We evaluated a total of 1104 pediatirc patients with acute lower respiratory tract infection forC.pneumoniaeinfection andM. pneumoniaeinfection by serology during July 1995 to December 1998. A microimmunofluorescence test was used for diagnosis of C. pneumoniae infection and a high density particle agglutination test for that ofM. pneumoniaeinfection. AcuteC. pneumoniaeinfection was found in 149 patients (13.5%), acute M. pneumoniae infection in 118 patients (10.7%), and dual infection in 27 patients (2.4%). Among 305 patients with pneumonia, M. pneumoniae infection (83 patients, 27.2%) was more common than C. pneumoniae infection (47 patients, 15.4%). However among 799 patients with bronchitis, C. pneumoniaeinfection (102 patients, 12.8%) was more common thanM. pneumoniaeinfection (35 patients, 4.4%). Patients with C. pneumoniae infection were more younger and more frequently wheezing than patients with M. pneumoniae infection. These findings demonstrate thatC. pneumoniaeinfection in very common pathogen of pediatric lower respiratory tract infection asM. pneumoniaeinfection in Japan.
We analyzed the anti-HIV antibody titer by particle agglutination (PA) on 11 HIV seroconversion panels. PA titer increased very rapidly and the titer went up to 1, 000 or more within 182 days after seroconversion. The results suggest that one to two weeks of duration will be enough to differentiate persons at the early stage of HIV infection from individuals with HIV screening test initially reactive but false positive. In Japan, HIV prevalence is very low and the majority of the HIV screening test-positive (reactive) cases turned out to be false positive. This HIV testing strategy (one to two weeks interval bleeding) will be very practical and useful to differentiate early stage of HIV infection cases from the majority of false positive cases.
The resistance against oral antibiotics to Streptococcus pneumoniae (S. pneumoniae) isolated from adult patients with respiratory tract infections in the Kurume area in 1998 was studied. The frequency of resistant strains, which were isolated penicillin-intermediate S. pneumoniae and resistant S. pneumoniae (PISP, PRSP) were both 41.2%. We examined the minimal inhibitory concentrations (MIC) of oral antibiotics and the susceptibility ratio of the strains for the drugs based on the breakpoint MIC. The breakpoint MIC of pneumonia against oral β-lactam antibiotics to PISP, PRSP, which were determined by Japan Society of Chemotherapy, were high in the order of FRPM>CDTR, CFPN>CFTM>CFDN, CPDX. In the case of the new oral quinolones, DU6859a>SPFX>LVFX> CPFX showed good results, in this order. DU6859a showed the most significant inhibitory effect to PISP, PRSP (MIC90 0.06μg/ml). By serotyping the percentage of 19, 6, 23 was 42.9%, 21.4% and 14.3%.
Orientia tsutsugamushi was isolated from one of 8 patients' sera in Aichi Prefecture, and was identified to have the same antigenicity with the KN-2 strain (KN-2 like) based on the reactivity with 13 types of strain-specific or cross-reactive monoclonal antibodies to Karp, Gilliam, and Kato strains. Four isolates from 4 unfed larvae and adult of Leptotrombidium pallidum were also classified as the KN-3 like strains. Using indirect immunofluorescence, sera from 20 patients with tsutsugamushi disease were tested for reactivity with KN-1, KN-2, KN-3, and GJ-1 strains, isolated from patients in Gifu Prefecture. Fifteen sera showed the highest titer against KN-2 strain in Immunogloburin M (IgM). Of the other 5, three were higher for KN-3 strain in IgM, and two were KN-1 or GH, respectively. These results suggested that KN-2 like strains were prevalent in the region where the number of patients has been ranked the highest in Aichi Prefecture. KN-1, KN-3, and GJ-1 like strains were also existed in this area. KN-3 like strain was likely to be distributed in another area, Aichi Prefecture.
An optical immunoassay test, FLU OIA® (BIOSTAR, USA), was evaluated for the diagnosis of influenza viral infection. The reactivity of the FLU OIA test was evaluated using 42 influenza strains (25 human influenza A, 12 human influenza B, 2 swine influenza A and 3 avian influenza A strains). The FLU OIA test showed positive results for all influenza strains. There was no evidence that cross-reactivity occurred with non-influenza viruses. The detection limit of the FLU OIA test was found to be 3.0-6.5×104 pfu/assay for human influenza A and B strains. The sensitivity and specificity of the FLU OIA test compared to isolation in cell culture was 89.7% and 76.0% for testing of 54 nasopharyngeal aspirate specimens. The FLU OIA test is rapid and easy for the detection of influenza A and B viral antigen and provide a valuable tool for the rapid diagnosis of influenza viral infection.
The usefulness of glucocorticosteroid therapy in patients with sepsis has been controversial. We investigated the effect of steroid pulse therapy on the vital prognosis of pediatric patients with sepsis and followed the vital status up to one month after the use of pulse therapy. We reviewed the medical records of 89 pediatric cancer patients with sepsis treated at our hospital between 1988 and 1996. The risks of potential predictors were estimated by calculating crude and adjusted relative risk (RR). The total cumulative death was 33/89 (25%). All patients treated with steroid pulse therapy died (12/12). Patients with either interstitial pneumonia (IP), infection-associated hemophagocytic syndrome (IAHS) and graft-versus-host disease (GVHD) showed a significantly higher cumulative death (57% (12/21) vs 31% (21/68), p=0.03). Increased risk of cumulative death was suggested for the older age group, innapropriate antimicrobial therapy, and the conditions requiring steroid pulse therapy (IP, IAHS, and GVHD), (crude RR were 1.6, 1.6, and 1.9, respectively). However, when adjusted for pulse therapy, these three factors no longer indicated risk elevation.(adjusted RR=1.2, 1.2, and 0.3, respectively). On the other hand, steroid pulse therapy per se was independently associated with increased risk of culumative death (crude RR=3.6, adjusted RR=10). Thus, the risk of the conditions requiring steroid pulse therapy (IP, IAHS, and GVHD) firstly observed could be regarded as an apparent association due to steroid pulse therapy.
A total of 780 Salmonella serovar Hadar (S. Hadar) strains consisting of 601 domestic strains and 179 imported strains isolated in Tokyo, 1980-1998, were examined regarding their incidence and drug-resistance. Domestic strains accounted for 7.2% of all Salmonella (8, 359 strains) isolated from domestic cases, and imported strains accounted for 4.4% of all Salmonella (4, 083 strains) isolated from imported cases. A drug-resistance test using 9 drugs (CP, TC, SM, KM, ABPC, ST, NA, FOR, and NFLX) showed that 586 strains (97.6%) of the domestic strains and 175 strains (97.8%) of the imported strains were resistant to some of the drugs, excluding NFLX. Drugs with a high resistance rate were TC and SM for both groups. Drug-resistance patterns of the resistant strains varied among the 24 types. Among those, prevalent patterns recognized were TC·SM·KM (231 strains), TC·SM (205 strains), and TC·SM·KM·ABPC (65 strains) in the domestic strains, and TC·SM (135 strains) and TC (13 strains) in the imported strains.
Since April 1995 increased number of type 7 were isolated in Japan and also in Kawasaki city. From May 1996 to March 1999, Adenovirus type 7 (Ad7) were isolated from 49 patients with high body temperature, and longer febrile period were observed in infants and younger children. Lower respiratory tract infection occured and a young child developed fatal pneumonia. Ad7 were isolated not only in summer but in winter. They were prevalent all season. We analyzed 27 strains of Ad7 genetically using restriction enzyme and compared the results with epidemiological and clinical data. Consequently we can not found any differance in genetic pattern between these Ad7 regardless of age or symptom. The pattern was all the same as Ad7d that of already issued in Japan.
Based upon the phenomenon that the peptidoglycan, a common component of Gram positive and negative bacteria, reacts specifically with silkworm larvae plasma (SLP), a new laboratory method named “SLP test” was developed to measure the reaction products in plasma quantitatively as SLP. This SLP test seems to be able to diagnose both Gram positive and negative bacterial infection. So we evaluated its usefulness in diagnosing clinical infectious diseases. This study included 14 patients with result to positive bacterial blood culture, 22 patients with bacterial local infection, 7 patients without any evidence of bacterial infection, and 19 healthy volunteers. It seemed that the cut-off value of this SLP test should be set at 0.6 neml. The sensitivity and specificity of this SLP test were 57.1%, 100%, respectively. A significant difference was not detected statistically between SLP values of patients with Gram positive and Gram negative bacterial infectious diseases. So the SLP test did not appeared specific to either Gram positive or Gram negative bacteria. This test may become a new method diagnosing bacterial infectious disease.
Fungal infection is a major opportunistic infection in AIDS. Histoplasmosis is often seen in American AIDS, but only one case has been reported in Japan. We report a AIDS case of with histoplasmosis in Japan. The patient was a forty year old male living in the U. S from 1987 to 1990. He was diagnosed as candidial esophagitis in July, 1994, and human immunodeficiency virus type 1 (HIV) antibody positive led to a diagnosis of AIDS. He was admitted to our hospital with fever and lymphadenopathy (neck, abdomen) in August. The therapy for candidial esophagitis was successful and he was recovering, but he was newly diagnosed as atypical mycobacteriosis and Kaposi's sarcoma. Though the fever was slight, it persisted. He was discharged from our hospital in October. He was readmitted for a high fever and dehydration in December, but died after a week from disseminated intravascular coagulation (DIC). Histoplasma capsulatum was found by blood and ascites cultures on second admission. Many yeast like histoplasma cells in granuloma of tha liver were found at autopsy. For moderate or severe histoplasmosis, amphotericin B is genellaly used as the first induction therapy. Fluconazole (FLCZ) is used as a maintenance therapy. We did not use amphotericin B, but used FLCZ because we did not diagnose histoplasmosis before death, and his general condition became worse. The effect of FLCZ therapy was unclear in our case because he had other infections. We expect that AIDS with histoplasimosis will increase in Japan through HIV infected patients infected in the U. S. A.
Recently, several class-related adverse events have been recognized with antiretroviral drugs. For nucleoside analogue reverse transcriptase inhibitors (NRTI), lactic acidosis with hepatomegaly and hepatic steatosis have been reported. These appear to occur at a low ferquency, but with a high fatality rate. We report a case of fatal lactic acidosis in a patient with acquired immunodeficiency syndrome (AIDS) treated with stavudine (d4T), lamivudine (3TC) and indinavir (IDV). A 48-year-old male AIDS patient was admitted with complaints of general fatigue and dyspnea. His medications at presentation included d4T, 3TC and IDV. Physical examination demonstrated icteric sclerae and abdominal tenderness with hepatomegaly. Laboratory data demonstrated a severe metabolic acidosis with an anion gap due to lactate accumulation. Despite intensive treatment, caradiorespiratory arrest accurred and this could not be resuscitated.