Associations were studied between the polymorphism of northern Han Chinese leukocyte antigen (HLA) alleles and the outcomes of hepatitis B virus (HBV) infection and HBV genotypes. HLA-A, B, and DRB1 alleles in peripheral blood mononuclear cells (PBMCs) were detected by polymerase chain reaction (PCR) with sequence-specific primers. The PBMCs were collected from 61 persons who tested positive for hepatitis B surface antigen (HBsAg) for more than 6 months (Persistent group), 32 persons who tested negative for both HBsAg and HBV DNA but positive for both anti-HBc and anti-HBs (Recovered group), and 40 persons who tested negative for all serologic markers of HBV infection (Uninfected group). HBV genotypes in serum specimens from 56 of 61 patients with persistent HBV infection were determined by nested PCR with 6 pairs of HBV genotype-specific primers (A to F). The frequency of HLA-DRB1*12 was significantly higher in the Persistent group than in the Recovered group (P = 0.004). HLA-A*02 was significantly higher in the Recovered group than in the Persistent group (P = 0.044). HLA-DRB1*15 was significantly higher in the HBV genotype B group than in the C group (P = 0.013). These findings suggested that there were associations not only between HLA polymorphisms and outcomes of HBV infection but also between HLA polymorphisms and the infected HBV genotypes.

A collection of 68 isolates of Salmonella enterica serovar Kentucky collected during the period 2003 - 2004 from humans in two geographical regions in the Slovak Republic was studied. The original isolate of this serovar was associated with travel to Egypt, and the emergence of other isolates was due to the nosocomial spread of this strain in two hospitals. Antimicrobial susceptibility testing, class I integrons content, pulsed-field gel electrophoresis (PFGE) analysis and plasmid DNA profiles were performed on all isolates. A high proportion (89.7%) of the isolates was multidrug-resistant, while 67 strains expressed resistance against ciprofloxacin. By sequence analysis of randomly selected strains, the point mutations in quinolone resistance-determining region of the DNA gyrase were found. The S. Kentucky isolates investigated were determined to be clonally related by PFGE as well as plasmid DNA analysis.

We selected a high-risk group based on clinical manifestations and performed virological tests to detect intrauterine cytomegalovirus (CMV) infection. We tested the efficacy of this detection protocol in this study. We analyzed 2,309 newborns at 22 weeks or more of gestation from January 1992 to December 2000. Clinical manifestations of the mother, fetus, and newborn were used in the initial step to identify the high-risk group. For the high-risk group, if the causes of clinical manifestation remained unclear, we assayed for CMV DNA in the amniotic fluid, umbilical cord blood, or newborn urine using polymerase chain reaction (PCR) as a second step. Positive PCR results were confirmed by isolating CMV. The initial step detected 287 high-risk cases from 2,309 deliveries. In this group, 100 cases did not have reasonable explanations for the clinical manifestation. In the second-step PCR, intrauterine CMV infection was diagnosed in 10 of 100 cases (10%). The initial clinical classification reduced the proportion of cases needing laboratory investigation to 4%. Thus, our strategy detected intrauterine CMV infection in as many as 10% of high-risk patients after the first step, which is much higher than the general screening rate.

Metronidazole is often used to eradicate clarithromycin-resistant Helicobacter pylori. The aim of this study was to determine the appropriate duration of metronidazole-containing treatment for the eradication of H. pylori infection in northern Japan. We enrolled 83 H. pylori-positive patients in whom first-line triple therapy consisting of a proton pump inhibitor, amoxicillin and clarithromycin had failed. Prior to the second-line therapy, patients underwent endoscopy to obtain H. pylori strains to test the susceptibility to antibiotics. Patients were administered lansoprazole (30 mg b.d.), amoxicillin (750 mg b.d.) and metronidazole (250 mg b.d.) for 5 or 7 days, and the treatment results were tested by ¹³C-UBT. None of the isolated H. pylori strains was amoxicillin- or metronidazole-resistant. All the patients completed the regimen without major adverse effects. The eradication rate was 95.1% (39/41; 95% confidence interval [CI], 83.5 - 99.4%) in the 41 patients who were treated for 5 days and 95.2% (40/42; 95% CI, 83.8 - 99.4%) in the 42 patients treated for 7 days. The results suggest that 5 days could be a sufficient duration for triple therapy of lansoprazole, amoxicillin and metronidazole as a second-line H. pylori eradication therapy in areas where metronidazole-resistant strains are rare.

Itraconazole has a broad spectrum of activity against the most common fungal pathogens. Prior problems with absorption in severely ill patients have been overcome with the introduction of an oral solution and an intravenous preparation. An open-labeled, non-competitive, multicenter phase IV study was conducted to investigate the efficacy and safety of itraconazole administered intravenously for the treatment of invasive fungal infections in Chinese patients. Patients were treated with itraconazole intravenously for 2 weeks (200 mg twice daily for 2 days, then 200 mg once daily for 12 days) followed by 28 days of oral capsules (200 mg twice daily). Efficacy evaluation included an assessment of the clinical efficacy, fungal efficacy and total efficacy on days 14 and 42. Of 156 evaluable patients, 35 patients had proven and 62 suspected invasive fungal infections, and 59 patients were treated empirically. On day 14 the total efficacy rate in patients with proven infection was 54.3% (19/35; 95% confidence interval [CI], 37 - 71%) and on day 42 it was 65.7% (23/35; 95% CI, 48 - 81%). The most common adverse events were hypokalemia (13.5%), gastrointestinal disorders (12.8%), elevation of liver enzymes (10.9%) and increase of bilirubin (8.3%). Itraconazole intravenously followed by oral capsules is thus tolerated and effective in severely ill patients with proven invasive fungal infection.

We have performed intra-hospital syndromic surveillance to rapidly detect nosocomial acute respiratory infection outbreaks in both inpatients and health care workers in a hospital. Syndromic surveillance allows the rapid detection of sudden outbreaks, including infections caused by unknown pathogens. This approach depends on the identification of specific “symptoms” as signs of a possible outbreak, with no need for specific diagnoses. Moreover, syndromic surveillance is quick, easy, and inexpensive. Nosocomial infection surveillance is usually performed on inpatients only. However, during the outbreaks of SARS and seasonal influenza, for example, many hospital personnel were infected. In cases of this kind, in order to quickly detect the prevalence of such infections, a surveillance system that includes hospital personnel is essential. This surveillance is promising as a strategy to prepare for re-outbreaks of SARS and the emergence of novel influenza pandemics.

Urinary tract infection is one of the most common diseases in children. Early diagnosis and com-prehensive treatment can significantly decrease late serious complications. Knowledge of the sensitivity and resistance pattern of uropathogens in specific geographical locations is an important factor for choosing suitable antibacterial treatment. This study was conducted in order to evaluate the antibacterial resistance of urinary pathogens at Mofid Children’s Hospital between March 2000 and August 2001. Positive urine cultures from 1,177 children aged less than 12 years (mean age, 31.7 months; female to male ratio, 2:1) were studied. Cultures were performed on urine samples obtained by sterile urine bags in infants and midstream urine in older children; if samples were contaminated then a suprapubic sample was taken in infants. Sensitivity was measured by the disc diffusion method using the NCCLS protocol. The most prevalent urinary pathogen was Escherichia coli (666 cases, 56.6%). Overall, the lowest resistance rate of microorganisms was that against ciprofloxacin (6.7%) and the highest resistance rate was that against penicillin (83%). A comparison of these data with those of other countries shows that there is considerable geographic variation in bacterial patterns of sensitivity and resistance properties. Therefore, the selection of antibiotics for empiric therapy should be based on the sensitivity and resistance pattern of uropathogens in the respective city.

The standard methodology for titrating dengue viruses, the plaque assay, is slow, time consuming and relatively expensive. Other methods require machinery that may not be routinely accessible to all researchers, particularly those in developing nations. We therefore sought to develop a rapid, simplified semiquantitative polymerase chain reaction (PCR) methodology based on the use of a template mimic. In particular, it was desired that the mimic should be applicable for use a DNA template to avoid the requirement for producing an in vitro RNA transcript. A 511 base pair fragment of the capsid-PrM junction of dengue serotype 4 was cloned into pGEM-T Easy vector and subjected to splicing overlap extension-PCR to generate a 160 base pair deletion. The deleted plasmid mimic competed competitively against the parent plasmid as well as the first strand cDNA of all four dengue viruses. The primers used are specific for the dengue virus, and no product was seen with first strand cDNA from a closely related flavivirus, Japanese encephalitis virus. Under the conditions used, accurate quantitation of the dengue viruses in the range of 10³ to 10⁶ pfu can be achieved in a single day, as opposed to the 7 days required for conventional plaque assay.

The study was undertaken to prospectively evaluate a Streptococcus pneumoniae urinary antigen test for diagnosis of pneumococcal pneumonia among patient and control groups between 2004 and 2006. Microbiological analysis for these patients included Gram staining for sputum, sputum and blood culture. Nonconcentrated urine samples were tested using an immunochromatographic assay, the NOW S. pneumoniae antigen test. The urinary antigen test was positive in 9 (15.3%) of 59 patients enrolled in the study and in 8 (73%) of 11 patients with pneumococcal pneumonia confirmed by conventional methods. The test revealed a sensitivity of 72.7% and a specificity of 97.6% with conventional microbiological criteria used as the reference standard. The positive predictive value was 88.9% and the negative predictive value was 93%. We concluded that the urinary antigen test can supplement conventional microbiological tests in the diagnosis of pneumococcal pneumonia.

The aim of this study was to investigate a tularemia outbreak in the Thrace region of Turkey. The outbreak occurred in Demirkoy village of Edirne, in 2005. Of 400 villagers, 266 were examined and their sera were taken. Throat swabs and lymph node aspirates were cultured. Specific antibodies in patients and domestic animals were screened by a microagglutination test. PCR assays and cultures of the samples of patients, animal tissues, and water sources were performed, along with active surveillance to identify risk factors. Seven out of 10 cases were diagnosed as oropharyngeal form; the remaining three patients were asymptomatic. The cultures for tularemia were negative; however, PCR assays were positive in one lymph node aspirate and in water from one spring. Some animals had the specific antibody at low levels. Increased rodent population in the vicinity, exposure to wild rabbits, and drinking from one of the springs were identified as risk factors with the risk ratios (and 95% confidence interval) of 10.5 (10.3 - 10.7), 6.5 (5.43 - 7.57), and 2.1 (1.1 - 2.5), respectively. Therapeutic and preventive measures were taken. When tularemia cases have been detected in a region even a few decades earlier, tularemia should be considered in the differential diagnosis of patients.

The adenovirus DNA load ranged from 10⁵ to 10¹⁰ copy/mL and from 10⁴ to 10⁷ copy/mL in throat swabs and blood from patients with adenovirus-associated exudative tonsillitis, respectively. The copy number of adenovirus DNA in blood was positively correlated with the duration of the fever.

Seven cases of Streptococcus suis infection in Japan during 1994 and 2006 were summarized. All cases had porcine exposure and five of them had hand skin injury during the exposure. Five cases presented symptoms of meningitis, three presented symptoms of sepsis, and one resulted in sudden death. All of the isolated S. suis belonged to Lancefield’s group D and to serotype 2. They were susceptible to penicillin G, ampicillin, cefotaxime, and ciprofloxacin. However, six of them were resistant to both erythromycin and clindamycin, and four were also resistant to minocycline. Multilocus sequence typing of six isolates showed that they belonged to sequence type (ST) 1, and their pulsed-field gel electrophoresis (PFGE) patterns were similar. The remaining isolate was ST28 and its PFGE pattern was distinct from those of the others.

In Ethiopia human immunodeficiency virus (HIV) infection is a major health and socioeconomic problem. Sex workers, youth, and mobile populations all show increasing prevalence of HIV. However, there is currently no information about the seroprevalence of HIV and the knowledge of HIV among street dwellers in this country. To fill this gap, 404 street dwellers residing in Gondar, northwest Ethiopia, were included in this cross-sectional study. Socio-demographic data, factors that prompted the subjects to become street dwellers, and their knowledge about HIV were all assessed using a structured questionnaire. Stool samples for diagnosis of intestinal parasites and venous blood for HIV antibody testing were collected and processed following standard procedures. Poverty-associated movement to urban areas in search of work was reported as a major factor that forced them to live in the streets, followed by divorce, family death, and addiction and peer pressure. One or more intestinal parasites were found in 67.6% of the street dwellers. Multiple parasitic infections were detected in 27.7%. The prevalence of HIV in the street dwellers was 6.9%. Fifty-nine (16.6%) participants responded that HIV can be transmitted by eating food together. Seventy-three (18%) believed an infected needle cannot transmit HIV, while 51 (12.6%) said HIV can be transmitted by hand shaking. One hundred ninety-two (47.5%) responded that antiretroviral therapy will not prolong the life of HIV-infected individuals. In summary, the prevalence of HIV and intestinal parasitic infection was quite high among street dwellers in Gondar. Therefore, strategies to control HIV and other infectious diseases should include this group, and regular mass deworming may help to reduce the burden of infection.