Respiratory syncytial virus (RSV) infection, a common lower respiratory infection in infants, is now recognized in the USA as a significant problem in elderly adults. RSV infection has rarely been reported in adults in Japan.
Nasal samples from 77 patients with influenza-like illness (ILI) and negative for influenza in a rapid antigen detection kit were also tested by polymerase chain reaction (PCR) to identify RSV. A clinical trial was also conducted using a new antigen detection test kit for RSV based on immunochromatography.
RSV was detected by nested RT-PCR in samples from nasal swabs of 10 patients-3 children and 5 adults-and nasal aspiration samples in 2 children. The frequency of RSV detectionby nested RT-PCR in ILI patients with a negative response for influenza virus using the rapid detection kit was 27.3% (3/11) for children aged 0 to 1 year and 33.3% (2/6) for children aged 2-3 years. The frequency was 10% (1/10) for adults aged 30-39 years, 25% (1/4) for those aged 70-79 years, and 60% (3/5) for those aged 80-89 years. By month, the frequency was 25% (2/8) for December, 27.3% (6/22) for January, and 4.4% (2/45) for February.
The main clinical symptoms of the 10 patients with RSV were: peak body temperature during the clinical course of 37.2-39.7°C, cough, and rhinorrhea in 9. Stridor was observed in all five children, but not in the five adults.
Clinical examination showed CRP to be 0.2-3.4 (mean 1.3) mg/dL and WBC to be 3, 070-8, 000 (mean 5, 584) /μL for nine patients. Lymphocytopenia was observed in the four adults from whom WBC fraction data was obtained. Chest X-ray was within normal limits.
RSV was detected by the new rapid antigen detection kit in 9 of the 10 patients in whom RSV was detected by PCR, but not in any of the 67 patients in whom RSV was not detected. The diagnostic accuracy of the new antigen detection kit for RSV was thus excellent at 98.7% compared to PCR.
RSV was detected from nasal swab specimens of a substantial number of elderly Japanese by PCR or the antigen detection kit.

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Since 2003, we have been restricting the length of carbapenems use in the treatment of infections. For this four-year period, we have compared annual data for Pseudomonas aeruginosa(P. aeruginosa) clinical isolates (85 isolates in 2003, 91 in 2004, 100 in 2005 and 100 in 2006) in drug sensitivity/resistance, MIC₅₀/MIC₉₀ and cross-resistance rate. The mean antimicrobial use density (AUD) for carbapenems decreased significantly (p<0.01) from 22.5±4.0 before implementing restrictions to 6.7±1.8 after implementation. P. aeruginosa resistance (%) for carbapenems showed the following changes from 2003 to 2006: for IPM/CS, from 24.7% to 9.0%; for MEPM, from 11.8% to 2.0%; for BIPM, from 10.6% to 5.0%; for CAZ, from 15.3% to 2.0%; for CPFX, from 16.5% to 16.0%; and for AMK, from 2.4% to 0.0%. Comparison of sensitivity and resistance for IPM/CS, MEPM, BIPM, and CAZ between 2003 and 2006 shows that sensitivity increased as resistance decreased, but no change was seen in CPFX. MIC₅₀ values were almost the same for IPM/CS, MEPM and BIPM. MIC₉₀ values were the same for MEPM and BIPM, but was one tube higher for IPM/CS. Different combinations of cross-resistance to antimicrobial agents were detected. It is thusnecessary to regularly survey of the antimicrobial sensitivity of P. aeruginosa in the hospital setting and to determine optimal use of antimicrobial agents.

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A waterborne outbreak of cryptosporidiosis occurred among visitors at a hotel with a swimming pool, gymnasium, and other sports facilities, in northern Nagano Prefecture. The outbreak began in late August, peaked on August 27 and 28, and tapered off at the beginning of September 2004. On August 30, 288 clinical cases with digestive symptoms, including watery diarrhea, vomiting, abdominal cramps and tenesmus, were reported to local authorities. Among case-patients who submitted stool samples, 74 were positive for Cryptosporidium. Descriptive epidemiology, environmental investigations, and laboratory tests suggested that a fecal accident in the swimming pool by swimmers infected before attending the summer training camp was thought to be the source of contamination, and case-patients were mostly among swimmers. Some other clinical-cases had no history of swimming in the pool during their stay and likely were infected through drinking contaminated self-made sports drinks dissolved in water from contaminated faucets and/or sinks nearby the gymnasium toilet. The sink was used to deal with the aftermath of a toilet accident at the entrance of the toilet by a swimming school attendee on August 21. This report is, to our knowledge, the first of a cryptosporidiosis outbreak associated with swimming pools in Japan.

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Background: Viral load quantification is standard for monitoring HIV-1 therapy and is crucial in deciding whether to switch or to continue a current antiretroviral regimen. In Japan, serum is widely adapted as a specimen of the HIV-1 viral load quantification assay.
Methods: We evaluated an emerging HIV-1 RNA quantification of the COBAS AmpliPrep/COBAS TaqMan HIV-1 Test (COBAS TaqMan). The test was evaluated for matrix equivalence between plasma and serum and for correlation with the AMPLICOR HIV-1 Monitor Test v1.5 (Amplicor) for HIV-1 RNA quantification.
Results: The test result from serum specimens showed good correlation with test results from plasma specimens. HIV-1 RNA quantification results using serum specimens correlated well with those obtained by both ultrasensitivity assay and standard Amplicor assay.
Conclusions: The fully automated COBAS AmpliPrep/COBAS TaqMan HIV-1 Test meets requirements for a wide dynamic range and reliable quantification of HIV-1 RNA in serum clinical specimens.

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Streptococcus bovis very occasionally causes rarely sepsis, endocarditis, and meningitis in newborns and the elderly. We report the case of infant meningitis caused by S. bovis despite normal cerebrospinal fluid (CSF) findings at the first CSF examination. A 77-day-old boy with 21-trisomy and patent foramen ovale and seen for a high fever underwent blood examination and lumbar puncture due to toxic appearance despite a lack of meningeal signs, and was admitted. His CSF findings were normal and he was given intravenous ceftriaxone against potential bacteremia. He had systemic seizures with continuous fever for 2 days after admission and a second CSF examination. Gram-positive coccus grew from his CSF at the first examination, and CSF cells from the second lumbar puncture increased to 4, 060/μL (86% neutrophils), so vancomycin was added against potential enterococcal meningitis. S. bovis was finally grown from the first CSF, ceftriaxone discontinued, and intravenous ampicillin added. He recovered after 20 days of antibiotic administration. S. bovis becomes a potential pathogen for meningitis in infants, and must be considered as a cause of meningitis despite its very rarity. CSF findings at the first lumbar puncture may be normal for meningitis in newborns and infants at the first CSF examination, so we must be very careful in the diagnosis of bacterial meningitis even with normal CSF findings, and considered antibiotic treatment against potential bacterial meningitis.

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Conventional polymerase chain reaction (PCR) used to identify mycobacterial species does not distinguish betweenMycobacterium tuberculosisandM. bovisBCG, and several weeks or months may be needed to identify individual slow-growing Mycobacterial species. We report a 4-year-old girl who had subcutaneous abscess and sternal osteomyelitis after BCG vaccination at 4 month of age. We directly identified M. bovis BCG genome in the punctured abscess within a few days using PCR and PCR-restriction fragment length polymorphism. Such PCR is useful for rapidly diagnosing and managing of appropriate therapy in patients with infection due toM. bovisBCG.

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We report two consecutive cases of staphylococcal scalded skin syndrome (SSSS) in our neonatal intensive care unit (NICU). Methicillin-resistantStaphylococcus aureus(MRSA) was isolated from skin swabs. An epidemiological survey conducted on the NICU staff, isolated MRSA from nasal swabs of three personnel. Gene analysis of these five isolates using pulsed-field gel electrophoresis (PFGE) of the bacterial genome and polymerase chain reaction (PCR) for a panel of toxin genes encoded two patient-derived isolates of exfoliative toxin B (ETB) considered to be identical based on the spectrum of toxin genes encoded and PFGE patterns. Three staff-derived isolates did not, however, encode ETB and showed different repertoires of toxin genes and PFGE patterns from those of the two patient-derived isolates. Nasal application of mupirocin to all carriers successfully eradicated MRSA. Horizontal transmission of ETB-producing MRSA between the two patients in the NICU was confirmed, but no NICU personnel carried the same isolate. We therefore wish to emphasize the importance of strict standard and contact precautionary measures and the monitoring of MRSA in the NICU, together with the usefulness of gene analysis using PFGE and PCR as epidemiological tools.

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We report the case of a 75-year-old man with acute myeloid leukemia who developed hyponatremia after linezolid administration. Because induction therapy did not achieve complete remission for this man, we initiated re-induction therapy with enocitabin and daunomycin. Seven days after chemotherapy, the patient experienced a catheter-related blood stream infection (CRBSI) due to methicilin resistant staphylococcus aureus (MRSA). When treatment with albekacin and fosfomycin was in effective, linezolid was administrated intravenously and he became afebrile. On day 8 after linezolid administration, however, he reported general fatigue and slight consciousness disturbance. His serum sodium concentration was 119mEq/L and his urinary sodium excretion rose to 143mEq/day, although intravenous sodium intake was 98mEq/day. Because of the sufficiency of urine volume and weight loss, we surmise that inappropriate ADH secretion (SIADH) syndrome was unlikely. We diagnosed renal salt wasting syndrome (RSWS) based on calculation of the amount of sodium intake and the amount of sodium excreted from the kidneys. After linezolid was discontinued and aggressive treatment with sodium supplement begun, his consciousness cleared as his low serum sodium level rose. This is, to the best of our knowledge, the first case reported on the development of RSWS after linezolid treatment. Although the process remains unclear, our case suggests that linezolid may induce RSWS after intensive chemotherapy.

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A 60-year-old woman seen at the National Hospital Organization Nagasaki Medical Center of Neurology with a cough and abnormal chest radiography was found in CT to have interstitial shadows in the bilateral lower lung fields. She was diagnosed with interstitial pneumonia and treated with steroids. Treatment was effective, and the predonisolone dosage was gradually tapered. When dosage was 17.5mg/day, her chest Xray showed exacerbation. Cyclophosphamide at 50mg/day was added, and chest radiography improved. Two months later, her chest radiography showed infiltration with cavities in the left lung field. Although several antibiotics (sulbactam/cefoperazone, levofloxacin) were administered, no improvement was seen Sputa on hospital day 60 showed the presence of gram-positive branched rods, identified as Nocardia beijingensis. We administered sulfamethoxazole/trimethoprim, meropenem and levofloxacin together, and shadows improved. With recurrent aggravation of interstitial pneumonia, however, new cavity shadows occurred in the bilateral lung due toAspergillus fumigatus. Shadows worsened and she died of respiratory failure. Testing for pulmonary nocardiosis should be added to differential diagnosis procedures as an opportunistic infection in immune-compromised hosts.

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A 24-year-old woman hospitalized with fever, general fatigue, and upper abdominal pain was found to have liver dysfunction and an increase in atypical lymphocytes in peripheral blood. Serum immunological studies showed positive Epstein-Barr virus (EBV) VCA IgM antibody and human herpesvirus 6 (HHV-6) IgM and IgG antibodies, and negative EBV VCA IgG and EBNA antibodies on admission. Liver function was back within normal limits 8 weeks after onset, EBV VCA IgM and IgG antibodies were positive, EBNA and HHV-6 IgM antibodies were negative, and the HHV-6 IgG antibody titer was 8 times higher than that on admission. This case was diagnosed as infectious mononucleosis due to EBV with suspected reactivation of HHV-6.

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A 72-year-old woman with deteriorated renal function underwent hemodialysis with a central venous double lumen catheter and was treated with predonisolone when diagnosed with MPO-ANCA associated rapidly progressive glomerulonephritis. She developed a high fever. On hospital day 64, the central venous catheter was removed immediately, and VCM and RFP were started. On hospital day 70, chest CT showed multiple nodular cavitated lesions, and she was diagnosed as septic pulmonary embolism (SPE). Six days later, chest radiography showed asymptomatic right hydropneumothorax. An intercostal tube was inserted and purulent fluid drained. Methicillin-resistantStaphylococcus aureuswas isolated from blood culture, the central venous catheter, and pleural effusion. Her condition improved slowly, and she was discharged mobile on hospital day 129. Pneumothorax is reported to be a rare but possibly lethal complication of SPE in intravenous drug abusers. To our knowledge, this is the first case report of pneumothorax secondary to SPE due to central venous catheter infection. SPE related to intravascular devices or catheters has been increasing, and the significance of this SPE complication in the critically ill should be recognized.

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