The costs of outpatients with influenza.
Outbreak of influenza occurs every winter in Japan and it brings a huge impacts on society and the individual.
We calculated the costs of medications and medical examinations for outpatients with influenza in hospital.
After we confirmed the diagnosis of influenza by rapid diagnosis system (Directigen Flu A) or hemagglutinin inhibition test, neutralization test, comparison of costs was done between influenza patients (89 cases) and non influenza patients (212 cases).
Mean cost of total medication and medical examinations were 14, 800±980yen for an influenza patient and 12, 420±976yen for a non influenza patient.
This data showed that treatment of the influenza patient is more expensive than non influenza patient. It must be considered that prophylaxis with influenza vaccine and treatment with antiinfluenza drugs given in the early stage of influenza are useful for reducing medical costs.

View full abstract

We described the clinial and bactriological features of 12 cases of liver abscess caused by Streptococcus milleri group (SMG) during a 6-year period from 1993 to 1998. The gender was 11 males and 1 female with their ages ranging from 39 to 76 years old (mean: 53.4). The common symptoms were fever (100%), abdominal pain (67%), and appetite loss (58%). Nine cases had underlying diseases such as carcinomas and diabetes mellitus. Predominant causes of the liver abscess were cryptogenic (42%) and biliary tract disease (33%). Three patients died of an exacerbation of the carcinoma. Eight cases (67%) was single infection of SMG and no mixed infection with anaerobes. No strains isolated in this series showed resistance against penicillin G and ampicillin. SMG was highly isolated from the blood culture in eight of the 11 cases (73%). Liver abscess should be taken into consideration as one of the causes of SMG septicemia.

View full abstract

The similarities between clinical features of erythema infectiosum and collagen disease or other viral infections prompted us to investigate clinical manifestations and laboratory data of parvovirus B19 (B19) infection in adults. We diagnosed all five patients as acute B19 infection by antibody assays. The age of patients ranged from 18 to 39 years old (mean 29), and all patients were female. All five patients showed high fever, arthralgia and edema of the extremities. Four of the five patients showed skin rash of the extremities or cheeks. Two patients were diagnosed as erythema infectiosum by family physicians before coming to us. The three remaining patients were suspected to be systemic lupus erythematosus, adult Still disease or rubella indivisually and referred to our hopsital.
A-27-old female (case 5) visited our hospital because of polyarthralgia and butterfly rash on her face. A test for antinuclear antibodies (ANA) was positive at a dilution of 1: 320. Rheumatoid factor (RF) was also detected by latex fixation test. Her AST was 51IU/L, ALT 68IU/L and LDH 568 IU/L. Her symptoms persisted for 3 weeks and hepatic dysfunction recovered within 3 weeks. Five months later, ANA was negative at the dilution of less than 1: 40. We suggest that the similarities between some symptoms of B19 infection and clinical and serological manifestation of collagen diseases merit closer attention.

View full abstract

Methicillin resistant Staphylococcus aureus (MRSA) is one of the most important strains which induce hospital and post-operative infection.
In cases of infective endocarditis in which VCM was not efficacious, MRSA strains were chronologically isolated at three different times and examined with the following parameters: minimum inhibitory concentration (MIC), fractional inhibitory concentration (FTC) index, Mu 3 agar, population analysis, pulse field gel electropholesis (PFGE).
The PFGE banding patterns of the three MRSA isolates were the same, therefore, it was concluded that the same strain of MRSA was selected for reduced susceptibility. A pattern of Mu 3 and Mu 50 was demonstrated under population analysis.

View full abstract

In Japan, an isolated vaccine of measles is used because MMR vaccines have been suspended due to the frequent occurrence of aseptic meningitis after their use. It is administered only once with the cover rate having been approximately 70%. An outbreak of measles was experienced in eight of our health care workers (three doctors, three nurses and two clerks of our hospital) and in seven of our medical students, accompanying local outbreaks. Their condition was severe enough to require admission to our school hospital. One of medical students developed encephalitis, but he has recovered completely. The social cost including medical cost per worker was approximately \500, 000 (about $4, 500). We measured antibodies against measles, rubella, chickenpox and mumps using the ELISA assay in 1048 health care workers less than 40 years of age and 99 medical students before their clinical practice two or three months after the outbreak. The cost includingthe measuring of antibodies and vaccination for these workers and students was approximately \2, 800, 000 and it will be \700, 000 for new workers each year. The negative rates for workers were 1.2% for measles, 8.8% for rubella, 10.0% for mumps and 2.0% for chickenpox and those for the medical students were 1.0%, 22.0%, 9.0% and 5.0%, respectively. Of the workers, 9.6% who had more than the defined very high titer were thought to have subclinical reinfection because they were non-symptomatic. The rates were 1.2% for rubella, 0.5% for chickenpox and 0.0% for mumps for more than the defined high titers among the workers, suggesting a risk of outbreaks in the future. Therefore, the antibodies of health care workers and medical students should be measured at the hospital and the antibody-negative person should be vaccinated to prevent infection not only from their patients but also prevent other patients from becoming infected by contracted health care workers or students.

View full abstract

The total number of foodborne outbreaks due to Vibrio parahaemolyticus in Tokyo during the last 12 years between 1989 and 2000 were 710. The number of outbreaks in a year was 55 in 1989, 75 in 1990, and there was a gradual decrease to 24 outbreaks in 1993 which was the smallest number during those 12 years. After 1994, the number of outbreaks increased dramatically year by year until 1998 (107 outbreaks). Then they had decreased slightly to 74 in 1999, 65 in 2000. The monthly incidence of V. parahaemolyticus foodborne outbreaks showed a peak in August (44.2%) each year . In the last 12 years, 88.7% of V. parahaemolyticus foodborne outbreaks occurred during the 3 months between July and September, while 99.9% occurred between June and October. The most prevalent serotype of V. parahaemolyticus also changed, the most prevalent was O4: K4 in 1989, O4: K8 in both 1990 and 1991, O1: K56 in 1992, and O4: K8 from 1993 through 1995. Serotype O3: K6 became the most prevalent in 1996 and has remained so to date.
In addition, the new serotype O4: K68 had also appeared in 1998.
The number of outbreaks due to serotype O4: K68 followed that of O3: K6.
Thus, the trends of V. parahaemolyticus foodborne outbreaks during the last 12 years in Tokyo showed various characteristics and dramatic changes in causal organisms.

View full abstract

Coxsackievirus A16 (CA16) has been isolated mainly from hand, foot and mouth disease patients for the past several years in Saitama Prefecture, Japan, but in 2000, enterovirus 71 (EV71) was isolated with high frequency. Also, many cases with aseptic meningitis were reported unusually. We determined partial nucleotide sequences of EV71 isolated in this year and compared them with those of the viruses isolated previously.
Eighteen strains of EV71 were isolated from May to September in 2000. The sequence analysis of about 700 nucleotides between 5' NCR and VP2 region indicated that the EV71 strains isolated in Saitama Pref. in 2000 were classified into three groups. The first group was consisted of the strains which showed 89 to 91% nucleotide similarity with TW/2086/98, NCKU 9822 isolated in Taiwan and strain SA/448/99 isolated in Saitama Pref. in 1999. The second group was highly similar to both Taiwan strains and SA/448/99 (92 to 93% nucleotide similarity). The first and second groups were also considered to be subgroups belonging to the same group. And the third group was highly similar to 18/Sin/97, 13/Sin/98 isolated in Singapore. These viruses were genetically close to MS7423/87, which has shown neurovirulence. Furthermore, from geographical origin of specimens, we found that the Taiwan like strains were isolated in the west area (Kawagoe, Tokorozawa) and Singapore like strains were isolated in the south area (Urawa, Kawaguchi, Toda). Also, almost every EV71 strains isolated from the patient with aseptic meningitis were close to Singapore strains. It was found that EV71 strains isolated in 2000 were different from the strains isolated past in Saitama Pref. and some of them were close to the neurovirulent strain.

View full abstract

“HITAZYME C. pneumoniae” is a diagnostic reagent that has been recently developed by adopting an ELISA method for detection of anti-Chlamydia pneumoniae (C. pneumoniae) antibodies. A case presenting bilateral interstitial opacities and severe respiratory failure with high titers of “HITAZYME C. pneumoniae” was described. Sputum, blood, serological, and bronchoalveolar lavage examinations failed to reveal other etiology to explain his severe respiratory illness. Clinicians should be aware that C.pneumoniae may cause severe respiratory failure or ARDS. Further studies are needed to evaluate the role of C. pneumoniae infection in the development of severe pneumonia or ARDS.

View full abstract

A previously healthy 25-year-old female was admitted to our hospital in November, 1997, for treatment of a spike-fever of 2 weeks' duration. She had a cat in her house but reported no history of cat bites or scratches. No peripheral lymphadenopathy was detected. White blood cell count was within normal limits, but an increased C-reactive protein level of 11.4mg/dl was noted. Infectious disease was suspected but ruled out as blood cultures were negative. Empiric therapy with clarithromycin, isoniazid, and rifampicin was ineffective. In January, 1998, abdominal ultrasonogram revealed multiple hypoechoic mass lesions in the spleen and liver, and a splenectomy was performed in March. Histopathlogic examination showed numerous necrotizing and caseating granulomas, which tested positive for Bartonella henselae DNA by PCR. Furthermore, the patient tested positive for B. henselae antibody by immunofluorescence assay. A diagnosis of systemic cat-scratch disease with hepatospnenic involvement was made. Combination therapy with minocycline, sulbactam/cefoperazone, and tosufloxacin was administered and her inflammatory findings improved gradually. We report an adult case of systemic cat-scratch disease with liver and spleen involvement in the nonimmunocompromised host.

View full abstract

Pleural effusions seldom accompany nontuberculous mycobacterial infections. We resorted one such case of M. avium lung infection with pleural effusion. A 40-year old male was admitted to our hospital complaining of right chest pain and general fatigue. His chest X-ray showed a consolidation in the right lower lung field. The day after admission, a right pleural effusion appeared. The fluid was exudative and microbiological examinations of the effusions, including staining and culturing, proved negative. However, one month afteradmission, acid fast bacilli were observed in his sputum and a subsequent sputum culture specimen revealed the presence of M. avium. Treatment with antimycobacterial agents was promptly commenced and the patient's effusion and lung consolidation was gradually resolved.

View full abstract