To clarify the environmental distribution of Vibrio vulnificus, sea water, sea mud, and oysters were examined at 13 sites, i. e. 4 sites in the Tokyo Bay (eastern Japan) and 9 sites (5 sites for oysters) in Tokushima Prefecture (western Japan). 1. V. vulnificus was isolated from 80 (54.8%) of the 146 samples of sea water examined. It was isolated from 19 (41.3%) of the 46 samples from western Japan and 61 (61.0%) of the 100 samples from eastern Japan. 2. It was isolated from 40 (40.8%) of the 98 samples of sea mud obtained in eastern Japan. 3. It was isolated from 655 (30.3%) of the 2, 165 samples of oysters. They were 30 (9.7%) of 309 samples from western Japan and 625 (33.7%) of 1, 856 samples from eastern Japan. 4. The density of V. vulnificus was 0.3-1.1×106MPN/L in seawater, 0.3-1.1×105MPN/100g in sea mud, and 0.3-1.1×107MPN/100g in oysters. 5. Seasonally, V. vulnificus was isolated from 44 (6.2%) of the 713 samples in spring, 450 (72.6%) of the 620 samples in summer, 264 (51.8%) of the 510 samples in fall, and 17 (3.0%) of the 56 samples in winter. Thus, the isolation rates of V. vulnificus from sea water and oysters tended to be higher in eastern Japan than in western Japan and to be highest in summer, then, in fall.
The clinical utility of two serum Candida mannan antigen detection kits with ELISA, UNIMEDI Candida and PLATERIA Candida Ag, was investigated. Thirty-four serum samples from 12 cases with candidemia diagnosed at Kawasaki Medical School Hospital in 1999 and 15 samples from 15 healthy volunteer were examined. The sensitivities and specificities of the two kits were 82.1% and. 40.0%, 100% and 100% respectively. This sensitivity was higher than that achieved with the conventional methods. However, it was realized that the discrepancy between the sensitivity of these two kits was quite significant. This may have been caused by a difference in the reactivities of the respective kits against different species of Candida. A combined application of these methods and other supportive diagnostic methods, such as serum (1-3)-β-D-glucan detection, will improve their utility. A larger number of cases should be evaluated to clarify the characteristics of these new kits.
The control of hospital-acquired infections is a matter of social concern, especially in the proper use of antimicrobial agents. The fundamentals of treatment for infectious diseases involve the exact identification of the responsible bacteria, and the minimum essential use of narrow-spectrum antimicrobial agents for the identified bacteria. We tested the antimicrobial susceptibility of 13 species which belong to the gram-negative rod type and isolated 50 or more strains at Tottori University Hospital in 2001. We evaluated the susceptibility pattern for every species, and have proposed a plan for the sensible use of narrow-spectrum antimicrobial agents. The resistant frequency in the present study was equal to or lower than previously reported. We think that it is possible to use narrowspectrum antimicrobial agents more often, because the susceptible frequency to these agents was fairly high for some species. It is not too much to say that the history of the development of antimicrobial agents has been a road to broad-spectrum. Though the proper use of antimicrobial agents seems to go against this view, we should remain farsighted. Not only is the publicity of proper use indispensable but excellent surveillance is also highly necessary. We hope for the establishment of a good surveillance system gifted with simplicity, universality, high reproduction and continuity.
We evaluated the efficacy of antimicrobial agents used for patients with community-acquired pneumonia (CAP) based on the guidelines of Japanese Respiratory Society. A total of ninety-nine hospitalized patients who were suspected to have bacterial pneumonia at the time of admission between January, 1998 and December, 2000 were assessed. Our conclusions were as follows. 1) The rate which was considered as effective by the guidelines were 83.3% (5 of 6 cases), 98.7% (74 of 75 cases), 85.7% (12 of 14 cases), and 100% (4 of 4 cases) for penicilin, cephem, carbapenem and tetracycline, respectively. 2) These guidelines were useful and practical for identifying the etiological organisms, determining the severity of pneumonia and evaluating the efficacy of chemotherapeutic agents in CAP. 3) Gram-positive organisms were isolated more frequently among the “mild” group. The number of isolated gram-negative was increased significantly as the severity of pneumonia progressed from “mild” to “severe” group. 4) Factors such as body temperature and white cells count were not always applicable for evaluating the clinical effect in elderly cases. 5) Risk factors such as underlying diseases, or complications, age (over eighty years old) and specific etiological organisms might influence the ineffectiveness of antimicrobial agents among the cases that had no clinical response. 6) The choice of antibiotic agents for the treatment of CAP should be made with consideration to the local-specific profiles of each medical facility as described in the guidelines.
We experienced a rare case of papulonecrotic tuberculide (PT). A twenty-four year old female was referred to our hospital because she had had an eruption for the last for four years. Her chest Xray revealed no abnormal shadow three years ago when her eruption had already appeared. This time, the skin biopsy and repeated chest X-ray were investigated. These results showed pulmonary tuberculosis acompanied with PT. Both rifampin and isoniazid were administered and apparent improvement was achieved after six months-of treatment. Pt also showed improvement. Her skin involvement was preceded by pulmonary tuberculosis. Nowadays, PT is a rare disease but physicians should be on the alert for this disease as a sign of tuberculosis.
We experience a case of a 83-year-old male who was admitted complaining of chills, cramp, high fever and respiratory distress. His blood revealed marked hemolysis. Gram positive Rods was observed in the hemoliesed blood taken on admission. About 2 hours after admission, he suddenly fell into a critical condition. He died about 6 hours after admission in spite of resuscitation. Clostridium perfringens was detected from the blood and liver obtained by autopsy. We suspected that he died of acute intravascular hemolysis caused by α-toxin produced by C. perfringens. In conclusion, for a patient who has a high fever with strong hemolysis such as our case, C. perfringens infection should be considered.
A 75-year-old male suffered from interstitial pneumonia in December 2000 and treated with predonisolone. The treatment was effective, and the dosage of predonisolone had been gradually tapered. In January 2001, when the dosage was 30mg/day, he complained of cough and yellowish sputum. The chest X-ray and CT revealed bilateral infiltrations with cavities. He was treated with cefozopram and fluconazole. However, there were no improvements. The sputa of the 2nd, 3rd, 6th and 8th hospital days showed the presence of gram-positive branched rods, which were identified as Nocardia farcinica. Therefore, the treatment was changed to sulfamethoxazole-trimethoprim. During the treatment, serum concentration of sulfamethoxazole was repeatedly measured, and kept over 60 microgram/ml. Be was swiftly recovered after the start of sulfamethoxazole-trimethoprim. This case was supposed to be the seventh one of N. farcinica pneumonia in Japan, and the measiirpmpnt of the concentration of sulfamethoxazole was useful to determine its dosage.
We here reported two Japanese cases of mixed infections of plasmodium species, whose DNAs were detected using the PCR test. One case was a 31 year-old male, who presented fever and fatigue, and had a travel history to Kenya, Cameroon and Indonesia. Smear test of his peripheral blood found the presence of Plasmodium vivax, while nested-PCR diagnosis detected the DNAs both P. vivax and Plasmodium malariae. The other was a 54 year-old female suffering from general fatigue. She had been treated with chloroquine for falciparum malaria in Indonesia two weeks before. Malaria antigen test showed positive although no Plasmoduim organisms were found in the smear test. The nested PCR detected the DNA of Plasmodium ovale in addition to that of Plasmodium falciparum. In conclusion, the PCR test is helpful and useful for detection of mixed infections of Plasmodium species
Pseudomonas aeruginosa is a common causative agent of septicemia in compromised host and the entry site of organism is most commonly the respiratory and genitourinary tract. P. aeruginosa septicemia is often associated with vesicular or pustular skin lesions, subcutaneous nodules, deep abscess, cellulites and bullae. We report a case of P. aeruginosa pneumonia with multiple pustular skin lesions on the chest and leg. A 77-year-old male was admitted to our hospital complaining of fever, productive cough and eruputions. Laboratory findings revealed a leucocytosis (14830/μl) and an elevated CRP (21.72mg/dl). The chest radiograph and computed tomography revealed a fluid level in preexisting bullae and a consolidation shadow with multiple cavities in the right upper lobe and nodular shadow with cavity in the left lower lobe. P. aeruginosa strain was isolated from the bronchial lavage and pustule. Blood cultures were negative. Skin biopsy specimens showed histologically a dense infiltrate of neutrophils in the horny cell layer. He was diagnosed as Pseudomonas aeruginosa pneumonia complicated with multiple pustular skin lesions. He was treated with antimicrobial agents for 24 days and his clinical condition improved.