Delayed Stent Infection after Deployment of a Carotid Dual Layer Stent in Dialysis Cases.

Objective: Infection after carotid artery stenting (CAS) is rare. We report two dialysis cases of delayed stent infection associated with a carotid dual-layer stent (DLS), which occurred several months after deployment of the stent. Case Presentations: Case 1: A 74-year-old man receiving dialysis underwent CAS with DLS. Three months after CAS, the patient developed a high fever, neck pain, and neck swelling. Neck CT and carotid ultrasonography (CUS) indicated an abscess around the inserted DLS. The patient was treated with antibiotic agents and fully recovered. Case 2: A 73-year-old man receiving dialysis underwent CAS with DLS. Two months after CAS, this patient also developed a high fever, neck pain, and neck swelling. Contrast-enhanced neck CT indicated inflammatory effusion with an abscess and a giant infectious pseudoaneurysm. Endovascular stent graft reconstruction was employed urgently under antibiotic therapy to prevent its rupture. However, intracranial hemorrhage occurred postoperatively and left hemiparesis remained. Conclusion: Delayed carotid stent infection is a rare but severe complication. The use of a DLS might be avoided during CAS for dialysis cases.

Meningitis caused by Chromobacterium haemolyticum suspected to be derived from a canal in Japan: a case report.

BACKGROUND: The genus Chromobacterium, of which 12 species have been recognized, comprises bacteria that reside in tropical and subtropical environments. Of these species, Chromobacterium violaceum and Chromobacterium haemolyticum are known to cause infections in humans. There have been few reports of infections caused by Chromobacterium haemolyticum. CASE PRESENTATION: Chromobacterium haemolyticum was detected in spinal fluid and blood samples isolated from a 73-year-old Japanese male patient who fell into a canal in Kyoto City, Japan and developed bacteremia and meningitis. Although meropenem and vancomycin were administered, this patient died 9 days after admission. Although the infection was misidentified as being caused by Chromobacterium violaceum by conventional identification methods, average nucleotide identity analysis revealed that the causative pathogen was Chromobacterium haemolyticum. The same bacteria were also detected in the canal in which the accident occurred. Phylogenetic analysis of the strain isolated from the patient and the strain isolated from the canal suggested that the two strains were very closely related. CONCLUSIONS: Chromobacterium haemolyticum can be misidentified as Chromobacterium violaceum by conventional identification methods and tends to be more resistant to ß-lactams than Chromobacterium violaceum. Pigment production and ß-hemolysis on blood sheep agar can provide clues for the early identification of Chromobacterium haemolyticum.

[A case of genetic Creutzfeldt-Jakob disease that required differential diagnosis of acute encephalopathy associated with Sjogren's syndrome].

An 86-year-old female was admitted to our hospital with acute progressive gait disturbance and cognitive impairment. Brain MR diffusion weighted imaging revealed abnormal high signal intensities in the bilateral hemispheres, dominantly in the frontal lobe. We first suspected acute encephalopathy due to Creutzfeldt-Jakob disease (CJD) from her clinical information. At the same time, we could not negate the possibility of Sjögren's syndrome (SjS) -related encephalopathy based on the abnormal findings on brain MRI and positive anti-SS-A antibody in the serum. After consulting with an otorhinolaryngologist and a pathologist, biopsy of the salivary gland was performed with a strict precaution against infection of prion virus. Pathological examination of the biopsy specimen showed accumulation of many lymphocytes around the gland, which satisfied grade 4 in the Greenspan classification. A definite diagnosis of SjS was made based on the pathological findings, and intravenous high dose methylprednisolone followed by oral prednisolone were administered for suspected SjS-related encephalopathy. However, the neurological symptoms did not improve and we judged that SjS-related encephalopathy was unlikely. The poor response to steroid therapy and the presence of tau protein, strongly positive 14-3-3 protein and a codon 180: Val/Ile mutation in the cerebrospinal fluid finally led to a clinical diagnosis of genetic CJD. In-hospital cooperation in terms of infection prevention is important when performing invasive procedure in the case of suspected CJD to distinguish treatable encephalopathy.

Present State of the Infection Protection System and Effects of a Change in the In-Hospital System in Endovascular Treatment for Large Vessel Occlusion in Acute Stroke Patients at a Single Institution.

Objective: Endovascular treatment (EVT) for large vessel occlusion in acute ischemic stroke patients during the SARS-CoV-2 epidemic requires the implementation of an in-hospital system to guard against infection. Changes to this system may be needed upon aggravation of the epidemic in a particular region. The objective of this study was to clarify the present state of infection protection and the effects of a change in the in-hospital system in EVT at a single institution. Methods: The subjects were consecutive patients treated by EVT under the protocol of infection protection using medical history and chest CT at our hospital between April 2020 and February 2021. For the subjects, background factors, time metrics, including door-to-puncture time (D2P), clinical outcome, and success of infection protection for medical staff were examined. The patients were divided into a group of those with PCR measurement after EVT (Group C; from April 2020 to November 2020) and a group of all with PCR measurement before EVT (Group P; from December 2020 to February 2021). Time metrics and clinical outcome were compared between the groups. Results: There were 69 subjects, including 40 and 29 patients in groups C and P, respectively. The median age was 82, which was higher in group P. The median D2P was 70 min, which did not differ significantly between the two groups, but it was slightly longer in group P than in group C by multivariate analysis. A favorable outcome (modified Rankin Scale 0-2 at 3 months) was observed in 23 patients (38%), which did not differ significantly between the two groups, but the rate of a favorable outcome was slightly lower in group P than in group C by multivariate analysis. Although medical staff wearing full personal protection equipment were needed for 15 patients (22%), 12 of whom were suspected of being positive and three (4%) were confirmed positive for SARS-CoV-2 by PCR, no staff member who participated in EVT was infected. Conclusion: The median D2P was 70 min and 38% had a favorable outcome of EVT under the present state of infection protection. After a change in the in-hospital system for clinical settings during the SARS-CoV-2 epidemic, the D2P increased and the rate of a favorable clinical outcome slightly decreased, but both were not significantly affected and infection protection for medical staff was effective. Therefore, the effects of a change were acceptable considering the circumstances.