Background : Lung abscess, although curable when caught early and treated appropriately, still may recur repeatedly or require surgery. We retrospectively assessed prognostic lung abscess factors and predictive recurrence factors. We evaluated comorbidity using the Charson comorbidity index (CCI). Methods : Subjects numbered 44 hospitalized for lung abscesses between June 2004 and May 2009 and classified as ; elderly (over 65 years) or non-elderly and cured treatment failed. Results : Mean age and the CCI of failed treatment were statistically higher than in cures at 80.8 years and 3.25 vs 64.1 years and 1.25 (p＜0.05). Abscess location, smoking habits, symptoms, white blood cell count and C-reactive protein did not differ on day 1. The causative organism, fistula presence at 65.6％ vs 45.5％ (p＝0.30) and lesion size at 59.8 mm vs 71.6 mm (p＝0.14) did not differ between groups, but the degree of lesion size reduction in treatment failures was lower than cures at 24.9％ vs 69.1％(p＜0.05). Conclusions : Lung abscess prognosis is thus adversely affected by age and comorbidity. In Japan, subjects having multiple comorbidities are expected to increase with aging. The degree of lesion size reduction appears to be a predictive factor in recurrence, underscoring the importance of follow-up in imaging, including chest computed tomography.

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Reverse transcription-loop-mediated isothermal amplification (RT-LAMP) assay we developed detects novel influenza A (H1N1) of swine origin and seasonal influenza A (H1N1 and H3N2) viruses. Individual primer sets targeting the HA gene for novel H1N1, H1N1, and H3N2 were newly designed to specifically detect these subtypes. No cross-reactions occurred among novel H1N1, H1N1, and H3N2, and 7 respiratory viruses-influenza B virus, influenza C virus, adenovirus, respiratory syncytial virus, metapneumovirus, parainfluenza virus, and rhinovirus―had no reaction to 3 RT-LAMP assays. RT-LAMP is assayed at 63℃for 40 min. In our RT-LAMP assay, Eriochrome Black T was added to the reaction mixture as an amplification indicator to detect virus genomes without using real-time turbidimetry. Positive reactions were indicated in blue and negative reactions remained purple. Of 139 samples from suspected novel H1N1 subjects tested by both RT-LAMP and real-time RT-PCR assay, 110 were positive in both assays. Two samples with low copy numbers were positive only in real-time RT-PCR assay. Of 27 novel negative H1N1 samples, 4 were positive for H3N2 on viral isolation and conventional RT-PCR assay. RT-LAMP assay for detecting H3N2 obtained the same findings. Our RT-LAMP assay is thus potentially useful in rapidly detecting influenza A virus such as novel H1N1, H1N1, and H3N2.

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Procalcitonin (PCT) was initially described as a calcitonin prohormone and later shown to be a useful marker for identifying bacterial infection and sepsis. We evaluated PCTʼs clinical efficacy in assessing bacterial infection severity, measuring PCT and systemic inflammatory response syndrome (SIRS) markers in 180 subjects with suspected infection. PCT titer was higher with increasing infection severity. PCT was thus useful in identifying those in critical condition.

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We tested for antimicrobial susceptibility of 1,317 clinical isolates of Haemophilus influenzae at a pediatric facility during 2004-2008. The percentage distribution of β-lactamase-non-producing ampicillin (ABPC) sensitive strain (BLNAS) was 47.8％, that of β-lactamase-non-producing ABPC-resistant strain (BLNAR) 32.7％ that of intermediately resistant strain (BLNAI) 8.9％ that of β-lactamase producing ABPC resistant strain (BLPAR) 6.8％ and that of clavulanic acid/amoxicillin resistant strain (BLPACR) 3.7％. BLNAR prevalence was 30％ between 2005 and 2008, increasing slowly. Though reduced susceptibility was seen in most β-lactams, piperacillin and tazobactam/piperacillin showed good susceptibility for H. influenzae. Of 1,317 strains, 83 (6.3％) were serotype b (Hib）. The frequency of Hib was high in sterilized site.

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Increased morbidity and mortality in pregnant women were reported following three major historical influenza pandemics. To prevent influenza infection during pregnancy, the Centers for Disease Control (CDC) and the American College of Obstetricians and Gynecologists (ACOG) recommend that all pregnant women and those intending to get pregnant during the influenza season be vaccinated. In 2004, they advised expanding vaccination guidelines from the second and third trimester to all three trimesters. We evaluated the safety of influenza vaccination during pregnancy in 182 subjects from 2007-2009. No adverse events were seen in pregnancy or fetal medical condition regardless of the pregnancy stage at which vaccine was administered.

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We report the confirmation of classical tsutsugamushi disease in August 2008. A 17-year-old woman seen for fever and eschar on the back reported having been bitten by an insect nine days earlier while fishing on the Omonogawa river. The suspected culprit was Leptotrombidium akamushi. During convalescence serum IgM and IgG antibody titers rose significantly against the Kato serotype antigen in indirect immunoperoxidase staining. Epidemiology, clinical symptoms and the antibodies detected suggested classical tsutsugamushi disease infection. Such disease transmitted by L. akamushi have not been reported since 1993 in Akita Prefecture. The public should thus be informed about Orientia tsutsugamushi prevention, in case such disease re-care in this area in the future.

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We report a case of chikungunya fever, rarely seen by Japanese physicians. A 35-year-old Japanese man admitted September 12 for a 3-day fever had traveled to Flores island, Indonesia, July 14-Sep. 10. He had bilateral wrist arthralgia, mild bilateral finger swelling, and nonitching skin eruptions on the face, trunk,and both arms. The viral chikungunya genome was identified in serum on Sep. 12. Negative serum antichikungunya virus IgM antibodies on Sep. 12 became positive on Sep. 14, yielding the suspected diagnosis. Given the many Japanese visiting endemic chikungunya fever areas, Japanese physicians must learn to recognize such cases among travelers returning from such areas with fever, arthralgia, and skin eruptions.

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Group B streptococcus (GBS), a major cause of neonate and pediatric sepsis and meningitis, rarely causes invasive infection beyond infancy. We report the case of a 10-year-old girl developing GBS bacteremia during corticosteroid therapy for chronic idiopathic thrombocytopenic purpura. Brought to the emergency room due to sudden high fever and abdominal pain, she was in compensated shock. White blood cell count was 19,600/mm³ and C-reactive protein 0.18mg/dL. She was diagnosed with sepsis and admitted for evaluation. Cefotaxime (100mg/kg/day) administration and fluid replacement were begun immediately after blood culture. Her condition improved over the next 6 hours and she was afebrile by the next day. GBS isolated from blood had a serotype of Ib. Based on routine susceptibility testing, this strain was susceptible to penicillin, cephem, carbapenem, erythromycin, clindamycin, and vancomycin, but resistant to quinolone, including levofloxacin (MIC≧8.0μg/mL) and gatifloxacin (MIC≧4.0μg/mL). She was discharged on hospital day 8. This is, to our knowledge, the first report of pediatric meningitis-free GBS bacteremia in Japan. Physicians should therefore be aware of the possibility of invasive GBS infection such as bacteremia in this age group, especially during immunosuppressive therapy, because epidemiological studies in the US have showed significant mortality in those aged 1 to 14 years old with invasive GBS.

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Case1 : A 74-year-old man having a weekʼs fever and diagnosed with a liver abscess was treated with several antibiotics and percutaneous liver drainage. His respiration gradually worsened and chest computed tomography (CT) showed right pleural effusion and a left-lung mass. Percutaneous fine needle aspiration of the pulmonary mass detected Entamoeba histolytica. Case2 : A 44-year old, zoo office worker admitted for fever and right chest pain was found in CT to have right pleural effusion and a mass with a liver abscess necessitating abscess drainage. Injected contrast medium detected a fistula connected to the right. Following surgical drainage, E. histolytica was detected from the resected lung. Both cases responded well to metronidazole.

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We report three cases of acute conjunctivitis due to different types of human adenovirus (HAdV) in medical workers. Case 1 : A 37-year-old man had epidemic keratoconjunctivitis and urethritis caused by human adenovirus type 37 (HAdV-37). Case 2 : A 27-year-old woman had acute conjunctivitis due to human adenovirus type 15 (HAdV-15). Case 3 : A 32-year-old woman had acute follicular conjunctivitis leading to a serotype of human adenovirus-53 serotype (HAdV-53). Note that HAdV-37 infection may cause keratoconjunctrivitis and urethritis. HAdV-15, -37, and -53 are important causative agents of nosocomial outbreak, and the application of a rapid diagnostic kit or PCR to a rapid diagnosis and proper infection-control measures can significantly reduce infection spread.

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