本研究は，トジナメラン被接種者に出現した副反応の経日的な調査，および副反応の出現率に影響する共変量の探索を目的とした．

2021年3月から4月において，福岡市民病院にて本ワクチンが接種された職員を対象に，注射部位および全身の副反応（13項目）を接種当日（day 1），day 2，day 3，day 4，およびday 5以降ごとに調査した．

副反応の出現率は，ほとんどがday2において最高値を認めた．1回目接種後（および2回目接種後）のday2での出現率は，注射部位の疼痛が86.0%（86.9%），倦怠感が33.2%（76.9%），頭痛が14.3%（56.9%），筋肉痛が37.0%（57.2%），発熱が5.2%（51.1%），および関節痛が9.3%（43.9%）であった．2回目接種後は1回目と比較して副反応が遷延する頻度，および中等度以上の副反応（疼痛，腫脹，皮疹を除く）が出現した被接種者の割合がそれぞれ有意に高かった．各副反応の出現率に性差，年齢差，および接種回数による差のいずれかが存在することが認められた．特に全身倦怠感および頭痛の出現率は，女性，55歳以下の年齢および2回目接種のすべてにおいて有意に増加した．女性および2回目接種は，影響する副反応の出現率の上昇のみをもたらす共変量であった．

本ワクチンの副反応の出現率は，2回目接種翌日における女性および55歳以下の被接種者において高いことが示された．本研究結果は，本ワクチン被接種者の副反応の予測，および接種日の設定の際に有用であると考えられる．

肺炎クラミジア（Chlamydia pneumoniae）による気管支炎，肺炎などの急性呼吸器感染症は，小児だけでなく，高齢者への感染も認め，家族内感染や集団内流行もしばしば見られる．また，他の細菌やウイルスとの重複感染も少なくない．他の呼吸器感染症と同様の臨床像を示すことが多いため，その鑑別が重要となるが，汎用検査法である抗体価検査法には測定時間，交差性，感度などの課題がある．我々は遺伝子増幅法であるLAMP法を原理とした新規肺炎クラミジア検出試薬をPCR法及び抗体価検査法と比較検討し，その臨床的有用性を前向き研究及び後ろ向き研究で検討した．その結果，PCR法との一致性は鼻咽頭拭い液では全体一致率96.9％（281/290）と良好で，喀痰を対象検体とした前向き研究でも，全体一致率98.1％（51/52）であった．一方，抗体価検査法であるヒタザイム法，AniLab法との陽性一致率は，鼻咽頭拭い液でそれぞれ8.2％（4/49），11.8％（2/17），喀痰でそれぞれ20.0％（2/10），66.7％（2/3）となり，抗体価検査法の偽陽性と考えられるものが多く，血清診断による肺炎クラミジア陽性判定には問題があることが示唆された．LAMP法の試薬は，鼻咽頭拭い液又は喀痰を対象検体とした肺炎クラミジア感染の診断補助に有用な性能を有していると考えられた．

また，今回の研究では同一検体を用いて，LAMP法試薬を一般的な核酸抽出法による用手法と，全自動核酸検査装置Simprovaを用いた全自動検査の2通りで検討したが，その一致率は良好であった．

研究目的：改良PCR法を用いて地域健常者の咽頭肺炎球菌保菌率を調べ，さらに増菌培養/PCR法により決定した血清型分布におけるワクチン接種の影響を検討する．

方法：健常者測定のフィールドを新たに構築し，2014～2020年に地域健常成人449名（重複なし，65才以上361名）を調査した．肺球球菌検出はlytAのPCR検出で，血清型別は増菌培養/PCR法で行った．

結果：肺炎球菌咽頭保菌率は46.1%で，既報の培養法による成人保菌調査と比べて約10倍高く，保菌率は2017年まで増加傾向を示した．保菌者207名（被験者の46.1%）から188名の血清型を決定し，18C型が66名と最も多く，次いで14型，4型の順で，7価肺炎球菌ワクチン（PCV7）血清型保菌率は67.6%，13価肺炎球菌ワクチン（PCV13）血清型保菌率は73.4%であった．23価肺炎球菌ワクチン（PPSV23）の血清型保菌率は全保菌者中88.9%であり高いカバー率を示した．PPSV23接種を受けていた被験者は193名（65才以上被験者の53.5%），うち保菌率は38.9％で非接種者の保菌率49.4％よりも有意に低かった．

結語：改良PCR法により地域成人健常者の46.1％に肺炎球菌保菌が検出されたが，保菌株血清型にPPSV23接種による顕著な影響はなく，PPSV23のカバー率は90.8%だった．

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.