2013年から2022年までの期間に東京都内医療機関で分離された侵襲性肺炎球菌感染症（IPD）由来肺炎球菌（Streptococcuspneumoniae）780株（小児398株，成人382株）を対象とし，血清型別，薬剤感受性試験およびペニシリン（PCG）耐性遺伝子型別を実施した．調査期間を1期（2013～2016年），2期（2017～2019年）および3期（2020～2022年）に分け血清型を比較した結果，1期から3期の間で，小児ではPCV13血清型の割合が19.4%から1.2%へ有意に低下し，成人ではPPSV23血清型の割合が76.2%から44.4%へと有意に低下していた．薬剤感受性試験において，PCG耐性率は1期の25.5%が2期19.1%に低下したが3期では30.3%に上昇した．また，PCG耐性遺伝子型においてgPRSPの割合は同様に推移した．非PCV13型で，PCG耐性率が高い血清型として，15A，23Aおよび35B等が認められ，2020年以降増加傾向の35BはPCG耐性率が1期から3期の間で69.0%で，3期のみの耐性率は87.5%であった．一方で，エリスロマイシン（EM）の非感受性率は2～3期において低下傾向にあった．35Bは全株がEM非感受性で，61.9%はメロペネム非感受性であった．

以上より，ワクチン導入後，東京都における血清型分布は小児，成人ともにワクチン型の割合が低下した．また，菌株のPCG耐性率が再び上昇傾向を示したのは，35BをはじめとするPCG耐性率の高い非ワクチン型の血清型が増加したためと考えられた．

A 72-year-old woman was diagnosed as having diffuse large B-cell lymphoma (DLBCL) in 2017 and showed complete remission (CR) in response to six courses of R-CHOP therapy. In April 2021, when she developed her first disease relapse, she was started on bendamustine-rituximab (BR) as salvage chemotherapy. In June 2021, 23 days after she received her second vaccination for coronavirus disease 2019 (COVID-19) with the BNT162b2 vaccine, she was hospitalized with severe anemia. Blood and bone marrow examinations revealed evidence suggestive of pure red cell aplasia with hemolytic anemia. The anemia resolved rapidly with the administration of prednisolone (PSL), and after two courses of BR, the patient achieved CR again. In March 2022, 29 days after a booster COVID-19 vaccination with the mRNA 1273 vaccine, the patient was re-hospitalized with Coombs-positive autoimmune hemolytic anemia (AIHA), and again showed rapid treatment response to PSL administration. Considering that our patient experienced repeated episodes of hemolytic anemia after COVID-19 vaccinations, we suspected an autoimmune mechanism secondary to COVID-19 vaccination as underlying the development of hemolytic anemia in our patient.

Autoimmune pulmonary alveolar proteinosis (APAP) is known to be associated with a high risk of infections, although the underlying mechanism remains unclear. Herein, we report a case of pulmonary nocardiosis associated with APAP that stabilized after therapeutic whole-lung lavage (WLL). The patient was a 75-year-old man; he was diagnosed as having APAP in 20XX-3 and his condition improved with WLL. A follow-up chest computed tomography (CT) in 20XX-1 revealed a 7-mm nodular shadow in the upper lobe of the left lung, and two CT-guided percutaneous transthoracic needle biopsies (CT-PTNB) were performed, the first in 20XX-1 and the second in 20XX. Although the first CT-PTNB did not yield a conclusive diagnosis, culture of the second biopsy specimen grew Nocardia sp., and we diagnosed the patient as having pulmonary nocardiosis secondary to APAP. He was treated with meropenem for the first 9days andsulfamethoxazole-trimethoprim for 6 months, and follow-up CT revealed a decrease in the size of the nodule. Physicians should bear in mind the possibility of nocardiosis as a complication in patients with APAP even when the disease becomes stable after treatment by WLL.