A technology of genetic analysis has been applied for clinical use. By using such technology, we can detect the pathogens earlier than the conventional microorganism tests. In order to understand the current status of the genetic test for infectious diseases, a questionnaire survey was conducted among member physician of the Japanese Association for Infectious Diseases (JAID) between November 4 and December 15,2016.
Valid responses were obtained from 4.5% of questionnaire recipients (282/6,227 physicians). When restricted on infectious disease specialists certified by the JAID, valid responses were obtained from 13.8% (143/1,037). A percentage of the respondents who answered the genetic testing in hospital was important and necessary for the diagnosis of infectious diseases and infection control was 93.4% and 90.8%, respectively. Of the respondents, 90.8% answered that the genetic testing in hospital was useful for rapid detection of the difficult-to-culture pathogens. However, there was significant differences between infectious disease specialist and non-specialist in a percentage of respondents who answered that it is useful for detection of drug-resistant or virulence genes (83.9% in specialists and 72.7% in non-specialists, respectively ; p=0.022). A percentage of respondents who performed the genetic testing for infectious disease in hospital was 47.2%. The items that are frequently performed were Mycobacterium tuberculosis (75.2%), non-tuberculosis mycobacteria (54.1%) and Mycoplasma pneumoniae (30.8%). The drug-resistant genes, such as methicillin-resistant gene,ESBL genes and carbapenemase genes were performed in over 20%. The reasons not to implement the genetic testing was high-cost to perform and expensive equipment (72.9%), manpower shortage (65.1%), and no insurance coverage (48.1%). There were few respondents who answered the reason as no needs to perform it in hospital (4.7%). The demand items for insurance coverage were carbapenemase genes (56.0%), ESBL genes (55.7%) and methicillin-resistant gene (45.7%). In this questionnaire survey, we investigated the current status of fully automated platform for genetic testing. A percentage of respondents who answered to implement the fully automated platform was only 7.4%. Among the respondents who answered not implementing it, 11.0% (28/255) answered to plan an implementation. The reasons not to implement were high-cost perform (70.2%), circumstances of the laboratory (68.0%) and no insurance coverage (52.9%). A percentage of respondents who answered no needs to perform in hospital was very low (8.0%). In addition, approximately 90% of all respondents answered that the fully automated platforms were useful for diagnosis of infectious diseases.
This questionnaire survey revealed that the most physicians recognized the importance and necessity of genetic testing for infectious diseases. However, half of them could not perform it in hospital due to highcost and no insurance coverage.
Since the introduction of the Haemophilus influenzae type b (Hib) conjugated vaccine for infants, the incidence of invasive Hib disease in children has decreased dramatically, while non-typeable and capsulated strains other than serotype b which were not contained in the Hib vaccine were thought to be increasing. We have studied invasive H. influenzae disease of all age group who visited our hospital. A total of 20 patients were included as analysis objects between January 2003 and October 2015. Of the 20 patients, 11 (median age 2 years old, range 13 days-5 years old) were children and 9 (median age 71 years old, range 29-88 years old) were adults. All pediatric cases were documented before 2010, in which the analyzed capsular typing of those were all type b. However 8 of 9 cases of adult patients occurred after 2012 and the capsular typing of these cases was non-typeable H. influenzae (NTHi) (6 cases), type e (1 case) and unknown (2 cases). Infected organs were meningitis (5 cases), pneumoniae (5 cases), epiglottitis (5 cases), cholangitis (3 cases) and intra-uterine infection (1 case). Invasive NTHi infection may have increased after the routine vaccination with the Hib vaccine for infants.
A serological assay was conducted to investigate Yersinia pseudotuberculosis infections. The assay was based on agglutination against whole cell antigens of Y. pseudotuberculosis serogroups 1 to 6. Samples with a titer at dilution of ≧1：160 were diagnosed as positive. A total of 1,308 serum samples was examined from 654 subjects most of whom were pediatric patients. Ninety-eight subjects (15.0%) were seropositive for single O-antigen. The serogroup O：5 was the largest serogroup including 42 subjects (42.9%). From among 22 subjects whose stool or blood samples or whose associated environmental water samples were culture positive for Y. pseudotuberculosis, 18 (81.8%) were seropositive against the corresponding serogroups to the respective isolates. The positive rate of serum samples was higher in the suspected Y. pseudotuberculosis infection group (18.5%) than in the suspected Kawasaki disease group (10.9%) (p＜0.01). The frequencies of diarrhea, erythema nodosum, abdominal pain, renal failure, onset in the family and use of natural water sources were significantly higher in the seropositive than in the seronegative group (p＜0.005).
Although intramuscular benzathine penicillin G is a standard treatment for syphilis in many countries,it is not available in Japan. Instead, The Japanese Society for Sexually Transmitted Diseases recommends a therapeutic regimen using 1,500mg of oral amoxicillin (AMPC) for syphilis treatment. However, the efficacy of this treatment regimen has not been evaluated sufficiently in the past literature. We conducted a retrospective observational study including 63 patients who were diagnosed as having syphilis (47 HIV patients；median age 40 years) and treated with 1,500mg of oral AMPC. Treatment success was defined as a 4-fold decline in the rapid plasma reagin (RPR) titer within one year after the initiation of the treatment. The overall treatment efficacy was 95.2% (95% confidence interval (CI), 86.7-99.0%). The efficacy for HIV patients, non-HIV patients, early syphilis and late syphilis was 95.7% (95% CI, 85.5-99.5%), 93.8% (95% CI, 69.8- 99.8%), 97.8% (95% CI, 88.5-99.9%) and 88.2% (95% CI, 63.6-98.5%), respectively. Our data suggests that 1,500 mg of oral AMPC was shown to be effective for syphilis.
Subject：An information gathering system for infectious agent surveillance was strengthened by revision of an act on prevention of infectious diseases and medical care for patients with infectious disease.
We investigated the influence of the revision on sentinel surveillance of category 5 viral diseases.
Method：In 81 local public health institutions in Japan which carry out viral examinations questionnaires were conducted which investigated the number of specimens of viral disease obtained in each institution from April to September of each year from 2014 to 2016. The number of specimens before and after institutional revision were compared.
Result：The number of specimens of influenza significantly increased following revision of the system. However, there was no common increase in other diseases in pediatric subjects after the revision.
Conclusion：The increase of the number of the specimens in the influenza surveillance was regarded as a result of national standardization following the revision. On the other hand it was thought that the revision had little influence on other virus disease surveillance results.
A 48-year-old HIV-positive female had discontinued her hospital visits for about 1.5 years. Immediately after returning from a 1.5-month stay in India, she suffered from diarrhea about four times a day and, therefore, visited our outpatient department. Liver dysfunction was noted on blood sampling, and bileduct dilatation was detected by magnetic resonance imaging (MRI)．Using feces, duodenum, and large intestine specimens, neon blue autofluorescence of the oocyst wall was detected under UV excitation with a fluorescence microscope. These specimens were molecularly biologically identified as Cyclospora cayetanensis using PCR sequencing. Since approval could not be obtained for the treatment of Cyclospora, only antiretroviral therapy (ART) was resumed. The CD4-positivity was above 180/μL for about 4 months, but alkaline phosphatase became exacerbated. Subsequently, the treatment of Cyclospora was started by prescribing trimethoprim/sulfamethoxazole (ST) (80/160mg, 4 tablets) for 10 days. The liver dysfunction and diarrhea were promptly alleviated, and the bileduct dilatation was improved on MRI.
In the present study, biliary disease and enteritis due to Cyclospora could be effectively treated with an ST formulation. Although it is well-known that C. cayetanensis causes not only enteritis, but also bile duct/biliary tract lesions in immunocompromised HIV-infected patients, such cases have rarely been reported in recent years.
A 47-year-old man was referred to our hospital for gradual onset of chest and back pain associated with fever and chills. Chest computed tomography demonstrated a giant bulla with an air-fluid level on the left lung. Culture of sputum, blood and pleural effusion were negative. Empiric treatment with broad spectrum antibiotics was initiated under a diagnosis of an infected bulla, with no resolution of his fever and laboratory data. Bulla resection with video assisted thoracic surgery was performed,and Nocardia nova was isolated from the bulla fluid. Histopathology of the surgical specimen showed inflammatory cells and granulomatous lesion with central necrosis. Nocardia species should be considered as a pathogenic bacterium of infected bullae.
Shewanella haliotis is an aquatic gram-negative rod, recently isolated from the gut microflora of abalone (Haliotis discus hannai) in 2007. Human disease caused by this species is extremely rare. We report the case of a 66-year-old man undergoing hemodialysis who was admitted for necrotizing soft-tissue infection on the left hand with sepsis. He had a history of liver cirrhosis and colon cancer. Clinical findings showed swollen erythema with purpura and bullae on his left hand. Gram-negative rods were detected in the blood culture. The colonies grew on the Thiosulfate Citrate Bile Salts Sucrose medium (TCBS), and produced H2S on the Triple Sugar Iron (TSI) agar. The pathological features presented hemorrhagic necrosis with an infiltration of neutrophils and lymphocytes in the subcutaneous tissue. S. haliotis was identified by 16S rRNA sequence analysis, nevertheless automated identification in the hospital showed Shewanella algae. Ceftazidime and isepamicin administration for 1 week and cefozopran and isepamicin administration for 1 week followed by oral levofloxacin for 1 week cured the sepsis, and furthermore, topical ointment completely cured the skin ulcer over 2.5 months. We should be aware that human infection caused by S. haliotis can result in severe necrotising soft-tissue infection with sepsis.
Cerebral syphilitic gumma is classified as tertiary syphilis. It has become rare owing to antiluetic treatment, but there are some cases reported recently which developed in less than 1 year after the suspected syphilis infection. We report herein on the case of a 41-year-old HIV- negative man who attended our hospital due to convulsions, diagnosed noninvasively as having cerebral syphilitic gumma, and treated effectively during suspected primary syphilis following supposed infection 9 months previously.
Herein we present the case of a 19-year-old healthy Filipino woman with a 4-day history of fever and headache, who upon admission had a dry cough and rashes distributed on her trunk and proximal limbs. The patient had recently traveled to the Philippines, 1-4 weeks prior to admission, where she had been in close contact with cats and rodents. Laboratory tests showed thrombocytopenia, and elevation of liver enzyme and C-reactive protein levels. Subsequent polymerase chain reaction (PCR) tests for Dengue, Chikungunya,and Zika virus, respectively, and Giemsa-stained blood smear for malaria were negative. Her chest Xray was normal. Our initial diagnosis was typhoid fever. However, even after administering ceftriaxone, the patientʼs fever and headache remained unimproved. A PCR analysis for Rickettsia species was then performed on day 6 of hospitalization, which revealed the presence of Rickettsia typhi. Therefore, the patient was diagnosed as having murine typhus, and minocycline treatment was started on day 9 of hospitalization. The patientʼs clinical symptoms then continued to improve until discharge on day 11 of hospitalization. Diagnosing murine typhus is difficult in clinical practice because of the non-specific symptoms. Respiratory symptoms and rashes spreading to the extremities will be indicators in distinguishing murine typhus from typhoid fever.