Thoracic empyema caused by Alloscardovia omnicolens and Bifidobacteriumdentium.

A 62-year-old man was admitted to our emergency department with the complaint of worsening dyspnea after initiating anti-tuberculous therapy (isoniazid [300 mg/day], rifampicin [600 mg/day], ethambutol [750 mg/day], and pyrazinamide [1,500 mg/day]) for tuberculous pleuritis. His oral hygiene status was poor. The patient had no significant past medical history. However, he had a history of smoking (10 cigarettes per day for 45 years) and was a social drinker. Chest radiography revealed increased right pleural effusion and pneumothorax. The pleural fluid was purulent, and the culture grew Alloscardovia omnicolens, Bifidobacterium dentium, and Prevotella loescheii. He was treated with antibiotics (3 g of intravenous ampicillin/sulbactam every 6 h, which was changed to oral amoxicillin/clavulanate potassium on day 34) in addition to anti-tuberculous therapy, he underwent chest tube insertion, and subsequently improved. Bifidobacteriaceae are commensal flora of the mouth and pulmonary infections caused by these organisms are extremely rare. Nevertheless, clinicians should consider these organisms as a possible cause of pulmonary infections, and consider that respiratory infections caused by commensal flora of the mouth may occur during the treatment of other diseases in patients with poor oral hygiene.

Peribronchial Connective Tissue Infection Caused by Bifidobacterium longum and Veillonella Species Mimicking Lung Cancer.

An 86-year-old woman was admitted for the investigation of atelectasis of the upper lobe of her right lung with a mass shadow in the hilum (Golden S sign). Chest computed tomography revealed swollen connective tissue around the right bronchus, and needle aspirate grew Bifidobacterium longum and Veillonella species. She was diagnosed with peribronchial connective tissue infection, and her condition improved with antibiotics. Although this sign is strongly suggestive of malignant disease, benign disease should be considered in the differential diagnosis. Pulmonary infection caused by Bifidobacterium longum is extremely rare; however, clinicians should consider it as a possible cause of pulmonary infections.

Different anti-Mullerian hormone (AMH) levels respond to distinct ovarian stimulation methods in assisted reproductive technology (ART): Clues to better ART outcomes.

PURPOSE: We asked whether the relationship between anti-Mullerian hormone (AMH) value and the response to ovarian stimulation (OS) might be AMH value-related and differ for each regimen, aiming at getting clues as to how to choose OS protocols according to AMH levels. We further addressed how AMH value connects with ART outcome. METHODS: A total of 1112 women undergoing egg retrieval in ART were included. We adopted four OS protocols, that is, clomiphene, clomiphene + low-dose gonadotropins (Gns), GnRH (Gn-releasing hormone) + Gns (short), and GnRH antagonist. RESULTS: Anti-Mullerian hormone showed a stronger correlation with egg number compared with age over a wide age range. When patients were stratified into four groups by AMH value (<1, 1-2, 2-3, and 3≦ ng/mL), the relationship between AMH and egg number differed among differential OS regimes. The number of eggs rose as AMH and total doses of Gn increased. When analyzed for each AMH group, egg number, but not AMH, was associated with pregnancy rate. CONCLUSION: Different AMH levels exhibit characteristic responses to distinct OS regimens. To improve ART outcomes, personalized OS should be selected so as to maximize egg number, which seems to be a more precise variable than AMH for predicting pregnancy.

Pulmonary Nocardiosis: A Clinical Analysis of 30 Cases.

Objective Pulmonary nocardiosis frequently develops as an opportunistic infection in patients with malignant tumor and is treated with steroids. This study was performed to clarify the clinical features of pulmonary nocardiosis in Japan. Methods The patients definitively diagnosed with pulmonary nocardiosis at our hospital between January 1995 and December 2015 were retrospectively investigated. Results Nineteen men and 11 women (30 in total) were diagnosed with pulmonary nocardiosis. Almost all patients were complicated by a non-pulmonary underlying disease, such as malignant tumor or collagen vascular disease, or pulmonary disease, such as chronic obstructive pulmonary disease or interstitial pneumonia, and 13 patients (43.3%) were treated with steroids or immunosuppressors. Gram staining was performed in 29 patients, and a characteristic Gram-positive rod was detected in 28 patients (96.6%). Thirty-one strains of Nocardia were isolated and identified. Seven strains of Nocardia farcinica were isolated as the most frequent species, followed by Nocardia nova isolated from 6 patients. Seventeen patients died, giving a crude morality rate of 56.7% and a 1-year survival rate of 55.4%. The 1-year survival rates in the groups with and without immunosuppressant agents were 41.7% and 59.7%, respectively, showing that the outcome of those receiving immunosuppressants tended to be poorer than those not receiving them. Conclusion Pulmonary nocardiosis developed as an opportunistic infection in most cases. The outcome was relatively poor, with a 1-year survival rate of 55.4%, and it was particularly poor in patients treated with immunosuppressant agents. Pulmonary nocardiosis should always be considered in patients presenting with an opportunistic respiratory infection, and an early diagnosis requires sample collection and Gram staining.

[Antimicrobial Susceptibility of Streptococcus pneumoniae Isolated from 8 Hospitals in Chiba Prefecture Following the Introduction of 7-valent Pneumococcal Conjugate Vaccine].

We investigated the susceptibility of Streptococcus pneumoniae isolated from 8 hospitals in Chiba prefecture during 2012-2013. We further checked the serotype of S. pneumoniae derived from invasive pneumococcal disease (IPD). We tested for antimicrobial susceptibility in 256 clinical isolates (137 isolates from children, 119 isolates from adults) for 25 drugs. In MIC50 and MIC90, there were very little differences between children and adults, but there were 3 isolates from adults which were resistant to levofloxacin. The most major serotypes were 15A and 3 in IPD. Additionally there was no isolation of the type contained in the 7-valent pneumococcal conjugate vaccine in children, so it seems that the vaccination is very effective for children. Furthermore, in contrast with our preceding report, a decreasing was seen in PCG resistant proportion of S. pneumoniae. The maximum PCG-MIC was 2 µg/mL.

Acute myelogenous leukemia with Leptotrichia trevisanii bacteremia.

A 74-year-old woman visited an otolaryngology clinic with pharyngeal pain, and was diagnosed with a peritonsillar abscess. She received antibiotics and underwent incisional drainage, but displayed high white blood cell and blast cell counts, and was referred to our hospital. Gram-negative rods (Leptotrichia trevisanii) were detected in blood cultures performed on admission. She was diagnosed with bacteremia and acute myelogenous leukemia (FAB classification: M1). After antibiotic therapy, she temporarily recovered from the bacteremia, but subsequently died on day 34. Although Leptotrichia trevisanii bacteremia is extremely rare, clinicians should consider it in cases involving immunocompromised patients with oral lesions.