We had a case of lung tuberculosis in an 80 year-old woman, who was diagnosed 3 months after admission to a health service facility for the elderly requiring long-term care. Here we report how we coped with the situation.　　The diagnosis was made by the use of a gene-amplification method. Predonine 7.5 mg/day was prescribed for interstitial pneumonia. TB infection prevention program included a QFT test and chest radiography, and medical interviews was carried out 42 users and 17 staffers of the facility. The program was examined for two years. It was managed by a regional Public Health Center, however, we were involved in many matters offering medical and social information of the subjects to the Center and often notifying the subjects and their family of the schedules and information. Many of the user subjects had been discharged from the facility when the investigation was over, so it was difficult to communicate with them. The QFT test was regarded important and the QFT test positive persons were treated as latent TB infection cases.

　　Mushrooms that had been handpicked were butter-roasted and eaten by six neighborhood residents. All 6 individuals subsequently developed nausea within 60 min to 90 min after the meal. They requested an ambulance and were brought to our emergency department. The ambulance service staff mentioned the possibility that the ingested mushrooms were Lampteromyces japonicus. After admittance, symptomatic conservative treatment relieved the symptoms and all 6 individuals were discharged the next day. However, one patient was rehospitalized due to complaints of abdominal pain and anorexia and another patient was rehospitalized with complaints of vomiting and bloody stool 2 days after initial discharge. In the latter patient, abdominal computed tomography revealed marked wall thickening of the duodenum and jejunum. Typically, the symptoms caused by Lampteromyces japonicus are vomiting, diarrhea, and abdominal pain within 30 min to 3 h after ingestion, but intestinal edema may occur after a few days in severe cases.

Cases of Japanese spotted fever (JSF) have been reported mainly in the warm southwest region of Japan. A woman in her 40s developed a fever after being bitten by a tick attached to her pet dog in Hyogo Prefecture (west Japan). She then traveled to a vacation home in Yamanashi Prefecture (central Japan). Though she sought medical care in both prefectures, her symptoms did not improve, so she was admitted to our hospital, which is located in Nagano Prefecture near her vacation house. She had high fever and eruptions and had developed acute disseminated intravascular coagulation. From an interview, we suspected tick-borne disease and administered doxycycline and levofloxacin. She subsequently recovered. Nine months after discharge, a serological test performed at the National Institute of Infectious Diseases in Tokyo confirmed a diagnosis of JSF. JSF is a rare disease in Nagano Prefecture, with only 3 cases reported from 1999 to June 2020. As shown by this case, we should consider JSF in the differential diagnosis of patients with acute high fever and eruptions regardless of geographic region, because unlimited travel across Japan is now common.

Edwardsiella tarda causes enterocolitis, which does not need to be treated in many cases. However, in immunocompromised hosts, the disease becomes severe resulting in soft tissue abscess. In such cases, removal of the lesion is required at an early stage. An 83-year-old woman presented to the emergency department with a chief complaint of fever, which was initially treatment as complex urinary tract infection. Further evaluation revealed she had E. tarda sepsis and that the bacteria was highly likely to originate from an abscess of the uterine adnexa. Because we thought a complex surgery was necessary, we transferred her to a regional core hospital. However, she recovered with only administration of antibacterial agents at that hospital.Then, 1 year and 4 months later, she was admitted to our hospital again. We made a diagnosis of disease recurrence. She did not improve with antibacterial therapy this time, so she was transferred to the other regional core hospital and underwent surgery. Histological examination revealed an appendiceal carcinoma in the abscess lesion. This case suggests that when E. tarda bacteremia is diagnosed, its focus and the root cause should be investigated.

Hospital A has 12 dedicated beds for patients with intractable neurological diseases, which are chronic conditions that increase dependence on medical care as they progress. Disease progression also varies by disease and by patient. Patients and their family become more anxious about discharge when they think about how much the patient’s condition has changed since admission. Caregivers must acquire specialized skills due to the patient’s increased dependence on medical care and the increased number of care tasks, and it takes time to master those skills. Discharge is associated with many financial, physical, and mental stressors, and in some cases discharge coordination is difficult and the timing for discharge is missed. We sought to investigate how to provide more efficient discharge support and conducted a case study of 3 patients with intractable neurological diseases. Here we discuss our findings and our creation of a discharge support manual that clarifies when to start discharge coordination, necessary preparations, and topics for counseling patients and caregivers.