Objective Stenotrophomonas maltophilia is an emerging nosocomial pathogen that causes fatal infections in critically ill or immunocompromised patients. S. maltophilia bacteremia (SMB) is a rare condition, and its clinical characteristics in Japanese settings are not well known. Methods The medical charts of patients with SMB were retrospectively reviewed at two medical facilities (Okayama University Hospital and Tsuyama Chuo Hospital) for seven years. The data were analyzed along with those previously reported from other Japanese facilities. Result A total of 181 patients (110 men and 71 women) were evaluated. The major underlying diseases included hematologic malignancy (36.5%), solid organ malignancy (25.4%), and neutropenia (31.5%). The recent use of carbapenem was seen in 56.9% of the cases in total, and more than one-third of the patients in our hospitals were treated with carbapenem at the onset of SMB. Of 28 (63.6%) of 44 cases treated for S. maltophilia, those who did not survive were more likely to have been treated with broad-spectrum antibiotics. A multivariate analysis revealed that a higher updated Charlson Comorbidity Index [odds ratio (95% confidence interval), 1.75 (1.11-2.75); p=0.015] and intubation [odds ratio (95% confidence interval), 12.6 (1.62-97.9); p=0.016] were associated with mortality in our cases. Pathogens were often resistant to ceftazidime but susceptible to minocycline, trimethoprim/sulfamethoxazole, and fluoroquinolones. The overall mortality rates within 30 and 90 days were 37.5% and 62.5%, respectively. Conclusion The clinical characteristics of SMB in Japanese cases were similar to those reported from other countries. Clinicians should be aware that breakthrough infection by S. maltophilia may occur during administration of carbapenem.

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ABSTRAm. Using four different digoxin kits, it was disclosed that the majority of various samples including amniotic fluid, cord blood, and serum from neonates contained substantial levels of digoxin-like immunoreactive substance. The differences in data seemed to be due to the range of epitopes which are recognized by antidigoxin antiserum. The day-to-day studies on sera serially obtained from infants at birth to 48 days old revealed that the level of the substance (0.31 f 0.12 ng/ml) in sera of the l-dayold neonates rapidly declined to the level of 0.1 ng/ml by the 2nd postnatal wk and thereafter gradually declined. The immunological specificity and accuracy of the detection of digoxin-like immunoreactive substance was confirmed by a sample dilution test, a recovery test for standard digoxin, and an absorption test with antidigoxin antiserum. The amniotic fluid and cord blood also contained Recent reports (1-3) renewed our attention toward the falsepositive digoxin measurements in the plasma of premature infants (4). From the clinical viewpoint, these observations raise some important questions. The first question is whether the falsepositive digoxin measurement really indicates the presence of a DLIS which leads to an erroneous judgment about the level of digoxin in monitoring of neonatal samples. The second question is whether there is any similarity in biochemical specificity between DLIS and the so-called "ouabain-like substances" detected in other organs or body fluids (5-13). It seems that previous reports (1-3) have not yet provided substantial evidence for their conclusion that the substance is not a product of technical or nonimmunological false positivity. Therefore, in this communication, we tried to confirm the previous findings using Received September 6, 1984; accepted August 19, 1985. Address for correspondence Hiroyoshi Ebara, M.D., Department of Pediatrics, Gunma University School of Medicine, 3-39-22 Showa-machi, Maebashi-shi, Gunma-ken, Japan. amniotic fluid, cord blood, and serum specimen from neonates and also to evaluate immunological specificity of the reaction and presence of a DTLIS. MATERIALS AND METHODSThirty-one amniotic fluid and 53 cord blood samples were obtained from mothers who had not received any digitalis glycosides during pregnancy and labor. One hundred eleven sera were also obtained from 23 neonates over 35-wk gestational age who were delivered from healthy mothers who had not been on digitalis therapy. The mean and range of birth weight of the neonates were 3264 g and 20 16-4420 g, respectively. The investigation was approved by the ethical committee of the hospital and informed parental consent was obtained for blood sampling. All samples were stored at -20" C in separate small quantities to avoid unnecessary freezing and thawing, and analyzed at various intervals, always within 30 days of collection.For the detection of DLIS, one EIA kit and three RIA kits available in Japan were used: kit A (Markit Digoxin, DainipponSeiyaku, Osaka, Japan); kit B (Amerlex Digoxin RIA k...

We herein present the case of a 69-year-old Japanese man who had unprotected sexual contact with a local commercial sex worker in an East Asian country and was diagnosed as having disseminated gonococcal infection (DGI). The organism was confirmed to be Neisseria gonorrhoeae based on 16S rRNA sequencing and positive results for the cppB gene. This case indicates that a diagnosis of DGI should also be considered in elderly individuals. DGI potentially causes many complications, and the pathogen has recently been reported to be resistant to various antibiotics. Physicians must therefore pay more attention to the possible occurrence of DGI in various clinical settings.

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A 27-year-old woman visited our hospital because of high fever. She had been diagnosed as 22q11.2 deletion syndrome (22q11.2DS) due to her cardiac history (tetralogy of Fallot), thymic hypoplasia and 22q11.2 deletion. She had a normal CD4/CD8 ratio, a slightly decreased lymphocyte count and normal serum immunoglobulin levels. Blood cultures were positive for Staphylococcus lugdunensis (S. lugdunensis). Infection route of S. lugdunensis in this case was unclear. The patient was successfully treated with several intravenous antibiotics. Infection should be considered when managing patients with 22q.11.2DS. regardless of whether their immune system is impaired.

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