Two antibiotics recommended by the guideline of Infectious Diseases Society of America (IDSA) were selected for treatment of febrile neutropenia, and these paired antibiotics were changed periodically three times. The clinical efficacy of each antibiotic was retrospectively evaluated at the end of the final period. There was no significant difference about efficacy rate between two kinds of antibiotics in the same sequential period. However, the efficacy rate has been rising and febrile duration has been shortening by degrees. Only a few drug resistant bacteria were recognized by the surveillance culture during antibiotic cycling. Recently, antibiotic cycling therapy has attracted attention especially in the ICU. However, a clinical study of treatment for febrile neutropenia has not been reported. Our trial suggests that cycling therapy may be useful for febrile neutropenia. However, Some deviation in the patients characteristics of each period may affect the result. It seems that further examination is necessary about usefullness of the cycling therapy for febrile neutropenia.

View full abstract

Tsutsugamushi disease has been a notifiable disease in Japan since the implementation of the Infectious Diseases Control Law in April 1999. In order to assess the role of public health laboratories in detecting Tsutsugamushi disease, a questionnaire regarding routine testing of suspected cases of Tsutsugamushi disease was sent to 73 regional public health laboratories (47 prefectural laboratories and 26 municipal laboratories) in July 2001. The response rate was 92% (67/73 laboratories). It was found that most prefectural laboratories are well prepared to routinely receive and test specimens of suspected Tsutsugamushi disease cases. Additionally, we found that some regional public health laboratories are using two or more detection methods to improve the accuracy of their routine tests. In southern Japan, Kawasaki and Kuroki strains, strains endemic to the region, are widely used in addition to Kato, Karp, and Gilliam strains, the standard strains used for serum antibody tests in Japan. For the years 2000 and 2001, we found that for some prefectures, the annual number of cases confirmed by regional public health laboratories was nearly equal to the annual number of cases the prefecture reported to the National Notifiable Diseases Surveillance System. In these prefectures, it appears that an effective communication network has been established between physicians, public health laboratories, and local health centers, ensuring laboratory confirmation and proper notification.

View full abstract

A retrospective study was conducted on 28 patients with bacterial meningitis who were admitted to our department between April 1988 and March 2002.
The most commonly detected pathogen was group B Streptococcus in those under 1 month of age and Haemophilus influenzae (72.2%) among those over 1 month. The most commonly administered antibioticombination (67.9%) at the initial treatment was that of cefotaxime (CTX) and ampicillin (ABPC).
We encountered one case that was resistant to both CTX and ABPC. Through this experience, it became apparent that for the initial treatment of bacterial meningitis in infants, it is necessary to apply a combination of two antibiotics, instead of a single agent, and new antibioticshould be considered for such combinations rather than persisting on conventional CTX and ABPC.
The aforementioned 28 patients were divided into 2 groups-7 patients (25.0%) with sequelae and 21 (75.0%) without-and various factors noted during the diagnosis were evaluated retrospectively. It was found that the number of days leading to admission at the hospital and the development of convulsions were unrelated to the prognosis. Those who succumbed or suffered sequelae were all infants under 1 year of age. All cases were caused by genus Haemophilus.

View full abstract

During the influenza season, outbreaks of influenza may occur in the pediatric wards due to spread from the patients hospitalized with influenza, or from those hospitalized during the latency period and develop influenza afterwards. Post-exposure prophylaxis with neuraminidase inhibitors has been reported to be effective in preventing outbreaks among household members and nursing home residents. However, for nosocomial spread, its effectiveness and possible adverse effects are to be determined. During the 2002/2003 influenza season, we experienced a total of 3 nosocomial outbreaks of influenza in the pediatric wards in two hospitals in the Kanto district, Japan. Since the number of contacts who developed influenza had been increasing despite the isolation precaution implemented, post-exposure prophylaxis with oseltamivir (2mg/kg/dose, maximum 75mg/dose, once a day for 7-10 days) was implemented with a permission from the parents to terminate the outbreaks. In the outbreaks (one with influenza A, two with influenza B), a total of 29 inpatients had contact with influenza patients: among those 29, 13 were given post-exposure prophylaxis, 16 were not. Out of 16 patients who did not receive post-exposure prophylaxis, 11 (69%) developed influenza: out of 13 with post-exposure prophylaxis, none developed influenza. Those patients who developed influenza were given oseltamivir (2mg/kg/dose, maximum 75mg/dose, twice a day for 5 days) and accommodated in a private room or a room with other patients with influenza of the same type. No significant adverse effects due to oseltamivir were observed among those who were enrolled in this study.

View full abstract

A 50-year-old male with left cervical lymphadenopathy visited our hospital. Infectious and lymphomatous diseases were suspected in the patient. Since the patient owned a dog, which often licked the patient's face, Bartonella infection was also suspected. Histopathological examination in the lymph node biopsy revealed the epithelioid granuloma, but B. henselae was not detected from the culture of the lymphnode. B. henselae DNA also was not detected from the lymph node. Since the antibody titer (lgG) to B. henselae showed 1: 128 by immunfluorescent anitibody technique (IFA), he was serdogicalg diagnosed as cat-scratch disease. ‘Cat-scratch disease’ is named after cat scratch, however we propose ‘B. henselae infection’ which is more appropriate since other animals could serve as a cause of infection.

View full abstract

A woman bought two ferrets from a pet shop. These ferrets became brutal soon, excreted a large amount of saliva and then died. One of these ferrets had bitten the owner's hand before it died. As for the ferret, rabies and distemper were suspected. To receive rabies post-exposure prophylaxis the woman visited our vaccine clinic. To clarify the ferret's cause of death virological examinations were requested to Tokyo Metropolitan Institute of Public Health. The rabies examination of the ferret that had bitten the owner was performed according the law. However the tests of the other ferret that had not bitten the owner was not done though it was suspected to die from rabies, because the law does not mention such a case like the latter ferret. The virological tests concerning distemper were not accepted by the Institute, so the examination was done at a private laboratory. These two ferrets were diagnosed to have had distemper from the results. It is clearly shown from this biteaccident that the legal system where the cause of the animal's death required is extremely incomplete in Japan.

View full abstract

Corynebacterium propinquum, which is included in Corynebacterium group ANF-3, exists as a commensal in the oral flora. This organism has not yet been fully recognized as a respiratory pathogen. Wepreviously reported that the first case with respiratory infection caused by C. propinquum. On the other hand, Corynebacterium pseudodiphtheriticum is recognized as a causative organism in respiratory infections. Recently we experienced two cases with C. Propinquum respiratory infections in our hospital. Three types of the onset such as a community-acquired infection, a hospital-acquired infection, and a nursing home acquired infections were observed. Our analysis indicated that gram staining of the purulent sputum is an essential tool to evaluate whether C. propinquum is a respiratory pathogen or not, because this organism is a commensal bacteria.

View full abstract

We report a patient with bacterial translocation-associated sepsis who was healthy and did not have any related-background. The 57-year-old male had been well until 16 hours before admission, when nausea and vomiting gradually developed and increased in intensity. In the morning of May 22, 2002, he had shaking chills, temperature of 38.6°C and watery diarrhea, and was admitted to Kawasaki Municipal Hospital. On admission, temperature was 40.7°C but otherwise physical examination revealed no particular abnormality. Laboratory data showed total white blood cells of 28, 400/μl, platelet count of 130, 000/μl, creatinine of 2.0mg/dl and C-reactive protein of 7.5mg/dl. 1g of cefmetazole was administered every eight hours. In the early morning of May 23, he suddenly went into shock. At that time, laboratory findings revealed total white blood cells of 33, 700/μl, plateltet count of 65, 000/μl, C-reactive protein of 24.9mg/dl, creatinine of 5.6mg/dl and serum potassium concentration of 5.7mEq/l. Gram positive cocci and gram negative rods were isolated from blood culture obtained on admission. Cefmetazole was changed to 1.5g/day of imipenem/cilastatin sodium and 600mg/day of clindamycin. In addition, hemodialysis and endotoxin removal with an adsorbent column using polymyxin B were performed. Bacteria detected in the blood on admission were identified as Klebsiela oxytoca and Enterococcus faecium. Imipenem/cilastatin sodium and clindamycin were continued for 13 days. The patient recovered fully and was discharged on June 11. This case suggests that bacterial translocation-associated sepsis might occur even in a hitherto healthy adult.

View full abstract