Drug-resistant Enterobacteriaceae are distributed worldwide. In the present study, 1,577 extended spectrum β-lactamse (ESBL)-producing Enterobacteriaceae, 78 carbapenemase-producing Enterobacteriaceae, and 232 carbapenem-resistant Enterobacteriaceae were isolated in 22,241 clinical isolates of Enterobacteriaceae collected from 9 hospitals in the Hanshin area between January 2014 and December 2015. The resulting data were compared with those obtained in an earlier survey, conducted from 2010 to 2011. ESBL-producing Enterobacteriaceae accounted for 7.1% in the 2014-2015 survey, which was a significant increase from 3.5% in the 2010-2011 survey (p＜0.001). ESBL-producing Enterobacteriaceae, carbapenemase-producing Enterobacteriaceae, and carbapenem resistant Enterobacteriaceae were considered to be community-acquired in 23.2%, 12.8%, 11.2% patients, respectively (p＜0.001). Screening for carbapenemase production is important in order to apply appropriate clinical management and infection control measures.

International travelers are at a risk of infectious diseases, especially influenza virus infection, which is one of the most common respiratory infections in the world. Although the prevalence and seasonality of influenza vary in different countries and areas, there are few reports that have described the clinical and geographical characteristics of travel-related influenza infection in Japan. As physicians should pay attention to the local influenza patterns and frequency, we aimed to evaluate the epidemiology and characteristics of travel-related influenza infection.
Between 2012 and 2016, we retrospectively reviewed the patients who visited the Disease Control Center in the National Center for Global Health and Medicine, Tokyo, within 48 hours of visiting or returning to Japan, and were diagnosed as having influenza infection.
Patient data were collected from their medical records, including their age, sex, visiting date, duration of stay, destination, the purpose of travel, and initial symptoms.
During the study period, in the travel-related patients with fever or respiratory symptom, 56 (4.2%) comprised (confirmed) cases of influenza infection. Among those 56 of patients, 27 (48%) were men with a mean age of 37.8 years [Standard deviation = 17.7 years], and 49 (88%) were Japanese. Forty-four patients (79%) were diagnosed as having influenza type A. There were no significant differences in the primary symptoms of type A and B influenza. The most frequently reported area was Asia (80%), mainly, Southeast Asia (39%), followed by Africa (11%) and South America (5%). The number of patients peaked in the winter and summer seasons and, patients traveling from Southeast Asia were dominant in all seasons and months. None of the patients required hospitalization or were suspected of having avian influenza.
In conclusion, case of influenza infection among international travelers are reported throughout the year in Japan, even in non-epidemic seasons. Especially, influenza in patients traveling from Southeast Asia is more frequent than in those from other regions. In accordance with the epidemiological situation, proactively suspecting influenza infection and making an early diagnosis are important factors to prevent any epidemic influenza. Further studies are needed to elucidate the accurate epidemiology of travel-related influenza.

A 71-year-old woman who was being treated for dermatomyositis with a corticosteroid developed multiple lung nodules. A biopsy from the right middle lung lobe revealed a lung adenocarcinoma harboring the EGFR mutation. During chemotherapy with gefitinib, she suddenly presented with acute respiratory failure. Chest computed tomography did not reveal any abnormalities other than pulmonary nodules, which are signs of metastasis of lung cancer, so we could not determine the cause of respiratory failure. She died within four days after the onset of respiratory failure. An autopsy revealed pulmonary cryptococcosis consisting of multiple lung nodules and intracapillary cryptococci in multiple organs, in addition to the right middle lobe lung adenocarcinoma accompanied with bone metastasis. Intracapillary cryptococci are a rare pathological condition resulting from disseminated cryptococcosis. Intracapillary cryptococci could lead to acute respiratory failure by obstruction of pulmonary capillaries, and would be difficult to diagnose using computed tomography.