Skin preparation for phlebotomy with 10% povidone-iodine requires 2 minutes for antisepsis. In cases of blood sampling from the vein for blood culture, waiting for 2 minutes has not necessarily been maintained in the Toyota Memorial Hospital. Accordingly, the hospital changed the antiseptic from 10% povidone-iodine to 1% chlorhexidine-alcohol that has a rapid sterilizing effect. After changing, a detection of coagulase negative staphylococci, a contaminating bacteria, in the culture bottle significantly decreased from 2.96% to 1.65% (p ＜0.0001) throughout the hospital. The decrease rate was not significantly different between the wards including the intensive care unit and the outpatient department including the emergency room. These findings indicate that 1% chlorhexidine-alcohol should be used for sterilizing the skin in blood sampling for blood culture through in all hospital departments.

We conducted a surveillance study in nursing home residents and hospital inpatients to evaluate the safety and prophylactic efficacy of laninamivir octanoate hydrate (hereafter, laninamivir) in high-risk patients who need maximum protection from influenza virus infection, including the elderly. This study was done as part of post-marketing surveillance of laninamivir according to the rules of the Japanese Ministry of Health, Labour and Welfare. The safety analysis population included 479 patients, and they were all aged 65 and older. No adverse drug reaction to laninamivir was reported. The efficacy analysis population (n = 440) included 17 patients (3.9%) who showed influenza symptoms within 10 days after prophylactic administration of laninamivir. The prevalence of influenza virus infection confirmed or suspected was 2.5% (11/440). These results were comparable to those obtained in the clinical trials for the prophylactic efficacy of laninamivir. These trials were carried out among healthy subjects. Patients with a positive PCR test result accounted for 5.2% (23/440) of the efficacy analysis population. A positive result was found in 7.4% (5/68) of “same room”and 5.3% (18/341) of “same floor.”The results confirmed the safety profile of laninamivir for post-exposure prophylaxis for influenza among the elderly and indicated that influenza virus infection may have spread among residents/inpatients by the time the first influenza virus infection is confirmed. Early prophylactic use of a single administration of laninamivir 40mg of or 20mg once daily for two days should be considered at such facilities.

Dengue is endemic in tropical and subtropical regions and the incidence is increasing worldwide. Whereas, the number of Japanese tourists travelling abroad is growing, particularly in young people. Here we report two cases of dengue fever in a family that were on a trip to Thailand. A 43-year-old male and his 16-year-old son were admitted to our hospital with sudden fever, followed by a rash and was later diagnosed as dengue after returning to Japan. His wife however, had no symptoms even though she was also bitten by mosquitoes in the jungle. This family was unaware of endemic diseases. The incidence of dengue has been increasing in international travelers, particularly in travelers in groups and in young people. Children have a higher risk of developing severe dengue in comparison to adults, and this is known to be a leading cause of morbidity and death in children. Therefore, it is important to routinely educate and publicize accurate knowledge about dengue in order to minimize the risk of infection and to control global outbreaks.

　Infant botulism is characterized by flaccid paralysis caused by the neurotoxin produced by Clostridium botulinum.

　We report herein on the case of a 10-month-old girl presenting with decreased activity. There was no history of perinatal or developmental problems. Disturbance of consciousness was suspected on admission. Her clinical manifestations of floppy infant syndrome, poor feeding, and weak cry had progressed over three days prior to admission. Although laboratory test results were normal, respiratory muscle palsy caused respiratory arrest 12 hours after admission. A definitive diagnosis of infant botulism was made when Type A botulinum toxin was detected in her feces.

　Infant botulism presents as flaccid paralysis without impaired consciousness. However, it is difficult to exclude coma in patients with flaccid paralysis, particularly in infants.

　Gemella haemolysans are gram-variable cocci arranged in pairs, tetrads, clusters, or short chains. These bacteria are commensals of the upper respiratory, gastrointestinal and genitourinary tracts, but may also cause infections including endocarditis.

　We here on report a 70-year-old female with a past history of mitral valve replacement for mitral valve stenosis who presented with several days of fever, dyspnea, left lower abdominal pain and anorexia. Chest X-ray showed congestion, and all blood cultures drawn at admission revealed gram positive cocci in clusters on day 3. Transthoracic echocardiography on day 3 revealed a mobile echogenic mass at the middle atrial site of the mitral bioprosthetic valve. As Staphylococcus aureus was initially suspected as a pathogen, vancomycin was administrated intravenously. However colony growth on blood agar medium revealed α-hemolysis and as such, the causative organism was “not identified”using conventional methods. Matrixassisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) and partial 16SrRNA gene sequencing identified the pathogen as G. haemolysans on day 5 after admission. We thus made the diagnosis of infective endocarditis caused by G. haemolysans. As head MRI (diffusion) revealed acute phase lacunar infarction, a combination of ceftriaxone and gentamicin was administrated for 5 weeks. Her symptoms improved gradually. Finally, the vegetation disappeared on transesophageal echocardiography on day 26 after admission. Enhanced computed tomography revealed no evidence of fresh organic infarction on day 42. There has not been any recurrence of infective endocarditis and no progression of mitral regurgitation for over a year.

A 79-year-old female with a history of liver cirrhosis was admitted to our hospital with dyspnea on exertion and right hip pain. Her chest CT showed a combination of pulmonary infiltration and multiple nodules and her head MRI showed 3 nodules in the cerebrum. We obtained bacteriological specimens from the hip abscess and lung abscess. Gram staining showed the presence of branching gram positive rods, which suggested Nocardia. We administered sulfamethoxazole - trimethoprim and imipenem/cilastatin, and her condition and radiology findings promptly improved. Nocardiosis is commonly seen in immunosuppressed patients but is also seen in the immunocompetent. Malignancy, HIV infection, diabetes mellitus and chronic pulmonary disease are common underlying diseases and some report the presence of nocardiosis together with liver cirrhosis. Disseminated nocardiosis has high mortality and it is important to make an initial assessment appropriately and to administrate proper antibiotic agents as early as possible. The gram-stain is an effective way to evaluate nocardia infection because a long time is usually needed to obtain the result of bacterial cultures.

A 88-year-old woman who was admitted to our hospital with aspiration pneumonia developed bacteremia with Bacillus cereus.She had cellulitis around the intravenous catheter on her leg. Then bacterial cultures were performed on her belongings and environment, and B. cereus was cultured positive from the towels brought by her family. At the same period of time, we experienced 4 other febrile cases in the same ward and B. cereus bacteremia was comfirmed in one case. Bacterial culture examination was performed to seek the source of the bacteria, and we had a positive result with B. cereus from the keyboard of a personal computer on the same floor. Horizontal transmission of B. cereus from the towels brought by the index patientʼs family was suspected.