Measurement of (1→3)-β-D-glucan (BDG), a component of the fungal cell wall, in the serum is a useful method for the diagnosis of deep-seated mycoses. Although, two kinetic turbidimetric methods based on the clotting activity of Limulus hemocytes and a synthetic chromogenic substrate have been used previously for the measurement, neither method addresses the issue of natural resource conservation. Therefore, the analytical performance of the newly developed Immunotesta BDG reagent (SEKISUI MEDLICAL CO., LTD.), a sandwich enzyme-linked immunosorbent assay (ELISA) using a BDG-specific monoclonal antibody, was evaluated in this study. The ELISA showed good performances with regard to accuracy, within-run precision, limit of detection, dilution linearity, and intermediate precision; in addition, they have proved useful in interference studies. The measurments obtained from the Wako β-glucan Test (turbidimetric assay) and the Fungitec G-test ES “Nissui”(chromogenic assay) were compared with those from the ELISA. The correlation between the results of ELISA and the turbidimetric assay was R = 0.938 (p ＜0.001, y = 2.48x +10.6), and that between ELISA and the chromogenic assay was R = 0.971 (p ＜0.001, y = 0.97 × ­2.97). The slope of the correlation between the results of the ELISA and the turbidimetric assay was 2.48, and the BDG measurment value differed by about 2 times. A good correlation was observed between the results of the ELISA and the chromogenic assay, and the overall concordance rate of 90.7% was below the cutoff value of 20 pg/mL. These results indicate that the new ELISA method may be useful for obtaining measurements of BDG in the clinical setting.

While the association of Cryptococcus neoformans meningoencephalitis with cerebral infarction is widely known, the underlying mechanism remains unknown. We encountered an 82-year-old male patient with C. neoformans meningoencephalitis, associated with multiple cerebral infarctions. Even during treatment with liposomal amphotericin B and flucytosine, the patient developed a new infarction in the pons. The patient eventually died of aspiration pneumonia. Autopsy revealed C. neoformans infiltrating the perivascular spaces of the perforating branches of the middle cerebral and basilar artery regions, with inflammation and thrombotic occlusions of these vessels. This case serves to highlight the fact that it is the thrombosis caused by the significant perivascular inflammation, and not infiltration of the vessels by C. neoformans itself, that plays the major role in the pathogenesis of cerebral infarction in non-HIV patients with C. neoformans meningoencephalitis.

The World Health Organization primarily recommends artemisinin-based combination therapy (ACT) for the treatment of uncomplicated Plasmodium falciparum malaria. In Japan, artemether-lumefantrine (AL) is the only ACT antimalarial drug available under the national health insurance system. We report the case of a 35-year-old man with recurrent P. falciparum malaria who was treated twice with AL. After returning to Japan from Tanzania, he was referred to us for fever, muscle pain, and diarrhea, and was admitted. The rapid diagnostic test for malaria was positive and a peripheral blood smear revealed malaria parasites within the red blood cells (RBC). Nested-PCR detected P. falciparum DNA. We diagnosed the patient as having uncomplicated P. falciparum malaria and treated him with AL for three days. He had appetite loss during the treatment, due to nausea. By day 3 after admission, the parasites had disappeared from the RBC. On day 5, he was discharged without any symptoms. However, 12 days after discharge, he developed fever again. The parasites were again observed in the RBC, and nested-PCR again revealed P. falciparum DNA, indicating recurrence of P. falciparum malaria. We treated the patient again with AL administered for three days. We also guided him to take fat during the treatment. He was cured completely and developed no further recurrence. Dietary fat is reported to increase the absorption of AL. However, reports showing the existence of a relationship between the therapeutic effect of AL and dietary fat intake in actual malaria patients are scarce. Our experience with this case showed the importance of dietary fat intake during AL treatment in an actual real malaria patient.

We report a newly diagnosed patient with pulmonary tuberculosis (TB) patient who showed initial monoresistance to pyrazinamide (PZA) associated with total deletion of the pncA gene. The patient was a 73- year-old man who was diagnosed as having pulmonary silicotuberculosis. He had no history of prior treatment for TB. In vitro major anti-tuberculosis drug susceptibility testing showed monoresistance to PZA. Further investigation at the Research Institute of Tuberculosis revealed that the species was Mycobacterium tuberculosis sensu stricto, that lacked pyrazinamidase activity. Further sequencing analysis revealed deletion of the entire pncA gene. To the best of our knowledge, this is the first reported case of PZA monoresistance associated with total pncA deletion.

We report the case of a 39-year-old man who developed disseminated gonococcal infection (DGI) while receiving eculizumab treatment for paroxysmal nocturnal hemoglobinuria (PNH). He visited the emergency department with a 4-day history of high-grade fever and generalized malaise. After three days, erythematous papules and pustules appeared on his extremities, along with joint pain and tenderness. Urine, cerebrospinal fluid, and skin cultures were negative for fungi, but blood culture was positive for Neisseria gonorrhoeae, and polymerase chain reaction test of specimens from the skin revealed Neisseria gonorrhoeae nucleic acid ; therefore, the patient was diagnosed as having DGI. He was treated with intravenous ceftriaxone (CTRX) for 14 days, and his symptoms improved. The route of infection in this patient could not be identified, however, the importance of identifying the route of infection became apparent to us when the patient developed gonorrhea of the urinary tract 2 months later. He was treated for DGI, and both he and his partner were educated about the measures that they needed to adopt for prevention of sexually transmitted diseases.