Despite blood culture's usefulness in antimicrobial therapy, fewer blood cultures and the infrequency of more than 1 set in cultures appear to be problems in Japan. Since June 2007 infection control team (ICT) recommended more than 1 set in blood sampling and intervention in positive blood culture, coagulase negative Staphylococci (CNS) has frequently been isolated from blood culture and its clinical significance is often difficult to judge. To determine the effect of ICT intervention, we evaluated the number of blood culture specimens, the frequency of more than 1 set in all blood culture specimens, and decision-making on antimicrobial treatment for CNS isolated retrospectively from blood. The study was divided into term I in August 2007 to July 2008, term II in August 2008 to July 2009, and term III in August 2009 to February 2010. We also analyzed how physicians treated infection or its suspicion after CNS and its drug susceptibility.
The monthly number of blood culture specimens increased from 40.3 to 51.6 between terms I and III. The frequency of more than 1 set in a single blood culture session rose significantly from 67% to 89% between these terms (p<0.001). The number of indeterminate also dropped cases significantly during these 2 terms from 27% to 6% (p=0.017). Infection or suspected infection cases - 45 of 49 - had central vein catheter implantation. In appropriate treatment by physicians in these cases also dropped significantly from 85% (11/13) to 45% (5/11) (p=0.043) during the same 2 terms.
ICT Intervention may thus increase the number of blood culture specimens, enable more than 1 set in blood sampling, make it easier to judge the presence of infection, and increase appropriate treatment by physicians. We thus believe that the quality of antimicrobial treatment could be improved through education such as ICT action.

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To determine seasonal changes in the incidence of invasive pneumococcal disease (IPD) in children, we retrospectively analyzed 69 children with 72 episodes of IPD, admitted to a regional center in Kobe, Japan, between July 1994 and June 2011. IPD episodes involved occult bacteremia (n =48), pneumonia (n=10), meningitis (n=10), periorbital cellulitis (n=3), and mastoiditis (n=1), including 3 cases of two IPD recurrences. We analyzed 5 IPD-associated factors previously documented in Europe and North Amrica with inconsistent results - 1) age at onset, 2) sibling number, 3) preschool sibling number, 4) subjectsʼ day care attendance, and 5) siblingsʼ day care attendance. We collected information on these factors by reviewing medical charts or contacting subjectsʼ parents or guardians by telephone.
IPD peaked bimodally in April and May (n=21) and in November and December (n=20), decreasing prominently between July and September (n=8). Subjects with IPD attending day care formed a significantly higher propotion during April and May than did those developing IPD during other months : 12/21 [57.1%]vs. 12/51[23.5%], odds ratio 4.3, 95% confidence interval, 1.5-12.8 ; p=0.006. Combined day care attendance among subjects with IPD and/or their siblings also differed significantly between these two groups : 17/21[80.9%]vs. 27/51[52.9%], odds ratio 3.8, 95% confidence interval, 1.1-12.8 ; p=0.027. Not significant differences were seen in age at onset, sibling number, or preschool sibling number. In contrast, however children with IPD onset during November and December showed no significant difference in association with any of the 5 factors, compared to children with IPD onset in other months.
Our findings showed a bimodal peak in IPD in children, the first and highest of which occurred in April and May and was significantly associated with day care attendance by those with IPD and/or their siblings. This first peak may, however, be related to circumstances in Japan, where preschool children usually enter day care center or kindergarten in April.

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We retrospectively analyzed the clinical aspects of inpatients with pneumonia caused by influenza (H1N1) 2009 after classifying them into two groups based on the presence or absence of respiratory complications.
The study population -121 (5.6%) of 1,777 subjects diagnosed with influenza (H1N1) 2009 using a rapid influenza diagnostic kit or real-time reverse-transcription PCR- were hospitalized from August 2009 to May 2010 as detailed from admission to discharge in hospital medical charts. Of these, 72 had respiratory symptoms and most -56, or 3.2%, of the total-were diagnosed with pneumonia in chest radiography. The mean age of those with pneumonia was 6.9 years, 35.7% had a history of bronchial asthma and 80.4% were admitted within three days of onset. Some 75% of those with pneumonia, or 42, had respiratory distress (SpO₂ ≤ 93%) requiring supplementary oxygen. Significant lymphopenia and neutrophil increase were observed in blood tests of those admitted within three days of onset. Almost all were given an antiviral agent for 5 days.
Among pneumonia cases, 14 (25%) also had severe respiratory complications such as pneumomediastinum and atelectasis, designated the complications group. They also had significantly lower oxygen saturation and significantly more elevated non-specific IgE on admission than those in the non-complications group (n=42). Those with complications were hospitalized for significantly longer, and were administered isopretenol. All inpatients with influenza (H1N1) 2009 were discharged as healthy.
Based on our retrospectively analyzed results in those with influenza (H1N1)2009 pneumonia, we concluded that the following medical circumstances covered by the Japanese insurance system help lead to good outcomes : i) visiting the hospital soon after onset, ii) being diagnosed early using a rapid identification kit, iii) under-going systemic whole-body management, and iv) being administered antiviral and antibacterial agents.

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We report a case of fungemia caused by Scedosporium prolificans, an emerging pathogen. An 83-year-old man with myelodysplastic syndrome (MDS) and agranulocytosis was admitted for pneumonia in January 2009. He was treated with meropenem, minocycline, and γ-globulin for pneumonia and G-CSF and platelet transfusion for MDS. Although he recovered from pneumonia as neutrophil count increased, intermittent fever continued.
On hospital day 17, blood culture yielded fungal colonies indicating S. prolificans. Voriconazole was started immediately, but the manʼs general condition deteriorated with cerebral infarction and he died of cerebral hemorrhage on hospital day 65.
Attention must therefore be paid to the increasing scedosporiosis incidence in Japan.

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A 47-year-old Chinese woman with no significant medical history admitted for sudden-onset seizures and transient right homonymous hemianopsia had moved from China to Japan 4 years previously. Contrast brain computed tomography (CT) showed multiple calcified nodular lesions with surrounding edema, one in the left parietal lobe being likely responsible for her visual symptoms. After admission, two painful intramuscular nodular lesions were found in her left lower limb. Histopathologically biopsy specimens from these lesions were not diagnostic. Serum antibody testing (ELISA) for Taenia solium, however, was positive, yielding a diagnosis of (neuro) cysticercosis. The woman responded well to albendazole and prednisolone treatment. In the two years since discharge, she has not developed any new symptoms or seizure recurrence. With increasing global travel, clinicians must thus consider the possibility of neurocysticercosis in cases of nodular brain lesions in subjects from areas where Taenia solium remains endemic.

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