Two cases of allergic bronchopulmonary mycosis caused by Schizophyllum commune in young asthmatic patients]

We report on two patients, a 27-year-old and a 33-year-old woman, with allergic bronchopulmonary mycosis (ABPM) caused by the basidiomycetous fungus Schizophyllum commune (S. commune). Each patient had bronchial asthma. Both were admitted to our institution for further examination of cough, sputum, and abnormal chest shadows. ABPM was strongly suspected, because they showed eosinophilia in both peripheral blood and sputum, and increased serum IgE levels. A mold was isolated from their sputum, but identification was not possible. Systemic corticosteroid therapy relieved their symptoms and chest abnormal shadows. Later, S. commune, a basidiomycetous fungus, was detected from further examination of their sputum cultures, and serum anti-S. commune IgG was elevated. Finally, both cases were diagnosed as ABPM caused by S. commune. It is reported that this syndrome typically develops in women in middle age, but our patients were young women. It is important to take into account the possibility of ABPM caused by S. commune even in young patients when Aspergillus species are not isolated.     

An outbreak of parainfluenza 3 virus infection in the elderly in a ward]

In the D ward of Nagoyashi-Koseiin geriatric hospital (36-beds), upper respiratory illnesses were recognized in all the inpatients between July and August in 1995, and we studied 7 elderly subjects with parainfluenza 3 infection diagnosed by serology and viral culture. The outbreak of upper respiratory illnesses occurred in the ward during the 17 days from July 21 through August 6, 1996. Fifteen of the 18 elderly persons with upper respiratory illnesses were tested by serology; parainfluenza 3 infection was identified in 7. One of the 7 patients, parainfluenza 3 virus was isolated. Seven elderly subjects with parainfluenza 3 infection were 2 males and 5 females and five of them (71.4%) were bedridden. The most common complaint was fever and coughing in 7/7 (100%), followed by sputum in 5/7 (71.4%), wheezing in 4/7 (42.9%). The pyrexial period in the parainfluenza-infected group ranged from 1 to 4 days (average 3.1 days), and was significantly shorter than that of the influenza group. The maximum recorded temperature in the parainfluenza-infected group ranged from 37.0 to 39.2 degrees C (average 38.1 degrees C), and was significantly lower than that of the influenza group. Two of the 7 patients with parainfluenza 3 virus infection had pneumonia, but nobody died, and all 7 patients recovered without sequele. It is possible that parainfluenza 3 virus infection among elderly subjects cause secondary bacterial infection, so we think that prevention of nosocomial parainfluenza infection should be a high priority in the case of outbreak of such an infection in a ward.     

Gastroesophageal infection caused by cytomegalovirus in immunodepressed patients. Presentation of 3 cases]

We report three cases of upper gastrointestinal infection by Cytomegalovirus in immunocompromised patients. Two patients suffered from AIDS and the other one had a recent heart transplantation and was on immunodepressant drugs for an episode of rejection. The stomach in two cases and the esophagus in the other were the affected organs. In all cases there were upper gastrointestinal symptoms and the diagnosis was established by biopsy of endoscopically suspicious lesions. Antiviral therapy was effective in all three cases. This diagnosis has to be considered whenever immunocompromised patients present with unusual clinical and endoscopic findings.     

Two cases of successfully treated invasive pulmonary aspergillosis following influenza virus infection]

While invasive pulmonary aspergillosis usually occurs in immunocompromised hosts, it has been described after influenza virus infection in healthy individuals. The first case was a 76-year-old previously healthy woman admitted because of chest pain, cough, sputum, fever, and a chest radiograph abnormality. A transbronchial biopsy specimen showed fungal hyphae. Amphotericin B (AMPH) and Itraconazole (ITCZ) were given, and she improved gradually. A viral test showed a titre of 1/128 to influenza A. Case 2 was a 72-year-old previously healthy man admitted because of cough, fever, chest pain and a consolidation and cavitation on the chest radiograph. Antibiotics were ineffective. Cavitation with a halo sign appeared on the contralateral lung. Because his daughter was infected with Influenza B, we suspected he had been infected with IPA following influenza infection. AMPH and ITCZ and Micafungin sodium were given. His respiratory failure worsened, and on the tenth hospital day he required artificial ventilation; his condition improved gradually, (extubation after 40 days.) A viral test showed a titre of 1/128 to influenza B. IPA must be considered for the differential diagnosis of complications of influenza virus infection.     

Two cases of pulmonary Mycobacterium xenopi infection]

We report on two patients diagnosed as having Mycobacterium xenopi infections. Case 1 occurred in a 40-year-old man. His chest radiograph revealed a cavitary lesion with a granular shadow in the right upper lung field. His sputum and bronchial lavage were negative for acid-fast bacilli and malignant cells. For a definitive diagnosis, lung resection was performed by video-assisted thoracoscopy. Case 2 was in a 45-year-old man. His chest radiograph showed a cavitary lesion with infiltration in the right upper lung field. Acid-fast bacilli were seen in his sputum specimens and M. xenopi was identified by culture. Despite medication with isoniazide, rifampicin and ethambutol, the infiltrative shadow in his radiograph increased in size. In this case, right upper lobectomy was performed. In recent years, 8 cases of pulmonary Mycobacterium xenopi infection have been reported in Japan. In the future, the number of such case reports may increase as a result of diagnosis by molecular biological methods. It is necessary to consider carefully whether surgical resection is required when chemotherapy is refused by the patient or is likely to be unsuccessful.     

Two cases of severe necrotizing pneumonia caused by community-acquired methicillin-resistant Staphylococcus aureus]

We present 2 cases with severe necrotizing pneumonia due to community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection. The patients were a 89-year-old man and a male student of 15 years of age. Chest X-rays and CT scans demonstrated multiple consolidations with cavitary lesions showing necrotizing pneumonia. MRSA strains were isolated from the sputum cultures on admission in these patients who did not have any established risk factors for MRSA infections such as history of hospitalization, surgery, hemodialysis, the presence of a permanent indwelling catheter or percutaneous medical device, and residence in a long-term care facility. These patients thus satisfied the international criteria for CA-MRSA presented by the Centers for Disease Control and Prevention (CDC). Unfortunately, the first case died of CA-MRSA pneumonia in spite of intensive treatments including anti-MRSA antibiotics. Unlike the severe CA-MRSA cases in western countries, Panton-Valentine leukocidin (PVL) genes were not detected in the present cases, suggesting that factors other than PVL had a significant effect on the severity of necrotizing pneumonia. To the best of our knowledge, this is the first report of severe necrotizing pneumonia caused by CA-MRSA in Japan.     

Bacterial involvement in parainfluenza virus infection in children

37 children with serologically confirmed parainfluenza virus (PV) infection were studied by new serological methods for evidence of concomitant bacterial infection. 24 of the children were hospitalized because of croup and 13 because of lower respiratory tract infection. Serological evidence of bacterial involvement was found in 4 (11%) of the 37 children, in none of the 24 children with croup but in 31% of the 13 children with PV infection of the lower airways (p less than 0.05). Streptococcus pneumoniae was implicated in 3 cases and Haemophilus influenzae in 1. Serological evidence of staphylococcal involvement was not seen in any case. The 3 patients with pneumococcal involvement had pneumococcal antigen in the acute serum. In all of them pneumonia was associated with PV type 1 or 3, and in 2 serum C-reactive protein was elevated. The data presented support the view, that secondary bacterial infection is rare in children with croup, but common in lower respiratory tract infection caused by PV.     

氧氟沙星致精神症状二例

例 1 ,患者 ,女性 ,46岁。因持续高热 1 0ｄ入院。经临床检查和肥达氏反应结果 (“Ｏ”抗体 1∶32 0 ,“Ｈ”抗体 1∶6 40 ) ,诊断为伤寒。使用氨苄青霉素加氧氟沙星 0 .4ｇ ,予葡萄糖注射液一同静脉滴注 ,1次 /ｄ ,。治疗第 5天后体温逐渐下隆 ,症状好转 ,至第 7天患者出现精神恍惚 ,答非所问 ,给予安定 1 0ｍｇ肌注后夜间安静入睡。次日晨 ,继续使用氧氟沙星过程中再次出现烦躁不安、幻听、哭笑无常等精神症状。神经系统检查未见异常。急查脑电图、心电图、肝、肾功能、电解质均正常。停止使用氧氟沙星 ,继续用氨苄青霉素治疗 ,第 2天精神…     

苏州地区人副流感病毒3感染住院患儿临床特征

目的探讨苏州地区因急性呼吸道感染住院患儿中副流感病毒3型(HPIV3)感染临床特征。方法收集2013年1月~2013年12月因急性呼吸道感染住院2298例患儿的痰标本,应用直接免疫荧光法测呼吸道合胞病毒、流感病毒(A、B)、人副流感病毒(1~3)和腺病毒,采用实时PCR检测人博卡病毒DNA,逆转录PCR检测人偏肺病毒及鼻病毒RNA。分析人副流感病毒3型感染患儿的临床特点及流行病学特征,并与呼吸道合胞病毒(RSV)感染进行比较。结果 2298例痰标本中病毒检测阳性者983例(42.78%),HPIV3阳性98例(4.26%),次于RSV阳性233例(10.14%);HPIV3常年均可感染,以春、夏季为发病高峰,夏季发病率高达45.92%;发病年龄均为6岁以下儿童,1岁以下检出率高,占62.30%;98例阳性标本中,HPIV3单独感染61例,主要引起支气管肺炎(80.33%)、急性毛细支气管炎(13.11%),以咳嗽(96.72%)、喘息(44.26%)、发热(47.54%)为主要临床症状;与RSV比较,HPIV3住院患儿喘息发生率低,主要引起支气管肺炎,差异有统计学意义(P0.05)。结论 HPIV3是苏州地区住院患儿呼吸道感染的重要病原之一,其有单独的致病性,与RSV相比,在季节分布、临床表现等方面有一定差异。     

黑热病误诊致脾切除2例

1　临床资料病例 1 ,男 ,5岁。因发热 ,面色苍白 4月 ,腹胀半月入院。患儿 4月前无明显诱因出现发热 (未测体温 )。在当地按“感冒”治疗后有所缓解。数天后再次发热 ,面色渐苍白 ,伴神萎 ,纳差 ,在当地乡医院抗感冒治疗无效。 2月前至某市级医院住院治疗 ,血常规示 WBC 2 .5× 1 0 9/ L,RBC2 .63× 1 0 12 / L,HB63 g/ L,PLT91× 1 0 9/ L。腹部 CT示脾大 ,脾内多个结节状低密度实质性占位 ,提示淋巴瘤可能。诊断为“脾脏恶性淋巴瘤”。2月前行脾脏切除术。术后 2 d无发热 ,后再次每日发热 ,体温 3 9℃～ 40 .5℃。切除脾脏病理诊断…     

Two cases of respiratory infection complicating treatment with infliximab]

Infliximab, an anti-TNF-alpha agent, is highly effective against rheumatoid arthritis and Crohn's disease. However, respiratory infection can occur as a complication. We report two cases complicated by respiratory infection following administration of infliximab. The first case, a 67-year-old woman with rheumatoid arthritis, developed pneumocystis pneumonia after three courses of infliximab therapy. The second case, a 31-year-old man with Crohn's disease, developed pulmonary tuberculosis after four courses of infliximab therapy. Respiratory complications associated with anti-TNF therapy include infectious diseases such as pneumocystis pneumonia, tuberculosis, and bacterial pneumonia. They often lead a fulminant course, and early diagnosis is essential. The final report of a survey of the initial 5000 cases with rheumatoid arthritis treated with infliximab in Japan was released in April 2006; pulmonary infectious complications included 22 cases of pneumocystis pneumonia, 14 cases of tuberculosis, and 108 cases of bacterial pneumonia. The growing use of anti-TNF therapy might lead to increasing pulmonary complications. Accumulation of similar cases is expected to elucidate the mechanism of the complications and methods for effective prophylaxis.     

Pulmonary infection caused by Mycobacterium gordonae]

A 57-year-old woman who had been operated on for colon cancer and given chemotherapy, presented in September 1995 with worsening cough and abnormalities on her chest X-ray film. Acid-fast bacilli were isolated from the sputum. The organism was classified as M. gordonae by biochemical tests and DNA/DNA hybridization. The patient was treated with rifampicin and clarithromycin. Subsequently, sputum cultures became negative and the chest x-ray film showed a decrease infiltration. The findings in the present case suggest that M. gordonae may cause pulmonary infection and should be considered as an opportunistic pathogen.     

Biology of infection caused by the dengue virus

In this review the most important aspects of the biology of the disease caused by the dengue virus are described: the characteristics of the disease, the epidemiology, the vector, the virus (proteins and genome), the diagnostic techniques and the vaccines.     

12例嗜麦芽窄食单胞菌感染及其药敏研究

目的：研究嗜麦芽窄食单胞菌引起的感染危险因素及有效抗生素,方法分析１２例嗜麦芽窄食单胞菌感染的临床资料,应用Ｓｃｅｐｔｏｒ系统测定了１８株嗜麦芽窄食单胞菌对２０种抗性素的敏感度。结果嗜麦芽窄食单胞菌多见于呼吸道染,其次为菌血症及局部感当了菌株对大多数抗生素耐药,结论严重基础疾病,应用广谱抗生素及免疫抑制剂是嗜麦芽窄食单胞菌感染的危险因子,替卡西林、环丙沙星和阿米卡星为抗嗜麦芽窄食单胞菌有相对活性的