A Case of Acute Tubulointerstitial Nephritis after Oral Administration of Valacyclovir / 日本農村医学会雑誌

A woman in her 80s developed a feeling of abnormal sensation in her face and excessive salivation. She was diagnosed with right facial nerve paralysis and was admitted to a local hospital. On admission, serum creatinine level was 0.54mg/dL and estimated glomerular filtration rate was 79mL/min/1.73m2. She was started on oral valacyclovir at a dose of 3,000mg/day to treat the right facial nerve paralysis. However, 5 days after starting oral administration, she developed generalized fatigue, vertigo, and vomiting. Serum creatinine level rose to 4.99mg/dL with mild disturbance of consciousness, so she was transported to our hospital on suspicion of acyclovir-induced encephalopathy. We performed hemodialysis for 3 consecutive days to remove the acyclovir from the circulation, which subsequently improved all her symptoms. She was later diagnosed with allergic tubulointerstitial nephritis based on renal biopsy.After discharge from our hospital, laboratory data showed a serum creatinine level of 0.67mg/dL. We later confirmed that the serum acyclovir level before the first hemodialysis session had been very high (11.9μg/mL).

Candidemia in a Regional Hospital without Infectious Diseases Department / 日本農村医学会雑誌

  In Japan, there are many hospitals which do not have departments specializing in infectious diseases. Treatment of critical nosocomial infections such as candidemia is not sufficient and varies greatly from one institution to another. We reviewed the cases of candidemia in Saku Central Hospital from 2004 to 2008, and examined fungal species, clinical background, therapy, prognosis and the rate of treatment in accordance with the Infectious Diseases Society of America (IDSA) guidelines for candida infection. Blood culture revealed 43 cases diagnosed as candidemia. <i>Candida albicans</i> was the most common fungus. Antibiotics were administered to 84% of the patients and 79% had central venous catheters (CVC). The empirical antifungal administration included fosfluconazole and micafungin, but 23% of the patients did not receive any appropriate antifungal therapy. CVCs were removed from 23 of 34 patients, and 42% of the patients underwent ophthalmologic examination. Some of the patients (42%) were treated according to the IDSA guidelines, but most were not. The 28-day mortality rate was 33%. This study demonstrated that the strategy for treating candidemia in our hospital was insufficient, and also suggested that critical nosocomial infections cases were treated in adequately in many other regional hospitals in Japan. In conclusion, a well-organized and guideline-based therapeutic system is necessary in hospitals without the infectious diseases department.