Oseltamivir is a neuraminidase inhibitor preventing the release of the infectious influenza virus particles from the infected respiratory tract cells of the patients. It is known that the medicine reduces the duration and the severity of this infectious disease and the incidence of pneumonia as its complication. Recently some reports emerged mainly from Japan that neuropsyciatric events are provoked by oseltamivir. However, the neuraminidase inhibitor might be expected to prevent the events, as it reduces the viral burden. Therefore it was investigated whether oseltamivir reduces the incidence of the events. Patients and Methods: The study was conducted at the Yokohama Rosai Hospital, Kanagawa, Japan since December 2006 to March 2007. Patients with fever who had got the positive result of the influenza viral antigen test but no neuropsyciatric events, older than one year old, were enrolled in this study. The cases were the patients who visited the outpatient department of the hospital for their neuropsychiatric events (Case Group). The controls were the patients more than one year old with no neuropsychiatric events (Control Group). Nasopharyngeal aspirate fluid was used for detecting influenza virus by using a rapid diagnosis test, the ESPLINE Influenza A&B-N (Fujirebio Corp., Japan). The proportion of gender, age, and the use of oseltamivir were compared in the two groups with t-test and chi-squared test. Results: Twelve cases and 335 control patients were enrolled in this study. The mean age and its standard deviation of the Case Group was 8.25±3.22 years old, which was significantly higher than that of the Control Group (6.09±3.74 years old, p=0.049). The Case Group consisted with 9 boys (75.0%) and 3 girls (25.0%), as the Control Group had 183 boys (54.6%) and 152 girls (45.4%). The frequency of the type A virus was not significantly higher in the Case Group (7 patients, 58.3%) than in the Control Group (168 patients, 50.1%) (p=0.162). Six cases (50.0%) in the Case Group had taken oseltamivir prior to the neuropsychiatric events on the contrast that 261 patients (77.9%) in the Control Group were prescribed the same medicine, the difference was statistically significant (p=0.024). Conclusion: It is concluded that oseltamivir, an influenza virus neuraminidase inhibitor, significantly reduces the incidence of the neuropsychiatric events of the patients with influenza virus infection.
Microimmunofluorescence testing (micro-IF) is a standard serological test Chlamydia pneumoniae (C.pneumoniae) infection, but requires sophisticated techniques. ELISA, a simple, easy diagnostic method, has thus come into wide use and is included by the National Insurance System of Japan as an approved and reimbursable procedure. Based on Kishimoto's criteria, initial C.pneumoniae infection is diagnosed by ELISA at single serum IgM antibody titer in children ID ≥1.10, adult ID ≥ 1.60. The positive percentage of C.pneumoniaeIgM antibody in children, however, is unexpectedly high, and the antibody level has been found to remain positive for several months or more. In an effort to revise positive criteria for initial infection with C. pneumoniae, we compared IgM antibody titer of ELISA to that of micro-IF and Western blotting (WB) in acute pediatric respiratory tract infection. Specimens were collected from 128 children with acute respiratory tract infection; 106 (11-months to 14-year-olds) with an IgM antibody ID≥1.10 and 22 (8-months to 12-year-olds) with an ID<1.10. The 77 samples with an ID≥1.40 of IgM antibody by ELISA included 4 negatives in micro-IF and 8 negatives in WB. Regarding definitive cases as C.pneumoniae-IgM positive by both micro-IF and WB, the receiver operating characteristic curve showed that the optimal value was ELISA ID 1.40; sensitivity 86.8%, specificity 96.3%, the positive predictive value 98.5%, and the negative predictive value 72.2%. Diagnostic precision in initial C. pneumoniae infection in children may therefore be improved by revising positive criteria of ELISA IgM titer.
Population-based studies on community-acquired pneumonia (CAP) are rare in Japan. Among 984 Chiba City children admitted with CAP to 19 local hospitals in 2005, 854 were younger than 5 years old. The annual CAP incidence among children<5 years old was 19.7 per 1, 000. Five, 4 of whom were under 5 years old, had pneumococcus isolated from blood. The incidence of CAP with pneumococcal bacteremia was 9.21 per 100, 000 among those<5 years old.
To clarify the clinical significance of Pneumococcal pneumonia in nursing-home-acquired pneumonia, we examined the positive disease rate of using sputum cultures and the Binax NOW Streptococcus pneumoniae urinary antigen assay in 154 nursing-home patients with pneumonia. These included 54 males and 100 females with a mean age of 86.2 years. Bacteriological findings for sputum culture in 130 patients showed Streptococcus pneumoniae to be cultured in 11 cases (8%). In 72 in whom the Streptococcus pneumoniae-urinary antigen test (Binax NOW) was done, the urinary-antigen-positive rate (26/72; 36%) was higher than the culture positive rate for S. pneumoniae. Both examinations were done in 64 patients, among whom 5 in whom S. pneumoniae was cultured also had positive results for the urinary antigen test. Almost half of those undergoing percutaneous endoscopic gastroscopy (PEG) tube nutrition had positive results for the urinary antigen test, but not all such patients had positive cultures for S. pneumoniae. Although the culture-positive rate for S. pneumoniae in sputum was low, we concluded that S. pneumoniae was frequently linked to nursing-homeacquired pneumonia, especially in“total-care” patients.
We evaluated 12 children infected with group B Streptococcus (GBS) at Asahikawa Kosei Hospital, in Japan between 1998 and 2007. The diagnosis was bacteremia in 8 and meningitis in 4. Infection occurred before day 7 in 3 patients, between days 7 and 28 in 4, and between days 29 and 131 in 5. The incidence of early onset GBS infection was 0.4 cases/1, 000 live births. Four of 11 mothers were found to have GBS in antenatal culture screening. Although 2 underwent intrapartum antibiotic prophylaxis, infants suffered GBS infection. No patients with GBS infection died, but sequelae seen in 3 patients involved epilepsy and developmental delay of varying severity. The most frequent serotypes were III in 7 patients, followed by Ia in 2, Ib in 2, and II in 1. The MIC90 was 0.015μg/mL in panipenem and imipenem, 0.03μg/mL in meropenem, 0.06μg /mL in cefotaxime and ceftriaxone, and 0.12μg/mL in ampicillin. Serotypes and MICs were measured in 28 strains from pregnant women, 11 from newborns, 19 from children, and 30 from adults between May 2007 and December 2008. The frequency of serotype III in patients with GBS infection was significantly more than that in pregnant women or adults (p<0.05). The MIC90 in these strains was the same as those of patients with GBS infection.
Two hundred thirty-one Campylobacter were isolated from acute diarrheic patients between January 2001 and December 2005. We evaluated annual changes in identified species of Campylobacter and their susceptibilities against antibiotics. Campylobacter jejuni (219 strains; 94.8%) and Campylobacter coli (12 strains; 5.2%) were identified to the species. Susceptibilities to four antimicrobial agents, minocycline (MINO), levofloxacin (LVFX), erythromycin (EM) and clindamycin (CLDM) were examined. The resistant rates of four antimicrobial agents in C.coli were significantly higher than that in C.jejuni. The susceptibility of C.jejuni to LVFX was variable, and MICs gave a bimodal distribution. The resistant rate against EM was estimated to be 9.2% in C.jejuni, 66.7% in C.coli. Moreover, young people ranging from 19 to 24 years old were predominant (47.7%) among the Campylobacter enteritis patients.
A 74-year-old woman with hepatitis due to hepatitis C virus followed up using oral predonisolone (3mg/day) for two years because of hypergammaglobulinemia-associated purpura reported fever and lumbago in February 2005. Upon admission in June, she was found in chest-computed tomography to have atelectasia in the right middle lung lobe and a nodule with a cavity in the right lower lobe. She tested positive for tuberculous glycolipid antibody. Gallium scintigraphy showed an abnormal accumulation in the lower lumbar vertebra. Magnetic resonance imaging showed abnormal enhancement at L4, L5, and their intervertebral disc. Mycobacterium intracellulare (M. intracellulare) was detected in blood culture, bronchoalveolar lavage, and a biopsy specimen from the intervertebral disc, yielding a diagnosis of disseminated nontuberculous mycobacteriosis (NTM) due to M. intracellulare. She was treated with clarithromycin (CAM), ethambutol (EB), and rifampicin (RFP), but EB and RFP were discontinued due to of the fever they induced. She was then treated with a combination of CAM, levofloxacin, and streptomycin and followed up as an out patient. Based on case reports of disseminated NTM infection in Japan, the prognosis is poor and a protocol must be established for its treatment.
A 58-year-old man admitted for fever, nausea, vomiting, and anuria after the start of HAART, including tenofovir, had a viral load of 1.1×105copies/mL, a CD4-positive lymphocyte count of 81/μL and serum creatinine of 0.8mg/dL before HAART. He underwent renal biopsy and temporary dialysis. We concluded that the patient had acute tubular necrosis because of potentially impaired renal function and the high amount of medication, and judging from the renal biopsy specimen and clinical course. When implementing HAART, physicians should be aware of and monitor potential patient misunderstanding of instructions on dosage and administration and for possible complications in medicinal combinations and potential side effects. TDF taken together with lopinavir may increase the plasma concentration of TDF or other medications that could worsen renal function. It should also be noted that renal dysfunction is a potential complication in the elderly.