Chemiluminescent assay can give the result of the detection of MRSA about 13 hours more rapidly than conventional broth microdilution method. In order to apply chemiluminescent assay to detection of MRSA, we compared MIC and antimicrobial susceptibility to MPIPC in using chemiluminescent assay with these in using broth microdilution method. In MSSA, rate of concordance of MIC and antimicrobial susceptibility to MPIPC obtained by both methods was 87%, but all MICs come to be agreed by modifying the concentration of bacterial liquid. In MRSA, all MICs and susceptibility to MPIPC are agreed in both methods. Although we have used chemiluminescent assay to detect MRSA for one year, no trouble has been reported by clinical side. The chemiluminescent assay is evaluated to be good in detecting MRSA.

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The combination of vancomycin and β-lactam antibiotic synergistically is known to act on vancomycin-susceptible Staphylococcus aureus (VSSA). But some MRSA with the antagonism in the combination of vancomycin and β-lactam antibiotic was identified in Japan. We called the MRSA “β-lactam antibiotic-induced vancomycin-resistant MRSA (BIVR)”, to distinguish it from hetero-VISA. The percentage of hetero-VISA isolated in Japan that Hiramatsu et al. reported in The Lancet in 1997 was that of “candidate-hetero-VISA” because it did not satisfy the criteria for detection of hetero-VISA that they proposed. Therefore, except for Mu3, a strictly defined hetero-VISA strain has never been detected in Japan. However, BIVR is certainly detectable in Japan. We performed a retrospective study of BIVR in 189 MRSA strains isolated from blood between 1978 and 1999 at the same institution. To performed a retrospective study, 189 MRSA strains were divided such as 1978-1984 (45 strains), 1985-1989 (45 strains), 1990-1994 (49 strains), 1995-1999 (50 strains). MIC₉₀ of anti-MRSA drugs according to above chronological transition were 2, 2, 2, 1 as vancomycin, 2, 1, 1, 1 as teicoplanin, and 8, 8, 1, 1μg/mL as arbekacin, respectively, and then the detection rate of BIVR was 2.2, 2.2, 6.1, 10.4%, respectively. The BIVR detection rate in MRSA isolated from blood at 14 institutions was 14.8% (12/81) in 1999-2002, and that of non-blood was 4.6% (42/905) (p<0.001; χ²-t examination). Of particular importance is that the percentage of BIVR isolated from blood is higher than that from non-blood, and the detection rate of BIVR from blood increases annually.

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Although there have been measles outbreaks involving more than 100, 000 patients every few years in Japan, vaccination is not compulsory under Japanese law and the vaccination rate remains low. In addition, because MMR vaccines have been suspended due to complications, monovalent measles vaccine is still used and administered only once for life. Under these circumstances, a new system was started to develop motivation for vaccination in order to try to eliminate measles and rubella. Although educational campaigns for vaccination are important, their effect is frequently temporary. To maintain a high vaccination rate after such campaigns, we advocated checking children for susceptibility, recommended vaccination and asked for certificates of vaccination at school entry. The participating subjects were 65/68 kindergartens, 55/55 primary schools and 24/24 junior high schools in Kurashiki City, Japan. The total number of subjects was 11, 365. The susceptibility rate for measles and the unknown rate were 5.6% and 2.0% at kindergartens, 4.6% and 4.4% at primary schools, and 3.0% and 8.3% at junior high schools, whereas the susceptibility rate for rubella and the unknown rate were 14.0% and 2.3% at kindergartens, 21.8% and 5.4% at primary schools, and 35.2% and 11.7% at junior high schools. Among the children who were susceptible to measles, we confirmed that a certificate of vaccination was presented by 38.0% of pupils in kindergartens, 85.3% of those in primary schools and 43.7% of those in junior high schools. As for rubella, we confirmed 21.8% presented a certificate in kindergartens, 28.6% in primary schools and 11.6% in junior high schools. As a result, we achieved our goal for measles, which was previously determined as more than 90% for students with past history of infection or vaccination. However, we could not attain our goal for rubella. These systems were more effective than educational campaigns alone and were thought to increase the motivation for vaccination through their continuation. The rate of those who could not receive the vaccination due to allergy or seizure among the susceptible was 26% in total but more than 40% in some schools. We should educate not only parents but also doctors regarding vaccination and advocate that it be done.

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We examined the clinical symptoms and laboratory findings of 21 children with aseptic meningitis caused by echovirus 13 during the summer of 2002.
All patients (mean age: 8.3 years) complained of fever and headache. Some had mild vomiting and some had severe vomiting of 4 times or more. In the early stage of the disease, the mean count of WBC was 8, 283/μl, mean level of CRP was 0.8mg/dl, and there were no abnormalities in levels of GOT, GPT, or LDH. The levels of protein and sugar, in cerebrospinal fluid showed no abnormalities, and mean total cell count was 560/μl. The mean number of polynuclear cells was 357/μl, and of mononuclear cells was 203/μl, showing polynuclear cell predominance. In the recovery period, the tendency to polynuclear cell predominance in the early stage of the disease shifted to mononuclear predominance. One of the 21 patients exhibited multinucleated cell predominancein the cerebrospinal fluid, a high CRP value of 6.2mg/dl, as well as symptoms of restlessness including numbness of the limbs, hyperpnea, and excitation, needed careful diagnosis as aseptic meningitis. Almost all of the patients were mild cases, and no large differences were seen with the clinical and laboratory findings in previous reports of echovirus aseptic meningitis.

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A 26-year-old woman Japanese public official servant in Lao People's Democratic Republic was introduced to our hospital on December 12, 2002, because of two months duration of low grade fever and severe eosinophilia. There was no significant finding in physical examination. Laboratory tests showed leukocytosis (15, 700/μl) with severe eosinophilia (42%), and no abnormal lymphocyte was observed. Furthermore, elevation in alkaline phosphatase (748IU/l), gamma-glutamyl transpeptidase (190IU/l), leucine aminopeptidase (150IU/l), and slight elevation in CRP (2.8mg/dml) were pointed out. A computed tomographic scan of the abdomen obtained multiple cystic lesions in the right lobe of the liver. On parasitological study, a stool specimen examined by the formalin-ether concentration method revealed positive for Opisthorchis viverrini eggs. She was orally administered with40mg/kg of praziquantel a day for two consecutive days. Following check-up by medical-affairs official at Embassy of Japan in Lao PDR confirmed the normal eosinophil count and her fever disappeared. It was considered eosinophilia in this case was induced by acute phase of severe ophisthorchiasis.

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A 52-year-old man was admitted to our hospital because of fever and dyspnea. Chest X-ray film showed infiltrative shadows in the right lower lung fields and serum creatinin was 6.7mg/dl. The patient was diagnosed as pneumonia complicated with acute renal failure. He was treated with antimicrobial therapy. However he developed respiratory failure and exhibited mental confusion. Legionnaires' disease was suspected, because pneumonia was found to be associated with multiple organ dysfunction. We started treatment with intravenous administration of minocycline and continuous hemodiafiltration and his condition had been rapidly improved. We diagnosed this case as legionnaires' disease due to the positive of urinary Legionella pneumophila serogroup 1 antigen. Since the cases of legionnaires' disease with acute renal failure are serious, prompt diagnosis and adequate treatment are essential.

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