Pulmonary nocardiosis caused by Nocardia cyriacigeorgica in patients with Mycobacterium avium complex lung disease: two case reports

Background

Pulmonary nocardiosis frequently occurs in immunocompromised hosts and in some immunocompetent hosts with chronic lung disease; however, few reports have described pulmonary nocardiosis with nontuberculous mycobacterial lung infection. Here we report for the first time two cases of pulmonary nocardiosis caused by Nocardia cyriacigeorgica associated with Mycobacterium avium complex (MAC) lung disease caused by M. avium.

Case presentation

Case 1 is that of a 72-year-old Japanese man with untreated MAC lung disease, who was diagnosed with rheumatoid arthritis and initiated on methotrexate. After 3 years of methotrexate therapy, the patient remained smear-negative and culture-positive for MAC, but also became smear-positive for Nocardia species. He received trimethoprim/sulfamethoxazole, and his symptoms and lung infiltrates improved. Case 2 is that of an immunocompetent 53-year-old Japanese woman with MAC lung disease, who was treated with a combined therapy of clarithromycin, rifampicin, ethambutol, and levofloxacin. MAC sputum culture was negative after 1 year of combined treatment, which was maintained for 2 years. After four treatment-free years, Nocardia species were occasionally isolated from her sputum, although MAC was rarely isolated from sputum cultures over the same period. In both cases, the Nocardia species were identified as the recently defined N. cyriacigeorgica by 16S ribosomal RNA gene sequencing.

Conclusion

We report two cases of pulmonary nocardiosis caused by N. cyriacigeorgica associated with MAC lung disease caused by M. avium and suggest that N. cyriacigeorgica may be a major infective agent associated with MAC lung disease.

Electronic supplementary material

The online version of this article (doi:10.1186/s12879-014-0684-z) contains supplementary material, which is available to authorized users.

Comparison of the immunogenicity and safety of polysaccharide and protein-conjugated pneumococcal vaccines among the elderly aged 80 years or older in Japan: an open-labeled randomized study

An open-labeled randomized study was conducted to compare the immunogenicity and safety of polysaccharide (PPV23) or protein-conjugated pneumococcal vaccine (PCV7) among the elderly aged 80 years or older. A total of 105 nursing home residents were enrolled in this study. We analyzed the geometric mean concentration (GMC) of serotype-specific immunoglobulin G (IgG) and the geometric mean titer (GMT) of the opsonization index (OI) for serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F. The GMCs of serotype-specific IgG and the GMTs of the OI significantly increased one month after vaccination in both groups for all seven serotypes evaluated. In the PCV7 group, study subjects with serotypes 4, 9V, 18C, and 23F exhibited statistically significant elevations in both serotype-specific IgGs and OIs compared to those of the PPV23 group. Both vaccines were tolerated without any severe adverse events, and no differences in systemic adverse events were observed between the two groups, although adverse reactions such as redness and localized swelling were more common in the PCV7 group. Our data demonstrated that the GMCs of serotype-specific IgG and the GMTs of the OI were higher in the PCV7 group compared to those in the PPV23 group. Our study also confirmed the safety of both the PCV7 and PPV23 vaccines in elderly people aged 80 years or older.

Description of two new Ecuadorian Zilchistrophia Weyrauch, 1960, with the clarification of the systematic position of the genus based on anatomical data (Gastropoda, Stylommatophora, Scolodontidae)

Two new species of the genus Zilchistrophia Weyrauch, 1960 are described from Eastern Ecuadorian rain forest: Zilchistrophiahilaryaesp. n. and Zilchistrophiashiwiarorumsp. n. These two new species extend the distribution of the genus considerably northwards, because congeners have been reported from Peru only. For the first time we present anatomical data (radula, buccal mass, morphology of the foot and the genital structure) of Zilchistrophia species. According to these, the genus belongs to the family Scolodontidae, subfamily Scolodontinae (=“Systrophiini”). The previously assumed systematic relationship of Zilchistrophia with the Asian Corillidae and Plectopylidae based on the similarly looking palatal plicae is not supported.

Evolutionary optimality in sex differences of longevity and athletic performances

Many sexual differences are known in human and animals. It is well known that females are superior in longevity, while males in athletic performances. Even though some sexual differences are attributed to the evolutionary tradeoff between survival and reproduction, the aforementioned sex differences are difficult to explain by this tradeoff. Here we show that the evolutionary tradeoff occurs among three components: (1) viability, (2) competitive ability and (3) reproductive effort. The sexual differences in longevity and athletic performances are attributed to the tradeoff between viability (survival) and competitive ability that belongs to the physical makeup of an individual, but not related to the tradeoff between survival and reproduction. This provides a new perspective on sex differences in human and animals: females are superior in longevity and disease recovery, while males are superior in athletic performance.

A New-Type Photosystem II Inhibitor which Blocks Electron Transport in Water-Oxidation System

The mode of action of three types of conjugated enamine compounds was investigated by means of thermoluminescence measurement. Cyanoacrylate and 2-(l-ethoxyethylam inom ethylidene)- 4-dodecyl-5,5-dim ethyl-cyclohexane-1,3-dione (ACm12) converted the B-band (30 °C) arising from S2QB - charge recombination to a downshifted 6 °C-band. This band was proved to be identical with the DCM U-induced Q-band (6 °C) arising from S2QA - recombination, indicating that these two compounds block QA to QB electron transport. 3-(1-dodecylam inopropyridene)-6- methyl-2H-pyran-2,4-dione (APp12 ), on the other hand, induced an abnormal band peaking at 15 °C between the Q-band and B-band. From the gradual downshift of its peak temperature in titration experiments, this band was assigned to arise from a modified S2QB - charge pair, in which the properties of either QB - or S2 is altered. The 15 °C-band showed normal oscillation during the first 2 flashes, but the oscillation was interrupted thereafter. Another therm oluminescence analysis by use of post flash low temperature illumination protocol revealed that APp12 affects neither QA to QB nor QB 2- to PQ electron transport, but specifically blocks S3 to S0 transition. These results indicate that APp12 is a new-type PS II inhibitor.

Human middle longitudinal fascicle: variations in patterns of anatomical connections

Based on high-resolution diffusion tensor magnetic resonance imaging (DTI) tractographic analyses in 39 healthy adult subjects, we derived patterns of connections and measures of volume and biophysical parameters, such as fractional anisotropy (FA) for the human middle longitudinal fascicle (MdLF). Compared to previous studies, we found that the cortical connections of the MdLF in humans appear to go beyond the superior temporal (STG) and angular (AG) gyri, extending to the temporal pole (TP), superior parietal lobule (SPL), supramarginal gyrus, precuneus and the occipital lobe (including the cuneus and lateral occipital areas). Importantly, the MdLF showed a striking lateralized pattern with predominant connections between the TP, STG and AG on the left and TP, STG and SPL on the right hemisphere. In light of the results of the present study, and of the known functional role of the cortical areas interconnected by the MdLF, we suggested that this fiber pathway might be related to language, high order auditory association, visuospatial and attention functions.

Left-right asymmetric expression of dpp in the mantle of gastropods correlates with asymmetric shell coiling

Background

Various shapes of gastropod shells have evolved ever since the Cambrian. Although theoretical analyses of morphogenesis exist, the molecular basis of shell development remains unclear. We compared expression patterns of the decapentaplegic (dpp) gene in the shell gland and mantle tissues at various developmental stages between coiled-shell and non-coiled-shell gastropods.

Results

We analyzed the expression patterns of dpp for the two limpets Patella vulgata and Nipponacmea fuscoviridis, and for the dextral wild-type and sinistral mutant lineage of the pond snail Lymnaea stagnalis. The limpets had symmetric expression patterns of dpp throughout ontogeny, whereas in the pond snail, the results indicated asymmetric and mirror image patterns between the dextral and sinistral lineages.

Conclusion

We hypothesize that Dpp induces mantle expansion, and the presence of a left/right asymmetric gradient of the Dpp protein causes the formation of a coiled shell. Our results provide a molecular explanation for shell, coiling including new insights into expression patterns in post-embryonic development, which should aid in understanding how various shell shapes are formed and have evolved in the gastropods.

Reduced fractional anisotropy and axial diffusivity in white matter in 22q11.2 deletion syndrome: a pilot study

Individuals with 22q11.2 deletion syndrome (22q11.2DS) evince a 30% incidence of schizophrenia. We compared the white matter (WM) of 22q11.2DS patients without schizophrenia to a group of matched healthy controls using Tract-Based-Spatial-Statistics (TBSS). We found localized reduction of Fractional Anisotropy (FA) and Axial Diffusivity (AD; measure of axonal integrity) in WM underlying the left parietal lobe. No changes in Radial Diffusivity (RD; measure of myelin integrity) were observed. Of note, studies in chronic schizophrenia patients report reduced FA, no changes in AD, and increases in RD in WM. Our findings suggest different WM microstructural pathology in 22q11.2DS than in patients with schizophrenia.

Longitudinal differentiation among pelagic populations in a planktic foraminifer

Evolutionary processes in marine plankton have been assumed to be dependent on the oceanic circulation system, which transports plankton between populations in marine surface waters. Gene flow facilitated by oceanic currents along longitudinal gradients may efficiently impede genetic differentiation of pelagic populations in the absence of confounding marine environmental effects. However, how responsible oceanic currents are for the geographic distribution and dispersal of plankton is poorly understood. We examined the phylogeography of the planktic foraminifer Pulleniatina obliquiloculata in the Indo-Pacific Warm Pool (IPWP) by using partial small subunit ribosomal DNA (SSU rDNA) sequences. We found longitudinal clines in the frequencies of three distinct genetic types in the IPWP area. These frequencies were correlated with environmental factors that are characteristic of three water masses in the IPWP. Noteworthy, populations inhabiting longitudinally distant water masses at the Pacific and Indian sides of the IPWP were genetically different, despite transportation of individuals via oceanic currents. These results demonstrate that populations of pelagic plankton have diverged genetically among different water masses within a single climate zone. Changes of the oceanic circulation system could have impacted the geographic patterns of dispersal and divergence of pelagic plankton.

CRTH2 is a critical regulator of neutrophil migration and resistance to polymicrobial sepsis

Although arachidonic acid cascade has been shown to be involved in sepsis, little is known about the role of PGD(2) and its newly found receptor, chemoattractant receptor-homologous molecule expressed on Th2 cells (CRTH2), on the septic response. Severe sepsis is associated with the failure of neutrophil migration. To investigate whether CRTH2 influences neutrophil recruitment and the lethality during sepsis, sepsis was induced by cecal ligation and puncture (CLP) surgery in mice. CRTH2 knockout (CRTH2(-/-)) mice were highly resistant to CLP-induced sepsis, which was associated with lower bacterial load and lower production of TNF-α, IL-6, and CCL3. IL-10, an anti-inflammatory cytokine, was higher in CRTH2(-/-) mice, blunting CLP-induced lethality in CRTH2(-/-) mice. Neutrophil accumulation in the peritoneum was more pronounced after CLP in CRTH2(-/-) mice, which was associated with higher CXCR2 levels in circulating neutrophils. Furthermore, sepsis caused a decrease in the level of acetylation of histone H3, an activation mark, at the CXCR2 promoter in wild-type neutrophils, suggesting that CXCR2 expression levels are epigenetically regulated. Finally, both pharmacological depletion of neutrophils and inhibition of CXCR2 abrogated the survival benefit in CRTH2(-/-) mice. These results demonstrate that genetic ablation of CRTH2 improved impaired neutrophil migration and survival during severe sepsis, which was mechanistically associated with epigenetic-mediated CXCR2 expression. Thus, CRTH2 is a potential therapeutic target for polymicrobial sepsis.

Chiral speciation in terrestrial pulmonate snails

On the basis of data in the literature, the percentages of dextral versus sinistral species of snails have been calculated for western Europe, Turkey, North America (north of Mexico), and Japan. When the family of Clausiliidae is represented, about a quarter of all snail species may be sinistral, whereas less than one per cent of the species may be sinistral where that family does not occur. The number of single-gene speciation events on the basis of chirality, resulting in the origin of mirror image species, is not closely linked to the percentage of sinistral versus dextral species in a particular region. Turkey is nevertheless exceptional by both a high percentage of sinistral species and a high number of speciation events resulting in mirror image species. Shell morphology and genetic background may influence the ease of chirality-linked speciation, whereas sinistrality may additionally be selected against by internal selection. For the Clausiliidae, the fossil record and the recent fauna suggest that successful reversals in coiling direction occurred with a frequency of once every three to four million years.

A randomized-controlled trial to investigate the effects of rivoglitazone, a novel PPAR gamma agonist on glucose-lipid control in type 2 diabetes

AIM

To examine the efficacy, safety and tolerability of rivoglitazone, a novel thiazolidinedione (TZD), and explore its effects on glucose and lipid control compared to placebo and pioglitazone in Chinese type 2 diabetic patients who are treatment naÏve or treated with a single oral blood glucose-lowering drug.

METHODS

This was a double-blind, randomized, placebo- and active-controlled study. A total of 287 Chinese type 2 diabetic patients with suboptimal glycaemic control (defined as HbA1c ≥6.5 to <10% and fasting plasma glucose ≥7 to ≤15 mmol/l) were enrolled. One hundred and seventy-four eligible patients were randomized into one of the five treatment arms for 12 weeks: placebo, pioglitazone 30 mg daily, rivoglitazone of dose 0.5, 1.0 or 1.5 mg daily. In a full set analysis, we used analysis of covariance to compare the primary endpoint defined as change in HbA1c from baseline to week 12/last observation carried forward in the rivoglitazone group at each dose level with the placebo group.

RESULTS

Changes in HbA1c were -0.11% in the 0.5-mg group; -0.22% in the 1-mg group and -0.17% in the 1.5-mg rivoglitazone group; -0.06% in the 30-mg pioglitazone group and 0.61% in the placebo group. Compared to placebo, changes were significant in all active treatment groups (all p < 0.05). Increase in high-density lipoprotein cholesterol and decrease in triglyceride were observed in the rivoglitazone 1 and 1.5 mg groups, respectively, compared to placebo from baseline to week 12 (p < 0.05). Drug-related oedema was reported in eight patients (7.7%) in all rivoglitazone groups compared to six patients (16.2%) in the pioglitazone group and one patient (3.0%) in the placebo group.

CONCLUSIONS

Rivoglitazone is an efficacious, safe and well-tolerated TZD which improved glycaemic control in Chinese type 2 diabetic patients up to 3 months.

Enantiomorphs differ in shape in opposite directions between populations

Development is left-right reversed between dextral and sinistral morphs of snails. In sympatry, they share the same gene pool, including polygenes for shell shape. Nevertheless, their shell shapes are not the mirror images of each other. This triggered a debate between hypotheses that argue either for a developmental constraint or for zygotic pleiotropic effects of the polarity gene. We found that dextrals can be wider or narrower than sinistrals depending on the population, contrary to the prediction of invariable deviation under a developmental constraint. If the pleiotropy is solely responsible instead, the mean shape of each morph should change, depending on the frequency of polarity genotype. Our simulations of this mean shape change under zygotic pleiotropy, however, show that the direction of interchiral difference remains the same regardless of genotype frequency. Our results suggest the presence of genetic variation among populations that changes the maternal or zygotic pleiotropic effect of the polarity gene.

Fitness consequences of reciprocally asymmetric hybridization between simultaneous hermaphrodites

Depending on fitness consequences, hybridization may rescue Inbred populations; generate premating barriers, reproductive Interference, or hybrid species; or extinguish a species. However, the fitness of hybrids is unpredictable without direct quantification of their performance in fitness components across multiple generations. The land snails Bradybaena pellucida and B. similaris, which are Indigenous and non-Indigenous in Japan, respectively, copulate with each other simultaneously and reciprocally. However, only B. pellucida produces hybrids, because it ends mating by removing the penis before transferring a spermatophore, while B. similaris Inseminates B. pellucida. To evaluate the strength of an Intrinsic postzygotic barrier against the hybrids produced by B. pellucida, we conducted breeding experiments in the laboratory and measured six life-history traits: (1) growth rate, (2) body weight at maturity, (3) number of days to first oviposition after being permitted to mate, (4) clutch size, (5) fecundity, and (6) hatchability. We also calculated the relative intrinsic fitness based on five of these trait values (excluding clutch size). F(1) hybrids exhibited heterosis in growth rate, body weight at maturity and relative intrinsic fitness. F(2) hybrids also showed heterosis in body weight at maturity. Nevertheless, the F(2) hybrids produced significantly fewer progeny than the mid-point value of the parental species. Thus, the F(2) hybrids exhibited weak out-breeding depression in reproduction, offsetting their vigor in body size. These results indicate that only a weak postzygotic barrier, contrasting with strong F(1) heterosis, has evolved during genetic divergence of the two sibling species in allopatry.

Fluorescent pigment distinguishes between sibling snail species

Traditional taxonomy of shell-bearing molluscs does not generally use soft-body coloration. However, the land snails Bradybaena pellucida and B. similaris have been distinguished only on the basis of the color of the soft-body visible through the shell. Thus, the taxonomic status of the two species has traditionally been questionable. We found that dense spots of pigments embedded in the dorsal mantle are responsible for the yellow coloration of B. pellucida . Similar spots in B. similaris are white and less densely aggregated in whorls further from the apex, and the brown color of the hepatopancreas is visible through the shell. The yellow pigments of B. pellucida seep out with mucus from the body in natural and laboratory conditions. The two species became externally indistinguishable after 30 days of laboratory feeding, because the yellow spots disappeared in B. pellucida and the color of the hepatopancreas changed from dark brown to pale brown in both species. Irradiation with ultraviolet A demonstrated that the yellow pigment of B. pellucida fluoresces. Adult specimens of the two species were distinct in penial microsculpture, with F(1) hybrids intermediate in form. Populations of the two species differed significantly in allelic frequencies at four allozyme loci. Therefore, B. pellucida and B. similaris are morphologically and genetically distinct. The fluorescent yellow pigment distinguishes B. pellucida from B. similaris under natural conditions despite its environmental dependence.