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2.
IDCases ; 31: e01648, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36447935

RESUMO

Entamoeba histolytica infections, which can be asymptomatic, are endemic to developing countries; traveling to such countries is a risk factor for contracting these infections. A 65-year-old Japanese man was hospitalized for coronavirus disease 2019 (COVID-19)-associated respiratory distress, and was treated with remdesivir, dexamethasone, and oxygen supplementation. Although his respiratory condition improved and the oxygen support was discontinued, he developed a fever, severe abdominal pain, and diarrhea on day 13 of hospitalization. Fifteen years ago, he was hospitalized for diarrhea of an unknown origin in Suzhou, China, and had a history of passing loose stools for 1 year. Contrast-enhanced abdominal and pelvic computed tomography revealed liver abscesses in both lobes and intestinal edema from the ascending colon to the descending colon. The abscesses were suspected to be amebic based on the characteristics of the drained abscess fluid. The patient was treated with cefotaxime and metronidazole, and his temperature declined and abdominal pain improved. A culture analysis of abscess fluid yielded negative findings; however, polymerase chain reaction analyses of abscess and stool samples were positive for Entamoeba histolytica. We speculated that the patient was infected with Entamoeba histolytica while in China, and that the corticosteroid usage for COVID-19 had exacerbated the infection. Clinicians should be aware that corticosteroid treatments can lead to recurrent invasive amebiasis in asymptomatic amebic carriers.

3.
J Infect Chemother ; 28(8): 1189-1192, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35525700

RESUMO

BACKGROUND: Staphylococcus epidermidis is a common cause of health care-associated bacteremia, especially in patients with an indwelling medical device. However, S. epidermidis is an uncommon causative organism in catheter-associated urinary tract infection, and rare pyelonephritis without any indwelling urinary device. To our knowledge, there are few cases reported of bacteremia secondary to urinary tract infection. We report two cases of pyelonephritis with bacteremia by S. epidermidis in male patients with unilateral nephrolithiasis and review prior case reports. CASE PRESENTATION: Case 1: 74-year-old man with a history of diabetes and overactive bladder had fever and pyuria with a right nephrolithiasis on abdominal CT scan. Case 2: 79-year-old man with a history of diabetes and post-myocardial infarction status had fever with a left nephrolithiasis on abdominal CT scan. In both cases, both the urine culture collected at ureteral stenting and blood culture were positive for S. epidermidis. We initiated intravenous antibiotics in these patients in addition to ureteral stenting. CONCLUSIONS: S. epidermidis is acknowledged as an uncommon pathogen that can cause bacteremia secondary to pyelonephritis without an indwelling urinary device. Clinicians should consider the possibility of pyelonephritis due to S. epidermidis if the pathogen is identified in blood and urine in patients with nephrolithiasis.


Assuntos
Bacteriemia , Nefrolitíase , Pielonefrite , Infecções Urinárias , Idoso , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Humanos , Masculino , Nefrolitíase/complicações , Pielonefrite/complicações , Staphylococcus epidermidis , Infecções Urinárias/complicações
4.
Rinsho Ketsueki ; 63(3): 217-223, 2022.
Artigo em Japonês | MEDLINE | ID: mdl-35387936

RESUMO

We report a case of a 15-year-old girl who developed refractory Clostridioides difficile infection (CDI) after allogeneic bone marrow transplantation (BMT). She was treated successfully with fecal microbiota transplantation (FMT). The patient who had aplastic anemia underwent allogeneic BMT from an HLA 1-locus-mismatched unrelated donor. Four months later, she developed gastrointestinal graft-versus-host disease (GVHD), and immunosuppressive treatment improved the GVHD. However, she developed CDI 5 months after BMT and experienced recurrence after that. Fifteen months after transplant, CDI relapsed despite discontinuation of immunosuppressive treatment; thus, she underwent FMT. Colonoscopy at the time of FMT revealed round aphthae, mainly in the ileocecum, and colonic biopsy revealed inflammatory cell infiltration and noncaseating epithelioid granuloma, which fulfilled the diagnostic criteria for Crohn's disease. Following FMT for CDI, she was treated with enteric budesonide and intravenous methotrexate for Crohn's disease. These interventions resulted in a marked improvement in both CDI and Crohn's disease. Twenty-eight months after FMT, both CDI and Crohn's disease remained in remission with oral mesalamine monotherapy.


Assuntos
Clostridioides difficile , Infecções por Clostridium , Doença de Crohn , Doença Enxerto-Hospedeiro , Transplante de Células-Tronco Hematopoéticas , Adolescente , Medula Óssea , Transplante de Medula Óssea , Infecções por Clostridium/terapia , Transplante de Microbiota Fecal/métodos , Feminino , Humanos , Recidiva , Transplantados , Resultado do Tratamento
5.
Intern Med ; 61(14): 2233-2237, 2022 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-35283374

RESUMO

Capnocytophaga species are among the typical zoonotic pathogens causing infections following direct contact with animals. Recently, a putative novel species of zoonotic Capnocytophaga, Capnocytophaga stomatis, was reported. We herein report the first case of bacteremia caused by C. stomatis. A woman in her 80s with multiple myeloma who was receiving bortezomib and dexamethasone therapy was admitted to our hospital with a 2-day history of a fever and right calf redness. She was often licked by her cat. On a blood culture, thin, Gram-negative rods were detected, which were identified as C. stomatis by whole-genome sequencing. The patient was successfully treated with ampicillin-sulbactam treatment. Our case highlights the pathogenic potential of the putative novel Capnocytophaga, C. stomatis, in immunocompromised hosts.


Assuntos
Bacteriemia , Mordeduras e Picadas , Infecções por Bactérias Gram-Negativas , Mieloma Múltiplo , Animais , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Capnocytophaga , Feminino , Infecções por Bactérias Gram-Negativas/complicações , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Humanos , Mieloma Múltiplo/complicações
6.
Intern Med ; 61(17): 2687-2689, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-35185045

RESUMO

Kikuchi disease, also called histiocytic necrotizing lymphadenitis, is an idiopathic and generally self-limiting disease affecting young adults and children. Kikuchi disease does not commonly manifest neurological complications at its initial presentation. We herein report two cases of Kikuchi disease that initially presented with aseptic meningitis and encephalitis rather than the more common signs of lymphadenopathy, rash, and arthritis. A 15-year-old boy presented with aseptic meningitis with an extremely high intracranial pressure. A 28-year-old man presented with dysesthesia of the right lower extremity, coinciding with abnormal magnetic resonance imaging findings. In both cases, painful cervical lymphadenopathy was observed following the central nervous system symptoms. Both patients improved after treatment with steroids. Kikuchi disease occasionally affects the central nervous system, to which lymphadenitis may be observed subsequently. A repeated, careful physical examination of the cervical lymph nodes may be helpful for the diagnosis.


Assuntos
Encefalite , Linfadenite Histiocítica Necrosante , Linfadenopatia , Meningite Asséptica , Adolescente , Adulto , Criança , Encefalite/complicações , Linfadenite Histiocítica Necrosante/complicações , Linfadenite Histiocítica Necrosante/diagnóstico , Humanos , Linfonodos/patologia , Linfadenopatia/etiologia , Masculino , Meningite Asséptica/complicações , Meningite Asséptica/diagnóstico , Adulto Jovem
7.
J Infect Chemother ; 28(5): 699-704, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35197215

RESUMO

Mycobacterium tilburgii, a nonculturable mycobacterium, is an important nontuberculous mycobacterium that occasionally causes serious infections in patients with cellular immune deficiencies. Due to its nonculturable nature, information about its drug susceptibility is not available, and data about its clinical response to antimycobacterial treatment remains insufficient. Here, we report a case of a patient who presented with neck swelling and was finally diagnosed with cervical abscess caused by M. tilburgii carrying anti-interferon gamma autoantibodies using a molecular method. The relevant literature was reviewed in the context of epidemiological and clinical data on M. tilburgii infections. In this report, 15 patients were reported to be infected with M. tilburgii. Almost all patients had a cellular immune deficiency and presented with disseminated infections. Multiple refractory or relapse cases that often required prolonged antimycobacterial treatment have been reported, although a few fatal cases have also been reported. In conclusion, M. tilburgii is an important pathogen in patients with cellular immune deficiency. Physicians should thoroughly investigate cellular immune deficiency, including adult-onset immune deficiency with anti-interferon gamma autoantibodies, in patients with M. tilburgii infection.


Assuntos
Infecções por Mycobacterium não Tuberculosas , Mycobacterium , Abscesso/tratamento farmacológico , Adulto , Autoanticorpos/uso terapêutico , Humanos , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/microbiologia
8.
IDCases ; 27: e01415, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35096529

RESUMO

It is challenging for clinicians to determine the cause of occurrence of fever in COVID-19 patients after corticosteroid discontinuation. Blood cultures help us distinguish between secondary infections and rebound phenomena. We report a case of non-typhoidal Salmonella bacteremia in a 34-year-old male COVID-19 patient who developed fever after discontinuing corticosteroids.

9.
Jpn J Infect Dis ; 75(2): 205-208, 2022 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-34470959

RESUMO

Transitioning from intravenous to oral antibiotic therapy for Escherichia coli bacteremia could reduce the length of hospital stay and drug costs without compromising efficacy. Despite the expansion of extended-spectrum ß-lactamase (ESBL)-producing E. coli, limited data are available regarding the effectiveness of switching to oral antibiotic therapy in patients with bacteremia caused by this organism. To compare clinical outcomes between oral transition therapy and intravenous therapy in patients with bacteremia due to ESBL-producing E. coli with a urinary source, we conducted a retrospective cohort study at 3 Japanese hospitals. The effects were estimated by Cox hazard analysis using propensity scores. Among 996 patients with bacteremia due to E. coli, 73 were included in the study. In the adjusted analysis weighted by propensity scores including 26 patients in the oral switch group and 47 in the intravenous group, oral transition did not increase the risk of treatment failure within 60 days (adjusted hazard ratio 0.86, 95% confidence interval 0.18-4.10), whereas the length of hospital stay was shorter in the oral switch group than in the intravenous group (median, 12 days vs. 19 days, P = 0.04). Intravenous-to-oral transition may be an effective treatment option that shortens the hospital stay.


Assuntos
Bacteriemia , Infecções por Escherichia coli , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Escherichia coli , Infecções por Escherichia coli/tratamento farmacológico , Humanos , Estudos Retrospectivos , Fatores de Risco , beta-Lactamases/farmacologia
10.
J Mol Diagn ; 23(2): 164-170, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33259955

RESUMO

Molecular testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the mainstay for accurate diagnosis of the infection, but the diagnostic performances of available assays have not been defined. We compared 12 molecular diagnostic assays, including 8 commercial kits using 155 respiratory samples (65 nasopharyngeal swabs, 45 oropharyngeal swabs, and 45 sputum) collected at two Japanese hospitals. Sixty-eight samples were positive for more than one assay and one genetic locus, and were defined as true-positive samples. All the assays showed a specificity of 100% (95% CI, 95.8%-100%). The N2 assay kit of the US Centers for Disease Control and Prevention and the N2 assay of the Japanese National Institute of Infectious Disease (NIID) were the most sensitive assays with 100% sensitivity (95% CI, 94.7-100), followed by the Centers for Disease Control and Prevention N1 kit, E assay by Corman, and Japanese National Institute of Infectious Disease N2 assay multiplex with internal control reactions. These assays are reliable as first-line molecular assays in laboratories when combined with appropriate internal control reactions.


Assuntos
Teste para COVID-19 , COVID-19/diagnóstico , Técnicas de Diagnóstico Molecular , SARS-CoV-2/genética , SARS-CoV-2/isolamento & purificação , COVID-19/virologia , Humanos , Sensibilidade e Especificidade
11.
J Infect Chemother ; 27(4): 632-638, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33309629

RESUMO

INTRODUCTION: The epidemiology of infectious diseases in Japan remains undefined despite the increasing tourism. GeoSentinel, an epidemiological surveillance system for reporting imported infectious diseases, has only two participating facilities in Japan. Although the number of infectious diseases is reported by the National Institute of Infectious Diseases, there is no detailed clinical information about these cases. Therefore, we established J-RIDA (Japan Registry for Infectious Diseases from Abroad) to clarify the status of imported infectious diseases in Japan and provide detailed information. METHODS: J-RIDA was started as a registry of imported infectious diseases. Case registration began in October 2017. Between October 2017 and September 2019, 15 medical institutions participated in this clinical study. The registry collected information about the patient's age, sex, nationality, chief complaint, consultation date, date of onset, whether visit was made to a travel clinic before travel, blood test results (if samples were collected), travel history, and final diagnosis. RESULTS: Of the 3046 cases included in this study, 46.7% to Southeast Asia, 13.0% to Africa, 13.7% to East Asia, 11.5% to South Asia, 7.5% to Europe, 3.8% to Central and South America, 4.6% to North America, 3.9% to Oceania, and 2.8% to Central and west Asia. More than 85% of chief complaints were fever and general symptoms, gastrointestinal symptoms, respiratory symptoms, or dermatologic problems. The most common diseases were travelers' diarrhea, animal bite, upper respiratory infection, influenza, and dengue fever. CONCLUSIONS: We summarized two-year cases registered in Japan's imported infectious disease registry. These results will significantly contribute to the epidemiology in Japan.


Assuntos
Doenças Transmissíveis Importadas , Doenças Transmissíveis , Animais , Ásia , Doenças Transmissíveis/epidemiologia , Doenças Transmissíveis Importadas/diagnóstico , Doenças Transmissíveis Importadas/epidemiologia , Diarreia , Europa (Continente) , Humanos , Japão/epidemiologia , América do Norte , Sistema de Registros , Viagem
12.
J Infect Chemother ; 26(8): 854-857, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32471794

RESUMO

Here, we describe two mild SARS-CoV-2 pneumonia cases. One was imported from Wuhan, and the other was locally transmitted in Japan without recent travel to China. In both cases, lower respiratory tract symptoms were observed first, and high fever progressed in about one week. The laboratory findings revealed normal WBC and CRP despite apparent lung infiltrations, and typical observations on CT imaging were important diagnostic clues. In the domestic endemic situation, a comprehensive evaluation of the clinical course, and laboratory and radiological findings was required for diagnosis.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Pneumonia Viral/virologia , Adulto , COVID-19 , China , Infecções Comunitárias Adquiridas/diagnóstico , Infecções por Coronavirus/complicações , Tosse/virologia , Diarreia/virologia , Dispneia/virologia , Fadiga/virologia , Feminino , Febre/virologia , Humanos , Japão , Masculino , Pandemias , Faringite/virologia , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/transmissão , SARS-CoV-2 , Avaliação de Sintomas , Viagem
13.
Emerg Infect Dis ; 25(8): 1581-1583, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31310214

RESUMO

Bejel, an endemic treponematosis caused by infection with Treponema pallidum subspecies endemicum, has not been reported in eastern Asia and the Pacific region. We report local spread of bejel among men who have sex with men in Japan. Spread was complicated by venereal syphilis.


Assuntos
Homossexualidade Masculina , Doenças Bacterianas Sexualmente Transmissíveis/epidemiologia , Treponema pallidum , Infecções por Treponema/epidemiologia , Infecções por Treponema/microbiologia , Adulto , Genes Bacterianos , Humanos , Japão/epidemiologia , Masculino , Filogenia , Vigilância em Saúde Pública , Análise de Sequência de DNA , Treponema pallidum/classificação , Treponema pallidum/genética , Treponema pallidum/isolamento & purificação , Adulto Jovem
14.
15.
Am J Trop Med Hyg ; 96(5): 1185-1189, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28193740

RESUMO

AbstractRecently, reports of delayed hemolytic anemia after treatment with artemisinin and its derivatives have emerged. Here we report two cases of delayed hemolytic anemia in a patient with severe falciparum malaria after treatment with oral artemether-lumefantrine (AL). The first patient, a 20-year-old Japanese male student, was diagnosed with falciparum malaria and was administered AL. As having a high parasitemia rate (20.6%) was the only severe malaria criterion met in this case and his general condition was stable, we continued with AL treatment. Despite disappearance of malarial parasites after 4 days of AL administration, a persistent fever remained. On days 13 and 16, a diagnosis of hemolytic anemia was made (lactate dehydrogenase [LDH]: 1,466 U/L, hemoglobin [Hb]: 7.2 g/dL). A blood smear at that time revealed no parasites. He recovered naturally from delayed hemolysis. The second patient, a 27-year-old Japanese female student, was diagnosed with falciparum malaria (parasitemia: 4.5%) and treated initially with oral quinine hydrochloride and doxycycline. The following day, parasitemia increased to 7.9% and oral AL was initiated. She was discharged on day 4 after achieving parasite clearance and afebrility. However, on day 5, fever (body temperature > 38°C) recurred, and on day 11, a diagnosis of hemolytic anemia was made (LDH: 712 U/L, Hb: 8.8 g/dL). A follow-up confirmed that her condition improved gradually. AL treatment of severe malaria can cause delayed hemolytic anemia. Patients should be followed up for up to 4 weeks to detect signs of hemolysis and provide appropriate symptomatic treatment.


Assuntos
Anemia Hemolítica/induzido quimicamente , Antimaláricos/efeitos adversos , Artemisininas/efeitos adversos , Etanolaminas/efeitos adversos , Fluorenos/efeitos adversos , Malária Falciparum/tratamento farmacológico , Parasitemia/tratamento farmacológico , Plasmodium falciparum/efeitos dos fármacos , Adulto , Anemia Hemolítica/sangue , Anemia Hemolítica/diagnóstico , Antimaláricos/administração & dosagem , Combinação Arteméter e Lumefantrina , Artemisininas/administração & dosagem , Contagem de Células Sanguíneas , Convalescença , Combinação de Medicamentos , Etanolaminas/administração & dosagem , Feminino , Fluorenos/administração & dosagem , Hemoglobinas/metabolismo , Humanos , L-Lactato Desidrogenase/sangue , Malária Falciparum/parasitologia , Malária Falciparum/patologia , Masculino , Parasitemia/parasitologia , Parasitemia/patologia , Plasmodium falciparum/crescimento & desenvolvimento , Plasmodium falciparum/patogenicidade , Fatores de Tempo
16.
Kansenshogaku Zasshi ; 91(2): 145-50, 2017 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-30277699

RESUMO

The newly developed rapid diagnostic test (RDT, DK14-CA1, Denka Seiken Co., Ltd.) to detect Campylobacter antigen was evaluated using fecal specimens of patients with enteritis. The RDT is an immunochromatographic assay using colored latex and can detect Campylobacter antigen (C. jejuni and C. coli) from patients' stool samples within 15 minutes. A total of 227 stool samples obtained from patients with enteritis were examined and the results were compared with conventional culture methods. Overall sensitivity, specificity, accuracy and positive predictive value (PPV) were 75.6%, 98.6%, 89.9% and 97.0% respectively. Among 53 severe cases defined with their clinical findings, sensitivity, specificity, accuracy and PPV were 82.1%, 100%, 90.6% and 100% respectively. Mean time to obtain the result with the RDT was 7 minutes whereas the culture method took 2.2 days. This study revealed the usefulness of the newly developed RDT as a rapid detection tool for Campylobacter antigen. Although the RDT has a little lower sensitivity compared with culture method, the simple and rapid test can contribute to treatment decisions for patients with enteritis and can be used at the patient's bedside and in outpatient clinics.


Assuntos
Antígenos de Bactérias/análise , Infecções por Campylobacter/microbiologia , Campylobacter/isolamento & purificação , Enterite/microbiologia , Imunoensaio/métodos , Antígenos de Bactérias/imunologia , Campylobacter/imunologia , Humanos
17.
Medicine (Baltimore) ; 95(21): e3628, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27227924

RESUMO

Hypothermia is a risk factor for death in intensive care unit (ICU) patients with severe sepsis and septic shock. In the present study, we investigated the association between body temperature (BT) on arrival at the emergency department (ED) and mortality in patients with bacterial infection.We conducted a retrospective cohort study in consecutive ED patients over 15 years of age with bacterial infection who were admitted to an urban teaching hospital in Japan between 2010 and 2012. The main outcome measure was 30-day in-hospital mortality. Each patient was assigned to 1 of 6 categories based on BT at ED admission. We conducted multivariable logistic regression analysis to adjust for predictors of death.A total of 913 patients were enrolled in the study. The BT categories were <36, 36 to 36.9, 37 to 37.9, 38 to 38.9, 39 to 39.9, and ≥40 °C, with respective mortalities of 32.5%, 14.1%, 8.7%, 8.2%, 5.7%, and 5.3%. Multivariable analysis showed that the risk of death was significantly low in patients with BT 37 to 37.9 °C (adjusted odds ratio [AOR]: 0.2; 95% confidence interval [CI] 0.1-0.6, P = 0.003), 38-38.9 °C (AOR: 0.2; 95% CI 0.1-0.6, P = 0.002), 39-39.9 °C (AOR: 0.2; 95% CI 0.1-0.5, P = 0.001), and ≥40 °C (AOR: 0.1; 95% CI 0.02-0.4, P = 0.001), compared with hypothermic patients (BT <36 °C).The higher BT on arrival at ED, the better the outcomes observed in patients with bacterial infection were.


Assuntos
Infecções Bacterianas/mortalidade , Temperatura Corporal , Serviço Hospitalar de Emergência/estatística & dados numéricos , Mortalidade Hospitalar , Sepse/mortalidade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Sexuais , Choque Séptico/mortalidade , Fatores Socioeconômicos
18.
Antimicrob Agents Chemother ; 59(9): 5107-13, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26100708

RESUMO

The efficacy of cefmetazole and flomoxef (CF) for the treatment of patients with extended-spectrum ß-lactamase-producing Escherichia coli (ESBL-EC) bacteremia (ESBL-CF group) was compared with that of carbapenem treatment for ESBL-EC patients (ESBL-carbapenem group) and with that of CF treatment in patients with non-ESBL-EC bacteremia (non-ESBL-CF group). Adult patients treated for E. coli bacteremia in four hospitals were retrospectively evaluated. The 30-day mortality rates in patients belonging to the ESBL-CF, ESBL-carbapenem, and non-ESBL-CF groups were compared as 2 (empirical and definitive therapy) cohorts. The adjusted hazard ratios (aHRs) for mortality were calculated using Cox regression models with weighting according to the inverse probability of propensity scores for receiving CF or carbapenem treatment. The empirical-therapy cohort included 104 patients (ESBL-CF, 26; ESBL-carbapenem, 45; non-ESBL-CF, 33), and the definitive-therapy cohort included 133 patients (ESBL-CF, 59; ESBL-carbapenem, 54; non-ESBL-CF, 20). The crude 30-day mortality rates for patients in the ESBL-CF, ESBL-carbapenem, and non-ESBL-CF groups were, respectively, 7.7%, 8.9%, and 3.0% in the empirical-therapy cohort and 5.1%, 9.3%, and 5.0% in the definitve-therapy cohort. In patients without hematological malignancy and neutropenia, CF treatment for ESBL-EC patients was not associated with mortality compared with carbapenem treatment (empirical-therapy cohort: aHR, 0.87; 95% confidence interval [CI], 0.11 to 6.52; definitive therapy cohort: aHR, 1.04; CI, 0.24 to 4.49). CF therapy may represent an effective alternative to carbapenem treatment for patients with ESBL-EC bacteremia for empirical and definitive therapy in adult patients who do not have hematological malignancy and neutropenia.


Assuntos
Bacteriemia/microbiologia , Cefmetazol/farmacologia , Cefalosporinas/farmacologia , Escherichia coli/efeitos dos fármacos , Escherichia coli/enzimologia , beta-Lactamases/metabolismo , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
19.
BMJ Open ; 5(4): e007049, 2015 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-25922102

RESUMO

OBJECTIVES: The prognostic utility of serum C reactive protein (CRP) alone in sepsis is controversial. We used decision curve analysis (DCA) to evaluate the clinical usefulness of combining serum CRP levels with the CUBR-65 score in patients with suspected sepsis. DESIGN: Retrospective cohort study. SETTING: Emergency department (ED) of an urban teaching hospital in Japan. PARTICIPANTS: Consecutive ED patients over 15 years of age who were admitted to the hospital after having a blood culture taken in the ED between 1 January 2010 and 31 December 2012. MAIN OUTCOME MEASURES: 30-day in-hospital mortality. RESULTS: Data from 1262 patients were analysed for score evaluation. The 30-day in-hospital mortality was 8.4%. Multivariable analysis showed that serum CRP ≥150 mg/L was an independent predictor of death (adjusted OR 2.0; 95% CI 1.3 to 3.1). We compared the predictive performance of CURB-65 with the performance of a modified CURB-65 with that included CRP (≥150 mg/L) to quantify the clinical usefulness of combining serum CRP with CURB-65. The areas under the receiver operating characteristics curves of CURB-65 and a modified CURB-65 were 0.76 (95% CI 0.72 to 0.80) and 0.77 (95% CI 0.72 to 0.81), respectively. Both models had good calibration for mortality and were useful among threshold probabilities from 0% to 30%. However, while incorporating CRP into CURB-65 yielded a significant category-free net reclassification improvement of 0.387 (95% CI 0.193 to 0.582) and integrated discrimination improvement of 0.015 (95% CI 0.004 to 0.027), DCA showed that CURB-65 and the modified CURB-65 score had comparable net benefits for prediction of mortality. CONCLUSIONS: Measurement of serum CRP added limited clinical usefulness to CURB-65 in predicting mortality in patients with clinically suspected sepsis, regardless of the source.


Assuntos
Pressão Sanguínea , Nitrogênio da Ureia Sanguínea , Proteína C-Reativa/metabolismo , Confusão/epidemiologia , Taxa Respiratória , Sepse/mortalidade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Técnicas de Apoio para a Decisão , Serviço Hospitalar de Emergência , Feminino , Mortalidade Hospitalar , Hospitais de Ensino , Hospitais Urbanos , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Medição de Risco , Sepse/diagnóstico , Sepse/metabolismo
20.
Kansenshogaku Zasshi ; 88(2): 155-9, 2014 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-24783457

RESUMO

A 31-year-old Japanese female had stayed in Australia from January to May 2013. She presented with a sudden onset of left ankle and right knee arthralgia in March but neither fever nor rash was present. As her arthralgia persisted, she visited our hospital upon her return to Japan in May. When she came to our hospital, she complained of left ankle and right knee pain, but no arthritis findings. Laboratory findings were also within normal ranges. Ross River virus (RRV) antibody levels were examined as she was suspected of having contracted the disease in Australia. RRV IgG antibody and IgM antibody were positive, and the patient was confirmed as a case of acute RRV disease. RRV disease is endemic in Australia, but there are no prior reports of the disease in Japan. This is the first case of RRV disease confirmed in Japan. Typical symptoms of RRV disease include arthralgia, fever, and rash. Our patient had only arthralgia. With the increase in the number of travelers and length of stay in RRV endemic regions, health care providers need to consider the disease in their differential diagnosis, among returning travelers with arthralgia, fever, rash and a travel history to RRV-endemic regions.


Assuntos
Infecções por Alphavirus/epidemiologia , Ross River virus , Viagem , Adulto , Austrália , Feminino , Humanos , Japão/epidemiologia
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