We assessed the sensitivity and specificity of the Capilia Flu AB rapid diagnosis kit for influenza that utilizes the immunochromatography method. Tested were 114 influenza like illness patients in the 2001/2002 influenza season. We used Capilia Flu AB and Influ A·B Quick, a rapid diagnosis kit based on enzyme immunoassay. As laboratory confirmation tests, influenza virus isolation and polymerase chain reaction (PCR) were done. Those patients with positive results from virus isolation or PCR were regarded as influenza patients. The sensitivities of nasal swab, pharyngeal swab, and nasal wash specimens were 82.8%, 80.0%, and 75.0%, respectively. The specificities of nasal swab, pharyngeal swab, and nasal wash specimens were 95.3%, 93.9%, and 100%, respectively. A total of 20 patients displayed different results in comparison of their nasal and pharyngeal swabs: 15 patients were positive with the nasal swab but negative with the pharyngeal swab and 5 patients were negative with the nasal swab but positive with the pharyngeal swab. Nasal swab would seem to be preferable in terms of sensitivity. The sensitivity and specificity of Capilia Flu AB were a little higher than those of Influ A·B Quick, but with no significant difference. The one-step operation of Capilia Flu AB is easier than the four steps required by Influ A·B Quick, but the time required to make a diagnosis is the same. No significant age related difference in the effectiveness of the kits was found. The Capilia Flu AB rapid diagnosis kit is useful in clinical practice because it has good sensitivity (about 80%) and specificity (about 90%), and it is easy to use.
Percentage of the outbreaks by O3: K6 Vibrio parahaemolyticus (V. p) in Aichi Prefecture Japan increased from 3% (3/86) for 1988-95 to 75% (33/44) for 1996-2001. The percentage of the sporadic diarrhea cases caused by O3: K6 V. p in a general hospital in Aichi Prefecture also increased from 0% (0/253) to 61% (135/221) during the same periods. Thermostable direct hemolysin (TDH)-positive O3: K6 were isolated from 95% (19/20) of the outbreak incidents and 100% (135/135) of the sporadic cases. Only one TRH (TDH-related hemolysin)-positive O3: K6 was isolated from one outbreak incident. Percentage of the outbreaks by O3: K6 V.p associated with the consumption of boiled shellfishes increased from 5% (6/117) for 1988-95 to 25% (15/59) for 1996-2001, in particular, boiled crabs and squillas associated outbreaks increased from 2% (2/117) to 17% (10/59) and from 2% (2/117) to 10% (6/59), respectively. From 1, 548 raw sea foods sampled in the Nagoya Central Wholesale Market in Aichi Prefecture in 1995-99, one TDH-positive O3: K6 was isolated from one live squilla (1/30). Increase in the percentage of outbreaks associated with TDH-positive O3: K6 V. p after 1996 in Aichi Prefecture was revealed to correlate with the increase in the outbreaks associated with consumption of boiled sea foods, especially boiled crabs as well as squillas. Accordingly, it becomes clear that sanitary handling of these boiled foods is important to prevent outbreaks and sporadic cases of diarrhea caused by O3: K6 V. p infection.
To clarify the bacteriological interpretation of nasopharyngeal flora from infants and children with influenza (n=38), nasopharyngeal swabs were obtained. From 38 patients, 83 strains of bacterias were obtained. Chief pathogenic bacteria isolated from infants and children with influenza were B. catarrhalis (28 strains), S. pneumoniae (22 strains), H. influenzae (19 strains), S. aureus (6 strains) and chief nonpathogenic bacteria isolated from infants and children with influenza were Corynebacterium spp. and α-streptococcus (3 strains each) and Moraxella sp (2 strains). From infants and children without influenza (n=34), 83 strains were obtained. The chief pathogenic bacteria isolated from infants and children without influenza were B. catarrhalis (23 strains), H. influenzae (22 strains), S. pneumoniae (18 strains), S. aureus (7 strains) and chief nonpathogenic bacteria isolated from infants and children without influenza were Corynebacterium spp. and Moraxella sp (5 strains each), α-streptococcus (2 strains) and Neisseria sp (1 strain). There was no significant difference in nasopharyngeal flora between infants and children with influenza and infants and children without influenza. In cases showing detection of multiple bacterial strains, common combinations were one or more of B. catarrhalis, S. pneumoniae, H. influenzae, S. aureus and nonpathogenic or weakly pathogenic bacteria. There was also no significant difference in combinations of nasopharyngeal flora between infants and children with influenza and those without influenza. We emphasize that we must study whether a difference in nasopharyngeal flora between infants and children with influenza and infants and children without influenza develops with time. Therefore, we must repeatedly obtain nasopharyngeal swabs from infants and children with influenza and infants and children without influenza.
As a part of basic studies to elucidate the source of infection of Verotoxin-producing Escherichia coli (VTEC) infectious disease, fresh feces were collected from pigs raised in Kanto District (A and B Prefectures) and Kyushu District (C and D Prefectures) between April and October in 2000, and isolation, serotyping, toxin typing, and drug sensitivity test of VTEC were performed. 1) Of 411 fecal samples tested, VTEC was isolated from 44 samples (10.7%), consisting of 12 of 112 samples (10.7%) from A Prefecture, nine of 100 samples (9.0%) from B Prefecture, 18 of 99 samples (18.2%) from C Prefecture, and five of 100 samples (5.0%) from D Prefecture. 2) Forty-five isolates were serotyped. Four isolates (8.9%) were typed as type 3, but the remaining 41 isolates (91.1%) could not be typed. The four typed isolates consisted of two O112ac: Hisolates and one each of O126: H-and O157: H7. 3) Toxin was typed in 45 isolates. Twenty-seven (60.0%) and 17 isolates (37.8%) produced VT 2 and VT1, respectively, and one isolate (2.2%) produced both VT1 and VT2. 4) Drug sensitivity tests of 45 isolates were performed. All 45 isolates (100%) were multidrugresistant that were resistant to multiple drugs. Nineteen, nine, four, four, seven, one, and one isolates were resistant to five, six, two, three, four, eight, and nine drugs, respectively. The above findings confirmed contamination in all districts, although the VTEC isolation rate varied among the sampling districts. Serotyping clarified the presence of O157: H7 and O112ac: H-that are detected in human VTEC infectious disease. The drug sensitivity tests clarified the presence of many multidrug-resistant strains.
We have been analyzing cases suspected as outbreak of Mycobacterium tuberculosis in Tokyo using RFLP method. This time we analyzed 27 strains of MTB from 5 cases in two hospitals, a family, member of social activity and stuff of a corporation using both RFLP and AP-PCR methods. At 4 cases, over 80% of strains were same pattern in each cases with RFLP and AP-PCR and were identified as a patient to patients transmission of MTB. At one case, in a hospital, each strains were completely different patterns at both methods, which showed it was not a outbreak case. Results of RFLP and AP-PCR were completely same, which indicates AP-PCR is also useful and rapid method for epidemiological analysis of MTB infection as well as RFLP.
We examined the relationship between clinical isolates from inpatients, mainly methicillin resistance Staphylococcus aureus (MRSA), and usage of parenteral antibiotics in Yamagata University Hospital and comparison of the relationship of the previous decade and the present. The first period was from 1988 to 1990 in a row, and the second period was from 1998 to 2000 in a row. In the first period, third generation cephems were used much and usage of antibiotics was shifted from latamoxef to flomoxef. Isolations of MRSA were decreased. In the second period, the third generation cephems decreased, cefazolin and the forth generation cephems increased. And also decrease in usage of penicillins was observed. Isolations of MRSA were increased. For further examination of these relation, we studied by statistical analysis the number of MRSA patients and usage of antibiotics per month in the second period. MRSA patients showed positive correlation with cephems and carbapenems, negative correlation with penicillins. In major antibiotics MRSA patients showed positive correlation with cefazolin, negative correlation with piperacillin. In multiple linear regression analysis, MRSA patients calculated multiple regression model including cefazolin. In conclusion, it was suggested that cefazolin related with MRSA. It has been estimated that cefazolin were administered before the appearance of MRSA. It is a possibility that cefazolin related with the appearance or fixation of MRSA.
Methicillin-resistant Staphylococcus aureus (MRSA) strains were isolated from the inpatients in orthopaedics ward hospitalized from March 1998 to November 2000, hospital environments, medical workers and the inpatients transferred from TCC (Trauma and Critical Care Center). Genotype by pulsed field gel electrophoresis (PFGE) and biotype according to the production of coagulase, enterotoxin and toxic-shock syndrome toxin-1 (TSST-1) were determined for the MRSA strains to analyze the infection source and transmission route of the infection. Out of 673 S. aureus strains isolated from the inpatients, 390 strains (57.5%) were MRSA. In 89 medical workers in orthopaedics ward, MRSA were isolated in 23 (25.8%) and 7 (7.9%) workers from nasal cavity and hand, finger, respectively. In contrast, no MRSA was isolated from hospital environments. Eighty MRSA strains (80%) from the inpatients and 8 MRSA strains (75%) from the medical workers were shown to have same biotype; coagulase II-enterotoxin C-TSST-1 (+) (II-C-(+)). MRSA strains isolated from the inpatients were grouped into 24 types according to PFGE patterns, and types 17 (17 strains), 12 (13 strains), 1 (8 strains), 4 (8 strains) and 13 (6 strains) were dominant among the MRSA strains isolated. It was shown that MRSA strains with the same PFGE genotype were detected at the same time in the different wards. In addition, MRSA strains isolated from medical workers were all PFGE genotypes 1 and 4. MRSA strain isolated from a new inpatient had a different PFGE type from the 24 kinds of genotype. These results suggest that the involvement of the medical workers might be important as infectionsource and for transmission of MRSA in hospital.
Viral gastroenteritis is caused mainly by NV (Norovirus). Rotavirus, Astrovirus and Adenovirus are the major cause of gastroenteritis in humans although there are rare cases. From the end of June to the begining of July 2002, we had an endemic of community gastroenteritis by Adenovurus. In our investigation, the patients were separated into 3 groups. On comparison of the viruses from each groups we abserved that they had the same caracteristics. In conclusion, we found that the infection was caused by person to person contact and not by food.