We evaluated rapid urinary antigen test kit for Streptococcus pneumoniae (Binax NOW S. pneumoniae) in 85 inpatients between February 2002 and November 2002. Diseases of patients were pneumonia in 82 and meningitis in 3. The age range of the patients was from 4 months to 14 years. We studied urinary antigen assay and culture of nasopharyngeal swab in all patients. Three infants with meningitis were measured liquor by the kit. Two infants with meningitis due to S. pneumoniae showed positive reactions in urine and liquor, but result of 1 infant with meningitis due to Haemophilus influenzae was negative. Of 82 patients with pneumonia, S. pneumoniae was isolated from 52 patients and the urinary antigen test was positive in 39. Thirty-eight patients were isolated S. pneumoniae in 39 positive patients and 14 children were isolated it in 44 negative patients. Sensitivity in this test kit was 73.1% and specificity was 96.8%. This test is useful for children as well as adults.
Asymptomatic prostatitis is classified as category IV in NIH classification of prostatitis syndrome (1999). No report concerning this category has been present. We investigated this category histopathologically and clinically, in order to clarify the histopathological distribution and its correlation to the clinical features, in this study. Among 785 patients who were suspected prostate cancer because of their high prostatic specific antigen (PSA) values and to have a sextant prostate needle biopsy was performed between January, 1996 and December, 2000, 88 patients (11.2%) were diagnosed as NIH category IV prostatitis (asymptomatic prostatitis). We observed all pathological specimens stained with Hematoxylin-Eosine, and classified them into subtypes according to the classification criteria for prostatitis defined by True et al.(1999). We also investigated the relationship between histopathological distribution and clinical features such as PSA values, PSA density, the incidence of pyuria or bacteriuria. In the histopathological study, grade distributions were 12.5% (11/88) in mild, 71.6% (63/88) in moderate, and 15.9% (14/88) in severe. Location distributions were 2.3% (2/88) in glandular, 68.2% (60/88) in periglandular, and 29.5% (26/88) in stromal. No relationship between these subtypes and clinical features was recognized statistically. However, 7 patients (7.95%) were diagnosed as prostate cancers, later Pyuria was found in 29.1% (23/79). Bacteriuria was present in 14.3% (11/77). Isolated bacteria were 4 strains of Enterococcus faecalis, 2 strains of each of Pseudomonas aeruginosa and Staphylococcus aureus, and one strain of each of Escherichia coli, Klebsiella oxytoca, Enterobacter cloacae, Enterobacter aerogenes, Staphylococcus haemolyticus, and Staphylococcus epidermidis, Gram positive rod, and Candida sp. No relationship between these subtypes and bacterial species was recognized These results indicated that the incidence of NIH category IV prostatits was not low without correlation to any clinical features. However, we should pay attention to the presence of prostate cancer, because a small number of the patients were diagnosed as prostate cancer, later.
We report a case of pulmonary tuberculosis, which was preceded by skin tuberculosis. 65-year old male was admitted to our hospital complaining of skin eruption which last one year. Skin biopsy proved granuloma with acid-fast bacilli. Mycobacterium tuberculosis was detected by PCR examination using skin biopsy and skin tuberculosis was confirmed. Chest roentogenography demonstrated small nodules with bilateral infiltrates compatible with pulmonary tuberculosis. M. tuberculosis was attained by culture examination using sputa sample. In this case, skin tuberculosis was a first clinical sign to suggest pulmonary tuberculosis. Peripheral blood test showed that he has developed adult Tcell leukemia and this could be an important factor for developing skin tuberculosis. Although skin tuberculosis becomes rare disease, physician should pay attention for this disease as differential diagnosis of lasting eruption.
We have reported two orthopedic patients with Methicillin-resistant Staphylococcus aureus (MRSA) infections successfully treated with linezolid. The first case was a 64-years-old man with bacteremia, spondylitis and psoas abscesses caused by MRSA. He was treated with arbekacin (ABK) and vancomycin (VCM), and then became afebrile. However he complained of a recurrence of fever and oliguria, we administered linezolid for two weeks intravenously because of fluctuating renal dysfunction. Thereafter his clinical conditions improved. The second case was a 26-years-old man with MRSA infection of the pelvis after a trauma. He was treated with teicoplanin (TEIC) for two weeks. However the minimum inhibiratory concentrations (MICs) of TEIC and VCM against MRSA, isolated from the wounds, were 4μg/ml each, we administered linezolid intravenously and the patient was successfully treated in four weeks. Linezolid has been proven to have high efficacy against MRSA by some trials abroad. But the agent has the indication only for VRE by the Medical Insurance in Japan. These cases also suggest that linezolid is useful for MRSA infections in these cases.
We reporta case of leptospirostihsa t was diagnosedi n the earlys tage of infection by using flaB-PCR. The flaB gene of Leptospira was amplifiedf rom the DNA extract of the patient'sb lood at hospital day 1, while leptospiraaln tibody was negative by the method of microscopica gglutination test and micocapsulea gglutinatiotne sta t that time. Seroconversion occurred at hospital day 6 and Leptospira was isolatefdr om the patient's blood at hospital day 16, demonstrating that flaB-PCR method was very usefuli uearly diagnosios of leptospirosis.
Two cases of Haemophilus influenzae type b (Hib) meningitis were occurred continuously in a day nursery. Both isolates obtained from cerebrospinal fluids of 2 patients were β lactamase producing amoxicillin/clavulanic acid sensitive strains. But biotypes and restriction fragment length polymorphism patterns by Sma I digested pulse-field gel electrophoresis of two isolates were different, respectively. Although it was already reported simultaneous occurrence of two cases of Hib meningitis caused by same strain through the nursery contact, none were reported by different strains. It was considered that two colonized strains had caused meningitis in two patients continuously.