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Background: Tsukamurellaspp. are obligate aerobic, gram-positive, non-motile, and slightly acid-fast bacilli belonging to the Actinomycetes family. Theyshare many characteristics with Nocardia, Rhodococcus, Gordonia, and the rapidly growing Mycobacterium species. Therefore, standard testing may misidentify Tsukamurella spp. as another species. Accurate and rapid diagnosis is critical for proper infection management, but identification of this bacterium is difficult in the standard laboratory setting. Case presentation: A bloodstream infection caused by a gram-positive bacterium and related to a central venous catheter was identified in an immunocompromised 2-year-old girl. Tsukamurella tyrosinosolvens was identified by modified secA1 sequencing. Antibiotic treatment and removal of the central venous catheter resolved the infection. Inappropriate management of the catheter during an overnight stay outside of the hospital was considered as a possible source of infection. Conclusions: SecA1 sequencing may be a useful diagnostic tool in the identification of T. tyrosinosolvens. Providing proper central venous catheter care instructions to patients, their families, and medical staff is important for infection prevention.

Background Cerebral ventricular shunt infections caused by methicillin-resistant Staphylococcus aureus (MRSA), especially strains with elevated minimal inhibitory concentration (MIC) values, have a poor prognosis. Monitoring serum vancomycin (VCM) levels with therapeutic drug monitoring and maintaining high VCM concentrations in the cerebrospinal fluid (CSF) are critical to treatment success. However, there have been a few reports about CSF penetration and the pharmacokinetics of VCM in children. Case presentation Here, we report a pediatric case with cystoperitoneal shunt-related meningitis caused by MRSA with an MIC of 2 µg/mL. The adequate VCM concentration was maintained by monitoring the VCM concentration in the CSF via the external ventricular drain, and frequent blood taking was avoided. VCM showed a good CSF penetration in our patient, and she was discharged without complications. Conclusions Therapeutic drug monitoring of VCM concentration in the CSF may result in successful treatment even if MRSA shows a higher MIC. Therapeutic drug monitoring of VCM concentration in the CSF may also reduce the frequency of blood collection and side effects.

Background: Several effective vaccines against Coronavirus disease 2019 (COVID-19) have been developed to control the spread of the disease. A few cases of thrombosis have been reported post-vaccination, especially among young adult women immunized with viral vector-based vaccines; although pediatric cases of cerebral venous sinus thrombosis (CVST) have been rarely reported after messenger ribonucleic acid (mRNA) vaccine administration. Case presentation: Here, we report a case of CVST in a 14-year-old girl immunized with the BNT16B2b2 vaccine. Other than this recent COVID-19 vaccination, there were no precipitant risk factors in her medical history. Laboratory work-up showed low levels of protein S activity. Further research revealed no pathological gene mutation. She was treated with anticoagulant therapy and discharged with mildly impaired coordination/movement of the fingers. Conclusion: CVST may occur following a mRNA COVID-19 vaccination, even among children. Further investigations are needed to establish whether thrombotic events are merely incidental or are a complication associated with mRNA-based vaccines.

Waterhouse-Friderichsen syndrome and central diabetes insipidus are uncommon but potentially fatal endocrine and metabolic diseases. Waterhouse-Friderichsen syndrome is defined as adrenal insufficiency caused by adrenal hemorrhage, which is typically bilateral and most frequently due to meningococcal infection. It is usually diagnosed by necropsy. Central diabetes insipidus in children is often caused by trauma, intracranial lesions, autoimmune diseases, and infections. In addition, it can be caused by mutations in the AVP-NPII gene, although this occurs typically later in childhood rather than in the neonatal period. This report describes a term infant who developed Escherichia coli meningitis, which resulted in septic shock and disseminated intravascular coagulation. Abdominal ultrasound led to an early diagnosis of bilateral adrenal hemorrhage and appropriate treatment with corticosteroids. Symptomatic central diabetes insipidus developed a few days after the onset of meningitis. Intravenous vasopressin was effective in resolving hemodynamic instability. In conclusion, sepsis and meningitis may have severely affected the endocrine system in this patient. Early diagnosis and appropriate treatment for both diseases may have resulted in better clinical outcomes for this patient.

Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) virus, has spread worldwide since 2019. Several studies report that adult patients hospitalized with severe COVID-19 can be treated successfully with remdesivir (RDV). However, few studies report the safety and efficacy of RDV for children. This study included 20 hospitalized patients who were diagnosed with COVID-19 and received RDV at Kobe Children's Hospital, Japan, between February and June, 2022. The median age was 2 years (IQR, 1-11 years; range, 5 months to 19 years). Twelve (60%) patients were male. Three (15%) patients were previously healthy, whereas the other 17 had at least one underlying medical condition: five (25%) patients had respiratory disease, four (20%) had cardiac disease, three (15%) had central nervous system disease, four (20%) had hematologic or oncologic disease, and two (10%) had a chromosomal abnormal. All patients recovered without any sequelae, and no serious adverse events were reported. The adverse events were elevated liver enzymes in 4 children (20%), leukopenia (5%), neutropenia (5%), and hypokalemia (5%). Our study may show that the use of RDV for COVID-19 in children led to no serious adverse events.

Postpartum thyroiditis (PPT) is characterized by mild thyrotoxicosis occurring within one year of parturition commonly followed by transient hypothyroidism. Having genetic background of autoimmune thyroid disorders is a risk factor for it because the immune reactivation during postpartum period is a trigger for PPT. Pandemic of COVID-19: caused by SARS-CoV-2 infection is a global health problem, and occurrence of Graves' disease and Hashimoto's thyroiditis after the viral infection have been reported but occurrence of PPT with COVID-19 has never been reported. A 29-year-old woman developed general fatigue four and a half months after parturition, and was diagnosed as having PPT: one month before, she had COVID-19. Hereafter, we define the date of delivery as Day 0 to make timeline clear. SARS-CoV-2 infection was diagnosed by PCR on Day 103, its disappearance from the upper airway confirmed on Day 124, and the thyroiditis diagnosed on Day 136. She had been euthyroid on Day 0 and 95, but thyrotoxic on Day 136. Serum thyroglobulin (Tg) concentration was normal in the presence of anti-Tg antibody, other thyroid-related autoantibodies were negative, and by ultrasonography, the thyroid gland was normal in size and no evidence of increased vascularity. Thyroid function returned to normal by Day 172 without any specific drug therapy. In conclusion, although a clear causal relationship could not be found, we documented the world's first case of PPT developed following COVID-19.

Early-onset sepsis caused by Gram-negative spiral organisms is rarely reported, with Campylobacter fetus being a better known causative agent than other Campylobacter species. We report the case of a 2-day-old girl who presented with hematochezia and bacteremia caused by Campylobacter jejuni. She was born full-term. Her family ate undercooked chicken, and Campylobacter enteritis was diagnosed before her birth.

Pseudomonas aeruginosa is a relatively rare cause of neonatal meningitis, and most patients have serious underlying diseases, prematurity, immunodeficiency, or anatomical abnormalities. We report the case of a 7-day-old girl with meningitis caused by P. aeruginosa. She was born full-term and had no immunodeficiency or anatomical abnormalities as far as our investigation ascertained. Through the use of anti-Pseudomonas antibiotics, she recovered without any complications other than a slight hearing disability revealed by audiology testing. P. aeruginosa was also isolated from a domestic sponge brush used to clean her milk bottle. Physicians should consider P. aeruginosa as a possible pathogen of neonatal meningitis even in full-term infants with no immunodeficiency or anatomical abnormalities. Physicians should give advice concerning appropriate hygiene practices to be applied to the neonate's environment.

We describe the clinical features of a 75-year-old man who presented to our hospital with frequent urination for 3 months. Retrograde urethrography showed extended and continuous narrowing of the stricture in the anterior urethra. Cystourethroscopy showed extended narrowing of the urethral lumen without normal membrane. Urine acid-fast bacillus culture and polymerase chain reaction assays indicated a diagnosis of urethral tuberculosis. Anti-tuberculosis therapy was initiated. Urethral tuberculosis is a very rare cause of urethral stricture in developed countries that can be diagnosed by cystourethroscopy. Urethral tuberculosis should be considered in the differential diagnosis of urethral stricture.

We report a case series of 6 patients with confirmed coronavirus disease 2019 (COVID-19) in Wakayama prefecture, Japan. All 6 of the patients tested positive via pharyngeal swab polymerase chain reaction (PCR) tests, and 2 of the 6 were still positive at 3 weeks after onset. All of the patients exhibited bilateral ground glass opacities on computed tomography (CT). This article also reports narrative information on the spectrum of symptoms collected directly from the patients. It would be difficult to triage patients with COVID-19 based on the typical symptoms of fever and/or cough, although PCR and CT are definitive in diagnosis.

Erysipelothrix rhusiopathiae is a major causative organism of swine erysipelas, but the infection has rarely occurred in humans. A soft-tissue infection with this organism is described as “erysipeloid.” Most reported cases in human are related to occupational exposure. Endocarditis is a common complication of E. rhusiopathiae bacteremia in human.We report the case of a previously healthy 52-year-old Japanese female who presented with fever and an inflamed hand after being bitten by a stray cat. Blood culture was positive for E. rhusiopathiae, but no sign of infective endocarditis was observed. It may be prudent to consider E. rhusiopathiae infection in patients with animal bites. Keywords: Erysipelothrix rhusiopathiae, Animal bites, Bacteremia

As device geometry shrinks to 0.35 mm and below, the parasitic capacitance between closely spaced metal lines becomes important in terms of RC time delay in device switching. In this study, we investigated the use of fluorine doped plasma enhanced chemical vapour deposition (PECVD) grown silicon oxide thin film as a low dielectric constant inter-metal dielectric (IMD) material. We evaluated C2F6 and an organometallic liquid source as the F dopant. It was found that the dielectric constant generally decreased as the F concentration increased. However, we also found that above certain F concentration, the F-doped oxide film would become unstable and absorb moisture from ambient. At similar F concentrations, the films deposited with the liquid source are always more stable than those deposited with C2F6. This, in addition to the different stress versus low frequency rf power behaviour between the two types of film, suggests that the already present SiF bond in the liquid precursor results in a denser and more stable film comparing to the C2F6 doped film where interstitial F may be present.

As device geometry shrinks to 0.35 μm and below, the parasitic capacitance between closely spaced metal lines becomes important in terms of resistance-capacitance time delay in device switching. In this study, we investigated the use of fluorine doped plasma enhanced chemical vapor deposition grown silicon oxide thin film as a low dielectric constant intermetal dielectric material. We evaluated C 2 F 6 and an organometallic liquid source triethoxyfluorosilane as the F dopant. It was found that the dielectric constant generally decreased as the F concentration increased. However, we also found that above a certain F concentration, the F-doped oxide film would become unstable and absorb moisture from the ambient. At similar F concentrations, the films deposited with the liquid source are always more stable than those deposited with C 2 F 6 . This, in addition to the different stress vs. low frequency radio frequency power behavior between the two types of film, suggests that the already present Si-F bond in the liquid precursor results in a denser and more stable film compared to the C 2 F 6 doped film where interstitial F may be present.

Fluorine-doped plasma-enhanced chemical vapour deposition (PECVD) tetraethylorthosilicate (TEOS) SiO2 thin film was investigated for improvement in gap-filling capability as an inter-metal dielectric. Both C2F6 and triethoxyfluorosilicate (TEFS) were evaluated as fluorine (F) dopants. Both kinds of F-doped films provided significantly better gap-filling capability than undoped films. This was attributed to the good bottom-step coverage and preferential sidewall etching due to the presence of F. However, there was a markedly different relationship between gap-filling capability and F concentration for the two dopant precursors. Finally, it was shown that either C2F6 or TEFS doping can extend the gap-filling capability of SiO2 down to 0.35 μm metal spacing with an aspect ratio of 2.0:1.