Onychomycosis is a frequent fungal infection of nail apparatus (particularly nail plate and nail bed). It is much more common in toenails due to their slow growth rate compared with fingernails. Onychomycosis represents one-third of all mycotic infections of skin and approximately a half of all nail disorders. It is estimated that the prevalence of onychomycosis in Japan, like many other countries, may be higher than 10% of general population and is still increasing presumably due to lifestyle changes and the ageing of the population. Dermatophytes are the most prevalent causative pathogens of onychomycosis, and two Trichophyton species, T. rubrum and T. mentagrophytes, are responsible for more than 90% of all cases. Much less frequently, onychomycosis is also caused by yeasts (mainly Candida albicans) and a wide range of nondermatophytic molds, such as Aspergillus spp., Fusarium spp., and Scopulariopsis brevicaulis. Currently, onychomycosis can be divided into five major clinical forms:(i) distal and lateral subungual onychomycosis (the most common form of the disease),(ii) superficial white onychomycosis,(iii) proximal subungual onychomycosis,(iv) endonyx onychomycosis, and (v) total dystrophic onychomycosis. A number of risk factors are associated with predisposition to onychomycosis, including advanced age, heredity, tinea pedis, diabetes, peripheral vascular disease, and immunodeficiency. Onychomycosis can cause nail disfigurement due to discoloration, thickening, distortion, irregular surface modifications and hyperkeratosis of the nail plate. In addition to such aesthetic problems, onychomycosis is often associated with pain or discomfort, leading to physical and occupational limitations and decreased QOL. Moreover, serious complications such as cellulites and secondary bacterial infections can occur in many patients with onychomycosis. The disease is also a public health concern because of its high worldwide incidence and prevalence and its potential for spreading infective fungal elements to other healthy people and for contaminating communal facilities. Therefore, rigorous clinical management should be indicated from both medical and psychosocial perspectives, and for its successful achievement, it is essential to have sufficient knowledge and understanding of mycological and clinical characteristics of onychomycosis.

We report the case of 1 year and 5-month-old boy with Kawasaki disease who clinically improved using immunoglobulin therapy. Neisseria species was isolated from his throat culture at the time of admission and identified as Neisseria meningitidis by MALDI-TOF MS. Although the explanation of attending doctor, the guardians worried about his condition and requested reexamination of his throat culture and antibiotic treatment for sterilization of N. meningitidis.They also consulted another medical institute for second opinion. After that, this isolated strain was identified as N. polysaccharea by 16S rRNA and recA gene sequences. MALDI-TOF MS is fast and cost-effective diagnostic tool of clinical microbiology laboratories. However, the result of MALDI-TOF MS should be confirmed with additional tests for N. meningitidis.

We report three cases of coronavirus disease 2019 (COVID-19) pneumonia treated with ivermectin monotherapy. The patients included two men (aged 40 and 49 years) and a woman (aged 53 years), all of whom had high fever and bilateral pneumonia. We administered 0.2 mg/kg of ivermectin orally every alternate day. They defervesced soon after, the blood inflammatory markers and chest radiographic findings improved and the patients were discharged. There was no need for additional therapy. These three patients improved following ivermectin administration. Oral ivermectin may have a role to play in the home treatment of COVID-19 patients.

Although infrequent, drug-induced agranulocytosis can be caused by antibiotics. Here, we analyzed the Japanese Adverse Drug Event Report (JADER) database to identify profiles of antibiotic-induced agranulocytosis.

We analyzed reports of agranulocytosis from April 2004 to January 2021 from the JADER database. The reporting odds ratio and 95% confidence interval were used to detect agranulocytosis signals. We evaluated the time-to-onset profile and hazard type using the Weibull shape parameter.

Ten out of 60 antibiotics showed signals for agranulocytosis; the reporting odds ratios (95% confidence intervals) for ampicillin/sulbactam, amikacin, cefmetazole, cefozopran, clindamycin, ciprofloxacin, imipenem/cilastatin, kanamycin, teicoplanin, and vancomycin were 2.65 (1.79–3.80), 2.94 (1.91–4.34), 4.48 (2.27– 6.92), 2.77 (1.88–3.95), 1.64 (1.04–2.47), 2.01 (1.40–2.82), 2.78 (2.11–3.60), 6.05 (2.16–13.7), 2.05 (1.31–3.07), and 3.54 (2.73–4.54), respectively. The median times- to-onset of agranulocytosis for ampicillin/sulbactam, cefmetazole, cefozopran, clindamycin, imipenem/cilastatin, kanamycin, teicoplanin, and vancomycin were 20, 6, 10, 16, 12, 3, 18, and 13 days, respectively. The 95% confidence intervals of the Weibull shape parameter β for these antibiotics were over and excluded 1, indicating that the antibiotics were the wear out failure type.

We identified 10 antibiotics that may be associated with high risk of agranulocytosis, suggesting that absolute neutrophil counts in patients taking these drugs should be monitored carefully in the clinical setting.