Anti-glomerular basement membrane disease complicated with posterior reversible encephalopathy syndrome and subcortical cerebral hemorrhage: a case report and review of the literature.

A 71-year-old woman was hospitalized for the treatment of fatigue, fever, and cough. On admission, she showed increased serum inflammation markers, severe anemia, pulmonary hemorrhage, and advanced acute kidney injury requiring hemodialysis. Her serum anti-glomerular basement membrane (GBM) antibody titer was found to be extremely high on the 7th hospital day. She was eventually diagnosed with anti-GBM disease. She was treated with a combination of corticosteroid pulse therapy, oral prednisolone and cyclophosphamide, and plasma exchange, but continued to require maintenance hemodialysis for end-stage kidney disease. During her treatment, she suddenly developed headache, blindness, seizure, and consciousness disturbance. She was diagnosed by magnetic resonance imaging with posterior reversible encephalopathy syndrome (PRES) with subcortical cerebral hemorrhage. Both the PRES and cerebral hemorrhage subsided soon after control of her hypertension and reinforcement of immunosuppressive treatment. PRES, particularly when accompanied by cerebral hemorrhage, may cause irreversible and lethal neurological abnormalities, and nephrologists should, therefore, be aware of the potential risk of PRES in patients with anti-GBM disease. We discuss the current case in the light of the previous literature.

Community spread of extended-spectrum ß-lactamase-producing bacteria detected in social insurance hospitals throughout Japan.

We surveyed the status of community-acquired infections involving four extended-spectrum ß-lactamase (ESBL)-producing bacteria (Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, Proteus mirabilis) isolated from clinical specimens from 11 social insurance hospitals in Japan in 2012. These are member hospitals of the Japan Community Healthcare Organization, an independent administrative hospital organization. The isolation rates for E. coli, K. pneumoniae, K. oxytoca, and P. mirabilis were 14.0% (165/1176), 3.3% (16/480), 3.1% (4/130), and 15.9% (17/107), respectively. The CTX-M-9 group, the most frequently detected genotype, was found in 77.0% (127/165) of E. coli and 43.8% (7/16) of K. pneumoniae isolates. Among K. oxytoca isolates, 75% (3/4) were the CTX-M-1 group, and all 17 P. mirabilis strains were the CTX-M-2 group. ESBL-producing bacteria isolation rates in each hospital ranged from 5.8% to 21.5% (median 9.5%), and the proportion of community-acquired infections among ESBL-producing bacteria isolates ranged from 1.6% to 30.8% (median 11.4%) in each hospital. Overall, the rates of ESBL-producing bacterial infection in all community-acquired infections and in all hospital infections were 10.6% (115/1081) and 10.7% (87/812), respectively. The ESBL-producing bacteria are not limited to certain regions or hospitals but are spreading in communities throughout Japan.

[New criteria for discharge from ward in patients with pulmonary tuberculosis using mycobacteria growth indicator tube].

OBJECTIVES: To find a new method to predict the result of the egg based Ogawa medium using the Mycobacterium Growth Indicator Tube (MGIT) system and to evaluate the usefulness of a new discharge criterion that uses the new prediction method for smear positive pulmonary tuberculosis patients. MATERIALS AND METHODS: We compared mycobacterial growth of sputum specimens weekly between the Mycobacterium Growth Indicator Tube (MGIT) and the egg based Ogawa solid media, using a total of 3952 sputum specimens of patients with pulmonary tuberculosis (TB) who underwent chemotherapy in our hospital from September 2001 to March 2006 to find relationship between the results of the two culture methods and to utilize the findings to new discharge criteria of pulmonary TB patients. And we compared the duration of hospitalization between two patients' group: one group using the new discharge criterion, the other the old one. RESULTS: We found that if a specimen shows negative culture on the MGIT system within the first two weeks, the same specimen shows negative or scant growth on the Ogawa media in the 8th week. Introducing this fact as a part of new criteria for hospital discharge of patients with pulmonary tuberculosis, the median duration of hospitalization in our hospital was shortened from 121 days to 71 days and no patient showed treatment failure. DISCUSSION: We have used the result of sputum culture on Ogawa medium as a standard when we judge infectivity of patients with pulmonary tuberculosis in Japan, but it was one of the reasons why Japanese pulmonary tuberculosis patients stay long in TB hospital. Using our finding, we can predict the results of Ogawa system six weeks earlier, when a specimen shows negative culture on the MGIT system in the first 2 weeks. After we introduced this fact into new criteria for hospital discharge of patients with pulmonary tuberculosis, the median duration of hospitalization in our hospital was shortened and no patient shows treatment failure until now. We highly recommend the usefulness of the MGIT system (especially when a specimen shows negative growth in the first two weeks) as a reliable method of predicting infectivity of patients with pulmonary tuberculosis and propose that the new TB discharge criterion should be widely confirmed and used in other hospitals.