A case of thrombotic thrombocytopenic purpura refractory to plasma exchange.

We experienced a case of thrombotic thrombocytopenic purpura (TTP) finally relieved after 74 sessions of plasma exchange (PE). The patient was a 56-year-old male. In August 1999, he was examined in emergency because of brown urine and a lowered level of consciousness. As TTP was suspected according to the laboratory findings of abnormally high lactate dehydrogenase and total bilirubin, decreased platelet counts, and numerous fragmented erythrocytes, he was admitted to the ICU of our hospital. Immediately after admission, PE was started consecutively. Upon concomitant use of antiplatelet drugs and prostacyclin, the level of platelet counts recovered to 100,000/microl once, but decreased again. Thus, in addition to the PE, prednisolone and vincristine were administrated, which elevated the level of platelet counts to 200,000 to 300,000/microl. Since the erythrocyte fragmentation was noted frequently, PE was continued twice a week. From the 60th day of admission onward, however, his body temperature rose above 40 degrees C with a rapid increase of C-reactive protein. A blood culture detected methicillin-resistant Staphylococcus aureus (MRSA) which derived from a left lung abscess. During the course of anti-MRSA treatment, he presented acute renal failure and acute hepatic dysfunction, but survived because of the combined therapy. He was discharged on the 180th day of admission. These results suggest that a combined therapy of steroid and vincristine is effective to treat TTP refractory to PE, but careful attention should be paid to the complications caused by immunosuppression.

Double filtration plasmapheresis for the treatment of bullous pemphigoid: a three case report.

Bullous pemphigoid (BP) is an autoimmune disease caused by an antidermal basal lamina antibody. In recent years double filtration plasmapheresis (DFPP) has been reported to be an effective therapy for BP. We experienced 3 cases of BP treated by DFPP. DFPP resulted in an improvement in clinical symptoms and remission allowing a decrease in the required dose of corticosteroid. DFPP was found to be an effective treatment for all 3 patients without noticeable adverse events resulting from DFPP. From these results it is concluded that DFPP is worth considering as an option as treatment for BP patients who were unresponsive to conventional steroid therapy, those in whom corticosteroids should be reduced or discontinued because of complications such as diabetes mellitus and/or osteoporosis.

Plasma exchange for the treatment of human T-cell lymphotropic virus type 1 associated myelopathy.

A 55-year-old man was admitted to our hospital because of myelopathy. He had a history of chronic renal failure due to polycystic kidney disease at the age of 39, being treated by hemodialysis for 9 years with several blood transfusions for the treatment of renal anemia. After cadaver renal transplantation at the age of 48, he discontinued hemodialysis. At 50 years of age, he had pulmonary tuberculosis and tuberculous arthritis of the left elbow joint. He has experienced difficulty in walking since he was 48 years old, with mild dysuria. Gait disturbance gradually aggravated after that, and urinary retention was observed. When he was 55 years old, being human T-cell lymphotropic virus type-1 (HTLV-1)-positive in the serum and cerebrospinal fluid, he was diagnosed as having HTLV-1-associated myelopathy (HAM). As active steroid therapy was unapplicable because of the history of pulmonary tuberculosis and immunosuppression for transplanted kidney, a series of plasma exchanges (PE) was performed with fresh frozen plasma as a replacement fluid. After PE, dyskinesia of the left leg and dysuria subjectively and objectively improved. These results suggest that PE seems to be one of the therapeutic tools for the treatment of HAM.

A case of factor VIII inhibitor-positive acquired hemophilia treated by plasmapheresis.

We report on a case of factor VIII inhibitor-positive acquired hemophilia in which combined therapy of plasma exchange (PE) and steroids was effective. The patient, a 68-year-old man, had undergone hemodialysis since April 1998, due to chronic renal failure caused by diabetic nephropathy. The hemostasis of blood access sites gradually became difficult after the initiation of dialysis and the prolongation of activated partial thromboplastin time (APTT) (74.5 s), and a decrease in factor VIII (0.02%) and an abnormally high concentration of factor VIII inhibitor (111 U/ml) were found. Under the diagnosis of factor VIII inhibitor-positive acquired hemophilia, 3 consecutive PE were performed, followed by a large dose administration of gamma globulin. However, the effect of this therapy disappeared within 20 days. Then the PE therapy was performed again accompanied by pulse methylprednisolone therapy. After that, factor VIII inhibitor was suppressed and the patient's hemostatic defect continued to improve even after the reduction of the steroid dose. These results suggest that PE is very effective in treating factor VIII inhibitor-positive acquired hemophilia.

Efficacy of florfenicol on experimental Actinobacillus pleuropneumonia in pigs.

The efficacy of florfenicol was evaluated on experimental Actinobacillus pleuropneumonia in 5 to 7-week-old pigs. All pigs were intranasally inoculated with bacterial suspension containing 10(8) or 10(9) colony forming units of Actinobacillus pleuropneumoniae, Fukushima (serotype 2), Shope4074 (serotype 1), K17 (serotype 5), 8541 or 8543 (serotype 2; thiamphenicol-resistant strain). Florfenicol and thiamphenicol were given in feed for 12 days, from 5 days before inoculation to 7 days post inoculation (at necropsy). More than half the pigs died in the infected control groups, while no pigs died in florfenicol 50 ppm groups inoculated with each strain. On inoculation with thiamphenicol-sensitive strains, Fukushima, Shope4074 and K17, the average total score of clinical signs and percentage of lung lesion area in florfenicol 50 ppm groups were significantly lower than those in the infected control groups (P < 0.05). On inoculation with thiamphenicol-resistant strains, 8541 and 8543, the average total score of clinical signs and percentage of lung lesion area in florfenicol 50 ppm groups were significantly lower than those in the infected control and thiamphenicol 200 ppm groups (P < 0.05). The development of pleuropneumonia was remarkably prevented by medication with feed containing florfenicol in pigs inoculated with serotype 1, 2, 5 strains and thiamphenicol-resistant strains of A. pleuropneumoniae.

Effect of terdecamycin on experimentally induced swine dysentery in pigs.

The authors evaluated the effect of terdecamycin, a novel antibiotic, on experimentally induced Serpulina (S.) hyodysenteriae infection in pigs. In a prophylactic test, feed containing terdecamycin was fed to pigs for 7 days before inoculation and 21 days after inoculation. Dysenteric diarrhea, development of lesions in the large intestinal mucosa and colonization of S. hyodysenteriae in colonic mucosa were completely inhibited by treatment with 5 ppm or 10 ppm terdecamycin. In the therapeutic test, an unmedicated feed was fed to pigs inoculated with S. hyodysenteriae, until the typical mucohemorrhagic diarrhea appeared after inoculation, and was then changed to the medicated feed for 10 days. By treating with 20 ppm terdecamycin, the clinical signs in the pigs were improved and S. hyodysenteriae was completely eradicated.

Effect of terdecamycin on experimentally induced Mycoplasma hyopneumoniae-infection in pigs.

The effect of terdecamycin, a new antibiotic, was evaluated on experimentally induced Mycoplasma hyopneumoniae infection in pigs. Tylosin and josamycin were used as the positive control drugs. Five to 7-week-old pigs were inoculated intranasally with homogenate of pig lung lesions containing M. hyopneumoniae. In experiments 1 and 2, drugs were given in feed for 42 days, from 7 days before inoculation to 35 days after inoculation, and necropsy was carried out 35 days after inoculation. In experiment 3, drugs were given in feed for 10 days, from 3 days before inoculation to 7 days after inoculation and necropsy was carried out 28 days after inoculation. Drug efficacy was evaluated on the basis of clinical signs, lung lesions, (including percentage of gross lung lesion area), isolation of M. hyopneumoniae and growth performance data. The total number of days on which coughing was observed and the mean percentage of lung lesion area in pigs given feed containing terdecamycin at 50 ppm or above were lower than those in unmedicated control pigs. Average daily weight gain in terdecamycin-treated pigs was higher than that in unmedicated control pigs. Treatment with terdecamycin showed equal or better efficacy as compared with treatment with tylosin or josamycin.

In vitro and in vivo activities of sedecamycin against Treponema hyodysenteriae.

Sedecamycin (lankacidin A), one of the lankacidin-group antibiotics, showed potent activity against Treponema hyodysenteriae. The MICs of sedecamycin against 79 field isolates of T. hyodysenteriae ranged from 0.78 to 12.5 micrograms/ml, the MIC for 90% of the strains tested (MIC90) being 3.13 micrograms/ml. The protective and therapeutic effects of sedecamycin were compared with those of carbadox, tiamulin, and lincomycin against experimental infection with T. hyodysenteriae in mice. The protective effect of sedecamycin was similar to that of carbadox, two times more potent than that of tiamulin, and three times greater than that of lincomycin. In the therapeutic test, sedecamycin showed activity similar to that of carbadox and was two times more active than both tiamulin and lincomycin. At doses of 10 mg or more of sedecamycin per kg, the recurrence of shedding of T. hyodysenteriae into the feces of mice was not detected for at least 8 weeks postmedication.