A serosurvey of severe fever with thrombocytopenia syndrome virus (SFTSV) infection in domestic animals was conducted in the rural areas of Laizhou City, Shandong Province, China to determine strategies for control and prevention of SFTS. Serum samples were collected from cattle, goats, dogs, pigs, and chickens and antibodies against SFTSV were detected by double-antigen sandwich enzyme-linked immunosorbent assay (ELISA). Of 641 serum samples, the SFTSV seropositive rate was 41.8% (268/641): 74.8%, 57.1%, 52.1%, 35.9%, and 0%, for goats, cattle, dogs, chickens, and pigs, respectively. We also found that the SFTSV seropositive rates were high among the aged cattle, goats, dogs, and chickens. SFTSV infections existed among cattle, goats, dogs, and chickens in Laizhou City, and goats had the highest seroprevalence. SFTSV seroprevalence increased with an increase in age among animals. To control of animal infestation with ticks may prevent human SFTSV infections.

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The aim of this study was to explore the rate of device-associated nosocomial infections (DANIs) and the distributions of causative agents and patterns of antibiotic resistance in the medical-surgical intensive care unit (ICU) over a 3-year period and to compare these rates with those reported by National Nosocomial Infections Surveillance System and International Nosocomial Infection Control Consortium. A total of 1,798 patients were hospitalized in our ICU for 13,942 days, of which 309 patients had DANIs, indicating an overall infection rate of 22.1 per 1,000 ICU-days. The central line-associated bloodstream infection rate was 6.4 per 1,000 catheter-days, whereas the ventilator-associated pneumonia rate was 14.3 per 1,000 ventilator-days and the catheter-associated urinary tract infection rate was 4.3 per 1,000 catheter-days. Overall, 87.4% of all Staphylococcus aureus DANIs were caused by methicillin-resistant strains. With respect to Pseudomonas aeruginosa, 30.9% of the strains were resistant to ciprofloxacin, 23.3% to amikacin, 43.1% to ceftazidime, 19.1% to piperacillin-tazobactam, and 34.7% to imipenem. Furthermore, 1.9% of the Enterococcus spp. were resistant to vancomycin, and 51.1% of Enterobacteriaceae were resistant to ceftriaxone. DANI rates decreased over the 3-year study period, which was likely in response to the infection control measures implemented in our ICU.

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The mutant virus Mu-3 was isolated from the soluble receptor-resistant mutant 7 virus (srr7), which is a neuropathogenic strain of the mouse hepatitis virus JHMV, and cloned as a soluble receptor-resistant mutant from the highly neuropathogenic JHMV strain cl-2 virus (cl-2). In order to identify specific characteristcs of Mu-3, the pathology of Mu-3-infected mice was compared with that of srr7- and cl-2-infected mice. The neuropathology after Mu-3 infection exhibited a mixed pattern comparable to that induced by srr7 and cl-2 infections. In addition, Mu-3 infection caused marked apoptotic lesions in the hippocampal region, particularly in the CA2 and CA3 subregions, in the brains of all infected mice. In contrast, in cl-2 infection, 10–20% of the infected mice exhibited apoptosis in the hippocampus, which was primarily observed in the CA1 subregion. Apoptosis also occurred in the pyramidal neurons and CD11b-bearing cells. The apoptotic cells, indicated by caspase 3-activation, were a mixed population of infected and a higher number of uninfected cells. These data indicated that apoptosis observed in Mu-3 infection could be induced by the indirect effects of infection in addition to direct effects of the infected cells occurring in a cell-autonomous manner.

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The objective of this study was to determine the prevalence of urethral Mycoplasma genitalium infections among male patients attending a sexually transmitted disease (STD) clinic in China and identify risk factors associated with this disease. A total of 423 patients were recruited in Hezhou City, Guangxi Province, China, and each was requested to complete a questionnaire regarding sociological and sexual behaviors. First-void urine samples were collected for M. genitalium analysis by polymerase chain reaction. Of the 406 urine samples collected, 114 were M. genitalium-positive, giving a prevalence rate of 28.1%. Univariate logistic regression analysis showed that M. genitalium infection was associated with younger age, having received at least senior high school education, and single marital status. In both univariate and multivariate logistic regression analyses, M. genitalium infection was found to be associated with lack of symptoms for STD in the past year (adjusted odds ratio [AOR] = 2.839; 95% CI = 1.495–5.392; P = 0.001), no use of condoms with steady partners in the past year (AOR = 2.830; 95% CI = 1.468–5.455; P = 0.002), and having sexual encounters with female sexual workers within the past 3 months (AOR = 2.955; 95% CI = 1.637–5.336; P < 0.0003). The observed high rate of M. genitalium infection among male STD patients in Hezhou City indicates an M. genitalium epidemic in the study population; thus, the national surveillance program and clinical health providers in China should more closely monitor this disease.

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In this study, we investigated the pro- and antioxidant status of patients with a pathogenesis of Crimean-Congo hemorrhagic fever (CCHF) in terms of their role in its pathogenesis. During the study period, 34 children and 41 adults were diagnosed with CCHF. The control group consisted of healthy age- and gender-matched children and adults. Serum levels of the total antioxidant capacity (TAC), total oxidant status (TOS), oxidative stress index (OSI), and plasma total thiol (TTL) were evaluated and compared between groups. The difference in mean TAC values between CCHF patients and healthy controls was not statistically significant (P > 0.05). Mean TOS, OSI, and TTL values were significantly lower in CCHF patients than in healthy controls (P < 0.001). Comparisons between the 2 groups revealed that mean TOS and OSI values were significantly lower in adults with CCHF than in their healthy counterparts (P < 0.001). Similarly, mean TTL levels were lower in both children and adults with CCHF when compared separately with healthy controls (P < 0.05). There was no significant difference in the mean serum TTL levels between children and adults with CCHF (P > 0.05). Our results suggest that TTL may play a more important role in CCHF pathogenesis than the other parameters investigated. The mean TOS and OSI values were higher in the control group than in CCHF patients.

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Although imported malaria poses a grave public health threat in Japan, diagnostic methods and disease management among patients and primary care providers has rarely been reported. Here, we retrospectively reviewed medical records of patients diagnosed with imported malaria in our hospital from 1991 to 2010. Thirty-four malaria cases were identified, corresponding to approximately 2% of the total number of cases in Japan. Falciparum malaria has become predominant in the last 2 decades, and compared with patients in the earlier decade (1991–2000), patients in the latter decade (2001–2010) showed significantly shorter delays in consulting medical facilities. The overall hospital delay also tended to be shorter in the latter decade, although delayed referral of patients by a week or more was still observed in more than one-third of the cases. The prevalence of risk factors for severe malaria among patients on the day of the referral visit was also lower in the latter decade. Further, the number of WHO-defined cases of severe malaria was smaller, and the length of the hospital stay was not prolonged during that decade. These findings indicated that a shorter delay in seeking medical treatment could reduce the risks of severe malaria.

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Clinical presentations of patients with 2009 H1N1 influenza are generally similar to those of patients with seasonal influenza. A cross-sectional study was conducted among adults at an outpatient clinic in a university hospital setting during the 2009 epidemic. Infections in all patients were confirmed by real-time reverse transcription-polymerase chain reaction. There were 269 patients with 2009 H1N1 influenza and 128 patients with seasonal influenza. Compared with patients with seasonal influenza, patients with 2009 H1N1 influenza were more likely to be aged <20 years (25.7% vs. 8.6%, P < 0.001) and to be students (38.7% vs. 22.0%, P = 0.001), or healthcare workers (20.1% vs. 10.9%, P = 0.022); however, they were less likely to have an underlying disease (25.6% vs. 39.8%, P = 0.004) and influenza vaccination (4.2% vs. 12.2%, P = 0.021). There were no differences in the illness duration, vital signs, and symptoms between groups. Patients with seasonal influenza were more likely to be admitted to the intensive care unit (2.4% vs. 0%, P = 0.033) and exhibited a higher mortality rate (2.4% vs. 0%, P = 0.093). A history of contact with a confirmed 2009 H1N1 influenza case (odds ratio [OR] = 12.91, P < 0.001) and age (OR = 1.05 per 10 years younger, P = 0.015) were associated with 2009 H1N1 influenza infections. In conclusion, these results showed differences in characteristics between the patients with 2009 H1N1 influenza and those with seasonal influenza.

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In this study, we prospectively investigated changes in Streptococcus pneumoniae serotypes among Japanese children after heptavalent pneumococcal conjugate vaccine (PCV7) inoculation. We acquired nasopharyngeal swabs from the children at each routine PCV7 inoculation and again at least 2 months after the last PCV7 inoculation. We defined 2 periods with regard to each culture: the inoculation period as “the period of pre- or incomplete vaccination” and post-inoculation as “the period of post- or completed vaccination.” The prevalence of vaccine-type (VT) pneumococci was significantly reduced from 9.5% in the inoculation-period cultures to 2.9% in the post-inoculation cultures (P < 0.01). There was no statistical difference in the prevalence of non-vaccine-type pneumococci between the inoculation-period and post-inoculation cultures (24.1% versus 23.4%). The protection of PCV7 against nasopharyngeal colonization was inferred from the decrease in VT carriage post-inoculation. The decrease in VT carriage may be conducive to reducing VT transmission within the study area.

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Proteus mirabilis strains that produce extended-spectrum β-lactamase (ESBL), AmpC β-lactamase, and carbapenemase pose potential threats to patient care because most clinical diagnostic laboratories may not attempt to detect these three major groups of enzymes. Therefore, the objective of this study was to ascertain if P. mirabilis isolates collected from our heathcare facility possess various mechanisms of resistance to β-lactams (i.e., ESBL, AmpC, and carbapenemases) and to additionally arrive at conclusions regarding concurrent testing for these three mechanism of drug resistance in order to reduce cost and time in routine diagnostic testing. Between January 2011 and June 2011, 60 consecutive non-repeated strains of P. mirabilis were evaluated for production of ESBLs, AmpC β-lactamases, and carbapenemases. Of these, 36 isolates were found to be ESBL producers, and 7 (12%) were positive for production of AmpC β-lactamases and ESBLs. Therefore, 19.4% of ESBL-producing Proteus strains coproduced AmpC enzymes. The modified Hodge test confirmed carbapenemase production in only 1 isolate (1.7%), which was also ESBL- and AmpC-positive. The clinical impact of additional AmpC expression in ESBL-producing P. mirabilis results in a newly acquired resistance to β-lactamase inhibitors. In addition, to save time and costs, we recommend the use of cefepime/cefepime-clavulanate or boronic acid for the ESBL detection but in only those strains that were positive for ESBL by screening and negative by confirmatory tests.

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A molecular epidemiological survey was conducted to identify the tick-borne disease agents Anaplasma phagocytophilum and Borrelia burgdorferi sensu lato in Selenge Province, Mongolia. The survey was in response to a suspected A. phagocytophilum infection in a patient. In 2012, a total of 129 questing Ixodes persulcatus adult ticks were sampled by flagging vegetation. A. phagocytophilum and Borrelia spp. were detected by PCR, targeting the 16S rDNA (rrs) and 5S–23S intergenic spacer region, respectively. Infection rates for A. phagocytophilum and B. burgdorferi sensu lato spp. were 6.2% and 55.0%, respectively. Six of the 129 ticks (4.9%) were coinfected with A. phagocytophilum and B. burgdorferi sensu lato. Among Borrelia spp., the highest prevalence rate was that for B. garinii 20047 type (26.3%), followed by B. afzelii (7.8%) and B. garinii NT29 type (7.0%). Furthermore, ticks were detected that were dually infected with B. afzelii and B. garinii 20047 type (7.8%) and B. garinii NT29 and 20047 types (6.2%).

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Central nervous system tuberculosis (CNS-TB) is a devastating manifestation of tuberculosis (TB) caused by the hematogenous spread of Mycobacterium tuberculosis. Here, I present a retrospective analysis of 20 CNS-TB cases in Israel, a country with a low incidence of TB over an 11-year period (2000–2010). Most of the cases were those of African migrants, with an increased prevalence in adult females and in those with HIV coinfections. Clinical manifestations were usually non-specific, and miliary infiltrates were rare. Lymphocytic meningitis was frequent with bacteriological confirmation in 50% of the cases. The yields of cerebrospinal fluid smear examinations were low (20%). Brain computed tomography revealed tuberculomas (45%) and hydrocephalus (15%). All patients received individual treatment on the basis of drug susceptibility patterns and adjunctive steroid therapy. However, 35% of the patients died within the first year and the mortality rate was strongly correlated to disease severity (90%), HIV coinfection (85%), and hydrocephalus (66%). Progress in new diagnostic tests and early treatment may improve the current high mortality and morbidity rates.

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The purpose of this study was to examine the in vitro susceptibilities to antimicrobial agents and genetic diversity of 195 clinical strains of Salmonella spp., which were isolated and examined for the extended-spectrum β-lactamase (ESBL) bla_CTX-M gene and the presence of gyrA, gyrB, parC, and parE genes mutations in Hyogo, Japan, from 2009 to 2012. Forty-three of the 195 strains were antimicrobial resistant. Two Salmonella enterica subsp. enterica strains, 1 serovar Schwarzengrund, and 1 serovar Enteritidis were identified as ESBL-producing strains possessing bla_CTX-M-15 and bla_CTX-M-2, respectively. Among 8 nalidixic acid-resistant strains, 7 had mutations in gyrA alone or in gyrA and parC. In conclusion, we identified CTX-M ESBL-producing Salmonella clinical strains with multidrug resistance. Further studies are needed to monitor these serious drug-resistant Salmonella strains in Japan.

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In this study, genetic environments of the transferable plasmid-mediated bla_CTX-M-3 gene were characterized among 14 isolates of cefotaxime-resistant Serratia marcescens using PCR and BLAST DNA sequence analysis. A total of 3 types of genetic architectures in the regions surrounding this bla_CTX-M-3 gene were identified. Type I architecture was characterized by the presence of a complete insertion sequence of tnpA-ISEcp1, identified as interrupting a reverse IS26 sequence in the upstream region of the bla_CTX-M-3 gene. A reverse-directional orf477 fragment was located downstream of the bla_CTX-M-3 gene, which was in the same direction of the mucA gene. A common region containing the orf513 element was located upstream of the mucA gene. Moreover, a copy of the 3′-CS2 element was located immediately upstream of the orf513 element. A novel complex class 1 integron was characterized by the presence of the dfrA19 gene, which was flanked by two copies of class 1 integrons. This is the first report to describe the dfrA19 gene within a novel complex class 1 integron in S. marcescens isolates from Taiwan. This novel complex class 1 integron structure was located distantly upstream of the bla_CTX-M-3 gene.

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Next-generation DNA sequencing technologies have led to a new method of identifying the causative agents of infectious diseases. The analysis comprises three steps. First, DNA/RNA is extracted and extensively sequenced from a specimen that includes the pathogen, human tissue and commensal microorganisms. Second, the sequenced reads are matched with a database of known sequences, and the organisms from which the individual reads were derived are inferred. Last, the percentages of the organisms' genomic sequences in the specimen (i.e., the metagenome) are estimated, and the pathogen is identified. The first and last steps have become easy due to the development of benchtop sequencers and metagenomic software. To facilitate the middle step, which requires computational resources and skill, we developed a cloud-computing pipeline, MePIC: “Metagenomic Pathogen Identification for Clinical specimens.” In the pipeline, unnecessary bases are trimmed off the reads, and human reads are removed. For the remaining reads, similar sequences are searched in the database of known nucleotide sequences. The search is drastically sped up by using a cloud-computing system. The webpage interface can be used easily by clinicians and epidemiologists. We believe that the use of the MePIC pipeline will promote metagenomic pathogen identification and improve the understanding of infectious diseases.

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