Japanese doctors are somewhat unfamiliar with imported infectious diseases, however, the following imported infectious diseases are notable : cholera, which is currently endemic in Haiti and which there is a possibility of it being imported to Japan from endemic areas ; typhoid fever and paratyphoid fever, whose causative organisms showing low sensitivity to fluoroquinolones have become predominant ; rabies, which exhibits a high mortality ; avian influenza H5N1, which has the possibility of changing into a new type of human influenza ; chikungunya fever, in which the number of Japanese patients is increasing ; and cyclosporiasis, which led to a number of food poisonings in the USA and Canada, and as a growing number of Japanese travel abroad, the number of infected Japanese patients returning from endemic areas will increase. It is thus important to identify the presence of these diseases on diagnosis.
The first case in Japan of 2009 pandemic influenza A (H1N1) was reported in May, with pediatric hospitalization exceeding that of adults. We evaluated six adults hospitalized for 2009 H1N1 respiratory complications and compared the pandemic to seasonal influenza. Hospitalization was due to aggravated asthma in four of the six, two of whom had simultaneous pneumonia probably virus-caused, and two cases of bacterial pneumonia. Among the three seasons examined, the number of adults increased slightly but the hospitalization rate was low in 2009-2010. Respiratory complications such as viral pneumonia were not seen outside of 2009-2010. Attention should therefore be paid to respiratory complications in adults with pandemic 2009 influenza A (H1N1) virus.
An evaluation committee studied the relationship between initial treatment drug and prognosis in 339 of 466 subjects with bacterial meningitis treated at 108 institutions between April 2004 and January 2007, after excluding those with uncertain diagnosis or non-assessable records. Prognosis was considered unfavorable if meningitis sequelae such as quadriplegia, deafness, or epilepsy were present in 3－month follow-up; Based on this definition, 43 (12.7％) had a poor prognosis. No significant relationship was seen between unfavorable prognosis and age or causative pathogen. More had an unfavorable prognosis if treatment was initiated 4 days or later after onset. The percentage with an unfavorable prognosis was 6.4％ (4/64) in the group administered combined panipenem/betamipron (PAPM/BP) plus ceftriaxone (CTRX), 10.5％ (6/57) administered MEPM plus cefotaxime (CTX), 14.0％ (7/50) administered meropenem (MEPM) plus CTRX, and none of the 23 administered CTRX alone. The percentage with an unfavorable prognosis was 26.2％ (11/42) in those administered MEPM, significantly higher than that in those administered PAPM/BP plus CTRX,MEPM plus CTX, or CTRX alone (p＜0.05). We concluded that in initial treatment, it would be more desirable to use MEPM combined with another drug than alone.
We determined temporary changes in group B Streptococcus antimicrobial susceptibility and serotype distribution from perinatal strains. We examined invasive microbiological isolates from neonates with early-onset group B streptococcal disease (n＝14), and colonized isolates from those born uneventfully (n＝55) and from the genital tracts of pregnant and puerperal women (n＝198), collected between 1999 and 2009. All isolates were susceptible to penicillin. No significant differences were seen in susceptibility of 12 antimicrobial agents examined between invasive and colonized isolates. MIC50,MIC90, and resistance did not differ between stage I (1999-2005) and II (2006-2009) isolates. Serotype distribution significantly differed, however, serotypes III and Ia predominated among invasive isolates, while serotypes Ib and VI were common among their colonized counterparts. These findings suggest that to date, penicillin remains effective in intrapartum prophylactic use in colonized pregnant women.
Oka varicella vaccine was developed to confer active immunity to varicella-zoster virus (VZV) in immunocompromized and immunocompetent children. It is now used to prevent varicella in about 20 million people worldwide. Although VZV infection is relatively unstable compared to other viruses, cell-free virus is stabilized and lyophilized vaccine has been developed. Virus titers were evaluated in vaccine distributed to six clinics in 5 years. Yearly mean virus titers at the vaccine producer were 42,000～67,000 plaque-forming units per dose, corresponding to Oka varicella vaccine (Zostavax) used to prevent zoster and postherpetic neuralgia by Oxman et al. Virus titer was found to be stable during delivery to clinics. Virus titers of varicella vaccine were equivalent to Zostavax and vaccine delivered to clinics had enough virus titer to confer active immunity to VZV in this study.
Objectives : We studied physician partner testing (PT) practice and obstacles against PT in the clinical settings in Japan. Methods : Subjects were 513 physicians identified at HIV/AIDS sentinel hospitals. The questionnaire included demographics, current practices, factors for facilitating PT, experience in finding new HIV cases through PT, and information channels for PT. Results : Of physicians interviewed, 66％ did PT for all HIV cases, with 37％ finding 185 new HIV cases through PT. Physicians reported too little time for PT, together with a lack of legal authorization and standardized educational material. Of those interviewed, 78％ did PT orally. Conclusions : Detecting new HIV cases showed the effectiveness of PT in identifying and diagnosing HIV cases as early as possible in Japan. To expand PT legal authorization, standardized practices, and educational material all require development.
A 41-year-old man admitted for fever and respiratory failure had visited a local clinic 8 days earlier for fever and cough. Several days earlier, his 3 children had been diagnosed with influenza A by rapid influenza diagnostic test (RIDT) by nasopharyngeal swabs. At the clinic, RIDT done by nasopharyngeal swab two times on two consecutive days had negative results. On admission, chest computed tomography (CT) showed bilateral subpleural and peribronchovascular opacity, although RIDT by nasopharyngeal swab was negative. His respiratory distress worsened rapidly over the next several hours, necessitating intubation. Real-time reverse transcriptase-polymerase chain reaction (RT-PCR) with nasopharyngeal secretion was also negative. Despite test results, 2009 influenza A (H1N1) was strongly suspected due to chest CT and history. Oseltamivir was administered and respiratory distress gradually disappeared. He was extubated on hospital day 7. Bronchoalveolar-lavage collected on admission and sent to the laboratory for RT-PCR on hospital day 8, from which the result was positive for influenza A. He was discharged on hospital day 22.
Because the Bacillus Calmette-Guérin (BCG) prevents infants from contracting miliary tuberculosis and tuberculosis meningitis, BCG vaccination is recommended for those under 6 months old in Japan. Complications such as favorable local inflammatory reactions including redness, induration, and abscess formation may occur, but severe adverse effects such as osteomyelitis, periostitis, and disseminated BCG infection are generally rare. We report an 11-month-old boy with severe combined immunodeficiency dying of serious disseminated BCG infection despite anti-tuberculosis therapy and blood stem cell transplantation. He was vaccinated with disseminated BCG infection at 4 months before severe combined immunodeficiency diagnosis was confirmed by specific RD gene deletion based on allele-specific polymerase chain reaction. Although BCG is considered safe, we should keep in mind that subjects with immunological deficiency may suffer severe BCG complications.