A multi-center open study using the internet was performed during the influenza season of 2001-2002 to evaluate the effectiveness of the anti-influenza agent, oseltamivir, on influenza in relation to: (1) age of patients; (2) type of influenza virus; and (3) timing of initial administration after the onset of the first symptoms of influenza. The study comprised of 779 cases of influenza confirmed by rapid detection tests from 44 clinics in Japan. Patients consisted of 4 age groups, 0-6, 7-15, 16-64 and 65-85 years. All patients were administered oseltamivir within 24 hours, at 25-48 or after 48 hours from the onset of the first symptoms of influenza. Data collected from each age group were the highest body temperature and duration of fever (≥37.5°C). The percentage of afebrile patients was calculated at 24, 48 and 72 hours after the initial administration; data were also evaluated by the type of influenza virus A and B. The highest body temperature was higher with statistical significance as patients' age decreased. The duration of febrile period (days) was significantly longer in 0-6 years (2.57±0.95) than in 65-85 years (2.18±0.93). Evaluation of the percentage of afebrile patients revealed: the percentage at 24 hours was significantly lower in 0-6 years (28.4%) than in 16-64 years (44.0%); the percentage at 48 and 72 hours showed similar results in each age group; the percentage at 48 and 72 hours was significantly higher when administered initially within 24 hours than over 48 hours after the onset of the first symptoms of influenza; the percentage at 24 and 48 hours was significantly higher when administered within 24 hours than at 25-48 hours; and the type of influenza virus did not affect the percentage. In conclusion, effectiveness of oseltamivir seemed to be affected to an extent by the patients' age and little by the type of influenza virus. Oseltamivir was more effective when administered as early as possible after the onset of the symptoms of influenza.
A total of 1, 505 household dogs were investigated for the prevalence of Strongyloides spp. infection by fecal examination in relation to their fecal conditions, rearing environments, origins, age, sex and breed. Strongyloides spp. infection was demonstrated in 29 of 1, 505 (1.93%) dogs. Strongyloides stercoralis was detected in 28 dogs, and Strongyloides planiceps was detected in one dog. The rate of Strongyloides spp. infection was higher in dogs reared indoors, originated from pet shops/breeding kennels and aged 1-6 months. The infected rate was higher in dogs excreting soft feces. No significant sex-related difference was observed in Strongyloides spp. infection. The rate was high in Pomeranians and low in mongrels. The detection of S. stercolaris in dogs reared indoors will involve a serious problem in public health, because the parasite has zoonoitic potential. It suggests that a positive sanitary instruction against a dog's owner and a worker in pet shops/breeding kennels seems necessary for prevention of transmission from dogs to humans. Furthermore, the reliable treatment for dogs infected with S. stercoralis seems to be important.
Saquinavir (SQV) is a human immunodeficiency virus (HIV) specific protease inhibitor. When combined with ritonavir (RTV), plasma concentration of SQV is increased. In this study, we examined pharmacokinetics of SQV soft-gel capsule (SQV-SGC) 400mg twice daily (BID) combined with RTV in HIV-1-infected patients (n=4) and compared with those of SQV hard-gel capsule (SQV-HGC) 400mg BID combined with RTV (n=12). Pharmacokinetics of SQV-SGC 1, 200mg single dose in healthy subjects (n=10) were also studied. Peak SQV concentration in plasma (Cmax) and area under the plasma concentration-time curve from 0 to 8 hour (AUC0-8h) of SQV-SGC 400mg BID combined with RTV group were higher than those of SQV-HGC 400mg BID combined with RTV group; increase of 14.7% and 25.5%, respectively. Cmax and AUC0-8h of SQV-SGC were higher than SQV-SGC 1, 200mg single dose group; increase of 3.9 fold and 8.5 fold, respectively. These results indicated that SQV-SGC combined with RTV therapy is the most potent antiviral effect among SQV-SGC with RTV, SQV-HGC with RTV, and SQV-SGC alone.
We carried out clinical and basic studies of the Directigen Lateral Flow RSV (Becton, Dickinson and Company, USA), a rapid test kit that detects respiratory syncytial virus (hereinafter referred to as “RSV”) antigens based on immunochromatography. For the clinical study, 103 nasopharyngeal aspirates from patients with acute respiratory infections were used to evaluate the kit. Compared to the cell culture method, the Directigen Lateral Flow RSV showed a sensitivity of 100% (16/16) and a specificity of 94.3% (82/87), and an agreement rate of 95.1% (98/103). When compared to conventional testing kits, we found that the total agreement rate with the Directigen RS (Nippon Becton Dickinson and Company) was 88.3% (91/103) and with RSV TestPack (Dainabot Co., Ltd.) was 91.3% (94/103). The detection limit of the Directigen Lateral Flow RSV was 2×103PFU/ml for both RSV subgroups A and B. In the crossreactivity test, only RSV was found positive. No other microorganisms were crossreactive. We also studied storage stability of nasopharyngeal aspirates and found that stability was not affected by storage at room and refrigerator temperatures for 14 days. Taken all together, the Directigen Lateral Flow RSV is useful for the diagnosis of RSV infection in a clinical setting because its performance is equivalent to conventional testing kits and is easy to use.
We report a case of bulla infection caused by Mycobacterium fortuitum. The patient was a 66 yearoldfemale associated with interstitial pneumonitis. The chest X-ray film showed cavities with thickwalls and niveau formation, which initially suggested pulmonary abscesses. The chest CT scanshowed infiltrative shadows surrounding multiple bullae. Smears and cultures of the sputum wererepeatedly positive for mycobacteria, which was identified to be M. fortuitum. By chemotherapy withimipenem cilastatin sodium, clarithromycin, levofloxacin, and minocycline on the basis of susceptibilitytest, sputum converted to negative within 2 months, abnormal shadows on the roentgenogramand laboratory data showed improvement. There are no signs of recurrence after completion of the treatment for 12 months.
Corynebacterium propinquum, which is classified as Corynebacterium ANF-3, has not yet been described as a cause of the respiratory infections. In this paper, we reported a case of 67-year-old immunocompetent male with community-acquired pneumonia caused by C. propinquum. Our study suggested that Gram staining of the pulurent sputum was the most important diagnostic tool to determine the pathogenecity of this organism.
We reported an infant with occult bacteremia caused by group B Streptococcus (GBS). An 8-week-old girl, who was uneventfully born to an 18-year-old mother, was hospitalized because of a 4-hour history of fever. On admission, she appeared nontoxic, and the temperature was 39.0°C, and the pulse and respiratory rates were 162/min and 42/min, respectively. Laboratory findings showed a total white blood count of 5, 200/μl with 44% neutrophils and C-reactive protein of 0.7mg/dl. Cerebrospinal fluid and urine examinations did not disclosed any abnormalities. After a complete evaluation of sepsis including cultures from blood, cerebrospinal fluid, urine, stool, and throat swab, intravenous cefotaxime was administered at 100mg/kg/day in three fractions. Nine hours after the start of the culture, GBS was isolated from blood, and thereafter from the throat, but not from other culture sites obtained on admission. However, at that time she fed well and her temperature was subsiding. Fortyeight hours after admission, she became afebrile and cefotaxime administration was continued for 7 days. Based on the examinations of minimal inhibitory concentrations of various antibiotics, serotype analysis, and restriction-digestion patterns of genomic DNA, the 3 GBS strains isolated from the patient's blood and throat and the maternal anus were identical, suggesting that the infant was infected by her mother. This is the first report in Japan describing the clinical course of GBS occult bacteremia. According to a case series published in the English literature and our case, there are few clinical and laboratory markers predictive for GBS occult bacteremia, but this condition may develop focal invasive infections. A high index of suspicion is required for correct diagnosis. Further accumulation of such patients is warranted to establish the appropriate treatment.