Case of primary cutaneous Aspergillus caldioustus infection caused by nerve block therapy

We report a case of primary cutaneous Aspergillus caldioustus infection caused by nerve block therapy. A 67-year-old Japanese woman had been treated with oral predonisolon and tacrolimus for adult-onset Still disease and interstitial pneumonia. She presented with a 2-month-history of the lesions on the left back. A biopsy specimen from the skin lesion revealed granulomatous inflammation with hyphae. Culture of the pus and the skin specimen confirmed the diagnosis of cutaneous Aspergillus infection. The sequence of β- tubulin gene was analyzed to confirm the mycological diagnosis and the causative agent was identified as A. caldioustus. The patient was treated with surgical removal of the lesions and oral 200 mg/day itraconazole but she died of infectious interstitial pneumonia due to Pneumocystis jiroveci and Cytomegalovirus infection Percutaneous infection may have been responsible for the incidence of localized infection. There was no evidence of systemic aspergillosis. A. caldioustus is an emerging opportunistic fungal pathogen in immunocompromised patients. Immunocompromised patients who have persistent traumatic atypical skin lesion need to be ruled out of such rare fungus infection. An opportunistic infection in Immunocompromised patients can be life-threatening and prompt treatment based on accurate diagnosis is important.     

Chromoblastomycosis caused by Fonsecaea monophora

Fonsecaea species are major etiologic agents of Chromoblastomycosis (CBM). By genetic analysis, the genus Fonsecaea has recently been revised and classified into F. pedorosoi, F. monophora and F. nubica. Here we report a severe chronic case of CBM caused by F. monophora. A 55-year-old Filipino male developed progressive skin lesions on the left lateral ankle in 1973, when he worked at a coconut plantation in the Philippines. In 1999, he received medical treatments for enlarged, multiple lesions on the left lower limb. When he moved to Japan in 2005, the lesions were remarkably improved and he discontinued taking the medicine. On our first examination in October 2008, a large, reddish, cicatricial plaque was observed on the left lower aspect of his leg. Several tumorous lesions surrounded the plaque, indicating that the therapies performed before had been insufficient. In addition, there were many patchy scars scattered on the thigh and the upper part of the lower leg. The diagnosis of CBM was made by the presence of muriform cells. Black, pulverulent colonies were yielded in culture of skin scrapings and tissues. Although the fungus could not be identified by microscopic morphology, r-RNA ITS sequence analysis enabled identification of Fonsecaea monophora. The patient responded well to oral voriconazole combined with local thermotherapy using pocket warmers. The tumoral masses subsided in 6 months, leaving pink scars with negative fungal culture. Voriconazole treatment was continued for 18 months. It seems that drugs are insufficiently delivered in the cicatricial lesions because of the paucity of blood flow, suggesting that a long-term follow-up is necessary for such a case.     

1,2-Dilinoleoyl-<Emphasis Type="Italic">sn</Emphasis>-glycero-3-phosphoethanolamine ameliorates age-related spatial memory deterioration by preventing neuronal cell death

Background  

Accumulating evidence has pointed that a variety of lipids could exert their beneficial actions against dementia including Alzheimer disease and age-related cognitive decline via diverse signaling pathways. Endoplasmic reticulum (ER) stress-induced neuronal apoptosis, on the other hand, is a critical factor for pathogenesis of neurodegenerative diseases such as Alzheimer disease and Parkinson disease, senile dementia, and ischemic neuronal damage. The present study examined the effects of 1,2-dilinoleoyl-sn-glycero-3-phosphoethanolamine (DLPhtEtn), a phospholipid, on ER stress-induced neuronal death and age-related cognitive disorders.     

A case of theophylline-associated seizures with postictal fever and postictal pleocytosis

We report a 70-year-old man who developed theophylline-associated seizure with postictal fever and postictal pleocytosis. He was admitted to our hospital for a left hemiconvulsion lasting for two hours. The concentration of theophylline was high (21.6ng/ml), and electroencephalogram demonstrated periodic lateralized epileptiform discharges. Diffusion-weighted magnetic resonance imaging showed high signal intensity lesions in the right cingulated gyrus, insula and thalamus. Temperature above 38.0° was detected 5.5 hours after seizure and lasted for 60 hours. Cerebrospinal fluid (CSF) analysis on day 2 demonstrated pleocytosis (62/uL) with a predominance of polymorphonuclear leukocytes (90%). Temperature and CSF pleocytosis subsided after sedation. Intracranial inflammatory or infectious disease is the first consideration in epilepsy with fever and CSF pleocytosis, and then diagnosis of postictal fever and postictal pleocytosis should be made only by rigorous exclusion of that possibility.     

Measuring attention using flash-lag effect

We investigated the effect of attention on the flash-lag effect (FLE) in order to determine whether the FLE can be used to estimate the effect of visual attention. The FLE is the effect that a flash aligned with a moving object is perceived to lag the moving object, and several studies have shown that attention reduces its magnitude. We measured the FLE as a function of the number or speed of moving objects. The results showed that the effect of cueing, which we attributed the effect of attention, on the FLE increased monotonically with the number or the speed of the objects. This suggests that the amount of attention can be estimated by measuring the FLE, assuming that more amount of attention is required for a larger number or faster speed of objects to attend. On the basis of this presumption, we attempted to measure the spatial spread of visual attention by FLE measurements. The estimated spatial spreads were similar to those estimated by other experimental methods.     

Syndrome of inappropriate antidiuretic hormone secretion following adjuvant CDDP and 5-FU administration in a patient with esophageal carcinoma

A case of hyponatremia following the first course of systemic adjuvant chemotherapy with cisplatin (CDDP) and 5-FU in a previously treated patient with esophageal cancer is reported. A 61-year-old man was admitted to our hospital for adjuvant chemotherapy after transthoracic esophagectomy and 3-field lymphadenectomy for esophageal cancer. Six days following chemotherapy, his serum sodium concentration was found to be 118 mEq/L, without edema or dehydration. This hyponatremic state was diagnosed as the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) induced by CDDP, based on the hypo-osmolality of his serum and urine, and an inappropriate level of plasma vasopressin.     

Analysis of fungi detected in human cadavers

We examined and identified fungi flora found growing on two human cadavers. The main isolate colonized on the surfaces of the skin and bones was morphologically identified as Eurotium repens. The genus Eurotium usually inhabits soil and exhibits osmophilic properties. Because the cadavers contained abundant organic materials, Eurotium species formed ascomata and conidia. To our knowledge, this is the first study to describe in detail the species of fungus obtained from human cadavers. Because the detection of some species of fungus found in human cadavers may reveal the local habits of them, more forensic cases is needed to develop fungi into the forensic tool.     

Scalp infection by Candida Albicans in an immunocompetent patient: a description of a rare case

Candida is a large genus of yeast, consisting of about 150 species, among which C.albicans is the most prevalent fungal species of the human microbiota. C. albicans is the most important fungal opportunistic pathogen that can cause infection when the host becomes debilitated or immunocompromised. We report a case of a scalp infection by C.albicans in a patient without an obvious immunocompromised state.