Kansenshogaku Zasshi
Online ISSN : 1884-569X
Print ISSN : 0387-5911
ISSN-L : 0387-5911
Volume 86, Issue 5
Displaying 1-9 of 9 articles from this issue
Original Article
  • Shin NIHONYANAGI, Yuzuru ADACHI, Tomoyo ONUKI, Nobuhiko NAKAZAKI, Yasu ...
    2012 Volume 86 Issue 5 Pages 555-562
    Published: September 20, 2012
    Released on J-STAGE: April 25, 2013
    JOURNAL FREE ACCESS
    We report herein on the isolation of three linezolid-resistant Enterococcus faecalis strains in 2011 from two pediatric inpatients at Kitasato University Hospital, Japan. Three linezolid resistant strains were isolated from two patients who shared the same room of a pediatric inpatient ward. Two linezolid resistant strains were isolated from patient A who had been treated with a total of 17,600mg of linezolid during 60 days of hospitalization (strains 1 and 2). The linezolid resistant E. faecalis persisted through the time that the patient had been discharged from the hospital. Another linezolid resistant strain was isolated from patient B who had no history of linezolid administration. The resistant strain in patient B phased out spontaneously. The minimum inhibitory concentration of linezolid in these strains ranged from 8.0 to 16.0μg/mL. PCR amplification of the chromosomal gene encoding domain V of the 23S rRNA and subsequent nucleotide sequencing revealed that all the strains had at least one G2576T mutation. The pulse-field-gel electrophoretograms of the DNA treated with the SmaI restriction enzyme showed an identical profile suggesting that they were derived from a single resistant strain. These results suggested that the resistant strain occurred in patient A and was transmitted to patient B within the inpatient ward.
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  • Kazushi MOTOMURA, Masaru YOKOYAMA, Tomoichiro OKA, Kazuhiko KATAYAMA, ...
    2012 Volume 86 Issue 5 Pages 563-568
    Published: September 20, 2012
    Released on J-STAGE: April 25, 2013
    JOURNAL FREE ACCESS
    Norovirus GII.4 is a major etiological agent of acute viral gastroenteritis worldwide. We examined GII.4 evolution using 277 near-full-length GII.4 genome sequences from human stool specimens collected at 20 sites in Japan between May 2006 and March 2010. We found outbreaks of 8 monophyletic GII.4 subtypes,among which a single subtype, termed 2006b, had continually predominated (222/277 : 80.7%). Four of the 8 GII.4 subtypes were chimera viruses of recently prevalent GII.4 subtypes. Notably, single putative recombination breakpoints with the highest statistical significance were constantly located around the border of open reading frame 1 (ORF) 1 and ORF 2 (P<0.0001), suggesting outgrowth of specific recombinant viruses in the outbreaks. The GII.4 subtypes had many unique amino acids at the time of their outbreaks, especially in the N-term, 3A-like, and capsid proteins. Unique amino acids in the capsid were preferentially positioned on the outer surface loops of the protruding P2 domain. These data and computer-assisted structural study of NoV capsid protein are compatible with a model of antigenic drift with tuning of the structure-functions of multiple proteins for the survival strategy of GII.4 2006b variant.
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  • Hajime YOKOI, Toshimitsu TANAKA, Ayano MIZUMURA, Tomoko KITAHASHI
    2012 Volume 86 Issue 5 Pages 569-576
    Published: September 20, 2012
    Released on J-STAGE: April 25, 2013
    JOURNAL FREE ACCESS
    The TaqMan-based quantitative real-time RT-PCR assay we developed uses specific probes to identify respiratory syncytial virus (RSV) and to distinguish RSV subgroups A (RSV-A) and B (RSV-B).
    We selected conserved regions of the F gene as assay targets and designed new primers and TaqMan MGB probes to detect RSV-A and B. RSV-A and B control plasmids confirmed real-time reverse transcription polymerase chain reaction (RT-PCR) reactivity whose efficiency was 2.5×101 to 2.5×107 copies/tube. The assay detection limit was 10 to 102 times higher than that of the conventional RT-PCR assay and was equal to the nested PCR assay. No cross-reactions occurred against other respiratory viruses, including influenza virus, metapneumovirus, measles virus, coxsackievirus, enterovirus, echovirus, mumps virus, parainfluenza virus, and rhinovirus.
    Of 154 clinical specimens derived from subjects with acute respiratory infection and tested by using both real-time RT-PCR and nested PCR, 40 were RSV-positive in both assays. Of these, 25 were identified as RSV-A and 15 as RSV-B by both assays. There was 100% concordance in RSV subgroup identification between real-time RT-PCR and nested PCR assays.
    These results indicate that our real-time RT-PCR assay can be used for rapid detection, quantitative analysis and subgrouping of RSV-A and RSV-B.
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  • Masaki YONEDA, Yousuke URANISHI, Akiko OKAYAMA
    2012 Volume 86 Issue 5 Pages 577-581
    Published: September 20, 2012
    Released on J-STAGE: April 25, 2013
    JOURNAL FREE ACCESS
    This study is based on clinical information on 894 subjects diagnosed with influenza (H1N1) 2009 in Nara Prefecture from June 15, 2009, to March 4, 2010, and from July 9, 2010, to March 6, 2011. Clinical data for 2009-2010 and 2010-2011 was compared.
    Results showed that 43% of 2009-2010 subjects were 0-9 years old and 38% were 10-19 years old. They also showed that 25% of 2010-2011 0-9 years old, 20% 10-19 years old, 20% 20-29 years old and 16% 30-39 years old. Both seasons showed a high percentage of subjects 0-9 years old. Numbers of subjects aged 20-39 years old increased in 2010-2011. Results thus suggest that an age shift occurredinsubjects, in Nara Prefecture. The most frequent symptom was fever, e.g., 38℃, in 88%. Upper airway inflammation was seen in 68%, lower airway inflammation in 20% and gastroenteritis in 6%. Lower airway inflammation decreased from 20% in 2009-2010 to 7% in 2010-2011. Neuraminidase inhibitor was prescribed for 408 (46%) subjects, oseltamivir for 262 (63%), zanamivir for 120 (29%), peramivir for 10 (2.4%), and laninamivir for 12 (2.9%). Two neuraminidase inhibitors were prescribed for 11 subjects. Oseltamivir prescription rates were lower among subjects 10-19 years old, following guidelines for the use of antiinfluenza drugs.
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  • Masayoshi SHINJOH, Satoshi IWATA, Yoshitake SATO, Hironobu AKITA, Keis ...
    2012 Volume 86 Issue 5 Pages 582-591
    Published: September 20, 2012
    Released on J-STAGE: April 25, 2013
    JOURNAL FREE ACCESS
    We conducted a pediatric survey of bacterial meningitis epidemiology from January 2009 to December 2010 in Japan, and obtained the following results for 314 cases (186 boys, 124 girls, and 4 with gender not reported). Children younger than one year old accounted for the majority of cases (51.2%, 161/314), and the incidence decreased with increasing age. Haemophilus influenzae (in children aged 1 month to 5 years old) was the most common cause of infection (53.2%), followed by Streptococcus pneumoniae (1 month to 12 years, 24.2%), Streptococcus agalactiae (0-4 months, 7.6%), and Escherichia coli (0-3 months, 3.2%). Susceptibility tests showed that 50.1% (78/153) of the H. influenzae isolates and 63.0% (46/73) of the S. pneumoniae isolates were drug-resistant. Combinations of ampicillin and cephem or carbapenem and other β-lactams were mainly used as the initial antibiotics for patients under 4 months of age (77.8%, 42/54), and a carbapenem and other β-lactam combination was used for patients aged 4 months and older (76.4%, 198/259). The final antibiotics for H. influenzae and S. pneumoniae were mainly cefotaxime (CTX) or ceftriaxone (CTRX) and carbapenem, respectively. The overall fatality rate was 2.0% (6/305). Since the Haemophilus influenzae type b vaccine (Hib vaccine) and the 7 valent pneumococcal conjugate vaccine (PCV7) are not widely used in Japan, only 5 patients in our cohort (all with meningitis not caused by H. influenzae) had been immunized with the Hib vaccine, and none had been immunized with the PCV7 vaccine. No remarkable changes in the characteristics of pediatric meningitis have been observed for several years in Japan.
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Case Report
  • Masanobu OHYA, Yasukiyo NAKAMURA, Masanori YOSHIDA, Hiroaki NAGANO, Ke ...
    2012 Volume 86 Issue 5 Pages 592-596
    Published: September 20, 2012
    Released on J-STAGE: April 25, 2013
    JOURNAL FREE ACCESS
    A case of nocardiosis with associated endobronchial excavated lesions is reported. A 79-year-old woman was diagnosed as having dermatomyositis in March, 2010. She was started on prednisolone (50mg/day) and was then switched to betamethasone due to lower limb edema and tapered to a dose of 2.5mg/day. A periodic chest X-ray examination in July, 2010, incidentally revealed nodular densities and associated cavities in the upper right lung field. On thoracoabdominal computed tomography (CT), bilateral pulmonary nodular shadows with various-sized cavities and multiple, new, intrahepatic, low-density regions were also identified. On bronchoscopy, a white, excavated lesion resembling an ulcerous lesion was observed in the left upper lobe bronchus, and a small exophytic lesion was observed in the right B6 bronchus. Nocardia asteroides complex was isolated from cultures of bronchial lavage fluid and sputum. The patient was treated with 4 weeks of intravenous imipenem (1.5g/day), followed by oral minocycline therapy (200mg/day) for 6 months, after which lesion resolution was confirmed on CT and treatment was discontinued. No recurrence has been reported in the roughly 18 months of follow-up to date.
    Nocardiosis results from infection with bacteria of the zoonotic, aerobic, Actinomyces genus and presents with disseminated lesions. Reported cases of human infection are increasing due to greater numbers of immunocompromised patients and improved diagnostic techniques. However, nocardiosis involving endobronchial lesions is extremely rare, and, to the best of our knowledge, the present case is the first report of endobronchial excavated lesions caused by nocardiosis.
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  • Nobuaki MAMESAYA, Hiromi TOMIOKA, Toshihiko KANEDA, Yoko KIDA, Masahir ...
    2012 Volume 86 Issue 5 Pages 597-603
    Published: September 20, 2012
    Released on J-STAGE: April 25, 2013
    JOURNAL FREE ACCESS
    Chronic necrotizing pulmonary aspergillosis (CNPA), also called semi-invasive pulmonary aspergillosis, was first described in the early 1980s as a distinct type of pulmonary aspergillosis. CNPA was an indolent, cavitary, infectious process of the lung parenchyma secondary to local invasion by Aspergillus species. Diagnosis is confirmed by pathological evidence of lung tissue invasion by the fungus. Clinical diagnosis by combined clinical, radiological and laboratory findings is needed because histopathological confirmation cannot always be obtained in the clinical setting. CNPA is recognized as a clinical syndrome in Japan, and has been poorly defined histologically. We report three autopsy cases of CNPA evaluated histopathologically. Subjects were middle-aged to older men with a medical history of pulmonary mycobacterial infection who presented with pulmonary or systemic symptoms. Radiologically, progressive upper lobe cavitary infiltrates were seen with mycetomas and infiltration in lower lung fields. Clinically, CNPA was diagnosed based on 2007 Japanese guidelines for the diagnosis and treatment of deep fungal infection. Subjects died of respiratory failure within one month to three years of diagnosis despite antifungal therapy including micafungin, voriconazole, or itraconazole combined with broad spectrum antibiotics. Autopsy findings showed cavities containing the fungus but no fungal invasion of viable lung tissue. The area of progressive infiltration revealed bacterial pneumonia, organizing pneumonia or organizing diffuse alveolar damage without Aspergillus. In conclusion, CNPA is a chronic progressive clinical form of pulmonary aspergillosis with significant morbidity and mortality.
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  • Aya IWATA, Kousaku MATSUBARA, Hiroyuki NIGAMI, Yoshiko UCHIDA, Kouji K ...
    2012 Volume 86 Issue 5 Pages 604-607
    Published: September 20, 2012
    Released on J-STAGE: April 25, 2013
    JOURNAL FREE ACCESS
    Group B Streptococcus (GBS) infection in infants aged over 90 days, known as ultra-late onset disease (ULOD), is extremely rare. We present 2 cases of ULOD and investigate etiology from both the host and microbiological aspects.
    Case 1, 99-day-old girl born in the late preterm, had a history of 6-hour fever. Bacterial meningitis was diagnosed and the patient was treated with intravenous ampicillin for 14 days. The isolate was serotype III GBS. Case 2, a 7-month-old girl with no medically significant history had an intermittent fever for 2 weeks before admission. Serotype Ia GBS was isolated from urine and blood, leading to a diagnosis of urosepsis. Intravenous cefotaxime was administered for 7 days. Both patients were discharged without any sequelae.
    We examined the host risk factors for ULOD development. (i) One subject had underlying preterm birth and the other had bilateral vesicoureteral reflux. (ii) Both had extremely low serum anti-serotype specific immunoglobulin levels, an important measure of protective immunity. The anti-type Ia antibody concentration was 0.24μg/mL and the anti-type III IgG antibody concentration was 0.25μg/mL.
    We employed multilocus sequence typing (MLST) to determine the genetic background of bacterial isolates. Sequence types (STs) of isolates were ST-335 (one allele variant of ST-19) and ST-23. ST-335 is an epidemic invasive GBS disease strain in Japan and is dominantly correlated with serotype III. ST-23 is highly associated with serotype Ia and is also a common invasive type in Europe, the United States and Japan. Our findings suggest that ULOD likely develops combined with underlying host disease, immunological factors and highly virulent strains. Continuous investigation of large numbers of cases is needed to better understand ULOD etiology.
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