In viral gastroenteritis outbreaks occurred by Norovirus (NV), NV was detected not only from patients but also from healthy persons who have taken the same food, and also detected from healthy staff members working at community places such as hospital, school and nursing home. The number of fecal NV genome copies of patients, healthy persons and food handlers are examined by real-time PCR method, to investigate foodborne gastroenteritis and person to person transmission outbreaks. There is no significant difference on the number of NV genome copies in feces between patients, and NV-detected healthy persons. Those result indicate asymptomatic carrier of NV who were working as food handlers or staff members at community places will become an origin of food-borne gastroen-teritis or person to person transmission outbreaks.

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Between September 2000 and March 2003 healthy subjects in 10 prefectures of Japan were in-vestigated to identify carriers of Neisseria meningitidis. Twenty-five N. meningitidis strains were iso-lated from 5.886 throat swab specimens collected from healthy persons, such as students, elderly, and foreigners. Of the 25 carriers, 9 were teenagers, 15 were in their twenties, and only one was in the fif-ties. The male-female ratio of the carriers was 17 to 8, showing male dominance. The serogroups of the 25 strains were B (9 strains), Y (4 strains) and non-groupable (12 strains). One of the strains was found to be deficient in γ-glutamyl aminopeptidase activity, which is an identification marker for N. meningitidis.

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An epidemic outbreak of tuberculosis resulting from exposure at an autopsy occurred at the Na-tional Defense Medical College Hospital. It consisted of 3 tuberculosis patients and 68 infected staff members over a 6-year observation period from 1997 to 2002 after exposure to an index patient. We report the incident and the background of the tuberculosis infection in our hospital. A 72-year-old man with myelodysplastic syndrome was admitted to our hospital and later died. Miliary tuberculo-sis was diagnosed at autopsy. The first non-periodic health examination was performed on the hospi-tal staff who had contact with the patient. Tuberculosis infection was defined as an area of erythema not less than 30 mm in diameter in the tuberculin skin test. 13 of the 39 hospital staff members who had had contact with the patient were infected, and 3 developed tuberculosis. Of the latter 3 secon-dary tuberculosis patients, the only contact point two had had with the index case was in the autopsy room, and the other had had contact both in the autopsy room and on the ward. The incidence of tu-berculosis infection among the staff who had had contact in the autopsy room alone was higher than among the staff who had had contact on the ward alone(odds ratio=5.04; 1.08-23.42: 95% confi-dence interval). Because one of the secondary tuberculosis patients had bronchial tuberculosis, which is a strong source of infection, the second non-periodic health examination was performed on the staff who had had contact with the secondary tuberculosis patient, and 69 inpatients who had had contact with the staff were carefully observed over a two-year period. 58 of the 171 staff members were infected, and none developed tuberculosis. However, 23 patients were diagnosed with active tu-berculosis after admission to our hospital during the 6 years from 1997 to 2002. Many of them were elderly patients with underlying diseases. An autopsy was performed on 6 of those who died. but only one was diagnosed with active tuberculosis before death. Five of the six autopsied patients had old, healed tuberculous lesions. This outbreak underlines the need for standard precautions. includ-ing anti-air droplet infection at autopsy, because antemortem diagnosis of tuberculosis is not always possible, and there is a risk of elderly hospitalized patients developing tuberculosis if they have been previously infected withMycobacterium tuberculosis.

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To detect an 18S ribosomal DNA fragment of Toxoplasma gondii Nested-PCR was used to detect an 18S ribosomal DNA fragment of Toxoplasma gondii in the CSF of 13 patients at 6 facilities in whom Toxoplasma meningoencephalitis had been suspected between January 2001 and Feburary 2005. Based on the diagnostic criteria of the CDC, all patients were treated with the anti-toxoplasmic che-motherapybased on the clinical diagnosis. Clinical improvement was observed in 11 patients, and the final diagnosis was toxoplasmosis, but the conditions of 2 patients deteriorated, and they were ulti-mately diagnosed with malignant lymphoma. Based on the results of the clinical diagnosis, we as-sessed the effectiveness of the nested-PCR method of examining the CSF for making the diagnosis of Toxoplasma meningoenephalitis.
The results of the nested-PCR were positive in 8 of the 13 cases, and all 8 cases had been diag-nosed with Toxoplasma encephalitis clinically. The results were negative in 5 of the 13 cases, but 3 of the 5 negative cases had been clinically diagnosed as toxoplasmosis, indicating that the test was false-negative in some cases(27.3%; 3/11).
Toxoplasma meningoencephalitis is so difficult to diagnose that the development of the new, high-specificity diagnostic methods is being eagerly awaited.

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Group B Streptococcus (GBS) are pathogens that involve a risk of vertical transmission. They are the infecting organism in approximately one quarter of all cases of neonatal sepsis and meningitis, making prevention of GBS infection an important goal. The United States Centers for Disease Con-trol and Prevention (CDC) recommends administration of antibiotic prophylaxis to GBS-colonized pregnant women at least 4 hours before delivery, but the time of antibiotic prophylaxis administra-tion is not generally reported in Japan. The purpose of the present study was to identify the care pro-vided to GBS-colonized pregnant and intrapartum women in order to prevent of vertical transmis-sion of GBS. The subjects were women (n=150) judged during pregnancy to have been colonized by GBS. who delivered vaginally at one of two hospitals between January 2000 and December 2004, and their neonates (n=151). The relation between the care provided and GBS transmission was ana-lyzed. GBS was transmitted to the neonates of 18 of the 150 women (transmission rate 12.0%). The relation between transmission to the neonate and time between administration of antibiotic prophy-laxis and delivery was investigated, and transmission to the neonate was found to be significantly greater when it was less than 3.5 hours (transmission to 9 neonates of 53 women) than more than 3.5 hours (transmission 4 neonates of 83 women) (p<0.05). The time between admission and delivery was significantly shorter in the cases of transmission (p<0.05). This indicates the need for thorough health guidance for expectant mothers, especially multipara, during pregnancy regarding the timing of admission for delivery, in order to ensure sufficient time between administration of antibiotic pro-phylaxis and delivery.

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Tetanus is characterized by tetanic convulsions related to the actions of tetanospasmin pro-duced by Clostridium tetani. Another important characteristic of tetanus is the instability of the car-diovascular system related to sympathetic hyperactivity in the autonomic nervous system, and it may be an important prognostic factor. We report a patient with tetanus in whose unstable circula-tory kinetics made circulation management difficult.
A 77-year-old woman who injured in a fall, 11 days after trismus appeared and 3 day after con-vulsion appeared. It was not severe case in the acuity classification. However, repeated generalized convulsions and autonomic imbalance involving the cardiovascular system were observed clinically, suggesting a severe case.
Because of the unstable circulatory kinetics, the patient was carefully managed was performed in the intensive care unit (ICU), and she improved. ICU management may be essential for treating severe tetanus with cardiovascular complications.
Acquired immunity is not achieved after the onset of tetanus, and since elderly people. in par-ticular, as in our own caset, are easily injured when they fall, we recommend vaccination.

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