Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy
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J. Infect. Chemother. · Jun 2019
Case ReportsTwo pediatric cases of Pneumocystis jirovecii pneumonia diagnosed by polymerase chain reaction of gastric lavage.
Detecting Pneumocystis jirovecii by bronchoalveolar lavage or lung biopsy is the gold standard for diagnosis of P. jirovecii pneumonia (PJP); however, these techniques are not always applicable in children because of their high invasiveness. We report two pediatric cases of PJP diagnosed by polymerase chain reaction (PCR) of gastric lavage that were successfully treated. To date, there are no reported cases of using PCR of gastric lavage to diagnose PJP. ⋯ P. jirovecii was detected by PCR of gastric lavage and trimethoprim-sulfamethoxazole was administered for 3 weeks, following which their condition improved. They were long-term steroid users, but without any prophylaxis. PCR of gastric lavage in cases of suspected PJP may help in confirming the diagnosis in children who have mild to moderate airway symptoms, or have difficulty with invasive examination like bronchoscopy.
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J. Infect. Chemother. · Apr 2019
Case ReportsPelvic cellulitis caused by Raoultella planticola in a neutropenic patient.
Raoultella planticola is a gram-negative, encapsulated, aerobic bacterium within the Enterobacteriaceae family. It has been primarily described as pathogen in cases with pneumonia and gastrointestinal infections. ⋯ A literature review is provided to put this case in context with previous reports on R. planticola. This report highlights that awareness for uncommon pathogens is crucial in the clinical management of infections in neutropenic patients.
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J. Infect. Chemother. · Apr 2019
Observational StudyAssociation between rapid antigen detection tests and antibiotics for acute pharyngitis in Japan: A retrospective observational study.
The application and clinical impact of rapid antigen detection test (RADT) in the treatment of acute pharyngitis is unknown in Japan. We aimed to examine the proportions of RADT usage to identify Group A β-hemolytic Streptococcus (GAS) in outpatients with acute pharyngitis and evaluate the association between RADT and antibiotic treatment. We analyzed health insurance claims data from 2013 to 2015. ⋯ In conclusion, the proportion of RADT usage for outpatients with acute pharyngitis was low in Japan. With appropriate indication and evaluation, we expect that more utilization of RADT can help promote antimicrobial stewardship for outpatients with acute pharyngitis by prompting penicillin therapy. Further investigation with detailed clinical data are warranted.
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J. Infect. Chemother. · Mar 2019
Case ReportsSuccessful voriconazole treatment of Talaromyces marneffei infection in an HIV-negative patient with osteolytic lesions.
Talaromyces marneffei (T. marneffei) is a dimorphic fungus that causes systemic infection in immunocompromised patients. Here, we present a case of T. marneffei infection in an immunocompetent patient with an osteolytic lesion. ⋯ The patient responded rapidly to intravenous voriconazole, followed by oral voriconazole. We reviewed 18 reported cases of T. marneffei infection with osteolytic lesions, which suggests a much higher rate of osteolytic lesions in immunocompetent patients than previously thought.
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J. Infect. Chemother. · Mar 2019
Efficacy and safety of intermittent maintenance therapy after successful treatment of Mycobacterium avium complex lung disease.
The optimal duration of antimicrobial therapy for Mycobacterium avium complex lung disease (MAC-LD) is unknown, and recurrence rates are high after treatment discontinuation. Intermittent therapy is recommended for the initial treatment of non-cavitary nodular/bronchiectatic MAC-LD. We hypothesized that intermittent maintenance therapy (IMT) could effectively prevent recurrence after successful treatment of MAC-LD. ⋯ IMT after successful treatment may be a feasible option for patients with MAC-LD. Further studies should determine the population that would benefit from this strategy.