A two-year analysis was performed at our hospital to evaluate the incidence and clinical impact of bloodstream infections (BSI) in medical, surgical, and intensive care unit patients. During 1999-2000 there were 521 cases of BSI with an incidence of 10.1/1,000 admissions. The most frequent predisposing factors for BSI were intravascular catheter (56.4%) and previous use of antibiotics (50.9%). Infections were considered as primary in 67.9% of cases. Urinary tract and intravascular catheter were the most frequent source of secondary bacteremia (43.1% and 35.9%, respectively). At the time of the first positive blood culture, 83.5% of patients were receiving empirical treatment, but it was adequate in only 53.9% of cases. After antimicrobial susceptibility testing, adequate antibiotic treatment was given in 67.9% of cases. Statistical analysis of independent risk factors showed that mortality was significantly related to age (P < 0.048), rapidly-fatal diseases (P < 0.001), septic shock (P < 0.020), multiorgan failure (P < 0.001), previous use of antibiotics (P < 0.008), Enterobacteriaceae producing extended-spectrum β-lactamases (P < 0.036), and inadequate empirical treatment (P < 0.039). Based on local epidemiology and susceptibility data, microbiology laboratories should periodically release recommendations on the optimal empirical treatment for different wards.

We screened 495 serum samples from 20 species of non-human primates for the antibody against hepatitis E virus (HEV). Anti-HEV IgG was detected in 84 of 232 (36.2%) Japanese monkeys, 2 of 19 (10.5%) cynomolgus monkeys, 3 of 83 (3.6%) rhesus monkeys, and 1 of 1 (100%) Taiwanese monkey, respectively. These results suggest that HEV is circulating among monkeys belonging to the genus macaca. A high prevalence of anti-HEV IgG was observed in Japanese macaques (M. fuscata) despite the fact that Japan is non-endemic for hepatitis E. It is possible that HEV can be transmitted from Japanese macaques to humans. Further, the rate of antibody positivity was found to increase with age in Japanese macaques. Seropositive macaques were found throughout Japan, but the seroprevalence rate differed among geographic regions.

We investigated the relationship of infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) to p53 mutation in hepatocellular carcinomas (HCC) from six countries, including Japan, China, Korea, Vietnam, Spain, and the Unites States. For this purpose, we used formalin-fixed, paraffin-embedded liver tissues obtained from 449 patients with HCC to detect the viral and p53 genes by polymerase chain reaction (PCR). HBV was the most prevalent in Korea (69.1%), China (66.1%), Vietnam (60.5%), and Spain (38.6%). In contrast, HCV was the most prevalent in Japan (59.8%) and in the United States (41.5%). Type C of HBV was the most common genotype (78.6%) encountered in HCC in these countries. Importantly, among 125 intrahepatic HBV DNA-positive patients, 44 (35.2%) were serologically negative for HBsAg (occult hepatitis B). Based on PCR, immunohistochemical, serological, and clinical findings, 4.8% of HCC patients were diagnosed with non-B, non-C. A point mutation at exon 7 of p53 was detected in 20 of the 239 HCC samples examined, including those from 9 Chinese, 5 American, 2 Japanese, 2 Korean, and 2 Spanish patients, respectively. Interestingly, a point mutation with an amino acid substitution at codon 251 (Ile → Asn) was detected frequently in 11 of 20 (55%) cases. A specific mutation induced by aflatoxin B₁ at codon 249 was seen in two patients, both Chinese. Our results suggest that genotype C of HBV may play an important role in hepatocarcinogenesis in different geographic regions, and that in situ detection of HBV genomes could be important for clarifying the agent(s) of unknown etiology related to HCC.

We carried out a molecular-based epidemiological survey of hepatitis viruses, including hepatitis B virus (HBV), hepatitis C virus (HCV), and hepatitis E virus (HEV), in Harbin, China. The study population of 358 subjects consisted of 132 healthy blood donors and 226 liver disease patients residing in Harbin City and surrounding suburbs. The infection rate of each virus among healthy subjects was 14.4% (19/132) for HBV and 2.3% (3/132) for HCV. In contrast, among liver disease patients, the infection rates were 72.6% (164/226) for HBV and 7.5% (17/226) for HCV, respectively (P < 0.01 and P < 0.05, respectively). In particular, nearly 64% of hepatocellular carcinoma patients in Harbin was found to be infected with HBV. The most common viral genotypes were HBV type C (80%) and HCV type 1b (31.3%). Interestingly, a high prevalence of the HBV pre-S1/S2 deletion mutant was found in 13 of 58 (22.4%) subjects. Moreover, testing for HEV among 202 subjects resulted in the detection of anti-HEV IgG in 53 cases (26.2%). The prevalence of anti-HEV IgG has already reached 20% in tested cases aged less than 10 years. These results suggest that HBV infection is widespread in Harbin, China and has led to a high incidence of acute and chronic liver disease in this region.

This study was designed to detect the age-specific rubella seroprevalence of an unvaccinated population of adolescents in Ankara, Turkey. Four hundred and forty adolescents (227 females, 213 males), aged 9-16 years, who were admitted to the Adolescent Unit from July to August 2000 were included in this study. For each participant, a questionnaire was completed and rubella-specific IgG antibodies were screened quantitatively by enzyme-linked fluorescent assay. Of the 440 patients screened for rubella antibodies, 32 (7.3%) were seronegative. Rubella seronegativity values according to sex and age groups were as follows: 15.3, 6.6, and 1.3% in females, and 12.0, 6.1, and 6.2% in males, in the age groups of 9-10, 11-13, and 14-16 years, respectively. The routine health supervision visit recommended between the age of 11 and 12 is an ideal time to immunize unvaccinated adolescents.

A total of 157 sera from febrile patients in the Philippine General Hospital in Manila, Luzon, and the Northern Samar Provincial Hospital, the Philippines, were used. Serum antibodies against spotted fever group Rickettsia (SFGR) and typhus group Rickettsia (TGR) were detected by indirect immunofluorescence test. Antibody positive rates were 1.3% for SFGR (Rickettsia japonica) and 2.5% for TGR (R. typhus), respectively. Rickettsial antibodies in humans in the Philippines were found for the first time. These results underscore the need for further epidemiological study of clinical rickettsioses in the Philippines.

Leptospirosis is a disease with protean manifestations. We report a case of Guillain-Barré syndrome (GBS) in a pediatric patient following infection with Leptospira. Infecting Leptospira presumably belonged to serovar Copenhageni. The patient recovered completely. The possibility of GBS developing as a result of antecedent leptospiral infection should be kept in mind.