From July 1999 to June 2004, we evaluated Streptococcus pneumoniae bacteremia in 40 children in Kamikawa and Soya Subprefectures in Hokkaido by obtaining the patient's information from 7 out of 9 hospitals in the area. The incidences of S. pneumoniae bacteremia in children aged<2 years and<5 years were 79.1 and 63.4. Median age was 19.6 months with a range from 4 months to 4 years. Thirtyone (77.5%) of the total were less than 2 years old. All of the children were admitted. The diagnosis were occult bacteremia in 12 patients, pneumonia or bronchitis in 11, pharyngitis in 7, pneumonia and acute otitis media in 5, acute otitis media in 3, orbital cellulitis in 1, and arthritis in 1. All of the patients had fever and temperatures and 35 (87.5%) of them were more than 39°C. Ten patients had a febrile convulsion. Twenty-nine had a high total white blood cell counts (>15, 000/μg/ml) and 31 had positive CRP values (>0.6 mg/dl) on admission. Meningitis and poor prognosis did not occur after occult bacteremia in our patients. We studied the susceptibility to penicillin G in 22 strains of S. pneumoniae isolated from the children. One and 18 strains were penicillin.-resistant (MIC≥2.0μg/ml) and intermediate (MIC 0.1-1.0μg/ml).
In 2002 we estimated the measles cumulative vaccination coverage (CVC) in Japan by randomly selecting a total of 5, 000 3-year-old children from the total Japanese population and examining the age in months when they were vaccinated against measles. This survey revealed that in Japan measles CVC at ages 18, 24, and 36 months were 61.7±1.6%, 79.6±1.3%, and 86.9±1.1%, respectively.The results obtained in 2003 revealed that the measles CVC among 3-year-old children in 2003 was higher than that obtained in 2002, with especially noticeable improvement in their period of 12 to 23 months of age. It is estimated that this improvement was attributed to the effort made by many persons concerning vaccination to raise the vaccination rate. In 2003 oral polio vaccine (OPV) CVC was investigated for the first time, in addition to measles CVC. OPV CVC of the first dose at 6, 12, and 36 months of age were 44.2±1.5%, 85.5±1.1%, and 94.7±0.8%, respectively. The results of the second dose at 12, 18, and 36 months of age were 42.3 ± 1.5%, 73.5 ± 1.3%, ± 90.7 ± 0.9%, respectively. Even at 36 months of age the CVC level of the second dose of OPV was found to be slightly lower than that of the first dose.
We evaluated the usefuleness of a rapid urinary antigen detection kit (Binax NOW) to detect Streptococcus pneumoniae in the early diagnosis of pneumococcal respiratory tract infections in 313 patients with presumptive respiratory tract infections. We compared results of this test with those of sputum Gram staining. Urinary antigen and sputum Gram staining were respectively positive in 37 and 36 of 57 patients with pneumococcal respiratory infections. The urinary antigen showed moderate positive rate of 64.9% and low false positive rate of 2.3%. The sputum Gram staining also showed moderate positive rate of 64.3% and low false positive rate of 3.5%. Pneumococcal antigen was more frequently detected in patients with severe pneumococcal infections (6/6) than those with mild (5/10) and moderate (26/41) infections. Of the 9 patients who had received antibiotics before testing, antigen was detected in 8 but positive results of sputum Gram stain were in 4. In conclusion, urinary antigen test is a useful test for early diagnosis of pneumococcal respiratory infections especially in adult patients with moderate or severe infections for whom demonstrative results of a sputum Gram stain is unavailable, even after commencement of antibiotic treatment.
Prevention of candidemia has been difficult and empirical therapy may eventually reduce morbidity and mortality. Successful empirical therapies depend on understanding of fungal features and antifungal agents. Susceptibility to amphotericin B (AMPH-B), flucytosine (5-FC), fluconazole (FLCZ), itraconazole (ITCZ), miconazole (MCZ), and micafungin (MCFG) of 41 Cadida species isolated from blood were determined. Candida albicans was the most common species (23species), followed by C. parapsilosis (5 species), C tropicalis (4 species), C. glabrata (3 species), C. guilliermondii (2 species), C. krusei (1 specie), and Candida spp (3 species). The isolation rates of the drug-resistant (DR) fungi were 5% for 5-FC. The rates of DR and susceptible dose dependent (S-DD) fungi were 0% and 2% for FLCZ, respectively. The rates of DR and S-DD fungi were 0% and 17% for ITCZ, respectively. No shift to resistant species in C. albicans occurred in our hospitals. All C. albicans were susceptible for the antifungal agents examined.
A 78-year-old Japanese female was admitted to our hospital because of headache. Trismus, opisthotonus and convulsion appeared in the early morning on the second hospital day. She was diagnosed as tetanus based on these symptoms and the history of trauma on her left hand 6 days ago. A piece of bamboo was extracted from her left hand. However, Clostridium tetani was ot identified. Thiamylal and mechanical ventilation were initiated combined with Pancronium, Diazepam and tetanus immune globulin. Gabexate Mesilate was also added for disseminated intravascular coagulation syndrome probably associated with rhabdomyolysis. By these treatments, she was healed leaving only a disuse syndrome of her limbs.