Detection of bacteria, fungi, and viruses by a real-time PCR assay using universal primers and probes from blood in patients with febrile neutropenia.

Febrile neutropenia is the main treatment-related cause of mortality in cancer patients. During June 2012 to April 2013, 76 blood culture samples from patients receiving chemotherapy for hematological malignancy and cancer with febrile neutropenia episodes (FNEs) were examined for the presence of bacteria and fungi based on 16S rRNA gene and 18S rRNA combined with real-time PCR amplification and sequencing. Furthermore, we used a loopmediatedisothermal amplification (LAMP) assay for the detection of herpes simplex virus type 1 and 2 (HSV-1,2), varicella zoster virus (VZV), epstein-barr virus (EBV), cytomegalovirus (CMV) and human herpes virus type6 and 7 (HHV-6,7), followed by a real-time PCR amplification assay. Of these samples, bacteria were identified in 19 of 76 FNEs (25.0%) by a real-time PCR assay and in 9 of 76 (11.8%) by blood culture. In 6 blood culture-positive samples, real-timePCR assay detected the same type of bacteria. No fungus was detected both real-time PCR assay and blood culture. Viruses were identified in 6 of 76 FNE (7.9%). During antibiotic therapy, all samples were negative in blood culture, but a real time PCR assay yielded a positive result in 2 cases of 2 (100%). The number of bacteria DNA copy and serum CRP titer of patients with FNE did not correlated well. We conclude a real-time PCR assay could be given higher microbe\u27s detection rate, and need shorter turnaround time, and smaller blood sample than blood culture. Using a real-time PCR assay combined with blood culture improves microbiological documentation in febrile neuropenia episodes

Home-based subcutaneous immunoglobulin after switch from intravenous immunoglobulin improved quality of life in pediatric patient with common variable immunodeficiency: A case report

　Common variable immunodeficiency (CVID) is one of the primary immunodeficiency. Regular immunoglobulin G (IgG) replacement therapy is often performed for patients with CVID.　We experienced a patient who was hospitalized in our hospital for repeated pneumonia and diagnosed CVID at the age of 10 years. He had often been absent from school due to infectious diseases. We were administered intravenous IgG (IVIG) two times and his serum level of IgG became over 1,000 mg/dL. Afterward, he was affected the hand-foot-and-mouth disease one week after discharge. At that time, his IgG level decreased to 751 mg/dL. To maintain stable IgG trough levels, we introduced subcutaneous IgG (SCIG). Since then, his IgG levels remained around 1,000 mg/dL, he has lived without suffering from infectious diseases.　There are some reports that IVIG and SCIG were compared and SCIG was able to obtain a stable IgG trough levels to prevent infection. In addition, because our patient is a mother and child family, it was difficult to visit the outpatient department frequently, so it was desirable to infuse at home.　We experienced a patient who had a stable trough levels with SCIG and improved quality of life, so we report this case with literature reviews

Long-term survival with RAS-associated autoimmune leukoproliferative disorder with somatic KRAS mutation:A case report

　RAS -associated autoimmune leukoproliferative disorder (RALD) is a recently reported rare nonmalignant autoimmune disorder. The characteristic clinical findings of RALD include monocytosis, leukocytosis, lymphoproliferation, and autoimmune phenomena. RALD is defined by somatic mutations in KRAS or NRAS . It is a new disease that was reported by Niemela and Takagi in 2011. The prognosis and incidence are currently unknown and the treatment strategy has not yet been established.　Here we describe the long-term survival of a patient with who displayed a somatic KRAS G12D mutation. His clinical features and labolatory data were overlapped with juvenile myelomonocytic leukemia and chronic myelomonocytic leukemia. Mercaptopurine hydrate, hydroxycarbamide and azacitizine were administered to control white blood cell count and improve clinical symptoms. He had a long survival time without hematopoietic stem cell transplantation