A technology of genetic analysis for gastrointestinal infection has been developed. By using such technology, we can detect the pathogens earlier than the conventional microorganism tests. However, it is necessary to think about operation of such technology. Furthermore, it is important to understand the current status of diagnosis of gastrointestinal infection to think about it. The first questionnaire survey for diagnosis of gastrointestinal infection was conducted among member physician of the Japanese Association for Infectious Diseases (JAID) between January and February, 2020.

Antimicrobial use in dental outpatient care accounts for approximately 10% of the total clinical antimicrobial use in Japan. Accordingly, effective antimicrobial stewardship (AS) programs targeting dentists are needed to reduce the spread of antimicrobial resistance (AMR). To evaluate the antimicrobial prescription practices and investigate the effectiveness of AS in dental outpatient care, we conducted a questionnaire survey of dentists. Questionnaires were sent to participants of a lecture on antimicrobial usage in dental outpatient practice. The questionnaire included questions on the participantsʼ basic profile, knowledge of AMR, implementation of countermeasures for AMR, and most frequently prescribed antimicrobials. Furthermore, dentists practicing in-house dispensing (i.e., those who did not outsource dispensing to external pharmacies) were asked additional questions about the numbers and types of in-house antimicrobials prescribed as well as the reasons for their selection. We also asked about the timing and duration of prophylactic antimicrobial use for dental procedures. Fifty-four dentists responded to the questionnaire. Among the respondents, 83.3% indicated that they had knowledge about AMR, but only 42.6% had implemented specific countermeasures. The most frequently prescribed antimicrobials were cephalosporins (56.8%), followed by penicillins (29.5%) and macrolides (13.6%). Approximately 93.0% of the respondentsʼ clinics stocked cephalosporins, but only 48.8% stocked penicillins. The most common reason (63.6% of respondents) for selecting the in-house antimicrobials was “Learned from senior dentists.”The most common timing for antimicrobial prophylaxis was after a procedure (78.6%), and 79.6% of the respondents stated that the standard duration of prophylactic antibiotic prescription was 3 days. Although neither international nor domestic guidelines recommend prophylactic use of cephalosporins for dental procedures, these were frequently prescribed and were commonly available as in-house antimicrobials. In addition, the timing and duration of antimicrobial prophylaxis also deviated from the guidelines. These findings indicate the importance of further education to improve awareness about AS guidelines among dentists in Japan.

SARS-CoV-2 is detected in some newborns born to women with COVID-19, there still remains the possibility of mother-to-child transmission of COVID-19 after childbirth, and little is known about the clinical course of the infection or the infectivity of newborn infants with COVID-19. Also, there are few reports on how the spread of COVID-19 in the Newborn Intensive Care Unit can be prevented. Herein, we report the case of a newborn infant to a mother with COVID-19. Following the prearranged plan, we provided appropriate care separately for the mother and the baby, and adopted preventive measures under the assumption that the baby was infected. As a result, we were able to successfully prevent mother-to-child transmission as well as nosocomial infection.

A 22-year-old woman presented to our hospital with fever and headache. Ten days before the onset of symptoms, she had traveled to the Republic of South Africa for volunteer activities, where she had watched wild animals during a safari and walked in bush areas without taking insect-repellent measures. Physical examination revealed an eschar and lymphadenopathy in the right axilla. There were no remarkable laboratory abnormalities, except for mild leukopenia. The patient was started on oral doxycycline 200mg/day for presumed rickettsiosis. The symptoms resolved completely after a 7-day course of doxycycline. PCR assay of a specimen obtained from the eschar revealed Rickettsia africae, and convalescent serology revealed a significant increase in the titer of IgG antibody against R. africae. Based on the findings, we made the diagnosis of African tick-bite fever (ATBF). With increasing globalization in recent years, the number of ATBF cases around the world in on the increase. Clinicians should include ATBF in the differential diagnosis of patients with the relevant travel history and typical physical findings, such as an eschar.

With the introduction of Haemophilus influenzae type b (Hib) conjugate vaccine, while the incidence of invasive Hib disease has decreased dramatically, cases of invasive H. influenzae disease (IHD) caused by nontypeable and non-type b strains continue to be seen. As compared to the incidence of IHD in the United States and European countries, the incidence of IHD among children, especially that of IHD caused by nontype b strains, is quite low in Japan. Infections by highly resistant and multiple-resistant H. influenzae are issues of global concern.

The number of people traveling overseas from Japan is increasing and multidrug resistance bacteria is increasing in foreign countries. Therefore, there are some people who develop drug-resistant infections or carry such bacteria when receiving treatment at local medical institutions, and they are sometimes regarded as drug-resistant carriers. For patients with a history of travel, it is important to understand the risk of infection with drug-resistant bacteria prior to transfer, and to take appropriate measures. Herein, we present the cases of two patients who transferred from foreign countries for continuing medical treatment (medical evacuation). A 67-year-old man (Case 1) from Vietnam and a 54-year-old man (Case 2) from Bangladesh were transferred to our hospital as medical evacuees. Both had undergone invasive procedures or surgical intervention and multi-drug resistant microorganisms, including carbapenem-resistant Acinetobacter baumannii (CRAB), vancomycin-resistant Enterococci (VRE), Candida tropicalis,andKlebsiella pneumoniae were isolated on screening culture on admission. Although the patients were treated with broad-spectrum antibiotics used in combination, only Case 2 survived. Nosocomial transmission was prevented in both cases.

A preliminary report from a global study showed that remdesivir, a nucleoside analog pro-drug that was originally developed as a therapeutic drug against Ebola virus, may exert clinical efficacy in cases of COVID-19, by shortening the time to recovery. We had the opportunity to use this new drug in the treatment of 7 COVID-19 patients with respiratory failure.