Journal of Infection and Chemotherapy最新文献

Aerococcus urinae, a gram-positive, catalase-negative coccus, has emerged as a notable pathogen in clinical microbiology. It is traditionally associated with urinary tract infections in elderly males with underlying urologic conditions. Recently, A. urinae has been implicated in severe invasive infections outside the genitourinary tract including infective endocarditis, vertebral osteomyelitis, peritonitis, lymphadenitis, and discitis. We present the case of 84-year-old male with a history of aortic graft replacement who presented with five days of fever and fatigue. Blood and urine cultures grew gram-positive cocci, identified as A. urinae. Thoracoabdominal contrast-enhanced CT revealed a slightly increased soft tissue shadowing around the prosthetic stent in the ascending aorta, indicating a possible aortic stent-graft infection. Gallium-67 scintigraphy demonstrated inflammation around the prosthetic stent in the ascending aorta consistent with an aortic stent-graft infection. The patient and family opted for conservative treatment and despite a six-week inpatient course of ampicillin, followed by oral amoxicillin, the patient died one week after discharge. This is the first published case of A. urinae causing an aortic stent-graft infection. Clinicians should remain cognizant of the disseminated source of infection in cases of A. urinae bacteremia.

Purpose: To investigate the effect of studying abroad on catch-up vaccination coverage for measles, rubella, mumps, varicella, and tetanus during the pretravel consultation among young adult travelers.

Methods: This retrospective cohort study analyzed data from the Japan Pretravel Consultation Registry (J-PRECOR) on individuals aged 18-21 years with childhood vaccination records. Propensity score weighting was used to estimate the average treatment effect on the proportion of participants receiving catch-up vaccination.

Results: Among 1,091 eligible participants, the catch-up vaccination need was highest for mumps (65.7%) and varicella (49.0%) and lowest for measles (9.9%) and rubella (14.0%). In the unadjusted analysis, the catch-up vaccination rate was 70.6% for tetanus, 50.9% for measles, 47.7% for rubella, 40.0% for mumps, and 23.9% for varicella. In the weighted analysis, the study-abroad group had significantly higher catch-up vaccination rates for measles (54.6% vs. 29.8%, P = 0.039), rubella (53.0% vs. 22.1%, P < 0.001), and varicella (26.8% vs. 10.9%, P = 0.002), whereas the non-study-abroad group had a higher catch-up vaccination rate for tetanus (62.4% vs. 78.4%, P = 0.024).

Conclusion: Compared with other travelers, the catch-up vaccination rate among travelers studying abroad was higher for measles, rubella, and varicella, but lower for tetanus. In clients planning to study abroad, vaccinations required for travel should be recommended in addition to those required by the host institution, and vaccination against highly infectious diseases with potential for complications, such as measles, rubella, mumps, and varicella, should be recommended to clients traveling for reasons other than studying abroad.

Background: Rapid identification of the causative organism in blood stream infections is essential for early initiation of appropriate antimicrobial therapy. Direct identification of bacteria in positive blood culture bottles using matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry is a promising application. A variety of direct identification methods have been reported; however, few studies have evaluated the impact of these methods on physician decision making regarding antimicrobial therapy.

Methods: We developed a simple method for direct bacterial identification and applied it to daily clinical practice to investigate the impact of direct identification of bacteria in positive blood culture bottles on physicians' choice of antimicrobial agents for treatment.

Results: From January 2016 to December 2022, we attempted direct identification in 98 cases and successfully acquired identification results in 88 cases. In three cases, no empiric antimicrobial agents were initiated at the time of venipuncture for blood culture but later initiated based on the direct identification results. In the remaining 85 cases, empiric antimicrobial therapy was initiated at the time blood cultures were performed, and in 29 cases, empiric antimicrobial therapy was changed after direct identification. In 17 of these 29 cases, the antimicrobial therapy was changed based on the direct identification of bacterial genus/species, resulting in a change to an effective antimicrobial therapy before the antimicrobial susceptibility testing results were available.

Conclusions: Direct identification of bacteria from positive blood culture bottles could contribute to earlier selection of or changes to antimicrobial therapies by attending physicians.

Introduction: This retrospective, cross-sectional, multi-center study aimed to evaluate the impact of laboratory results and treatments on the treatment response in patients diagnosed with tularemia.

Methods: The study included 190 adult patients diagnosed with tularemia between November 2023 and June 2024.

Results: 67.9 % were female, mean age was 45.8 ± 14.9 years. The most frequently detected symptoms were sore throat (74.2 %), fatigue (71.6 %), and neck swelling (56.3 %). The most common form of tularemia was oropharyngeal (82.6 %) and glandular (14.2 %). The most used monotherapy was ciprofloxacin (80.5 %, n = 136), and combination therapy was streptomycin-ciprofloxacin (81.0 %, n = 17). Treatment failure was observed in 29 patients (15.2 %). No difference was found between patients who responded and didn't respond to treatment regarding laboratory parameters. Lymph node drainage or excision was performed in 47 patients (23 %). Suppurative lymphadenitis, abscess, necrosis, and conglomerate lymphadenopathy were more common in the lymph node drainage group. Reactive lymph nodes were more common in the group without lymph node drainage. There was no difference between the two groups regarding laboratory parameters of patients with and without lymph node drainage. The duration of antibiotic treatment was longer in patients who underwent lymph node drainage than in those who didn't.

Conclusion: Radiological evaluation of lymph nodes upon hospital admission, in addition to antibiotic therapy during treatment, may help predict which patients are more likely to require surgical drainage. Laboratory parameters may not provide significant benefits in predicting the need for lymph node drainage and long-term treatment did not affect the treatment response.

Bacterial contamination of plasma is unusual owing to frozen storage nevertheless reported. We report a case of transfusion transmitted infection due to Burkholderia cepacia contaminating fresh frozen plasma. A 31 year old male with decompensated chronic liver disease presented with breathlessness due to pleural effusion. Due to elevated prothrombin time, fresh frozen plasma was infused. After ten minutes of transfusion, he became febrile, tachypnoeic and transfusion was stopped. Plasma bag and blood cultures from patient grew B. cepacia. He became hemodynamically unstable due to underlying disease and died after a week.

Background: The two-drug regimen of dolutegravir/lamivudine (DTG/3TC) is currently an optional antiretroviral therapy (ART). Despite its reported advantages on body weight and lipid profile, the same effects have not yet been reported for Asian population.

Methods: We conducted a single-center retrospective study involving Japanese people living with HIV (PLWH). They were divided into four groups: those who had received abacavir/lamivudine/dolutegravir (ABC/3TC/DTG) and continued the same (ABC-ON group) or switched to DTG/3TC (ABC-OFF group), those who had received tenofovir alafenamide fumarate/emtricitabine/dolutegravir (TAF/FTC/DTG) and continued the same (TAF-ON group) or switched to DTG/3TC (TAF-OFF group). We compared changes in viral load, CD4⁺ cell count, CD4⁺/CD8⁺ ratio, body weight, BMI, lipid profiles, estimated glomerular filtration rate (eGFR), and fibrosis index based on four factors (FIB4-index) between the pre-switch and post-switch period.

Results: Of the 541 PLWH on DTG-based ART, 165, 94, 264 and 18 constituted the ABC-ON, ABC-OFF, TAF-ON, and TAF-OFF groups, respectively. Neither viral rebound nor CD4⁺decline was observed in the post-switch period in all groups. Multivariate analysis showed significant reduction in total cholesterol, LDL-C and HDL-C in the ABC-OFF group (-6.280, -6.957 and -2.268, p = 0.040, 0.012 and 0.022, respectively), but not in the TAF-OFF group (-3.000, 6.708 and 0.046, p = 0.607, 0.276 and 0.983, respectively). No significant changes were observed in body weight, eGFR, or FIB4-index at 72 weeks after the discontinuation of ABC or TAF.

Conclusions: Switching from ABC/3TC/DTG to DTG/3TC lowered lipids significantly, but not with TAF/FTC/DTG. Neither switch affected body weight or other markers.

Objectives: We aimed to analyze the relationships between single nucleotide polymorphisms in the ATP-binding cassette transporter B1 (ABCB1) and G2 (ABCG2) genes and plasma concentrations of tenofovir alafenamide (TAF), tenofovir (TFV), and emtricitabine (FTC).

Methods: We recruited 10 people living with HIV receiving once-daily treatment with a single tablet containing TAF (25 mg), FTC (200 mg), and bictegravir (50 mg). Peripheral blood samples were collected at 0, 1, 2, 3, 4, 6, 8, 12, and 24 h after administration. Plasma concentrations of TAF, TFV, and FTC were quantified using liquid chromatography-tandem mass spectrometry. Genotyping for allelic variants of ABCB1, including 1236C > T (rs1128503), 2677 G > T/A (rs2032582), 3435C > T (rs1045642), 4036 A > G (rs3842) and ABCG2 421C > A (rs2231142), was performed using TaqMan Drug Metabolism Assays.

Results: None of the genotypes for ABCB1 1236C > T, 2677 G > T/A, 3435C > T, and ABCG2 421C > A exhibited correlations with plasma concentrations of TAF, TFV, and FTC. In contrast, individuals with the ABCB1 4036 AG genotype (188.7 ng/mL, n = 3) exhibited a significantly higher mean peak plasma concentration of TAF than those with the ABCB1 4036 AA genotype (67.7 ng/mL, n = 7) (p = 0.0167). However, these genotypes did not affect the elimination of terminal half-lives of TAF.

Conclusions: The allelic variant ABCB1 4036 A > G is associated with reduced protein expression and function of ABCB1. Individuals with this genetic variant exhibited significantly high peak plasma concentrations of TAF, potentially due to the reduced expression of efflux transporters in the intestines linked to this variant.

Biological false-positive reactions to non-treponemal syphilis tests occur under various conditions, including in patients with infectious mononucleosis. However, false-positive treponemal test results are rarely reported. We present three cases of Epstein-Barr virus-associated infectious mononucleosis that exhibited concurrent false-positive results in both treponemal and non-treponemal tests, effectively imitating syphilis serology. Notably, the false-positive treponemal test results were transient and persisted for more than 6 months before reverting to negative. This is atypical for true Treponema pallidum infection (syphilis), in which treponemal tests usually remain positive for life. This case series highlights the potential for misdiagnosis and emphasizes the importance of careful interpretation of syphilis serology results in the context of infectious mononucleosis. This is particularly important when typical syphilis symptoms are absent, as in our patients. The similarity in the clinical manifestations between infectious mononucleosis and syphilis, including sore throat, lymphadenopathy, rash, and hepatitis, further complicates the diagnostic process. Clinicians should consider recent Epstein-Barr virus-associated infectious mononucleosis when interpreting positive syphilis serology, especially in young adults presenting with mononucleosis-like symptoms. Follow-up serological testing is useful to avoid unnecessary treatment and potential patient mismanagement.

Escherichia coli is a facultative anaerobic bacterium that causes urinary tract and bloodstream infections. Generally, E. coli is easily identified in routine clinical microbiology laboratories. Herein, we report a case of pyelonephritis with bacteremia due to extended-spectrum β-lactamase (ESBL) producing E. coli, which delayed the identification of the isolate as it exhibited carbon dioxide (CO₂)-dependent growth. The patient was a 62-year-old man who presented with nausea and an altered mental status. Contrast-enhanced computed tomography revealed multiple abscesses in the left kidney. The anaerobic bottles of the two sets of blood cultures were positive, but growth on a routine aerobic culture was weak. Identification of the isolate was delayed because it grew only on agar plates incubated in a 5 % CO₂ atmosphere. The isolate was suspected to be an ESBL-producing strain based on antimicrobial susceptibility testing, which was confirmed by polymerase chain reaction analysis. The patient was successfully treated with administering meropenem and nephrectomy. To the best-of-our-knowledge, this is the first reported case of a human infection caused by ESBL-producing carbon-dioxide-dependent E. coli.

Background: More than 200 symptoms of post coronavirus disease (COVID-19) condition (PCC) impacting patients' quality of life have been reported. This study describes the symptoms of well-known PCC and diseases/conditions diagnosed after COVID-19 and analyzes the trends in well-known PCC according to the epidemic waves in the Japanese population.

Methods: Patients with a COVID-19 diagnosis in the JMDC claims database were matched 1:1 with individuals without COVID-19 diagnosis (controls) based on sex, year and month of birth, and risk factors for aggravation. The first month of COVID-19 diagnosis from January 2020-March 2022 was the index month, and the observation period was from July 2019 to 6 months from the index month (patients) and July 2019-September 2022 (controls).

Results: Of 263,456 each of patients and controls after matching, 51.8 % were aged 18-49 years, 56.3 % were male, and 24.5 % had risk factors for aggravation. One in 18 patients experienced well-known PCC 2-3 months after severe acute respiratory syndrome cornonavirus 2 infection, with the highest odds ratio (OR) being for pulmonary thromboembolism (29.37), followed by smell/taste disorder (13.34) and respiratory failure (8.28). Some of the common diseases/conditions diagnosed after COVID-19 comprised those of the genitourinary system, eye and adnexa, and ear and mastoid process and certain infectious and parasitic diseases. Overall, the risk difference decreased from the first to the sixth wave, but the OR was >1.00 for most symptoms even during the sixth wave.

Conclusions: PCC symptoms showed a declining trend over time but persisted. Physicians and patients need to recognize PCC symptoms.