Twenty-three cases of systemic pneumococcal infection diagnosed from October 1988 to September 1998 were analyzed retrospectively in order to characterize the epidemiology of systemic pneumococcalinfections. The clinical diagnosis of those cases were 8 pneumonia, 8 meningitis, 3 septicemia, 3 septic arthritis, and 1 peritonitis. The patients ranged in age from 6 months to 21 years old (mean±SD=3 years, 6months±5 years, 2 months), and 61% of the patients were younger than 24 months. Resistance to penicillin G (PCG) was detected in 57% of all cases. Resistance to cefotaxime (CTX), imipenem (IPM), erythromycin (EM), and clindamycin (CLDM) was 33%, 9%, 70%, and 65%, respectively. Of the 13 isolates resistantto PCG, 2 were resistant to IPM, 11 to EM and 11 to CLDM. Serotyping was performed on 17 isolates.The identified serotypes were 19 (6 isolates), 6 (5 isolates), 23 (3 isolates), 14 (2 isolates), and 5 (1isolate). Eleven isolates resistant to PCG were limited to serotypes 6, 19, or 23. One patient had a recurrentepisode of bacteremic pneumonia 7 months after the first episode. Streptococcus pneumoniae isolatesfrom both episodes were compared by serotyping and pulsed-field gel electrophoresis with restriction digestion, and were confirmed as the same strain.

View full abstract

We administered amantadine to 52 children for therapy and 3 children for prophylaxis of influenza A infection from January to March 1998. Among the 23 children in the therapy group withproven influenza A/H3N2 infection, 15 patients (60%) allayed fever within 3 days but 9 (40%) hadpersistent fever for more than 4 days after administration of amantadine. Seven of these nine patients (40%) received amantadine within 2 days after the onset of fever. Two of these nine had secondarybacterial infections. One child had insomnia as side effect. We concluded that administrationof amantadine for therapy is safe and effective, if given to patients without secondary bacterial infections in the first 48 hours of the illness.

View full abstract

The ZstatFlu^® test (ZymeTx, USA) is a rapid detection kit for influenza A and B viruses. Thistest is based upon the reaction between viral neuraminidase from influenza viruses and a chromogenicsubstrate. The clinical performance of the ZstatFlu^® test was determined by comparisonwith viral isolation in cell culture. A total of 176 respiratory specimens from 172 pediatric patientswith influenza like illnesses during the 1998/99 season were tested. Influenza viruses were recoveredfrom 97 specimens (type A: 6, type B: 91) in cell culture. ZstatFlu^® demonstrated 67.4% sensitivity (29/43) and 62.7% specificity (37/59) for throat swabs. Of the 22 ZstatFlu^®-positive, culture-negativethroat swabs tested by RT-PCR, 18 were positive by RT-PCR. ZstatFlu^® showed 48.1% sensitivity (26/54) and 90.0% specificity (18/20) for nasopharyngeal aspirates. Of the two ZstatFlu^®-positive, culture-negative nasopharyngeal aspirates tested by HI titer of paired sera, one showed a 4-fold increaseof HI titer. Nasopharyngeal aspirates therefore showed lower sensitivity than throat swabs atthis test, different from EIA test kits such as Directigen FluA^® or FLU OIA^®. Overall, only 5 specimenswere false positive by the ZstatFlu^® test. Therefore, this test demonstrated high specificity andpositive predictive value. In conclusion, the ZstatFlu^® test is useful for the rapid detection of influenza A and B viruses to identify patients who need antiviral treatment.

View full abstract

To investigate the efficacy of influenza vaccine in the elderly, hemagglutination inhibition (HI) antibody titer for the three types of influenza viruses were measured and the influenza infection ratewas determined serologically in geriatric inpatients.
Influenza vaccination was done for inpatients. For patients who had influenza vaccination in theyear prior to the study, influenza vaccine was administered once or twice, and the number of injectionswere determined randomly. Influenza vaccine was injected twice to those had not received influenzavaccine in the previous year. Serum samples were collected from 166 vaccinated and 104 unvaccinatedpatients before and after 1996/1997 influenza season. In the vaccinees who had been vaccinatedthe previous year, 56 patients were injected once and 58 patient were injected twice. Fiftytwopatients had not been vaccinated the previous year.
Serologically diagnosed influenza infection rate in the 104 unvaccinated patients was 16.3% forinfluenza A/H3N2 and 8.7% for influenza B. The infection rate was 3.0% for influenza A/H3N2 and0.6% for influenza B in the 166 vaccinated patients. The infection rates were significantly lower inthe vaccinees than in the unvaccinated patients (p<0.001 with A/H3N2 and p<0.01 with B). Therewas no significant difference in the infection rate among the three vaccinated groups. These resultssuggest that the influenza vaccination had significant protective efficacy for influenza infection in theelderly. Prior vaccination did not diminish the efficacy of the influenza vaccine. The efficacy of a single influenza vaccine injection was equivalent to that of two injection.

View full abstract

We studied the high-level resistant to cefotaxime (CTX, MIC≥512μg/ml) clinical isolates of Escherichiacoli and Klebsiella pneumoniae in Teikyo University Hospital.
The CTX-resistance could be transferred to E. coli K-12χ 1037 or ML4903 strains from 30 of the33 isolates by cojugation at a frequency of 10^-4. When the hydrolysis rate of benzylpenicillin was 100%, the P-lactamases which were extracted from the transconjugants hydrolyzed CTX, CAZ and AZT at the rate of 38-95%, 0-8.6% and 0-56%, respectively. These results demonstrate thatthese enzymes should be categorized into ESBL. The nucleotid sequence of CTX-resistant gene wasidentified to that of the CTX-M2 gene which was first described in Argentina. It was found to have99.9% homology to Toho-1 gene in Japan and 99.6% homology to CMY-2 gene. Using a PCR methodsfor the detection of one of ESBL gene such as CTX-M2, Toho-1 or CMY-2, the DNA was amplifed from all strains (11 isolates of E. coli and 21 isolates of K. pneunoniae).

View full abstract

A total of 1, 223 elderly people in nursing homes in Niigata Prefecture, Japan, were immunizedwith one or two doses of commercial trivalent split vaccine formulation, against strains including A/HN, A/H3N2 and B for three seasons (1996-1999). The frequencies of adverse reactions and antibodyinduction were assessed.
Frequent side effects of vaccination were local reactions such as redness and tennerness at thesite of injection, but there were no serious reactions, suggesting that the vaccine was quite safe forthe elderly. Furthermore, antibody induction by immunization was relatively high and independentof the degree of activities of daily living (ADL). Annual repeated influenza vaccination did not diminishprotection against influenza. However, antibody induction against antigens was insufficient in the1997/1998 season, and further improvement in the combination of quantities of the four included antigensmay by required. A booster dose after the first dose did not enhance immune responses in the nursing staff, and the one dose method appeared to be indicated for the elderly.

View full abstract

Between 1992 and 1998, serotyping of 82 Chlamydia trachomatis cervical isolates were examinedby micro-IF method in Nagano Prefecture. Of these, 17 isolates (20.7%) were serovar E, 15 (18.3%) were serovar F, 14 (17.1%) were serovar D and 10 (12.2%) were serovar G, and the isolates typedthese serovars were found to be 68.3% whole. Furthermore, serovars B (7.3%) and K (9.8%) werecomparatively frequently found. From 1992 to 1994, the number of isolates of B-complex, intermediateand C-complex were 18, 17 and 6, respectively. On the other hand, from 1995 to 1998, the numberof the isolates were 19, 8 and 14, respectively. The distribution of serovars of C. trachomatis tended tofluctuate from serovars D and E to F and G as the patients grew older. Moreover, serovar E isolateswere only detected from patients less than 40 years old. Although most of the serovar I isolates weredetected from the patients with vaginal discharge, the other isolates did not clearly indicate the relationship of serovars and clinical symptoms.

View full abstract

A comparative study of 890 patients with community-acquired pneumonia requiring hospitalization in a community hospital was performed. The patients were divided into an elderly patient group and a non-elderly patient group. The elderly patients with community-acquired pneumonia exhibited frequent atypical symptoms such as dyspnea, consciousness disturbance and complication of shock, and also were frequently in a poor nutritional condition.
The causative microorganism was isolated in 40.8% of the elderly patients and in 44.0% of the non-elderly patients. Polymicrobial agents were detected frequently in the elderly patients. Streptococcus pneumoniae (19.4%), MSSA (16.8%), Klebsiella pneumoniae (15.1%) and Haemophilus influenzae (15.0%) were frequently isolated from the sputum of the elderly patients, while Mycoplasma pneumoniae (25.2%), H. influenzae (15.0%), S. pneumoniae (12.2%) and MSSA (10.2%) were frequently isolated from that of the non-elderly patients. Regarding treatment with antibiotics, therapy with a single antibiotic therapy, such as cephem or carbapenem was carried out for the elderly patients, while new quinolone or tetracycline was administered to the non-elderly patients. Although the treatment with antibiotics was adequate according to the guidelines of the American Thoracic Society, the prognosis was poor; i. e. in the elderly patients an efficacy rate of 74.3% and a mortality rate of 9.5%. In the non-elderly patients, the prognosis was good; i. e. an efficacy rate of 88.0% and a mortality rate of 1.7%.
These results suggest that the most important factors affecting the prognosis were the general condition of elderly patients and delay in an adequate diagnosis and treatment because of atypical clinical findings.

View full abstract

There have been few reports on the clinical features of infective endocarditis (IE) in Japan. We clinically investigates 45 episodes (36 cases) of definite IE that were experienced from January 1985 to March 1997 at a community hospital, Okinawa Chubu Hospital, Okinawa, Japan. Regarding age, prior dental procedure, causative organisms and sites of infection, analyses and comparison were performed on a total of 94 episodes, by adding another 49 episodes of IE that were experienced between 1977 and 1984 at our hospital.
The mean age was 47 years and majority of patients in the recent 12 years were older than 50 years of age. Mortality of all 94 episodes was 20%, while that of recent 45 cases was 13%. Eight% of all episodes had history of recent dental treatment but significance of the finding remains unclear. Alpha streptococci were most common (33%) and Staphylococcus aureus was the second most common organism (17%). Eleven % of all episodes were culture-negative and there was a statistically significant difference in the histories of prior antibiotic therapy between culture-negative and culturepositive episodes. Regarding sites of infection, 27% of all episodes involved mitral valves, while 24% involved aortic valves. Prosthetic valves were involved in 12%. Ninety-eight % of the recent episodes had fever, 98% had cardiac murmurs and 27% had characteristic mucocutaneous lesions. Heart failure was the most common complication (27%) and half of the cases with prosthetic valve infection had heart failure. Cerebral embolism was most frequently seen among the major arterial embolic complications.
Our results were similar to those which were previously reported from other countries. We should have a high index of suspicion for endocarditis whenever we see patients who present various clinical manifestations and fever of which origin remains unclear. Willigness to obtain blood culture before starting antibiotics is most important.

View full abstract

A clinical studies were carried out on gastrointestinal diseases associated with HIV infection. During the 6 years between January 1993 and December 1998, 71 HIV infected cases visited to Yokohama Municipal Citizen's hospital, and 26 of them developed gastrointestinal complications during the course of their illness. They consisted of 24 males and 2 famales, with the mean age of 44.7 years and the medial value of 42.5 years. Of the 26 patients, 21 were Japanese, and the remaining 5 were Southeast Asian. The mean CD4 count was 143/μl and the medial value was 32/μl at the time of development of complications. Gastrointestinal complications were esophageal candidiasis in 6 patients, cytomegaloviraus (CMV) gastritis and gastric Kaposi's sarcoma in 1 patient each, amebiasis in 8 patients, infectious colitis in 11 patients, and asymptomatic pathogen carriers in 3 patients. Esophageal and gastric complications were common in patients with low count of CD4, and endoscopy was useful for diagnosis. Amebiasis developed even in patients with normal CD4 and was common in males with experience in homosexual contact. It seems that homosexual contact acquire not only HIV infection but also Entamoeba histolytica through sexual contact. Protozoan and acid-fast bacteria were detected at high rate in patients with infectious colitis and asymptomatic pathogen carriers. Besides food-born infections, imported infections were seen in foreign and Japanese patients who had traveled abroad. The gastrointestinal diseases associated with HIV infections for the most part were opportunistic infections or tumors but imported, food-born, and sexually transmitted infections were also observed. It seems necessary to take into consideration of varying background of patients in the treatment of gastrointestinal diseases associated with HIV infections.

View full abstract

Mycobacterium avium-intracellulare complex (MAC), isolated from patients with MAC infection in five cities in Japan, was classified into M. avium and M. intracellulare by DNA-DNA hybridization assay (DDH). They were also classified into serovars by seroagglutination test and thin-layer chromatography (TLC) detecting serovar-specific antigens.
The ratios of M. avium: intracellulare isolated in Sendai, Maebashi, Kobe, Hamamatsu, and Kumamoto, were 100: 0, 26: 16, 37: 12, 37: 39, and 17: 54, respectively. It was high in the northern city, Sendai, whereas the ratio in the southern city, Kumamoto, was low.
The main serovars detected in Sendai and Maebashi were 8 and 4. Various serovars including a new type of M. intracellulare were detected with main serovars 16 and 7 in Kumamoto. M. intracellulare including main serovar 16, and M. avium including main serovar 4, were detected in the same ratio in Hamamatsu. M. avium including main serovars 8 and 4, was detected in cosiderable high ratio in Kobe. Geographic distribution was observed in both species of MAC and serovars.

View full abstract

To elucidate the mechanism of neutrophil dysfunction in patients with maintenance hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD), intracellular enzyme activity such as oxidative burst, elastase, cathepsin, and collagenase, was investigated. Response of enzyme activity to in vitro addition of TNF-α, which is known to have a powerful priming effect on neutrophils, was also evaluated. Peripheral blood from 15 HD and 15 CAPD patients was washed and incubated with Cell Probe^TM, an indicator for intracellular enzyme activity. Mean fluorescent intensity of neutrophils, which represents neutrophil enzyme activity, was measured by flowcytometry. In HD group, unstimulated enzyme activity was similar to that of control, but activity after addition of TNF-α was significantly lower than the control. In the group of CAPD, enzyme activity without stimulation was not different from that of control, and in TNF-α stimulated neutrophils, only elastase activity was lower than control. Many of the enzyme activities after stimulation were lower in HD than in CAPD. Response to in vitro addition of TNF-α was diminished in both dialysis groups, but more prominent in HD neutrophils. Duration of dialysis, serum concentration of β₂-microglobulin (β₂-MG) and parathyroid hormone (PTH) was significantly related inversely to intracellular enzyme activity in HD patients. To the contrary, in CAPD group, although β₂-MG and PTH showed similar negative correlation, duration of dialysis was not related to enzyme activity. These results indicate that neutrophils in patients with maintenance dialysis have diminished intracellular oxidative burst, elastase, and cathepsin activity. Especially, impaired response to TNF-α closely related to neutrophil dysfunction in dialysis patients.

View full abstract