Pectin-containing liquid enteral nutrition for critical care: a historical control and propensity score matched study.

BACKGROUND AND OBJECTIVES: Pectin-containing liquid enteral nutrition (PCLEN) contains pectin, which becomes solid in the stomach and therefore mitigates vomiting and diarrhea. Its efficacy for use in critical care medicine was evaluated. METHODS AND STUDY DESIGN: We used liquid enteral nutrition (LEN) (traditional LEN (TLEN)) as the primary LEN at the emergency and critical care center. We adopted PCLEN as the primary LEN from 2014. During 2012-2016, 954 patients admitted to intensive care units and emergency wards were given PCLEN or TLEN. We conducted propensity score matching for 693 eligible patients for age, sex, and organ dysfunctions for six organs. RESULTS: We included 199 PCLEN patients and 199 TLEN patients. Severity was higher in the PCLEN group. The enteral nutrition failure rate was significantly lower for PCLEN than for TLEN. The diarrhea incidence rates were 28.1% vs 38.2% (p=0.033), and the incidence rates of nosocomial pneumonia were 4.5% and 9.6% (p=0.048). For PCLEN, the enteral nutrition failure rates were not different for patients with gastric acid inhibitors and without them. CONCLUSIONS: PCLEN can be used effectively for critically ill patients irrespective of the use of gastric acid inhibitors. It can decrease the incidence of enteral nutrition failure and diarrhea.

Systemic nocardiosis caused by Nocardia concava in China.

A 42-year-old man with polychondritis and a 2-year history of using low-dose prednisone and other immunosuppressive drugs was admitted to our hospital due to persistent high fever of 10 days duration. A strain of Nocardia was twice isolated from his blood and subsequently identified to be N. concava. The patient was initially treated with sulphadiazine sodium, vancomycin and imipenema for 7 days but the symptoms persisted. Consequently, the regimen was changed to sulphadiazine sodium, ciprofloxacin and amikacin sulfate based on the antibiotic susceptibility tests of the Nocardia isolate. The fever disappeared and the patient's condition improved after 10 days of this treatment to the extent that he was discharged. However, 7 days later, the patient's condition deteriorated and he died due to multiple organ failure. This is the first report of N. concava causing systemic nocardiosis in China.

Early diagnosis and antibiotic treatment for fulminant Clostridium difficile infection.

In fulminant Clostridium difficile infection (CDI), early diagnosis is important, and early diagnosis could save fulminant CDI patients that do not qualify for surgery due to severe complicating conditions by conservative antibiotic therapy.

Identification of Trichosporon spp. strains by sequencing D1/D2 region and sub-typing by sequencing ribosomal intergenic spacer region of ribosomal DNA.

To re-identify and further group 25 isolates of Trichosporon spp. identified morphologically previously, sequences of D1/D2 region of large subunit (LSU) of ribosomal DNA (rDNA) of 25 tested strains for identification and those of ribosomal intergenic space 1 (IGS1) region of 11 strains for subgrouping were detected. The identifications of tested strains were changed except 6 strains. According to the alignment of the IGS1 region, 6 T. asahii isolates tested fell into 4 groups and 5 T. faecale isolates into 3 groups. Polymorphism of 2 T. japonicum isolates was found in 10 positions. With the alignments obtained in this research compared with the relative GenBank entries, it was found that T. asahii, T. faecale and T. japonicum species were divided into 7, 3 and 2 subtypes respectively. Morphological and biophysical methods are not sufficient for Trichosporon spp. identification. Sequencing becomes necessary for Trichosporon diagnosis. There is obvious diversity within a species.

Single versus divided administration of intravenous immunoglobulin for sepsis: a retrospective and historical control study.

BACKGROUND: Intravenous immunoglobulin (IVIG) is regarded as effective, theoretically, for sepsis. The IVIG regimen for severe infection covered by Japanese health insurance is administration of 5 g/day for three days: an extremely low dosage. We investigated its effectiveness by comparison between divided dosage and single dosage of 15 g for one day. METHODS: Patients who were admitted to our hospital's Emergency Medical Center and treated with IVIG for sepsis were included and were analyzed retrospectively. The dosage regimen was 5 g for three days in the early half period, and 15 g for one day in the latter half period employing the same indication criteria. RESULTS: Each group included 57 patients. No significant difference was found in their baseline characteristics, survival probability, or length of mechanical ventilation. However, the ICU stay and hospital stay lengths were shortened significantly by administration of the single dosage regimen. Disseminated intravascular coagulopathy markers and inflammatory indices were improved significantly earlier in the 15 g for one day group. Regarding adverse events, no significant difference was found. CONCLUSIONS: For sepsis treatment, single administration of 15 g IVIG for one day improved the condition and inflammation earlier than divided dosage.

Basidiomycosis: Schizophyllum commune osteomyelitis in a dog.

A six-year-old female Labrador retriever dog was suffering from osteomyelitis in her hindlimb. A puncture wound caused by a rotted bamboo stick was presumed as the source of infection. The dog suffered from pre-existing aortic stenosis, but otherwise exhibited no significant abnormality in her systemic conditions excluding claudication of the left hindlimb. The results of cytology and pathological examinations of biopsy samples revealed the diagnosis of mycotic osteomyelitis in this dog. Mycological and DNA tests showed the pathogen as the mushroom Schizophyllum commune. Antibiotic sensitivity testing also revealed susceptibility to itraconazole, which was used to successfully treat the dog. This is a rare case of canine basidiomycosis with S. commune as the etiologic agent.

A thyroid storm patient with protracted disturbance of consciousness and reversible lesion in the splenium of corpus callosum: A case report.

RATIONALE: Various neurological manifestations are observed in thyroid storm patients but protracted disturbance of consciousness is rare. PATIENT CONCERNS: A 58-year-old male was admitted to our hospital after a traffic accident. DIAGNOSES: Although awake on arrival, he fell into coma after admission. Based on the clinical symptoms and hyperthyroidism, the patient was diagnosed with thyroid storm (TS). INTERVENTIONS: Even after improvement of hyperthyroidism, disturbance of consciousness was protracted. Considering the possibility of immune-related etiology, methylprednisolone pulse was started. OUTCOMES: His consciousness level improved over a 3-month period, and he became able to walk with some assistance after 6 months. LESSONS: His condition was atypical of TS-associated encephalopathy because of the long clinical course. Reversible splenial lesion was visible using brain imaging. In some cases of TS, disturbance of consciousness can be protracted for several months, but it is reversible. Therefore, it is necessary to judge the long-term neurological outcome carefully.

[Antifungal activity of the novel adduct, GX-95, of silver with nanometer-scale particles to peptidic hydrolysates from collagen].

Silver has long been known to have an antimicrobial activity against bacteria and other microorganisms, and has been used as eating utensils, as dental fillings and so on. We developed a novel adduct, GX-95, of silver with nanometer-scale particles to peptidic hydrolysates from collagen. Antifungal activity of the adduct against pathogenic yeasts and filamentous fungi was examined in terms of minimal inhibitory concentrations (MICs). GX-95 was found to possess strong and broad antifungal activities against all fungi examined in the following MICs: 0.25 to 0.31 microg/ml for Candida albicans including resistant strains to fluconazole, itraconazole and flucytosine, 0.05 to 0.2 microg/ml for Cryptococcus neoformans strains, 0.025 to 0.4 microg/ml for Aspergillus fumigatus strains, 0.4 microg/ml for Trichophyton rubrum, and 0.05 microg/ml for Cladophialophora carrionii.

A new antifungal macrolide, eushearilide, isolated from Eupenicillium shearii.

In screening for antifungal substances, a new macrolide, eushearilide (1), was isolated from Eupenicillium shearii IFM54447. The structure of 1 was established to be 24-membered macrolide having a non-conjugated diene and a choline phosphate ester moetiy on the basis of detailed investigation of NMR, UV, IR and MS spectral data. Compound 1 showed antifungal activity against various fungi and yeasts, including human pathogens Aspergillus fumigatus, Trichophyton spp. and Candida spp.

Extracellular enzymatic activities in Cryptococcus neoformans strains isolated from AIDS patients in different countries.

Three hundred and ten Cryptococcus neoformans strains isolated from AIDS patients in five different countries (151 from Brazil, 23 from Italy, 28 from Spain, 104 from Thailand and four from Turkey) were tested by the API-ZYM kit to detect their extracellular enzymatic activity. The enzymes esterase (C4) (no 3), esterase lipase (C8) (no 4), leucine arylamidase (no 6) and acid phosphatase (no 11) were commonly positive in most of the strains (more than 95%). These enzymes could be considered a useful tool not only for C. neoformans identification, but in particular for their possible relationship to new C. neoformans virulence factors and also for epidemiological research. Interestingly, it is also the high positive percentage of alpha-glucosidase and beta-glucosidase detected in all isolates. The serotype A was the most predominant serotype in all countries, except for Italy where the serotype D was predominant. Further studies are needed to draw a clear correlation between the API-ZYM profile and serotype.

4-benzyl-3-phenyl-5H-furan-2-one, a vasodilator isolated from Malbranchea filamentosa IFM 41300.

Screening of Malbranchea filamentosa IFM 41300 for bioactive compounds led to the identification of 4-benzyl-3-phenyl-5H-furan-2-one (1) as a vasodilator and erythroglaucin (2). The structure of 1 was established on the basis of spectroscopic and chemical investigations. Compound 1 inhibited Ca2+-induced vasocintraction in aortic rings pretreated with high K+ (60mM) or norepinephrine. Finally, compound 1 did not exhibit activity against human pathogenic microorganisms.

Specific oligonucleotide primers for identification of Hortaea werneckii, a causative agent of tinea nigra.

Hortaea werneckii, a black yeast-like hyphomycete that is widely distributed in tropical and subtropical environments, can cause superficial mycotic infection in humans. This fungus was recently isolated from superficial infectious lesions of a guinea pig in Japan. An oligonucleotide primer set specific for Hortaea werneckii was designed on the basis of the internal transcribed spacer regions of the ribosomal DNA (rDNA). Polymerase chain reaction (PCR) with this primer set yielded a 306 bp PCR amplicon from only H. werneckii. This primer set did not amplify DNAs of 42 other related dematiaceous species, including the medically important dematiaceous fungi Cladophialophora carrionii, Fonsecaea pedrosoi, Phialophora verrucosa, and Exophiala dermatitidis, and eight species of medically important yeasts, including Candida (C.) albicans, C. dublinensis, C. glabrata, C. parapsilosis, C. tropicalis, Cryptococcus neoformans var. neoformans, Malassezia furfur, and Trichosporon asahii var. asahii. PCR with this primer set may be a useful technique for rapid identification of H. werneckii.

Identification of the first isolates of Trichosporon asahii var asahii from disseminated trichosporonosis in China.

Infection with Trichosporon asahii is a major cause of deep-seated and disseminated trichosporonosis, which is associated with a high mortality rate. Disseminated trichosporonosis in individuals with no underlying disease has not been reported. In this study, we report the identification of the first isolate of Trichosporon asahii var. asahii in China. Two isolates were obtained from the liver and skin of a patient with disseminated trichosporonosis who displayed no evidence of underlying disease. The morphologic and physiologic characteristics of the two isolates differed slightly from those of usual strains of T. asahii var. asahii, including the type strain CBS 2479. Ubiquinone-9 was identified as the major ubiquinone in both isolates. Sequence analysis of the LSUrDNA D1/D2, ITS, and IGS1 regions from the two isolates showed them to be T. asahii var. asahii, and random amplified polymorphic DNA analysis strongly suggested that they were the same strain.

Identification of pathogenic dematiaceous fungi and related taxa based on large subunit ribosomal DNA D1/D2 domain sequence analysis.

The nucleotide sequences of the D1/D2 domains of large subunit (26S) ribosomal DNA for 76 strains of 46 species of pathogenic dematiaceous fungi and related taxa were determined. Intra-species sequence diversity of medically important dematiaceous fungi including Phialophora verrucosa, Fonsecaea pedrosoi, Fonsecaea compacta, Cladophialophora carrionii, Cladophialophora bantiana, Exophiala dermatitidis, Exophiala jeanselmei, Exophiala spinifera, Exophiala moniliae, and Hortaea werneckii were extremely small; as few as 0 changes were detected in C. bantiana, Fonsecaea and Exophiala species, 1 bp in C. carrionii and H. werneckii, and 2 bp in P. verrucosa. Inter-species nucleotide diversity between most species was higher. These data suggested that the D1/D2 domain is sufficiently variable for identification of pathogenic dematiaceous fungi and relevant species. The phylogenetic trees constructed from the sequence data revealed that most human pathogenic species formed a single cluster and that Cladosporium and Phialophora species were distributed polyphyletically into several clusters.

A new nonadride derivative, dihydroepiheveadride, as characteristic antifungal agent against filamentous fungi, isolated from unidentified fungus IFM 52672.

In the screening of searching for new antifungal agents, a new nonaride compound, dihydroepiheveadride (1), was isolated from unidentified fungus IFM 52672 as the most potent antifungal principle from this organism. The structure of 1 was established on the basis of spectroscopic and chemical investigation, as well as detailed comparison of the spectroscopic and physico-chemical data of the oxidized derivative (3) from 1 with those of heveadride (2). Compound 1 showed strong antifungal activity against various filamentous fungi including human pathogens Aspergillus fumigatus, Penicillium marneffei and Trichophyton spp. It also showed the growth inhibition activity against certain human pathogenic yeasts such as Trichosporon species, while it had weak or no antifungal activity against Candida spp. and Cryptococcus neoformans, and no antibacterial activity against Bacillus subtilis nor against Escherichia coli. The antifungal potencies of compounds 2 and 3 were found to be weaker than that of 1.

Effect of medium components and time of cultivation on chitin production by Mucor circinelloides (Mucor javanicus IFO 4570) -- a factorial study.

Chitin production of mycelia from Mucor circinelloides (Mucor javanicus) was studied with a two-level factorial design in all combinations of the following factors in the culture medium: time of cultivation, concentration of D-glucose, L-asparagine and thiamine. Chitin was characterised by infrared and nuclear magnetic resonance spectroscopy. The four factors showed statistically significant (95%) positive main effects on chitin production, without interactions between them. The highest chitin yield (23.9%) was obtained with the medium containing 60 g/l of glucose, 3 g/l of asparagine and 0.008 mg/l of thiamine and is comparable to the highest in the literature.

The epidemiology and mating behavior of Arthroderma benhamiae var. erinacei in household four-toed hedgehogs (Atelerix albiventris) in Japan.

An epidemiological survey of Trichophyton mentagrophytes var. erinacei in the household hedgehog and other rodents was made between January 17, 2002 and February 28, 2002 in Japan. Quills and hairs were collected from sources identified via the internet. The fungus was isolated only from the quills of four-toed hedgehogs (7/18; 39%) from Kanto to Kyushu regions. Isolates were examined morphologically, physiologically and genetically, and identified as T. mentagrophytes var. erinacei anamorph. The isolates were also genetically compared with European hedgehog (Erinaceus europeus)-borne T. mentagrophytes var. erinacei and Kenyan hedgehog (Aterelix albiventris)-borne Arthroderma benhamiae, and their genotypes of the ITS1-5.8S-ITS2 rDNA were all identical. The isolates were crossed with A. benhamiae Americano-European race and African race, A. vanbreuseghemii and A. simii, with the result that they mated only with African race (+) or (-). Mating types of the isolates were (+) in 6 isolates and (-) in one. An intra-isolate mating between one of the 6 plus isolates and the minus one formed abundant mature gymnothesia, the mating type ratio of the F1 progeny was approximately 1:1, and the sib crossings of F1 progeny produced abundant fertile gymnothesia. The present study revealed that the intra-Japanese hedgehog-borne isolate crossing showed complete fertility and that the sexual degeneration pointed out by Takashio (Mycologia 71: 968-976, 1979) did not exist. Two pairs of mating, (+) and (-) mating types of Japanese isolates with (-) and (+) tester strains of A. benhamiae African race formed less gymnothesia, mating type ratios were unbalanced, and sib crossings of F1 progeny produced small gymnothesia containing a low number of asci, pseudogymothesia, or none, respectively. These results show that A. benhamiae var. erinacei, the teleomorph of T. mentagrophytes var. erinacei, belongs to a different mating group (e.g. hedgehog race) than the Americano-European and African races in A. benhamiae.

An isolate of Arthroderma benhamiae with Trichophyton mentagrophytes var. erinacei anamorph isolated from a four-toed hedgehog (Atelerix albiventris) in Japan.

A female four-toed hedgehog probably imported from Africa and kept as a pet by a family suffered from depilation and mite (Caparinia tripilis) infection. Depilated quills were inoculated on a commercially available medium and an isolate of the dermatophytes was obtained. A giant colony after 14 days incubation on yeast extract Sabourauds agar had a central umbo with white granular surface and a yellow pigment ring in the reverse. The hedgehog isolate produced numerous elongated microconidia singly attached along the sides of hyphae. Macroconidia were somewhat irregular in shape and size and 2-6 septa. Abundant intermediate sized spores between micro- and macro conidia and few spirals were observed. Hair perforation and urease activity tests were positive. Maximum growth temperature was 40 C. In the mating tests using the tester strains of both African and Americano-European races of Arthroderma benhamiae, the strain produced numerous gymnothecia only when paired with the African race mating type minus(-). In addition, 591 bases of the internal transcribed spacer region of the ribosomal RNA gene including the 5.8S region (ITS1-5.8S-ITS2) were sequenced and corresponded to those of T. mentagrophytes var. erinacei (DDBJ/EMBL/GenBank accession numbers Z97996 and Z97997) by more than 99.7%. Therefore, our case is the first isolation of A. benhamiae with T. mentagrophytes var. erinacei anamorph in Japan.

The first isolation of Hortaea werneckii from a household guinea pig.

Hortaea werneckii, a black yeast and the causative agent of tinea nigra (a superficial type of dermatomycosis), is a human pathogen and is also found in the environment. It is not highly pathogenic but in the last fifteen to twenty years has been isolated from various human and environmental sources in Japan. As far as we know, there has been no report on the isolation of H. werneckii from animals. Recently, we found a case of a guinea pig with dark superficial lesions on the palm and dorsal areas. Cultural and morphological studies of scrapings from the lesion showed that the causative agent was a black yeast, which was identified as H. werneckii by morphological study and molecular biological screening. D1/D2 region of the 26S large subunit rDNA gene of this isolate was identical to those of 11 other H. werneckii isolates used as reference strains in this study. This is the first case recorded of tinea nigra caused by H. werneckii in a guinea pig.