To understand the presence or absence of bacterial infection in patients with systemic inflammatory response syndrome (SIRS), the level of procalcitonin (PCT), a precursor of calcitonin, was determined. Subjects consisted of14SIRS patients without complication by bacterial infection, 14SIRS patients complicated by sepsis, and14SIRS patients complicated by severe sepsis and septic shock. PCT levels in SIRS patients with sepsis (2.9±2.3ng/ml) were significantly higher than those in SIRS patients without complication by infection (0.7±1.1neml). However, there wrer no significant differences in the levels of C-reactive protein (CRP), interleukin6 (I-6) or tumor necrosis factor-α (TNF-α) between the two groups. PCT levels in SIRS patients with severe sepsis and septic shock (172.2±276.3ng/ml) were significantly higher than those in SIRS patients with sepsis. Levels of CRP, IL-6 and TNF-α were also significantly higher in the patients with sepsis compared to those in patients with local infection. Significant correlations were observed between the levels of PCT and those of CRP, IL-6and TNF-α in SIRS patients. It was suggsted that to measure the levels of procalcitonin in patients with SIRS is useful to diagnose the infection and severity of illness.
We investigated a new p24 antigen detection system by the chemiluminescence-enzymeimmuno-assay (CLEIA) and compared it with the conventional antigen-kits (A; Abbott, B; Coulter). The detection limit of CLEIA, A, and B were4.3pg/ml, 11.3pg/ml, and5.6pg/ml, respectively. When the patient's sera and panel sera were examined by the three method, compatible results with the detection limit were obtained. CLEIA can be completed within35min, and is performed by an automatic system, which can treat many samples at one time. Therefore, this system is more suitable for screening of donor blood because of the shortening of the window period.
Enterohemorrhagic Escherichia coli (EHEC) is an emerged bacterial agent as the cause of bloody diarrhea and a leading cause of hemolytic uremic syndrome in children. In our country, serotype O 157: H7is the predominant pathogen in the EHEC and the most frequently seen in human infections. The clinical disease is not associated with the STx types produced by the infecting strains. Non-O157serotypes of EHEC also produce STxs, and infections with some non-O157EHEC are occasionally associated with the illness caused by O157: H7. A rapid and simple enzyme immunoassay method (EIA) for the detection of STxs was established. This method is based on the use of anti-STxl or anti-STx2monoclonal antibody-labelled colloidal gold for detective factor and also used each anti-STx antibody for the capture antibody. The supernatant was used as the test sample after centrifugation of bacterial suspension treated with polymixin B (5, 000u/ml). These EIA-tests were specific for all supernatants of EHEC serotypes used, giving positive reactions (more than1: 16-32) by the RPLA method, and permitted the detection of ca. 203-812pg of STxl or STx2in a130μl applied to this test. This method will be an extremely useful tool for the detection of STxs from isolates or bacteria on selective agar-plates.
Epidemiological characteristics and virulence factors of VTEC O121: H19strains isolated in July 1997from a 15 year old female and a 20 year old male patient suffering from bloody diarrhea and severe abdominal pain were examined. The 2 VTEC O121: H19 isolates showed identical antibioticsusceptibility patterns, biochemical characteristics and plasmid profile while slight differences were observed in their Xba I and Not I PFGE patterns, suggesting that closely related 2 VTEC O121: H19 strains evoked the sporadic infectious cases in July 1997. The 2 VTEC O121: H19isolates, as well as VTEC O157: H7, possessed eaeA gene and a ca. 60 MDa plasmid which hybridised with CVD 419probe and produced enterohemolysin. In addition, the VTEC O121: H19 isolates produced almost the same amount of VT-2 in vitro as VTEC O157: H7 did. These results suggested that VTEC O121: H19possesed the virulence factor comparable to that of VTEC O157: H7. Incidence, molecular epidemiology and infectious source of VTEC O121: H19in this country have not been sufficiently understood. Antiserum for E. coli serogroup O121should be manufactured to clarify the epidemiology of the highly virulent VTEC strain.
Plasmid analysis and pulsed-field gel electrophoresis (PFGE) were used to study the epidemiologic relationship among methicillin-resistant Staphylococcus aureus (MRSA) strains isolated at Tokyo Medical and Dental University Hospital. We found that 263 of 276 MRSA isolates had plasmids, which could be classified into30different patterns according to the number and plasmid molecular weight. Strains which harboured a single plasmid of approximately 13.4 Mds in molecular weight were the most numerous (55.7 % of the isolates). These strains were isolated from 14 of 17 hospital wards. The largest number of strains with this plasmid pattern (33 strains) were isolated from a single ward. PFGE typing was then performed to further confirm the relationships among these 33 strains. The PFGE banding patterns of these strains were highly similar. The antibiogram profiles of these strains werealso correlated with the PFGE pattern. Thus, the results suggest that these strains are epidemiologically related and spread throughout the ward. Combined plasmid analysis and PFGE were effective for discriminating the various MRSA isolates.
The purpose of this study was to determine the prevalence of infection due to human papillomavirus (HPV) types of high and intermediate oncogenic risk, which was mostfrequently associated with uterine cervical neoplasia. The subjects were 236 prostitutes who visited a sexually transmitted diseases (STD) clinic in a metropolitan area in 1998. Another 95 women who visited a university hospital were selected as a normal control group. A swab sample collected from the uterine cervix and external os was subjected to hybrid capture assays for low-oncogenic-risk HPV types (HPVA; including types 6, 11, 42, 43 and 44) and high-and intermediate-oncogenic-risk HPV types (HPVB; including16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68), Chlamydia trachomatis and Neisseriagonorrhoeae. Fisher's exact test was used for statistical analyses. Among the microorganisms tested, the positive rate for HPV B was the highest both in the women attending the STD clinic (STD group) and in the control group. The positive rate for HPV B in the STD group was47.5% (112 of 236), and this was significantly higher than the5.3% (5 of 95) in the control group (p<0.0001). These findings suggest that HPVexamination is recommended for women who visit an STD clinic to assess the future risk of cervicalneoplasia.
The phagocytic bactericidal activity of the polymononucler neutrophils (PMNs) that were collected from healthy volunteer with and without antibody against Bordetella pertussis was investigated. Furthermore, these activity against B. pertussis under observing penicillins or macrolides antibiotics was investigated. Although no efficacy to B. pertussis strain by the PMNs in serum without antibody, but the viable cells of B. pertussis decreased to 1/1, 000 1hr after incubation and was not detected after 4hrs. In particular, the viable cells of B. pertussis by the PMNs in serum with antibody was markedly reduced when azithromycin was present. These results suggests that the synergistic action of macrolide antibiotics and antibodymediated phagocytic bactericidal activity on B. pertussis may have clinical relevance.
A 38-year woman was hospitalized because of myoma uteri. She underwent myomectomy on September30, 1997with2, 000ml blood loss. No blood transfusion was required, but she recieved a plasma protein product. On the14th postoperative day, a complete blood count revealed anemia (Hb 9.3g/dl) and leukocytopenia (1, 600/μl) But it did not reveal anemia before the operation. Bone marrow smears showed erythroblastopenia with giant proerythroblasts. Anti-parvovirus B19IgM antibody were positive in the serum and parvovirus B19DNA was detected in the bone marrow cells by polymerase chain reaction. From the results, the patient was diagnosed as the anemia and leukocytopenia secondary to parvovirus B19infection. Parvovirus B19was not detected in the samples of the plasma protein product recieved on the myomectomy. The reticulocyte gradually decreased to1%0 on the20th postoperative day. The anemia and leukocytopenia gradually improved. This case shows that parvovirus B19infection could cause hematological disorders in the normal person under acute blood loss. This report warns that a careful observation is necessary for the patients who have received operations with acute blood loss.
Three girls with systemic cat scratch disease, aged 10, 13 and 9 years, were reported. They presented a prolonged fever and back pain in the early stage of the disease, and had no regional lymphadenopathy. Two of them had hepatosplenic granulomas, one with multiple 5mm hypoechoic lesions in the liver and spleen, and the other with a single 2.5cm hypodense lesion in the left hepatic lobe. The latter patient underwent a partial left hepatic lobectomy. All patients had elevated titers of antibodies to Bartonella henselae.Polymerase chain reaction detected B. henselae DNA in tissue specimens of the patient who underwent a hepatic lobectomy. Cat scratch disease should be recognized as a cause of fever of unknown origin because the prevalence of B henselae infection might be higher in Japan.