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2.
Acute Med Surg ; 8(1): e659, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34484801

RESUMO

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created as revised from J-SSCG 2016 jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in September 2020 and published in February 2021. An English-language version of these guidelines was created based on the contents of the original Japanese-language version. The purpose of this guideline is to assist medical staff in making appropriate decisions to improve the prognosis of patients undergoing treatment for sepsis and septic shock. We aimed to provide high-quality guidelines that are easy to use and understand for specialists, general clinicians, and multidisciplinary medical professionals. J-SSCG 2016 took up new subjects that were not present in SSCG 2016 (e.g., ICU-acquired weakness [ICU-AW], post-intensive care syndrome [PICS], and body temperature management). The J-SSCG 2020 covered a total of 22 areas with four additional new areas (patient- and family-centered care, sepsis treatment system, neuro-intensive treatment, and stress ulcers). A total of 118 important clinical issues (clinical questions, CQs) were extracted regardless of the presence or absence of evidence. These CQs also include those that have been given particular focus within Japan. This is a large-scale guideline covering multiple fields; thus, in addition to the 25 committee members, we had the participation and support of a total of 226 members who are professionals (physicians, nurses, physiotherapists, clinical engineers, and pharmacists) and medical workers with a history of sepsis or critical illness. The GRADE method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members. As a result, 79 GRADE-based recommendations, 5 Good Practice Statements (GPS), 18 expert consensuses, 27 answers to background questions (BQs), and summaries of definitions and diagnosis of sepsis were created as responses to 118 CQs. We also incorporated visual information for each CQ according to the time course of treatment, and we will also distribute this as an app. The J-SSCG 2020 is expected to be widely used as a useful bedside guideline in the field of sepsis treatment both in Japan and overseas involving multiple disciplines.

3.
J Infect Chemother ; 27(12): 1765-1768, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34393039

RESUMO

Cryptococcosis is an invasive fungal infection that mainly affects the lungs and central nervous system. While patients with cell-mediated immunodeficiency are at high risk of developing cryptococcosis, there have been increasing reports of cryptococcosis in immunocompetent individuals with no underlying conditions. Herein, we report a case of cryptococcal meningitis in a 55-year-old apparently immunocompetent man with a history of heavy alcohol consumption. Although the patient was initially treated for tuberculous meningitis and varicella-zoster virus induced vasculopathy due to a history of exposure to tuberculosis and a presence of stroke, a multiplex polymerase chain reaction (PCR) assay of cerebrospinal fluid (CSF) identified Cryptococcus species unexpectedly, enabling swift treatment and a favorable clinical outcome. The multiplex PCR assay, which can identify multiple pathogens simultaneously and instantly, may lead to early diagnosis and treatment by detecting unanticipated pathogens. Furthermore, the strain was identified through multilocus sequence typing (MLST) analysis as Cryptococcus neoformans var. grubii, Sequence Type 5, molecular type: VNI. Although simplified microbial identification techniques such as mass spectrometry have recently been developed, molecular biological assays are still essential for the accurate identification of infectious strains.


Assuntos
Criptococose , Cryptococcus neoformans , Meningite Criptocócica , Meningite , Bioensaio , Cryptococcus neoformans/genética , Diagnóstico Precoce , Genótipo , Humanos , Masculino , Meningite Criptocócica/diagnóstico , Meningite Criptocócica/tratamento farmacológico , Pessoa de Meia-Idade , Tipagem de Sequências Multilocus , Reação em Cadeia da Polimerase Multiplex , Técnicas de Tipagem Micológica
4.
J Intensive Care ; 9(1): 53, 2021 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-34433491

RESUMO

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created as revised from J-SSCG 2016 jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in September 2020 and published in February 2021. An English-language version of these guidelines was created based on the contents of the original Japanese-language version. The purpose of this guideline is to assist medical staff in making appropriate decisions to improve the prognosis of patients undergoing treatment for sepsis and septic shock. We aimed to provide high-quality guidelines that are easy to use and understand for specialists, general clinicians, and multidisciplinary medical professionals. J-SSCG 2016 took up new subjects that were not present in SSCG 2016 (e.g., ICU-acquired weakness [ICU-AW], post-intensive care syndrome [PICS], and body temperature management). The J-SSCG 2020 covered a total of 22 areas with four additional new areas (patient- and family-centered care, sepsis treatment system, neuro-intensive treatment, and stress ulcers). A total of 118 important clinical issues (clinical questions, CQs) were extracted regardless of the presence or absence of evidence. These CQs also include those that have been given particular focus within Japan. This is a large-scale guideline covering multiple fields; thus, in addition to the 25 committee members, we had the participation and support of a total of 226 members who are professionals (physicians, nurses, physiotherapists, clinical engineers, and pharmacists) and medical workers with a history of sepsis or critical illness. The GRADE method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members.As a result, 79 GRADE-based recommendations, 5 Good Practice Statements (GPS), 18 expert consensuses, 27 answers to background questions (BQs), and summaries of definitions and diagnosis of sepsis were created as responses to 118 CQs. We also incorporated visual information for each CQ according to the time course of treatment, and we will also distribute this as an app. The J-SSCG 2020 is expected to be widely used as a useful bedside guideline in the field of sepsis treatment both in Japan and overseas involving multiple disciplines.

6.
Open Forum Infect Dis ; 7(7): ofaa243, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32754627

RESUMO

BACKGROUND: Severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) was found to be the causative microorganism of coronavirus disease 2019 (COVID-19), which started to spread in Wuhan, China. This study was to evaluate the effectiveness of questionnaire, symptoms-based screening, and polymerase chain reaction (PCR) screening of returnees from COVID-19-endemic areas on a chartered flight, to examine the proportion of infected persons and the proportion of asymptomatic persons among infected persons who returned from Wuhan. METHODS: A retrospective cohort study was done in 7 tertiary medical institutions in Japan. A total of 566 Japanese who returned from Wuhan participated in the study. RESULTS: Overall, 11 of the 566 passengers had a positive SARS-CoV-2 PCR result for pharyngeal swabs and 6 were asymptomatic. Only fever differed between SARS-CoV-2-positive and -negative individuals (P < .043). Six of the 11 PCR-positive individuals were asymptomatic; 4 remained positive on day 10, and 1 asymptomatic person tested positive up to day 27. Two of the 11 were negative on the first PCR test and positive on the second. CONCLUSIONS: Our results will be important insights on screening returnees from locked-down cities, as well as providing important data on the proportion of asymptomatic individuals infected with SARS-CoV-2. A 13-day observation period and a second round of PCR may be effective to screen patients, including asymptomatic infections.

7.
Am J Case Rep ; 21: e922960, 2020 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-32374721

RESUMO

BACKGROUND Calcified amorphous tumor (CAT) of the heart is a rare non-neoplastic intracardiac mass, which is composed of calcium deposition surrounded by amorphous fibrous tissue. The clinical presentation of cardiac CAT resembles that of other cardiac tumors or vegetation, though there is no previous report of a CAT complicated with infective endocarditis. CASE REPORT A 67-year-old male with a history of end stage renal failure and gastric cancer who was on adjuvant chemotherapy presented with a cardiac mass. The mass was resected and diagnosed as CAT pathologically. Two separate sets of blood cultures were positive for Enterococcus faecalis, thus, the patient was diagnosed with infective endocarditis. Antibiotic treatment was continued for 6 weeks after surgery, and the patient recovered uneventfully. However, he died from a complication of his gastric cancer 5 months later. CONCLUSIONS This is the first report of CAT associated with infective endocarditis. Blood cultures should be obtained to differentiate infective endocarditis or CAT with infectious endocarditis from CAT alone, because CAT with infective endocarditis may present atypically and may be more likely to require antibiotic treatment along with surgery.


Assuntos
Calcinose/patologia , Endocardite/diagnóstico , Neoplasias Cardíacas/patologia , Idoso , Endocardite/microbiologia , Enterococcus faecalis , Infecções por Bactérias Gram-Positivas/diagnóstico , Humanos , Masculino
8.
J Nutr Sci Vitaminol (Tokyo) ; 66(1): 60-67, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32115455

RESUMO

A treatment for hyperphosphatemia would be expected to reduce mortality rates for CKD and dialysis patients. Although rodent studies have suggested sodium-dependent phosphate transporter type IIb (NaPi-IIb) as a potential target for hyperphosphatemia, NaPi-IIb selective inhibitors failed to achieve efficacy in human clinical trials. In this study, we analyzed phosphate metabolism in rats, dogs, and monkeys to confirm the species differences. Factors related to phosphate metabolism were measured and intestinal phosphate absorption rate was calculated from fecal excretion in each species. Phosphate uptake by intestinal brush border membrane vesicles (BBMV) and the mRNA expression of NaPi-IIb, PiT-1, and PiT-2 were analyzed. In addition, alkaline phosphatase (ALP) activity was evaluated. The intestinal phosphate absorption rate, including phosphate uptake by BBMV and NaPi-IIb expression, was the highest in dogs. Notably, urinary phosphate excretion was the lowest in monkeys, and their intestinal phosphate absorption rate was by far the lowest. Dogs and rats showed positive correlations between Vmax/Km of phosphate uptake in BBMV and NaPi-IIb expression. Although phosphate uptake was observed in the BBMV of monkeys, NaPi-IIb expression was not detected and ALP activity was low. This study revealed significant species differences in intestinal phosphate absorption. NaPi-IIb contributes to intestinal phosphate uptake in rats and dogs. However, in monkeys, phosphate is poorly absorbed due to the slight degradation of organic phosphate in the intestine.


Assuntos
Absorção Intestinal/fisiologia , Microvilosidades/metabolismo , Fosfatos/metabolismo , Fosfatase Alcalina/metabolismo , Animais , Cães , Haplorrinos , Ratos , Proteínas Cotransportadoras de Sódio-Fosfato Tipo IIb/análise , Proteínas Cotransportadoras de Sódio-Fosfato Tipo IIb/genética , Proteínas Cotransportadoras de Sódio-Fosfato Tipo IIb/metabolismo , Especificidade da Espécie
9.
Int J Infect Dis ; 95: 210-215, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32205285

RESUMO

OBJECTIVES: The infectious diseases team at Kameda Medical Center, Japan, implemented a new outpatient parenteral antimicrobial therapy (OPAT) program in July 2012 and expanded the program with the support of home care services. This study reviews the OPAT program after 5.5 years of operation. METHODS: We prospectively collected data about the age, sex, diagnoses, causative organisms, types of OPAT, modes of administration, selected antibiotics, treatment durations, bed days saved, outcomes, readmissions, and estimated cost reductions of all patients who were treated in the OPAT program from July 2012 to December 2017. RESULTS: Of the 66 patients treated under the OPAT program, 45 (68.2%) were treated using clinic OPAT, and 21 (31.8%) were treated using homecare OPAT. The most commonly targeted organism was methicillin-susceptible Staphylococcus aureus. Continuous infusion with elastomeric pumps was employed in 55 patients (83.3%). Cefazolin was the most frequently used antibiotic (39.4%), followed by penicillin G (24.2%). The median OPAT duration was 13 days (range, 3-51), and the total bed days saved was 923. The estimated medical cost reduction was approximately 87,000 US dollars. CONCLUSIONS: Our experience shows that OPAT is a safe and feasible practice not only for efficient bed utilization and medical cost savings but also for better antimicrobial stewardship.


Assuntos
Antibacterianos/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial , Gestão de Antimicrobianos , Cefazolina/uso terapêutico , Feminino , Humanos , Japão , Masculino , Staphylococcus aureus Resistente à Meticilina , Pessoa de Meia-Idade , Penicilina G/uso terapêutico , Estudos Prospectivos , Centros de Atenção Terciária
10.
J Infect Chemother ; 26(2): 308-311, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31680035

RESUMO

Acinetobacter spp. are known to be a cause of nosocomial infections and to have diverse mechanisms of resistance to antimicrobials. Here, we report the case of a patient who presented to our emergency department with necrotizing fasciitis due to Acinetobacter junii as confirmed by Matrix-Assisted Laser Desorption/Ionization Time-of-Flight mass spectrometry (MALDI-TOF MS). Patients with liver cirrhosis are susceptible to gram-negative infection. Moreover, although Acinetobacter spp. infection is best known to be a cause of combat-related-skin and soft-tissue infections, we propose that medical professionals need to consider the presence of these potentially multi-drug-resistant, gram-negative pathogens when treating patients with liver cirrhosis who present with severe soft-tissue infections. To our knowledge, this is the first case report of severe-skin and soft-tissue infections caused by A. junii.


Assuntos
Infecções por Acinetobacter/diagnóstico , Acinetobacter/isolamento & purificação , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/microbiologia , Cirrose Hepática/complicações , Infecções por Acinetobacter/complicações , Infecções por Acinetobacter/tratamento farmacológico , Infecções por Acinetobacter/microbiologia , Idoso , Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/microbiologia , Fasciite Necrosante/complicações , Fasciite Necrosante/tratamento farmacológico , Humanos , Perna (Membro)/patologia , Masculino , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/métodos , Resultado do Tratamento , Ferimentos e Lesões/microbiologia
11.
J Infect Chemother ; 26(3): 285-288, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31680037

RESUMO

Ceftriaxone (CTRX) is a third-generation cephalosporin commonly used to treat infections such as community-acquired pneumonia and urinary tract infections caused by mainly Gram-negative bacteria and some Gram-positive bacteria. Here, we report a case of a patient on hemodialysis who had chorea-like symptoms with high blood concentration of CTRX. A 74-year-old Japanese woman receiving hemodialysis was admitted with obstructive cholangitis and was started on CTRX therapy at a dose of 2 g every 24 hours. On the 6th day after starting administration of CTRX, chorea-like symptoms appeared. We suspected that her symptoms were caused by a high blood concentration of CTRX. We performed a series of blood sampling to determine the concentration of CTRX at different time points before and after discontinuing CTRX administration. CTRX concentrations were higher than those expected in healthy adults, and her chorea-like symptoms had disappeared from the second day of discontinuation of CTRX. The association between CTRX blood concentration and chorea-like symptoms is unclear. However, measuring a series of plasma or serum concentrations from symptom onset to disappearance suggested that chorea-like symptoms appeared when the concentration exceeded approximately 450 µg/mL. Care should be taken when administering CTRX to patients with cholestasis undergoing hemodialysis, as blood CTRX levels may rise unexpectedly and result in complications.


Assuntos
Antibacterianos , Ceftriaxona , Coreia/induzido quimicamente , Idoso , Antibacterianos/efeitos adversos , Antibacterianos/sangue , Antibacterianos/farmacocinética , Antibacterianos/uso terapêutico , Ceftriaxona/efeitos adversos , Ceftriaxona/sangue , Ceftriaxona/farmacocinética , Ceftriaxona/uso terapêutico , Colangite/tratamento farmacológico , Coreia/fisiopatologia , Feminino , Humanos , Diálise Renal
12.
J Comp Eff Res ; 8(15): 1275-1284, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31736321

RESUMO

Aim: To compare hospital mortality in patients with aspiration-associated pneumonia treated with ceftriaxone (CTRX) and in those treated with ampicillin/sulbactam (ABPC/SBT). Methods: From a Japanese multicentre observational study cohort of patients with pneumonia, those diagnosed with pneumonia and having at least one aspiration-related risk factor were selected. Propensity score-matching analysis was used to balance baseline characteristics of the participants and compare hospital mortality of patients treated with CTRX and those treated with ABPC/SBT. Results: Hospital mortality did not significantly differ between patients treated with CTRX and those treated with ABPC/SBT (6.6 vs 10.7%, risk difference -4.0, 95% CI [-9.4, 1.3]; p = 0.143). Conclusion: Further studies are needed to compare CTRX and ABPC/SBT treatments in patients with aspiration-associated pneumonia.


Assuntos
Ceftriaxona/uso terapêutico , Pneumonia Aspirativa/tratamento farmacológico , Pneumonia Aspirativa/mortalidade , Idoso , Idoso de 80 Anos ou mais , Ampicilina/uso terapêutico , Feminino , Humanos , Masculino , Pontuação de Propensão , Fatores de Risco , Sulbactam/uso terapêutico
13.
Anaerobe ; 60: 102107, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31647977

RESUMO

BACKGROUND: The optimal and practical laboratory diagnostic approach for detection of Clostridioides difficile to aid in the diagnosis of C. difficile infection (CDI) is controversial. A two-step algorithm with initial detection of glutamate dehydrogenase (GDH) or nucleic acid amplification test (NAAT) alone are recommended as a predominant method for C. difficile detection in developed countries. The aim of this study was to compare the performance of enzyme immunoassays (EIA) detecting toxins A and B, NAAT detecting the toxin B gene, and GDH compared to toxigenic culture (TC) for C. difficile as the gold standard, in patients prospectively and actively assessed with clinically significant diarrhea in 12 medical facilities in Japan. METHODS: A total of 650 stool specimens were collected from 566 patients with at least three diarrheal bowel movements (Bristol stool grade 6-7) in the preceding 24 h. EIA and GDH were performed at each hospital, and NAAT and toxigenic C. difficile culture with enriched media were performed at the National Institute of Infectious Diseases. All C. difficile isolates recovered were analyzed by PCR-ribotyping. RESULTS: Compared to TC, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of EIA were 41%, 96%, 75% and 84%, respectively, and for NAAT were 74%, 98%, 91%, and 92%, respectively. In 439 specimens tested with GDH, the sensitivity, specificity, PPV, and NPV were 73%, 87%, 65%, and 91%, and for an algorithm (GDH plus toxin EIA, arbitrated by NAAT) were 71%, 96%, 85%, and 91%, respectively. Among 157 isolates recovered, 75% of isolates corresponded to one of PCR-ribotypes (RTs) 002, 014, 018/018", and 369; RT027 was not isolated. No clear differences in the sensitivities of any of EIA, NAAT and GDH for four predominant RTs were found. CONCLUSION: The analytical sensitivities of NAAT and GDH-algorithm to detect toxigenic C. difficile in this study were lower than most previous reports. This study also found low PPV of EIAs. The optimal method to detect C. difficile or its toxins to assist in the diagnosis of CDI needs further investigation.


Assuntos
Técnicas Bacteriológicas , Clostridioides difficile/genética , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/microbiologia , Toxinas Bacterianas/genética , Técnicas Bacteriológicas/métodos , Técnicas Bacteriológicas/normas , Clostridioides difficile/classificação , Clostridioides difficile/isolamento & purificação , Infecções por Clostridium/epidemiologia , Feminino , Humanos , Japão/epidemiologia , Masculino , Reação em Cadeia da Polimerase , Estudos Prospectivos , Ribotipagem , Sensibilidade e Especificidade
14.
Anaerobe ; 60: 102011, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30872073

RESUMO

Clostridioides (Clostridium) difficile is the leading cause of healthcare-associated infectious diarrhea in the developed world. Retrospective studies have shown a lower incidence of C. difficile infection (CDI) in Japan than in Europe or North America. Prospective studies are needed to determine if this is due lack of testing for C. difficile or a true difference in CDI epidemiology. A prospective cohort study of CDI was conducted from May 2014 to May 2015 at 12 medical facilities (20 wards) in Japan. Patients with at least three diarrheal bowel movements (Bristol stool grade 6-7) in the preceding 24 h were enrolled. CDI was defined by positive result on enzyme immunoassay for toxins A/B, nucleic acid amplification test for the toxin B gene or toxigenic culture. C. difficile isolates were subjected to PCR-ribotyping (RT), slpA-sequence typing (slpA-ST), and antimicrobial susceptibility testing. The overall incidence of CDI was 7.4/10,000 patient-days (PD). The incidence was highest in the five ICU wards (22.2 CDI/10,000 PD; range: 13.9-75.5/10,000 PD). The testing frequency and CDI incidence rate were highly correlated (R2 = 0.91). Of the 146 isolates, RT018/018″ was dominant (29%), followed by types 014 (23%), 002 (12%), and 369 (11%). Among the 15 non-ICU wards, two had high CDI incidence rates (13.0 and 15.9 CDI/10,000 PD), with clusters of RT018/slpA-ST smz-02 and 018"/smz-01, respectively. Three non-RT027 or 078 binary toxin-positive isolates were found. All RT018/018" isolates were resistant to moxifloxacin, gatifloxacin, clindamycin, and erythromycin. This study identified a higher CDI incidence in Japanese hospitals than previously reported by actively identifying and testing patients with clinically significant diarrhea. This suggests numerous patients with CDI are being overlooked due to inadequate diagnostic testing in Japan.


Assuntos
Clostridioides difficile , Infecções por Clostridium/epidemiologia , Infecções por Clostridium/microbiologia , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Clostridioides difficile/classificação , Clostridioides difficile/efeitos dos fármacos , Clostridioides difficile/genética , Geografia Médica , Humanos , Incidência , Japão/epidemiologia , Testes de Sensibilidade Microbiana , Tipagem Molecular , Vigilância em Saúde Pública , Estudos Retrospectivos , Ribotipagem
15.
J Gen Fam Med ; 20(1): 31-32, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30631658

RESUMO

A 76-year-old man presented with a 3-day history of a productive cough and right chest pain on inspiration. The Gram stain of the sputum showed unstained bacilli and polynuclear leukocytes, suggesting a diagnosis of pulmonary acid-fast bacillus infection. Mycobacteria can be identified by Gram staining and are reported to be Gram-neutral or Gram-ghost, and recognition of Gram-ghost bacilli in the initial specimen may assist in distinguishing mycobacterial infection from community-acquired pneumonia.

16.
J Infect Chemother ; 25(2): 141-146, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30100399

RESUMO

Lactococcus lactis is a rare causative organism in humans. Cases of L. lactis infection have only rarely been reported. However, because it is often difficult to identify by conventional commercially available methods, its incidence may be underestimated. We herein report the case of a 70-year-old man with cholangiocarcinoma who developed L. lactis cholangitis and review previously reported cases of L. lactis infection. Our case was confirmed by matrix-assisted desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). This case shows L. lactis is a potential causative pathogen of cholangitis and that MALDI-TOF MS can be useful for the rapid and accurate identification of L. lactis infection. We searched the literature for published case reports on cholangitis and any other infections caused by L. lactis, and thereby identified 36 cases, including our case. At least 66.7% (n = 24) of the cases had significant underlying conditions; 15 of the cases involved patients with an immunocompromised status. At least 41.7% (n = 15) had a significant food consumption history, such as the consumption of unpasteurized dairy products. The clinical sources of L. lactis were diverse and endocarditis was the most common diagnosis (n = 8), followed by hepatobiliary infection (n = 6), central nervous system infection (n = 5), and peritonitis (n = 4). The prognosis was favorable in most cases.


Assuntos
Bacteriemia/diagnóstico , Colangite/diagnóstico , Infecções por Bactérias Gram-Positivas/diagnóstico , Lactococcus lactis , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/métodos , Idoso , Humanos , Masculino , Tipagem Molecular
17.
Intern Med ; 58(2): 301-305, 2019 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-30210104

RESUMO

A 62-year-old man with diabetes mellitus and a two-day history of fever and dyspnea presented at our hospital. He was diagnosed with community-acquired pneumonia (CAP), septic shock, and respiratory failure. Sputum Gram staining revealed Gram-negative coccobacilli. Based on the Gram staining findings and history, Acinetobacter baumannii was considered as one of the causative organisms of his CAP. Consequently, he was successfully treated with the initial administration of meropenem. We suggest that A. baumannii should be considered as one of the possible causative organisms of CAP based on a fulminant clinical course, and the presence of Gram-negative coccobacilli.


Assuntos
Infecções por Acinetobacter/tratamento farmacológico , Acinetobacter baumannii , Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/microbiologia , Meropeném/uso terapêutico , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/microbiologia , Escarro/microbiologia , Infecções por Acinetobacter/diagnóstico , Infecções por Acinetobacter/microbiologia , Técnicas Bacteriológicas , Infecções Comunitárias Adquiridas/diagnóstico , Dispneia/microbiologia , Febre/microbiologia , Violeta Genciana , Humanos , Masculino , Pessoa de Meia-Idade , Fenazinas , Pneumonia Bacteriana/diagnóstico , Insuficiência Respiratória/microbiologia , Choque Séptico/diagnóstico , Choque Séptico/tratamento farmacológico , Choque Séptico/microbiologia , Coloração e Rotulagem
18.
IDCases ; 12: 119-120, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29942766

RESUMO

Strepotocuccus suis (S. suis) infection is known to be caused by the exposure to contaminated animals, specifically pigs and wild boars. This pathogen can cause bacterial meningitis, and one report indicated that it is the most common pathogen causing bacterial meningitis in Vietnam (Mai et al., 2008). A 67-year-old man was diagnosed with S. suis bacteremia and meningitis. In general, identification of this pathogen using standard biochemical methods takes time. We successfully diagnosed S. suis bacteremia in this patient, however, using the relatively new technology called Matrix-Assisted Laser Desorption/Ionization Time-of-Flight mass spectrometry (MALDI-TOF MS). Knowledge of the characteristics of S. suis and this newer technology led to the definitive diagnosis and prompt management of this patient. Herein, we highlight the use of a new technology in the context of sound microbiological knowledge in caring for patients.

19.
Intern Med ; 57(16): 2439, 2018 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-29607977
20.
Vaccine ; 36(21): 2960-2967, 2018 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-29685596

RESUMO

BACKGROUND: The effectiveness of inactivated influenza vaccine (IIV) against laboratory-confirmed influenza pneumonia in older adults remains to be established. METHODS: Pneumonia patients aged ≥65 years who visited a study hospital in Chiba, Japan, were prospectively enrolled from February 2012 to January 2014. Sputum samples were collected from participants and tested for influenza virus by polymerase chain reaction assays. Influenza vaccine effectiveness (IVE) against laboratory-confirmed influenza pneumonia was estimated by a test-negative design. RESULTS: Among a total of 814 pneumonia patients, 42 (5.2%) tested positive for influenza: 40 were positive for influenza A virus, and two were positive for influenza B virus. The IVE against laboratory-confirmed influenza pneumonia was 58.3% (95% confidence interval, 28.8-75.6%). The IVE against influenza pneumonia hospital admission, severe pneumonia, and death was 60.2% (95% CI, 22.8-79.4%), 65.5% (95% CI, 44.3-78.7%), and 71% (95% CI, -62.9% to 94.8%), respectively. In the subgroup analyses, the IVE against influenza pneumonia was higher for patients with immunosuppressive conditions (85.9%; 95% CI, 67.4-93.9%) than for those without (48.7%; 95% CI, 2.7-73%) but did not differ by patients' statin use status. CONCLUSION: IIV effectively reduces the risk of laboratory-confirmed influenza pneumonia in older adults.


Assuntos
Vacinas contra Influenza/administração & dosagem , Vacinas contra Influenza/imunologia , Influenza Humana/prevenção & controle , Pneumonia/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Animais , Feminino , Humanos , Japão/epidemiologia , Masculino , Orthomyxoviridae/isolamento & purificação , Pneumonia/epidemiologia , Reação em Cadeia da Polimerase , Estudos Prospectivos , Escarro/virologia , Resultado do Tratamento
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