This study was aimed at monitoring the adverse reactions to tozinameran (mRNA vaccine against SARS-CoV-2) in the vaccine recipients, and to investigate factors that might affect the risk of development of these reactions.

The adverse events (13 injection-site and systemic reactions) on day 1 (vaccination day), day 2, day 3, day 4, and day 5- were monitored in the employees of Fukuoka City Hospital who were vaccinated at the hospital between March 2021 and April 2021. The severities of the adverse reactions were also investigated.

The frequencies of virtually all the adverse reactions were the highest on day 2, both after the first and after the second dose. The incidence of adverse reactions on day 2 after the first (and second) vaccine dose was 86.0% (86.9%) for pain at the injection site, 33.2% (76.9%) for fatigue, 14.3% (56.9%) for headache, 37.0% (57.2%) for myalgia, 5.2% (51.1%) for fever, and 9.3% (43.9%) for joint pain. The proportion of recipients with any adverse reactions on day 5- was significantly higher after the second dose than after the first dose. The incidence of moderate to severe adverse reactions (except for pain and swelling at the injection site, and rash) was also significantly higher after the second dose. Differences in the incidence of adverse reactions by sex, age, and number of doses were observed. In particular, female sex, age 55 years or under, and second vaccine dose were associated with a significantly increased incidence of fatigue and headache. Female sex and second vaccine dose were identified as being consistently associated with an increased frequency of adverse reactions.

The results of the present study would be useful for predicting adverse reactions in prospective recipients, and for setting the vaccination day.

Acute respiratory infections such as bronchitis and pneumonia caused by Chlamydia pneumoniae are found not only in children, but also in the elderly, and there are often reports of intrafamilial transmission and small outbreaks. In addition, there are numerous reports of coinfections with C. pneumoniae and other bacteria or viruses. The clinical symptoms of Chlamydia infections are often similar to those of other respiratory infections, so that correct identification of the organism is important. The antibody titer test method, which is the general-purpose test method, has problems such as turnaround time, cross-reactivity, and sensitivity. We compared a novel C. pneumoniae detection assay based on the LAMP method with PCR-based assay and the antibody titer test. We evaluated its clinical usefulness of the new method by both prospective and retrospective studies. In the case of nasopharyngeal swab and sputum specimens, the results of this novel assay showed overall concordance rates of 96.9% (281/290) with the results of PCR assay. In the case of sputum samples, the overall concordance rate was 98.1% (51/52) with the results of PCR assay (prospective study only). On the other hand, the positive concordance rates with the antibody titer test, HITAZYME test and AniLab test were only 8.2% (4/49) and 11.8% (2/17) for nasopharyngeal swab specimens, and 20.0% (2/10) and 66.7% (2/3) for sputum samples, respectively. The antibody titer test is associated with a high frequency of false-positives, suggesting that serological diagnosis of C. pneumoniae infection using serology is problematic. Our novel assay is considered to show satisfactory performance for diagnosing C. pneumoniae infection from nasopharyngeal swab and sputum specimens.

In this study, evaluation of this novel assay was performed using the same sample by two extraction methods (general nucleic acid manual extraction reagent and automatic extraction using a fully-automated system, Simprova), and the concordance rates with those of the PCR-based assay were satisfactory.

The purpose of this study was to determine the pharyngeal colonization rate and serotypes of Streptococcus pneumoniae in healthy adults in our community by our modified PCR detection method. We set up a new surveillance system for surveying the pharyngeal pneumococcal colonization rate in healthy adults. The pharyngeal colonization rate and the serotypes of S. pneumoniae were investigated in 449 randomly selected healthy adults living in the community between 2014 and 2020, after the launch of the 23-valent pneumococcal polysaccharide vaccine (PPSV23). The 449 examinees included 361 adults aged 65 years or over, who were eligible to receive the PPSV23 vaccine. We performed PCR-based lytA detection using our modified procedure and found pharyngeal S. pneumoniae colonization in 207 examinees (46.1%), a significantly high rate as compared with that reported previously. We then determined the serotypes of the colonizing S. pneumoniae in the examinees by PCR using serotype-specific primers. The PPSV23 serotypes of S. pneumoniae were detected in the pharynx of 188 examinees. Serotype 18C was the most frequently detected, and serotypes 14 and 4 were also detected at a high frequency. The colonization rate of S. pneumoniae belonging to the PCV7 serotypes was 67.6%, while the rate for the PCV13 serotypes was 73.4%. Since the colonization rate of S. pneumoniae belonging to the PPSV23 serotypes was 88.9%, PPSV23 as well as PCV13 were found to be applicable to elderly people in the district.

Of the elderly examinees age 65 or over, 53.5% had received the PPSV23 vaccine before this study. The pharyngeal colonization rate of S. pneumoniae in the group that had already received the PPSV23 vaccine was 38.9%, whereas that in the group that had not received the PPSV23 vaccine was 49.4%. The colonization rate was not influenced by prior influenza vaccination or the contact frequency of the elderly examinees with their grandchildren. Conclusion; We found a much higher rate, as compared with previous reports, of pharyngeal S. pneumoniae colonization in local community-dwelling adults using our modified PCR method. We also found no apparent serotype changes in the S. pneumoniae colonizing the pharynx in local community-dwelling adults after the introduction of the PCV13 or PPSV23 vaccine.

We report a case of meningitis caused by Listeria monocytogenes in a 37-year-old man. He presented with the chief complaint of severe headache and fever, and his body temperature at presentation was 39.6°C. He gave a history of frequently consuming cheese and dry-cured ham, and also a history of heavy drinking. He was found to have a fatty liver, but laboratory examination revealed serum AST and ALT levels within their respective normal ranges, with slight elevation of the serum γ-GTP level. Gram staining of the cerebrospinal fluid showed Gram-positive rods and the fluid showed growth of Listeria monocytogenes on culture. The patient received intravenous antibiotic treatment for about 3 weeks, with significant improvement. Listeria monocytogenes, a facultative anaerobic intracellular Gram-positive organism, is a rare, but emerging foodborne pathogen, especially in high-risk groups, such as immunosuppressed patients, pregnant women, infants, and elderly people. A few cases of listeriosis have also been reported in previously healthy persons, and in such cases, it is speculated that the size of the bacterial inoculum may overwhelm intact immunity, leading to severe systemic illness.

The possible diagnosis of listeriosis should be borne in mind in patients presenting with relevant symptoms, not only in high-risk patients, as it has been so far, but also in relatively young people and patient groups without any conspicuous underlying diseases.

Patients who bypass medical institutions to obtain drugs to treat human immunodeficiency virus (HIV) infections often take the medications irregularly or self-interrupt their own therapy; this is problematic because it leads to drug resistance. In addition, the presence/absence of drug resistance is a determinant of the success of HIV treatment. Thus, testing for drug resistance is essential for initial drug selection.

We present the case of a highly drug-resistant HIV infection in a patient who irregularly took self-prescribed pre-exposure prophylaxis medications (lamivudine/zidovudine/nevirapine). We also showed that dolutegravir and darunavir/ritonavir might be effective as initial therapies in such patients.

We describe a case of asymptomatic lung toxocariasis in a man in whom severe eosinophilia (WBC count: 4,780 /μL; Eosinophils: 35.0%) detected during a medical check-up led to the diagnosis. The patient gave a history of habitually consuming the raw livers of cows, even after this was legally banned in Japan. His chest computed tomography (CT) revealed nodules with halos and ground-glass opacities in the lungs; the nodules migrated over time before treatment was started. Immunoserological examination by microplate-enzyme-linked immunosorbent assay showed a high optical density for specific antibody against Toxocara spp. excretory secretory antigen (TcES). A positive reaction for TcES was also confirmed by Western blotting. Based on these findings, the patient was diagnosed with lung toxocariasis. He was successfully treated with albendazole, which led to improvement of the eosinophilia and resolution of the abnormal opacities on the chest CT. The antibody titer against TcES also decreased. Even though ingestion of the raw livers of cows has been legally banned in Japan, the possibility of toxocariasis should be considered in the differential diagnosis of patients with severe eosinophilia.

We report the case of an 11-year-old girl who presented with nocardia brain abscess developing following intractable pneumonia. About 2 months before admission to our hospital, she developed pneumonia/lung abscess and was admitted to another hospital. She recovered after 3 weeks of antibiotic therapy, although the causative agent remained unknown. Three weeks after discharge from the previous hospital, she presented to us with involuntary movements of the eyes and neck. Gadolinium-enhanced magnetic resonance imaging of the brain revealed multiple masses with ring enhancement, surrounded by widespread edema, in the brain. As nocardiosis was considered in the differential diagnosis, biopsy of the brain mass was performed. Histopathology of the biopsy specimens revealed the diagnosis of brain abscess, and Kinyoun staining of material obtained from the abscess showed actinomycetes, which were identified as Nocardiabeijingensis, based on the sequence of the 16S rRNA gene. At first, she was treated with intravenous meropenem and sulfamethoxazole-trimethoprim (ST). Around 10 days after the start of the antibiotic therapy, she manifested side effects of ST. Then, after successful ST desensitization, with extension of the duration of administration from the original schedule, oral ST therapy was continued for 12 months. The abscesses eventually disappeared, with no recurrence, over 18 months.

We aimed to identify bacteria from companion animals in Japan using blood culture (BC) and determine their antimicrobial susceptibility. We compared dog/cat-origin BC results from 2017-2020 with those from 2014-2016. There was a significant increase in two set BC requests in 2017-2020. We observed a significant increase in 50 BC-positive cat samples. The percentage of Escherichia coli and Staphylococcus intermedius group (SIG) including extended-spectrum β-lactamase-producing E. coli and methicillin-resistant SIG in 2017-2020 were similar to those in 2014-2016. There were significant changes in the percentage of non-fermentative or anaerobic bacteria, including Cutibacterium acnes during 2017-2020. While the percentage of orbifloxacin resistant E. coli significantly increased, that of SIG resistant to gentamicin/chloramphenicol significantly decreased during 2017-2020. Our observations reveal the dog/cat blood-origin prevalence of bacteria and their antimicrobial susceptibility patterns, in Japan.