Frequency and risk factors for sepsis resulting from neuroendovascular treatment.

OBJECTIVE: Endovascular treatments are minimally invasive and rarely cause complicating infections. Although cases complicated by device infections have been reported, we could not find any studies evaluating infections following neuroendovascular treatment in particular. Therefore, we assessed the frequency of sepsis and other associated risk factors. METHODS: From September 2006 to May 2008, we investigated 256 prospective neuroendovascular treatment cases at our facility. We examined the frequency of sepsis and other associated risk factors as well as organisms and the early detection tests such as various cultures and serodiagnoses. RESULTS: The rate of sepsis due to complications was 8.6% in the aggregate and 5.7% in 193 procedures without a central venous catheter and hemodialysis. All sepsis cases were successfully treated with antibiotics. However, in 2 cases, the patients developed methicillin-resistant STAPHYLOCOCCUS AUREUS infections, which were intractable. The highest risk factors for sepsis were a large sheath size [>7 F; OR =5.03; P =0.01; 95% confidence interval (CI) 1.29-19.47] and meningioma embolization (OR =13.25; P =0.04; 95% CI 1.07-163.56). The degree to which experienced staff (OR =0.09; P =0.05; 95% CI 0.09-0.97) affected the incidence of sepsis was less significant. Microorganisms were isolated from half the operating field, and the risk factor, in this case, depended on inexperienced surgical staff (OR =1.98; P =0.03; 95% CI 1.07-3.67). Although we were unable to find a means to predict sepsis, we presumed antibiotic prophylaxis would be useful. CONCLUSIONS: The frequency of sepsis following neuroendovascular treatment is high. We should pay particular attention to the sterilization process and the operating field when undertaking neuroendovascular treatment that requires the use of a large-size sheath in patients with serious conditions.

Evaluation of a high-speed but low-throughput RT-qPCR system for detection of SARS-CoV-2.

With the emergence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), a high-speed and convenient detection technology should be at the forefront of medical care worldwide. This study evaluated the usefulness of GeneSoC, a compact, high-speed reciprocal flow quantitative reverse transcription polymerase chain reaction system, for the detection of SARS-CoV-2. The results support the use of this system for the rapid identification of SARS-CoV-2. This approach can contribute to the strategic selection of initial management strategies for patients with COVID-19.

Topical treatment of pulmonary aspergilloma by antifungals. Relationship between duration of the disease and efficacy of therapy.

Twelve patients with aspergilloma were treated with intracavitary or endobronchial administration of antifungals. Patients with successful therapy had significantly shorter mean duration of the disease course (3.6 months) than the less effective group (44.4 months, p < 0.01). Minimal inhibitory concentrations of antifungal agents against isolated strains of aspergilli were considerably lower than estimated intracavitary concentrations of the antifungals. A pathologic examination suggested that the old mycetoma was for the most part comprised of dead mycelial cells, against which antifungal agents were not effective. However, clinical improvement was obtained, regardless of the roentgenographic improvement. Our study suggested that early diagnosis and therapy are recommended to achieve better therapeutic effect.

A clinical comparison between Mycobacterium avium and Mycobacterium intracellulare infections.

Susceptibility, clinical features, and response to treatment were compared between 29 cases of Mycobacterium avium infection and 43 cases of Mycobacterium intracellulare infection detected in the Nagasaki (Japan) area and identified by a DNA probe method. In vitro susceptibility of two species to antituberculous agents was determined by a microdilution method, and M avium was more resistant to enviomycin at 25 mg/L than M intracellulare, while M intracellulare was more resistant to isoniazid at 5 mg/L and to cycloserine at 20 mg/L. No significant difference was found between infections caused by two species as to background factors, laboratory data, clinical symptoms, and chest radiographic findings at the onset of the disease. Approximately 70 percent of the patients in each group had underlying diseases; among them, pulmonary tuberculosis was the most common. Negative conversion of bacilli during the 6-month treatment was seen in 17 of 29 patients (59 percent) with M avium infection and in 21 of 43 patients (49 percent) with M intracellulare infection. Bacilli-negative conversion was slightly faster in the former than in the latter. However, these differences were statistically not significant. In conclusion, most M avium-intracellulare complex organisms are clearly identified as M avium or M intracellulare by the DNA probe method, and there was no significant difference in clinical features and response to treatment between infections caused by the two species.

Prospective comparative study of ofloxacin or ethambutol for the treatment of pulmonary tuberculosis.

The efficacy of ofloxacin, rifampicin and isoniazid was prospectively compared with the regimen of ethambutol, rifampicin and isoniazid for the primary treatment of pulmonary tuberculosis in 124 patients. All drugs were given orally daily for nine months. Culture conversion rates three months after starting treatment were 98 percent in the ofloxacin group and 94 percent in the ethambutol group; by six months all patients in both groups were culture-negative. Significant radiological improvement of pulmonary infiltrates was observed in 83 percent of the ofloxacin group and 85 percent of the ethambutol group one year after starting treatment. No relapse in either group was observed during a two-year follow-up period after the cessation of chemotherapy. Ofloxacin appears to be as useful as ethambutol in the treatment of pulmonary tuberculosis when either drug is combined with isoniazid and rifampicin.

Effect of sequential combination of amphotericin B and azole antifungal agents against Aspergillus fumigatus.

Patients with aspergillosis have a poor prognosis because there are no effective antifungal agents except for amphotericin B. However, administration of amphotericin B is limited in immunocompromised patients due to its toxicity, which includes impairment of renal function. We attempted to evaluate the efficacy of a sequential combination of antifungal agents against Aspergillus fumigatus strain. The in vitro effects of sequential combinations of antifungal agents against five strains of Aspergillus fumigatus were determined by assessing changes in the wet weight of mycelial cells. The effect of a sequential combination was examined by pretreating mycelial cells with an antifungal agent, followed by the addition of a second antifungal agent. Pretreatment with amphotericin B (AMPH) followed by miconazole (MCZ) or fluconazole (FLCZ) resulted in better in vitro effects compared with the effect of simultaneous use of the agents. In contrast, pretreatment of mycelial cells with azole antifungal agents, other than MCZ, followed by AMPH, resulted in an increase in the wet weight compared with that recorded after simultaneous incubation with AMPH and azole antifungal agents. Our results showed that combined treatment, of AMPH followed by MCZ or FLCZ, inhibited the growth of A. fumigatus, suggesting that such a regimen may be effective against aspergillosis.

Clinical evaluation of 61 patients with pulmonary aspergilloma.

OBJECTIVE AND METHODS: We retrospectively evaluated 61 cases with pulmonary aspergilloma representing patients admitted to Nagasaki University Hospital between January 1991 to June 1998. RESULTS: Fifty-two (85%) were males and 9 (15%) were females, aged between 14 to 80 years (average, 65 years). Forty-four (72%) patients had history of old pulmonary tuberculosis. Chest radiographs showed "fungus ball" in the cavities in 42 (67%) cases while 16 (26%) cases showed thickening of the cavity wall. Aspergillus fumigatus was isolated in 24 (39%) patients. Aspergillus antigen or antibody was positive in 8 (13%) and 43 (70%) patients, respectively. Oral itraconazole was used in 16 (26%) of patients, and surgical excision was performed in 15 (25%) patients. During hospitalization or after discharge, 19 (31 %) patients died. SUMMARY AND CONCLUSION: Pulmonary aspergilloma usually occurs in elderly patients with old tuberculosis and respiratory failure. Many cases did not respond to antifungal therapy with itraconazole or amphotericin B. Our analysis indicates that more effective and appropriate therapeutic regimens are needed for the treatment of patients with pulmonary aspergilloma.

Detection of Cryptococcus neoformans in bronchial lavage cytology: report of four cases.

Four cases of pulmonary cryptococcosis were diagnosed by cytological detection of Cryptococcus neoformans in bronchial lavage. Three patients had underlying diseases, but not HIV infection. The chest X-rays showed 2 patients with nodular lesions and 2 with cavitary lesions. The cryptococcal antigen in the serum was positive in all four patients. In the cytology of bronchial lavage, Cryptococcus neoformans was detected after period-acid-Schiff (PAS) staining and was cultured in Sabouraud-dextrose agar. The cytology of bronchial lavage is useful for the rapid diagnosis of pulmonary cryptococcosis.

Superinfection of chronic necrotizing pulmonary aspergillosis by Mycobacterium tuberculosis.

A 63-year-old woman with chronic necrotizing pulmonary aspergillosis complicated by active pulmonary tuberculosis is reported. A small infiltrative shadow appeared, but no definite diagnosis was made. Six years later the shadow was found to have increased in size; chest CT revealed a fungus ball, while a transbronchial lung biopsy revealed aspergillus hyphae. The intrabronchial inoculation of amphotericin B proved ineffective, and a lobectomy was performed. Histopathologic findings showed necrotic granulomas containing aspergillus and some acid-fast bacilli. While the superinfection of healed tuberculous lesions by Mycobacteria or Aspergillus species is well documented, their coexistence is rare.

An adult case of severe chronic active Epstein-Barr virus infection syndrome.

A 23-year-old man with persisting high fever developed hepatosplenomegaly, lymphadenopathy and massive pericardial effusion. Immunological examination revealed a marked elevation of anti-Epstein-Barr virus antibodies (anti-viral capsid antigens IgG-antibody 1:10,240, anti-early antigens-DR IgG-antibody 1:5,120), decreased activities of Epstein-Barr virus specific cytotoxic T lymphocytes, natural killer cells and lymphokine activated killer cells. A liver biopsy showed moderate sinusoidal lymphocytosis with punched-out lesions. These findings suggested severe chronic active Epstein-Barr virus infection syndrome. The patient was treated with recombinant human interleukin-2, but it was discontinued because of an adverse reaction. Twelve months later, he died of suspected pulmonary infection.

Aspergillus fumigatus isolated from blood samples of a patient with pulmonary aspergilloma after embolization.

Aspergillus DNA was detected by PCR in the serum sample of a 78-year-old man and galactomannan antigen of Aspergillus by sandwich ELISA was found. However, the infiltrative hyphae were not detected by the histopathologic examination of the lung. He developed hemoptysis, which required embolization of bronchial arteries. Aspergillus fumigatus was isolated from blood samples after embolization by the lysis centrifugation method. To our knowledge, this is probably the first case in which Aspergillus spp. has been isolated from the systemic circulatory blood in a patient with pulmonary aspergilloma after embolization.

Invasive pulmonary aspergillosis diagnosed early by polymerase chain reaction assay.

We compared the usefulness of a polymerase chain reaction (PCR) assay for the early diagnosis of invasive pulmonary aspergillosis with the serodiagnosis of sufficient concentrations of galactomannan using the same serum samples. A patient was treated with prednisolone for the management of hepatitis. Computed tomography (CT) scan of the chest showed the nodular shadow with a cavity containing a clear fungus ball. DNA of Aspergillus spp. from a serum sample was detected and using the same serum sample, both latex agglutination and sandwich enzyme-linked immunosorbent assay (ELISA) of galactomannan were negative. PCR assay provides an early diagnosis of invasive pulmonary aspergillosis compared with ELISA of galactomannan.

An outbreak of Legionnaires' pneumonia in a nursing home.

An outbreak of Legionnaires' pneumonia occurred at a nursing home in December 1990. A 79-year-old female and a 73-year-old male clerk who were staying at the nursing home developed pneumonia with only a 5-day interval. Legionella pneumophila serogroup I was isolated from transtracheal aspirate of the former and sputum of the latter. After treatment with a combination of erythromycin and rifampicin both patients improved. Serological surveillance of inpatients and staff of the nursing home was performed in February 1991. Seven out of 51 samples (14.0%) showed a titer higher than 1:128 of anti-Legionella pneumophila serogroup I antibody determined by indirect immunofluorescence; two of these seven complained of respiratory symptoms. Molecular epidemiology analyzed by restriction endonuclease digestion of isolated L. pneumophila showed an identical pattern which suggested a common origin.

Fatal pneumonia caused by Corynebacterium group JK after treatment of Staphylococcus aureus pneumonia.

A 76-year-old man who was admitted to the hospital because of chronic renal insufficiency and chronic hepatitis died of Corynebacterium group JK pneumonia, after showing a slight improvement by treatment of Staphylococcus aureus with sulbactam/cefoperazone and minocycline. Transtracheal aspiration (TTA) just before his death revealed numerous gram-positive bacilli phagocytized by many neutrophils and more than 10(8) colony forming units (CFU)/ml of Corynebacterium group JK. A drug susceptibility test showed Corynebacterium group JK was resistant to many antibiotics, with the exception of vancomycin and amikacin.

Evaluation of sandwich ELISA galactomannan test in samples of positive LA test and positive aspergillus antibody.

OBJECTIVE: The detection of circulating Aspergillus galactomannan antigen is a useful tool for serodiagnosis of aspergillosis. However, the latex agglutination test for the detection of galactomannan is not completely reliable due to it's low sensitivity. The sandwich ELISA was developed to achieve high sensitivity. MATERIALS: The sandwich immunocapture ELISA was evaluated by testing 56 sero-positive and 56 sero-negative samples of circulating galactomannan detected by LA test retrospectively. RESULTS: Sixty of the samples were positive for galactomannan as measured by sandwich ELISA. Fifteen samples out of 56 samples negative by LA test were positive by ELISA and 4 samples out of 56 samples positive by LA test were negative by ELISA. Among 47 serum samples positive for anti-Aspergillus antibody, 14 samples were positive by ELISA. CONCLUSION: In conclusion, galactomannan may be detected in more samples of by the new sandwich ELISA than by LA test.

[The future of antifungal agents. Non azole antifungal agents].

We investigated the efficacy of non-azole antifungal agents. Long circulating immunoliposomal amphotericin B was potent in murine invasive pulmonary aspergillosis. The concentration of AMPH-B was still high in the lung after 6 hours of 34A-PEG-liposomal AMPH-B. Lipid nanosphere amphotericin B (NS-718) showed efficacy against pulmonary aspergillosis in rats and pulmonary cryptococcosis in mice. The renal toxicity of NS-718 was estimated to be lower than that of AMPH-B from the results of the toxicity study in the rat infusion model. FK 463, a novel (1,3)-beta-D-glucan synthase inhibitor, showed efficacy against azole-resistant Candida albicans in murine experimental disseminated candidiasis. FK463 could be a promising drug and the therapy of choice for azole resistant C. albicans infection.

[A case of invasive aspergillosis in an amyloidosis patient].

A sixty-four-year-old male patient was admitted on 13 April 1995 with diagnosis of old pulmonary tuberculosis and pulmonary aspergilloma. He developed a tarry stool and frequent loose motion in early November 1995. Histopathological findings of endoscopic biopsy from the duodenum and colon were suggestive of secondary amyloidosis. In spite of antibiotic and steroid pulse, he developed shock, and massive infiltration shadow appeared in chest X-ray. The patient died on 29 December 1995. The postmortem examination in the specimens of the lung, heart, kidney, liver, and spleen revealed hyphae of Aspergillus sp. and in the specimens of the lung, kidney, spleen, esophagus, adrenal gland, and thyroid revealed amyloid. He was finally diagnosed as invasive aspergillosis with secondary amyloidosis.

[Severe mycosis-factors with fungus and host].

The deep-seated mycosis occurred in immunocompromized patients. Normally, the deep-seated mycosis became sever infection because of the defects of host defense or the adverse effects of antifungal agents. The major factors of the reason on the severity of the deep-seated mycosis depends on the pathogenesity and the drug resistance for antifungal agents in infected fungi. The clinical factors related with hosts defenses are important to the other reason on the severity. We investigated that the multiple drug resistant (MDR) mechanism may be one of the major roles plays in the azole resistant Candida albicans strains isolated form the patients with oropharyngeal candidiasis infected HIV. We analyzed which clinical factors are related with the prognosis of the patients with pulmonary cryptococcosis and aspergilloma. The titer of cryptococcal capsular antigen was earlier improve in the patient without underline disease than in the patients with underline diseases diagnosed pulmonary cryptococcosis. CRP was higher in the death cases in the patients with pulmonary aspergilloma, compared with alive cases.

[A case of MRSA sepsis treated by the sequential combination therapy netilmycin and minocycline].

A sixteen year old female was feverish from June 12, 1993. Methicillin-resistant Staphylococcus aureus was isolated from the blood, the diagnosis of MRSA sepsis was established. Vancomycin (2 g/day) was administered for eighteen days, but MRSA was not eradicated in the blood culture. Then she was administered a combination therapy of arbekacin (200 mg/day) and imipenem/cilastain (1 g/day) for seven days, but MRSA in the blood was cultured continuously. The sequential combination therapy of netilmycin (200 mg/day) and minocycline (200 mg/day) was started, MRSA was eradicated from the blood culture after four days. The sequential combination therapy netilmycin and minocycline was seemed to be effective for MRSA infection.

[Detection of mecA gene of methicillin resistant staphylococci from oral swabs by polymerase chain reaction].

We evaluated the polymerase chain reaction method (PCR) for the rapid detection of methicillin resistant Staphylococcus aureus (MRSA), and compared it with the conventional culture method. Primers for amplification of mecA gene were synthesized by DNA synthesizer according to the published sequences of mecA gene. The results were as follows: Specificity of PCR was excellent, as there was no cross-reaction with any organism other than MRSA. Fifty colony forming units of MRSA were detected, indicating good sensitivity. We examined oral swabs from 13 bed-ridden patients (age range: 65-82 yrs) by PCR and the conventional culture method. The PCR elicited positive results in 6 out of 13 cases. MRSA or coagulase negative Staphylococci (CNS) in Mueller-Hinton agar containing 12.5 micrograms/ml methicillin were obtained from all of these PCR-positive specimens. Two of 7 PCR-negative specimens raised MRSA or CNS colonies, but the number of colonies from these specimens was below the sensitivity threshold of the PCR. The good specificity and sensitivity of the PCR method for the detection of mecA gene obtained in this study suggest the possibility of application of this method for detection of MRSA in clinical specimens.