Infective endocarditis due to a rare pathogen, Streptococcus constellatus, in a patient with gingivitis: A case report and review of the literature

A 78-year-old Japanese man with a 5-day history of fever (～38°C) and decreased appetite was admitted to our hospital. Transesophageal echocardiography revealed aortic valve vegetation. Streptococcus constellatus was detected from a blood culture. An antibiotic sensitive to this strain was administered for 6 weeks, and the patient has been well for 6 months without any sign of relapse. A review of all documented cases of infective endocarditis due to S. constellatus revealed nonspecific initial symptoms, especially coughing, and complications of abscess formation and septic embolisation. Clinicians should carefully consider the choice of antibiotic agents in the treatment of infective endocarditis due to S. constellatus, because penicillin-resistant strains have been documented in some cases.     

Meropenem was effective to the bacterial meningitis due to beta-lactamase negative ampicillin-resistant Haemophilus influenzae; case report

We experienced a case in the infant of the bacterial meningitis due to beta-lactamase negative ampicillin-resistant Haemophilus influenzae (BLNAR) which has increased in recent years. In the present condition, the sensitivity of the bacteria to the antibacterial-drug used as the initial treatment for the bacterial meningitis is sometimes inadequate. If it takes into consideration that BLNAR participates in H. influenzae meningitis, it will be one of the choice to use meropenem with other antibacterial-drug concomitantly.     

Treatment of invasive infections due to rare or emerging yeasts and moulds

Emerging fungal infections represent a serious problem in an immunocompromised host. Rapid developments in in vitro antifungal susceptibility testing and the availability of several new antifungal agents have provided excellent opportunities to treat infections that are caused by various Candida spp. and to some extend by Aspergillus spp. However, recently the epidemiology of fungal infections has significantly changed and several new pathogens have emerged. This article attempts to summarise the available data on the management of emerging infections with fungal infections that have recently gained importance. Updated recommendations on antifungal treatment are also discussed.     

Treatment of invasive infections due to rare or emerging yeasts and moulds

Emerging fungal infections represent a serious problem in an immunocompromised host. Rapid developments in in vitro antifungal susceptibility testing and the availability of several new antifungal agents have provided excellent opportunities to treat infections that are caused by various Candida spp. and to some extend by Aspergillus spp. However, recently the epidemiology of fungal infections has significantly changed and several new pathogens have emerged. This article attempts to summarise the available data on the management of emerging infections with fungal infections that have recently gained importance. Updated recommendations on antifungal treatment are also discussed.     

A case of neonatal meningitis due to Flavobacterium meningosepticum successfully treated with cefmetazole and cefotaxime

A 3-day-old male infant, weighing 3,413 g and a gestational age of 38 weeks developed neonatal meningitis due to Flavobacterium meningosepticum. Treatment with cefmetazole and cefotaxime led him to a complete recovery without neurologic deficit. Of 82 previously published cases under 1 year old, 41 cases died and 16 of survivors developed hydrocephalus because the organism was resistant to many antibiotics. Therapy of meningitis due to the organism has not been standardized but the early laboratory identification and the choice of effective and safe antibiotics determined by antimicrobial sensitivity test improve the outcome.     

A rare debilitating neurological adverse effect of ranolazine due to drug interaction with clarithromycin

Medication errors may occur at any point during patient care in the health care system. Drug interaction in known with macrolide antibiotics and ranolazine and is primarily related to effects on the cytochrome P4503A (CYP3A) metabolic pathway. This case highlights medication errors that resulted in rare debilitating neurological adverse effects of ranolazine in an elderly due to drug interaction with clarithromycin.KEY WORDS: Drug interaction, medication error, neurological adverse effects, ranolazine     

A rare case of desquamative gingivitis due to linear IgA disease: morphological and immunofluorescence features

Linear IgA disease (LAD) is an acquired subepidermal bullous disorder, characterized by linear deposition of IgA along the basement membrane. Although the oral cavity is involved in up to 50% of cases, its exclusive involvement is very rare. The case of a 57-year-old woman with 13 months history of desquamative gingivitis chiefly located in the maxilla gingiva is presented. She had been diagnosed by her dental practitioner with an oral infection one year previously and had been receiving local anti-inflammatory and antibiotic medication, with no improvement. She was referred to our Oral Pathology Department, where the biopsy performed revealed a submucosal blister with chronic infiltrate. Direct immunofluorescence showed a linear deposition of IgA in the basal membrane zone, and a diagnosis of LAD was rendered. The patient was treated with topical cortisone, triamcinolone and systemic oral methylprednisolone at a daily dose of 32 mg, and continued at decreasing doses for 3 months. At the most recent check-up, 7 months after initial presentation, she was no longer taking any medication and remained asymptomatic and disease-free.