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Aim: Streptococcus pneumoniae is the most frequently detected bacterium in pneumonia. RAPIRUN Streptococcus pneumoniae (RAPIRUN) using sputum and BinaxNow Streptococcus pneumoniae (BinaxNow) using urine have been used as rapid diagnostic methods for S. pneumoniae detection in Japan; however, their correlation with quantitative culture tests has not been well evaluated. Methods: A prospective study was conducted on adult patients with respiratory tract infections whose sputum and urine samples were available in six hospitals. Sputum and urine samples were tested at each site, and quantitative sputum cultures were performed. The performance of RAPIRUN and BinaxNow was compared in cases in which quantitative culture showed S. pneumoniae. Results: A total of 192 patients were analyzed. Of these, 167 were diagnosed with pneumonia (87.0%) including 161 of community-acquired pneumonia. Of the 192 cases, 86 (44.8%) were culture-proven for S. pneumoniae. There were 83 and 57 RAPIRUN- and BinaxNow-positive cases, respectively. The sensitivity and specificity of RAPIRUN were 84.9% and 90.6%, respectively, and those of BinaxNOW were 55.8% and 91.5%, respectively, indicating that RAPIRUN was significantly superior in sensitivity (p < 0.0001) with almost equal specificity (p = 0.317). Positive and negative percent agreements of both tests were 59.3% (κ, 0.114 [95% CI, 0.053–0.281]) and 99.1% (κ, 0.942 [95% CI, 0.830–1]), respectively, indicating they were well matched in specificity but not in sensitivity. The positivity rate of RAPIRUN increased with an increase in the number of bacteria (p< 0.0001) but not BinaxNow (p = 0.275). Conclusion: In adult patients with respiratory tract infections in whom sputum collection is feasible, RAPIRUN will increase the diagnostic efficacy of S. pneumoniae infection., Acta medica Nagasakiensia, 66(2), pp.71-79; 2023

A 35-year-old non-HIV patient developed pulmonary cryptococcosis after the initiation of infliximab. He recovered by fluconazole treatment and completed the therapy for a total of 6 months. However, he experienced a relapse 16 months later during retreatment with infliximab, revealing an interesting clinical course contradicting retreatment. This case also represents the first case of relapsed pulmonary cryptococcosis suspected during treatment with a biologic agent. Both of these aspects generated important clinical questions about the length of pulmonary cryptococcosis treatment and the necessity of introducing a second prophylaxis for such patients.

Introduction Gefitinib is a molecularly targeted drug for oral administration, a selective epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI). It is effective for patients with lung cancer who have EGFR mutation and enables long-term survival of patients with advanced disease.Case presentation An 84-year-old Asian female with lung cancer (adenocarcinoma, cT4N3M1b stage IV PUL BRA OSS ADR) was treated by gefitinib for two years. The primary tumor was markedly reduced, and bone metastasis had almost disappeared. However, the patient became unconsciousness with general edema and died two days after falling unconsciousness. In the autopsy, it was diagnosed as infectious cerebral thromboembolism due to infectious endocarditis. The cause of death was cardiac tamponade.Conclusions While long-term survival can be expected in patients with advanced lung cancer by molecular-targeted agents, cautious management is warranted for complications, the same as for the primary disease.

A 74-year-old man with poorly controlled diabetes mellitus was admitted to our hospital because of severe respiratory disturbance, fever, and sputum. We found massive consolidation of the right lung and nodular shadows on the left lung on chest X-ray, and detected influenza virus and Streptococcus pneumoniae antigen from a nasopharyngeal swab and urine sample, respectively. Co-infection with influenza virus and bacteria was suspected, and oseltamivir and biapenem were prescribed. Laboratory data improved after the addition of sivelestat sodium hydrate, an inhibitor of neutrophil-derived elastase; however, chest X-ray findings became worse on Day 8, and we administered 1 g methylprednisolone intravenously for two days. On Day 12, we detected Mycobacterium tuberculosis in the sputum, even though we did not previously detect any acid-fast bacilli, and started anti-tuberculosis drugs, such as isoniazid, rifampicin, ethambutol hydrochloride, and pyrazinamide; however, the patient died 12 days later. Severe influenza-related bacterial pneumonia with Streptococcus pneumoniae and subsequently secondary tuberculosis infection were finally suspected in this case. This was a very rare case in which additional tuberculosis infection was found in a patient with fulminant pneumonia due to co-infection of influenza virus and bacteria. It is necessary to observe patients with influenza carefully, especially when steroids are used, even if antibiotics are also administered.

We determined the natural history of immunoglobulin A nephropathy (IgAN) among patients who presented with mild proteinuria (0.2 to 0.4 g/day), and factors associated with development of adverse clinical events, defined as proteinuria 竕ｧ 1.0g/day, blood pressure > 130/80mmHg, serum creatinine 竕ｧ 1.4mg/dl. We did analyzed data from 27 patients(mean age 30 ﾂｱ 12 years) with IgAN accompanied by mild proteinuria between 1990 and 1998. We also evaluated semiquantitave scores of glomerulosclerosis, tubulointerstitial injury, hyaline arteriosclerosis, and IgAN classification. The median duration of follow-up was 51 months. During followup, at least one adverse clinical event affected 15 patients (56%): among who eight (53%) developed proteinuria. And one of 8 developed impaired renal function and 7 (47%) became hypertensive. Another 12 patients (44%) were not affected by adverse clinical events. The clinical findings were not significantly different between the adverse events and no evens group. The scores of glomerulosclerosis and tubulointerstitial injury reveled significant differences between events. The only renal histological parameters of glomerulosclerosis and adverse clinical events were statistically correlated with renal survival. We concluded that IgAN with mild proteinuria frequently follows a slow by progressive course and that the severity of glomerulosclerosis may be predictable prognostic factor in patients who have IgAN with by mild proteinuria., Acta medica Nagasakiensia. 2003, 48(1-2), p.39-43

We determined the natural history of IgA nephropathy (IgAN) among patients who presented with proteinuria, and factors associated with the development of clinical events, namely blood pressure(BP)竕ｧ130/85 mmHg, serum creatinine 竕ｧ1.4mg/dl. We analyzed data from 16 patients(mean age 35 ﾂｱ 14 years) with IgAN accompanied by proteinuria between 1990 and 1998. We also semiquantified scores of glomerulosclerosis (GS), tubulointerstitial damage (TID), hyaline arteriosclerosis (HA), and IgAN classification. The median duration of follow-up was 48 months. During clinical follow-up, seven (44%) patients became hypertensive, among who five (31%) developed impaired renal function and two (13%) progressed to treatment with hemodialysis. Events did not develop in the other 9 patients (56%). Clinical findings were not significantly different between the events and event-free groups. The GS and TID scores revealed significant differences between patient groups. Only the renal histological parameters of GS and events were statistically correlated with renal survival. We conclude that the severity of GS may be the important prognostic factor inpatients with IgAN accompanied by proteinuria at the time of the initial biopsy., Acta medica Nagasakiensia. 2002, 47(3-4), p.123-126