Over the past decades, the incidence of transfusion-transmitted diseases has been dramatically reduced. These reductions have been due to a multifocal approach to the collection, processing, and release of blood components. The estimated risks of transfusion-transmitted hepatitis viruses are now extremely small, but the possibility of infections with emerging pathogens always exists because preventive measures may not be available for all cases. Thus, some patients may be harmed before preventive measures are introduced. Beside transfusion-transmitted infections (TTI), unsolved residual risks such as transfusion-related acute lung injury or incompatible blood components transfusion still exist as major concerns. Continuous efforts toward research on and the prevention of adverse reaction-related blood components must be made to ensure blood safety. The purpose of this article is to introduce the concept of the current risks of transfusion including TTI, review the preventive measures already implemented, and discuss future visions for transfusion safety in Japan.

Meningococcal disease has been regarded as a very rare infection in Korea. Until now, there have been no reports on the serological or genetic characterization of Neisseria meningitidis isolates in Korea. This study was the first report of the serogroup, PorA VR subtype, pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), and antimicrobial susceptibility of N. meningitidis isolates collected from 2002 to 2003. Of 11 meningococcal isolates, serogroup Y was found to be the most frequent (nine isolates). In addition, one isolate was from serogroup B and one was from serogroup 29E. Four isolates showed a reduced sensitivity to penicillin G. However, all strains tested were susceptible to chloramphenicol, cefotaxime, ciprofloxacin, and rifampin. Among the 11 isolates, seven PorA types were identified. P1.5-1, 2-2 was the most prevalent PorA type, accounting for 55.6% of the serogroup Y isolates. In terms of PFGE patterns, nine isolates of serogroup Y were divided into three clusters, but the isolates shared a high level of PFGE pattern similarity. The serogroup Y isolates were characterized as ST-1625 (five strains) and ST-23 (four). They belonged to the ST-23 complex/Cluster A3. In this study, the ST-23 complex/Cluster A3 was prevalent, with the PorA type P1.5-1, 2-2 accounting for 55.6% of the nine serogroup Y strains. Also, we identified the ‘hypervirulent lineage’ strain such as ST-6667 of ST-41/44 complex/Lineage 3 in Korea. The results of this study show the need for comprehensive epidemiological surveillance to monitor any changes in the meningococcal disease situation so that prompt intervention can be initiated.

The human sapovirus (SaV) causes acute gastroenteritis mainly in infants and young children. A food-borne outbreak of gastroenteritis associated with SaV occurred among junior high school students in Yokohama, Japan, during and after a study trip. The nucleotide sequences of the partial capsid gene derived from the students exhibited 98% homology to a SaV genogroup IV strain, Hu/Angelholm/SW278/2004/SE, which was isolated from an adult with gastroenteritis in Solna, Sweden. An identical nucleotide sequence was detected from a food handler at the hotel restaurant, suggesting that the causative agent of the outbreak was transmitted from the food handler. This is the first description of a food-borne outbreak associated with the SaV genogroup IV strain in Japan.

Out of 68 Escherichia coli O157 field isolates tested in vitro for Shiga toxin (Stx) 2 production, 12 (17.6%) produced no or a limited amount of Stx2 (Stx 2 non- or low-producing strain; TNLP) even though all 68 possessed the stx₂ gene. The remaining 56 were Stx2 high-producing strains. The 12 TNLPs carried the q21 gene allele, which encodes a transcription antiterminator Q protein and is highly homologous to that of Ф21 phage. They also carried nucleotide substitutions and insertions in the promoter region of the stx₂ gene compared with that of O157 EDL933, producing a considerable amount of Stx2. In contrast, the Stx2 high-producing strains carried the q933 gene allele, which was first reported on an stx₂ phage (933W), but not the q21 gene allele, and did not have mutations in the promoter region of the stx₂ gene. These 2 genetic characteristics, i.e., replacement of the q gene and mutation in the promoter region of the stx₂ gene, seemed to determine the amount of Stx2 produced by each strain. The TNLPs were more frequently isolated from healthy carriers than from patients (P < 0.05), suggesting that TNLPs are less virulent than those with normal Stx2 production.

Viral respiratory tract infections are a major cause of hospitalization in children. Influenza is common but often not laboratory proven. We report a prospective study of children admitted with a clinical diagnosis of pneumonia. Infants and children (ages 1 month - 15 years) who were hospitalized with community-acquired pneumonia were enrolled in the study. Their nasopharyngeal aspirated samples were analyzed for common respiratory viruses, including influenza virus, by reverse transcription-polymerase chain reaction (RT-PCR) or PCR. Out of 257 patients, we identified 127 (49.4%) cases with respiratory viruses, and influenza was found in 32 of these cases (12.5%). Other common respiratory viruses included respiratory syncytial virus in 42 (16.3%), human metapneumovirus in 24 (9.3%), adenovirus in 17 (6.6%) and parainfluenza virus in 12 (4.7%). The median age of the influenza group was 2 years and 3 months, and 27 (84%) of children in this group were under the age of 5. Asthma was the most common co-morbidity (4/32, 12.5%). Common clinical presentations were fever and cough (100%) with crepitations (90%). The median length of hospitalization was 6 days. Three patients developed respiratory failure, with one mortality (3.1%). One child developed infection-associated hemophagocytic syndrome. Our study demonstrated that young children had a high risk of hospitalization due to influenza pneumonia, which contributed to a significant morbidity.

The aim of the present study is to define the characteristics of the clinical and histopathological features of chronic necrotizing pulmonary aspergillosis (CNPA) cases with severe hemoptysis. We conducted a histological study of three patients clinically diagnosed as having CNPA who had hemoptysis for 5 years. A tuberculosis sequelae was found as the underlying disorder in all three cases. All patients had fever, general fatigue, and hemoptysis, and their chest computed tomographic images revealed fungus balls, cavity wall thickening, consolidation surrounding the cavity, and satellite foci. All had been treated with anti-fungal drugs and corticosteroids. However, all patients died from respiratory failure due to massive hemoptysis. Histopathological examination revealed that the cavity wall consisted of three layers comprised of necrotic, granulation, and fibrous tissue layers. Aspergilli were found in both the fungus ball and necrotic tissue comprising the inner layer of the cavity. In addition, most of the vessels were incompletely occluded with thrombosis and were necrotic, as well as showing local invasion of Aspergilli. Surgical intervention should be considered as a prior procedure for CNPA patients, because vessels at the cavity wall, whether occluded completely or incompletely, are usually necrotic and/or show local invasion of Aspergilli.

Group A streptococcus (GAS) is a major cause of pediatric pharyngotonsillitis. In this study we determined the T serotype and antimicrobial susceptibility of GAS isolates from Japanese children. From January to December 2006, a total of 438 isolates of GAS were obtained from pharyngeal swabs of 438 children with pharyngotonsillitis. The commonest T serotype was type 1 (110 strains, 25.1%), followed by type 12 (107, 24.4%) and type 4 (77, 17.6%). All GAS isolated from pharyngeal swabs were susceptible to β-lactams (benzylpenicillin, amoxicillin, cefotaxime, ceftriaxone, imipenem, panipenem, and cefditoren) and vancomycin, but 19.6, 19.6, 3.2, 11.6, and 27.6% were resistant to erythromycin, clarithromycin, clindamycin, minocycline, and norfloxacin, respectively. Resistance varied considerably with the T serotype. In particular, type 4 isolates had the highest resistance (67.5, 67.5, 26.0, and 53.2% were resistant to erythromycin, clarithromycin, minocycline, and norfloxacin, respectively).

To determine the vaccination rate and its adverse reactions after influenza vaccination, we administered an anonymous questionnaire survey during the last three influenza seasons from 2005-2006 to 2007-2008. In total, the rate of Influenza vaccination was 82.3% in health-care personnel. Dividing the subjects into four groups by work category, the vaccine coverage rates were as follows: physicians 67.9%; nurses and nursing assistants 91.2%; technicians, pharmacists, therapists, and administrative personnel 80.2%; and other personnel not directly involved in patient care but having the potential of being exposed to infectious agents 89%. The most frequent adverse reaction after vaccination was soreness at the injection site in 33.4%, followed by skin redness in 18.1%, myalgia in 17.7%, fatigue in 17%, and febrile sensation in 15.2%. After vaccination, such adverse reactions began within 24 h in 70.6% of subjects. Eighty-nine percent of those adverse reactions persisted for 1 - 3 days, but 11% persisted more than 4 days. Serious adverse reactions were not noted; the reported adverse reactions were relatively minor and transient. Surprisingly, among those who were vaccinated, the physicians’ participation was the lowest. We believe that influenza vaccination is safe and that physicians should be more concerned with influenza vaccination and its impact on the health-care community.

Human metapneumovirus (hMPV) is an etiologic agent of respiratory tract infections. In this study, we compared the sensitivity and specificity of real-time reverse transcription (RT)-polymerase chain reaction (PCR), conventional RT-PCR, and nested PCR in detecting hMPV genes. A total of 146 clinical specimens from 143 patients who showed acute respiratory tract infection symptoms were tested by real-time RT-PCR, conventional RT-PCR, and nested PCR targeting for the fusion gene. We detected hMPV RNA from 14 (9.6%) clinical specimens (real-time RT-PCR, 8; conventional RT-PCR, 5; and nested PCR, 13). When conventional RT-PCR was the reference standard, the sensitivity and specificity of real-time RT-PCR were 100 and 97.9%, respectively. When nested PCR was the standard, the sensitivity and specificity of real-time RT-PCR were 53.8 and 99.2%, respectively. Therefore, real-time RT-PCR was more sensitive than conventional RT-PCR but less so than nested PCR. Phylogenetic analysis showed that the real-time RT-PCR detected four genetic sublineages of hMPV. These results taken together indicate that real-time RT-PCR is an efficient method for detecting four genetic sublineages of hMPV from clinical specimens.

We surveyed reservoir animals of leptospires in the northern part of Miyazaki Prefecture, where a cluster of human leptospirosis had occurred during the summer of 2006. Leptospira was isolated from 6 of 57 large Japanese field mice (Apodemus speciosus). The serogroups of the isolates were Autumnalis (5 strains) and Hebdomadis (1 strain) and the partial nucleotide sequences of their flaB genes suggested that the isolates belonged to L. interrogans. The human patient sera reacted specifically with the Leptospira strain isolated from the mice captured around the area where each patient occurred, suggesting that mice are the source of human infection. We also detected leptospiral DNAs by flaB-polymerase chain reaction in the kidneys of large feral animals; wild boars (positive ratio 10.3%; 4 of 39) and deer (19.2%; 10 of 52). The Leptospira spp. harbored by these animals were deduced to be L. interrogans (in 5 animals) and L. borgpetersenii (in 9 animals) by the nucleotide sequences of the amplicons. Anti-Leptospira antibodies were also detected among symptomatic hound dogs. These results suggest that these feral animals may cause leptospirosis and pose a potential risk to hunters and workers in the meat processing industry.

Many of the protective immune responses of old people are impaired and this leads to an increased risk of oral bacterial infections. Little is known about the interaction between the systemic immune response on one hand and oral infections and oral diseases on the other. Here, we conducted an epidemiological study of the independent elderly to determine the relationships between activated natural killer (NK) cells and oral bacterial infections: oral diseases such as dental caries and periodontal disease. One hundred independent elderly people aged 77 years old (53 males, 47 females) were examined. Blood samples were drawn, and activated NK cells were evaluated using CD16, CD56, and CD69 monoclonal antibodies with flow cytometry. Bacterial counts for oral streptococci, lactobacillus, and opportunistic pathogens were performed using culture techniques. Oral disease examinations were performed by dentists. A larger percentage of CD69⁺NK cells (CD16⁺CD56⁺) showed significant correlations to the isolation numbers of total streptococci (r = 0.409, P < 0.01), the species numbers of opportunistic pathogens (r = −0.318, P < 0.01), the numbers of decayed teeth (r = −0.223, P < 0.05), and the amount of bridge work (r = 0.219, P < 0.05). A higher proportion of CD69⁺NK cells is associated with the incidence of dental caries and the number of opportunistic pathogens and total streptococci in the oral cavity of the elderly. This suggests that the proportionate number of CD69⁺NK cells may be a useful indicator for oral infection in elderly subjects.

Septicemia of Vibrio spp. such as non-O1 Vibrio cholerae presented with diarrhea, fasciitis, cellulitis or otitis media are common in cirrhotic patients (Lin, C.-J., Chiu, C.-T., Lin, D.-Y., et al., Am. J. Gastroenterol., 91, 336-340, 1996). It may result from a lower C3/C4 level, a lower serum ferritin level or opsonophagocytosis dysfunction. High mortality in such cases has been noted. However, endophthalmitis is rare in such patients, and has never been reported. We present a cirrhotic patient of non-O1 and non-O139 V. cholerae septicemia complicated with endophthalmitis.

Spontaneous perforation of the uterus is rare and only several cases have been reported in the English medical literature. Most of the patients had gynecological malignancy and almost all were associated with cervical occlusion. We report a case of diffuse peritonitis resulting from spontaneously perforated pyometra with an intrauterine device (IUD) inserted for more than two decades. This case differs from others in that the cervical canal was not occluded. In the absence of other possible causes of uterine perforation, the etiology in this case is mostly likely hemorrhagic necrosis related to the long-term IUD.

Human bocavirus (HBoV) is a novel virus which can cause respiratory tract disease in infants and children. Recently, the prevalence of this virus was studied worldwide not only in the respiratory tract, but also in the gastrointestinal tract. The results of this study focusing on the HBoV detection in stool samples showed that HBoV could only be found in the stool of children with acute gastroenteritis (0.9%), not in the healthy control samples. Moreover, the complete coding sequences of these HBoV also showed very conserved sequences.

The infection rate of Enterobius vermicularis was investigated in 1,070 preschool children aged 5-7 years in Kayseri, Turkey by cellotape anal swab from May-September 2005. The children's parents were asked to complete questionnaires inquiring into the potential risk factors involved. The overall egg positive rate for E. vermicularis was 5.1%. The infection rate among boys and girls was similar. The association between family size, household income/month, education level of the parents, employment status of the mother and enterobiasis were found to be significant.

In this study we analyzed 15 cases of empyema due to Streptococcus milleri group treated between January 2000 and December 2007. The majority (87%) were men, and the mean patient age was 62 years (range 36 to 83). An underlying disease was present in 14 of 15 cases. Six cases were complicated by pneumonia. Polymicrobial infection with S. milleri group was recognized in four patients. Most patients underwent chest tube drainage (87%), and all received antibiotic treatment (100%). The average duration of chest tube drainage was 8.4 days and that of antibiotic treatment was 14.0 days. Six cases (40%) underwent video-assisted thoracoscopic surgery for decortication. The duration of hospitalization was 19.6 days. The clinical effect of treatment was comparatively good (93%), and the prognosis was also good (mortality rate 7%).

The isolation rate of Legionella pneumophila serogroup 2 from clinical samples is low. In 2007, we encountered the second case known to occur in Japan. As the L. pneumophila serogroup 2 type strain, the Kobe strain isolated in 1988, and the Okinawa strain isolated from the present patient could not be differentiated using the usual biochemical and serological tests, we tried to achieve differentiation by observing colony morphology. In Oxoid BCYEα medium, colonies of the Kobe strain developed multiple protuberances on the surface, but these did not develop on the other two strains. In Becton-Dickinson BCYEα medium, colonies of the Okinawa strain had several outgrowths from the margin, but the type strain and the Kobe strain did not have any outgrowths. The Okinawa strain isolated from the present case showed intermediate characteristics between the type strain and the Kobe strain in the appearance of colony morphology. It may be useful to conduct an investigation of this rare serogroup.

To determine the major molecular mechanisms of macrolide resistance among Streptococcus pneumoniae isolates in Turkey, we examined a total of 151 isolates collected from different regions of Turkey. Overall, 40 (26.4%) isolates were resistant to erythromycin. The most common mechanism (38/40) was target site modification due to erm (B) genes. Only two isolates harbored the mef (A)/(E) efflux gene. A clonal spread of resistant strains could not be demonstrated by BOX-polymerase chain reaction. The results from this study have shown that the erm (B) gene is predominant in Turkish S. pneumoniae isolates, as in isolates from the rest of the world, and a clonal dissemination is not responsible for this resistance profile.

To determine the infectivity of Crimean-Congo hemorrhagic fever (CCHF) virus via routine contacts between serologically confirmed cases and their close relatives from May 2005 up to March 2006, 79 serum samples of 57 close relatives of 12 newly diagnosed serologically confirmed CCHF cases in the Sistan-va-Baluchestan province of Iran were tested for IgG and IgM antibodies against CCHF virus using the enzyme-linked immunosorbent assay technique. Nine levels of contacts were considered: percutaneous contact with the patient's blood, cutaneous contact with the patient's blood, cutaneous contact with non-sanguineous body fluids, cutaneous contact with the patient's skin, sexual contact, eating at the same table, being a roommate of the patient, being a housemate of the patient, and living with the patient in the same building. Only one out of 57 relatives was positive for anti-CCHF IgG (1.8%, 95% confidence interval 0.0 to 9.8%). Thus, the infectivity of the virus via usual routine contacts with patients appears to be low.

Enterovirus 71 (EV71) is one of the causative agents of hand, foot, and mouth disease (HFMD) and is known to cause encephalitis, but several reports have identified EV71 in cerebrospinal fluid (CSF). We detected EV71 in CSF from a 20-month-old infant. The patient was diagnosed with brainstem encephalitis associated with HFMD. The clinical features of the patient were high fever (39.1℃) and myoclonic jerks, and magnetic resonance imaging of the brain showed a bright signal area around the 4th ventricle. From a nasopharyngeal swab and rectal swab, EV71 was detected using reverse transcription (RT)-nested polymerase chain reaction (PCR). From CSF, the EV71 genome was identified using pan-enterovirus RT-nested PCR and sequencing. By real-time PCR, the nasopharyngeal swab, rectal swab, and CSF contained 1.8×10⁴, 9.8×10⁴, and 1.8×10 copies of the EV71 genome/µL, respectively. The enterovirus could only be isolated by cell culture from the rectal swab, and it was identified by a neutralization test using EV71-specific antiserum. RT-nested PCR and real-time PCR are considered to be sensitive tools for EV71 diagnosis in CSF.

Human metapneumovirus (hMPV) has been shown to be a leading cause of viral lower respiratory tract infections in children. Nevertheless, few reports regarding hMPV infections over consecutive years in children in primary care settings are available. We carried out virologic and clinical studies to determine the role of hMPV in febrile lower respiratory infections in children at a primary care clinic over 3 years and 5 months. Nasopharyngeal aspirates obtained from children with acute respiratory tract infections accompanied by high-grade fever (≥39℃) and productive cough were studied for hMPV by reverse transcription-polymerase chain reaction and for other respiratory viruses by viral cultures and immunoassays. Of 379 patients tested, 202 were positive for at least 1 virus, including 98 with hMPV, 69 with respiratory syncytial virus, 18 with adenovirus, 12 with enterovirus, 8 with parainfluenza virus, 3 with rhinovirus, 2 with influenza virus type C, and 1 with herpes simplex virus. The male:female ratio of hMPV-infected children was 0.96:1 with an overall mean age of 3.5 years (range, 2 months to 9 years). These infections occurred predominantly from February to July, and the hospitalization rate was 4%. Of 93 patients infected with hMPV alone, 52 (56%) showed evidence of a lower respiratory tract infection.