We investigated of Trichosporon beigelii by a surveillances tudy for two years in the Tokyo Metropolitan Police Hospital.
T. beigelii was frequently found in the urine in aged patients with indwelled urethral catheter and in serious stage patients associated with malignancy.
T. beigelii was in allc ases isolated from the samples of patients ian hospital stay over 5 days. Minimum inhibitoryc oncentrations (MICs) of anti-fungala gents against T. beigelii were determined by agar-dilutiomn ethod. Fluconazole resistants trains of T. beigeliwie re found by this method. Microscopic examination revealed phagocyted T. beigelii in multinucleated neutrophils in some cases.
In conclusion, T. beigelii might be suggested a causative organism of opportunistic infection in urinary diseases.

View full abstract

A marked change in age distribution of measles inpatients from 1981 to 2002, namely the in-crease in number of infants under one year of age and that of young adult of 20-24 years were observed. Recent decrease in number of measles inpatients of 2-4 years of age seemed to result from the effect of vaccination against measles given to young children over 12 months of age. Relative increase of infant patients younger than 1 year of age appeared to result form the decrease in number of patients over 1 year old or from the absolute increase in number of infant patients below 1 year of age which arisen from decreased level of anti-measles antibody transferred from their mothers. To clarify which is the more important cause, however, further investigations will be necessary. Relative increase in adult inpatients of measles is speculated to result from the increase in number of adult susceptible to measles because they were not vaccinated against measles and did not contracted measles.

View full abstract

We have experienced an outbreak of enterohemorrhagic E. coli O 157: H7 (Shiga-liket oxin 1 &2 producing) in child independence support facilities in the all dormitory system, in Saitama August 2001. There were 13 patient and EHEC O157s were detected in a total of 29 specimens. As a result of epidemic inspection and microbiological investigation. We recognized that the causative food was Japanese-style pickles named “Wafu-Kimuchi” which had been sold in Saitama and Tokyo area. As the same period, several infections caused by EHEC O157 were considered the same origin in Saitama (8 patients in 5 families). Furthermore some infections happened also in Tokyo. It was made clear this outbreak was a part of a diffuse outbreak caused by Wafu-Kimuchi.
In diffuse outbreaks, it is important to grasp a common feature of the individual cases in a wide area. The exchange of epidemic information between two or more municipalities and the guess of the identity in the DNA levels of strains were the key role to the elucidation of this case.

View full abstract

Mu3 strain with heterogeneous intermediated-resistance to vancomycin (hetero-VISA) reported in 1997, also have possessed a character of an antagonistic effect of β-lactam antibiotics and vancomy-cin. Mu3 is only strain which satisfies the definition of hetero-VISA in Japan. But, MRSA with antago nistic effects of β-lactam antibiotics and vancomycin, was reported by many institions. To separate hetero-VISA, we called “β-lactam antibiotic induced vancomycin-resistant MRSA (BIVR)”. But the detection rate of clinical isolated BIVR in Japan is unknown, we reported on the detection method and the epidemiological investigation for BIVR.
Mu 3 agar containing 4μg/mL of vancomycin is used to detect BIVR.
Mu3 strains were spread on the agar, BIVR can grow around the paper disc impregnated with ceftizoxime or grow on the whole surface on Mu 3 agar after incubation.
The detection rate of BIVR was 45 in 717 (6.3%) clinical isolated strains. In detected strains as BIVR, the number of strains with grown on the whole surface of Mu3 agar showing a high resistance to vancomycin were 10 strains (1.4%). Besides, from 106 strains of blood isolates MRSA, BIVR were detected 16 strains (15.1%), from 611 strains of non-blood isolates MRSA, BIVR were detected 29 strains (4.7%) (P<0.0001). In BIVR strains grown on the whole surface of Mu3 agar, the number of BIVR strains isolated from blood were 8 in 106 (7.5%), from non-blood were 2 in 611 (0.3%) (P<0.0001). On one side, hetero-VISA were not detected from all of BIVR growing on the whole surface of Mu3 agar.
As a result, detection method and the definition of BIVR were quite different from those of hetero-VISA. An existence of BIVR in Japan was confirmed, we thought that the high detection rate of BIVR isolated from blood compaired with that of non-blood showed the pathogenecity of BIVR which contribute to MRSA infections.

View full abstract

A 45-year-old man visited the first hospital complained of high fever on January 2003. He was diagnosed as having Influenza virus type A infection and prescribed of Oseltamivir. He was afebrile next day, but severe myalgia of neck, shoulder, lumbar region and right femoral region was appeared. His illness was considered as polymyalgia rheumatica and started of oral steroid therapy. His symptom was deteriorated and transferred to our hospital. Echography, Ga scintigraphy, computed tomography and magnetic resonance imaging revealed the multiple abscesses and the diagnosis of pyomyositis was made. Pyomyositis following Influenza virus infection must be considered as a differential diagnosis of myalgia after Influenza virus infection.

View full abstract

Three elderly patients were consecutively found to harbor or to become infected with intermediate-level penicillin-resistant Streptococcus pneumoniae in a hospital respiratory ward. All the isolates from the respective patients produced mucoid-type colonies on sheep blood agar plates and were found to have an identical antibiogram, indicating that those were resistant against erythromycin, clarithromycin, clindamycin and minocycline. Pulse-field gel electrophoresis of genomic DNA digested Sma I and Apa I demonstrated homology among the isolates, which may suggest person-toperson spread in a hospital setting. With this, it is an urgent to establish the institution-based infection control precautions against S. pneumoniae.

View full abstract

We described a rare case of Salmonella enteritidis osteomyelitis of the tibia combined with arthritis of the ankle joint. A 4-year-old, otherwise healthy girl was hospitalized with 9-day history of fever, left leg pain, and diarrhea. On admission, her left lower leg and ankle were markedly reddened and swollen. Laboratory examinations disclosed a WBC of 16, 300/μl and a C-reactive protein of 15.6mg/dl. A T₂-weighed magnetic resonance image of the leg depicted a high intensity area around the left distal tibia and an extremely high intensity fluid in her left ankle joint, leading to our diagnosis of purulent osteomyelitis of the tibia and arthritis of the ankle joint. Salmonella enteritidis was isolated from ankle joint fluid and later aspirated bone marrow of the tibia, but not from blood or stool. Because of poor response to intravenous treatment with panipenem/betamipron for 2 days, she underwent drainage and washing of the joint fluid, and intramedullary administration of cefotaxime and ampicillin. She completely recovered without sequelae following treatment with sensitive antibiotics for 4 weeks in total. There has not been any relapse for more than 1.5 years.
The authors also bibliographically surveyed the literature published from 1966 to 2002 and found 35 Japanese patients with Salmonella osteomyelitis. The present patient was the second case caused by Salmonella enteritidis in Japan. Septic arthritis is a rare complication, accounting for only8% of the patients. Since Salmonella enteritidis has been a leading serotype among human isolates of Salmonella species during the past decade, it whould be warranted to determine whether osteomyelitisdue to this organism is likely to increase.

View full abstract

The case was a 32 years old female who contracted measles. Two days after the appearance of skin eruptions, ground-glass opacities and small nodular opacties were detected in both lung fields on a X-ray and a chest computed tomography (CT). CT seems to be a useful method to detect measles pneumonia. Pneumonia complicating measles may be caused by either the measles virus itself or by a secondary bacterial infection. Culture of the bronchoalveolar lavage fluid (BALF) was negative for bacteria, acid-fast bacilli, and mycetes, and polymerase chain reaction (PCR) analysis did not detect mycoplasma, but reverse transcriptase PCR detected the measles virus. The demonstration of measles virus RNA in BALF by the reverse transcriptase PCR technique was useful for definitive diagnosis of measles pneumonia.

View full abstract