flow cytometric analysis of his peripheral monocytes indicated a significant reduction in Bruton's tyrosine kinase expression. Thus, we diagnosed his illness as X-linked agammaglobulinemia (XLA). Although immunoglobulin replacement therapy was performed, he developed recurrent lower respiratory tract infections. Low-dose long-term erythromycin treatment resulted in decreased frequency of respiratory tract infections. These results suggest that erythromycin therapy may be useful for the control of lower respiratory tract infections in patients with XLA. Even in adults with recurrent bacterial respiratory tract infections, the presence of XLA as an underlying disease should be considered. The effect of macrolide therapy for chronic lower respiratory tract infection associated with humoral immunodeficiency has rarely been reported. This case study may provide valuable information about macrolide therapy for such an infection in patients with humoral immunodeficiency.

Isolation of nontuberculous mycobacteria from patients with pneumoconiosis.

This study aimed to confirm the isolation of nontuberculous mycobacteria (NTM) from patients with pneumoconiosis. Monthly sputum examinations in 155 patients were performed from April 1998 to December 2002. When NTM were isolated, species were identified and the frequency of isolation was reviewed. We then identified the patients who satisfied the bacteriologic criteria for the diagnosis of nontuberculous mycobacterial pulmonary disease (NTM pulmonary disease) recommended by the American Thoracic Society (ATS). Symptoms and findings on computed tomography (CT) scans were evaluated. NTM were isolated from 60 patients (39%): common etiologic species defined by the ATS, i.e., Mycobacterium avium, M. intracellulare, M. abscessus, and M. kansasii, were identified in 21 patients; unusual etiologic species, i.e., M. fortuitum, M. simiae, and M. szulgai, were identified in 11 patients; and undefined species, which appeared to be nonpathogenic, were identified in 41 patients. The bacteriologic criteria were satisfied in 8 patients. NTM species isolated in conformity with the bacteriologic criteria were: M. avium in 4 patients, M. intracellulare in 2, a combination of M. intracellulare and M. kansasii in 1, and M. gordonae in 1 patient. Two patients, from whom M. avium were repeatedly isolated, satisfied the ATS diagnostic criteria for NTM pulmonary disease. It is important to note that NTM, including both pathogenic species and nonpathogenic species, were isolated from patients with pneumoconiosis.

[A case of pulmonary nocardiosis with a polypoid lesion in a bronchus].

A 62-year-old woman was admitted with fever and bloody sputum. A mass shadow in the left S3 and obstruction of the left B3 were seen on a chest radiograph and CT. Obstructive pneumonia was suspected, and cefotiam and imipenem/cilastatin were administered. However, this treatment did not show adequate efficacy. Bronchoscopy demonstrated a yellowish-white polypoid lesion in the left B3, but histopathological findings with HE staining yielded no definite diagnosis. Subsequently, Nocardia asteroides was detected in sputum test. A sulfamethoxazole-trimethoprim combination and minocycline were administered, and the clinical findings improved. Gram-positive microfilaments were confirmed retrospectively in the pathologic specimen, and a diagnosis of pulmonary nocardiosis was made.

[Influenza virus].

Influenza virus is highly infectious and transmitted from human to human by droplet infection. Therefore, once the virus is brought into a hospital, this can lead to a severe outbreak of influenza among medical workers and inpatients, resulting in the failure of hospital functions. The fundamental protective measures against in-hospital infection include stopping the outbreak of influenza and minimizing the spread of infection when mass infection of influenza occurs in a hospital. Thus, it is vital that the infection control committee in each hospital prepares specific countermeasures against influenza infection reflecting the realities. As one such countermeasure, it is recommended is to give influenza vaccination to medical workers and patients before the illness becomes epidemic. Further, once an outbreak of influenza occurs in a hospital, administration of anti-influenza drugs to high-risk patients also needs to be considered.