A world trend such as the free trade agreement (FTA) promoted by the World Trade Organization (WTO) results in an expansion of both importation and exportation of industrial materials, grain, food products and domestic animals, as well as pets and wild animals. Nowadays not only foods but also various kinds of animals are arrived from all over the world to Japan, and an increase in the risk for invasion of zoonoses from abroad to Japan has been pointed out for many years. Actually, BSE, 0-157, highly pathogenic avian influenza (HP AI) etc., invaded into Japan within recent several years, and a possibility of the outbreak of rabies, plaque or tularemia which might be introduced by imported animals is still high. In this article, I discuss the risk for zoonoses from the following points. They are “from animal to human, background of the world wide expansion of zoonoses, a warning to human being from nature, zoonosis control strategy. and future problems on zoonosis to be dissolved”.
This review discusses the clinicoradiological findings of community-acquired respiratory infections and the treatment strategy for respiratory infections. To make a differential diagnosis between bacterial pneumonia, pneumonia caused by atypical pathogens, and mycobacterial infections, it is very important to analyze the radiological findings of inflammatory lung diseases based on normal antomical structures. If clinicoradiological anlyses could make these differentiations, the appropriate treatment strategy for respiratory infections could be established. To accomplish this, exact orientations of pulmonary lobulus, acinus, and respiratory bronchioles is very important. Then, through analyzing chest CT findings and distribution patterns based on normal anatomical structures, estimation of causative pathogens could be possible. Especially, whether inflammatory exudates could pass Kohn's pores as well as Lambert's channel or not is very important factor to affect radiological findings of several pneumonia (as traditionally called “segmental” and “nonsegmental” distribution). To differentiate infections caused by Mycobacterium tuberculosis from nontuberculous mycobacteria, several important criteria have been demonstrated. Briefly, it has been suggested that Mycobacterium avium complex (MAC) respiratory infection is increasing especially in elderly women without underlying diseases. In MAC respiratory infection, right middle lobe and left lingula are frequently involved and centrilobular nodules and diffuse bronchiectases are characteristic radiological findings. Finally, the role of telithromycin in the treatment of respiratory infections is discussed.
Considerable information has been accumulated in the field of anaerobic bacteria and anaerobic infections in the last ten years. Here we tried to briefly introduce several selected topics of clinical importance in this field: Proposal of the term “Nanaerobe”, Changes of classification and nomenclature of anaerobes, Anaerobic bacteremia, Lemierre's syndrome as a revival anaerobic infection, Atopobium vaginae as Bacterial Vaginosis-associated bacteria, and new actions of the Clostridium perfringens toxins.
Although there have been many reports of the usefulness of serodiagnosis of enterohemorrhagic Escherichia coli (EHEC) O157, the serotype of the bacteria detected and the increase in anti-LPS antibody have not always been consistent. In this study we investigated the diagnostic significance of measurements of anti-LPS antibody by ELISA in an outbreak of O157 infection among schoolchildren in whom the bacteriological test findings were clarified and the age groups were uniform. The anti-LPS antibody titer was measured in 31 patients (77 serum samples) in an outbreak of EHEC O157: H7 infection (220 children infected) that occurred in a primary school in Morioka in 1996. The anti-O157 LPS antibody positivity rates of IgM, IgG, and IgA were 98.7%, 85.7%, and 98.7%, respectively. Between the time the meal that caused the outbreak and 19 days later, anti-O157 LPS IgM antibody and IgA antibody were detected in all patients. The specificity was investigated using control serum, and the specificity of IgM, IgG, and IgA was 93.5%, 93.5%, and 97.2%, respectively. Some samples contained antibodies against O111 and O26 LPS, but the titers were lower than the anti-O157 antibody titer. The anti-O111 antibody titer and anti-026 antibody titer were highly correlated, suggesting that they were crossreactive antibodies for O157 LPS. No significant correlation was found between differences in clinical manifestations and the anti-O157 LPS antibody titer in this O157 outbreak in schoolchildren. It was clarified that an increase in anti-LPS antibody was found to support the diagnosis of mild cases of O157 infection infection as well as severe cases.
Between August 1998 and July 2005, we studied the serotypes and mutation of penicillin-binding protein (PBP) genes of 46 strains of Streptococcus pneumoniae isolated from children with invasive pneumococcal infection in Hokkaido. The clinical diagnosis was pneumonia in 16 cases, occult bacteremia in 15, meningitis in 8, upper respiratory infection in 6, and arthritis in 1. Patients ranged in age from 2 months to 9 years old. Prevalent serotypes were 6B (39.1%), 23F (17.4%) 6A (8.7%), and 19F (8.7%). The serotype coverage rate by the 7-valent pneumococcal vaccine was greater than 70% in children. Mutation of 3 genes (Penicillinbinding S. pneumoniae, PRSP) was detected in 18 isolates, mutation of 10 genes (pbpla and pbp2x, or pbp2x and pbp2b) in 2, and of pbp2x alone in 15. PRSP was found in serotypes 6A, 6B, and 23F, and the rate of PRSP in 6A, 6B, and 23F was 75.0%, 62.5%, and 55.6%, respectively.
Isolated of multidrug resistance Pseudomonas aeruginosa (MDRP) that the receptivity pattern of the antimicrobial suscepti respectively resembled isolated from clinical specimens (sputum) in two patients of each internal medicine ward in Kitasato University East Hospital for two days from September 18 and 20, 2004. Both of bacteria were formed small colonies of a smooth-type on dollargalluskey improvement-type BTB agar plates, and the judgment of Class B (metallo)-β-lactamase by biochemical properties and disk diffusion method sodium mercaoto-acetic acid (SMA) was mutually corresponding. Moreover, it was same serotype C according to the serotype, and it was confirmed that it was the same bacterial strain from the molecular epidemiology analysis by Random amplified polymorphic DNA polymerase chain reaction (Random amplified polymorphic DNA polymerase chain reaction: RAPD). From the investigation of clinical backgrounds of two patients who isolated bacterial strains, September 18, 2004, 10: 20 a.m., and 10: 40 a.m., other chances that can become with contact infection in this hospital, except conducted X-Ray or roentgenograph of the chest and abdomen of Portable X-ray device continuously done by one radiation technician was not seen. Because it had turned out that a radiation technician who had taken charge had been neglecting the hand washing at the time of each X-Ray or roentgenograph, it was guessed the case with nosocomial infection by contact infection occurred via specific radiation technician.
Measles epidemic occurred in southern part of Fukushima Prefecture from April 2002 to July 2003. Public Iwase hospital in Sukagawa City was the central hospital in the measles epidemic area and 382 patients with measles were admitted to the hospital during the epidemic. Based on clinical records, age distribution, vaccination history, familiar infection and complications were retrospectively investigated. Moreover, the vaccination rates and their calculating methods in the area were compared and the problems on immunization against measles were discussed. As the result, we found that 1) measles epidemic centered on unvaccinated infants, 2) measles was still serious disease with many complications and sometimes fatal, 3) measles was highly infectious and there was no way for prevention except vaccination, 4) the actual condition of measles vaccination was not reflected exactly by the current calculating methods used for the local health reports by the Ministry of Health Labour and Welfare. For the prevention of measles epidemic, it is necessary to know the exact numbers of patients infected with measles and patients deceased due to measles, to calculate precise vaccination rate, and to form the consensus among parents, physicians and administrators to control measles epidemic by the vaccination.
Diphtheria-tetanus-acellular pertussis vaccine (DTaP) developed in Japan is now widely used worldwide. DTaP is safer than the diphtheria-tetanus-whole-cell pertussis vaccine (DTwP) and has fewer severe side effects, but local reactions such as redness, swelling, and induration are still reported. The pathophysiological mechanism of these reactions is controversial. To clarify the cause of local reactions, we conducted studies using the mouse model. After administering either one or two abdominal subcutaneous DTaP inoculations, we observed changes in histopathology at the injection site at 24h, 48h, and 7days. The control group, inoculated with physiologic saline, showed no significant changes either pathologically or with the naked eye. All mice after DTaP vaccination showed indurations at the injection site. Pathologically, we watched leukocyte invasion into or around the site, especially neutrophils and eosinophils. After the first vaccination, the extent of the invasion was strong 24h and 7days later. At 24h following the second vaccination, a dramatic leukocyte invasion seen persisted at 7days. At 7days after the first vaccination, peripheral fibrosis had begun, and when a second vaccination was administered, it began even earlier at the second site. These histopathological changes show that local reactions are caused by both inflammatory and allergic responses. Because this mouse study resulted in the same pattern of reactions observed in humans, this method will be useful for studies focusing on local reactions.
We report a case of invasive sinus aspergillosis that extended to the orbital cavity and cavernous sinus and was improved by treatment with micafungin and itraconazole. Case report. A 83-year-old woman was referred to our hospital because of headache and impaired of eye movement on the right side. Physical examination revealed impaired function of cranial nerves, II, III, IV, and VI on the right side. MRI showed evidence of inflammation of the right sphenoid sinus and ethmoidal sinus and an enhancing mass in the right cavernous sinus and orbit. Because a culture of a specimen from the right sphenoid sinus extracted during endoscopic sinus surgery, yieledeAspergillus fumigatus, a diagnosed of invasive sinus aspergillosis complicated by cavernous sinus symdrome and orbital apex symdrome was made. It was difficult to completely remove the mass in the sinuses surgically and drug therapy with micafungin was started and then itraconazole was added. The clinical manifestations and the impaired function of cranial nerves II, III, IV, and VI improved, and MRI showed regression of the mass in the sinuses temporary in response to drug therapy. Conclusion. Invasive sinus aspergillosis often progresses rapidly in the absence of surgery. Our case is valuable, because invasive sinus aspergillosis was improved by drug therapy alone, and combined treatment with micafungin and itraconazole was effective.
A 46-year-old man was admitted to Shin-Kokura Hospital because of fever and right chest pain. Laboratory studies showed mild leukocytosis, an increased erythrocyte sediment rate, positive C-reactive protein, and abnormal liver function. The tuberculin skin test was positive. A chest X-ray showed massive right pleural effusion, and exudative pleural effusion fluid was obtained by thoracocentesis. The pleural fluid revealed an increased adenosine deaminase concentration and cultures were negative for mycobacteria. A polymerase chain reaction test of the pleural effusion for Mycobacterium tuberculosis was positive. The patient was diagnosed with tuberculous pleuritis, and antitubercular therapy was started. The fever and chest pain was improved, but rashes appeared on the lower extremities. A biopsy of the skin lesion showed anaphylactoid purpura. Steroid ointment improved the skin lesion. Anaphylactoid purpura associated with tuberculosis is rare. The immunological response to mycobacteria may heve been related to the mechanism of the anaphylactoid purpura in this case.