Objectives: We analyzed the possibility of using sales data on over-the-counter (OTC) medicine in syndromic surveillance for early detection and/or prediction of influenza pandemics.
Methods: Data who collected on daily November 2003-April 2004 sales of common cold medication commercially obtained from 600 pharmacies in Japan enrolled in reporting throughout the 2003/04 influenza season. OTC sales data were compared to daily influenza incidence data to determine correlations and predictability. Data included Sentinel Surveillance of influenza, National Surveillance of Dally Influenza Outpatients (Daily Case Reporting: DCR), and Mailing-List-Based Influenza Epidemic Database (MLflu).
Results: The seasonal influenza epidemic peak for 2003-2004 was observed on January 30, February 1, and February 2 for sentinel surveillance, DCR, and MLflu. Sales peaks of OTC medicines occured twice in 2003-2004 season, once at the end of the year and once on January 27. Peak OTC sales for common cold medication per pharmacy were preceded by 18, 21, and 13 days for sentinel surveillance, DCR, and MLflu. OTC sales successfully explained 74-85% in the variation of influenza incidence which is interpretable as sufficient power of explanation.
Conclusions: OTC sales proved to be a good indicator of real-time surveillance for influenza epidemics. Further analysis on multiyear data is needed to demonstrate the robustness of results. To confirm the advantage in the system of real-time syndromic surveillance, it is also necessary to check explanatory power of OTC sales on the variation of influenza incidence with prospective datasets.

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A rare food poisoning outbreak caused by S. Oranienburg occurred at a junior high school athletic meet in Kurashiki, Okayama, in September 2005. The 70 patients included junior high school students, teachers and other school staff, and their families. This bacillus was isolated from stools of two employees and another in catered sandwiches. The cause of the outbreak was determined by evidence and epidemiological investigation to be sandwiches served at the athletic meet. Biochemical features, sensitivity to 12 antibacterial agents, and DNA patterns determined by pulse field gel electrophoresis (PFGE) and enterobacterial repetitive intergenic sequence PCR (ERIC2-PCR) agreed for all isolates from outbreak samples. Isolates resembled strains isolated from broilers and a patient stool in an outbreak involving cuttlefish chips from 1998 to 1999 in Okayama Prefecture. A number of differences in strains isolated from broilers, chicken appendix content, and feed were detected in 2004, so we concluded that few outbreaks of food poisoning occurred due to S. Oranienburg in Okayama, attention is required for food poisoning by S. Oranienburg in the future because the dissemination of S. Oranienburg strains showing different features has been confirmed.

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As a preventive action plan against gastroenteritis caused by the Norovirus (NV), we studied hand hygiene effects using with three hand rubbing products, four wet wipe products, and two functional water types using Feline Calicivirus as a Norovirus surrogate. After treatment using antiseptic hand rubbing products containing chlorhexidine, quaternary ammonium, and povidone-iodine, high inactivation detected by TCID₅₀ was observed compared to products containing povidone-iodine, although no difference was seen in viral removal measured by the amount of viral genome copies in real-time-PCR. Among wet wipes soaked in chlorhexidine, quaternary ammonium, benzoic acid and PHMB, two groups showed viral inactivation and removal. Two products were more effective for functional water, viral decrease was seen in rinsing in running electrolyzed acid water and handwashing by soap.
Results underscore the importance of selection in hand washing metheds (alternative soap and also) in preventing viral gastroenteritis.

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Two cases of group infections with the group A rotavirus (ARV) occurred among adult residents at welfare facilities. Case 1 occurred at a care facility for the elderly between March and April of 2000, where 14 patients aged 68 to 93 (average: 85) of 93 residents developed cardinal symptoms of diarrhea, vomiting and fever. ARV was found in 7 stool samples and their G-serotype was G2. Case 2 occurred at a facility for the disabled in April 2006, where 15 patients aged 28 to 64 (average: 48) of 51 residents developed cardinal symptoms of diarrhea, vomiting and fever. ARV was found in 11 stool samples and their G-serotype was Gl. The ARV route of infection was not specified in either case.
Since G2 was identified among sporadic diarrheas in the general public during the 1999/2000 season when Case 1 occurred, and similarly for G1 during the 2005/2006 season for Case 2, there may be an associations between group-infection cases among adults and sporadic diarrhea in the general public.
Of the three types of antigen detection kit and RT-PCR used to detect ARV for this study, RT-PCR showed the highest detection. RT-PCR was considered to be the most effective in detecting the virus for group infection cases.

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Objective: We assessed the clinicopathological features of invasive pulmonary aspergillosis.
Patients and Methods: We conducted chest radiograph-pathologic correlations in 8 cases with invasive pulmonary aspergillosis diagnosed at autopsy. Results: Subjects were 4 men and 4 women with a mean age of 57.4 years and all having leukemia as an underlying hematological disorder. All had been treated with anticancerous drugs and corticosteroids. Histopathologically, coagulation necrosis with marginal hemorrhage and agranulocytosis were observed in 6 whose initial abnormal shadows in chest X-ray appeared during the neutropenic phase less than 500/μL. In contrast, numerous infiltration of neutrophils and colliquation necrosis at the center of lesions were observed in 2 whose initial abnormal shadows in chest X-ray appeared having more than 500/μL of neutrophils in the peripheral blood.

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We studied 316 adults with community-and hospital-acquired bacterial pneumonia admitted from January 1998 to July 2003. Of these, 66 (20.9%) died. Classified by age, none under 70 died, but mortality increased to 22.6% in the 70-79 age group, 31.6% in the 80-89 age group and 24.2% in the group over 90. Mortality was 3.4% (6/177) for mild pneumonia, 32.0% (24/75) for moderate pneumonia, and 56.3% (36/64) for severe pneumonia. Mortality in hospital-acquired pneumonia (69.1%) was significantly higher than that in community-acquired pneumonia (10.7%). This may result from the higher percentage of moderate by and severe by ill patients who contracted hospital-acquired pneumonia, since 80% of those with hospitalacquired pneumonia were in the moderate and severe group compared to 36.4% of those with communityacquired pneumonia.
For antibiotic regimens, mortality was 18.2% to 36.4% for patients who underwent Penicillins-Cephems therapy compared with 51.6% to 66.7% for Carbapenems-Quinolones therapy. The reasons for these differences remain unclear.
Our study indicates that severity of illness, age, and antibiotic therapy were factors correlated with death from pneumonia. Underlying diseases such as respiratory failure, chronic heart failure, cerebrovascular disease, renal failure, malignancy, and senile dementia may also be associated with mortality.

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We conducted the comparative study to clarify the clinical efficacy and features of ciprofloxacin (CPFX) and biapenem (BIPM) in the treatment of moderate or severe pneumonia. Among 209 patients enrolled, 173 patients (CPFX; 87, BIPM; 86) complying with the protocol were evaluated for safety and 171 (CPFX; 85, BIPM; 86) for efficacy. No significant difference was noted between groups in patient profiles. Both groups were similar in efficacy, as evaluated by the following variables: fever, WBC, CRP, and chest X ray score. The incidence of adverse drug reactions was 16.1% (14/87 patients) in the CPFX group and 16.3% (14/86 patients) in the BIPM group. Phlebitis occasionally occurred in the CPFX group and drug eruption and liver function disorder occasionally in the BIPM group. In conclusion, both CPFX and BIPM were useful in treating moderate or severe pneumonia and no difference was seen between groups in efficacy. Some differences were noted in adverse reactions, however.

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We studied the immunogenicity of trivalent-inactivated influenza vaccine. Subjects were 259 children under 4 years old who visited six pediatric clinics to undergo influenza vaccination. Age distribution was 64 aged<1.0, 65 aged 1.0-1.9, 64 aged 2.0-2.9, and 66 aged 3.0-3.9 years, including subjects who had been previously vaccinated within the last three years, 0% (0/64) aged<1.0, 26% (17/65) aged 1.0-1.9, 72% (46/64) aged 2.0-2.9, and 77% (51/66) aged 3.0-3.9 years old. Two doses of vaccine were given subcutaneously four weeks apart. Dosage was 0.1mL for children under 1 year old, while for children aged one year or older, dosage was 0.2mL, based on standard Japanese recommendations. To measure hemagglutination inhibition (HI) antibody titer, triplet sera were obtained before vaccination (S0), 4 weeks after the first vaccination (S1), and 4 weeks after the second vaccination (S2). The geometric mean of HI antibody titer, the response proportion (titer rise≥4-fold), and the achievement proportion (postvaccination titer≥1: 40) were calculated by age group. Analysis of variance was used to estimate the independent effect of age and prevaccination titer on antibody increase. The geometric means of HI antibody titer were lower among the two younger age groups than among the two older age groups, regardless of vaccine strain or when blood samples were collected. The achievement proportion after 2 doses of vaccine in the<1.0, 1.0-1.9, 2.0-2.9, 3.0-3.9 year age groups were 38%, 58%, 89%, and 85% against A (H1); 52%, 54%, 81%, and 73% against A (H3); and 23%, 49%, 67%, and 71% against B. Regarding the analysis of variance, prevaccination titer consistently indicated strong effects on antibody increase, regardless of vaccine strain or combination of paired sera. After two doses of vaccine (S2/S0), significant effects of age on antibody induction were shown against A (H1) and B (p=0.000 and 0.002). Thus, the immunogenicity of trivalent-inactivated influenza vaccine was strongly influenced by prevaccination titer and age. Even two doses of vaccine did not induce a protective antibody level in about 50 to 80% of subjects among infants aged<1.0 year, and 40 to 50% among children 1.0-1.9 year old.

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We report the familial occurrence of bronchiolitis obliterans (BO) associated with pulmonary aspergillosis. A mother and daughter admitted for dyspnea after taking Sauropus androgynus both had overfiltration of both lungs in chest X-ray and severe obstructive impairment in lung function tests. They were initially diagnosed with severe asthma and treated with high-dose prednisolone (0.5mg/kg/day) for 1 month to no effects. They did not show reversibility in lung function test. They were difinitively diagnosed with BO associated with Sauropus androgynus. Six months later, the mother's symptoms worsened with productive sputum and severe dyspnea, and her chest X-ray showed patty shadow in both upper lung fields. Precipitating antibodies to aspergillus antigen were positive and aspergillus fumigatus was detected from her sputum culture. She was diagnosed with aspergillosis and treatment with Micafungin (MCFG) and Itraconazole (ITCZ) was started. The daughter's symptoms also worsened and her chest tomography showed multiple cavities in both lung fields. Precipitating antibodies to aspergillus were positive. She was diagnosed with Invasive aspergillosis. She was treated unsuccessfully with MCFG and Amphotericin B (AMPH) and ITCZ. Few reports cover BO with aspergillus infection without organ impairment. In these 2 cases, treatment with steroids' or immune suppression of the lung with BO may a trigger aspergillus infection.

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A 65-year-old man with diabetes mellitus reporting fever and urination disturbance on a flight from Bangkok back to Japan in July 2003 was admitted elsewhere for acute prostatitis. Despite intravenous antibiotics, his condition deteriorated. On admission to our hospital, he suffered from respiratory failure, with laboratory data showing disseminated intravascular coagulation (DIC). Computed tomography (CT) shows infiltrative and nodular shadows in both lung fields and low-density areasin the left kidney and prostate gland, consistent with pneumonia and abscesses in these organs. He also developed broad osteomyelitis in the right lower extremity with cellulitis and arthritis in the right hand, knee, and foot. Blood, urine, and joint fluid culture all yieldedBurkholderia pseudomallei, so he was diagnosed with melioidosis. Treatment was started with meropenem and minocycline, then meropenem was changed to imipenem. His symptoms gradually improved after ciprofloxacin was added, so all intravenous antibiotics were discontinued and he underwent oral treatment with chloramphenicol, minocycline, and sulfamethoxazole/trimethoprim in September 2003. He developed fever again, however, and oral therapy was discontinued and intravenous antibiotics restarted. After resolution of fever, oral maintenance therapy was initiated again with levofloxacin and minocycline in October, and his condition remained stable. After discharge in April 2004, he has been followed up with no evidence of relapse. This is considered to be the seventh case of melioidosis reported in Japan. Our patient manifested multiple organ lesions with sepsis and DIC, and was difficult to treat, but clinical symptoms improved in long-term antibiotic administration. With travelers to Southeast Asia increasing, greater attention must be paid to imported infectious diseases, such as melioidosis.

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Pyometra is defined as the pooling of pus in the uterus. An uncommon condition, it occurs mainly in elderly women, mostly due to constriction of the cervical canal or problems in vagina self-cleaning arising with age. We report two cases of pyometra presented with fever for over two weeks. Uterine cervical cancer occluded the cervical canal, causing pyometra in both cases. A 65-year-old woman was treated with drainage and an antibacterial agent (cefmetazole). A 30-year-old woman was treated with an antibacterial agent alone (ampicillin/sulbactam). Culture of the discharge showed polymicrobial infection including anaerobes in both cases. Although pyometra is a rare source of fever, it can cause severe complications such perforation. This disease should thus be considered as a condition that manifests with fever and/or abdominal pain in women.

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A 21-year-old woman admitted for a low-grade fever, dry cough, polyarthralgia, and general fatigue was found to have elevateal accustomed to eating raw meat and cattle liver peripheral blood eosinophil counts and serum IgE. Chest X-ray imaging and computed tomography (CT) showed multiple small nodules in both lung fields. A multiple dot-ELISA assay of her serum showed that she had visceral larva migrans caused byAscaris suumorToxocara canis. Following treatment with albendazole, she developed myelopathy and was again admitted. A cerebrospinal fluid examination showed increased eosionophils and significant antibody elevation againstT. canis. Her disease was considered to have entered the central nervous system, one of the target organs of visceral larva migrans. She was successfully treated with dietylcarbamazine and has shown no reccurrence.
This case showed the different manifestations of visceral larva migrans and the rising incidence of this disease in Japan raises concerns about associated of diet.

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