Globally, Haemophilus influenzae type b (Hib) is one of the leading causes of childhood meningitis and pneumonia. Vaccines against Hib have been developed and introduced into routine immunization programs in most industrialized nations, in which the burden of Hib disease has been clearly demonstrated. In Asia, the burden of Hib disease has been perceived as relatively low compared with other parts of the world. However, the results of several recent studies have allowed for a more cautious assessment of the disease burden in different populations and settings throughout Asia. These studies suggest that the true burden of Hib disease may have been underestimated, and point to several key factors that may have contributed to this problem, such as antibiotic use prior to the analysis of blood and cerebrospinal fluid in infants and children suspected of having invasive Hib disease. Trials evaluating Hib vaccines in Asian populations have shown that they are effective and safe. These results may aid in the decision about whether to implement routine Hib vaccination in Asia and help to track the impact of Hib vaccination in the future.

The aims of this study were to determine the distribution of serogroups and serotypes as well as the antimicrobial resistance pattern of Shigella isolates from Gondar patients with acute diarrhea. A cross-sectional study was conducted from August 2006 to February 2008. Stool specimens were received from study subjects and cultured. Isolates were confirmed by biochemical and serological tests. The isolates were tested for antimicrobial susceptibility by the disc diffusion method. Of the 1,200 stool specimens, 90 (7.5%) yielded Shigella isolates with the serogroups of Shigella flexneri (72.2%), S. dysenteriae (10.0%), S. boydii (8.9%), and S. sonnei (8.9%). S. flexneri was the predominant serogroup. S. dysenteriae type 1 was absent, and S. sonnei was present. Eighty-five (94.5%) of the isolates showed resistance to one or more drugs, and 79% of those were multi-resistant. S. flexneri showed the highest resistance (91.2%). S. flexneri serotype 1, resistant to ciprofloxacin and norfloxacin, was observed. All isolates were sensitive to nalidixic acid and ceftriaxone. Only 5 (5.6%) of the isolates were sensitive to all antibiotics tested. Based on these findings, we recommend ciprofloxacin as the drug of choice for treatment of shigellosis in Gondar, with frequent monitoring of drug susceptibility testing.

An influenza pandemic—an outbreak of a novel influenza virus that spreads around the world—is a real threat. To predict the spread of an influenza pandemic across the whole of Japan, this study applies a real individual-based model (ribm) to the whole of Japan and simulates how a single case of influenza could spark pandemic influenza throughout Japan. We used Person-Trip (PT) data for nine regions (the Tokyo metropolitan area, Kansai, Chukyo, Fukuoka, Sendai, Sapporo, Miyazaki, Okinawa, and northern Ibaragi). PT data were collected from randomly chosen persons and contain information on their locations and their uses of all transportation modes including trains, cars, buses, bicycles, and walking. In total, the nine regions have a population of about 72 million, of whom more than 2.20 million individuals participated in the PT surveys. Estimates on the probability of movement among the nine PT regions are based on the results of the Third National Survey for Movement in 2003. Disease transmission in each region or on a train is assumed to occur within a 1-m radius. The approximate numbers of new cases arising on day 14 after the arrival of the first infected person are estimated to be 322,000 in Tokyo, 25,000 in Kansai, 4,800 in Chukyo, 3,600 in Sapporo, 2,600 in Fukuoka, 600 in Sendai, 17 in Okinawa, and 300 in Miyazaki. The disease seems to spread more slowly in smaller cities such as Miyazaki and Okinawa than in big cities such as Tokyo and Kansai. Area quarantines may help to contain outbreaks in smaller cities, but probably not in larger cities. Because this study demonstrates that ribm is useful for simulating the spread of pandemic influenza in Japan, it is hoped that this modeling technique will be used in the creation of preparedness plans.

Fever of different etiology is common in tropical and subtropical countries of the world. Etiological agents of febrile illnesses were assessed in 653 acute febrile patients aged 3 to 17 years who attended the outpatient departments of Dembecha Health Center, Jiga Health Center, Quarit Health Center, and Finoteselam Hospital in western Gojjam zone, northwestern Ethiopia. Malaria was the most prevalent illness, infecting 62% of all cases. Its prevalence varied significantly from 52% (Dembecha) to 72.7% (Quarit) (χ² = 15.02, P = 0.000). Plasmodium falciparum was the first cause of malaria (47.3%) followed by P. vivax (23%). Mixed infection of both P. falciparum and P. vivax was found in 7.2% of the cases. The other febrile infections were pneumonia (7%), typhoid (5.8%), typhus (5.1%), and brucellosis (2.6%). The availability of diagnostic facilities and the awareness of the community regarding the prevalence of non-malaria febrile illnesses are very low, and these illnesses are diagnosed clinically. As these illnesses are nonspecific, especially during the early stages of onset, misdiagnosis and mistreatment can occur. Therefore, it is recommended that the necessary diagnostic materials and awareness should be in place for prompt treatment of febrile cases in these districts.

A seventh round behavioral and serological surveillance found that the HIV epidemic had remarkably increased to 7% among intravenous drug users (IDU) in Central Bangladesh, indicating the urgent need to increase prevention. The main purposes of this study were to find out, by collecting data and the necessary information from sero-surveillances, published reports, and articles, what the prevalence of HIV/AIDS is, and what the acquisition and transmission routes are. In addition, trends in HIV-related risk behaviors among recognized high risk groups were observed, and estimations and projections of HIV transmission up to the year 2020 presented. The Estimation and Projection Package was used to estimate and project HIV transmission. The study results reveal that Bangladesh is a low prevalence country which is turning into one with a concentrated epidemic due to the high HIV prevalence rate of IDU (7%) among the most-at-risk groups. Within this at-risk population, IDU have the highest prevalence rate of HIV transmission, followed by female sex workers, clients of sex workers, and men who have sex with men. If the transmission rate continues to increase, the situation will be uncontrolled. Therefore, there is an urgent need for a comprehensive prevention program to control the spread of HIV.

The number of children infected by Helicobacter pylori is increasing worldwide. The aim of this study is to identify demographic and maternal risk factors affecting H. pylori positivity in asymptomatic children. One hundred sixty-five asymptomatic children, 75 (45%) females, and 90 (55%) males, between 2 and 12 years of age (mean 6.8 ± 3.0 years) were tested for the presence of H. pylori stool antigen. The ages, genders, weights, heights, and breastfeeding histories of the children were reported. Information concerning the age and education levels of the mothers, number of siblings, and family incomes was also taken. H. pylori stool antigen positivity was 30.9% (n = 51) of the children and 30.4% (n = 48) of their mothers. H. pylori positivity was detected in 70.6% (36) of children whose mothers were positive (P < 0.001, r = 0.64). Lower education level of mothers, lower family income, poor living conditions, and higher numbers of siblings were correlated with higher H. pylori positivity in children. The children living in the worst conditions and having less well educated mothers were at higher risk for H. pylori infection. The best way to decrease the prevalence of H. pylori infection in children is to educate women about how to protect themselves and their offspring from H. pylori infection.

In order to develop an inexpensive, simple, and accurate method of monitoring for the reemergence of schistosomiasis japonica in Yamanashi Prefecture, Japan, the distribution and habitation density of the intermediate host, Oncomelania nosophora, were spatially analyzed using geographic information systems. The 1967-1968 density distribution maps prepared by Yamanashi Prefecture and Nihei were digitized and geocoded. The habitats and population density of O. nosophora were estimated by referring to the data compiled by the Yamanashi Association for Schistosomiasis Control (1977). These earlier findings were compared with average population densities between 1996 and 2000 previously recorded (Nihei, N., Kajihara, N., Kirinoki, M., et al., Parasitol. Int., 52, 395-401, 2003 and Nihei, N., Kajihara, N., Kirinoki, M., et al., Parasitol. Int., 53, 199-205, 2004). A variance map was created to compare the spatial distribution maps of population density from each of the two periods of interest. The changes in distribution were remarkable and the map was found to be effective for future control. The most appropriate monitoring sites were chosen on the basis of the spatial population density maps and the variance map. Moreover, the paddy fields at risk were extracted using the normalized difference vegetation index value based on Advanced Land Observation Satellite images. The combination of this method with the global positioning system provides an inexpensive means of monitoring modern schistosomiasis endemic areas in Japan and also in China, the Philippines, and other countries as well, where the intermediate snail grows in paddy fields and marshlands under consistently wet conditions.

Lemierre's syndrome is characterized by a primary oropharyngeal infection in a young healthy person who subsequently develops septic thrombophlebitis of the internal jugular vein and metastatic abscesses. We here report an uncommonly severe case of Lemierre's syndrome with acute respiratory distress syndrome (ARDS), in which polymyxin B-immobilized fiber (PMX) was used as supportive therapy. A 30-year-old, previously healthy man presented with sore throat, fever, rigor, and dyspnea. Chest computed tomography scan revealed multiple bilateral peripheral pulmonary nodules with small bilateral pleural effusions. The patient's condition rapidly deteriorated into ARDS after admission. Intubation followed by mechanical ventilation was required, and hemoperfusion with PMX was useful in alleviating the patient's condition. Isolation of Fusobacterium necrophorum from the blood culture and the contrast-enhanced scan revealed thrombosis and thrombophlebitis in the left internal jugular vein. The patient was diagnosed with Lemierre's syndrome, and an alternative treatment regimen with prolonged administration of ampicillin, clindamycin, and metronidazole resulted in improvement of the patient's respiratory function and general condition. Our case indicated that PMX might be an effective supportive therapy in severe cases of Lemierre's syndrome with ARDS that possessed no indication of surgical interventions.

We conducted the first epidemiological study of influenza in Lebanon, a temperate country in the Middle East. Between January to May 2008, 39 patients with influenza-like illness were tested. Of these, 51% contracted influenza in January alone, while no influenza cases were detected in May. Among the 39 patients, 11 influenza A and 4 influenza B cases were detected by rapid kit in addition to 10 respiratory syncytial virus cases by real-time PCR. The influenza viruses were genetically divergent from the 2007/2008 season's vaccine strains, but resembled strains circulating in other countries during the same season.

Artemether-lumefantrine, a tablet formulation of these respective antimalarial compounds, has been developed for the treatment of patients with drug-resistant malaria worldwide. Many studies have shown that it is most effective of the antimalarial compounds in shortening the fever and parasite clearance times. However, several treatment failures have been reported. These failures are believed to be a consequence of poor bioavailability of the lumefantrine component when ingested without fatty food. This paper reports the first case of such treatment failure of imported malaria in Japan in a 58-year-old Japanese man who showed recrudescence of Plasmodium falciparum after treatment with artemether-lumefantrine. The drug was administered to the patient in 6 doses, each time without fatty food and on a seemingly empty stomach. It is believed that treatment failure was due to poor absorption and a subsequent low plasma concentration of lumefantrine. Although artemether-lumefantrine has not been approved for use in Japan and is thus not commonly used there at present, it is thought to be the most promising drug of choice for the treatment of drug-resistant malaria. Taking an appropriate dosage and providing patients with proper instructions on taking the drug concurrently with fatty food are required for effective treatment with artemether-lumefantrine.

Anaplasma phagocytophilum, which belongs to the order Rickettsiales, is an obligate intracellular bacterium and causes an emerging, tickborne, and febrile infectious disease, anaplasmosis, in humans and other mammals. This bacterium expresses a variety of 44-kDa immunodominant proteins encoded by the p44/msp2 multigene family on the surface for the purpose of avoiding the host immune defense due to the antigenic variation. In Japan, little is known about the molecular and biological features of A. phagocytophilum. In this study, we tried to characterize in detail the p44/msp2 multigene family of A. phagocytophilum from two tick species, Ixodes persulcatus and I. ovatus in Japan. A total of 174 amino acid sequences from the recombinant p44/msp2 clones after TA cloning of the amplicons obtained from the ticks were phylogenetically analyzed. The results showed that most of the clone sequences from I. ovatus were very similar to each other, but the sequences from I. persulcatus were diverse, and the sequences from the ticks were distinct from those from a wild deer that was previously reported. These findings suggest that Ixodes ticks are probably responsible for the transmission of certain genetic variants of A. phagocytophilum and that additional organism selection might occur in I. ovatus.

Mucor spp. are rarely pathogenic in healthy adults, but can cause fatal infections in patients with immuosuppression and diabetes mellitus. Documented mucor fungemia is a very rare condition in the literature. We described a fungemia and cutaneous mucormycosis case due to Mucor circinelloides in an 83-year-old woman with diabetes mellitus who developed acute left frontoparietal infarctus while hospitalized in a neurological intensive care unit. The diagnosis was made based on the growth of fungi in the blood, skin biopsy cultures, and a histopathologic examination of the skin biopsy. The isolates were identified as M. circinelloides by molecular methods. This case is important in that it shows a case of cutaneous mucormycosis which developed after fungemia and provides a contribution to the literature regarding Mucor fungemia.

In our study we evaluated the Quantiferon-TB Gold (QFT-G) test and compared it with tuberculin skin test (TST) positivity in 44 pulmonary and 21 extrapulmonary tuberculosis cases in whom active tuberculosis infection was suspected on clinical, microbiologic and radiologic grounds. QFT-G positivity was 75% in pulmonary tuberculosis and 76.2% in extrapulmonary tuberculosis. TST positivity was 68.2 and 62%, respectively. Although QFT-G positivity was higher than TST positivity, the difference was statistically insignificant (P = 0.77). Similar to TST, QFT-G is one of the supplementary diagnostic tests for active tuberculosis disease and latent tuberculosis infection. Its advantage over TST is that it gives a result on the same day and it is unaffected by prior BCG and previous exposure to atypical mycobacteria. In conclusion, we think that, as with TST, a positive QFT-G result can be an adjunct to diagnosis in patients having clinical and radiological data compatible with tuberculosis.

We investigated the resistance determinant of 13 clinical isolates of carbapenem-resistant Acinetobacter baumannii collected from a regional hospital in the north of Thailand. All isolates were multidrug resistant and produced the OXA-23 carbapenemase. The bla_OXA-23 gene was found adjacent to ISAba1. Furthermore, two isolates carried the metallo β-lactamase gene, bla_IMP. The bla_OXA-23 and bla_IMP genes were plasmid-mediated according to the transformation assays. This is the first description of OXA-23-producing A. baumannii from Thailand.

A total of 46 carbapenem- and multidrug-resistant (CR- and MDR-)Acinetobacter baumannii bacteremic isolates from a Taiwanese medical center were investigated over the period 2000 to 2006 using randomly amplified polymorphic DNA (RAPD) profiling and by analysing the genetic organization of their integrons. The results of RAPD patterns revealed that before 2003 each CR- and MDR-A. baumannii bacteremic isolate was independent, but after 2003 the isolates appeared to belong in four epidemic strains and persisted in the hospital. All the CR- and MDR-A. baumannii strains harbored class I integron (intI1) genes. PCR amplification and nucleotide sequencing showed that the cassette genes of intI1 were found to form four different antibiotic-resistant gene alignments in those strains. The bla_IMP-1 gene in the cassette genes of intI1 was identified in a clone, which raised great concern that clonal spread of this strain or of an integron-mediated horizontal gene may have occurred.

Enterococci, a family of important opportunistic pathogens, exhibits intrinsic resistance to a number of antimicrobial agents in addition to acquired multidrug resistance. The present study was conducted to determine whether enterococci at a tertiary care hospital in India exhibit high-level aminoglycoside resistance and β-lactamase production. Enterococci were isolated from various clinical specimens and identified phenotypically. High-level resistance (HLR) to gentamicin, kanamycin, and streptomycin was determined by disc diffusion tests. β-lactamase production was detected using three methods: iodometric, acidometric, and chromogenic β-lactamase assays. Among the 86 enterococci isolated, 34 were found to have HLR to one or more aminoglycosides; HLR to kanamycin was most common. Vancomycin resistance was present in four of the isolates. Only one enterococcus produced β-lactamase, and it was sensitive to ampicillin on routine disc diffusion testing. β-lactamase production among enterococci, though not very common, may be missed on routine susceptibility testing. Frequent occurrence of HLR to kanamycin makes amikacin a poor choice for inclusion in combination therapy with cell wall-active agents.

In Turkey, where brucellosis is endemic, a comparison of conventional and molecular genotyping methods has not been published to date. In this study, we investigated the efficacy of single nucleotide polymorphism (SNP) analysis of rpoB gene in the genotyping of Brucella melitensis strains by sequencing. In light of the molecular genotyping method available now in Turkey, the adequacy of serological typing alone should be re-evaluated as a tool for epidemiologic studies of B. melitensis.

Direct colony polymerase chain reaction (DCPCR) is a useful molecular biological technique for application in the field of mycology. In this study, all of the 63 fungal strains examined, including those of the genera Candida and Aspergillus, were amenable to DNA amplification using an Ampdirect^® Plus kit, which allows direct PCR amplification with no requirement for DNA extraction, following 1 h of rapid fungal lysis. Moreover, we compared DCPCR of 35 strains, representing 20 species, using Ampdirect PCR and standard PCR with no lysis buffer. Thirty-four of these strains (97.14%) yielded positive results on Ampdirect PCR, while only 11 (including Aspergillus fumigatus TIMM1776) of the 35 strains (31.43%) showed PCR products when standard PCR reagents were used. Ampdirect DCPCR was also applicable to DNA amplification for spore and hyphal cells. This approach reduces DNA template preparation time before PCR from fungal colonies, and also reduces the cost of PCR.