CTX-M-3 has become the most common extended-spectrum β-lactamase (ESBL) produced by Serratia marcescens in Taiwan. An expanded effort to detect ESBL among 123 nonrepetitive isolates of S. marcescens was made and 15 (12%) ESBL-producers were identified, all revealing CTX-M-3. Without routinely detecting the ESBL for S. marcescens in clinical laboratories, 80% of the ESBL-producers were reported to be susceptible to cefepime. The clinical spectrum of ESBL-producing S. marcescens-related infections included febrile urinary tract infection (n = 3); afebrile pyuria (n = 2); pneumonia (n = 3); spontaneous bacterial peritonitis (n = 3); secondary bacteremia (n = 2) and one each with primary bacteremia and colonization of the central catheter tip. Overall, the 30-day mortality rate was 33.3% (5/15) and the outcome depended on the severity of the underlying disorder and infection per se. In conclusion, although our case numbers were limited, due to the substantial incidence and associated mortality of ESBL-producing S. marcescens and its potential treatment failure by an apparently susceptible cephalosporin, we recommend that the detection and report of ESBL production for S. marcescens in clinical laboratories be made mandatory.

Serratia marcescens is a Gram-negative bacterium that is often associated with nosocomial infections. Here we analyzed the resistance mechanism of the ceftazidime-resistant S. marcescens nosocomial strains. The five S. marcescens urinary tract infection-associated isolates were positive for chromosomal ampC and bla_TEM-1. Four of the five strains, ES11, ES31, ES42, and ES46, were single clone and ceftazidime resistant. The fifth strain, ES71, was susceptible to ceftazidime. Analysis of the deduced amino acid sequence revealed a Glu-235-Lys substitution in the third amino acid of the third motif of AmpC from both ES46 and ES71, and a site-directed mutagenesis experiment confirmed that this substitution is involved in the ceftazidime resistance phenotype. However, the resistance phenotypes of strains ES46 and ES71 to ceftazidime were quite different from one another, indicating that another mechanism, in addition to the AmpC mutation, is also involved in the determination of the resistance phenotype of these strains. Basal AmpC activity was more than two times higher in strain ES46 than in ES71, which could result in the differing resistance phenotypes of these two strains. The clinical significance and prevalence of extended-spectrum cephalosporin-resistant S. marcescens strains harboring the mutated chromosomal ampC gene are unclear in Japan and remain to be elucidated.

The purpose of this study was to evaluate clinical and laboratory findings, treatment modalities and final outcomes of brucellosis in children and to compare our data with those of other studies performed in Greece. Fifty-two children treated for brucellosis in the Department of Pediatrics during the decade 1995 - 2004 were analyzed. Of the 52 children, 47 were reexamined during July 2005. Fever, arthritis or arthralgia, hepatomegaly and splenomegaly were the main findings. Young children had positive blood cultures and lower or negative antibody titers statistically significantly more often than did older children. Brucella abortus was isolated in 9 of 18 patients with positive blood cultures. Antibiotic treatment lasted for 28 days on average. There were no complications or relapses, except one, and the final outcomes were excellent.

The aim of our prospective study was to evaluate the predictive value of serum procalcitonin (PCT) level in comparison with C-reactive protein level and erythrocyte sedimentation rate for the diagnosis of pulmonary tuberculosis (PTB) on admission and 6 months after the administration of anti-tuberculous chemotherapy (ATCT). Seventy-five adult male patients with active PTB who were mycobacteriologically diagnosed (smear and culture positivity) were examined in this study. As a control group, 75 healthy adult males were enrolled. The measured serum PCT levels were within the normal range both in healthy individuals and in patients 6 months after ATCT. Serum PCT levels had been slightly high on admission in patients with PTB in comparison with controls (P = 0.01) and patients who had ATCT (P = 0.001), and this difference was statistically significant, but the PCT levels of most cases with PTB (58.7%) were below the usual cut-off level (0.5 ng/mL). We conclude from this study that the serum PCT level was not a reliable indicator in the diagnosis of active PTB because of its low sensitivity (41.3%), and in most cases it was not capable of overcoming the cut-off level even if statistically meaningful results were obtained. The PCT test for the presumptive diagnosis of PTB cannot be substituted for microbiological, epidemiological, clinical and radiological data.

The prevalence of adult HIV/AIDS in Thailand is declining due to intense prevention strategies, but it still continues to be a critical health problem with a prevalence of 1.5%. Several HIV vaccine candidates for the prevention of HIV infection or progress to AIDS were examined in clinical trials. We evaluated the cost-effectiveness of a vaccination regimen (rBCG prime-rDIs boost) currently in its pre-clinical phase. The cost-effectiveness of three interventions (vaccination, highly active antiretroviral treatment [HAART], and the combination of the two) through an existing vaccination program was assessed in a Markov model. The disability-adjusted life year (DALY) was the main effectiveness measure. In the base case the efficacy of the vaccine for preventing HIV infection was assumed to be 30%. The cost of the vaccine was estimated on the basis of its predicted production capacities in Thailand. The incremental cost-effectiveness ratios of vaccination, HAART, and the combination were about $US 75, $US 610, and $US 267 per DALY averted compared with the do-nothing strategy in the base case. The HAART-only strategy seemed to be less cost-effective than the other options under the current assumptions. Sensitivity analyses indicated that the new HIV infection rate and the vaccine efficacy could affect the results.

Within the years 2001 to 2004, Sistan-va-Baluchestan was the only province with transmission of cholera in Iran. The objective of this study was to determine the epidemiological characteristics of the cholera outbreak that occurred in 2004 in the Sarbaz district in the southern parts of this province. The surveillance data were analyzed, and a matched case-control study was performed. From 22 October to 15 November 2004, from 2,242 diarrhea cases that were sampled for stool culture, 90 cases were positive for Vibrio cholerae O1 El-Tor biotype, serotype Ogawa. Multivariate analysis showed that risk factors for cholera were drinking beverages from street vendors (OR = 10.16, 95% CI: 2.55 - 40.50), illiteracy (OR = 5.76, 95% CI: 2.63 - 30.09), no hand washing with soap after toilet use (OR = 22.06, 95% CI: 2.91 - 167.11), no hand washing with soap before meals (OR = 3.64, 95% CI: 1.03 - 12.82), sex (OR = 3.73, 95% CI: 1.17 - 11.89) and eating food left over from previous meals without reheating (OR = 4.03, 95% CI: 1.23 - 13.18). The source of drinking water showed weak association with cholera only in univariate analysis (OR = 2.83, 95% CI: 1.12 - 7.19). The development of primary health care, even though it can improve the conditions that control the spread of an epidemic, is not enough of a control measure as long as the social hygienic standards are low and people do not follow the basic personal hygiene regulations.

In case of a new influenza pandemic, provision of masks to coughing patients could be used to slow expansion of the epidemic. To quantitatively assess the efficacy of different masks, we used an ultrasonic anemometer to measure the velocity of airflow from the mouth in coughing. We found that even the cheapest paper masks reduced the airspeed to less than 1/10, implicating their effectiveness in decreasing viral spread. We therefore propose that governments provide free masks to coughing patients in the general population upon the emergence of a new human influenza virus.

Nine group B streptococci (GBS) strains were isolated from five toxic shock-like syndrome cases of nonpregnant adults in Japan from 2001 to 2005. All of them were identified as Streptococcus agalactiae. The serotypes of these strains were Ib, III, V, and VII. Pulsed-field gel electrophoresis revealed that the patterns of the strains isolated from the different patients were variable. Antimicrobial susceptibility tests showed that all of the strains were susceptible to penicillin G, ampicillin, cefotaxime, clindamycin, and telithromycin. One strain showed intermediate resistance to erythromycin.

The purpose of this study was to measure the serum level of sICAM-1 and sE-selectin as markers for endothelial damage in patients with dengue fever (DF) and dengue hemorrhagic fever (DHF). Twenty-nine patients with serologically-proven dengue virus infection (age 10.6 ± 2.4 years, 55% male, DF = 13 and DHF = 16) were enrolled. Serum samples were collected from 25 healthy children (age 10.6 ± 2.3 years, 40% male) as the control group. A follow-up was done at a mean interval of 15.9 ± 1.6 days. The level of sICAM-1 at the toxic stage was significantly elevated compared to its level at the follow-up (494.1 ± 107.4 versus 358.2 ± 67.6 ng/ml, P = 0.001), but no difference was found between patients with DF and patients with DHF (444.1 ± 158.0 versus 465.1 ± 154.6 ng/ml, P = 0.74). The sICAM-1 level at the follow-up was similar to that of the control group (396.9 ± 113.0 ng/ml, P = 0.56). The level of sE-selectin at the toxic stage was not different from its level at the follow-up (75.9 ± 33.0 versus 75.5 ± 31.7 ng/ml, P = 0.96), and no difference was found between the DF group and the DHF group (64.1 ± 25.7 versus 78.8 ± 39.9 ng/ml, P = 0.30). These levels were not elevated compared to the sE-selectin level that was determined in 8 patients in the control group (94.7 ± 20.5 ng/ml, P = 0.12). In conclusion, there is evidence of endothelial activation by an increased sICAM-1 level in patients with dengue virus infection. However, the degree of endothelial activation alone may be similar for patients with DF and patients with DHF, and this fact by itself cannot explain the difference between the two clinical syndromes of dengue virus infection. The sE-selectin level was not elevated for patients included in this study.

It is not known whether atypical Mycobacterium (AM) causes peritonitis in humans. We described a case of tuberculosis-like peritonitis caused by an AM. Genetic analysis of the biopsy specimens suggested an AM infection. Thus, we concluded that peritonitis in humans can be caused by some AM species as well as by Mycobacterium tuberculosis complex.

Six hundred fifteen isolates of Streptococcus pyogenes were collected over a 6-year period from patients with pharyngitis in Korea. All isolates were characterized in terms of their antibiotic resistance, the phenotypes of erythromycin resistance, the frequencies of erm(B), erm(A), and mef(A) genes, and the emm genotype. The prevalent emm genotypes were emm12 and emm4. Moreover, the emm12 genotype was found to be the most resistant strain to erythromycin. Among the 126 strains demonstrating resistance to erythromycin, those with erm(B) were the most prevalent, accounting for 64.3% of the total. In summary, it is suggested that the S. pyogenes pathogen isolated from pharyngitis patients in Korea developed resistant gene acquisition, as well as a resistant phenotype, according to the annual prevailing emm type. It is also suggested that the emm genotype distribution of erythromycin-resistant strains is correlated to the acquisition of resistant genes.

During a 6-month period, swab samples were obtained from the nares, axilla, and perineum of 1,000 children, age 0 to 16 years, who were attending a pediatric outpatient clinic. Staphylococcus aureus was isolated in 173 of the children. Only one child, a 35-day-old boy who had remained at the neonatal intensive care unit for 1 week after birth, was identified as a carrier of methicillin-resistant S. aureus. Except in diagnosed cases of allergic rhinitis, potential predisposing factors for colonization with S. aureus in our sample were comparable to those in non-colonized children.

We investigated the frequency of amantadine-resistant influenza A viruses in Nara Prefecture during four epidemic seasons from 2001 - 02 to 2004 - 05. Point mutations within the M2 gene were identified using RT-PCR and DNA sequencing analysis. Five viruses (3.4%) with point mutation were observed from 145 strains analyzed. Three viruses (2.0%) possessed a change at position 31 (AGT→AAT, Ser to Asn), one virus (0.7%) showed a change at position 26 (CTT→TTT, Leu to Phe), one virus (0.7%) showed a change at position 27 (GTT→ATT, Val to Ile), and none showed a change at position 30. All of these changes were the transition type of mutation. These results indicated that the possible circulation of drug-resistant viruses to the community was not supported by the findings obtained during the 2004 - 05 season in Nara.