Capsule-forming Klebsiella pneumoniae K1 caused primary liver abscess in two household members of a family. The causative isolates had identical pulsed-field gel electrophoresis patterns and were determined to be sequence type 23. An additional member of the family was found to carry the same strain without clinical manifestation.CASE REPORTS Case 1. In January 2006, a 50-year-old male without underlying significant illness was diagnosed with liver abscess and treated empirically with fosfomycin for 3 weeks without drainage of the abscess and without documentation of the causative organism. Although the abscess disappeared once on computed tomography (CT) scans, it recurred in May 2007. The patient was admitted to Tokyo Teishin Hospital and drainage of the liver abscess was performed. Culture of the blood and aspirated pus yielded hypermucoviscous Klebsiella pneumoniae as the sole organism. The BacT/Alert 3D system (Sysmex bioMérieux, Tokyo, Japan) was used for the blood culture, and identification of the bacterial species was performed with the MicroScan WalkAway 40 SI system (Siemens Healthcare Diagnostics, Tokyo, Japan). Treatment with intravenous panipenem-betamipron, a carbapenem antibiotic available in Japan, for 4 weeks and subsequent treatment with oral ciprofloxacin for 4 weeks was successful. He had no history of travel around Asia except for Korea, which he had visited in 2000.Case 2. In December 2009, the son of the patient in case 1, a 21-year-old previously healthy male, presented to Tokyo Teishin Hospital with a fever of 40°C and abdominal pain. He was hypotensive upon presentation, and the white blood cell count was 14,000/l (reference range, 3,900 to 9,800), with 76% segmented cells and 13% bands. The values of serum aspartate aminotransferase, alanine aminotransferase, and creatinine were 94 U/liter (10 to 40), 138 U/liter (5 to 40), and 1.9 mg/dl (0.61 to 1.04), respectively. CT scans of the abdomen demonstrated a mass lesion measuring 7 cm in diameter and located in the right lobe of the liver. Serology results were negative for Entamoeba histolytica. After blood cultures were obtained and needle aspiration of the suspected liver abscess was carried out, empirical antibiotic therapy with imipenemcilastatin was started. Blood and aspirated pus culture revealed hypermucoviscous K. pneumoniae as the sole organism. The antibiotic treatment was changed to pazufloxacin, a fluoroquinolone with a spectrum of activity similar to that of ciprofloxacin, and metronidazole for the coverage of anaerobic bacteria that may have been possibly involved in the infection. The patient soon became afebrile and clinically stable, and results of laboratory tests returned to normal. The antibiotics were administered intravenously for 3 weeks, and therapy with oral levofloxacin was continued for another 3 weeks. The symptoms resolved completely, and the follow-up CT scans showed no signs of recurrence of liver abscess. He had no complaints of visual disturbance or neurological symptoms during the course of the illness...

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Placebo effect has become a tool during our clinical practice, but ultimately is an important tool that is used for research purposes. If the definition of placebo effect is when an inert substance or intervention can modify positively an illness or a discomfort, it result important to determine the factors related that can cause this result. This is a result of multifactorial situations, mainly psychological and neurobiological mechanisms that can demonstrate the analgesia-placebo complexity of the mind-body interaction. It is important to denote that the term placebo is not limited to the use of inert substances. A placebo does not cure, but it provides symptomatic relief. All aspects can be interrelated and the knowledge of each factor will be discussed during this review.The profound knowledge of the characteristics of the placebo effects, as well as their underlying psychological factors, physiological mechanisms, and the methodological biases involved in reaching a clinical response will contribute to a better understanding of the use of placebos in medical practice and in the clinical investigation.