We evaluated the effectiveness of the newly developed WAKOTM β-glucan test which measures plasma (1-3)-β-D-glucan concentrations in the diagnosis of Candida deep mycosis. This test was compared to the Cand-Tec test. The WAKOTM β-glucan test and Cand-Tec test were performed on 212 plasma specimens which were taken at 212 instances from 62 immunocompromised patients with serious diseases; i.e. hematopoietic malignancy, solid malignant tumor, etc. The sensitivities and specificities for the WAKOTM β-glucan test were 84.8 and 85.9%, respectively, and 60.9 and 80.0% for the Cand-Tec test.
Antagonistic interaction between Clostridium butyricum strain MIYAIRI 588 and enterohemorrhagic Esherichia coli (EHEC) strain O157: H7 006 was examined using streptomycin-treated SPF mice and germ free mice. All SPF mice pretreated with streptomycin were colonized with EHEC O157: H7. On the other hand, only 20% of the SPF mice pretreated with streptomycin and C. butyricum were colonized with EHEC O157: H7. In addition, germ free mice died within 4-7 days after infection with EHEC O157: H7. In contrast, all gnotobiotic mice mono-associated with C. butyricum survived after the challenge with EHEC O157: H7. Both the number of EHEC and the amounts of shiga-like cytotoxin (SLT, type 1 and type 2) in fecal contents of gnotobiotic mice treated with C. butyricum were less than those of mice infected with only EHEC O157: H7. In conclusion, the probiotic bacterium, C. butyricum strain MIYAIRI 588, has a preventive effect against EHEC O157: H7 infection.
It is well known that the change of state from the culturable to not culturable on pathogenic organisms could easily occurred. These states of bacteria were so called viable but nonculturable (VNC). The coccoid form of H. pylori is seems to be in this state. The possibility of resuscitation of H. pylori was examined in vitro. The coccoid form bacteria was treated with Ammonium Sulfate and heat shock before culture, and cultured in Brucella broth containing, sodium pyruvate, laked human erythrocyte and serum. The growth of the rod spiral form was found in the coccoid form bacteria, and further the bacteria could grow on blood agar and Skirrow agar as well as the original strain. It was strongly suggested that the resuscitation from VNC state of cells to culturable form consists of two processes, stimulation and supplemented of appropriate nutrition.
Shiga toxin-producing Escherichia coil (STEC) O157 were isolated from processed salmon roe which had been a suspected food item in sporadic infections which occurred in Japan in 1998. A total of 45 samples of the processed salmon roe were pre-enriched in trypticase soy broth (TSB) at 36°C for 6 h and novobiocin-supplemented modified EC broth (mEC-NB) at 42°C for 18 h. After the preenrichments, the cultures were examined for possible occurrence of STEC O157, using an immunomagnetic separation (IMS) method. From the examination, a total of 84 strains of STEC O157: H7 that were positive for both stx 1 and stx 2 genes were isolated. By applying the most-probablenumber technique, it was estimated that the number of STEC O157 was in the range of 0.73-1.5 per 10 g of the processed salmon roe. Subsequent analysis of the isolates by a pulsed-field gel electrophoresis (PFGE) revealed a pattern commonly seen in 82 isolates and another pattern in two isolates. Clinical isolates from 7 patients also showed an identical pattern to those of the 82 isolates and one isolate from a patient showed the other pattern identical to those of the two isolates. The isolates were found to belong to the phage type 14.
We investigated selective cultivation media and previous treatments of samples suitable for detection of Legionella species from environmental water and for elimination of co-existing microbes which gave rise to an interference with the evaluation of Legionella sp. growth. Twenty thousand U of polymyxin B (PL-B) /ml and 100μg of oxytetracycline(OTC)/ml seem to be useful as additives to MWY selective agar medium. Both antibiotics markedly inhibited the growth of co-existing microbes with almost no influence on the growth of Legionella sp. In the studies on the resistance of 8 strains of Legionella sp., 24 strains of co-existing microbes and 2 standard strains of Staphylococcus aureus and Escherichia coli to acid treatment(0.2 M HCl-KCl, pH 2.2, 25°C, 4 minutes)and heating(50°C, 20minutes), acid treatment or heating alone showed no inhibition on the growth of almost all strains examined. However, combination with acid treatment after heating resulted in an apparent extinction of almost all microbes except for Legionella sp., Seven strains from co-existing microbes showed an apparent growth inhibition against 8 strains of Legionella sp. with different serotypes and were all identified as Pseudomonas aeruginosa, which were all eliminated by means of the combination with acid treatment after heating. From these results, it was concluded that the combined pretreatment of water samples with acid after heating and the addition of PL-B and OTC into the selective cultivation medium is an useful method for detection of Legionella sp. from environmental water.
Human rotavirus (HRV) serotypes were studied from diarrheal stool specimens in children in 7 regions of Japan (Sapporo, Tokyo, Maizuru, Osaka, Kagawa, Kurume, and Saga) from 1984 to 1997 by enzyme immunoassay (EIA) with serotype-specific monoclonal antibodies against serotypes 1, 2, 3 and 4. In addition, reverse transcription-polymerase chain reaction (RT-PCR) was conducted for analysis of“others” which included nonserotypable and mixed-serotype rotavirus specimens by EIA. In 3756 rotavirus-positive specimens, serotype 1 was detected in 2649 (70.5%), serotype 2 in 362 (9.6%), serotype 3 in 232 (6.2%) and serotype 4 in 196 (5.2%). Overall, serotype 1 was predominant from 1984 to 1997, although there were a few cases in which serotype 2, 3 and 4 became predominant based on area and year. The frequency of serotype 1 has gradually increased since 1993. Twenty two, 2, 3 and 1 among 57 specimens of“others” by EIA from Tokyo, Maizuru, Sapporo and Kurume in 1995-1996 and 1996-1997 were determined as serotypes 1, 2, 3 and 9 by RT-PCR, respectively.
The efficacy and safety of Panipenem/Betamipron(PAPM/BP)on elderly patients of respiratory infections was examined at 17 hospitals in a cooperative study. Among the 95 case, we examined the efficacy of the medication in 86 cases, and the safety in all 95 cases. Efficacy was confirmed in 81.3% of pneumonia patients, 57.7% of secondary-infection patients of chronic respiratory diseases, and 74.4 % of the total. No significant difference was observed among each group according to age, comparing patients ≥65 years old grouped by 5 years, or when broadly comparing groups <>75 years and ≥75 years of age. The microbiological efficacy was 100% for Streptococcus pneumoniae, 80% for Staphylococcus aureus, 80% in Klebsiella pneumoniae; therefore, a very good disappearance rate of symptoms could be obtained in all major respiratory etiologic agents except Pseudomonas aeruginosa. In this study, we also examined other factors considered to affect the course of treatment for elderly patients of infectious diseases, namely the presence or absence of underlying diseases, the distinctness of infectious symptoms, the patient's condition before the appearance of infectious symptoms, and previous history of treatment with antimicrobial agents. For safety, the incidence rate of side effects was 14.7%, which was similar to the 16.9% in the developmental study. These two findings were also similar in content. No significant difference was observed among each age group, comparing patients ≥65 years old grouped by 5 years, or comparing groups >75 years and ≥75 years of age. From the above evaluation, we consider PAPM/BP to be an effective drug for normal adult patients as well as elderly patients of respiratory infections.
To investigate the isolation frequency of O-serotype of Escherichia coil, a total of 1, 563 faecal specimens obtained from patients with sporadic diarrhea in Ishikawa between July 1997 and June 1998, were examined. As a result of O-serotyping of isolated strains using commercially E.coli antisera (43 different types), 247 strains of 29 different O-serotypes were isolated. Isolation rate was 15. %. Most predominant O-serotype was 01 (128 strains, 52%), followed by O18 (26 strains, 11%), 06 (17 strains, 7%), 0111 (16 strains, 6%), and these 4 different O-serotypes took up three quarters of the isolatedE. coli. Between August 1996 and May 1997, E. coli isolation from faecal samples of 51, 893 healthy persons and O-serotyping of isolated strains using commercial antisera to 6 predominant O-serotypes (O-26, 111, 114, 128, 157 and 01) of VTEC/EHEC were carried out. Among 6 O-serotypes, the most predominant O-serotype was O1 (93% of isolates), followed by O26, 111, 128 (6%) and 0114, 157 (1 %). These isolation frequencies in patients were 80%, 18%, 2%, respectively, have resembled each other in healthy persons in many points. In a similar way, of these distributions of O-serotype of strains hemolysed on Beutin's blood agar plates, we compared patients with healthy persons. Fifty-six strains (3.6% of the total) of E. coli of different O-serotypes were isolated from 1, 563 patients and 57 strains (2.8% of the total) belonging to 11 serotypes from 2, 036 healthy persons. As a result of O-serotype frequency, both groups resembled each other. 018 and 06, the most predominant O-serotypes, occupied 64% of the isolated strains in patients and 74% in healthy persons. Next in patients, 01, 26 were 7% -level, 028 ac, 152, 157 were 4 % -level, respectively, and in healthy persons, 01 was 5% -level, 028 ac, 55, 146, 152 were 4% -level respectively. In the comparison of O-serotype frequency of E. coli isolated from sporadic diarrhea in other 5 areas (Kanto district, Tokyo, Oita, Aichi and Ishikawa), 01, 6, 8, 18, 25, 26, 55, 86a, 111, 125, 126, 127a, 128, 146, 148, 157 and 166 (17 types) have covered a wide area. On the other hand, 029, 44, 78, 112ac, 115, 136, 143, 152, 168 and 169 (10 types) have a tendency to distribute in local areas, we believe that there are regional differences even in the same Japanese territory.
The criteria proposed by Petersdorf has been in use internationally to define the fever of unknown origin (FUO) since 1961 and the research of FUO has progressed with this criteria. Meanwhile, new diagnostic methods have been developed and illness behavior of febrile patients has changed considerablly. Accordingly, the definition by Petersdorf is becoming less matched to current clinical situation. Therefore, we have developed a new practical criteria of FUO; i. e., out-patients who are febrile more than 2 weeks, documented temperature higher than 37.5°C at least on one occasion and undetermined diagnosis and in-patients who are febrile more than 1 week with documented temperature higher than 37.5°C, and undetermined diagnosis. Between October 1, 1993, and October 31, 1996, we prospectively collected a series of febrile patients who fulfilled our new criteria. We identified 56 patients by our criteria (23 male and 33 female, age: 49.7±20.6, range 15 to 88). Of this 56 patients, 19 (32%) were found to have infections, 18 (31%) had collagen disorders, 5 (9%) had malignancy and 6 (10%) had died. Of 56 patients, 38 (68%) were in the newly added group. Of these 38 patients, 4 patients had subacute necrotizing lymphoadenitis, 4 cytomegalovirus infection, 3 polymyalgia rheumatica, 3 tuberculosis. Four patients (10%) died. With our criteria, febrile patients who previously had not been included were found to have as poor a prognosis as with the Petersdorf group.
We prospectively investigated the etiology of community-acquired pneumonia among adult patients admitted to three general hospitals over one year. Antibody titers toChlamydia pneumoniaewerealso measured by ELISA method to investigate the incidence and clinical pictures of C. pneumoniaepneumonia in Japan. Two hundred and fourteen patients were enrolled in the study. Seventeen patients (7.9%) satisfied the criteria for diagnosis of acute infection due to C. pneumoniaeby ELISA method. C. pneumoniaewas the 3 rd leading causative agent followingStreptococcus pneumoniae(21.5%) andHaemophilus influenzae(8.4%). Preexisting antibodies were detected in 62.1% of the patients. Most of the patients with C. pneumoniae pneumonia were aged, and had comorbidities of respiratory system. Superinfection with bacterial pneumonia was recognized in some patients. Though there are several problems, ELISA method is thought to be useful to diagnose C.pneumoniaepneumonia, and is suitable for screening tests.
A 38-year-old Japanese male who had traveled in China from September 13 to October 5, 1997, developed fever and severe conjunctivitis from October 20. After he was hospitalized in Kyoto CityHospital for persistent high fever on October 29, he developed muscular weakness and dysphagiawhich continued for two weeks. An electromyogram showed a myogenic pattern, and laboratoryfindings showed significant elevation of serum enzyme levels of muscle origin: CPK, 3, 095 IU/l; aldorase, 195 IU/l; myoglobin, 7, 570 ng/ml, and myoglobinuria, 94, 700 ng/ml. The WBC was 10, 800/111with 45% eosinophils. Muscular biopsy showed degeneration of muscle fibers with infiltration ofmacrophages and lymphocytes. On further inquiry, it was revealed that the patient had eaten smoked bear meat in China onSeptember 30, three weeks prior to the onset of symptoms. A dot-ELISA serologic test for parasiteswas positive forTrichinella. Further, a coiled 1.2 mm longTrichinellalarve was recovered from approximately100 mg of frozen biopsied muscle by an enzyme digestion method. Mebendazole wasgiven to the patient at a dosage of 200 mg/day for seven days. CPK levels were normalized within 3days of the beginning of the treatment, and he was discharged without any symptoms. Physiciansmust be aware of trichinellosis and should include it in their differential diagnosis when examiningpatients with myositis and eosinophilia of unknown origin.
A 8-year old Japanese boy who returned from Tanzania was admitted to our hospital because of fever, vomiting, and headache. He was diagnosed as a Plasmodium falciparum infection verified by a blood smear. He was treated with quinine and halofantrine, and recovered completely. Malaria infection should be considered when patients return from Malaria endemic areas.
We report a 67-year-old male with Waldenstrom's macroglobulinemia who developedCumpylobucter fetussubspesisfetus (C. fetus) bactereoziaod thrombophlebitis. The patient developed a fever and pain in his left lower limb, and could not walk because of the pain. Radioisotopic venography showed thrombophlebitis his left lower limb. His blood culture grew C. fetus. After starting intravenous PAPM/BP, his symptoms resolved promptly. In contrast toCampylobacter jejuniwhich is a common cause of infectious diarrhea, C. fetus. infectiob has disdoct clinical features shbonwing systemic illess such as bacteremia and tbrnmbopblebids mainly occurring in immunocompromized patients. This organism should be considered as one of the possible pathogenes in the infectious complications of the immunocompromized patient.