As globalization progresses, over 10% of Japanese citizens now travel abroad. With this, there are many cases in which people catch a variety of infectious and contageous diseases abroad. In addition, new infectious diseases also have been emerging in the world. Therefore, protection of travelers' health and prevention of the import of infectious diseases are of ever increasing importance. From this point of view, at the Narita Airport Quarantine Station, a Health Information Corner for travelers going abroad was established in 1992, along with Health Consultation Rooms for arriving passengers. In order to overcome imported infectious diseases, the promotion of domestic and international cooperation among the health and medical organizations concerned is required for primary prevention, and early detection or treatment of the diseases.
In the past 8 years, we have experienced 58 cases of tuberculosis at Tsukuba University Hospital. Retrospective analysis of these patients was made to clarify the circumstances of tuberculosis in hospitals where no special isolated ward for tuberculosis patients is prepared. The half were above 60 years old and a fourth were under 40 years old. Approximately two thirds of the patients had underlying diseases and malignancy was the most common. Most of the patients complained of cough, sputum, and/or fever. Thirty-one patients were diagnosed as pulmonary tuberculosis, 18 were extra-pulmonary, and 9 were complicated with both. Extrapulmonary cases or patients who had underlying diseases showed unusual symptoms, and early diagnosis was difficult in several cases. Mycobacterium tuberculosis was detected in over 80% of the patients, and polymerase chain reaction procedure seemed to be useful for definite and rapid diagnosis of tuberculosis. There are no special isolated wards for tuberculosis patients in our hospital, but some patients could not be transferred because of their severe condition or complicated diseases. To prevent nosocomial infections of tuberculosis including occupational infection in the medical staff, early diagnosis, management of high risk staff, isolation rooms for patients who have potential risk of causative sauce of infection are needed.
Bronchopulmonary infection affects the prognosis of lung cancer patients. Thus, we investigated the relationship between the prognosis of bronchopulmonary infectious diseases and their causative bacteria isolated by transtracheal aspiration (TTA) in lung cancer patients. In the present study, we determined which factor is more predisposing for the outcome of bronchopulmonary infections, the type of causative bacteria or the host nutritional status. A total of 107 lung cancer patients, which consisted of 105 males and 5 females (mean age 67.3±8.0), were included in this study. The study was conducted from 1981 to 1994. They were classified into the survival group and the deceased group. Causative agents of infection were compared between these 2 groups. S. p n eum o n iae, α-Streptococcus sp., M. catarrhalis, and Neisseria sp. were predominant in organisms isolated from TTA-specimens of lung cancer patients with bronchopulmonary infections, regardless of prognosis. Nutritional status, as determined by serum levels of cholinesterase, albumin, and cholesterol, was poor in the deceased group than in the survival group. These results indicate that the outcome of bronchopulmonary infections in lung cancer patients are affected mainly by the nutritional status of the host.
In vitro examination was carried out to investigate the effects of protein A of Staphylococcus aureus (S. aureus) on the production of fibronectin (Fn) and the third component of complement (C3) by macrophages and that of CD11b, CD49e and H2O2 by granulocytes. Fn production of cultured murine peritoneal macrophages (Mφ) increased significantly (P <0.01) by treatment for 4 hr at 37°C with recombinant PA (rPA) and the supernatant of overnight culture of S. aureus Cowan I strain (CoCS) (p<0.01), not that of Wood 46 strain (WoCS), in comparison with that of control. The activity of rPA was inhibited strongly in the presence of CYH (1.0μg/ml). The production of C3 by cultured Mφ did not increased by treatment for 4 hr at 37°C with rPA, CoCS and WoCS. In these cells treated with CoCS and WoCS, however, the production increased by cultivation in serum free medium for a further 20 hr at 37°C after the treatment. But increase was not found in rPA treated cells. On the other hand, the production of Mac-1, VLA-5 and H202 by granulocytes did not increase by treatment with rPA and CoCS. These results show that rPA and PA in CoCS are major components which stimulates Fn synthesis and secretion by cultured Mφ, some component (s) contained in the supernatant of overnight culture of S. aureus increased the production C3 by cultured Mφ, and the supernatant may not contain stimulators to induce production of CD49e, CD11b and H2O2. Increase of Fn production of Mφ by PA stimulation may play an important role in the primary host defense against S. aureus infection.
Three sporadic cases of enterohemorrhagic Escherichia coli (EHEC) O157 infection which occurred in Kanagawa in 1996 were investigated. In an attempt to determine sources of the infection, a novel method of immunomagnetic separation (IMS) was employed to isolate the bacterium from feces, foods, and other associated items. In the first case, strains of EHEC O157: H7 producing Vero toxin (VT) 2 were isolated from both feces of the patient and suspected food (cattle liver) kept at a restaurant, and the strains were found to be genotypically identical through an analysis of pulsed-field gel electrophoresis (PFGE). Subsequent investigation in the meat processing store, from which the above cattle liver had been retailed to the restaurants revealed that the store was contaminated with EHEC O157: H7 producing both VT1 and VT2. In the second case, a strain isolated from the patient was EHEC O157: H7 producing both VT1 and VT2 while strains isolated from the patient's family (without apparent symptom) and the suspected facility were O157: NM producing VT2. PFGE analysis indicated that the latter two strains were genotypically identical, suggesting that the facility thus contaminated with EHEC O157 caused the infection in question. In the third case, EHEC O157: NM producing VT2 was isolated from 4 out of 7 family members including the patient, and these strains were found to be genotypically identical by subsequent PFGE analysis. Source of the infection was, however, not determined due to lack of suspected food item In this context, four slaughterhouses in Kanagawa Prefecture were investigated for presence of EHEC O157. As a result, strains of EHEC O157: H7 producing VT1 and VT2 were isolated from the contents of cattle's distal colon and surface of the skinned carcasses. Additional attempt was also made to determine a possibility of river water being contaminated with EHEC O157. The bacterium was, however, not isolated from water samples collected from 4 major rivers in the prefecture (at 10 collecting sites). Experiments were undertaken in order to evaluate the use of IMS in isolation of EHEC O157 from food items, with different pre-enrichment media and conditions. The results indicated that pre-enrichment by trypticase soy broth at 36°C for 6h followed by inoculating onto sorbitol MacConkey agar plate containing cefixime and tellurite was most appropriate to isolate EHEC O157 strains.
Three adult patients with chronic active Epstein-Barr virus infeciton (CAEBV) had high anti-EBV-VCA antibody, positive anti-EA, low anti-EBNA and were associated with systemic lymphadenopathies and immunosuppression. The case 1 and 2 had elevated serum immunoglobulin levels, and recurrent infections, and case 3 showed pancytopenia. These 3 cases developed both EBV and latent membrane protein (LMP) positive malignant histiocytosis, EBV positive but LMP negative plasmacytoma, and EBV negative acute myelogeneous leukemia, respectively. It was suggested that CAEBV belonged to high risk groups for the development of malignant neoplasms. Since HLA of the case 1 and his father was identical, we conducted a in vitro cytotoxicity test using EBV transformed autologous B lymphocytes, K562 cells, and Raji cells to clarify the association of immunosuppression and HLA. The case 1 showed a low level of specific cytotoxicity to autologous EBV transformed B cells, while his parents were negative for the specific cytotoxicity. The patient and his parents developed inducible cytotoxicity to all targets after in vitro incubation of peripehral mononuclear cells with recombinant interleukin 2 (rIL-2) for 7 days. The patient and his mother showed lower enhancement of cytotoxicity, while HLA identical father could induce good cytotoxic activity to all targets as well as normal controls, indicating that a low IL-2 induced cytotoxic activity observed in CAEBV was independent of HLA associated immunoregulation at least in the case 1. Further studies are required to clarify the exact mechanisms responsible for the development of CAEBV.
We evaluated eight cases of pulmonary mycosis in immuno compromised hosts. The underlying diseases were lung cancer with chemotherapy in one case, post bone marrow transplantation (post BMT) in two cases, acquired immunodeficiency syndrome (AIDS) in one case and bronchial asthma with massive steroid therapy in four cases. The causative fungi were Candida sp. in three cases, Aspergillus sp. in four cases, Tricosporon sp. in one case. Prognosis was guarded despite antifungal treatment. Five cases deteriorated and died of fungal infection. In five cases, who died of deterioration, 31.6 days was required from appearance of abnormal infiltration in the chest X-ray to determination of the causative fungi (including two cases who were diagnosed by autopsy) on the average. In three successfully treated cases, the average duration from the appearance of abnormal infiltration in the chest X-ray for the determination of the causative fungi was 8.3 days. On the contrary, the average duration between the appearance of abnormal infiltration in the chest X-ray and the initiation of antifungal treatment was 2. 6 days who died of deterioration and 8.3 days who survived. We conclude that early identification of causative fungi and not quick institution of antifungal treatment was mandatory in the treatment of opportunistic fungal pneumonia.
The status quo of infectious diseases associated with hematological malignancies was examined for clinical consideration. In addition, in vitro antibacterial activities and combination effects were also examined by means of various isolated strains derived from sepsis. In clinical practice, 76% of the fevers in patients with hematological malignancies was attributed to infectious diseases mainly involving “fever with granulocytopenia ”, sepsis, and pneumonia. The detection rate of causal pathogen remained at a low level and more than half of the causes of death were infectious diseases. In the in vitro examination, a favorable antibacterial effect was noted with vancomycin (VCM) for methicillin resistant Staphylococcus aureus (MRSA) and Enterococcus spp., imipenem (IPM) for methicillin sensitive S. aureus (MSSA), and ciprofloxacin, amikacin (AMK), and IPM for Pseudornonas aeruginosa and intestinal flora. But its clinical effect is not enough. Synergic and/or additive effect can be expected by combining IPM with VCM for MRSA and Enterococcus spp., and IPM with AMK for P. aeruginosa. These combination therapie were considered to be optimal as antibacterial chemotherapy for infectious diseases associated with hematological malignancies.
A 71-year-old male visited our hospital because of diarrheaA 71-year-old male visited our hospital because of diarrhea. At first we suspected infectious colitis and levofloxacin (300 mg/day) was administered for four days. But the diarrhea continued, so performed a barium enema after about 3 weeks from onset. Round polyposis from the rectum to the sigmoid colon were found. Colonoscopy was suggested to the patient, but was rejected. However diarrhea continued and fever appeared. Ceftriaxone (1 g/day) and sparfloxacin (200 mg/day) were administered, but the symptoms increased. He was admitted about 6 weeks from onset, and the colonoscopy showed multiple round yellow-white pseudomembranes. Pseudomembranous enterocolitis diagnosed because Clostridium difficile and its toxin were positive in the feces. After oral administration of vancomycin (1.5 g/day) was started, the symptoms alleviated rapidly and disappearance of pseudomembrane was confirmed by colonoscopy.