95 strains of Haemophilus influenzae (H. influenzae) isolated from blood of the patients with systemic infections were serotyped by staphylococcal coagglutination during the ten years from 1992 through 2001. As a result, 92 (96.8%) cases were caused by type b strains and 3 (3.2%) cases were caused by non-typeable strains. Three cases with systemic infection due to non-typeable H. influenzae were reported. One patient was a premature neonate with sepsis and respiratory failure who had a fulminant course and died. The other two patients were a 3-year-old girl and a 1-month-old boy both with pneumonia. About their underlying conditions, one received intravenous steroid therapy and the other suffered from respiratory syncytial virus infection. They were treated with appropriate antibiotics and their clinical courses were satisfactory and uncomplicated. Non-typeable H. influenzae was isolated from not only blood but also the lower respiratory tract in all three cases. Systemic infection due to non-typeable strain is rare. But, it should be recognized as a substantial proportion of the serious infections caused by H. influenzae.
To clarify the source and route of infection with Vero toxin-producing Escherichia coli (VTEC) in humans, we sampled gastrointestinal contents and isolated VTEC from wild birds captured to exterminate harmful birds between August 1997 and January 1998. Pigeons were caught in Sagamiharashi and crows were caught in Sagamihara-shi, Kawasaki-shi, Yokohama-shi, and the Tokyo metropolitan area. The following results were obtained. 1) VTEC was isolated from 32 of 521 birds (6.1%) examined. Among pigeons, VTEC was isolated from 25 of 262 birds (9.5%) captured in Sagamihara-shi. Among crows, VTEC was isolated from 7 of 184 birds (3.8%) captured in Sagamihara-shi, but not isolated from any bird of 11, 4, and 60 birds captured in Yokohama-shi, Kawasaki-shi, and the Tokyo metropolitan area, respectively. 2) Toxin was typed in 33 isolates. There were four VT1-producing isolates (6.5%), 27 VT2-producing isolates (88.7%), and two VT1, VT2-producing isolates (4.8%). 3) The serotypes of the isolates were: O78: H-, 10; O152: H-, 7; O153: H19, 2; O164: H-, 1; O128: H-, 1; O164/143: H-, and O1: HUT, 1. The serotype was unknown in 10 isolates. Among 10 isolates for which the serotype could not be determined, auto-aggregation was observed in one isolate. 4) EaeA was investigated in the 33 isolates, and 31 isolates (93, 9%) possessed eaeA. The above findings showed that strains with same toxin types and serotypes of human diarrheaderived VTEC were isolated from pigeons and crows, and the isolates frequently possessed eaeA, which is considered to have an important association with its pathology, suggesting that birds are involved in VTEC infection in humans as a source of infection.
It is well known that participation of two kinds of pigments, indigo blue and indigo red, are concerned with purple urine bag syndrome (PUBS). However, there is no research which describes the participation of other pigments. We separated three new kinds of red pigments, other than indigo blue and indigo red, from four patients with PUBS. One of the pigments was not visible to the naked eye and appeared only when an ultraviolet ray was irradiated. The appearance patterns of indigo blue, indigo red and the three new red pigments were in complete agreement in two cases, but differed in the other two cases. Moreover, bacteria isolated from the urine were cultured in an indican-added alkaline liquid media (pH9), 80% or more bacteria produced purple pigments. In case 1, from deep-colored pigments, each bacterium produced both indigo blue and indigo red, although new pigments could not be observed in the in vitro media.
Forty three well waters which are currently used as drinking water were studied for the presence of Helicobacter pylori. Using magnetic-beads purification and PCR amplification of H. pylorispecific gene, 4 of the 43 samples were positive for H. pylori-ureA gene (9.3%) and 1 of the 43 samples was positive for H. pylori-16SrRNA gene (2.3%). The presence of H. pylori-specific amplified product did not correlate with the type, depth and location of the wells. This study demonstrated that H. pylori can be transmitted via drinking water, especially well water in Japan.
From 1992 to 2001, we studied the prevalence of infants colonized MRSA and antibiotic usage for very-low-birth-weight infants in a neonatal intensive care unit at Asahikawa Kosei Hospital. We investigated nasopharyngeal swabs and stool samples every week after admission, and occasionally skin swabs, eye discharges and urines. Seventeen infants contracted nosocomial blood stream infection caused by MRSA which occurred between 1993 and 1996. Rate of infants colonized MRSA to all inpatients was 14.9% in 1992, which increased to 40.0% in 1994, and decreased to 7.1% in 2001. In each birth-weight group, rates of ≥1, 500g, 1, 000-1, 499g, and <1, 000g infants were 6.5%, 45.0% and 60.0% in 1992, 24.5%, 100%, and 100% in 1994, 6.2%, 10.5%, and 21.4% in 2001. The longest period of antibiotic usage was 148.4per 1000 patient-day in 1995 and decreased to 32.6per 1, 000 patient-day in 2001. The total value of antibiotics in 1995 was about \3, 050, 000, but in 2001 was about \470, 000.
Amphotericin B (AMPH) has been generally used for prophylaxis or treatment of specific fungal diseases in immunocompromised patients. However, because it is difficult for children to ingest, mainly because of its bitter taste, it is often diluted with soft drinks. We therefore investigated the effect of dilution of AMPH with various beverages on its antifungal activity in vitro. Candida albicans cells were exposed for 30min to AMPH diluted twofold with each of six commercially available beverages or distilled water, and percent survival was determined. The results showed 60% survival in the dilution with distilled water and higher survival when diluted with Yakult (136%; p<0.01), orange juice (104%; p<0.01), and coffeemilk (92%; p<0.01). By contrast, lower survival was obtained when diluted with gumsyrup (54%), sweet cider (76%), and shavedice syrup (52%) with no significant differences from distilled water (60%), suggesting that these three beverages may be useful for diluting AMPH. The results of this study are a warning to medical workers that some methods of making AMPH more palatable considerably decrease its antifungal activity and may have a negative effect on host defenses against infectious diseases.
Spread of multi-drug resistant malaria in the endemic areas has made malaria control more difficult. Thus, WHO recommends combination therapy for the treatment of malaria. The aim of combination therapy is to improve efficacy and to reduce the incidence of resistance development to the each component of the combination. Particularly, the combination with artemisinin derivatives shows good outcome in Thailand where high resistance for mefloquine has already been found. We report the first case of falciparum malaria, successfully treated with Artemether-Lumefantrine in Japan. Artemether-Lumefantrine is a newly developed artemisinin-based combination agent for the treatment of uncomplicated multi-drug resistant malaria. This drug has proved highly effective and well tolerated by some clinical trials abroad. This Japanese female case showed a good clinical course without any side effect.
A 27-year-old male visited the outpatient clinic of our hospital with the chief complaints of fever, right chest pain and shortness of breath. He was admitted to our hospital for detailed examination of the right hydrothorax. The pleural effusion obtained by thoracocentesis was exudative and negative for Mycobacterium tuberculosis. Since the titer of adenosine deaminase in the pleural effusion was abnormally high, antitubercular therapy was started under suspicion of tuberculous pleuritis. Thereafter, the patient's subjective symptoms and blood parameters improved. Necrotic tissues were obtained by pleural biopsy using the Cope needle. In order to make a definitive diagnosis, pleural biopsy was performed thoracoscopically. White tubercular lesions with a smooth surface were sparsely distributed on the pleura. Histopathologically, these lesions were characterized by central areas of caseous necrosis surrounded by epithelial cells and Langhans' giant cells. Therefore, they were considered to be granulomatous lesions. The patient was given a diagnosis of idiopathic tuberculous pleuritis, and was treated with four antitubercular drugs in combination. His clinical signs subsided, and he was discharged. This case indicates that the examination of the inside of the pleural cavity with a flexible bronchoscope, instead of thoracoscope, under local anesthesia is useful to diagnose patients having tuberculous pleuritis.