ABSTRACT
Leptospirosis is a worldwide zoonosis and common in tropical and subtropical areas with high rainfall. It should be noted as an imported infectious disease although it is sporadic in Japan. Some imported cases already have been reported in Japan and these cases occurred mainly in Southeast Asia. The case discussed in this article is the first reported Japanese case infected in Vietnam. Four days after returning back to Japan after a two-week stay in the mountain area near Hue, in the middle part of Vietnam, the patient suddenly experienced chills, a high fever, sore throat, gastrocnemius pain, and headache. Conjunctival jaundice, renal function disorder, and proteinuria were observed on the third day of onset. Significant increase in antibody titers against serovar Australis and Autumnalis strains was observed in paired serum samples by microscopic agglutination test (MAT). Consequently we recognized this case as a diagnosis of severe leptospirosis (Weil’s disease). Finally, renal function disorder did not deteriorate further, and then the patient recovered after the tenth day of onset with the administration of antibiotics and supportive care without sequelae. We experienced the first imported Japanese case of severe human leptospirosis infection from Vietnam that was successfully treated with ceftriaxone and minocycline.
ABSTRACT
<b>Objectives</b>: To optimize the treatment of patients on tube feeding, it is important to ascertain whether medicines are appropriate for administration by gastrostomy and nasogastric tubes. In this study, we evaluated the drug information services provided to medical staff by clinical pharmacists related to 109 patients administered medication via a feeding tube in a neurological ward.<br><b>Design and Methods</b>: We analyzed the records of drug information services provided to medical staff from January 2006 to December 2007 at the Higashi Nagoya Hospital. We classified drug information services for avoiding obstruction of the feeding tube and chemical changes into four categories: ‘formulation changes’, ‘medication changes’, ‘incompatibilities’ and ‘administration method’, and evaluated the acceptance rate of the pharmacists’ recommendations for drug therapy via feeding tube.<br><b>Results</b>: Drug information related to formulation and medication changes accounted for 130 and 88 cases, respectively. Information related to incompatibilities accounted for 19 cases, involving anticipated chemical changes related to concurrent administration of drugs. Information related to administration methods accounted for 24 cases. The acceptance rate for information by medical staff was 92.0%.<br><b>Conclusions</b>: Drug information to medical staff by pharmacists contributes to improved safety for patients administered medication via feeding tubes. The acceptance rate for drug information was high, and the provision of drug information by pharmacists in the neurological ward was considered useful.