Studies on the detection of SARS-CoV-2 by qualitative antigen tests and RT-PCR have been conducted. However, the relationship between virus detection in infectious patients and prevention of nosocomial infections is still unclear. In our study, samples for qualitative antigen tests and RT-PCR were collected on the day of admission from 1,101 patients admitted between February 21, 2021 and October 8, 2021, to determine retrospectively how each of the tests contributed to the prevention of nosocomial transmission of SARS-CoV-2 infection. There were seven patients with different test results between the two test methods: all were negative by the qualitative antigen test and positive by RT-PCR. There were nine patients in whom both tests were positive and 1,085 patients in whom both were negative. Six of the seven patients who tested negative by the antigen test and positive by RT-PCR were ultimately determined to be non-infectious. The remaining patient was determined to be infectious, and this patient had pneumonia. Thus, for detecting infectious patients, it appears that RT-PCR is more useful than the quantitative antigen test when the pretest probability of SARS-CoV-2 infection is high based on the symptoms or exposure status, whereas the quantitative antigen test could substitute for RT-PCR in situations of low pretest probability in the absence of symptoms and exposure.
Background: The usefulness of genome analysis of Mycobacterium tuberculosis (Mtb) for contact investigation of tuberculosis (TB) has not been evaluated in Japan.
Methods: A comprehensive molecular investigation of the epidemiology of TB based on analysis of the variable number of tandem repeats (VNTR) was performed in Yamagata Prefecture from 2009 to 2020. Among the clusters observed, comparison of the Mtb genome was performed among eight clusters (19 patients), including eight patients with TB reported in 2020. The results were evaluated in comparison with the results of active epidemiological surveys conducted by public health centers.
Results: Genome comparison of Mtb strains revealed that only 9 (47.4%) of the 19 strains were identified as genetically related strains (5 single nucleotide variants [SNVs] or 6-12 SNVs with confirmed epidemiological relationship among patients). Only half of the clusters contained genetically related strains. Epidemiological relationships were found in six (66.7%) out of nine patients with genetically related strains, but not in all 10 patients with non-related strains (SNVs≥13) (p< 0.01).
Conclusion: Mtb genome analysis with high discrimination power could identify genetically related strains, which strongly suggest epidemiological relationships among patients from the same VNTR cluster. The nature of genome analysis is expected to enable public health centers to allocate their human and time resources appropriately in active TB contact surveys.
We conducted a retrospective study of pediatric inpatients with coronavirus disease 2019 (COVID-19) in 38 medical facilities, including in all secondary medical care areas in Chiba Prefecture affiliated to the Chiba Pediatric Disaster Network. The first five waves of the pandemic (between March 2020 and December 2021) included 155 cases (median age, 6 years 10 months) and were noted in the observational study, and the sixth wave (between January 2022 and May 2022) included 354 cases (median age; 3 years) were noted on the mailing list. Comparison of the peak months showed that there were five times as many inpatients in the sixth wave as in the first to fifth waves. In the first to five waves, 90% of the cases showed mild symptoms (fever, upper respiratory tract infection, asymptomatic), and there was only one case of severe pneumonia. On the other hand, in the sixth wave, there was a higher number of cases hospitalized with convulsions (19.5%) or croup (4.5%). Status epilepticus and cluster cases accounted for 42% and 30.4% of the patients with seizures, respectively, and three cases were diagnosed as having encephalitis/encephalopathy. A total of 13 cases (3.7%), including the three cases, required intensive care or equivalent treatment. In the sixth wave, only 2.6% of patients aged 5-11 years and 40% of patients aged ≥12 years had received both primary doses of the vaccine against COVID-19. Therefore, during the Omicron wave, the symptoms of pediatric inpatients with COVID-19 changed as compared with those during the previous waves. The vaccine coverage among hospitalized cases was low, suggesting the importance of promoting vaccination of children to prevent severe COVID-19.
We report a case of an 82-year-old woman who developed an atraumatic rectus sheath hematoma (RSH) during the treatment for severe Japanese spotted fever (JSF). She had fever, skin rash, and eschar, thrombocytopenia, elevated liver enzymes and inflammatory markers. Rickettsial infection was considered likely, empiric antibiotic therapy was initiated with intravenous minocycline (MINO) and meropenem for septic shock. On day 2, vancomycin and noradrenaline were added due to decreased blood pressure and loss of consciousness. On day 4, she was definitively diagnosed as JSF by reverse transcription PCR. Only MINO was continued due to stabilization of her condition. However, anemia and thrombocytopenia persisted on day 5. CT scan on day 5 revealed a 3cm expanding RSH with extravasation, not present on day 4. She was transported by helicopter for transcatheter arterial embolization.
The number of JSF cases is increasing every year in Japan. Some JSF cases lead to DIC. On the other hand, RSH is a relatively rare disease caused by sudden muscle rupture or disruption of the upper and lower abdominal wall arterioles.
We suspected hematoma formation in our patient because of the persistent anemia and thrombocytopenia, which was different from the usual course of improvement in JSF. Continued monitoring with attention to laboratory findings led to early detection. We conducted a retrospective review of 13 patients with JSF at our institution for the past 10 years.
To our best knowledge, this is the first report of JSF complicated with RSH.
We report the case of a Vietnamese man in his twenties who presented with a few days' history mild fever and severe pain in the right hypochondrium. Laboratory findings showed elevated levels of the hepatobiliary enzymes and marked peripheral blood eosinophilia. Abdominal computed tomography (CT) showed map-like low density areas with unclear boundaries under the liver capsule. Suspecting a parasitic infection, we conducted enzyme linked immunosorbent assay (ELISA) for a panel of parasite antigens, including Fasciola antigen. However, no positive results for any parasites were obtained. Re-examination by contrast-enhanced CT revealed that the hepatic mass had moved and findings suggestive of perihepatic inflammation. Fascioliasis was suspected, and the ELISA for Fasciola antigen was repeated again after a period of time, but the result was again negative. Despite the negative test result, the patient was diagnosed as having fascioliasis, based on the severe pain in the right abdomen, persistent eosinophilia, and mobile liver mass, all of which are characteristic symptoms of fascioliasis. For the treatment with triclabendazole (TCB), he was referred to a hospital in the Research Group on Chemotherapy of Tropical Diseases, Japan, which imports nationally unlicensed medicines, including TCB. After the patient received treatment with TCB (10mg/kg), the symptoms disappeared, and the eosinophil counts decreased. Serological testing at 4 weeks after the TCB administration revealed positive antibody results for crude as well as recombinant Fasciola antigen. Fascioliasis is a relatively rare disease, with only few cases per year reported in Japan. There are no worm eggs in the feces in the acute phase, and serological analysis (such as antibody testing) is the basis for the diagnosis. However, in this case, tests for the fasciola antibody initially remained negative. It should be noted that serological analysis can be negative in the early stage of the disease.
Severe hepatitis is rarely seen in pediatric patients with coronavirus disease 2019 (COVID-19), except in association with multisystem inflammatory syndrome in children/pediatric inflammatory multisystem syndrome (MIS-C/PIMS) or with severe disease. Here, we present the case of an 8-year-old Japanese boy with mild COVID-19 who developed hepatitis. The patient was in good general condition without fever or respiratory symptoms, but had severe acute hepatitis that resolved spontaneously. Severe acute hepatitis of unknown etiology in children has been recently reported worldwide, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been identified in some patients. However, this is the first case report from Japan of severe acute hepatitis associated mild COVID-19 in a child.