Some patients with Mycoplasma pneumoniae infection are clinically resistant to antibiotics such as erythromycin, c1arithromycin, or clindamycin. We isolated M. pneumoniae from such patients and found that one of three isolates showed a point mutation in the 238 rRNA gene. Furthermore, 141 EM-sensitive clinical isolates of M. pneumoniae were cultured in broth medium containing 100 fLglml of erythromycin (EM). Among 11 EM-resistant strains that grew in the medium, point mutations in the 238 rRNA were found in 3 strains at A2063G, 5 strains at A2064G and 3 strains at A2064C. The relationship between the point mutation pattern of these EM-resistant strains and their resistance phenotypes to several macrolide antibiotics was investigated.

Mycoplasma pneumoniae (MP) is one of the most common causes of community-acquired pneumonia in children and young adults. Although MP sometimes causes self-limiting pneumonia, severe and fulminant cases with hypoxia occur, but their clinical features have rarely been reported. This study aimed to reveal the clinical manifestations, risk factors, and treatment of fulminant MP pneumonia (MPP). Using PubMed and abstracts from the proceedings of several domestic Japanese academic societies, we reviewed the Japanese and English literature for cases of fulminant or severe MPP reported in Japan. All clinical information such as sex, age, underlying diseases, clinical symptoms, clinical course, laboratory and radiological findings, and treatment was collected and analyzed. In total, 52 fulminant MPP cases were reported between September, 1979 and February, 2010. The dominant population of fulminant MPP was young adults without severe underlying diseases. Cough (97.3%), fever (100.0%), and dyspnea (83.3%) with diffuse abnormal findings in radiological examinations were noted. Antibiotics without anti-mycoplasmal activity were used in 32 cases (61.5%) as initial treatment prior to the onset of hypoxia. Anti-mycoplasmal drugs were appropriately used in 41 cases (78.8%) after onset of respiratory failure with steroids (23 cases, 45.1%) and effective. The majority of patients improved within 3-5 3 days after steroid administration. There were only 2 fatal cases. Although this small retrospective study did not reveal the apparent risk factors of fulminant MPP, initial inappropriate use of antibiotics may be a risk factor, and early administration of appropriate anti-mycoplasmal drugs with steroids as a cellular immune suppressor is required.4

A Mycoplasma pneumoniae cytadhesin P1 gene with novel nucleotide sequence variation has been identified. Four clinical strains of M. pneumoniae were found to carry this type of P1 gene. This new P1 gene is similar to the known group II P1 genes but possesses novel sequence variation of approximately 300 bp in the RepMP2/3 region. The position of the new variable region is distant from the previously reported variable regions known to differ between group I and II P1 genes. Two sequences closely homologous to this new variable region were found within the repetitive sequences outside the P1 gene of the M. pneumoniae M129 genome. This suggests that the new P1 gene was generated by DNA recombination between repetitive sequences and the P1 gene locus. The finding of this new type of P1 gene supports the hypothesis that the repetitive sequences of the M. pneumoniae genome serve as a reservoir to generate antigenic variation of the cytadhesin P1 gene.

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Cat-scratch disease (CSD) is a worldwide zoonosis primarily caused by Bartonella henselae (5,11,20,24,33,34), but Bartonella clarridgeiae has also been linked to a few human cases of CSD (17,19). The organism also causes bacillary angiomatosis (15,31) and peliosis (32) in immunocompromised individuals and bacteremia in immunocompetent individuals. The clinical manifestation of CSD is mainly characterized by pyrexia, papules on the site of the cat scratch or bite and unilateral lymphadenopathy, while cats themselves, the major reservoir of CSD, are asymptotic carriers, showing longterm bacteremia with antibody formation (1, 16).The number of human clinical cases of CSD has been increasing worldwide. Most cases are diagnosed based on clinical manifestations, the history of contacts with cats, serology (14,20,24,26,28,33) or PCR-based methods for examining the biopsy specimens (2, 10, 28). However, the isolation of the organism from patients is relatively difficult and only a few cases of the organism isolation have been reported worldwide (7,9,18,25), because suitable material is not available, the culture conditions are not appropriate or the organism shows fastidious, cytozoic and slow-growth properties. The isolation and establishment of Bartonella strains are extremely important for both etiological diagnosis and epidemiological and genetical analysis of the isolates. Though many clinical cases of CSD have been reported in Japan (20,24,33), there are to date no available reports of the isolation of B. henselae from human cases in Japan.B. henselae type II was detected in 18% of the isolates from CSD patients in the Netherlands (3), and 94% of cat isolates in Germany (27). In contrast, Maruyama et al. showed that type I is the predominant gene type in domestic cats in Japan (21). However, no data was available for the prevalence of gene type on the isolates from CSD patients in Japan.In this study, the authors describe a typical CSD case and the isolation of B. henselae from the patient in Medicine, Yame General Hospital, Fukuoka, Fukuoka 834-0034, Japan Received September 12, 2003; in revised form, October 27, 2003. Accepted November 20, 2003 Abstract: We isolated Bartonella henselae from an inguinal lymph node of a 36-year-old male patient with cat-scratch disease. The patient had many areas of erythema on his body, swelling of the left inguinal lymph nodes with pain and slight fever. The diagnosis was made on the basis of polymerase chain reaction for B. henselae DNA from the lymph node biopsies and blood sample, and isolation of the organism, histology of the lymph node and serology with an indirect immunofluorescent antibody test. We also analyzed the genome profiles for five strains of 90 isolates from the lymph node by pulsed-field gel electrophoresis after NotI endonuclease digestion. We found two different genomic profiles. These results suggest that the patient had been either co-infected or re-infected with two genetically different strains of B. henselae.

An adult case of pulmonary resection for repeated infections in a supernumerary tracheal bronchus combined with a pulmonary artery sling is reported. A 33-year-old woman with a pulmonary artery sling was referred for recurrent lung infections. Chest computed tomography showed the left pulmonary artery arising from the right pulmonary artery and coursing posterior to the trachea. The lung parenchyma connected to the tracheal bronchus showed dense opacity and traction bronchiectasis. Partial pulmonary resection was performed with an ultrasonically activated scalpel after the tracheal bronchus was auto-sutured. The patient's postoperative course was uneventful, and she is now in good condition.Miyazaki 3

A 50-year-old male with left cervical lymphadenopathy visited our hospital. Infectious and lymphomatous diseases were suspected in the patient. Since the patient owned a dog, which often licked the patient's face, Bartonella infection was also suspected. Histopathological examination in the lymph node biopsy revealed the epithelioid granuloma, but B. henselae was not detected from the culture of the lymphnode. B. henselae DNA also was not detected from the lymph node. Since the antibody titer (lgG) to B. henselae showed 1:128 by immunofluorescent antibody technique (IFA), he was serdogicalg diagnosed as cat-scratch disease. 'Cat-scratch disease' is named after cat scratch, however we propose 'B. henselae infection' which is more appropriate since other animals could serve as a cause of infection.

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