The “Diabetes Class” provides lifestyle guidance as part of patient treatment. However, outpatient visits are time-consuming and physically demanding, and may not last. We retrospectively analyzed the relationship between attendance at diabetes classes and hemoglobin A1c (HbA1c) level to verify if the guidance for diabetes treatment is effective and practical. Between 2013 and 2021, 339 people attended diabetes classes sponsored by the Department of Diabetes and Endocrinology, and their HbA1c levels were measured. Patients were 66 years old (median), and 57.2% were male. In the diabetes class, (1) doctors, (2) physical therapists, (3) nutritionists/pharmacists, and (4) nurses/medical technologists give lectures. HbA1c (NGSP) was measured using HLC-723G11 (Tosoh) within one month before and after the first and final classes. After the course, HbA1c levels worsened in 28 (8.2%), remained unchanged in 120 (35.4%), improved in 104 (30.7%), and significantly improved in 87 (25.7%). The significantly improved group was predominantly composed of males and those undergoing physical therapy. In the group with HbA1c levels above 8.0%, males who attended more than three classes and physiotherapy showed a significant improvement. The marked rate of nursing/medical technology students was also high. For diabetes, multidisciplinary teams should work together and support patients. It was shown that the number of lectures was high and that lectures on physiotherapy led to improvements in HbA1c level and were effective as educational opportunities for diabetic patients.

Purpose: Nosocomial clusters (NCs) of SARS-CoV-2 transmission are problematic because of the high infectivity of SARS-CoV-2. However, there have been few studies on the routes of infection transmission into hospitals using next-generation sequencing (NGS). In this study, whole-genome analysis using NGS, Pango lineage classification, and haplotype network analysis were conducted to analyze the transmission routes of the virus that caused NC infections. Methods: Whole-genome analysis using NGS was performed on 12 specimens from patients infected in an NC and 37 other specimens from those infected in the community (CM), which were selected from specimens that tested positive for SARS-CoV-2 by PCR analysis at Kurume University Hospital. Pango lineage classification and haplotype network analysis were performed on the obtained genome sequences to analyze the transmission routes in NC and CM. The data for Tokyo and Osaka were also obtained from GISAID to analyze the routes of infection in the cities. Results: In the Pango lineage classification, BA.2.24 was detected in all 12 NC specimens, but the CM specimens included a mixture of multiple strains of the Omicron variant. The haplotype network analysis suggested that the NC infection spread from a single route of entry from the community. NC and CM tended to be more strongly associated with Tokyo than with Osaka. It was also suggested that the disease spread from Tokyo in approximately 2 to 3 weeks. Conclusion: Whole-genome analysis and haplotype network analysis can be used to analyze the transmission routes of viral infections and provide useful information for future infection control.

Acute promyelocytic leukemia (APL) is a subtype of acute myeloid leukemia characterized by abnormal proliferation of promyelocytes and PML-RARA fusion gene. The microgranular type of APL (M3v) is characterized by a lack of cytoplasmic granules and atypical of nuclei. Thus, it is important to differentiate it from other types of monocytic AML on the basis of morphological features. Moreover, AML with CBFB-MYH11, known as M4Eo in the French–American–British classification, is diagnosed by the proliferation of myeloblasts, monoblasts, and abnormal bone-marrow eosinophils. To determine whether the CD2 expression is useful for the early detection of M3v and M4Eo, we investigated immunophenotypes especially focusing on CD2, morphologic features, and genetic/chromosomal abnormalities of APL including M3v, M4, and M4Eo. In an immunophenotypic analysis by flow cytometry (FCM), all cases of APL without the variant type were negative for CD2, and only one case of M4 showed CD2 expression. However, four of five cases (80%) of the M3v type were positive for CD2. Furthermore, eight of ten cases (75%) of M4Eo were positive for CD2. In comparison with other types of AML, including M0–M5, the frequencies of CD2 expression in M3v and M4Eo cases were statistically significantly higher (p < 0.001). In genetic and chromosomal investigations, PML-RARA mRNA and t(15;17) were detected in all cases of M3 and M3v. Moreover, all 10 cases of M4Eo showed CBFB-MYH11 mRNA, and inv(16). From these findings, the CD2 antigen will be a useful marker for diagnosing two types of leukemia, M3v and M4Eo, in the early stages, even though it is difficult to determine the type of disease on the basis of morphological findings.

A questionnaire survey was conducted among the EMTs and paramedics who gave a lecture on electrocardiography to clarify questions and demands in the emergency field. The subjects were 62 EMTs and 20 paramedics belonging to fire departments in Shimane Prefecture. Lectures were given on the current status of prehospital 12-lead electrocardiogram, how to apply the monitor and 12-lead electrocardiogram and its tips, the reading of frequent electrocardiograms, the reading of electrocardiograms of acute myocardial infarction, and the reading of electrocardiograms of tachyarrhythmias. The questionnaire was designed to determine the comprehension level of the EMTs and paramedics about the above lecture content, evaluation of ST changes, and differentiation of ST changes from leg block, and their understanding of the specular phenomenon. Differences in recognition and understanding by occupation were significantly higher for EMTs than for paramedics for all questions. The recognition by item was significantly lower for the differentiation of ST changes from bundle branch block than for the evaluation of ST changes. Although EMTs and paramedics commonly understood the evaluation of ST changes, they tended to have insufficient knowledge in differentiating ST changes from the bundle branch block, which may lead to incorrect interpretation at the scene of an emergency. We will prepare a lecture focusing on the items that were poorly understood to deepen understanding and improve the quality of reporting and collaboration among EMTs, paramedics, and hospitals.

Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by arterial/venous thrombosis or pregnancy complications caused by the appearance of antiphospholipid antibodies (aPLs). The presence of aPLs apparently constitutes a risk factor for arterial and/or venous thrombotic complications. However, the precise mechanisms underlying thrombotic complications in these patients have not yet been elucidated. In this study, we investigated the effects of IgG-aPLs on monocytes and granulocytes associated with thrombus formation and vascular inflammation by evaluating cell surface and cell adhesion. As a result, we found that the percentage of activated monocytes (CD14+/CD16+) was significantly increased by IgG-aPL stimulation compared with no stimulation. In addition, we confirmed the granulocyte surface CD44 expression after IgG-aPL stimulation. There was no significant change in the percentage of CD44-positive cells, but the percentages of granulocytes expressing CD44 v6 and overexpressing CD44 were increased by IgG-aPL stimulation. Moreover, IgG-aPL stimulation enhanced the adhesion of granulocytes to the extracellular matrix (fibronectin, collagen I, and collagen IV). We found that the presence of IgG-aPLs increases the percentage of activated monocytes associated with inflammatory and autoimmune diseases. CD14+/CD16+ monocytes may be involved in the pathogenesis of APS. We also found that IgG-aPLs may promote the inflammatory responses of granulocytes and their adhesion to vascular endothelial cells. These findings suggest that aPLs may induce the inflammatory responses of vascular endothelial cells and provide a scaffold for thrombus formation. Furthermore, granulocytes may have a “prothrombotic tendency” toward thrombus through their increased adhesive ability to vascular endothelial cells in vivo, in addition to the inflammatory state induced by IgG-aPL stimulation.

Objective: The aim of this study was to establish a manual liquid-based cytology (LBC) method for uterine cervical Papanicolaou preparation, without the need for a specialized automated system. Study Design: 3,383 cervical cytology specimens were examined. Cervex-Brush^TM and BD SurePath^TM collection vials were used for the specimen collection, and the specimens were processed manually by the manual LBC method. The cytodiagnosis was classified according to the Bethesda System 2014. After the evaluation of the processing and staining of the slides, the specimen adequacy was evaluated and the rate of “unsatisfactory” specimens was analyzed with specification of the reason. The results of cytodiagnosis were then compared with those of the biopsy diagnoses. Results: The quality of the LBC slides processed by the manual LBC method was adequate for making a cytodiagnosis according to the Bethesda System 2014. The cytodiagnoses were as follows: NILM (n = 2,975; 87.9%), ASC-US (n = 148; 4.4%), ASC-H (n = 52; 1.5%), LSIL (n = 119; 3.5%), HSIL (n = 58; 1.7%), and 16 other categories. Among the 130 cases with ASC or worse in which a biopsy was performed, the histological diagnosis was LSIL or HSIL in 99 (76.1%) cases. Conclusion: Manual processing of LBC specimens, without the use of a specialized automated system, could be realized by the manual LBC method, and the slides processed by this system were adequate for cytodiagnosis according to the Bethesda System 2014.

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne infectious disease caused by the SFTS virus, which is transmitted through tick bites into humans. SFTS has been observed in China and Southeast Asia, and it is distributed unevenly in Western Japan. In this study, we experienced 8 cases (2 cases in 2019, 1 case in 2020, and 5 cases in 2021) of SFTS whose diagnosis was confirmed by the nucleic acid amplification test at our hospital, which is in western Shimane, from June 2019 to July 2021. We investigated the clinical background, hematological findings, treatment, and severe symptoms of the SFTS patients. Results showed that most of the SFTS patients were suspected to be infected in areas with few houses and many fields, but some of the patients were also found to be infected in areas with houses and stores. Moreover, we confirmed that some of these patients were infected by not only ticks but also cats and dogs. The complications were observed in 4 cases that were varied, including disseminated intravascular coagulation, multiple organ failure, viral myocarditis, and hemophagocytic syndrome. However, no significant difference in hematological findings was found between the severe and mild cases. Since a definitive diagnosis is requested by the Public Health Institute, we have revised the manual of response to SFTS to make it understandable, and thus, we can respond quickly when we encounter a patient suspected of having SFTS.

In the paraffin-agar sandwich method, which is a new cell block manufacturing method, we focus on the known fact that the agar added during the preparation process disappears from the specimens for immunohistochemistry after heat treatment. To remove the agar that may interfere with the observation of hematoxylin-eosin-stained specimens, the temperature and heating time at which the agar disappears were quantified, and the amount of residual agar was compared. Results showed that at 98°C, there was a difference in the number of residual agar between the start of heating at 0 minutes and after 10 minutes of heating or later and between after 0.5 minutes of heating and after 15 minutes of heating or later. Furthermore, comparison of the number of residual agar between heating at 80°C and that at 90°C showed that after 60 minutes of heating, the maximum degrees of decreases were 15% at 80°C and 50% at 90°C, whereas at 98°C, a decrease of 99% was observed after 0.5 minutes of heating, which remained constant at 0.05% or less after 15 minutes of heating. From the above results, it was shown that the temperature required for the complete melting of agar was 98°C, and the shortest time for the complete melting of agar was 15 minutes after heating. In this paper, we will also report changes in the preparation procedure and new findings obtained from the first report.

There are cases in which the actual color tone differs from the device’s judgment of the urine color tone in the urine qualitative test. In particular, the cases in which “RED” and “OTHERS” are determined to be different from the actual color tone have been a problem. Here, we evaluated the performance of the color tone judgment function of the fully automatic urine analyzer US-3500, which uses a color tone judgment algorithm improved by Eiken Chemical Co. We collected color tone results from 1,190 specimens submitted to our laboratory and photographed the color tone of the specimens after measurement using a digital camera, and we then compared the algorithm judgments before and after the improvement. Of the 1,190 specimens, seven specimens were judged “RED” by the conventional algorithm (hereinafter referred to as “conventional”), three specimens by the improved algorithm (hereinafter referred to as “improved”), and 12 specimens by the conventional algorithm and three specimens by the improved algorithm were judged “OTHERS”. Next, we checked the images of a total of 19 specimens that were judged “RED” or “OTHERS” by the conventional method. Of the seven specimens that were judged “RED” by the conventional method, three specimens that were judged “RED” by the improved method also showed a red color tone. The remaining four specimens were determined to be “DARK BROWN” and “AMBER,” which were consistent with the images. Nine of the 12 specimens judged as “OTHERS” by the conventional algorithm were judged as “AMBER,” “YELLOW,” “STRAW,” or “LIGHT YELLOW” by the improved algorithm. Overall, the improved algorithm improved the accuracy of “RED” and “OTHERS” judgments in particular.

Yokohama City has been using the Integrated GIS “YokohaMap” since March 2022. The city has conventionally used GIS to process the data on influenza infection to date. For influenza infection, the National Epidemiological Surveillance of Infectious Diseases (NESID) System has been used to report the incidence of infection based on facilities/institutions and the number of patients per fixed point. For the incidence of infection based on facilities/institutions, it has become possible to centralize and visualize in the GIS the information obtained using polygon representation junior high school districts and based on detailed epidemic situations in schools. We hope that the enlightenment of the prevention of influenza infection in communities by polygonally representing junior high school districts and the number of patients reported per fixed point can be shown, and the currently available influenza infection data in respective Community General Support Centers can be displayed as well.

Background: Flow Cytometric Crossmatch (FCXM) is widely used as a histocompatibility test before renal transplantation. However, because the procedure and criteria for FCXM are not standardized, the quality control of FCXM is insufficient. Patients and Methods: We compared the FCXM results of 44 preoperative renal transplantation cases performed at our hospital and the Fukuoka Red Cross Hospital to validate the accuracy of FCXM at our hospital and investigate the causes of discrepancies between the results of the two hospitals. Results: The T-cell positive and negative concordance rates were both 100% (44/44) at our institution, whereas the B-cell positive and negative concordance rates were 100% (7/7) and 86.5% (32/37), respectively, as determined on the basis of data from the Fukuoka Red Cross Hospital. Two of the five patients with discrepancies had donor-specific antibodies (DSAs), two had non-DSAs, and one had negative anti-human leukocyte antigen antibodies. In the DSA-negative 3 cases, the lack of pronase treatment may have led to a false-positive result. Conclusion: Even though the concordance rate between FCXMs at both centers was relatively good when a weakly positive B-cell result is obtained in an FCXM without pronase treatment, the possibility of false-positive results should be considered, and the results of anti-human leukocyte antigen antibody identification tests should also be evaluated.

Gout caused by monosodium urate (MSU) crystals and pseudogout caused by calcium pyrophosphate (CPPD) crystals can be confirmed by the microscopic examination of crystals in synovial fluid. There is a report outside of Japan showing that “synovial fluid for observing crystals can be refrigerated for several days,” but as far as we investigated, there are no reports on this in Japan. We investigated the change of crystals over time by preserving synovial fluid. Of the synovial fluid specimens submitted to our inspection room from May 2020 to October 2022, 76 specimens with heparin added and 55 specimens with no anticoagulant, which could be examined, were used. The specimens were observed under a polarizing microscope, and the effects of storage were examined using a proprietary visual quantitative standard. The specimens were kept refrigerated at 4°C, and the change in crystals over time was observed after 24 hours, 48 hours, 72 hours, 96 hours, and 1 week. The concordance rates between visual quantification values before and after refrigerated storage were as follows: heparin addition: CPPD crystals, 96.0% (168/175); MSU crystals, 100% (40/40); no crystals, 100% (165/165); with no anticoagulant: CPPD crystals, 94.3% (99/105); MSU crystals, 100% (35/35); no crystals, 100% (135/135). Both types of specimen showed a good concordance rate before and after storage, and there was no particular difference due to the anticoagulant. Some CPPD crystals showed changes in visual quantitation during storage, but the crystals were sufficiently detectable. From the above, we believe that for crystal observation, refrigerated storage of synovial fluid for about one week is possible.

To avoid medical incidents and to improve the quality of medical care in healthcare settings, excellent and intense safety management has been required. ISO 15189 (ISO) is an international standard known as an organizational management tool for clinical laboratories, and it has been reported to improve quality assurance and safety management. We analyzed the number of incidents from 2017 to 2022, categorized by standard requirements of ISO. As a result, the years and numbers of incident cases were as follows: 2017, 27; 2018, 30; 2019, 14; 2020, 15; 2021, 6; 2022, 8. We found that the numbers were markedly reduced after 2019 when our laboratory acquired ISO in January of this year. We found that more than 80% of the incidents arose from “5.4 pre-examination processes” (42%), “5.5 examination processes” (39%), and “5.8 reporting of results” (14%), and the proportions have mostly remained unchanged throughout this period. Moreover, we introduce two documents with our original tips in ISO, which may reduce the number of incidents. One is “Flow chart to get to the roots of the problems about procedures”, and the other is “Improvement and prevention plans/reports”. Through these two documents, relevant divisions can easily and quickly identify the cause, plan, and perform corrective actions, and share the results with the entire clinical laboratory. Moreover, we consider that our quality managers play an important role in reducing the number of incidents, since they always carefully check, assess, and provide directions for corrective actions.

Background: In this study, we aimed to know the actual condition of cytology in Shiga from the results of external quality control obtained by local surveys and questionnaires for 10 years. Methods: The cytological quality control was performed using four images with clinical information. The answer was selected from five choices, and we requested that the cytological findings that led to the answer be described. Furthermore, we arranged the questions on “the propriety of the specimen” for two years, which recognized “quality assurance” as a recent concept of quality control. Using the questionnaire, we asked a number of cytotechnologists who belonged to each facility and their ages. Results: During the review, no facility had problems with basic cell judgments. However, on the cytological findings, there were no lists that they should have, or the lists did not appear in the images, which we showed. Therefore, we suggested improvements in the briefing session. On the propriety of the specimen, there were no facilities that had the wrong judgments; however, the grounds they examined were slightly fuzzy. Additionally, the investigations revealed that half of the cytotechnologists working in Shiga Prefecture were aged ≥ 50 years, and a remarkable aging situation was indicated. Conclusions: By law revision, the importance of external quality control is recognized, but in Shiga, the young group lacks interest. Conversely, it is a good tendency that the number of participants in the briefing session increased slightly owing to Web delivery that has recently become widespread. The cytotechnologists engaged in cytology had a problem, but they decreased the number of cytological examination duties to maintain balance with pathological examinations. On the basis of such situations, it will be more necessary to examine the questions’ contents, which will improve the actual situation.

The dawn phenomenon is an increase in insulin antagonist hormone secretion during the night, which causes an increase in blood glucose levels at dawn. It causes hyperglycemia in type 1 diabetics with reduced endogenous insulin secretion. If blood glucose control is unstable owing to the dawn phenomenon, management by CSII is recommended. In the present case, we experienced treating a patient who was on SAP therapy to reduce the effects of the dawn phenomenon and switched to HCL therapy. The patient, a woman in her 60s, had poor blood glucose control on MDI due to the dawn phenomenon, so SAP therapy was initiated. Later, on HCL therapy, the HbA1c level was 6.9 to 7.1%, and good blood glucose control was achieved with TIR above 70%, TBR below 4%, and TAR below 25%. However, the dawn phenomenon caused an increase in blood glucose levels from 4 to 7 am. Therefore, in addition to auto basal insulin infusion with HCL therapy, 0.5 units of insulin was infused to cope with the hyperglycemia caused by the dawn phenomenon. Compared with SAP therapy, pre-breakfast blood glucose levels were significantly elevated with HCL therapy alone but were comparable after the response. We experienced treating a patient in whom the auto-basic insulin infusion algorithm failed to respond to predictable changes such as the dawn phenomenon. The time of day when insulin infusion is insufficient should be determined by the user and managed accordingly.

Monosodium urate crystals and calcium pyrophosphate dihydrate crystals are widely known as crystals found in joint fluid, but in rare cases, basic calcium phosphate crystals, such as hydroxyapatite crystals, may cause arthritis. We report a case of massive ectopic calcification in the knee joint, in which a large number of hydroxyapatite crystals was detected in the joint fluid. A 30-year-old man on hemodialysis was referred to our orthopedic surgery department because a mass in his left knee gradually enlarged, self-destroyed, and showed white pus-like drainage for one month. Pyogenic arthritis was initially suspected; therefore, curettage and cleaning of the lesion were performed immediately. On postoperative day 40, a cell count and crystal test of the left knee joint fluid were performed. The cell count was 1,850 cells/μL, and the joint fluid appeared similar to white toothpaste. Microscopic observation using a simple polarizer revealed many small lumpy unpolarized unknown crystals, which were suspected to be hydroxyapatite crystals on the basis of their shape. Subsequently, a positive Kossa stain was confirmed, consistent with the characteristics of these crystals. In this case, high calcium levels due to the use of vitamin D preparations and calcium-containing phosphate binder, hyperphosphatemia due to difficulty in restricting diet, and calcium-phosphate product levels that remained around 80 to 100 for a long period were the possible causes of mass formation by ectopic calcification. Laboratory scientists must understand the patient’s background and the morphologic characteristics and properties of these crystals before testing for joint fluid crystals.

The patient was a 100-year-old woman who visited our hospital with the chief complaint of epigastric pain. The patient was lucid, but at the time of consultation, transfusion was started as her pallor was accompanied by hypotension. The drawn blood specimen submitted for blood testing showed strong hemolysis; thus, we drew blood three times, including re-drawing of blood, but significant hemolysis was found in all the specimens. Moreover, less than RBC 1 unit/HPF and hemolysis were found in occult blood (3+), and urinary sediment was detected by urine qualitative analysis. Subsequently, her symptoms did not improve, a depressed level of consciousness and tachypnea were detected, and hospitalization became urgent on suspicion of septic shock. We collected two sets of blood specimens for blood culture, and treatment was started using meropenem. However, the patient’s overall status worsened rapidly and she passed away 12 hours after hospitalization. Clostridium perfringens was detected in both sets of blood cultures, and an image of irregular gas was found in the liver by autopsy imaging after death.

A woman in her 50s was undergoing chemotherapy for breast cancer and bone metastasis. She had been admitted to our hospital with a diagnosis of obstructive jaundice since she had abdominal pain for one month. Blood culture was performed for a detailed examination of fever after biliary stent placement by endoscopic retrograde cholangiopancreatography (ERCP). Gram-negative bacilli were observed in blood cultures after 18 h of culture. It was determined to be Pseudomonas aeruginosa or Pseudomonas putida by VITEK2. As an additional test, the acyl amidase test was conducted and growth at 42°C was confirmed, but the results did not match those of either P. aeruginosa or P. putida, and thus the cells were not identifiable. In the drug susceptibility test, the strain was susceptible to both imipenem and meropenem, but resistant to doripenem. The strain was also found to be a carbapenemase-producing strain, as shown by the results of the modified carbapenem inactivation method. On the basis of these results, Pseudomonas otitidis was suspected. It was finally identified as P. otitidis, which is characterized by the presence of chromosomal metallo-β-lactamase determined using MALDI Biotyper. P. otitidis can only be identified using 16S rRNA gene sequence analysis and MALDI Biotyper. If we understand the pattern of drug susceptibility test results and the key biochemical characteristics of similar bacteria, we should be able to presume P. otitidis. We believe that this will lead to appropriate antimicrobial treatment and correct nosocomial infection control.

We report a case in which a neuro-otological examination led to the diagnosis of superior canal dehiscence syndrome (SCDS). Although SCDS can be suspected on the basis of a superior canal deficit finding on CT, bony thinning of the superior canal can occur with aging in normal adults. Therefore, even if a bone defect is found in the upper semicircular canal, it should not be diagnosed on the basis of CT findings alone because a thin bone wall may cover it. Thus, it is significant to confirm the presence or absence of fistula symptoms by neuro-otological examination. The patient, a woman in her 40s, had been aware of the symptoms of ear fullness and auditory hypersensitivity for two years. She was diagnosed as having a patulous Eustachian tube in another clinic and referred to our department for further examination and treatment. Audiometry revealed mild conductive hearing loss in the low-frequency range. The Eustachian tube function test showed no evidence of a patulous Eustachian tube. The nystagmus test using Valsalva stimulation revealed vertical and clockwise nystagmus in the lower eyelid direction. The vestibular-evoked myogenic potential (VEMP) showed an increased amplitude and a decreased threshold on the affected side. On the basis of subjective symptoms and the examination findings mentioned above, we diagnosed her as having left SCDS. In cases wherein the patient was treated for Eustachian tube dysfunction but the symptoms did not improve, it is helpful to perform neuro-otological tests to check for different diseases. Those tests are simple, noninvasive, and sometimes valuable for reaching an accurate diagnosis.

We experienced treating a case of invasive Haemophilus influenzae infection with H. influenzae serotype e (Hie). The patient was a woman in her 80s. Owing to hemodialysis due to end-stage renal disease, she was an outpatient at the nephrology department of our hospital. She was admitted to our hospital with a fever during hemodialysis, and a bacterial infection was suspected. H. influenzae was isolated from two sets of blood cultures (three cultures each) and sputum culture collected the same day, and invasive H. influenzae infection caused by bacterial pneumonia was diagnosed. A capsular type test of the detected bacterium was performed, and both strains derived from blood cultures and the strain derived from sputum culture were determined to be serotype e. Reports of invasive H. influenzae infection with H. influenzae serotype b (Hib) have declined since the introduction of routine H. influenzae type b (Hib) vaccine. Conversely, reports of invasive Haemophilus influenzae infections due to nontypeable Haemophilus influenzae (NTHi), which were originally thought to be frequent local infections such as otitis media and bronchitis, have increased. On the other hand, there are few reports on other capsular types, and future trends are important.

The patient was a 58-year-old male with complaints of left hemiplegia and headache after pulling out a right molar. Multiple masses in the right cerebral hemisphere were identified by magnetic resonance imaging (MRI). At neurosurgery in our hospital, burr hole drainage was performed. The Gram staining findings of fluid of a brain abscess showed small Gram-negative bacilli. We presumed oral microorganisms on the basis of morphological characteristics, and administration of meropenem was started. Aggregatibacter aphrophilus was identified by MALDI-TOF MS. In this case, it was suggested that brain abscesses were secondary to caused by dental and periodontal disease, as the patient had been receiving dental treatment. We consider that surgical treatment and detection of pathogenic microorganisms in a microbiological test, in addition to specifying the infection focus, are important for the treatment of brain abscesses. In this case, sharing information, such as the background of the patient, with a clinician was useful for identifying of the bacterial species, which contributed to the prompt initiation of treatment.