Human Rickettsia heilongjiangensis infection, Japan.

A case of Rickettsia heilongjiangensis infection in Japan was identified in a 35-year-old man who had rash, fever, and eschars. Serum contained R. heilongjiangensis antibodies, and eschars contained R. heilongjiangensis DNA. R. heilongjiangensis was also isolated from ticks in the suspected geographic area of infection.

[Successful reintroduction of mesylate imatinib after pneumonitis in two patients with gastrointestinal stromal tumor (GIST)].

We report 2 cases of successful reintroduction of mesylate imatinib for gastrointestinal stromal tumor (GIST) after drug-induced pneumonitis. Both of them were women in the fifth decade who had been medicated by mesylate imatinib about for 5 months previously, and had been given a diagnosis of imatinib mesylate-induced pneumonitis. After only cessation of that drug, symptoms and shadows on chest X-ray film improved. However, we had to reintroduce the drug because of the growth of primary tumor, so we gave half the previous dose of imatinib mesylate, with low dose prednisone. There has been no recurrence of drug related pneumonitis and effective control of the primary tumor was obtained. The evidence acquired from our cases suggests that it may be possible to reintroduce imatinib mesylate carefully by adjusting the dose with low dose prednisone in a GIST patient, without causing recurrence of drug-induced pneumonitis.

[Case of severe streptococcus pyogenes pneumonia with streptococcus toxic shock syndrome].

A 30-year-old woman who had until recently been healthy, was transferred to our hospital by ambulance with complaints of dyspnea and pain in both lower limbs. She had 1-week history of sore throat, fever and cough. She had been to a neighboring clinic three days previously, and had been prescribed some medication for bronchitis, but her symptoms had not improved. By the time of admission, she was already in shock and had severe respiratory failure. Laboratory data showed renal dysfunction, disseminated intravascular coagulation, CPK elevation and severe metabolic acidosis. Chest x-ray and CT films revealed consolidation of the entire right lung field. The patient was quickly intubated and we began mechanical ventilation. We immediately initiated broad-spectrum antibiotics, immunogloblin, dopamine hydrochloride and gabexate mesilate, but she died 7 hours later. From cultures of blood and sputum taken from the patient, Streptococcus pyogenes was isolated. On the basis of these clinical and bacteriological findings, we confirmed a diagnosis of pneumonia and toxic shock syndrome caused by Streptococcus pyogenes (STSS). Serologically her M protein was serotyped as M1, and with regard to Streptococcal pyrogenic exotoxin genes were identified as speA and speB. These serological findings were consistent with the most frequent type that causes STSS. In spite of the uncommon cause of community-acquired pneumonia, Streptococcus pyogenes can potentially affect healthy individuals. The pneumonia can be complicated with STSS and so the clinical course may be severe and fulminant. The evidence acquired from this case suggests that in the event of severe pneumonia with shock, we should be aware that this may represent the presence of Streptococcus pyogenes and/or toxic shock syndrome.

[Usefulness of support during treatment by alignment with health centers and DOT during hospitalization].

OBJECTIVES: To evaluate the effectiveness of patient support by alignment with public health centers and DOT during hospitalization, on treatment completion of tuberculosis patients. SUBJECTS: Four hundred seventy-seven patients (male 344, female 133) newly admitted from July 1, 2002 to June 30, 2003 to our hospital were enrolled in the study. METHOD: The patients were divided into two groups: one comprised of the patients who were discussed in the conference held by the hospital staffs and the regional public health center staffs about the necessity of support for continuing treatment regularly after discharge from our hospital (Conference (+) group; N=306), and the other who were not discussed in the conference (Conference (-) group; N=171). The Conference (+) group was further divided into two groups: One comprised of the patients who were regarded to need support after discharge (Support (+) group; N=106), and the other no need of support after discharge (Support (-) group; N=200). The patients' characteristics and backgrounds were compared between the Conference (+) and the Conference (-) groups, and between the Support (+) and the Support (-) groups. The rate of treatment completion and of default were compared between the Conference (+) and the Conference (-) group, and between the Support (+) and the Support (-) group. They were also compared between the patients with and without DOT for a month during hospitalization, and between the patients who were treated for the first time (new case) and those who had been treated previously (retreated case) or who had been treated when they were admitted to our hospital and continued treatment after admission (continuous cases). RESULTS: There is no significant differences in patients' characteristics and backgrounds between the Conference (+) and Conference (-) groups, but the ratios of male, sputum-culture positivity, far advanced lesions on chest X-ray, hypoalbuminemia, and disemployment were higher in Support (+) group than in Support (-) group. The overall (N=477) treatment outcomes were as follows: cured (defined by sputum-culture negativity at completion of chemotherapy) 300 (62.9%), completed (defined by no sputum data at completion of chemotherapy) 90 (18.9%), failed 5 (1.0%), defaulted 6 (1.3%), transfer out 6 (1.3%) and death 70 (14.7%). Therefore, the ratio of treatment success (defined by cured+completed) was 390/477 (81.8%). Because of more died cases in Conference (-) groups, treatment success rate was significantly higher in the Conference (+) groups than in the Conference (-) groups. There were no significant differences in the rate of treatment success and of default between the Support (+) and the Support (-) groups, but no defaulter case was seen in the Support (+) group. There were no differences in the rate of treatment success and of default between the groups with and without DOT for a month during hospitalization. There were no differences in the rate of treatment success and of default between the groups with the retreated and continuously treated cases and the new cases. CONSIDERATIONS: Treatment success rate was excellent in our study. DOT for a month during hospitalization didn't affect the improvement of treatment success after discharge, partly because the education on tuberculosis treatment was sufficiently done for most patients during hospitalization and a nurse made a telephone call to the patient who didn't attend the outpatient department of the hospital. CONCLUSIONS: To hold conference with regional public health center is effective for completion of tuberculosis treatment.