We experienced adverse reactions to antituberculous agents in 17 patients (53%) out of 32 patients treated for tuberculosis and nontuberculous pulmonary mycobacteriosis. Side effects were seen in 15 patients (47%), and abnormal laboratory findings were observed in 9 patients (28%). Most side effects mostly appeared within two weeks after the administration, and were of short duration. However, there were also side effects such as neurological symptoms, arthralgia, and general fatigue which appeared after one month and lasted for a long duration. These results suggest that careful observation for adverse reactions in antituberculous treatment is required. Finally, 11 patients with adverse reactions were successfully treated by changing antituberculous agents or readministration after temporary stop of the administration. Four patients improved even with continued use of agents causing side-effects. However, in the case of two patients who had to change antituberculous agents, adverse reactions to all antituberculous agents appeared and the treatment for tuberculosis and nontuberculous pulmonary mycobacteriosis had to be stopped.
1 To be used in the event of septic shock or severe sepsis.*2 Indicated only for patients with no visual impairment and patients with mild to moderate funduscopy findings.*3 Chorioretinitis caused by candida species that are of low susceptibility to FLCZ and VRCZ, such as C. glabrata.
This single-center, retrospective study was aimed to evaluate the prophylactic efficacy of oral cefcapene pivoxil （CFPN-PI） in preventing perioperative surgical site infections （SSIs）. We obtained hospital records of patients on CFPN-PI prescription between August 25, 2014, and August 25, 2017, at Showa University Hospital in Tokyo, Japan. Patients hospitalized for urological surgery were divided into the CFPN-PI group and non-CFPN-PI group according to administration of antibiotic injection within 72hr of surgery. The incidence of SSI was calculated up to 30 days postoperation in both groups. Of the 1,158 patients, 360 met the inclusion criteria, and 207 received oral cephalosporin and 153 did not. The incidence of SSI was 4.8％ and 3.2％ in the CFPN-PI and the non-CFPN-PI groups, respectively. The incidence of SSI was not significantly different between the two groups （crude odds ratio: 1.5, 95％ confidence interval: 0.50-4.50, p＝0.59）. Perioperative, prophylactic, oral administration of CFPN-PI does not reduce the risk of SSI in patients who have undergone urological surgery.
We investigated the detection of non-specific reactions in the measurement of plasma (1→3)-β-D-glucan (β-glucan) and countermeasures against them using alkaline treatment, chromogenic automated kinetic assay (alkaline-kinetic assay). In this study, we reexamined the values of β-glucan using the alkaline-kinetic assay with and without laminaran oligosaccharides (LO) as a kind of β-glucan that blocks the Limulus reaction. The materials for this study were 584 plasma samples in which β-glucan had been measured. These were taken from 232 patients in Kawasaki Medical School Hospital between January 2002 and March 2002. Non-specific reactions were judged by a calculated value under a LO additive condition. Determination as to whether or not the each time course of the Limulus reaction was influenced by a non-specific reaction was also studied by applying a non-specific reaction index set up independently. Non-specific reactions were recognized in 51.9% of the samples (81/156). The amount of non-specific reaction was 9.9pg/ml or less in major samples. On the other hand, when the cut off value of the index for detection of non-specific reactions was set at 0.5, the sensitivity was 88.9% and specificity was 73.7%. The positive and negative predictive values were 93.5% and 60.9% respectively. Non-specific reactions can be approximately distinguished by applying the non-specific reaction index. By so doing, unnecessary initiation of anti fugal therapy in response to non-specific reactions can be avoided. Further prospective and radical studies of nonspecific reactions in the alkaline-kinetic assay are necessary.
Chlamydia pneumoniae is a significant cause of both lower and upper acute respiratory illnesses, including community-acquired pneumonia. Furthermore, C. pneumoniae has been reported to frequently cause pneumonia in association with other respiratory pathogens, mainly Streptococcus pneumoniae. In this study, we investigated the clinical presentation of mixed pneumonia with Chlamydia pneumoniae and S. pneumoniae and compared it with S. pneumoniae pneumonia. A total of 13 cases of mixed pneumonia and 58 cases of S. pneumoniae pneumonia identified at Kawasaki Medical School and related hospitals between April 1996 and March 2001 were analyzed. The diagnosis ofC. pneumoniae infection was based on isolation and serologic testing of antibodies by the microimmunofluorescence test. The clinical presentation of mixed pneumonia and S. pneumoniae pneumonia was almost identical and no statistical differences were observed between the two groups. This is the same as what was observed before except eleven out of the 13 of the mixed pneumonia patients responded to treatment with only β-lactam antibiotics. Our results indicated that C. pneumnoniae may not be the primary cause of community-acquired pneumonia but it might descript the normal clearance mechanisms, enabling other pathogens to invade.
The efficacy and safety of micafungin (FK463), which is a new lipopeptide antifungal agent of the echinocandin class and is active against both Aspergillus and Candida species, were investigated in patients with deep-seated mycosis in this study. 70 patients were treated with micafungin 12.5–150 mg/d intravenously for up to 56 d. The overall clinical response rates were 60% (6/10) in invasive pulmonary aspergillosis, 67% (6/9) in chronic necrotizing pulmonary aspergillosis, 55% (12/22) in pulmonary aspergilloma, 100% (6/6) in candidemia, and 71% (5/7) in esophageal candidiasis. The response rates for patients with prior antifungal treatment which was considered ineffective or toxic, were similar to rates for patients without prior treatment. Mycological eradication was observed in patients infected with Aspergillus fumigatus, Aspergillus flavus, Aspergillus terreus, Aspergillus niger, Candida albicans, Candida glabrata, or Candida krusei. Adverse events related to micafungin were reported in 21 patients (30%), and there was no dose-related occurrence of any adverse event. It is concluded that treatment with micafungin as monotherapy seems to be effective and safe in patients with deep-seated mycosis.
