Cat scratch disease (CSD) is a syndrome characterized by lymphadenopathy, fever, and skin lesions following a cat scratch or bite. Bartonella henselae is the primary bacterial agent responsible for CSD. In this report, we describe cases with atypical presentation of serologically proven B. henselae neuroretinitis. In this study, 3 patients with neuroretinitis were evaluated. Animal contact histories; results of ocular examinations and systemic investigations; clinical findings; and treatment compliance of the patients were assessed. All patients denied history of contact with cats or other animals, and they did not have CSD findings. Serologic testing via indirect immunofluorescence assay (IFA) was used to diagnose Bartonella neuroretinitis. The IFA test results were positive for all patients. Two patients were treated with antibiotics. Optic disc edema and macular exudates resolved gradually, and at their last follow-up visits, all signs had disappeared. There was no disease recurrence after the completion of treatment. Serious complications were seen in the untreated patient. In conclusion, B. henselae infection should be considered even when there are no systemic signs and symptoms of CSD in patients with neuroretinitis.

Meningococcal disease can cause significant disability and mortality. The quadrivalent meningococcal polysaccharide diphtheria toxoid conjugate vaccine (Men-ACWY-D) protects against invasive meningococcal disease caused by serogroups A, C, W, and Y. This phase III, open-label, single-arm, multicenter study evaluated the safety and immunogenicity of a single vaccine dose in healthy Japanese adults. The study enrolled 200 participants between 2 and 55 years of age. Immunogenicity was assessed by quantifying the seroprotection rates (the proportion of participants with antibody titers ≥ 1:128 against the capsular polysaccharide from all 4 serogroups measured 28 days after vaccination). Safety endpoints included occurrence, nature, time to onset, duration, intensity, relationship to vaccination, and outcome of solicited and unsolicited adverse events (AEs) and serious AEs (SAEs). Participants included 194 adults, 2 adolescents, and 4 children. Among adults, the seroprotection rates for serogroups A, C, W, and Y were 91.2%, 80.2%, 89.1%, and 93.8%, respectively. Seroconversion rates (the proportion of participants with pre-vaccination titers of < 1:4 and a ≥ 4-fold rise from baseline) were 87.3%, 83.0%, 94.4%, and 96.4%, respectively. No immediate AEs, adverse reactions, SAEs, or deaths were reported for any age group. Men-ACWY-D is well tolerated and immunogenic, eliciting antibodies against capsular polysaccharides from all 4 serogroups in Japanese adults.

Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic viral disease. We aimed to investigate the cutaneous manifestations of CCHF and reveal their associations with fatality. Two hundred and sixty-nine patients diagnosed with CCHF were assessed. Skin findings were observed in 170 (63.2%) patients. A facial rash was the most common cutaneous finding (n = 82, 30.5%). In severe cases, hemorrhagic cutaneous manifestations (petechiae and ecchymoses) were recognized. A statistically significant correlation was obtained between cutaneous manifestations and fatality, and it was determined that there was a strong positive correlation between fatality and ecchymosis (r = 567, p < 0.001). In addition, a logistic regression analysis was performed, and death occurred 4.69 times more in those with skin signs than in those without. We hypothesize that CCHF patients with ecchymosis are at the highest risk and that cutaneous findings can contribute to the prognosis of CCHF.

The incidence of modified measles (M-Me), characterized by milder symptoms than those of typical measles (T-Me), has been increasing in Japan. However, the outbreak dominated by M-Me cases has not been thoroughly investigated worldwide. The largest importation-related outbreak of measles with genotype D8 occurred in Yamagata Prefecture, Japan, from March to April 2017. This phenomenon was observed after Japan had achieved measles elimination in 2015. We confirmed 60 cases by detecting the genome of the measles virus (MeV). Among the cases, 38 were M-Me and 22 were T-Me. Thirty-nine (65.0%) patients were 20–39 years of age. Three out of 7 primary cases produced 50 transmissions, of which each patient caused 9–25 transmissions. These patients were 22–31 years old and were not vaccinated. Moreover, they developed T-Me and kept contact with the public during their symptomatic periods. Considering that M-Me is generally caused by vaccine failure, some individuals in Japan may have insufficient immunity for MeV. Accordingly, additional doses of measles vaccine may be necessary in preventing measles importation and endemicity among individuals aged 20–39 years. Furthermore, to accurately and promptly diagnose individuals with measles, particularly those who can be considered as primary cases, efforts must be exerted to detect all measles cases using epidemiological and genetic approaches in countries where measles elimination had been achieved.

We previously reported human papillomavirus type 52 (HPV52) as the most prevalent high-risk genotype in non-cancer individuals in Vietnam. This study aimed to evaluate HPV genotypes and HPV16 E6 and E7 (E6/E7) gene variations in Vietnamese patients with genital cancers. Biopsy samples were collected from 124 Vietnamese patients with genital cancers (20 with vaginal, 50 with vulvar, and 54 with penile cancer). The HPV-DNA was amplified and genotyped, and HPV16 E6/E7 genes were compared with those previously reported for women with normal cervical cytology (N = 23). HPV-DNA was detected in 80.6% (100/124) of the cancer patients (80.0% of vaginal, 82.0% of vulvar, and 79.6% of penile), with HPV16/18 in 86.0% (86/100) and HPV52 in 7.0% (7/100) of the HPV-positive samples. The HPV-DNA prevalence and HPV genotype distribution did not significantly differ among the genital cancer patients (both P = 0.95). Significantly fewer instances of the HPV16 A4 sublineage (34.8% vs. 82.6%, P < 0.0001) and HPV16 E7 29S (36.4% vs. 87.0%, P = 0.0002) occurred in the cancer patients than in the women with normal cytology. Our results indicate that HPV16/18 accounts for more than 85% of genital cancers in Vietnam, and the HPV16 sublineage A4 containing E7 29S may be less oncogenic.

Anopheles (Anopheles) lindesayi Giles consists of 5 subspecies. In Japan, only one subspecies, An. l. japonicus Yamada, has been reported. Its geographical populations are morphologically diverse; however, they are regarded as a single subspecies. In this study, we re-evaluated the taxonomic status of An. l. japonicus in Japan, and that of another subspecies, An. l. pleccau, distributed in Taiwan, by comparative morphological and molecular analyses based on the gene sequences of mitochondrial DNA cytochrome c oxidase I (COI) and ribosomal DNA internal transcribed spacer 2 (ITS2). Nucleotide sequence divergence was calculated using the Kimura-two-parameter (K2P) distance model. Phylogenetic trees based on COI and ITS2 sequences showed 3 distinct clades: Eastern Japan, Western Japan, and the Ryukyus. The sequences of the Ryukyu specimens were located within the same clade as that of the sequences of the Taiwanese specimens. Regarding the COI sequences, the 3 geographical groups in Japan were genetically distinct. The following morphological characteristics distinguished the groups: larval seta 1-S, pupal setae 5 through segments IV–VII, and pupal setae 6 on segments IV–VII. Based on these results, it was revealed that An. l. japonicus included 3 genetically and morphologically distinct groups: 2 groups of An. l. japonicus and a group in the Ryukyus, which was a synonym of An. l. pleccau.

An outbreak of enterohemorrhagic Escherichia coli (EHEC) O157:H7 infection occurred in October 2016 in Kanagawa, Japan. A total of 61 patients and 17 asymptomatic cases of EHEC O157:H7 infection were confirmed by laboratory testing. Among them, 24 patients were hospitalized and 4 developed hemolytic-uremic syndrome. An epidemiological investigation revealed that this outbreak of EHEC O157:H7 infection was associated with the consumption of uncooked minced meat cutlets that were sold frozen at branches of a supermarket chain. The implicated uncooked meat cutlets were made of a mixture of minced beef, pork, onions, and eggs. All 40 meat cutlets tested from one particular batch were positive for EHEC O157:H7. The patterns observed on pulsed-field gel electrophoresis of strains isolated from the affected patients and meat cutlets were identical. The bacterial counts of EHEC O157:H7 and E. coli in meat cutlets ranged from 2.3 to 110 most-probable-number (MPN)/g and from 240 to 4,600 MPN/g, respectively. There are currently no national regulatory standards to ensure the safety of these types of meat products in Japan. Consumers should ensure that such products are cooked thoroughly and that safe food handling procedures are used to prevent infection.

By monitoring the sewage system in Heilongjiang province from 2013 to 2016, this study aimed to analyze the epidemiological tendency and genetic mutation of poliovirus (PV) found in the environment in order to setup a warning system for vaccine-derived poliovirus (VDPV) and the spread of wild poliovirus. In this study, we collected 139 sewage samples from 8 regions in Heilongjiang province. Poliovirus was identified from 72 samples, and the positivity rate was 51%. A total of 263 PV strains were isolated, including 22 strains of type 1 PV, 104 strains of type 2 PV, and 137 strains of type 3 PV. As a result of intratypic differentiation, using real-time PCR and nucleotide sequencing, 3 type 1 pre-VDPV, one type 2 VDPV, and 2 type 3 pre-VDPV strains were isolated. Interestingly, one type 1 strain with 5 nucleotide deletions and one type 3 recombinant on VP1 were isolated. By continuously monitoring the poliovirus in the environment, we aimed to recognize the VDPV or wild poliovirus with high neurovirulence from large-scale circulation and set up a warning system to avoid morbidity and virus transmission.

Dengue virus (DENV) has a considerable impact on the global health and is known to cause morbidity and mortality every year. By passaging DENV2 in baby hamster kidney (BHK)-21 cells, we isolated a mutant clone of DENV2 that shows rapid cytopathic effects in BHK-21 cells as compared with that showed by the parent strain. To investigate the relationship between amino acid mutations and proliferation activity of the isolated DENV2 clone, we performed full genome sequencing and identified 3 amino acid mutations in the coding region, the envelope T120K, NS4A M85T, and NS4B G124A. Genetically modified recombinant DENV2 (rDENV2) carrying the NS4A M85T and NS4B G124A mutations produced higher titers of progeny virus in BHK-21, Vero, and Huh-7 cells than in the wild-type (WT) rDENV2. rDENV2 with mutations at NS4A M85T and NS4B G124A failed to produce any plaques in C6/36 mosquito cell lines. Furthermore, rDENV2 possessing only the NS4B G124A mutation showed no plaque production in C6/36 cells but had higher viral titers in Vero and Huh-7 cells than the WT rDENV2 had. Our results clearly showed that the DENV2 NS4B G124A mutation has opposing effects on the virus proliferation in mosquito and certain mammalian cell lines.

Verocytotoxin-producing Escherichia coli (VTEC) of serogroup O157 are among the most important causes of severe cases of foodborne disease and outbreaks worldwide. As little is known about the characteristic of these strains in Romania, we aimed to provide reference information on the virulence gene content, phylogenetic background, and genetic diversity of 7 autochthonous O157 strains collected during 2016 and 2017 from epidemiologically non-related cases. These strains were typed by a combination of phenotypic and molecular methods routinely used by the national reference laboratory. Additionally, 4 of them were subjected to whole-genome sequencing (WGS), and public web-based tools were used to extract information on virulence gene profiles, multilocus sequence types (MLST), and single nucleotide polymorphism (SNP)-based phylogenetic relatedness. Molecular typing provided evidence of the circulation of a polyclonal population while distinguishing a cluster of non-sorbitol-fermenting, glucuronidase-negative, phylogenetic group E, MLST 1804 strains, representing lineage II and clade 7, which harbored vtx2c, eae-gamma, and ehxA genes. A good correlation between the routine typing methods and WGS data was observed. However, SNP-based genotyping provided a higher resolution in depicting the relationships between the O157:H7 strains than that provided by Pulse-field gel electrophoresis. This study should be a catalyst for improved laboratory-based surveillance of autochthonous VTEC.

Tinea pedis and tinea unguium are common infectious diseases, and many elderly people are reported to contract these infections. In this study, to investigate whether strains of the same origin are spreading inside a long-term care facility, we analyzed Trichophyton rubrum and Trichophyton mentagrophytes, isolated from the residents and staff at the facilities located in the Kanto area, using a genomic analytical method targeting tandem repeat regions in the nontranscribed spacer (NTS) region of ribosomal DNA. Five NTS types were confirmed in T. rubrum. T. rubrum of various types (types 1 to 5) was detected at each facility, but there was no isolate specific to one facility only. Eight NTS types of T. mentagrophytes were detected, and T. mentagrophytes that carried an NTS type that was confirmed at one facility only (types C4II, F4II, and D4II) was isolated. These T. mentagrophytes sequence types were isolated from several subjects residing at the same facility. This study proved that a T. mentagrophytes strain of the same type had spread in long-term care facilities. We believe in the importance of cleaning at a long-term care facility as a countermeasure to the spread of Trichophyton species.

We report the first case of invasive ophthalmologic infection by Acrophialophora sp. that was successfully treated using voriconazole (VRCZ). Acrophialophora spp., which has been reported to be an opportunistic pathogen, is a rare thermotolerant soil fungus, but its pathogenicity remains unclear. A 77-year-old man had neutropenia and prostate carcinoma and was receiving hemodialysis. His right eye had been infected for 2 days. His conjunctiva was congested, and it partially formed an abscess. Liposomal amphotericin B (L-AMB) was administered following systemic itraconazole. However, the treatment was changed from L-AMB to systemic VRCZ and VRCZ eye drops because his eye symptoms worsened. Subsequently, his symptoms stabilized and his vision was maintained. Acrophialophora sp. was identified by analyzing regions of internal transcribed spacer and domain 1 and 2 of the ribosomal RNA gene. He completed the 7-week systemic VRCZ course. The mean minimum inhibitory concentration of VRCZ for Acrophialophora spp. has been reported to be the lowest among various antifungal agents, and our results indicated the efficacy of VRCZ treatment for Acrophialophora sp. infection. Our results suggest that invasive Acrophialophora sp. infection may require long-term therapy. Further analysis of the clinical spectrum of Acrophialophora spp. infection and adequate treatment methods are required in the future.

In China, a rapid expansion of hand, foot, and mouth disease (HFMD) outbreaks has occurred since 2004, and HFMD has become an important issue in China. There are more than 20 types of enterovirus causing HFMD, of which coxsackievirus A16 (CA16) and enterovirus 71 (EV71) are the most common. This study aimed to analyze the epidemiological characteristics of HFMD caused by EV71 and CA16 in Linyi, Shandong province, China, from 2009 to 2017. The stool specimens and throat samples of 5,324 patients with HFMD were obtained for nucleic acid detection of enterovirus. A total of 4,040 HFMD cases were caused by viral pathogens. Of these, 1,706 cases were positive for EV71 and 1,266 were positive for CA16. These 2 virus strains appeared alternately in Linyi city. The incidence of EV71-positive and CA16-positive cases was highest in children aged 0–5 years, with male patients being predominant. This outbreak of HMFD caused by EV71 and CA16 mainly occurred between April and July and appeared alternately between the years 2011 and 2017. These results demonstrated that the epidemiological analysis of EV71 and CA16 can provide a scientific basis for the prevention and treatment of the disease.