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    • phosphodiesterase inhibitor Many serologic tests including i

    2018-10-25

    Many serologic tests including immunoassays and enzyme-linked immunosorbent assays that detect circulating antibodies have been developed for the early diagnosis of nocardial disease. However, using a single serologic method for the detection of nocardial infections may be limited due to the numerous species causing infections and the potential lack of sensitivity in immunocompromised patients. Molecular techniques such as multilocus sequence analysis of gyrase B of the β subunit of DNA topoisomerase (gyrB), 16S rRNA (16S), subunit A of SecA preprotein translocase (secA1), the 65-kDa heat shock protein (hsp65), and RNA polymerase (rpoB) have been developed to identify Nocardia species. Among these, 16S rRNA gene sequence analysis, which was developed in the 1980s for bacterial identification, is an excellent and extensively used technique to identify Nocardia isolates at the species level. In the present case report, the 16S rRNA phylogenetic tree revealed that Nocardia isolates (number 04-901-553856) from the patient were clustered with the reference strain of N. otitidiscaviarum (strain number IFM0239). Before the availability of antibiotic susceptibility of Nocardia species, empirical phosphodiesterase inhibitor with cotrimoxazole or minocycline were the most frequently used treatment for localized or mild nocardiosis, while combination therapy with a carbapenem or a third-generation cephalosporin with or without amikacin was recommended in severe cases or for those with central nervous system involvement. For those who fail to respond to standard antibiotic therapy, successful treatment with linezolid and amoxicillin-clavulanate has been reported. The mean treatment duration with amoxicillin–clavulanate has been reported to be 9.6 months, with a minimum of 4 months and a maximum of 22 months. However, geographic variations and species distribution have a significant impact on differences in terms of antibiotic susceptibility. In Taiwan, Lai et al found that eight N. otitidiscaviarum isolates were susceptible to linezolid, sulfamethoxazole, and amikacin, but not to amoxicillin–clavulanate, ceftriaxone, imipenem, or ciprofloxacin. Co-trimoxazole (sulfamethoxazole-trimethoprim) is the most common choice for treating actinomycetoma caused by Nocardia otitidiscaviarum. The total treatment duration regardless of antibiotic regimen is at least 10 months and as long as 55 months (Table 1). In the present case report, the drug of choice was based on the antimicrobial susceptibility test and the patient\'s past history of fixed drug eruptions from co-trimoxazole. In conclusion, herein we report a case that highlights the clinical course of actinomycetoma under various treatments for almost 30 years, with a partial response. Identification of the microbial isolates with molecular techniques, the selection of antimicrobials according to antimicrobial susceptibility tests, and compliance for complete treatment course are crucial for a good therapeutic response. To date, this patient is the first reported case of actinomycetoma induced by N. otitidiscaviarum with long-term follow-up in Taiwan.
    Introduction TS-1 is an oral fluoropyrimidine anticancer drug that contains tegafur [a prodrug that cells metabolize to fluorouracil (FU)], gimeracil (an inhibitor of dihydropyrimidine dehydrogenase, which degrades FU), and oteracil (which inhibits the phosphorylation of FU in the gastrointestinal tract, thus reducing its side effects on the gastrointestinal tract). We describe the case of a patient who developed a rare complication of Stevens–Johnson syndrome (SJS) 8 days after adjuvant TS-1 administration. To clarify the clinical characteristics of drug eruption associated with TS-1, this case and 24 previous cases reported in the literature were analyzed.
    Case report A 78-year-old Japanese man who was diagnosed with carcinoma of the oral floor (rT4aN0M0) was prescribed a standard dose of tegafur/gimeracil/oteracil (TS-1) at 80 mg/day. On the Day 8 after TS-1 administration, he developed eruptions on his axillae. On the 10th day, TS-1 was discontinued because of worsening of the confluent erythema involving the body, blisters on his genitals, and erosions associated with left eye tearing. Therefore, he was treated with 30 mg of prednisolone (PSL). On the 15th day, he developed fever. He also experienced diarrhea that could not be controlled with antidiarrheal medication. On the 18th day, he was referred to our department.