[A case report of toxic shock-like syndrome due to group A streptococcal infection in an alcoholic].

A 47-year-old male with a history of alcohol abuse had a sore throat on June 8, 1994. On June 13, he had swelling and pain on his right fore-arm. He had tense swelling, redness and pain on the right lower abdomen, left upper arm and left lower leg with high fever and noticed erythema and blisters on his back of the right hand on June 18, which gradually expanding to the entire fore-arm. He was admitted to the local hospital on July 2, where he was operated with excision of the skin and drainage for an abdominal subcutaneous abscess and was given three antibiotics and an intravenous immunoglobulin preparation. Although he showed transient hypotension and moderate liver dysfunction, his condition improved day by day under such treatment. He was transferred to our hospital on July 7 because of the unknown etiology. Aspirate from the abscess contained gram-positive cocci in chains, and group A streptococci were isolated. Panipenem/betamipron was used for an antibiotic during roughly two weeks and excision of the skin and drainage for abscess was performed twice. His skin lesions were continued to improve, normalizing peripheral white blood cell counts, serum levels of CRP and the liver function. On July 24, the antibiotic was changed to intravenous ampicillin and administered for 16 days and amoxicillin was given orally after that, and he was discharged on August 16. An isolate of the infecting Streptococcus pyogenes produced pyrogenic exotoxin A, B and the serotype was T-3 type.

Glutathione S-transferases as a cefpiramide binding protein in rat liver.

To clarify the intrahepatical transport mechanism of cefpiramide, we investigated effects of various agents mainly excreted into the bile by several different mechanisms on the biliary excretion of cefpiramide in rats. Sulfobromophthalein, indocyanine green, bilirubin and probenecid, known to be bound to glutathione S-transferases (GST) (EC 2.5.1.18) in liver cytosol, reduced the biliary excretion of cefpiramide, while neither secretory IgA, which is transported via vesicles in the liver, nor colchicine, which inhibits movements of vesicles, had any effect on the excretion of cefpiramide. Propranolol and metoprolol, metabolized by mixed function oxidases, had no effect on the biliary excretion of cefpiramide. In the chromatography of liver cytosol, the amount of sulfobromophthalein or benzylpenicillin bound to the GST fraction decreased in the presence of cefpiramide or probenecid. The study showed that cefpiramide was transported in the liver without relation to mixed function oxidases or vesichle-mediated transporting system, but in relation to GST which binds cefpiramide, sulfobromophthalein, benzylpenicillin and probenecid, indicating an important role of GST in the cefpiramide excretion into the bile.

[Useful abdominal ultrasonography for diagnosis of Fitz-Hugh-Curtis syndrome: two case reports].

Recently, Chlamydia trachomatis infection in sexually active women has increased. C. trachomatis cause pelvic inflammation. A few of these patients develop Fitz-Hugh-Curtis syndrome (FHCS). Clinical symptoms of FHCS include pain of sudden onset in the right upper quadrant mimicking acute biliary disease. Diagnosis of FHCS has been weighed upon laparoscopic findings. Since FHCS is a benign disorder which responds to appropriate antibiotics, non-invasive diagnostic method would be expected. We report here two cases of FHCS, diagnosed by a high serum antibody titer against C. trachomatis and clinical manifestations. Both cases showed small effusion in the pelvic cavity detected by ultrasonography, one of them was associated with small effusion in the right perirenal space suggesting perinephritis. Detection of small effusion intra abdominal cavity or pelvic space could be useful for non-invasive diagnosis of FHCS.

Anti-endotoxic activity of murine monoclonal antibody (E5) assessed by inhibition of priming of human phagocytes by endotoxin.

The in vitro activity of a murine monoclonal antibody (E5) reactive with endotoxin was examined in human whole blood by measuring the luminol-chemiluminescence (CL) activity in response to phorbol myristate acetate (PMA) as an index of the priming effect of lipopolysaccharide (LPS) on the release of reactive oxygen species. Whole blood samples obtained from healthy adults showed a significantly enhanced CL response to PMA after incubation with LPS (100 ng/ml, Escherichia coli O111:B4) for 10 min at 37 degrees C, as compared with untreated blood samples, through no CL response was induced by LPS itself. This priming effect of LPS varied from person to person. Similarly, various degrees of the priming effect were observed with other LPS preparations derived from E. coli O55:B5, Klebsiella pneumoniae, Serratia marcescens and Salmonella typhimurium. However, the priming effects of these LPS or a synthetic lipid A (LA-15-PP) of E. coli were significantly prevented to various degrees when such endotoxins were treated with E5 for 30 min at 37 degrees C prior to being added to blood samples. The inhibitory effect E5 was dose-dependent and was most potent against the LPS of E. coli O111:B4. These results indicate that E5 suppresses the priming effect of LPS on oxygen radical release from human whole blood, and therefore suggest that E5 may be a useful drug for supportive therapy in patients with gram-negative septicemia or endotoxemia, especially in a case involving serious neutrophil-mediated organ injury caused by excessive release of oxygen free radicals.

[Two cases of Campylobacter fetus subsp. fetus sepsis].

We encountered two relatively rare cases of sepsis due to Campylobacter fetus subsp. fetus (C. fetus). Case 1. A 54-year-old female with abdominal polysurgery developed a slight fever and vomiting in August 1984. Despite the administration of some digestive drugs by her family doctor, these symptoms continued. In mid-October, she was hospitalized with high fever with chill and rigor on the skin. On the third hospital day, C. fetus was detected in the blood culture. After combination chemotherapy of intravenous drip infusion of latamoxef (LMOX) (2 g/day) and oral administration of erythromycin (EM) (800 mg/day), her symptoms improved. Case 2. A 57-year-old male with diabetic retinopathy and nephropathy was hospitalized because of slight fever, general edema and pleural effusion. On the 6th hospital day, C. fetus was detected in the blood culture and he was diagnosed with sepsis. Under treatment with the intravenous drip of LMOX (2 g/day) and oral administration of EM (1200 mg/day), his condition improved. Both cases had common underlying diseases such as hypoproteinemia with edema and problems in the lower intestinal tract; the former had polysurgery and malabsorption syndrome, the latter had diffuse ulceration of the colon. Such underlying conditions may have permitted the invasion of C. fetus into the blood.

Comparative study of the effects of cefodizime and HBW 538 in potentiating the production of reactive oxygen species by human polymorphonuclear leukocytes.

The immunomodulatory activity of cefodizime (CDZM), an aminothiazolylcephalosporin, was compared to that of HBW 538, a derivative of the CDZM side chain at position 3 (the mercaptothiazolyl group) in respect to the production of reactive oxygen species (ROS) by human whole blood and polymorphonuclear leukocytes (PMN) in vitro. Ten-fold diluted whole blood and PMN from healthy individuals were incubated with CDZM or HBW 538 alone at the concentrations of 1, 10, or 100 micrograms/ml, or CDZM or HBW 538 at 100 micrograms/ml in combination with tumor necrosis factor-alpha (TNF-alpha) at 100 U/ml or lipopolysaccharide (LPS) at 1 microgram/ml. The production of ROS was measured by a chemiluminescence (CL) assay in which luminol was added to a mixture and after which the PMN or whole blood were stimulated with nonopsonized zymosan or phorbol myristate acetate. The following results were obtained: (1) The CL responses of whole blood and PMN were slightly but not significantly enhanced by CDZM at 100 micrograms/ml, whereas both CL responses were significantly enhanced by exposure to HBW 538 at 10 and 100 micrograms/ml. (2) The enhanced PMN CL response which followed priming with TNF-alpha or LPS was not augmented by CDZM but was significantly augmented by HBW 538. These results indicate that the ability of the HBW 538 molecule to enhance the production of ROS by stimulated PMN and to act agonistically with TNF-alpha or LPS is abrogated when HBW 538 is part of the CDZM molecule.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of mefloquine-resistant Plasmodium falciparum malaria with convulsion after antimalarial treatment].

We report a case of 40-year-old with chloroquine- and mefloquine-resistant Plasmodium falciparum. He had a single grand mal seizure 37 days following retreatment with quinine intravenously, which resulted in rapid clearance of fever and parasitemia, in addition to mefloquine. He had a long history of seizures, which were well controlled by phenytoin. Because he has never had such a seizure before and computerized tomographic scanning of the brain after admission showed no abnormal findings which caused convulsions, it seemed to be an adverse reaction caused by antimalarial drugs. It is possible that a double or triple combination treatment for the emergence of multiresistant falciparum malaria might more frequently produce severe side effects, such as psychiatric reactions and convulsions. This case suggests that physicians must have a long follow-up period for chronic toxicity of antimalarial drugs, especially after using drug combinations for falciparum malaria.