Hitoshi Miyamoto

Clinical Characteristics of Keratitis Due to Colletotrichum gloeosporioides

PURPOSE To determine the characteristics of the keratitis due to Colletotrichum gloeosporioides. METHODS The medical records of 3 cases of fungal keratitis caused by C. gloeosporioides were reviewed to determine the clinical characteristics. The minimal inhibitory concentrations of different antifungal drugs for all 3 isolates were determined. All 3 isolates were grown on Sabouraud dextrose agar at 25°C, 35°C, and 37°C to determine the temperature-sensitive growth. RESULTS All 3 patients lived in the southwestern part of Japan and had an ocular trauma involving organic materials. The infectious foci were localized in the anterior stroma, and they did not extend deep into the stroma in all cases. The keratitis was treated with antifungal medications including topical voriconazole and natamycin eye ointment, and was resolved in 2-3 weeks. All of the isolated strains grew well at 25°C but poorly at 35°C and 37°C. All isolated strains had similar drug-sensitivity profiles; they were sensitive to amphotericin B, itraconazole, miconazole, micafungin, and voriconazole, and relatively resistant to flucytosine, fluconazole, and natamycin. CONCLUSIONS All 3 cases of C. gloeosporioides keratitis had similar clinical features. The similarities in the drug-sensitivity profiles should be helpful in treating C. gloeosporioides keratitis.

In vivo and in vitro investigations of fungal keratitis caused by Colletotrichum gloeosporioides.

PURPOSE To report a case of fungal keratitis caused by Colletotrichum gloeosporioides, which is a rare pathogen in humans. METHODS An 80-year-old woman developed fungal keratitis after having sustained a traumatic injury during field work. The patient was initially examined by slit-lamp biomicroscopy and the Heidelberg Retina Tomograph II-Rostock Cornea Module (HRT II-RCM). Corneal scrapings were collected and submitted for laboratory investigations. RESULTS Many septate, hyphae-like interlocking and branching white lines were observed in the area of the infiltrate by HRT II-RCM. A tentative diagnosis of fungal keratitis was made, and the patient was treated with systemic and topical voriconazole and pimaricin ophthalmic ointment. The infectious focus resolved within 2 weeks, and there were no signs of a recurrence after 3 months of treatment with the antifungal agents. The culture of the corneal scraping grew C. gloeosporioides. CONCLUSIONS HRT II-RCM was useful in detecting filamentous fungi in the cornea. The treatment with voriconazole and pimaricin was effective in the treatment of C. gloeosporioides keratitis.

Pasteurella multocida pneumonia: Zoonotic transmission confirmed by molecular epidemiological analysis

Semin Oncol 2004; 31 (6 Suppl 18): 29–36. 5 Mendoza AR, Tomlinson MJ. The split denture: a new technique for artificial saliva reservoirs in mandibular dentures. Aust Dent J 2003; 48: 190–194. 6 Michael T, Leila J, Ship JA. Hyposalivation, xerostomia and the complete denture-A systematic review. J Am Dent Assoc 2008; 139: 146–150. 7 Sheiham A, Steele JG, Marcenes W et al. The relationship among dental status, nutrient intake, and nutritional status in older people. J Dent Res 2001; 80: 408–413. 8 Lindstrom RE, Pawelchak J, Heyd A, Tarbet WJ. Physicalchemical aspects of denture retention and stability: a review of the literature. J Prosthet Dent 1979; 42: 371–375. 9 Kikuchi M, Ghani F, Watanabe M. Method for enhancing retention in complete denture bases. J Prosthet Dent 1999; 81: 399–403. 10 Ship JA, Pillemer SR, Baum BJ. Xerostomia and the geriatric patient. J Am Geriatr Soc 2002; 50: 535–543. 11 Givens E Jr. Update on xerostomia: current treatment modalities and future trends. Gen Dent 2006; 54: 99–101. 12 Brennan MT, Shariff G, Lockhart PB, Fox PC. Treatment of xerostomia: a systematic review of therapeutic trials. Dent Clin North Am 2002; 46: 847–856. 13 Cassolato SF, Turnbull RS. Xerostomia: clinical aspects and treatment. Gerodontology 2003; 20: 64–77. 14 Niedermeier W, Huber M, Fischer D et al. Significance of saliva for the denture-wearing population. Gerodontology 2000; 17: 104–118. 15 Márton K, Boros I, Fejérdy P, Madléna M. Evaluation of unstimulated flow rates of whole and palatal saliva in healthy patients wearing complete dentures and in patients with Sjogren’s syndrome. J Prosthet Dent 2004; 91: 577–581.

Bacteriological characteristics of Arcanobacterium haemolyticum isolated from seven patients with skin and soft-tissue infections.

Bacteriological examinations were conducted for seven Arcanobacterium haemolyticum strains isolated from elderly patients with skin and soft-tissue infections, such as cellulitis and skin ulcers. Streptococcus dysgalactiae or Gram-positive cocci were isolated together with A. haemolyticum from all patients. The strains were identified as A. haemolyticum based on their being catalase negative, reverse Christie, Atkins and Munch-Petersen (CAMP) positive and phospholipase D gene positive in respective tests. Moreover, API Coryne and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry confirmed the identification of A. haemolyticum. All strains showed good susceptibility to minocycline, vancomycin and β-lactam antibiotics, but several strains were resistant to gentamicin and levofloxacin.

Clinical Characteristics and Bacteriological Profile of Moraxella Keratitis.

Purpose: Moraxella species are rare causative pathogens of severe sight-threatening keratitis. The aim of this study was to analyze the clinical presentation, predisposing risk factors, in vitro antimicrobial susceptibility, and treatment associated with Moraxella keratitis. Methods: We retrospectively reviewed 30 culture-proven cases of Moraxella keratitis from multiple centers in Japan. Results: The mean age of the patients was 58.4 ± 23.4 years. The most common ocular conditions were contact lens wearing (5 patients, 16.7%) and trauma (3 patients, 10.0%). Seven patients had diabetes mellitus. Sixteen patients exhibited hypopyon in association with the corneal focus. Ring-shaped infiltration was found in 9 patients (30.0%), and irregular or amoebic-shaped infiltration was observed in 13 patients (43.3%). Eight patients (26.7%) showed small round infiltrates. All Moraxella isolates were sensitive to fluoroquinolones and aminoglycosides. All were treated with a combination ophthalmic solution containing a fluoroquinolone, tobramycin, and cefmenoxime. Although no patients developed corneal perforation, the response to treatment was slow in all cases; the mean treatment period was 41.9 days. Conclusions: In Japan, Moraxella keratitis occurs in patients with contact lens wear, trauma, and diabetes mellitus. It presents as a small, round, ring-shaped, irregularly shaped, or amoebic-shaped focus. Moraxella species exhibit good susceptibility to fluoroquinolones and aminoglycosides. Because the treatment response may be very slow, these agents should be continued for a long period of time.

Kluyvera ascorbata infection in a neonate

Kluyvera is a species of Gram-negative bacilli belonging to the Enterobacteriaceae family, which includes K. ascorbata, K. cochleae, K. cryocrescens, and K. georgiana. Kluyvera species have been regarded as non-pathogenic bacteria and part of the normal flora of the human gastrointestinal tract. Recently, Kluyvera has been associated with clinically significant infections such as urinary tract infection (UTI), bacteremia, and severe sepsis. Of the 15 clinically significant cases of pediatric Kluyvera infection, three cases of fatal infection have been documented, but only a few neonatal cases of Kluyvera infection have been reported.

Tsukamurella inchonensis infection in a child with Hodgkin's lymphoma.

Tsukamurella spp. infection is a rare but important cause of bacteremia in immunocompromised patients. The organism is an aerobic, Gram‐positive, weakly acid‐fast bacillus that is difficult to differentiate from other aerobic Actinomycetales by standard laboratory methods. Here, we report on the case of a 14‐year‐old patient with Hodgkins lymphoma who, after intensive chemotherapy, developed Tsukamurella inchonensis bacteremia, which was identified on the peripherally inserted central venous catheter (PICC) using 16S rRNA sequencing analysis. The bacteremia was successfully controlled with antimicrobial therapy and subsequent removal of the PICC. This is the first report of bacteremia by Tsukamurella inchonensis in immunocompromised children. Careful observation and prompt analysis of opportunistic infection, including Tsukamurella spp., is very important in immunocompromised children.

Rapid identification of carbapenemase-type bla GES and ESBL-type bla GES using multiplex PCR

Guiana extended-spectrum (GES) β-lactamases are emerging in Japan. The GES family can be classified into 2 groups, one with extended-spectrum β-lactamase (ESBL)-like activity, which hydrolyzes penicillins and cephalosporins, and the other with carbapenemase-like activity with an extended spectrum toward carbapenems. This difference is mediated by variations in a specific amino acid in the GES protein: G170 N or G170S substitutions. We developed an amplification refractory mutation system (ARMS) PCR assay that enabled rapid identification of these variant genes without sequencing.

Rothia mucilaginosa infection in a child with acute lymphoblastic leukemia.

To the Editor: We report the first case of Rothia mucilaginosa bacteremia in a child with acute lymphoblastic leukemia (ALL) in Japan. Rothia mucilaginosa is a facultative anaerobic, gram-positive, coagulase-negative bacterium from the genus Rothia, which can be detected in the oral cavity and respiratory tract as normal flora in humans.1 Recently, R. mucilaginosa is emerging as an opportunistic pathogen in immunocompromised hosts and has been implicated in serious infections, such as bacteremia, endocarditis, and meningitis.2,3 However, there are only a few formal reports on R. mucilaginosa infection, especially in immunocompromised children. A 4-year-old boy with Down syndrome was transferred to our hospital with the diagnosis of B-cell precursor ALL. He received combination chemotherapy as induction therapy and achieved complete remission. However, his ALL recurred during maintenance therapy, and he received chemotherapy again. Seven days after recommencing induction therapy, neutropenia became apparent, with neutrophil counts of <500/μl. He suffered from febrile episodes with oral aphtha 12 days after induction therapy began. Laboratory examination revealed a decreased leukocyte count of 700/μl, with 1% neutrophils. After two consecutive blood cultures taken from the peripheral vein and central venous catheter line, meropenem was administered as empiric therapy. The blood culture exhibited only gram-positive, cluster-forming cocci fromtheaerobic bottle1dayafter culture (Fig. 1A). We then added vancomycin on the second day of the febrile episode.Usingmass spectrometry,we identifiedR.muciliaginosa in peripheral blood and oral aphtha samples taken from the patient.4 The same organism was detected in blood cultures and oral aphtha samples. Therefore, we considered that oral mucosa barrier dysfunction was associated with bacterial translocation of R. mucilaginosa. The gram-positive cocci formed sticky colonies, which were whitish to gray in color, nonhemolytic, smooth, and round, after 24-hr incubation at 37°C in CO2 atmosphere (Figs. 1B and 1C). Minimum inhibitory concentration for R. mucilaginosa was 0.5 μg/ml for meropenem and 1 μg/ml for vancomycin. R. mucilaginosa is generally sensitive to penicillin, ampicillin, cefotaxime, imipenem, and vancomycin, whereas is frequently resistant to clindamycin, aminoglycosides, sulfamethoxazole/trimethoprim, and ciprofloxacin. However, partial resistance to penicillin has been also reported in the literature.5 Therefore, vancomycin is recommended as empirical therapy while awaiting results of susceptibility testing.6 The combined antimicrobial therapy with meropenem and vancomycin finally led to a significant clinical improvement in symptoms. We continued antimicrobial treatment for 21 days until the patient’s neutropenia and oral mucositis was ameliorated. Because of the absence of Clinical Laboratory Standard Institute guidelines for this organism, poor clinical improvement by the administration of meropenem, and continued neutropenia, we did not perform deescalation from vancomycin to penicillin. To summarize, special attention should be paid for opportunistic infections due to Rothia spp. in immunocompromised childrenwith oral symptomsduring neutropenic phase.