In this study an immunofluorescence (IF) method was used to investigate the antigens of viruses and atypical bacteria in respiratory tract infections (RTI) in pediatric and adult age groups. In this prospective study of 2 years (1998 - 2000), IF was used to investigate the antigens of 7 viral and 3 atypical bacteria to be used for the etiological diagnosis of RTI. Sputum (33.6%) and nasopharyngeal aspirate specimens were obtained from pediatric patients (Group I, 76 cases) and adults (Group II, 135 cases) with RTI symptoms. Antigen detection rates were found to be 44.7% in Group I and 67.4% in Group II (P < 0.05). The following rates for specific antigens in Groups I and II, respectively, were as follows: Chlamydia pneumoniae, 17.1 and 13.3% (P > 0.05); Mycoplasma pneumoniae, 0 and 9.6% (P < 0.05); influenza A virus, 3.9 and 16.3% (P < 0.05); adenovirus, 3.9 and 14.8% (P < 0.05); parainfluenza virus type 1, 5.3 and 7.4% (P > 0.05); respiratory syncytial virus, 9.2 and 1.5% (P < 0.05); parainfluenza virus type 2, 3.9 and 3% (P > 0.05); and influenza B virus, 1.3 and 1.5% (P > 0.05). Mixed agents were found at a rate of 2.6 and 3.7% (P > 0.05) in Groups I and II, respectively. Parainfluenza virus type 3 and Legionella pneumophila antigens were not found. Since detecting etiological agents provides an important guide for determining the most appropriate antibiotic therapy, this IF method could be applied in clinical practice for arriving at a correct diagnosis and administration of effective treatment.

The aim of this investigation was to evaluate the epidemiology of Stenotrophomonas maltophilia in a university hospital of Turkey. From June 2000 to December 2001, S. maltophilia strains were collected, clinical presentations were noted, and MIC determinations were performed by means of E-test. Enterobacterial repetitive intergenic consensus sequences-PCR (ERIC-PCR) was used for molecular typing of the strains. Forty-four strains of S. maltophilia were isolated from 41 hospitalized patients in a teaching hospital. The majority of specimens were from the blood and respiratory tract. Antimicrobial sensitivities of these strains were as follows: 97.7% trimethoprim-sulfamethoxazole, 15.9% ticarcillin, and 95.4% ticarcillin-clavulanate. The strains were evaluated using the ERIC-PCR method. It was of interest to note that epidemiological typing revealed three small outbreaks that were caused by a total of 12 strains. The remaining isolates generated singular DNA patterns. DNA amplification was possible in 38 isolates and yielded 26 different patterns in a period of 20 months, leading to the suggestion that commensal bacteria becomes selected in the presence of a suitable host.

The magnitude of intestinal parasitic infection in human immunodeficiency virus (HIV)/AIDS patients requires careful consideration in the developing world. However, there have been very few studies addressing this issue in Ethiopia. This study was conducted to determine the prevalence of intestinal parasitic infection in HIV/AIDS patients at Jimma Hospital, Southwest Ethiopia, between January and February 2002. Stool specimens from HIV/AIDS patients and control groups were screened for intestinal parasitic infections using direct and formalin-ether sedimentation concentration methods. Out of 78 HIV/AIDS patients, 52.6% (41/78), and out of 26 HIV-negative individuals, 42.3% (11/26), were infected with one or more types of intestinal protozoa and/or helminthes. The parasites detected among HIV/AIDS patients included Ascaris lumbricoides (30.8%), Blastocystis spp. (14.1%), Entamoeba histolytica (10.3%), Trichuris trichiura (6.4%), Strongyloides stercoralis (5.1%), Giardia lamblia (3.8%), Schistosoma mansoni (2.5%), hookworm species (2.5%), and Taenia spp. (1.3%). Multiple infections were more common among HIV/AIDS patients. Blastocystis spp. were found to be significantly higher in HIV/AIDS patients than in controls (P < 0.05). The magnitude of intestinal parasitic infection was high both in HIV/AIDS patients and in controls. Routine examinations of stool samples for parasites would significantly benefit the HIV- infected and uninfected individuals by contributing to reduce morbidity.

This retrospective chart review describes the clinical features, pathogens, and outcomes of 46 patients with cerebrospinal fluid (CSF) shunt infections collected over 16 years. The overall CSF shunt infection rate was 2.1%, broken down into 1.7 and 9.3% in adult and pediatric groups, respectively. Fever and progressive consciousness disturbance were the most prominent clinical features in the adult patient group, whereas disturbance of consciousness and abdominal symptoms and signs were the two most common clinical features in the pediatric patient group. The most frequently isolated microorganisms were of the Staphylococcus spp., including Staphylococcus aureus and coagulase-negative Staphylococcus, which accounted for 47% of the episodes. Furtheremore, increases in polymicrobial and Gram-negative bacilli infections were observed in our study. Due to the high proportion of oxacillin-resistant Staphylococcus spp. and polymicrobial infections, we recommend initial empirical antibiotics with both vancomycin and a third-generation cephalosporin for cases in which the causative bacteria has not been identified or for which the results of antimicrobial susceptibility tests are not available. For patients who develop smoldering fevers, progressive disturbed consciousness, seizures, or abdominal fullness after ventriculoperitoneal shunt procedures, CSF shunt infections should be suspected. Although some infections have been managed successfully with antimicrobial therapy alone, the timely use of appropriate antibiotics according to antimicrobial susceptibility testing and the removal of the shunt apparatus are essential for successful treatment.

Transfusion-associated hepatitis is a great problem in developing countries including India due to endemic hepatitis infections and a lack of voluntary donors, trained personnel, and funds. The prevalence of post-transfusion hepatitis B and C in India is about 1 - 5% and 1%, respectively. A total of 128,589 blood donors were screened for hepatitis B surface antigen (HBsAg) and 76,089 donors were screened for anti-hepatitis C virus (HCV) from 1997 - 2002. Data were tabulated annually. Out of the total, 83.6% were replacement donors. Our study concluded that the prevalence of HBsAg and antibodies for HCV ranged between 1.7 - 2.2% and 0.25 - 0.9%, respectively among all of the donors. Seropositivity was definitely higher in replacement donors than in voluntary donors. Based on these results, we recognize an urgent need to establish a non-remunerated voluntary donor base in India. A stringent deferral system should be developed. The use of sensitive laboratory tests and the addition of antibody to core antigen (anti-HBc) to the mandatory screening test list would further reduce the incidence of post-transfusion hepatitis.

Many studies have been conducted in the United States regarding the microbial contamination of dental unit waterline, but not in Japan. Recently, acidic electrolyzed water has been used in the medical and dental fields. In this study, we investigated the bactericidal effects of the temporary inflow of acidic electrolyzed water on microbial contamination of the dental unit waterline. First, in order to observe the daily bacterial contamination of the dental unit waterline, water samples were collected at the end of handpieces and three-way syringes before the inflow of acidic electrolyzed water. They were cultured to detect viable bacteria. Later, the inflow of acidic electrolyzed water was conducted through the piping box of the dental unit. Before starting operation on next day, water samples were collected and cultured, as described above. The mean viable bacteria count was 910 ± 190 CFU/ml at the end of handpieces, and 521 ± 116 CFU/ml at the end of three-way syringes before the inflow of acidic electrolyzed water. However, bacteria were detected in only small numbers at the end of handpieces and three-way syringes on the next day. These results indicated that acidic electrolyzed water could be applied as an appropriate measure against bacterial contamination of the dental unit waterline.

The case of a child with Crimean-Congo hemorrhagic fever (CCHF) presumably infected with CCHF virus from her 27-year-old mother is described. The mother with CCHF was treated with ribavirin and did not present with any symptoms of obvious hemorrhage. The child developed fever on the 5th day after the mother’s onset. The partial virus genome was amplified by RT-PCR, and nested PCR from the child and the genome sequence were identical to that from the mother, indicating possible transmission of the virus from mother to child. This case indicates the importance of preventive measures for in-house outbreaks of CCHF.

Haemophilus influenzae type b (Hib) is a major cause of bacterial meningitis among children. Hib conjugate vaccines have effectively prevented Hib infection, and routine immunization with Hib conjugate vaccine has diminished the incidence of the disease in the United States and European countries. Introduction of Hib conjugate vaccines is also required in Japan. However, endotoxin that can carry over from Gram-negative H. influenzae with a purified component may contribute to adverse events following Hib vaccination. In the present study, we examined the endotoxin content in Hib conjugate vaccines. The Hib conjugate vaccine batches, which were produced by a European vaccine manufacturer, were shown to have considerably high endotoxin activity and to vary from 13.9 to 173.7 endotoxin units/dose. These results suggest that it is necessary to monitor the endotoxin content of the vaccine batches to ensure the quality and safety of the vaccines.

Fungal growth can be influenced by human physiological mediators such as androgenic hormones. The aim of this study was to investigate a possible relationship between androgenic hormones and susceptibility to dermatophytosis. To this purpose we measured the levels of testosterone, androstendione, and dehydroepiandrosterone sulfate (DHEA-S) in 60 male patients with dermatophytosis due to Epidermophyton floccosum and Trichophyton rubrum by enzyme link immunoassay. Serum testosterone concentration was found to be significantly lower in patients with E. floccosum than in healthy subjects. No significant differences in androstendione and DHEA-S levels were noted between the patients and the healthy individuals. The results showed that testosterone concentration can be considered a predisposing factor for tinea cruris infection.

Six patients unexpectedly presented with Japanese encephalitis (JE) from early August to mid-September 2002 in the Chugoku district of Japan. The mean age was 67.5 years (range 42 - 89 years); the onset period in two patients shifted to the middle of September. The JE virus was isolated from the cerebrospinal fluid samples from two patients, and the strain isolated in the one was identified as genotype III. Neurologically, consciousness impairment, meningeal signs, rigidity, hemiparesis, tetraparesis, and convulsive seizures were commonly observed. Magnetic resonance imaging uniformly revealed high signal intensities in the bilateral thalami, brainstem (substantia nigra), hippocampi, and brain cortices. In all patients, acyclovir was used, due to the unexpected outbreak of JE. Five patients, except for one without sequelae, had a severe outcome, including one death. This report indicates that JE in Japan is still a threat to adults and the elderly with decreased or absent immunity to the JE virus.

In Japan, mass vaccination for diphtheria, pertussis, and/or tetanus has been mandated by the Vaccination Law since 1948. In order to evaluate the efficacy of this vaccination policy, we conducted seroepidemiological studies on pertussis, diphtheria, and tetanus among individuals aged 0 - 80 years. The pertussis toxin seropositive rates of the vaccine-eligible groups and vaccine-ineligible groups were 55.0 and 57.9%, respectively. The seropositive rate of each group for diphtheria antitoxin was 76.3 and 75.7%, respectively. The tetanus antitoxin seropositive rates were 91.7 and 10.5%, respectively, showing a significant difference between the two groups (P < 0.001). For the three diseases, variations were seen between age groups in the geometric mean antibody titers due to changes of the vaccination program. The results of this study show that natural Bordetella pertussis infection has occurred more frequently than expected. In order to establish the most appropriate vaccination program for the control of pertussis, diphtheria, and tetanus in Japan, further evaluation is necessary.