Cryptococcus gattii Genotype VGIIa Infection in Man, Japan, 2007

We report a patient in Japan infected with Cryptococcus gattii genotype VGIIa who had no recent history of travel to disease-endemic areas. This strain was identical to the Vancouver Island outbreak strain R265. Our results suggest that this virulent strain has spread to regions outside North America

Characteristics of pneumonia with negative chest radiography in cases confirmed by computed tomography

Background Chest radiography is commonly used for diagnosing community-acquired pneumonia (CAP). Computed tomography (CT) is not routinely recommended for initial assessment of CAP patients but is more sensitive and more specific than chest radiography. Objectives To investigate characteristics of pneumonia with negative chest radiography in cases confirmed by CT. Methods We included patients diagnosed with CAP in the emergency department, and chest radiography and CT were performed and sputum cultures were collected. The CR- group was defined as patients for whom infiltration of pneumonia was detected only on CT. The CR+ group was defined as patients for whom infiltration was detected on both chest radiography and CT. Data were collected retrospectively from medical records. Results A total of 138 patients were included, with 58 patients in the CR- group and 80 patients in the CR+ group. Mean age was higher in the CR- group than in the CR+ group, and white blood cell counts and C-reactive protein (CRP) levels were lower in the CR- group than in the CR+ group (8.4 × 103/μL vs 12.4 × 103/μL, p = 0.01; 4.7 mg/dL vs 15.6 mg/dL, p < 0.001, respectively). Laterality of the infiltrated lungs differed between groups (right:left:bilateral = 14:30:14 vs 48:20:12, p = 0.006). Multivariate logistic analysis identified leukocytosis, elevated CRP levels (odds ratio (OR) 3.57, p = 0.003), laterality (OR 2.16, p = 0.006) as predictors of pneumonia in the CR- group. Conclusion In pneumonia with negative chest radiography in cases confirmed by CT, milder inflammation and infiltration in the left lung tended to be seen

Characteristics of serum endocan levels in infection.

Endocan is a newly recognized biomarker of sepsis. However, there have been no studies of the trends in endocan levels during infection and their associations with other clinical factors. The aim of this study was to assess the time course of endocan levels and the associations of endocan with clinical factors during infection by comparison with other biomarkers.Serum samples and blood cultures were obtained from patients who were diagnosed with infection from June 2013 to March 2014. Serum endocan, C-reactive protein (CRP), and procalcitonin (PCT) levels during four periods during infection were measured (day 0, day 1-2, day 3-5, and day 6-10).A total of 78 patients were enrolled in this study. The median endocan level decreased by only 23% during infection, whereas both serum CRP and PCT levels decreased by more than 80%. Endocan levels were correlated to neither CRP levels nor PCT levels in each period. Endocan levels at day 0 in patients with bacteremia were higher than those without bacteremia (1.09 ng/mL vs 0.82 ng/mL, P=0.002), but neither CRP levels nor PCT levels at day 0 were different between the two groups. Areas under the receiver operator characteristic (ROC) curves of endocan, CRP, and PCT at day 0 were 0.662, 0.343, and 0.563, respectively. Positive blood cultures tended to be related to high endocan levels, but not significantly (odds ratio: 4.24, 95% CI: 0.99-10.34, P=0.05).In bacteremic cases, serum endocan levels in bacteremia tended to be higher than in non-bacteremic cases. Although endocan level was not identified as a prognostic factor of bacteremia, further prospective study concerning the relationship between serum endocan level and bacteremia would be needed

Correlations between the results for C-reactive protein (CRP) and endocan (A), and those for procalcitonin (PCT) and endocan (B).

<p>The black and white circles represent the levels of the markers in the blood culture-positive (n = 29) and-negative (n = 49) groups, respectively. The y axes for endocan in (A) and (B), and the x axis for PCT in (B) are in log values.</p

Trends of endocan (A), C-reactive protein (CRP)(B), procalcitonin (PCT)(C) levels in patients during infection.

<p>The boxes represent the interquartile range, and the transverse lines in the boxes represent the medians of each group. The vertical lines represent 1.5 of the interquartile range. The circles indicate outliers of each group. The y axes for endocan in (A) and for PCT in (C), but not for CRP in (B) are in log values.* P<0.001.</p

Blood culture positivity and biomarkers during infection.

<p><b>The boxes represent the interquartile ranges, and the transverse lines in the boxes represent the medians of each group.</b> The vertical lines represent 1.5 of the interquartile range. The circles indicate outliers of each group. The y axes for endocan in (A) and for PCT in (C), but not for CRP in (B) are in log values.* P = 0.003, # P = 0.02, § P = 0.03</p