Sinobronchial Syndrome Patients with Suspected Non-Tuberculous Mycobacterium Infection Exacerbated by Exophiala dermatitidis Infection.

Background: Exophiala dermatitidis is an environmental black fungus that rarely causes respiratory infections, yet its pathophysiological features and treatment regimens have not been established. Case Series: Two cases of exacerbations of chronic bronchitis and sinusitis due to E. dermatitidis infection in Japan are presented. Both patients were women, and non-tuberculous Mycobacterium (NTM) infection was suspected based on chest radiological findings, but E. dermatitidis was detected from bronchial lavage fluid and nasal mucus, respectively. Both cases were successfully treated by antifungal agents such as liposomal amphotericin B, voriconazole, and itraconazole, but clarithromycin, rifampicin, ethambutol, and sitafloxacin for NTM were not effective. Conclusion: E. dermatitidis can become a respiratory pathogen, especially in patients with chronic sinobronchial syndrome.

Analysis of Risk Factors Associated with Reduced Trough Concentrations of Vancomycin in Relation to Renal Function in a Tertiary Hospital in Japan.

BACKGROUND: Low trough concentrations of vancomycin (VCM) are common in patients receiving the drug, because patients are often administered relatively low doses of VCM due to its high potential for renal toxicity. However, the clinical risk factors associated with low VCM trough concentration in relation to renal function are unclear. METHODS: Patients at our hospital who received VCM intravenously from January 2018 to December 2020 were analyzed. The patients were divided into two groups based on their renal function: normal and lower renal function, such as estimated glomerular filtration rate (eGFR) ≧60 and <60 mL/min/1.73 m2, respectively. In each renal function group, patients' background characteristics, laboratory data and treatments were compared between lower VCM concentration (<10 mg/L) and appropriate VCM concentration (10-20 mg/L) subgroups. RESULTS: Among 101 patients with normal renal function, 47 and 54 patients, respectively, showed lower and appropriate VCM trough concentrations. Elderly age, short stature, and higher C-reactive protein (CRP) level were significantly more common in the lower VCM concentration group compared with appropriate VCM concentration group. Among the 45 patients with renal dysfunction, 20 and 25 patients, respectively, showed lower and appropriate VCM trough concentrations. CRP levels were significantly higher in lower VCM concentration than appropriate VCM concentration subgroups. Multivariate analysis showed that insufficient total VCM doses and higher CRP might have affected the lower VCM trough concentration in patients with normal renal function. CONCLUSION: The results of this study suggest that higher CRP might be one of the risk factors associated with lower VCM concentration in both normal and low renal function patients. Severely ill and emergency patients might receive a lower VCM dose due to underestimation of the acceptable VCM dose.

Severe Pulmonary Mycobacterium abscessus Cases Due to Co-Infection with Other Microorganisms Well Treated by Clarithromycin and Sitafloxacin in Japan.

BACKGROUND: Mycobacterium abscessus frequently causes severe infections, yet its pathophysiological features and treatment regimens have not been established. CASE REPORT: We present five cases of severe pneumonia due to Mycobacterium abscessus infection in Japan. All cases were diabetic patients, with possible acceleration to pneumonia due to co-infection with other microorganisms. However, following a short period of hospitalization and combination therapy with intravenous imipenem/cilastatin and amikacin, all the cases were successfully treated as outpatients with oral clarithromycin and sitafloxacin. CONCLUSION: M. abscessus infections can become severe in the presence of diabetes mellitus and co-infection with other chronic infectious organisms. Sitafloxacin might be a key drug in the treatment of M. abscessus infection in future.

A Household Microsporum canis Dermatophytosis Suggested by Matrix-Assisted Laser Desorption/Ionization Time-Of-Flight Mass Spectrometry Analysis.

BACKGROUND Microsporum canis is a pathogenic dermatophyte that usually colonizes animals, and secondary infection of humans comes from pets. The infected patients show hair loss with erythema and are diagnosed as having dermatophytosis, but the transmission routes of M. canis from animals to others are sometimes unclear, although they are critical to the treatment of patients and infection control. To identify the pathogens and the transmission routes, morphological observations by microscopes and conventional polymerase chain reaction (PCR) have been used; however, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) has recently become a useful tool. CASE REPORT A 4-year-old girl presented with pruritic, erythematous lesions on the head with alopecia. The dermatologists diagnosed dermatophytosis caused by fungal infection, and M. canis was suspected as the pathogen because of the morphologic characteristics. All of her family members subsequently showed similar hair findings and symptoms. The growth of M. canis was also observed in serial cultures, and all strains were confirmed to be identical, but different from the standard strain on MALDI-TOF MS. In this household infection case, abandoned cats were considered to be the origin of M. canis transmission, and the family members finally improved following oral administration of antifungal agents. CONCLUSIONS M. canis should be carefully investigated as the causative pathogen of dermatophytosis secondary to household infection. MALDI-TOF MS appears to be an excellent tool to confirm the transmission routes of the fungal pathogens among infected patients.

Rhinovirus-Infected Patients in the COVID-19 Pandemic Period.

Human rhinovirus (HRV) is known as one of the most important respiratory pathogens, and the clinical characteristics of HRV infection might be similar to those of coronavirus disease 2019 (COVID-19). We identified 11 HRV-infected patients by polymerase chain reactions of the HRV genes among 151 outpatients with fever. All nine adult patients had underlying diseases and finally improved with the appropriate treatment in this COVID-19 pandemic period. Differential diagnosis between HRV and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection will be needed to save lives and medical resources.

Reduced Prescription of Baloxavir After Suspected Prevalence of a Baloxavir-Resistant Influenza Virus Strain and the Emergence of SARS-CoV-2 in a Tertiary Hospital in Japan.

OBJECTIVE: The use of baloxavir, a new anti-influenza agent, began in Japan from the 2018 to 2019 season and became the focus of attention due to its efficient viral reduction ability; therefore, we should know the prescription changes of anti-influenza agents. METHODS: We analyzed the changes in the prescription of anti-influenza agents between the 2018-19 season and the 2019-20 season in our hospital. RESULTS: The share of baloxavir was 15%, while the shares of oseltamivir and laninamivir were 42% and 31%, respectively in the 2018-2019 season. However, in the 2019-20 season, the share of baloxavir and laninamivir was reduced to 3% and 17%, respectively, in contrast to an increase in the share of oseltamivir (66%). The total prescription of anti-influenza agents for patients decreased in the 2019-20 season (205 patients), compared with the 2018-19 season (509 patients). CONCLUSION: These results suggest significant changes such as a reduction in the prescription of anti-influenza agents, especially baloxavir, likely due to the suspected prevalence of a baloxavir-resistant strain of influenza virus and the emergence of SARS-CoV-2 in Japan.

Mycobacterium abscessus Associated Peritonitis with CAPD Successfully Treated Using a Linezolid and Tedizolid Containing Regimen Suggested Immunomodulatory Effects.

BACKGROUND Mycobacterium abscessus is one of the most important mycobacteria, but its associated peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) appears relative rare, and the treatment regimen of the antibiotics are still unclear. CASE REPORT A 38-year-old female with chronic glomerulonephritis on CAPD who was diagnosed with M. abscessus-associated peritonitis. Symptoms exacerbated despite treatment with a 3-antibiotic regimen combining clarithromycin, imipenem/cilastatin (IPM/CS), and minocycline (MINO). However, after changing IPM/CS and MINO to linezolid (LZD), her condition and inflammation improved, and she was able to be maintained on oral tedizolid (TZD). CONCLUSIONS Oxazolidinones such as LZD and TZD might be candidate antibiotics for the treatment of M. abscessus-associated diseases with chronic renal failure due to their immunomodulatory effects and non-renal excretion.