In India, malaria transmission is prevalent across diverse geologies and ecologies. Temperature is one of the key determinants of malarial transmission, causing low endemicity in some areas than in others. Using a degree-day model, we estimated the maximum and minimum possible number of days needed to complete a malarial sporogonic cycle (SC), in addition to the possible number of SCs for Plasmodium vivax and Plasmodium falciparum under two different ecological settings with either low or high endemicity for malaria at different elevations. In Raikhalkhatta (in the Himalayan foothills) SCs were modeled as not occurring from November to February, whereas in Gandhonia village (forested hills), all but only one month were suitable for malarial SCs. A minimum of 6 days and maximum of 46 days were required for completion of one SC. Forested hilly areas were more suitable for malaria parasite development in terms of SCs (25 versus 21 for P. falciparum and 32 versus 27 for P. vivax). Degree-days also provided a climatic explanation for the current transmission of malaria at different elevations. The calculation of degree-days and possible SC has applications in the regional analysis of transmission dynamics and management of malaria in view of climate change.
Pseudomonas aeruginosa bacteremia occurs mainly in immunocompromised patients. However, P. aeruginosa bacteremia in immunocompetent patients has also been reported. The aim of this study was to evaluate the clinical characteristics of P. aeruginosa bacteremia in relation to the immune status of the patients. The medical records of 126 adult patients with P. aeruginosa bacteremia in Nagasaki University Hospital were retrospectively reviewed between January 2003 and December 2012. Of 126 patients with P. aeruginosa bacteremia, 60 patients (47.6%) were classified as immunocompetent. Mortality in immunocompetent patients tended to be lower than in immunocompromised patients (7-day mortality, 8% vs. 30%, P < 0.01; 30-day mortality, 23% vs. 39%, P = 0.053). Multivariate analysis showed that a higher sequential organ failure assessment score (hazard ratio [HR]: 1.27, P < 0.01) and underlying malignancies (HR: 3.33, P < 0.01) were independently associated with 30-day mortality. Initial antibiotic therapy (HR: 0.21, P < 0.01) and patients' immune status (HR: 0.29, P = 0.02) also had a significant impact on survival. However, there was a significant interaction between these 2 variables (P = 0.03 for interaction). A subgroup analysis showed that in immunocompromised, but not immunocompetent patients, initial appropriate antibiotic therapy was associated with lower mortality (30-day mortality 20.5% vs. 66.7%, P < 0.01 by log-rank test).
A stable relation was found between number of HIV/AIDS patients (P) and population size (N) and between HIV/AIDS incidence (I) and population density (D). The relation could be expressed as P = kNm or I = hDn, where k, h, m, and n are constants. For “AIDS”/“AIDS diagnosis”, the constant m was 1.5 for Japan and 1.3 for the United States of America (USA); n was 0.38 for both Japan and the USA. These observations indicated that larger population sizes related to disproportionately larger numbers of HIV/AIDS patients, and denser populations had disproportionately higher incidences of HIV/AIDS. Considering the wide geo-demographic difference between the two countries, it was striking that the same equations with constants within a narrow range were applicable to both Japan and the USA. Modes of HIV transmission appeared to be variable among prefectures in Japan. Homosexual transmission was suggested as being more predominant in more populated prefectures.
The aim of this study was to investigate the incidence of acute kidney injury (AKI) and risk factors due to colistin use in patients infected with multidrug-resistant pathogens. This multicenter, retrospective, observational study was conducted in Turkey, at 5 different research and university hospitals. Cox regression analyses were performed, to determine independent predictors of AKI. From April 2012 to July 2014, a total of 216 patients aged between 18–94 years, treated with colistimethate sodium (CMS) were included in the study. The mean age of the patients was 60.3 ± 20.1 years. The overall incidence of AKI was 34.3% (74/216) at any time during treatment. Concomitant use of loop diuretics, baseline creatinine level, and CMS dosage were independently associated with AKI. According to our results, patients with higher baseline creatinine levels, or patients who had to use concomitant loop diuretics may need to be monitored more closely, and dose adjustment should be done promptly. More comprehensive studies are, however, still needed to evaluate the efficacy of low-dose colistin since higher doses tend to increase the risk of AKI.
The aim of this study is to evaluate the effects of pyrimethamine (PYR) and sulfadiazine (SDZ) combined with levamisole and echinacea on the survival of mice infected with Toxoplasma gondii. For this, we used 99 specific pathogen-free BALB/c mice. All the mice were infected intraperitoneally with 105T. gondii tachyzoites and were divided into 11 groups, each including 9 mice. Except for the control group, oral treatment was initiated in all groups 24 h post infection and was continued for 10 days. The treatment regimen included dual combinations of PYR (dose, 6.25 and 12.5 mg/kg/day) and SDZ (dose, 100 and 200 mg/kg/day), triple combinations of PYR + SDZ, and levamisole (dose, 2.5 mg/kg/day) or echinacea (dose, 130 and 260 mg/kg/day) and echinacea alone (dose, 130 and 260 mg/kg/day). We observed that an effective dose of the combination of PYR + SDZ and levamisole resulted in a statistically significant increase in the survival rate from 33.3% to 88.9%. Similarly, half the dose of this combination resulted an increase in the survival rate from 0% to 44.4% (p < 0.05). Survival rate also increased in the groups treated with the combinations including echinacea; however, the difference did not reach statistical significance. The triple combination of PYR-SDZ-levamisole could be an alternative treatment option in case of infections caused by T. gondii.
Chronic pulmonary aspergillosis (CPA) is a refractory disorder that needs long-term antifungal treatment and occasionally results in fatal respiratory failure and hemoptysis. However, the pathological features of the disorder have not been thoroughly delineated. Thirty cases were therefore analyzed clinically and histologically to elucidate the pathophysiology of CPA. The subjects comprised 14 individuals who underwent surgical removal and 16 patients who died. No subject exhibited a severely immunocompromised state. The main symptoms included cough, hemosputum, and dyspnea. Chest computed tomography (CT) findings revealed a cavity, fungus ball, and consolidation and/or ground glass opacity (GGO); 27 serial CT scans showed enlarged consolidation and/or GGO (70%), dilatation of the cavity (26%), and extension to the opposite lung (22%). Histopathological findings revealed a cavity with ulceration, bronchitis, and various degrees of organizing pneumonia (OP) that were correlated with the area of consolidation and GGO on the CT scan. The essential pathophysiology of CPA can be understood as an active state of ulceration of the cavity and/or erosive bronchitis caused by contact with the fungus ball, which may play a significant role in the development of OP. Consequently, OP is thought to reflect respiratory failure that relates to the prognosis of CPA.
Enterotoxigenic Escherichia coli (ETEC) has the potential to cause nosocomial infantile diarrhea in a hospital setting. We detected 12 ETEC serotype O128:H45 isolates from diarrheal neonates in our neonatal unit from July through October 2012. These infants developed hospital-acquired and epidemiologically related diarrhea. Pulsed-field gel electrophoresis analysis and multilocus sequence typing of these 12 isolates suggested that a specific clone of ETEC serotype O128:H45-CS21-ST2332 caused nosocomial diarrhea among neonates. Of concern, this ETEC clone strain was resistant to multiple drugs, particularly third-generation cephalosporins.
The objective of this study was to clarify the efficacy of a currently available N,N-diethyl-m-toluamide (DEET) repellent against tick species in Japan. We performed 2 different field trials: “human trap,” and “flag-dragging.” In total, 482 ticks were collected from white flannel cloths in the field studies. The collected tick species were Ixodes persulcatus and I. ovatus, which accounted for 5.3% and 94.7% of the ticks in the human trap test and 31.4% and 68.6% in the flag-dragging test, respectively. The repellency levels of DEET-treated flannel cloths in the human trap and flag-dragging tests were 84.0% and 99.7%, respectively. The escape times for I. persulcatus and I. ovatus female adults from DEET-treated flannel cloths were determined. The median escape times for I. persulcatus and I. ovatus on DEET-treated flannel cloths were 48 s (95% confidence interval [CI]: 30–96) and 10 s (95% CI: 5–24), respectively. In contrast, many ticks remained on the untreated flannel cloths for 10 min after mounting. These results indicate that DEET repellents appear to prevent tick bites and that the use of DEET repellents against ticks is an effective personal protection measure.
Herpes simplex virus type 1 (HSV-1), a widespread virus, causes a variety of human viral diseases worldwide. The serious threat of drug-resistance highlights the extreme urgency to develop novel antiviral drugs with different mechanisms of action. Pentagalloylglucose (PGG) is a natural polyphenolic compound with significant anti-HSV activity; however, the mechanisms underlying its antiviral activity need to be defined by further studies. In this study, we found that PGG treatment delays the nuclear transport process of HSV-1 particles by inhibiting the upregulation of dynein (a cellular major motor protein) induced by HSV-1 infection. Furthermore, PGG treatment affects the nucleocapsid egress of HSV-1 by inhibiting the expression and disrupting the cellular localization of pEGFP-UL31 and pEGFP-UL34, which are indispensable for HSV-1 nucleocapsid egress from the nucleus. However, the over-expression of pEGFP-UL31 and pEGFP-UL34 could decrease the antiviral effect of PGG. In this study, for the first time, the antiviral activity of PGG against acyclovir-resistant virus was demonstrated in vitro, and the possible mechanisms of its anti-HSV activities were identified based on the inhibition of nuclear transport and nucleocapsid egress in HSV-1. It was further confirmed that PGG could be a promising candidate for HSV therapy, especially for drug-resistant strains.
In 2011, a multidrug-resistant Acinetobacter baumannii (MDRAB) outbreak occurred at a Japanese critical care center (CCC) in a tertiary care hospital. Multidrug-resistance in Japan is defined as resistance to the antimicrobials amikacin, carbapenem, and fluoroquinolone. We conducted a retrospective epidemiological investigation of this outbreak to identify the risk factors for MDRAB respiratory tract acquisition in this hospital. Cases were defined as hospitalized patients with MDRAB-positive cultures at least 3 days post admission to the CCC between June 1, 2011 and April 20, 2012. Fifteen MDRAB cases were identified, including 3 with infection and 12 with colonization. This case-control study demonstrated that hypoalbuminemia along with carbapenem administration were associated with MDRAB respiratory tract acquisition. Pulsed-field gel electrophoresis analysis and multilocus sequence typing using MDRAB isolates suggested a clonal dissemination of MDRAB strains with sequence type 74 occurred primarily among patients admitted to the CCC. From April 16, 2012, a decreased isolation rate of MDRAB in the hospital occurred after the implementation of the following infection control measures: closing the emergency room, discontinuing admission to the CCC, isolating patients with MDRAB colonization or infection to single room status, and conducting environmental cleaning. No MDRAB cases were detected between March 23 and April 20, 2012.
Nontuberculous mycobacterial bone infections among human immunodeficiency virus (HIV)-negative patients are rare, although a few studies have described such infections. We retrospectively reviewed the medical and microbiological data of HIV-negative osteomyelitis cases caused by nontuberculous mycobacteria treated in our tertiary-care hospital over 14 years from January 1, 2000, to December 31, 2013. Three HIV-negative patients had contracted bone infections due to nontuberculous mycobacteria. All of the patients had at least 1 predisposing condition that led to the infections: idiopathic CD4-positive lymphocytopenia and/or anti-interferon-γ autoantibody syndrome.
A 53-year-old Japanese woman who was working as a volunteer in the Commonwealth of Dominica in the Caribbean islands presented with a high-grade fever and severe incapacitating generalized arthralgia. The Asian genotype of the chikungunya virus was confirmed using reverse transcription-PCR and serology, based on the presence of a specific neutralization titer and immunoglobulin M antibodies. She was diagnosed with post-chikungunya chronic arthritis based on persistence of her polyarthritis for 3 months and the presence of rheumatoid factor, immunoglobulin G-rheumatoid factor, and matrix metalloproteinase-3. Chikungunya virus should be considered as a causative pathogen in travelers returning from Caribbean islands. Clinicians should consider chikungunya fever in the differential diagnosis of patients who complain of chronic arthritis and have a history of travel to an endemic area.
The number of notified syphilis cases in Tokyo has more than doubled in recent years. The number of reported primary and secondary syphilis cases increased from 108 cases (0.8 per 100,000 population) in 2007 to 245 cases in 2013 (1.9 per 100,000 population). During this period, the majority of cases was male (905/1,024), and the recent increase among primary and secondary syphilis cases was attributed to the increase among males (90/108 [83%] cases in 2007 to 218/245 [89%] cases in 2013); men aged 20–49 years contributed most to the increase, with those aged 30–34 years having the highest notification rate in 2013. Male-to-male transmission was the primary route of infection reported, and men who have sex with men (MSM) accounted for nearly 80% of male cases in 2013. Syphilis appears to be reemerging in Tokyo, and reducing the risk of acquiring syphilis among MSM aged 20–49 years should be a public health priority in Tokyo.