There have been fewer reports on Chlamydia pneumoniae infection during childhood than those in adults, although many of the C. pneumoniae infections occurred during childhood based on prevalence of the antibody. And there have been no reports concerning the double infection of C. pneumoniae and M. pneumoniae. We reported three cases of children with the double infection. We diagnosed this from significant alteration of these antibodies from the acute to convalescent phases. We omitted the cases without significant alteration of the antibodies, even diagnosed from isolation or detection of the antigens in the samples by direct fluorescent antibody. Case 1 was an 8-year-old-boy who was admitted to our hospital because of fever, cough with vomitting and erythema multiforme. The symptoms did not subside after administration of clindamycine but subsided after minocycline. Case 2 was an 1-year-old-boy who was admitted because of fever, cough, rhinorrhea and vomitting. C. pneumoniae organisms were isolated from the pharyngeal swab specimen. the symptoms subsided after administration of clindamycine. Case 3 was a 9-year-old boy who was admitted because of fever and a cough followed by erythema multiforme. The symptoms did not decrease after administration of clindamycine but after minocycline. The characteristic of these cases are a strong cough with comiting, weak response of acute reactants on the laboratory data, and skin eruption similar with that due to M. mycoplasmae in two of the three cases. We suspect that these double infections may induce the eruption, about which there have been no previous reports.
A 21-year-old male nearly drowned in a reservoir by a traffic accident and he aspirated a large mount of polluted water containing Aspergillus fumigatus. On admission to our hospital, he was alert but cyanotic. Chest rentogenograms showed scatter infiltrative shadows in bilateral lung fields. We administered methylpredonizolon and antimicrobial agents immediately because of respiratory failure which was rapidly progressing. During the following six days, infiltrative shadows diminished but multiple nodular shadows in both lung fields appeared. The diagnosis of pulmonary aspergilosis was confirmed by serological and microbiological studies. Intravenous amphotericin B and oral itraconazol were administrated, and clinical improvement was observed.
Recently group A streptococcus toxic shock like syndrome (TSLS) has been reported, but as for group B streptococcus (S. agalactiae) infection, there have been little documentation in the literature. We report a case of fluminant septic shock due to Streptococcus agalactiae (S. agalactiae). A 72-year-old male was admitted to our hospital because of general fatigue and azotemia. He was diagnosed as having MPO-ANCA related glomerulonephritis and treated with steroid therapy. Gradually he was doing well. On the 228th hospital day, he suddenly had tachypnea, transient conscious disterbance, and profound hypotension. About 16 hours later, he died despite intensive treatment. S. agalactiae was isolated from the blood. Autopsy revealed bilateral bronchopneumonia and shock liver. To our knowledge, this is the first report of septic shock caused by S. agalactiae.