The global polio eradication program, started in 1988, initially targeted the year 2000 for the worldwide elimination of the disease. Although poliovirus transmission has been markedly reduced, it has not been eliminated. As we enter the 20th year of the campaign, poliovirus continues to infect and cause paralysis in localized areas of South Asia and sub-Saharan Africa. To combat this scourge, the World Health Organization, together with other worldwide partners, has newly committed to worldwide eradication by 2009. It appears that the delay has been caused by a combination of the failure of globalization to deliver the prosperity it initially promised and technical problems specific to polio eradication. We hope that the world can reach zero level status for polio report, but verification would take many years and extended research due to the nature of poliovirus. We propose a scientific joint enterprise by which the polio endgame is accelerated, at the same time that a special immunization program against multiple other vaccine-preventable diseases is initiated. This newly organized collaborative effort, we believe, will maximize the benefits achieved by polio eradication and reduce childhood disease and deaths, namely achieve the Millennium Development Goal no. 4, in sub-Saharan Africa, the region that especially needs such action.
From 2003 to 2006, we surveyed the seroprevalence of amoebic infection in female outpatients at a gynecologist's office, which was designated as a sexually transmitted disease sentinel clinic by the Tokyo Metropolitan Government, using an enzyme-linked immunosorbent assay (ELISA). The annual rate of anti-Entamoeba histolytica (HM-1:IMSScl6 strain; HM-1) antibody-positive cases as detected by ELISA increased during that period, and anti-Chlamydia trachomatis antibodies were detected in 60%, i.e., 24 of 40 anti-HM-1 antibody-positive individuals, suggesting sexual transmission of E. histolytica. We designed an ELISA with better sensitivity using the antigen extracted from the virulence-augmented E. histolytica strains (LHM-1 and LLA526 strains) by liver-passaging in hamsters. The average ratios of the S/N value (optical density [OD] of sample/OD of negative control) of ELISA with either the LHM-1 or LLA526 antigen and that of ELISA with the HM-1 antigen were significantly higher in intestinal amoebiasis cases with low S/N values than in amoebic liver abscess cases. In the present study of the seroprevalence of E. histolytica infection, the sera testing positive with low S/N values (<10) by ELISA with HM-1 antigen exhibited higher S/N values by ELISA using LHM-1 and LLA526 antigens. This modification of the antigen preparation for ELISA is expected to be effective in detecting anti-E. histolytica antibodies from such asymptomatic patients who have low antibody titers.
The frequency and risk factors for contamination of Helicobacter pylori infection was investigated among Sakarya University students. Two-hundred students randomly chosen from among those who volunteered for the study and met its criteria were included. Data were obtained by a questionnaire. H. pylori positivity was checked with the monoclonal H. pylori stool antigen test. Statistical analysis was done with chi-square test. The average age of the subjects was 21.14 ± 2.06, and 76% of them were female. Monthly family income was below 575 Euros in 69.5% of them, and 56% were living in state dormitories. H. pylori positivity was found to be as high as 63% in our group. According to the qustionnaire (age, gender, blood groups, family income, crowded family living conditions, smoking, alcohol and caffeine consumption, the presence of gastric symptoms, family history, and hygienic behaviors), no statistical differences were found between the H. pylori positive and negative students. These data support the finding that personal and environmental conditions in adults did not affect H. pylori infectivity, and that H. pylori might be acquired in childhood.
The Culex pipiens complex consists of vector mosquitoes that transmit important human pathogens. In this study we established a simplified method to distinguish three members of the Cx. pipiens complex, Cx. p. pallens Coquillet, Cx. p. form molestus Forskal, and Cx.quinquefasciatus Say, collected in Japan. Sequence analysis of the Drosophila Ace-orthologous acetylcholinesterase (Ace) gene (668 to 680 bp) revealed that a single polymorphic region characterizes each species. Based on this region, specific primers that distinguish Cx. p. form molestus (ACEpip2) and Cx. p. pallens (ACEpall2) were newly designed. Polymerase chain reactions were performed with the genomic DNA of Culex mosquitoes as the template, and these primers clearly distinguished two Culex spp. The accuracy of the designed primers was evaluated with 38 colonies of mosquito samples collected from 9 prefectures of Japan. The testing revealed that the distribution of anautogenous Cx. p. pipiens has not been confirmed in Japan. It also revealed that the male of Cx. p. pallens possesses an Ace gene haplotype that is highly similar to the sequence of Cx. quinquefasciatus. This improved method allows the evaluation of vector competence of Cx. p. form molestus, which is the suspected vector of West Nile virus.
A false-positive tuberculin skin test (TST) may be a result of T-cell sensitivity due to Bacille Calmette-Guérin (BCG) vaccination or exposure to non-tuberculous mycobacteria, thus leading to unnecessary isoniazid preventive therapy, especially in low-risk populations. Unlike TST, T-SPOT.TB is not confounded by BCG vaccination or exposure to most of the other non-tuberculous mycobacteria, because this assay is based on enumeration of interferon-γ-secreting T cells in response to Mycobacterium tuberculosis-specific antigens. We compared the TST with T-SPOT.TB with respect to different TST cut-off points in healthy unexposed BCG-vaccinated schoolchildren. A total of 209 children between 6 and 10 years of age with a TST induration of 0 (n = 50), 10 - 14 (n = 45), 15 - 19 (n = 95) and ≥20 mm (n = 19) were enrolled. Among TST-positive subjects, only 26 (23%) were positive with T-SPOT.TB, and T-SPOT.TB was positive in 4, 7, 20 and 42% of children with TST indurations of 0, 10 - 14, 15 - 19 and ≥20 mm, respectively. We suggest that confirmation of a positive TST by the interferon-γ-based test would reduce unnecessary preventive therapy significantly in healthy unexposed BCG-vaccinated children.
Although well over 200 viral agents have been implicated in acute respiratory infections (ARIs) among children, no system able to detect such a wide range of viruses has been established. Between January 2004 and December 2005, a modified microplate method, including HEF, HEp-2, Vero E6, MDCK, RD-18S, and GMK cell lines (HHVe6MRG plate), was adopted to isolate viruses. A total of 1,551 viruses were isolated, representing both outbreaks and sporadic cases, from 4,107 nasopharyngeal specimens, at monthly isolation rates of 22.3 to 52.6%. Influenza, parainfluenza, respiratory syncytial (RS), and mumps viruses, and human metapneumovirus, enterovirus, parechovirus, rhinovirus, adenovirus, herpesvirus, and cytomegalovirus were all isolated. The use of multiple cell lines increased the isolation rates of most of these viruses. The findings showed that ARIs due to a number of respiratory viruses occurred across all seasons in succession and/or concurrently in children in the community. These data will help clinicians determine in which seasons and for which age groups they should use the rapid diagnostic test kits available for influenza virus, RS virus, and adenovirus. In conclusion, we verified that the modified microplate method was able to clarify the etiology and epidemiology of numerous viruses isolated from children with ARI.
Limited data are available on the relationship between nutritional status and pulmonary tuberculosis (PTB). Zinc plays a vital role in the immune status of the individual. The present study was carried out to estimate serum zinc and albumin levels in newly detected adult active PTB patients with (n = 20) and without (n = 20) HIV, and to compare them with the levels in controls (healthy family members; n = 20) who satisfied rigid selection criteria. Standard methods were adopted to collect an early morning fasting blood sample for zinc (by Atomic Absorption Spectrometer) and albumin (estimated by the bromocresol green method). The mean ± SD for BMI, zinc and albumin among the controls, HIV positive and HIV negative patients were 19.6 ± 0.6, 18 ± 0.4 and 18.5 ± 0.6 kg/m2; 117.13 ± 4.2, 53.9 ± 8 and 65.5 ± 9.8 µg/dL; and 4.1 ± 0.6, 2.9 ± 0.4 and 3.6 ± 0.7 g/dL, respectively. All three parameters were significantly low in active PTB patients irrespective of HIV status, but more so in HIV-positive individuals. These changes may be attributable to nutritional factors, enteropathy and acute phase reactant proteins. Hence, the National AIDS Control Organization (NACO) in India is providing nutritional supplements to those HIV-infected cases inducted for antiretroviral therapy and nutritional counseling for others as a part of a national policy.
Suppression of viral replication is followed by increases in CD4+ lymphocytes, and this has been shown to result in decreased susceptibility to opportunists after initiation of highly active antiretroviral therapy (HAART). However, clinical aggravations after the initiation of HAART have been thought to be due to the restored ability to mount an inflammatory response, or the immune reconstitution inflammatory syndrome (IRIS). The degree of IRIS observed in human immunodeficiency virus (HIV)-infected patients following initiation of HAART is variable. This prospective study was aimed at determining the proportion of IRIS and the pattern of opportunistic infections among 186 HIV/AIDS patients receiving HAART between December 2006 and July 2007 at Zewditu Memorial Hospital, Addis Ababa, Ethiopia. The proportion of IRIS was 17.2% (32/186). The mean number of days of IRIS occurrence for each disease ranged from 26 to 122 days with a mean of 80. Opportunistic diseases associated with IRIS were tuberculosis (68.8%, 22/32), herpes zoster rash (12.5%, 4/32), cryptococcosis (9.4%, 3/32), toxoplasmosis (6.3%, 2/32) and bacterial pneumonia (3.1%, 1/32). Compared to baseline readings there were significant increases in CD4 count, aspartate aminotransferase and alanine aminotransferase levels while hemoglobin values decreased during the development of IRIS. In summary, the proportion of IRIS and the pattern of opportunistic infections in HAART-treated patients in Ethiopia mirrored those reported in other countries. Further prospective surveys on epidemiological, immunological, microbial and clinical studies are imperative to assess the proportion and pattern of IRIS and effect of HAART in Ethiopia.
The anti-malarial activity of the anti-cancer drug methotrexate against chloroquine-sensitive T9-96 and the multidrug-resistant K1 strains of Plasmodium falciparum was assessed in vitro. Mean IC50 values of 0.32 ± 0.05 nM and 48.02 ± 4.40 nM were obtained for T9-96 and K1, respectively, indicating methotrexate's high potency against both sensitive and resistant P. falciparum strains in vitro. Our results suggest that methotrexate is potentially effective against falciparum malaria in short-term, low-dose regimens, minimizing the risk of toxicity. This, along with the practical advantages of methotrexate, warrants the clinical investigation of methotrexate in human cases of falciparum malaria.
Dysgonomonas capnocytophagoides belongs to a group of facultative anaerobic Gram-negative coccobacilli that was formerly designated CDC group DF-3. We evaluated the characteristics of this microbe and its susceptibility to antimicrobial agents. In this study, D. capnocytophagoides was isolated by anaerobic blood cultures from a 78-year-old male with pancreatic cancer, ischemic heart disease, and diabetes mellitus, who also showed symptoms of cholangitis. The isolated strain demonstrated resistance to various β-lactams, erythromycin, aminoglycosides, and fluoroquinolones, but was susceptible to sulfamethoxazole-trimethoprim, clindamycin, minocycline, and chloramphenicol. The results of all biochemical tests and the homology of the 16S rRNA gene were consistent with previous reports of D. capnocytophagoides.
The present paper describes a case of bilateral panuveitis due to Borrelia burgdorferi sensu lato diagnosed by a PCR approach using cerebral spinal fluid. Since the culture of B. burgdorferi takes a long time to grow and the accuracy of serological tests is doubtful in patients, the PCR method of amplifying a B. burgdorferi flagellin could be suitable to make a positive diagnosis in a case of atypical clinical history of Lyme disease.
The aim of this study was to estimate the prevalence and predictors of Chlamydia trachomatis infection among young adult low-risk women attending either of two inner-city family planning clinics in Trabzon, the most densely populated city in Turkey's Black Sea region. The study group comprised 150 sexually active women attending either of two family planning clinics. Two endocervical swabs were collected from each woman and tested for the presence of C. trachomatis by tissue culture and a commercially available enzyme immunoassay (ELISA). Multivariable logistic regression analysis was used to identify the associations of clinical factors for predicting C. trachomatis infection. C. trachomatis was detected in 19 of the samples (12.7%) by cell culture and in 15 (9.9%) by ELISA. None of the demographic characteristics could be associated with the state of infection, but the women preferring the withdrawal method for contraception accounted for a significantly higher percentage of the C. trachomatis-positive cases than women who used other contraceptive methods. The most frequent signs of cervical infection were vaginal discharge (RR = 4.86, 95% CI 1.60 and 14.79, P = 0.005) and cervical erosion (RR = 3.26, 95% CI 0.97 and 10.90, P = 0.056).
A number of cases of Trichophyton tonsurans infection have been reported among sportsmen and women participating in wrestling, judo, and sumo wrestling in Japan, but there have also been sporadic reports of cases with no history of contact with these sports. A molecular method using restriction enzyme analysis of PCR-amplified fragments targeting the non-transcribed spacer region (NTS) of ribosomal RNA gene in fungal nuclei was applied to T. tonsurans strains isolated from sporadic cases in Japan. Five of 6 molecular types recorded in Japan, i.e., NTS types I, II, IV, V, and VI, and two new types, designated NTS VII and NTS VIII, were observed among 10 strains isolated from sporadic cases. The NTS IV strains, considered not to be related to the present epidemic, were found to be the most prevalent molecular type accounting for 4 of the 10 strains isolated. NTS I was the most prevalent type in the current epidemic in Japan, but it was cultured from only one patient who was later noted to be the daughter of a retired judo practitioner. Four subjects had histories of living abroad and were considered to have been infected outside Japan. The strains in these cases were NTS II, V, VI, and VII. The results of this study suggested that the NTS IV strains were originally present in Japan at a low incidence, but that there has been a recent influx of NTS I, II, V, VI, and VII from abroad, which has been accompanied by the secondary spread of strains from wrestlers and practitioners of martial arts to the general community.
In this study, cultures of patients with tularemia were evaluated, and antimicrobial susceptibilities of two Francisella tularensis strains were tested by disk diffusion and E-test methods. A high-resolution multiple-locus variable-number tandem repeat analysis (MLVA) comprising six variable-number tandem repeat loci was applied to elucidate the genetic relatedness among Turkish and Bulgarian isolates which were isolated in a recent outbreak. The patients were diagnosed in two outbreaks in two cities of Turkey in 2005 and 2006. A total of 16 samples from 12 patients were cultured, and PCR tests were carried out on 15 samples that were positive in five lymph node aspirates and two soft tissue aspirates. F. tularensis was isolated from the lymph nodes of two patients. Aminoglycosides, quinolones, chloramphenicole, tetracyclines, nitrofurantoin, and rifampicin inhibited growth of the isolates. The Turkish isolates appeared to share a common MLVA pattern with one of the four Bulgarian outbreak genotypes.
Antibiotic-resistant urinary tract infections (UTIs) are on the rise. We investigated the recent emergence of representative resistant strains in patients diagnosed with UTIs at Kobe University Hospital between 2000 and 2006, focusing on resistant strains isolated from the urine of UTI patients, especially fluoroquinolone-resistant Escherichia coli (FQRE), multidrug-resistant Pseudomonas aeruginosa (MDRP), and methicillin-resistant Staphylococcus aureus (MRSA). We found 16 MDRP, 108 FQRE, and 251 MRSA UTI cases, reflecting a significant increase in the incidence of FQRE. Our data demonstrated that isolated ratios of FQRE rose as much as 26.3% in 2006 and that there were significantly more isolated cases in 2003 - 2006 than in 2000 - 2002. The data show a significant trend toward FQRE emergence. This trend should be considered when treating UTI.
This report describes a 2-year-old child with neuroectodermal tumor presenting with febrile neutropenia. Blood cultures drawn from the peripheral vein and Hickman catheter revealed Kluyvera cryocrescens growth. The Hickman catheter was removed and the patient was successfully treated with cefepime and amikacin. Isolation of Kluyvera spp. from clinical specimens is rare. This saprophyte microorganism may cause serious central venous catheter infections, especially in immunosuppressed patients. Clinicians should be aware of its virulence and resistance to many antibiotics.
To highlight the transmission and major phylogenetic clades of Mycobacterium tuberculosis, a retrospective study was carried out at two health facilities in a small agro-industrial area in São Paulo, Brazil, that has a low tuberculosis incidence rate. IS6110-RFLP and spoligotyping were performed on the isolates, with the former revealing that 31.3% (35/112) of strains were clustered. Epidemiological links were found in 16 of the 35 clustered patients and were associated with transmission among patients living in public housing. Spoligotyping grouped 62.8% of the strains. The T genetic family predominated among the isolates. Of interest is that five strains had a pattern characteristic of African or Asian origin (ST535), and two others were of the rare localized type ST1888 (BRA, VEN). In addition, three new types–1889, 1890, and 1891–were identified. Spoligotyping showed that some ST may be circulating to or from Brazil, and RFLP revealed ongoing transmission in inadequately ventilated public-housing buildings. This may point to a failure in tuberculosis control policy.
Salmonellosis constitutes an important public health problem throughout the world. In severe infections like meningitis and septicemia, antibiotic treatment is essential. Extended-spectrum cephalosporins are preferentially used to treat salmonellosis in children. Treatment failures due to in-vivo acquisition of an extended-spectrum β-lactamase (ESBL) gene in nontyphoidal salmonellae are now well established. A 45-day-old male baby presented to the pediatric intensive care unit with a history of fever, poor feeding, two episodes of seizures of 3 days duration and recurrent apnoea. At admission, cerebrospinal fluid, stool and blood cultures were done and Salmonella enterica serovar Typhimurium was isolated from all the samples. The stool isolate was confirmed to be ESBL producing. The baby expired due to acute pyogenic meningitis.
Urinary tract infection is a serious problem in diabetic patients, and asymptomatic bacteriuria (ASB) in these patients is a risk factor for pyelonephritis and renal dysfunction. In the present study, we investigated the relationships between age, body mass index, duration of diabetes, HbA1c level, glucosuria, glomerular filtration rate and microalbuminuria in type 2 diabetic patients with ASB. One hundred and twenty-three patients with type 2 diabetes mellitus were included in the study. The patients were divided into two groups according to ASB; Group I consisted of 22 patients with ASB, and Group II of 101 patients without ASB. There were no significant differences between the groups in regard to age, body mass index, creatinine clearance or microalbuminuria, while there were significant differences in HbA1c, duration of diabetes mellitus, glucosuria and pyuria (P < 0.05). The most commonly isolated microorganism was Escherichia coli. The present study identified the duration of diabetes, high HbA1c, glucosuria and pyuria as risk factors for ASB in type 2 diabetic patients.
This report describes a hepatitis A outbreak among Korean military personnel. Each case of hepatitis A in this outbreak was defined as a person who had symptoms compatible with acute viral hepatitis A and had positive HAV IgM between May 2 and August 14, 2007 in Inje district, Gangwon, Korea. We tested 70 cases with symptoms for HAV IgM, and 67 cases showed positive results. They included 4 sergeants, 1 officer and 62 privates. A positive result for HAV IgG among asymptomatic military personnel was seen in 11.8% of cases. This epidemic occurred after a heavy rainfall in the military compound area where drinking water was supplied by the stream water. After the outbreak, the supply of drinking water was switched to a public water system. All of 178 military personnel who had no HAV IgG were vaccinated on July 26, 2007. The outbreak was resolved after the control measures were implemented.
An epidemiological investigation on echinococcosis was made in Jiuzhi County of Qinghai Province, western China. Ultrasonography and an indirect hemagglutination test revealed a morbidity of 8.0% (124/1,549) and a seroprevalence of 25.8% (287/1,113), respectively, in the Tibetan population. The morbidity in herdsmen (16.6%) and Buddhist priests (15%) was significantly higher than that in other occupation groups (3.2%), and it was higher in females (9.8%) than in males (6.2%). The ultrasound images showed a coexistence of cystic echinococcosis (CE) and alveolar echinococcosis (AE), occupying 69 and 31% of the cases, respectively. An Echinococcus Western blot assay was performed as a serological backup test for differentiating CE and AE. The assay revealed that serum samples from most cases with a positive AE image showed a specific antibody against antigen bands at 16/18 kDa. Autopsy proved that 9 out of 12 stray dogs were infected with Echinococcus granulosus (n = 8) and E. multilocularis (n = 1). Inspection at the abattoirs demonstrated a hydatid rate of 78.5% in yaks and 82.6% in sheep. The data indicate that Jiuzhi County is an important endemic area for both CE and AE, in both human and animal populations.