The Clinical features of group G streptococcus (GGS) bacteremia have been reported, but the differences in the clinical features between the community-acquired group and the nosocomial group have not been discussed in detail. The objective of our study was to retrospectively examine the clinical features of GGS bacteremia in our hospital and elucidate the differences in the clinical features between the community-acquired group and the nosocomial group. We included all patients with GGS-positive blood cultures who had been treated between June 2005 and September 2014 at the Kameda Medical Center, a 900- bed teaching hospital in Japan. We collected demographic and clinical data and analyzed differences between the community-acquired group and the nosocomial group. During the study period, 104 episodes of GGS bacteremia were recorded, with 92 episodes for the community-acquired group and 12 for the nosocomial group. The median age was 81 years (range, 18-97 years) and underlying diseases were present in 84.6% of the patients. Cellulitis was the most common diagnosis (52.9%) followed by primary bacteremia (14.4%). In the nosocomial group, a lesser tendency of skin and soft tissue infections was noted (OR 0.05, 95% CI 0.01-0.27, p＜0.01) with a greater tendency seen of bacteremia without focus (OR 16.4, 95% CI 4.38-61.2, p ＜0.01) than in the community-acquired group. In our hospital, GGS bacteremia was observed mainly in elderly patients with underlying medical conditions, involing skin and soft tissue infections being the most common, similar to other reports. High median age and low percentage of primary bacteremia were the unique features. In the nosocomial group, the most frequent clinical diagnosis was primary bacteremia, and the skin and soft tissue infections were less likely.
Human metapneumovirus (hMPV) infection causes respiratory illness in children. The clinical symptoms of hMPV as isolated were similar to those caused by respiratory syncytial virus (RSV) infection. The Modified Pulmonary Index Score (MPIS) is a quantitative method for evaluating the respiratory conditions of patients with bronchial asthma. Although a number of studies have reported the utility of the MPIS for evaluating patients with RSV infection, there are no reports of its utility in evaluating hMPV infection. The aim of the present study was to determine the utility of the MPIS for evaluating pediatric patients with hMPV infection. Patients with hMPV or RSV who were admitted to our pediatric division of Sagamihara Kyodo Hospital between May 2014 and March 2016 were included in the present study. On admission, the patients underwent an MPIS assessment. Patients were diagnosed as having hMPV or RSV based on a positive result in a rapid antigen test. The patient background, the MPIS, the results of a blood examination, the correlation of the MPIS and the duration of hospitalization and treatment were evaluated retrospectively and compared between the two groups. The exclusion criteria were premature birth, chromosomal abnormalities, transportation to a higher medical institution, transfer to our hospital, and the administration of palivizumab. Rapid antigen tests for hMPV and RSV were performed in 573 cases. Thirty-eight (male, n=17) and 115 (male, n=63) patients were enrolled in the hMPV and RSV groups, respectively. The median age at admission was higher in the hMPV group (17 months；range：1～58 months) than in the RSV group (7 months；range：1～46 months；p＜0.01). The incidence of fever in the hMPV group was higher than that in the RSV group (97% vs 82%, p=0.02). The incidence of nasal discharge in the hMPV group was lower than that in the RSV group (82% vs. 98%, p=0.03). The complication of bronchial asthma occurred more frequently in the hMPV group than in the RSV group (39% vs. 12%, p＜0.01). In both the hMPV and RSV groups, there was a significant correlation between the duration of hospitalization and the MPIS (r2=0.26, p＜0.01；and r2=0.08, p ＜0.01, respectively). We estimated that the presence of underlying nasal discharge and respiratory rate were associated with decreased odds ratios of 0.06 (95% confidence interval [CI]：0.01～0.59, p＜0.01) and 0.89 (95% CI：0.83～0.96, p＜0.01), respectively, and that LDH was associated with an increased odds ratio of 11.2 (95% CI：1.2～108, p=0.03). In the hMPV group, the optimal cutoff MPIS values for the administration of oxygen, bronchodilators and steroids were 4.5 (area under curve：AUC 0.90；p＜0.01), 3.5 (AUC 0.94；p＜ 0.01), and 5.5 (AUC 0.87；p＜0.01), respectively. Our data suggest that MPIS could be useful for predicting the duration for which hMPV patients will be hospitalized and for determining an appropriate treatment plan.
Skeletal tuberculosis (TB) accounts for 2-3% of all TB cases, and the most common site for skeletal TB is the spine. The pubic bone is an unusual site for skeletal TB. We report herein on a rare case of a vesicopubic fistula due to tuberculous osteomyelitis of the pubic bone. A 66-years-old man was admitted to the department of urology with dysuria and gait disturbance of one weekʼs onset. He was diagnosed as having prostatic cancer and pubic bone metastasis with high prostate specific antigen value and destruction of the pubic bone based on CT findings at the beginning of hospitalization. However, high fever persisted for two weeks and the contrast CT showed a vesico-pubic fistula and prostatic abscess. Mycobacterium tuberculosis was detected from urine culture. He was finally diagnosed as having a vesico-pubic fistula due to tuberculous osteomyelitis of the pubic boneʼsacroiliac joint tuberculosis and a tuberculous prostatic abscess. Surgery and antimycobacterial therapy for 12 months after surgery cured his condition.
Aerococcus urinae is a facultative anaerobic gram-positive coccus that has been recognized as a human pathogen. It is frequently misidentified as other pathogens because of its bacteriological characteristics. We report herein on a case of spondylodiscitis and iliopsoas abscess due to A. urinae, initially undetected or misidentified by the microbiology laboratory. The culturing of an iliopsoas abscess aspirate initially yielded bacteria identified as Streptococcus spp., but they were subsequently reidentified as Aerococcus spp.. Urine culture initially grew only Escherichia coli, but Aerococcus spp. were also isolated on reculturing. Furthermore,Aerococcus spp. were isolated from blood culture. Matrix-assisted laser desorption ionization-time of flight mass spectrometry identified these Aerococcus spp. as A. urinae. When we note a gram-positive coccus in the shape of a tetrad or cluster in clinical specimens, especially urine, Aerococcus spp. should be considered as the pathogen.
Penicillin G has been generally used for the treatment of tetanus in Japan, while metronidazole is widely chosen in other countries. We report herein on the first case of tetanus successfully treated with metronidazole intravenous drip infusion in Japan. A 76-year-old Japanese man injured his left hallux 15 days before admission．Three days before admission, he noticed lock-jaw and then difficulty in opening his mouth and remarkable muscle rigidity developed. He was diagnosed as having tetanus. He was intubated and mechanical ventilation was initiated. Metronidazole and human anti-tetanus immuno globulin were administered intravenously. Tetanus toxoid was injected intramuscularly. Several kinds of anticonvulsants were also given. Debridement of the foot wound was performed. He recovered without any sequelae. Metronidazole intravenous infusion became available in Japan in September, 2014 and could be considered as a therapeutic option in patients with tetanus in Japan.