Killing of Legionella pneumophila by an antimicrobial ceramic was evaluated during culture in nine kinds of hot spring water at 40°C. After 24 hours, the efficacy against L. pneurnophila varied, depended on water quality. The strongest antibacterial effect was seen in chloride hot spring water from Wakayama and in deionized water. In four hot spring water samples (sulfur and hydrogen carbonate springs from Fukushima, simple thermals from Mie, and radioactive spring from Tottori), the decrease was<-2 log cfu after 48 hours. These results suggest that the antimicrobial ceramic is able to eradicate Legionella from hot spring waters.
A shiga toxin-producing Escherichia coli (STEC) 026 strain resistant to cefotaxime (CTX) and cefpodoxime (but not ceftazidime) was isolated from the faecal sample of a 17-year-old outpatient with diarrhea. The double disk synergy test, twin test, polymerase chain reaction and sequence analysis confirmed that the strain produced CTX-M-3 type extended-spectrum β-lactamase (ESBL). Conjugation experiment results suggested that the CTX resistance in this strain was determined by an approximately 85kbp plasmid that was readily transferable to a susceptible recipient E. coli strain. This is the first report from Japan of CTX-M-3type ESBL-producing STEC O26.
One hundred forty-seven Campylobacter were isolated using 3, 204 samples taken from sporadic diarrheic patients from January 2001 to December 2003. The detection rate of Campylobacter in 16 to 30 year old patients (12.9%, 83/641) was significantly higher than that in patients less than16 years of age, 5%, (29/1, 155) (p< 0.001) and more than 30 years of age, 2.5% (35/1, 408) (p< 0.001), respectively. The highest detection rate was obtained from the stool of males in the 16 to 30 year old range during the months from May to August, 26% (32/123). If the minimal inhibitory concentration (MIC) breakpoint for resistance of gentamicin (GM), erythromycin (EM), ciprofloxacin (CPFX), tetracycline (TC) were defined tentatively >16 μg/ml, >16μg/ml, >2 μg/ml, >16μg/ml, theresistant rate would be 0.0%, 0.0%, 22.0%, 42.8% in C. jejuni, 0.0%, 62.5%, 62.5%, 87.5% in C. coli, respectively. All the Campylobacter isolates were susceptible to GM. Three of the 8 C. coli isolates were multi-resistant in EM, CPFX, and TC. Five highly EM resistant strains with an MIC of >512 μg/ml did not show any zone around the EM disk; 7 susceptible strains with an MIC of less than 16μg/ml showed=zones of 24mm to 36mm and revealed a good correlation with the Etest method and the agar dilution method. Between the two time periods of January 2001-June 2002 and July 2002-December 2003, the resistant rate of CPFX in C. jejuni decreased from 27.5% to 15.5%, however, that was not significant decrease (p=0.133).
We measured IL-12 concentrations in the CSF of patients with purulent meningitis. Twentythree infants who were admitted between 1997 and 2003 and diagnosed as having purulent meningitis were included in this study. All patients in this study were admitted by the 3rd day of illness. After admission, appropriate antibiotics were administered to all infants. Two infants died and two other infants developed cerebral palsy and mental retardation (adverse outcome group). None of the other patients showed any neurologic abnormalities at discharge (good outcome group). As a control group, 16 infants who were diagnosed with diseases other than purulent meningitis were also investigated. The CSF IL-12 p40 concentrations in meningitis infants on admission (median [range], 1, 890 [< 15-7, 770] pg/ml) were significantly higher compared with those in the control group (p<0.001). Among infants with meningitis, there were no significant differences on admission between patients with adverse outcome group and those with good outcome group. Consecutive measurements were performed in 17 infants with meningitis including the 2 infants with adverse outcome group. The concentration in the infants with adverse outcome group seemed to decrease more gradually than that in those with good outcome group. IL-12 induces production of interferon-y, which enhances the function of polymorphonuclear leukocytes. IL-12 may contribute to local host defenses in the subarachnoid space.
National surveillance on human ecinococcosis has been performed since April 1999 when it was stipulated as a Category IV Disease under the Infectious Diseases Prevention Law. During the last 4 years of surveillance, 3 cases with unilocular hydatidosis (age range 27-81 years; median age 55 years) and 51 cases with alveolar hydatidosis (age range 15-86 years; median age 64 years) have been reported. The numbers of reported cases with alveolar hydatidosis have been increased with age, and the largest number reported in the age group >71 years. Three cases with unilocular hy datidosis have been reported from health centers in Honshu, and were likely to be imported cases. Seventeen reported cases had clinical symptoms. None of the reported cases had information on infection route. Fifty out of 51 cases with alveolar hydatid disease have been reported from health centers in Hokkaido. When analyzing the cases by subdividing Hokkaido into six regional districts, large number of cases were reported from health centers in Ishikari-Shiribeshi-Iburi region (20 cases) and in Nemuro-Abashiri-Kushiro region (15 cases). As detailed addresses of the cases were masked, we compared the number of cases per 100, 000 residents in regions. Health center in Nemuro-Abashiri-Kushiro region (2.13/100, 000) had largest rate and second was Souya-Rumoi region (2.05/100, 000). The results from current surveillance data only suggest the generation situation of human echinococcosis in several years ago or more, so the generation situation between 1999 April and 2002 December in surveillance is unknown.
We report a case of sphenoid sinusitis which could be diagnosed by orbital CT after detecting Strepotococcus pneumoniae from blood culture. A previously healthy 47 year-old Japanese male was admitted to our hospital with severe leftsided headache of 2days duration. From 9days before hospitalization (1 th day), the patient complained of cough and sputum. On physical examination, his neck was supple and his temperature was 38.3°C.The rest of the examination was normal. A chest radiograph, sinus radiograph, and head cornputed tomographic (CT) scan without contrast material disclosed no abnormalities. Lumbar puncture was done and cerebrospinal fluid was clear and cell counts and the levels of glucose and protein were normal. The peripheral white blood cell count was 14, 400/fl, and the C-reactive protein level was 9.6 mg/dl. After blood, urine, pharyngeal mucus and cerebrospinal fluid cultures were obtained, empirical antibiotic therapy with 2 gms of piperacillin twice daily was begun. He complained sever left-sided retro-orbital headahe on the next day too. The lumbar puncture and head CT scan with contrast material was done again but gave no diagnostic clues. The examinations by the otolaryngologist, ophthalmologist and dentist found no abnormal findings. On the 3rd hospitalized day. Strepotococcus pneumoniae was detected from the blood culture taken on the 1st hospitalized day. A CT scan focused on orbita was done and revealed a low density area of the left sphenoid sinus. The dose of piperacillin was increased to 4 gms twice daily and continued for 24 days. The patient 's headache improved and piperacillin was changed to oral levofloxacin 100mg, three times daily on the 26th day. The medication was stopped on the 73th day. Isolated sphenoid sinusitis is rare, but crtitical complications such as cranial nerve involvement, brain abscess, and bacterial meningitis may happen. It is necessary to also think of sphenoid sinusitis in practices of patients with severe headache.
A 49year-old woman with chronic renal failure (CRF) on continuous ambulatory peritoneal dialysis (CAPD) because of Goodpasture Syndrome was admitted to our hospital since she had a high fever and severe abdominal pain. A diagnosis of peritonitis was made from the physical examination and laboratory findings. The peritonitis was refractory to conventional antibiotics therapy. Candida parapsilosis was detected from dialysite. The peritonitis was aggravated although the antibiotic was changed to an antifungal agent (fluconazole 400mg/day). Fluconazole was replaced to micafungin (MCFG) and the catheter for CAPD was removed. The fungal peritonitis improved dramatically and β-D-glucan was decreased from 104 to 12.6 (pg/ml). No adverse effect was observed after using MCFG. It has been known that fungal peritonitis of CRF patients is refractory to treatment and the mortality rate is high. To our best knowledge, there is no report that MCFG was used for CRF patients with fungal peritonitis. However, we used MCFG safely and effectively for CRF patients. Therefore, it is suggested that MCFG is a new effective and safe antifungal agent for Candida parapsilosis peritonitis with CRF.