In basic studies on campylobacteriosis, we tested 53 strains from human diarrhea stools and 102 strains from chicken meat and feces obtained between 2002 and 2006 for drug sensitivity to different drugs and gene mutation in quinolone-resistant strains.
1) Of 15 drugs tested, all were resistant to one or more of the following 10 drugs: CEX, 99.4%; ABPC, 59.4%; NA, 40.6%; NFLX, 40.0%; TC and CPFX, 39.4%; PIPC, 38.1%; MINO, 30.3%; KM, 3.2%; and SM, 2.6%.
2) Of 155 drug-resistant strains, 28 (18.1%) were resistant to single drugs and 127 (81.9%) were resistant to multiple drugs. The most frequent pattern of multipledrug resistance was ABPC/PIPC/CEX, followed by ABPC/PIPC/CEX/TC/MINO/NA/NFLX/CPFX.
3) Mutation of GyrA (Thr86→Ile) was detected in 43 (97.7%) of 44 quinolone-resistant strains.
We found that resistance to B-lactams, quinolones, and tetracycline antibiotics was high, and most resistant strains were resistant to multiple drugs. We also found that most quinolone-resistant strains had GyrA mutation.

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We reported previously that cefazolin was related to an increase in methicillin-resistant Staphylococcus aureus (MRSA) between 1998 and 2000 at Yamagata University Hospital. The incidence of MRSA decreased, however, between 2001 and 2003. We examined the relationship between the use of antibacterial injection and MRSA incidence. MRSA increased in surgical and medical wards between 1998 and 2000, but decreased mainly in surgical wards between 2001 and 2003. We statistically analyed the number of inpatients detected with MRSA (MRSA patients) and the use of antibiotics per month. MRSA patients positively correlated with cephems and carbapenems, the highest positive correlation with cefazolin at a correlation coefficient (R) of 0.45 (p<0.001). In multiple linear regression analysis, cefazolin and carbapenems were chosen as independent variables of a regression equation predicting MRSA patients, during the MRSA decrease and in surgical wards. We thought, it was because carbapenems increased with cefazolin that only cefazolin was chosen as an independent variable during the MRSA increase. We found that the antibiotics as independent variables were associated with about 50% of MRSA by the multiple regression model contribution ratio. Cefazolin was used most for presurgical prophylaxis in surgical wards, and about 20% of surgical wards in medical wards. Carbapenems were use almost equally in surgical and medical wards, but the correlation with MRSA in medical wards was 0.21 (p<0.1) and in surgical wards 0.38 (p<0.005), showing a significant correlation with carbapenems in surgical wards.
In conclusion, cefazolin and carbapenems were related to the incidence of MRSA, and carbapenems showed a significant correlation in the presence of cefazolin. This strongly suggests that MRSA is significantly generated when inpatients are given carbapenems after administration of cefazolin.

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The NPO Biomedical Science Association provided telephone consultation, including contacts by fax and email, targeting the general public within the framework of influenza control measures worked out by the Japanese Ministry of Health, Labor and Welfare (MHLW).
We received 2, 813 inquiries during the 2003-2004 flu season and 2, 444 inquiries during the 2004-2005 season. By month, the highest number was in October-November, accounting for 42.6%. The preceding season showed a similar trend.
By gender, 72.5% of those seeking advice were women. By area of residence, the highest number was living in metropolitan Tokyo, and the remainder lived in the prefectures of Kanagawa, Chiba, Saitama, Nagano, Shizuoka, and Ibaraki in this order. We received no inquiries from the prefectures of Shimane or Saga.By occupation, housewives accounted for 1, 114 inquiries (45.6%), followed by private companies with 447 inquiries (18.3%) and health-care providers with 227 inquiries (9.3%), similar to the 2003-2004 flu season. By subject, 1, 545 inquiries concerned vaccines (62.2%) mainly, the pros and cons of vaccination, adverse reactions, and the number of inoculations required. Inquiries about pregnancy, infants and young children, and breast-feeding accounted for 19.2%.
Inquiries on vaccine shortages during the 2004-2005 flu season (7), SARS (22), and bird flu (22) decreased compared to the previous season, while the number of consultations on antiviral agents increased (209).
In discussing how information on influenza should be communicated to the public, we propose that “Influenza Q & A” provided by the Infectious Diseases Surveillance Center of the NIID, MHLW, should include information on influenza specifically addressing pregnant woman and breast-feeding or child-rearing mothers.

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We studied the effect of Lactobacillus reuteri strain SD2112 Tablets Reuterina (ERINA Co., Inc.), in suppressing H. pylori urease activity and to use the urea breath test (UBT) as a marker for the burden of infection. Method 1: Assessment of UBT and H. pylori density. Subjects were 33 H. pylori-positive patients from whom were obtained gastric biopsy specimens by upper gastrointestinal endoscopy. The correlation between UBT and H. pylori density was investigated. Individual UBT was established for each patient. Patients were divided by H. pylori density was 3 groups: Group I (low-density), Group II (moderatedensity), and Group III (high-density). The individual UBTs were then correlated to the established H. pylori quantity. Method 2: Assessment of suppressive effect of L. reuteri on H. pylori urease activity. Subjects were 40 asymptomatic volunteers with an UBT exceeding 15‰, randomly allocated to four groups: Subjects in Group A underwent active treatment for 4 weeks (period 1) and placebo treatment for the following 4 weeks (period 2). These in Group B underwent treatment in reverse order. Those in Group C underwent placebo. Group D consisted of volunteers with negative UBT undergoing active treatment for the full 8 weeks. Result 1: UBT was 11.6±2.0‰, 22.1±2.6‰, and 35.4±7.6‰ in Groups I, II, and III, showing UBT that increased significantly (I vs. II: p<0.01 and I vs. III: p<0.05) based on H. pylori density. Result 2: Significant differences were seen in the decrease in UBT before versus after medication in Groups A and B. In Group A, lower UBT was maintained until the end of the full 8-week period. The overall decrease in UBT due to medication with L. reuteri Tablets was 69.7±4.0% (p<0.05). Conclusion: Administration of L. reuteri Tablets [Reuterina (ERINA Co., Inc.)] significantly decreased UBT in H. pylori-positive subjects, demonstrating that L. reuteri suppresses H. pylori urease activity and H. pylori density.

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We studied the serovars, yearly and monthly frequency of isolates, and drug susceptibility of 3, 028 strains of Salmonella isolated from patients with sporadic diarrhea during April 1985 to December 2006 in Yamanashi Prefecture.
Results are as follows 1) Isolates were serologically classified into 72 different serovars. Predominant serovars were S. Enteritidis (59.3%), S. Typhimurium (10.5%), S. Oranienburg (2.9%), S. Hadar (2.4%), S. Litchfield (2.3%), and S. Infantis (2.0%).
2) Serovars of S. Haifa, S. Schleissheim, S. Livingstone, S. Mikawasima, S. Manhattan, S. Muenchen, S. Emek, S. Dublin, S. Javiana, S. Miami, S. Miyazaki, S. Weltevreden, S. Orion, S. Give, S. Aberdeen, S. Surat and S. Orientalis were isolated from human sources for the first time since 1995 in Yamanashi Prefecture.
3) Yearly frequency of isolation was 305 strains (10.1%) for 1996, 283 strains (9.3%) for 1999, 273 strains (9.0%) for 2000, 238 strains (7.9%) for 1989 and 228 strains (7.5%) for 1997.
4) Monthly frequency of isolation was 567 strains (18.7%) for August, 471 strains (15.6%) for September, 430 strains (14.2%) for July, 340 strains (11.2%) for October and 266 strains (8.8%) for June.
5) Predominant ages of patients from whom Salmonella strains were isolated were 2 years for 199 strains (6.6%), 1 year for 192 strains (6.4%), 3 years for 169 strains (5.6%), 4 years for 161 strains (5.3%), and under 1 year for 110 strains (3.6%).
6) The rate of isolation from males was higher at 56.3% than for females at 43.7%.
7) The isolation frequency of drug-resistant strains was 64.8% in 1985-2006. The most predominant resistance pattern was SM single resistance because of the increase in S. Enteritidis.
8) The number of resistant strains of was 1, 435 of 1, 780 strains (80.6%) for S. Enteritidis, and 214 of 322 strains (66.5%) for S. Typhimurium, 1 of 87 strains (1.1%) for S. Oranienburg and 73 of 73 strains (100%) for S. Hadar.
9) The serovar S. Typhimurium had much multiple drug resistance strains, being resistant ever to fluoroquinolone.

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We retrospectively reviewed 9 consecutive cases of primary pulmonary cryptococcosis having no comorbidity. At diagnosis, seven had no subjective symptoms and two had subtle symptom. Chest CT scan showed nodular shadows in 8, while 3 cases had infiltrative shadows. Eight of the nine were diagnosed with histopathology obtained by transbronchial lung biopsy or CT-guided needle aspiration biopsy. We also assessed PHA and Con A lymphocyte stimulation tests to measure cellular immune function in 6, four of whom showed decreased reaction of lymphocytes. We successfully treated seven of the nine with fluconazole alone and used fluconazole as a maintenance regimen in two. No relapse or treatment failure was seen after completion of antifungal treatment. Six cases were seropositive for serum cryptococcus antigen titer at diagnosis and only one showed seroconversion. We concluded that the duration of therapy for primary pulmonary cryptococcosis should not be necessarily determined by serum cryptococcus antigen seroconversion.

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We conducted a questionnaire survey of influenza vaccination among elderly nursing home residents, and investigated the actual condition and the view of vaccination of elderly people.
There was 272 elderly residents in Nagoya-shi, Kouseiin Medical Welfare Center, they were classified into the bed ridden group; 195cases (71.7%) according to the independence in activities of daily living, and 132cases (48.5%) were evaluated as the disturbance of community ability group. The number of vaccination in 2002/2003 was 163 residents (59.9%). When the vaccination group (163cases) was compared with the non-vaccination group (109cases), it becomes clear that the later has much bedridden or dementia.
The reply of questionnaire was obtained from 139 cases (51.1%) among 272 residents. As a reason of the residents who received vaccine, a prevention was 70.2%, mostly over whelmingly. The following were 17.0% of a custom of annual vaccination, and the recommendation by doctor and family were 5.3% and 3.2%, respectively. The main reasons for having not received a vaccine was inability of recoganization 22.2%. The afraid of adverse reaction or allergy, the ache of a injection was following 17.8%, respectively. In order to raise the rate of the vaccination in elderly nursing home residents, we should make into consideration that the educational campaign of the safety of vaccine and how to develop motivation for vaccination to the elderly with cognitive decline.

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Rifampicin (RFP) induces hepatic drug-metabolizing enzymes, making drug interactions a very important clinical problem. Clarithromycin (CAM) metabolism is reportedly enhanced by induction of hepatic drug-metabolizing enzymes (CYP3A4) by RFP, so that the blood lend of CAM decreases when RFP is administered concurrently. We connected an electrochemical detector to a high-performance liquid chromatograph (HPLC) for simple, rapid, easy measurement of blood concentrations of RFP and CAM. Using samples of patient serum, normal serum, and reference standards, we compared HPLC by an external laboratory and the results of LC/MS/MS analysis with those of this new assay. A strong correlation was seen between our HPLC results and those of the external laboratory in RFP levels (r=0.975, p<0.01). A strong correlation was also seen between results we obtained for CAM with the electrochemical detector in this assay and values measured by LC/MS/MS analysis (r=0.995, p<0.01). Our method enabled simple, rapid measurement of RFP and CAM by connecting the HPLC and electrochemical detector in tandem. This system was used to modulate dosage during combined therapy with RFP and CAM. The therapeutic effect for nontuberculous mycobacteriosis is expected to improve, and our HPLC is expected to be useful for simple, rapid, easy measurement of blood concentrations.

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Background: The introduction of second-generation QuantiFERON-TB (QFT) enables the diagnosis of Mycobacterium tuberculosis(TB) infection with high specificity and sensitivity. This in vitro diagnostic test uses 2 TB-specific proteins (ESAT-6 and CFP-10) to stimulate cells in heparinized whole blood and detects interferon-γ (IFN-γ) produced from blood cells. When QFT is done in laboratories outside of the hospital, several hours may be required to transport blood samples. We studied the relationship between QFT results and the time taken from collection of blood to incubation (preincubation time).
Methods: Heparinized whole blood drawn from TB suspects was immediately transported to a laboratory. We started to incubate 4 aliquots of blood with ESAT-6, CFP-10, mitogen (phytohemagglutinin), and nil control, at 1, 3, 6, 9, and 12h after blood was drawn. After incubation, the concentration of IFN-γ in each plasma sample was determined by ELISA, and values E and C were expressed as the concentration of IFN-γ with ESAT-6 or CFP-10, minus the concentration of IFN-γ in the nil control. Value E or C≥ 0.35IU/mL was considered positive, ≥ 0.10 and< 0.35IU/mL as equivocal gray zoneL and< 0.10IU/mL as negative. We analyzed 8 patients with value E or C≥ 0.10IU/mL at a preincubation time of 1h.
Results: Value E and C decreased especially for preincubation time> 6h. As a result, the interpretation of value E changed from “positive” to “equivocal” in 2 cases and from “equivocal” to “negative” in 2 cases. Interpretation of value C also changed from “positive” to “equivocal” or “negative” in 2 cases and from “equivocal” to “negative” in 1 case. Even if the higher of value E or C were used for analysis, QFT results changed in half of patients when preincubation time was > 6h.
Conclusion: Since QFT results in half of patients changed when preincubation time was > 6h, incubation of whole blood should start ≥ 6h after blood drawing.

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We analyzed data from tests for virus-specific IgM in 376, 000 serum specimens sent to a commercial diagnostic laboratory from clinics nationwide between 1995 and 2004. IgM antibodies to measles, rubella, mumps, parvo B19, and varicella-zoster viruses were tested using IgM-capture ELISA kits. Among specimens, 254, 000 (68%) had documentation of age, of which 56% were sera from persons<20 and 44%≥20 years of age. Monthly or yearly trends in IgM antibody-positive tests in< 20 year-old persons were similar to those in pediatric patients per sentinel clinic reported by the National Epidemiological Surveillance of Infectious Diseases (NESID), which collects weekly numbers of patients with designated infectious diseases from 3000 pediatrics clinics nationwide. Patterns of changes in monthly IgM positive tests in both<20 and ≥20 y specimens were similar, indicating that infections occur simultaneously in both children and adults. Adult IgM-positive specimens came from internal medicine clinics and from dermatology clinics for measles; from dermatology and obstetrics clinics for rubella and parvo B19; from otolaryngology clinics for mumps; and from dermatology and otolaryngology clinics for varicella-zoster virus. Analysis of large numbers of IgM test results at regular intervals may contribute to understanding of the epidemiology of these viral diseases in Japan.

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Of patients with influenza-like symptoms such as fever, myalgia and arthralgia 2399 visited Kawasaki Medical School Hospital in 2004-2005 and 2171 in 2005-2006. Among those patients over 16 years old, laboratory examinations using the rapid antigen test or the serum HI test were positive for 366 (A: 86, B: 280) in 2004-2005 and 372 (A: 370, B: 2) in 2005-2006. Influenza B achieved epidemic status first in 2004-2005, followed by influenza A (H3N2) after April 2005. Only influenza A was epidemic in 2005-2006. The slight difference in frequency or complication between these strains was not statistically significant. In spite of influenza vaccination inoculation in 20% of patients with influenza in 2004-2005 and 2005-2006, influenza spread. The prognosis of these patients, however, was comparatively good.

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We report a Food-borne group A streptococcus epidemic at Kitasato University campus on July 30 and 31, 2005, believed caused by lunch.
A current mass group A streptococcus infection differing from the food-borne epidemic above occurred at Kitasato University East Hospital, also believed caused by lunch.
Group A streptococcus was detected using a prompt diagnostic kit and bacterial culture from 116 clinical specimens taken from 116 patients with group A streptococcus pharyngitis at Kitasato University East Hospital on August 5, 2005.
To investigate the utility of immunochromatographic detection of group A streptococcus antigen, 116 clinical specimens obtained from pharyngeal membranes by swab were examined using a prompt diagnostic kit for group A streptococcus (ImmunoCard STAT! STREP A TEST) and conventional bacterial culture.
Group A streptococcus positivity differed between the two methods.
Fourteen patients were found to be positive by the prompt diagnostic kit and 23 by bacterial culture.
Four patients showing 1.0×10⁶cfu/mL estimated by the culture were difficult to diagnose with the prompt diagnostic kit, even though the detection sensitivity of this kit was 1.0×10⁶cfu/mL or more.
Conventional bacterial culture should therefore be used in addition to the prompt diagnostic kit to detect group A streptococcns, especially in pharyngeal samples obtained from patients with pharyngitis.

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We previously reported that penicillin-resistant Streptococcus pneumoniae (PRSP) and beta-lactamasenonproducing ampicillin-resistant (BLNAR) were detected at a frequency of 27% and 35% in 468 strains of Streptococcus pneumoniae and 557 strains of Haemophilus influenzae isolated from pediatric patients diagnosed with respiratory infection in 20 pediatric outpatient facilities throughout Japan between November 2002 and June 2003.
Here, we have added additional considerations regarding results of nasopharyngeal culture from 558 pediatric patents diagnosed with pneumonia, bronchitis, or otitis media and having no previous history of antibacterial drug administration.
No significant difference was seen in the detection of S. pneumoniae or H. influenzae between nasal and oral specimens, or between patients with pneumonia, bronchitis, and otitis media. The detection of S. pneumoniaein pediatric patients 4 years old was significantly higher, however than that in pediatric patients 5 years old. The detection of H. influenzae in pediatric patients with a history of attending group childcare facilities was significantly higher than that in pediatric patients with no such history. No significant differences were seen among groups in the percentage of PSRP and BLNAR isolated among S. pneumoniae and H. influenzae strains.
Nasopharyngeal culture of pediatric patients with respiratory infection yielded a higher frequency of S. pneumoniae in younger than older patients and a higher frequency of H. influenzae in pediatric patients with a history of attending group childcare facilities. The detection of resistant bacteria was considered related to other factors, such as the type of antibacterial drugs used, that are not discussed here.

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Dipylidium caninum, the dog tapeworm, is a common intestinal cestode of domestic dogs and cats, but few cases have been reported of human infection by this parasite in Japan.
We repot a case of D. caninum infection in a 17 month-old girl. who sometimes had symptoms of abdominal pain, diarrhea, and dysphoria at night. Her mother noted the appearance of small white worms in her stool, and she was seen by a local pediatrician. Despite antiparasitic therapy wiht pyrantel pamoate, the problem persisted and was eventually referred for further workup to Kurume University Hospital.
The diagnosis was made by microscopic examination of the excreted proglottids, which contained characteristicegg capsules. She was successfully treated with a singledose of praziquantel and four adult parasites were recovered. The longest intact worm was 32cm. Her family had household pets (a dog and a cat). The pets were seen by the local veterinary and both were evidenced D. caninum.
Humans, primarily children, become infected when they accidentally ingest fleas. Parents usually find proglottids as multiple white objects, often described as cucumber, melon, or pumpkin seeds, in stool, diapers, or on the perineum. Most general practitioners and pediatricians may treat children with enterobiasis (pinworm) infection, and in case the treatment fails, other parasite infection should be considered such as this worm. A history of dog or cat pets, fleas, and flea bites may be important clues to diagnosis. Pets found to be infected should also be treated.
[J. J. A. Inf. D. 81: 456-458, 2007]

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A 44-year-old woman referred for skin eruptions and an altered mental status was confirmed to have HIV infection on Western Blot analysis. Her CD4⁺ T cell count was 15/μl. On admission, she appeared quite ill with respiratory distress. Chest X-ray showed bilateral patchy infiltration and pleural effusions. She was treated with cefotaxime, pentamidine, and antituberculosis drugs, but her condition worsened and dopamine was initiated. Intensive treatment failed, and she died the following day. An autopsy showed purplish papules on her face and trunk and multiple white nodules in her liver, spleen and lungs. Culture was positive for Candida Albicans, yielding a diagnosis and of disseminated candidiasis.
It is rare for HIV patients to be diagnosed with disseminated candidiasis, since the pathogenesis usually requires disruption of the mucosal barrier. The defense mechanism against disseminated candidiasis is mainly neutrophils and macrophages, and its dysfunction is not a primary characteristic of HIV infection. To the best of our knowledge, this is the first report in Japan of a HIV patient to have disseminated candidiasis.
[J. J. A. Inf. D. 81: 459-462, 2007]

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