Helicobacter pylori infection is implicated in the pathogenesis of extradigestive diseases such as acne rosacea and idiopathic chronic urticaria and autoimmune diseases such as autoimmune gastric atrophy, rheumatoid arthritis, anti phospholipid antibody syndrome, autoimmune thyroiditis, Sjoegren syndrome, Henoch Schoenlein purpura, and Type B insulin resistance syndrome. H. pylori eradication ameliorated the condition in some, but not all, of those with these autoimmune diseases. Recent studies primarily in Italy and Japan found that H. pylori eradication in those infected with chronic immune thrombocytopenic purpura (ITP) results in a persistent platelet count increase in over half of those treated, suggesting that although pathogenetic mechanisms underlying the relationship between H. pylori infection and autoimmune disease remain unclear, yet-unknown immunological events induced by H. pylori infection almost certainly occur in the development of autoimmune response. A majority of isolated H. pylori strains express human Lewis (Le^x and/or Le^y determinants and in some strains, Le^a,Le^b, sialyl-Le^x), and H determinants in the O-chain of the surface lipopolysaccharide. Previous studies showed that this molecular mimicry helps the bacterium evade host responses while evoking autoantibody responses to Le antigens. The anti-Le^y autoantibody is also reported to promote H. pylori adhesion to gastric epithelial cells, leading to development of gastric atrophy. Moreover, one can hypothesize that anti-Le autoreactive antibodies induced by H. pylori infection are involved in the development of autoimmune diseases, although no clinical studies showing that anti-Le immune responses are involved in the etiology of these autoimmune diseases have been conducted. Proving this hypothesis would require quantitative and qualitative analysis of autoantibodies and T cell functions to Le antigens. High frequent phase variation of Le structures in the O-polysaccharide of H. pylori may influence the immune response of patients to Le antigens.

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In Japan, only one vaccine is commercially available for rabies (Chemo-Sero-Therapeutic Institute (Kaketsuken), Kumamoto, Japan). It is a tissue-cultured inactivated vaccine made using purified chick embryo cells (PCEC-K) and administered subcutaneously using a schedule differing from that recommended by the World Health Organization (WHO). The current regimen of pre-exposure prophylaxis for rabies in Japan consists of three subcutaneous administrations of PCEC-K vaccine at 0, 28, and 180 days, requiring 6 months to complete. With the exception of a few imported cases, Japan is rabies-free and rabies vaccine production is small. Globalization should trigger rabies re-emergence in Japan, however, we would have to determine whether PCEC-K vaccine is effective through intradermal administration following the WHO-recommended regimen. In a study of 50 healthy volunteers without a history of rabies vaccination and all of whom provided, PCEC-K vaccine (0.1mL, 2 sites) was administered intradermal by on days 0, 7, and 28, and the viral neutralizing antibody level (VNA) against rabies virus was tested using the rapid fluorescent focus-inhibiting test (RFFIT) on days 0, 14, 28, 42, 56, 84, and 208. On day 42, all individuals showed adequate VNA (GMT : 3.21IU/mL), maintained for 84 days. VNA acquisition differed slightly with the PCEC-K vaccine lot and local adverse effects were minor. The intradermal PCEC-K regimen was found to be safe and effective in inducing adequate VNA using a smaller amount of vaccine within a shorter period.

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Parasitic infections are widespread in developing countries. Enterobiasis, caused by the Enterobius vermicularis nematode, is probably the most common helminth infecting the humanrace. We studied fecal specimens from Japanese residents in developing countries to determine the prevalence of E. vermicularis infection in this population. Individual specimens were collected using the cellophane tape method from Japanese residents in Asia,the Middle East, East Europe, Africa, and Central and South America in 2004. The specimens were examined in Japan. Subjects surveyed numbered 2247. The E. vermicularis infection rate was 0.62％. The most children infected with E. vermicularis ranged between 5 and 8 years of age. The prevalence of infection among Japanese children living in developing countries was 1.82％, higher than that in those living in Japan. Our results underscore the need to continue preventive measures such as health education to eradicate E.vermicularis infection in this group.

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Between 1992 and 2007, a total of 86 isolates of Salmonella enterica Weltevreden were obtained from clinical human samples (n＝41), 45 farm animals and their environment on 20 farms, including poultry (n＝25), beef cattle (n＝5), swine (n＝5), dairy cattle (n＝3), mice (n＝2), pony (n＝1), fly (n＝1) and feed samples (n＝3), in Okinawa Prefecture, Japan. Only seven isolates (8.1％) of the isolates were resistance to one or more antimicrobial agents tested ; six streptomycin (7.0％), six oxytetracycline (7.0％), two ampicillin (2.3％), two kanamycin, (2.3％), two chloramphenicol (2.3％), two suffamethoxazole?trimethoprim (2.3％), whereas all iolates were susceptible to gentamicin, sefuroxime, colistin, nalidixic acid, fosfomycin and ofloxacin. Drug resistance patterns showed six patterns ; ABPC-SM-KM-OTC-CP-ST, ABPC-SM-ST, SM-KM-OTC, SM-OTC-CP, SMOTC, OTC. Two ampicillin-resistant isolates harbored the blaTEM genes, streptomycin-resistant isolates (four aadA,twostrA), tetracycline-resistant isolates (two tetA,threetetB), chloramphenicol-resistant isolates (two catA1), respectively.

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Background : Kidney disease is a significant cause of morbidity and mortality among persons infected with the human immunodeficiency virus (HIV). However, epidemiologic and clinical variables regarding kidney disease have not been determined among HIV-infected patients in Japan. Patients and Methods : A cross-sectional study of 788 HIV-infected outpatients including 706 men was conducted in 2009. The patientʼs mean age and CD4＋T cell count were 46.2±11.8 years and 418±202/µL, respectively. Of them, 677 patients (86％) had an undetectable HIV-RNA level (＜50 copies/mL). Random urine and blood samples were collected to study the coexistence of chronic kidney disease (CKD). In addition, serum cystatin C was measured since it is considered to be an alternative marker of early kidney dysfunction in the HIV population. The estimated glomerular filtration rate (eGFR) based on serum creatinine was calculated using the 3-variable equation, proposed by the Japanese Society of Nephrology [eGFR (mL/min/1.73m²) ＝194×Serum creatinine^－1.094×Age^－0.287×0.739 (if female)]. CKD stages were classified based on the National Kidney Foundation guidelines. Results : The prevalence of CKD and that of CKD ?stage 3 was 14.9％and 9.4％, respectively. The proportion of each stage was as follows : stage 1, 15 patients (1.9％) ; stage 2, 28 patients (3.6％) ; stage 3, 66 patients (8.4％) ; stage 4, 1 patient (0.1％) ; stage 5, 1 patient (0.1％) ; and stage 5D, 6 patients (0.8％). Elevation of serum cystatin C (?0.9mg?L) was found in 23.3％. Comorbidities such as hypertension and diabetes were found in 55.4％and 27.0％in patients with CKD /stage 3, respectively. Urinalysis showed 71 patients (9.1％) with proteinuria and 44 patients (5.6％) with hematuria. Conclusion : CKD has become an important comorbidity for HIV-infected patients in Japan, a point that should be given more emphasis from public health perspective.

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We surveyed pediatrics bacterial meningitis epidemiology from January 2007 to December 2008 in Japan, with the following results : Cases numbered 287-160 male and 127 female-equivalent to 1.54-1.62 of 1,000 pediatric hospitalization per year. Children under 1-year-old accounted for the highest number of cases,which decreased with increasing age. Haemophilus influenzae was the most common cause of infection, followed by Streptococcus pneumoniae, group B streptococcus (GBS), and Escherichia coli. GBS and E. coli were major pathogens in children under 4 months of age, while H. influenzae and S. pneumoniae mainly accounted for those over 4 months of age. Susceptibility tests showed that 51％of H. influenzae isolates and 56.5％of S. pneumoniae isolates in 2008 were drug-resistant. Ampicillin combined with cephem antibiotics effective against GBS, E. coli, and Listeria, were mainly used to initially treat those under 4 months of age. In those over 4 months of age, carbapenem antibiotics are effective against PRSP and cephem antibiotics against H. influenza.

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We retrospectively reviewed the background, clinical features, blood tests, and complications in the 720 children seen for acute respiratory tract infection from July 2004 to December 2005. Of these, 75 (10.5％) were diagnosed with pneumonia due to respiratory syncytial virus (RSV) and 19 (2.6％) with pneumonia due to human metapneumovirus (hMPV) based on multiplex PCR analysis of nasopharyngeal samples. RSV was PCR-positive mostly in winter, -from November to January-, and hMPV mostly in spring, -from March to June. The mean RSV pneumonia group age was 1.3±1.4 years and in the hMPV pneumonia group 3.0±3.1 years, showing a statistically significant differences in the age of virus onset. Clinically the RSV group showed more rhinorrhea and wheezing (p＜0.05) and the hMPV group a higher maximum body temperature and a longer wheezing duration (p＜0.05). Fever, cough, vomiting, diarrhea, fever frequency, and C reactive protein level were similar in both groups (p＞0.05). Complication prevalence was 49.3％in the RSV group and 42.1％in the hMPV group. Acute otitis media was seen more often in the RSV group (32.0％) and febrile convulsion more often in the hMPV group (15.8％) (p＞0.05). These findings may be helpful in clinically diagnosing community-acquired pneumonia due to RSV or hMPV.

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Questionnaires on Tsutsugamushi disease (TD) and Japanese spotted fever (JSF) recognition, were distributed at lectures to the general public held in Sakai, Osaka (Lecture A), and Sumoto, Hyogo (Lecture B). Questions included knowledge of transmission routes, symptoms, and seeing physicians after having suspected symptoms. Hyogo had more reported cases of both diseases than Osaka. The response was 57.9％(113/195) to Lecture A, and 87.2％(61/70) to Lecture B. Analysis covered 89 Lecture A and 53 Lecture B respondents after excluding medical and public health specialists and those with unknown occupations. Disease recognition for JSF, knowledge of TD transmission routes, and symptoms of both diseases were better among Lecture B respondents -a statistically significant finding. The two groups saw physicians after having suspected symptoms at roughly the same rate. When these two groups were combined, those with knowledge of transmission routes or symptoms were significantly more likely to see physicians (p＜0.05).

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To make up for the lack of data on influenza-like illness (ILI), we studied patterns among 6,828 ILI patients seen at 34 healthcare facilities during the 2008-2009 influenza season in Shonai, Yamagata, Japan. Healthcare facilities were classified into 1) hospitals, 2) pediatric clinics, 3) internal medicine and pediatric clinics, 4) internal medicine clinics, and 5) others. The majority went to hospitals, but the highest percentage in all outpatient visits was 13.7％seen at pediatric clinics during the peak epidemiological week. Based on estimated incidence and hospitalization data for pandemic (H1N1) 2009 from Ministry of Health, Labour and Welfare, Japan, we estimated the number of ILI patients at 59,600-89,400 and the number hospitalized for pandemic (H1N1) 2009 at 895-2,240 in Shonai. If those with ILI follow the same consultation patterns as outpatients in the 2008?09 influenza season, this indicates an estimated 23,800-35,700 with ILI will go to hospitals and 20,040-30,060 to pediatric clinics during the H1N1 pandemic. This in turns means that an urgent need will arise for appropriate measures reducing this potentially huge burden during pandemic (H1N1) 2009 outbreak in Japan.

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We report a case of severe leptospirosis infection (Weilʼs disease) in Tokyo. A 54-year-old man admitted on September 14, 2006, for a 5-day inability to walk due to severe progressive bilateral leg pain, shoulder pain, and fever exhibited jaundice, conjunctival suffusion, hypoxia, andgraspingpaininthebilateralleg muscles. Laboratory findings showed severe liver damage, renal failure, leukocytosis, anemia, thrombocytopenia, elevated CRP, hyponatremia, and hypokalemia. Chest X-ray imaging showed interstitial infiltrates in the bilateral lung fields. After cefepime was initiated, he developed chills, fever, and hypotension due to Jarisch-Herxheimer reaction, necessitating respiratory support. Pulmonary hemorrhaging was also found. On hospital day 2, a urine polymerase chain reaction test for leptospira proved positive for the same base sequence as part of the leptospira gene. A microscopic agglutination test showed elevated antibody titers against Leptospira interrogans. Based on a diagnosis of leptospirosis, the man was treated with 2g per day of ceftriaxione for 2 weeks and recovered fully. The leptospira strain was isolated from rodents captured at his home, and we identified the same base sequence as from his urine sample. Reports shows, leptospirosis in Japan have decreased recently, but, as this case can still be seen even in Tokyo, and diagnosticians should maintain an awareness of possible significance in patients with typical findings for this disease.

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Corynebacterium pseudodiphtheriticum, one cause of respiratory tract infection, is rarely considered as a pathogen because it is among normal bacterial flora colonizing the oral cavity. We report two cases of C. pseudodiphtheriticum causing respiratory tract infection―an exacerbation of chronic obstructive pulmonary disease and pneumonia―, both in the presence of underlying respiratory disease. Both required antibiotics after first-line chemotherapy failed. Isolates were susceptible to β-lactams. Gram-staining of respiratory tract specimens is important in diagnosing this infection and determining appropriate antimicrobial use.

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Salmonella enterica serovar Senftenberg may very rarely cause splenic abscess, which can be diagnosed using gallium scintigraphy and drained. A 14-year-old boy admitted for stomachache, diarrhea and fever and diagnosed from his symptoms as having enteritis did not respond when treated with fosfomycin, meropenem, and clindamycin. A low-density splenic area seen in abdominal computed tomography on admission did not show contrast medium enhancement. Gallium scintigraphy on hospital day 10, however, showed abnormal splenic accumulation confirming the splenic abscess diagnosis, after which we punctured and drained the abscessout. S.Senftenberg was isolated from pus aspirated pus from the abscess, after which responded well to ceftriaxone and levofloxacin. Follow-up gallium scintigraphy on hospital day 24 showed that the abnormal splenic accumulation had disappeared, after which he has been followed up with abdominal ultrasonography and blood tests as an outpatient. He has experienced no relapse of splenic abscess.

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