Leprosy is caused by Mycobacterium leprae. Currently, leprosy control is mainly based on WHO-recommended multi-drug treatment; thus, emergence of drug resistance is a major concern. M. leprae isolates resistant to single and multiple drugs have been encountered. In this review, the history of chemotherapy and drug resistance in leprosy and molecular biological insights for drug resistance are described. New methodologies to test susceptibility to anti-leprosy drugs instead of the traditional mouse footpad method are introduced. Awareness of the need to monitor drug resistance to prevent the spread of resistant cases is emphasized.

Mouse models of influenza play an important role in developing effective human influenza vaccines. We have demonstrated that intranasal immunization with inactivated subvirion (SV) vaccines, in conjunction with a cholera toxin B subunit adjuvant (CTB*), provides more effective cross-protection than parenteral immunization in BALB/c mice. In addition, the minimal effective dose of nasal vaccine for providing complete protection against a lethal influenza virus infection is 0.1 µg SV vaccine (containing about 30 ng hemagglutinin [HA]) (with 0.1 µg CTB*) in BALB/c mice (20 g body weight) immunized twice intranasally 4 weeks apart. The effective dose in humans can be estimated to be roughly 100 µg SV vaccine (containing approximately 30 µg HA) (with 100 µg CTB*)/20 kg body weight by using the dose/body weight ratio from actual vaccination trials. This estimation can be rationalized by the hypothesis that the distribution of strains (or individuals) in a mouse (or human) population, in relation to their HA antigen responsiveness, follows a normal distribution, and by the fact that BALB/c mice are intermediate responders for anti-HA antibody responses, and correspond to human intermediate responders, which form the largest population. We also discuss the use of innate immune responses, as well as antibody responses, in BALB/c mice to assess the efficacy of unknown adjuvants and the development of other adjuvants for nasal vaccines that should be clinically safer than CTB*.

Cefotaxime plus minocycline has been shown to have synergistic activity against Vibrio vulnificus; however, the clinical role of cefazolin in combination with minocycline in immunocompromised hosts has not been established. Therefore, antimicrobial susceptibility of the V. vulnificas clinical isolate Vv05191 was studied by the agar dilution method. Antibacterial activity of cefazolin, minocycline, and a combination of the two drugs was investigated by time-kill studies in vitro and further examined for therapeutic efficacy in a murine model. When cefazolin at a combination of 4 mg/L (1/2 × MIC) was combined with minocycline at a concentration of 0.03 mg/L (1/2 × MIC), sustained inhibitory activity was noted until 24 h. In BALB/cByJ mice with cyclophosphamide-induced neutropenia, an inoculum of 1.5 × 10⁸ CFU caused death within 96 h when the infected mice were treated by cefazolin (400 mg/kg every 3 h), while 6.3% of mice survived when treated by minocycline (4 mg/kg stat, then 2 mg/kg every 12 h). However, 62.5% of mice survived for 96 h when mice were treated by cefazolin (400 mg/kg every 3 h) plus minocycline (4 mg/kg stat, then 2 mg/kg every 12 h) (P = 0.002, log rank test). In conclusion, cefazolin in combination with minocycline exhibits in vitro synergistic antibacterial activity against V. vulnificus and provides a therapeutic advantage in neutropenic mice with V. vulnificus infection.

We investigated the spatial distribution and pyrethroid susceptibility of the mosquito larvae belonging to Aedes albopictus and Culex pipiens group in catch basins located in parks in Nagasaki city, Nagasaki, Japan. Among the 308 parks located in the central regions of the city, 194 were investigated. Cx. pipiens group larvae were collected from 31 sites; larvae of Ae. albopictus, from 34 sites. The Cx. pipiens group larvae were identified by PCR: 93.4% were found to belong to Cx. pipiens pallens, and 0.9%, to Cx. pipiens form molestus. A bioassay was performed by observing the knockdown of larvae during 30-min exposures to 0.4- and 0.1-ppm solutions of d-allethrin. High tolerance to d-allethrin (susceptibility index = 36) was observed in only 1 colony of Cx. pipiens pallens across 24 sites. On the other hand, Ae. albopictus showed high tolerance (susceptibility index > 30) in 8 of 22 sites; this indicated that Ae. albopictus populations tolerant to pyrethroids were spreading widely in Nagasaki city. The organized and massive larvicidal treatment of graveyard containers with DDT in the 1950s was thought to be one of the main causes for the development of pyrethroid resistance in Ae. albopictus.

Transcriptomics is an objective index that reflects the overall condition of cells or tissues, and transcriptome technology, such as DNA microarray analysis, is now being introduced for the quality control of medical products. In this study, we applied DNA microarray analysis to evaluate the character of Japanese encephalitis (JE) vaccines. When administered into rat peritoneum, Vero cell-derived and mouse brain-derived JE vaccines induced similar gene expression patterns in liver and brain. Body weights and blood biochemical findings were also similar after administration of the two vaccines. Our results suggest that the two JE vaccines are likely to have equivalent characteristics with regard to reactivity in rats.

PCR, including real-time PCR, usually requires at least 1 h to obtain results. To shorten this time, a novel real-time PCR method (Hyper-PCR) was developed. This method utilizes high-speed DNA polymerase and a thin disc-type reaction vessel that can quickly alter the temperature of the reaction mixture in a newly developed PCR machine. Reactions capable of amplifying adenovirus (Ad) DNA can be completed within 11 min (3 temperature steps, 55 cycles). Hyper-PCR can detect 3.1-18.0 DNA copies/reaction of Ad types 1-4, 7, 8, 11, 15, 19, and 37. Hyper-PCR and conventional real-time PCR were applied to diagnose 147 clinical samples, and the results were compared. Hyper-PCR had a sensitivity of 100% (73/73) and a specificity of 100% (74/74), using conventional real-time PCR as the gold standard. Our newly developed PCR method, Hyper-PCR, was able to diagnose Ad infection within 17 min (not including the time for genome extraction). The thermocycling time of the novel PCR is faster than that of previously available PCR applications, and this method is thought to be potentially applicable to clinical and environmental diagnostics, where rapid diagnosis is important.

A quick, reliable detection system is necessary to deal with bioterrorism. Loop-mediated isothermal amplification (LAMP) is a DNA amplification method that can amplify specific DNA fragments in isothermal conditions. We developed a new highly mobile and practical LAMP anthrax detection system that uses a disposable pocket warmer without the need for electricity (pocket-warmer LAMP). In our tests, the detection limit of the pocket-warmer LAMP was 1,000 copies of Bacillus anthracis pag and capB gene fragments per tube. The pocket-warmer LAMP also detected B. anthracis genes from DNA extracted from 0.1 volume of a B. anthracis colony. The lower detection limit of the pocket-warmer LAMP was not significantly different from that of a conventional LAMP using a heat block, and was not changed under cold (4ºC) or warm (37ºC) conditions in a Styrofoam box. The pocket-warmer LAMP could be useful against bioterrorism, and as a sensitive, reliable detection tool in areas with undependable electricity infrastructures.

DNA immunization or vaccination, which refers to the injection of DNA encoding the corresponding antigen proteins, has become an attractive method for inducing the production of antibodies (Abs) in animals, since it does not require proteins as antigens. However, a method for detecting Abs produced in response to antigens is still essential for the quantification of Abs in the sera of immunized animals and for the screening of monoclonal antibody (mAb)-producing hybridomas. Here, we report a new system for the evaluation of Abs against antigens that are difficult to purify, by employing intracellular biotinylation of the antigen protein. The antigen tagged with a peptide to be biotinylated (Bio-tag) and codon-optimized bacterial BirA biotin ligase were co-expressed in mammalian cells, and the biotinylated Bio-tagged antigen was captured on a streptavidin-coated plate. Abs against five human nuclear antigens that were difficult to purify as full-length recombinant proteins were detected in the sera of DNA-immunized mice, and IgG mAbs against three of these antigens were selected by ELISA. The results demonstrate that this system employing intracellular biotinylation of the antigen is a powerful technique for stimulating the production of Abs following DNA immunization.

Brucella abortus is the intracellular bacterium that causes bovine brucellosis and a chronic human disease known as undulant fever. Interferon (IFN)-γ plays critical roles in defending against intracellular bacterial infection. In this experiment, we demonstrated the difference in IFN-γ production between the splenocytes of mice inoculated with outer membrane proteins (OMPs) of B. abortus and whole live bacteria. Our results showed that the OMP-inoculated group showed more IFN-γ production than did the bacteria-infected group, suggesting that OMPs are candidates for the induction of immune response.

Intentional contamination of beverages with microbes is one type of bioterrorist threat. While bacteria and fungus can be easily collected by a centrifuge, viruses are difficult to collect from virus-contaminated beverages. In this study, we demonstrated that Viro-Adembeads, a rapid-capture system for viruses using anionic polymer-coated magnetic beads, collected viruses from beverages contaminated intentionally with vaccinia virus and human herpesvirus 8. Real-time PCR showed that the recovery rates of the contaminated viruses in green tea and orange juice were lower than those in milk and water. Plaque assay showed that green tea and orange juice cut the efficiency of vaccinia virus infection in CV-1 cells. These results suggest that the efficiency of virus detection depends on the kind of beverage being tested. Viro-Adembeads would be a useful tool for detecting viruses rapidly in virus-contaminated beverages used in a bioterrorist attack.

We attempted to apply the PCR-restriction fragment length polymorphism (PCR-RFLP) technique for the early detection and identification of Mycobacterium tuberculosis directly from clinical samples. PCR-RFLP of hsp65 was applied to the DNA extracted directly from sputum samples (n = 226) collected from 226 patients. We could detect and identify M. tuberculosis in 84.5% of the acid-fast bacillus (AFB) smear-positive samples (n = 149) and 11% of the AFB smear-negative samples (n = 18) obtained from patients with clinical and radiological evidence of tuberculosis. Sputum samples (n = 59) obtained from patients suffering from respiratory diseases other than tuberculosis were included as negative controls. To test the sensitivity of the assay, we spiked a smear-negative sample with serial dilutions of H37Rv. The protocol could detect down to 10 organisms/µl. PCR-RFLP was found to be a simple and reproducible method for early detection of M. tuberculosis from sputum samples. The present assay could be used to augment conventional methods of diagnosis of mycobacterial diseases and thus help clinicians to differentiate between M. tuberculosis complex and non-tuberculous mycobacteria directly in clinical samples. The assay could help clinicians to select appropriate chemotherapeutic agents early, which could considerably reduce the morbidity due to mycobacterial diseases.

Japanese encephalitis virus (JEV) is a fatal disease in Asia. Pigs are considered to be the effective amplifying host for JEV in the peridomestic environment. Bali Island and Java Island in Indonesia provide a model to assess the effect of pigs on JEV transmission, since the pig density is nearly 100-fold higher in Bali than Java, while the geographic and climatologic environments are equivalent in these areas. We surveyed antibodies to JEV among 123 pigs in Mengwi (Bali) and 96 pigs in Tulungagung (East Java) in 2008 by the hemagglutination-inhibition (HAI) test. Overall prevalences were 49% in Bali and 6% in Java, with a significant difference between them (P < 0.001). Monthly infection rates estimated from age-dependent antibody prevalences were 11% in Bali and 2% in Java. In addition, 2-mercaptoethanol-sensitive antibodies were found only from Bali samples. Further, the average HAI antibody titer obtained from positive samples was significantly higher in Bali (1:52) than Java (1:10; P < 0.001). These results indicated that JEV transmission in nature is more active in Bali than East Java.

In this report we present a case of a young lady with abdominal abscesses and septicemia caused by Mycobacterium chelonae complex. Identification of the organism and initiation of the appropriate antimicrobial therapy was delayed, resulting in significant morbidity and multiple hospital admissions. Gram staining of these organisms from blood culture can be easily overlooked or confused with either debris or diptheroids. We concluded that detection of Gram-positive rod colonies should prompt an acid-fast stain to distinguish diphtheroids from rapidly growing mycobacteria in immunosuppressed patients.

Chikungunya fever is an arboviral disease caused by chikungunya virus. A 37-year-old Japanese male visited India and developed fever, myalgia, rash, and persisting systemic arthralgia, the latter of which persisted for more than 2 months. The patient was diagnosed with chikungunya fever by virological and serological examinations. In the present study, we followed specific antibody responses over a 6-month period after the onset of the disease. IgM antibody was detected on days 58 and 108, but not on day 137, by enzyme-linked immunosorbent assay. Specific IgG and neutralizing antibodies were detected as late as day 192. The results indicate that specific IgM lasts for 3 to 4 months from the onset of the disease, and that IgG lasts more than 6 months.

We report the pathological and virological findings of the first autopsy case of the 2009 pandemic influenza (A/H1N1pdm) virus infection in Japan. A man aged 33 years with chronic heart failure due to dilated cardiomyopathy, mild diabetes mellitus, atopic dermatitis, bronchial asthma, and obesity died of respiratory failure and multiple organ dysfunction syndrome. Macroscopic examination showed severe plumonary edema and microscopically the lung sections showed very early exudative-stage diffuse alveolar damage (DAD). Immunohistochemistry revealed proliferation of the influenza (A/H1N1pdm) virus in alveolar epithelial cells, some of which expressed SAα2-3Gal on the cell surface. Influenza (A/H1N1pdm) virus genomic RNA and mRNA were also detected in alveolar epithelial cells. Real-time PCR revealed 723 copies/cell in the left lower lung section from which the influenza (A/H1N1pdm) virus was isolated. Electron microscopic analysis revealed filamentous viral particles in the lung tissue. The concentrations of various cytokines/chemokines in the serum and the autopsied lung tissue were measured. IL-2R, IL-6, IL-8, IL-10, IFN-α, MCP-1, and MIG levels were elevated in both. These findings indicated a case of viral pneumonia caused by influenza (A/H1N1pdm) virus infection, showing characteristic pathological findings of the early stage of DAD.

We describe an autopsy case of a patient with pandemic influenza (A/H1N1pdm) virus infection in Japan, who developed rapidly progressive viral pneumonia exhibiting diffuse alveolar damage. A 41-year-old female visited our hospital with a fever of 38.7℃. She was a public health nurse with no underlying disease and had had contact with a group of elementary school students who had been infected with the influenza (A/H1N1pdm) virus 1 week earlier. She was prescribed oseltamivir and returned to the hotel where she was staying alone. The next day, she was found dead in her hotel room. At autopsy, both lungs were voluminous and microscopic examination revealed acute-stage, severe diffuse alveolar damage with remarkable mononuclear cell infiltration and hyaline membrane formation in the lungs. CD8-positive T lymphocytes were dominantly observed. Immunohistochemically, influenza A viral protein was confirmed in the damaged type II pneumocytes and also in the infiltrated macrophages. Real-time RT-PCR analysis of both pre- and post-mortem pharyngeal swabs confirmed a novel influenza (A/H1N1pdm) virus infection. This is the second autopsy case of influenza (A/H1N1pdm) virus infection in Japan, and the findings indicated that the patient died due to an exceptionally rapid progression of viral pneumonia. This case indicates that patients with influenza (A/H1N1pdm) virus infection should be carefully monitor for acute respiratory distress syndrome.