Background and purpose―Urinary tract infections (UTIs) are frequently complicated with bacteremia. Many cases of this infection are diagnosed and treated by general practitioners. We retrospectively examined the characteristics of UTIs presenting with urosepsis. Methods-We assigned 57 UTI patients into two groups according to the results of the blood cultures. Patients were admitted to the Department of General Practice at Sakai City Hospital from January 1, 2011 to December 31, 2011. We investigated the medical records retrospectively. Results―22 patients presented with urosepsis and 35 did not. Urosepsis in the patients was significantly associated with diabetes mellitus and ureteral stones (diabetes : 32 vs. 3％, p＝0.004 ; ureteral stone : 23 vs. 3％, p＝0.03). Nausea or vomiting and hydronephrosis were seen in about one half of the patients with urosepsis and were significantly more frequent（nausea or vomiting : 45 vs. 17％, p＝0.03 ; hydronephrosis : 36 vs. 11％, p＝0.04). Leukocytosis (white blood cell (WBC) count＞12,000/μL) or leukopenia (WBC count ＜4,000 /μL) were significantly more frequent (68％vs. 29％) but no significant association was found between urosepsis and body temperature or C-reactive proteins. Conclusions―Nausea or vomiting, ureteral stones or hydronephrosis, diabetes mellitus and leukocytosis or leukopenia had significantly higher rates in the patients with urosepsis.

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We developed an assay for rapid, specific detection of Shigella, Salmonella, and verotoxin-producing Escherichia coli O157 using the direct PCR analysis of mixed human fecal specimens. In this study, the sensitivity of the direct PCR assay for 50 mixed human fecal specimen was found to be 1.3, 0.42, and 0.76 colonyforming units/kit for Shigella sonnei, Salmonella Typhimurium, and verotoxin-producing E. coli O157, respectively. We compared the efficiency of the direct PCR method with the conventional direct agar plate method for 5000 fecal specimens from food handlers. The 50 mixed fecal specimens were concentrated to approximately 2.5％in distilled water and were heated to 95℃for 5min. Then, 5μL of the specimen supernatant was added to 45μL of the PCR mixture. Direct PCR results were evaluated by melting curve analysis. Among the 5000 fecal specimens from food handlers, Salmonella Infantis was isolated from 1 specimen using the direct agar plate method, and it was positive for the Salmonella gene (stn), as confirmed with the direct PCR method. Shigella, Salmonella, or verotoxin-producing E. coli O157 were not detected in the remaining 4999 fecal specimens with the direct agar plate method. However, Salmonella Enteritidis isolated by the enrichment culture method from 1 fecal specimen was positive for stn. Non-O157 verotoxin-producing E. coli isolated using direct horse blood agar from another fecal specimen was positive for stx. Moreover, enteroinvasive E. coli isolated using direct BTB agar from one fecal specimen was positive for ipaH. We conclude that the direct PCR assay can be applied as a new rapid screening method for personal hygiene among food handlers.

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A 41-year-old-man with sore throat and fever visited a nearby clinic. He was given antibiotics, but on disease day 11, the left side of his neck had swollen. Because chest CT on disease day 16 showed bilateral multiple pulmonary nodules, he was admitted to our hospital. He had septic pulmonary embolisms and thrombophlebitis of the left internal jugular vein, and Fusobacterium necrophorum was isolated from the blood and neck pus culture, and we diagnosed him as having Lemierreʼs syndrome. We administered piperacillin/ tazobactam and heparin, and his symptoms improved thereafter. Lemierreʼs syndrome is relatively rare but is increasing in recent years. We report herein this case and compare reported cases in Japan with those from overseas.

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An 81 year-old woman whose chief complaint was fever and general fatigue was admitted to our hospital in Kamiamakusa City, Kumamoto Prefecture in October 2013. She was suspected to have Japanese spotted fever, which is a local pandemic disease in Kamiamakusa, because wide-spreaded skin erythema appeared on the palms of her hands and soles of her feet several days after admission. Though there was a delay of more than 6 days after onset, we treated her with minocycline (MINO) and levofloxacin (LVFX). Unfortunately, she died following the occurrence of disseminated intravascular coagulation (DIC).We could conclude that the delay of proper treatment was most related to her death. In addition, despite of the severity of the disease, cases in whom treatment, survival cases were likely to treat with MINO could be started in the early stage (that is, within 5 days after onset) were likely to survive our hospital. Rickettsia japonica was detected from genetic (PCR analysis from blood and urine) and a serological test in this case. We report herein on the first fatal case of Japanese spotted fever in Kumamoto Prefecture.

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We report herein on the case of a 71-year-old woman hospitalized for continued postauricular pain of unknown origin with tongue deviation. In view of the severe inflammatory reaction and multiple nodular shadows of the lungs, the existence of infectious disease was indicated. A contrast-enhanced CT scan of the neck revealed a thrombosis of the right internal jugular vein, osteomyelitis of right temporal-occipital bone and upper cervical spine, and cellulitis of the adjacent soft tissue. Multiple nodular shadows of the lungs were suspected to be the result of a metastatic septic embolism. Hence, she was diagnosed with Lemierre syndrome. Following treatment with long course of antimicrobial therapy including beta-lactams and clindamycin,complete recovery in this patient was achieved.

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