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A 73-year-old man was admitted to our hospital with a high fever and left paresis. A rapid diagnosis test was positive for influenza A was positive by rapid diagnosis test and diffusion-weighted MRI imaging of the brain showed a high intensity lesion of the right cerebral peduncle. The patient was therefore diagnosed as having influenza A virus infection complicated with lacunar infarction. In spite of initial treatment with oseltamivir and anticoagulant therapy, he lost consciousness eight hours after admission. The high intensity lesion of the cerebral peduncle enlarged and new lesions in the thalamus, hippocampus and calcarine cortex were detected with brain MRI. Additionally, an electroencephalographic study showed an entire slow wave and as the other causative pathogens of central nerve system infection were not detected, the likely diagnosis was influenza-associated encephalitis. We administered a high dose of intravenous immunoglobulin since the low-grade fever and mild unconscious state had continued in spite of the treatment with methylprednisolone pulse therapy. His consciousness was restored and body temperature became normal immediately. We could confirm the efficacy of our treatment by measurement of IL-6 levels in the serum and cerebrospinal fluid during the entire clinical course. In conclusion, a high dose of intravenous immunoglobulin therapy might be one of the effective treatments for influenza-associated encephalitis.

Ceftazidime (CAZ), a cephem antibiotic for injection, was administered at dose of one gram q.i.d. to adult hospital-acquired pneimonia patients, and the clinical efficacy and blood concentration of CAZ was studied in five cases. The assessment of clinical efficacy was "efficacy" in all cases, and early improvement of examination value including body temperature, the value of CRP, and white blood cell counts were obtained. Abnormality of hepatic function as adverse effect was noted in two cases. However, the severity was mild and didn't affect the treatment in both cases. The maximum drug concentration immediately after the end of infusion was 72.1-176.5 microg/mL (median, 82.7 microg/mL) and the trough level was 5.1-72.1 microg/mL (median, 26.6 microg/mL), therefore the blood concentration was maintained a higher level than the MIC of bacteria estimated to be causative. From these results, administration method of ceftazidime one gram q.i.d. was considered to be a good way with increase of drug efficacy by maintaining highly blood concentration over prolonged period, and expected to be a good effect for hospital-acquired pneumonia.

Diabetes mellitus (DM) has been considered to predispose to candidiasis. While poor glycemic control increases the risk of superficial candidiasis (especially oral candidiasis), invasive candidiasis is not related to DM. Invasive candidiasis is diagnosed by combination of clinical manifestation, laboratory findings and isolation of Candida spp. Strategy of treatment for invasive candidiasis is consist of prophylactic, empiric and targeted therapy. MCFG, FLCZ and AMPH-B are recommended as first line drugs for invasive candidiasis, and L-AMB, VRCZ, ITCZ are considered as alternative drugs in Japanese guideline.