Viridans streptococci are still under investigation concerning epidemiology, pathogenesis and clinical presentations. We aimed to investigate the clinical presentations and outcomes of pediatric patients infected with Streptococcus mitis/oralis. Based on the accumulation of bloodstream infections (BSI) caused by S. mitis/oralis in 4 patients in our Hematology and Bone Marrow Transplantation Department at a particular time, a review of the medical and microbiological records of pediatric patients with positive blood cultures for S. mitis/oralis in the entire hospital was performed. In addition, a retrospective case-control study was conducted. Pulsed-field gel electrophoresis of S. mitis/oralis in 4 patients displayed unrelatedness of the strains. A total of 53 BSI (42 BSI and 11 catheter-related BSI) were analyzed. Thirty-four percent of patients with BSI caused by S. mitis/oralis had febrile neutropenia. Clinical and microbiological outcomes were favorable and infection-related mortality was not observed. Although not significant, previous antibiotic use and trimethoprim-sulfamethoxazole prophylaxis were more common in the case group. S. mitis/oralis seems likely an important agent in bacteremic children who are particularly neutropenic because of the underlying hematologic and oncologic diseases. Prompt management of infections with appropriate antimicrobials, regarding antibiotic susceptibilities of organisms, may facilitate favorable outcomes.
The aim of this study was to evaluate the prevalence of nasopharyngeal (NP) carriage and the serotype distribution and antimicrobial resistance of Streptococcus pneumoniae in children with chronic diseases, which predisposes them to invasive pneumococcal disease in comparison with that in healthy children. A cross-sectional prevalence study was performed between February 2015 and February 2016 in Istanbul, Turkey. We enrolled 1,024 children with chronic diseases and 394 healthy children aged 0–18 years. The overall prevalence of S. pneumoniae NP (SPNP) carriage was 9.8%, with 8.4% in healthy children and 10.3% in children with chronic diseases. The prevalence rates of SPNP carriage were 17.5%, 13.5%, 10.5%, 9.3%, 8.6%, 8.6%, 8%, 6.7%, and 4%, respectively, in each of the following risk groups: primary immunodeficiency, asthma, chronic renal failure, congenital heart disease, chronic lung disease, leukemia, nephrotic syndrome, solid organ tumors, and type 1 diabetes mellitus. In the multivariate analysis, a history of otitis media within the last year, a history of pneumonia within the last year, and more than one sibling under 8 years of age were found to be independent risk factors for SPNP carriage.
The aim of this study was to determine the seropositivity levels of tetanus vaccine by age group in Ankara province, identify possible factors that affect immune status, and develop public health recommendations, especially for those 50 years and older. This cross-sectional epidemiological study covered individuals aged 3 years and older who are registered in the Family Medicine Information System. We received blood samples from 992 individuals and included 968 surveys in the analysis. Protective tetanus antibody levels were 80.5% in the 3–5 years age group, 92.0% in the 6–12 years age group, 94.3% in the 13–20 years age group, 95.2% in the 21–39 years age group, 84.4% in the 40–49 years age group, and 57.3% in the 50 years and older age group. Tetanus seropositivity decreased with age. Awareness of the importance of tetanus vaccine boosters for adults should be increased by providing training, ensuring booster vaccination against tetanus at 10-year intervals, and if necessary, considering mandatory tetanus vaccination for those 50 years and older.
In this study, the ability to discriminate viable from dead cells of Mycobacterium tuberculosis complex (MTC), using an ethidium monoazide (EMA) treatment-dependent viable bacteria selection PCR kit was examined. Detection of dead bacteria was possible for bacterial concentrations in the range 1.5 × 107–3.0 × 107 CFU/mL, which was equivalent to McFarland No. 0.05–0.10. There was a significant difference between the results for viable and dead bacteria, and the sensitivity and specificity of this method for culture-negative samples from patients were 83% and 100%, respectively. To the best of our knowledge, this is the first successful selective detection of DNA from viable cells of MTC by EMA-PCR, using the viable bacteria selection kit for PCR (gram-positive), an EMA treatment kit. We believe that application of this method could promote earlier discharge of patients undergoing tuberculosis treatment by discriminating dead from viable cells.
In Japan, HIV infection is classified as “HIV” or “AIDS” depending upon whether the infection was detected before or after the development of AIDS. In male homosexuals, in the plot of the number of “AIDS” notified annually versus the that of “HIV” notified annually, the plot fell on a straight line with a slope close to 1. When the number of “HIV” no longer increased, that of “AIDS” also stopped increasing. The number of “HIV” notified in one region or age group was correlated with that of other regions or age groups, respectively. However, no such correlation was observed among male heterosexuals. “HIV” was detected more frequently among male homosexuals and females than among male heterosexuals. The rate of “AIDS” detection increased with age in all infection categories. Our analysis, supported by findings of other studies, suggested that the higher rate of “HIV” detection among male homosexuals and females was attributed to the increased risk of receptive sexual intercourse, while the higher rate of “AIDS” detection among the elderly people was attributed to immunological senescence.
The frequency of the ages at which HIV/AIDS-related deaths occurred and that of patients detected before or after development of AIDS followed a normal distribution. The median age of HIV/AIDS-related deaths was 40–44 years in 1995-1998 and 50–54 years in 2014-2016, whereas the median age at detection of “HIV” or “AIDS” infection was constantly 25–29 years, implying that the survival time of the HIV/AIDS patients became longer by 10 years in the past 20 odd years. The increased survival time could possibly be attributable to the introduction of HIV/AIDS therapies such as HAART. Importantly, however, during the same period, the life span of the Japanese population was lengthened by nearly 10 years. Under the assumption that HIV/AIDS patients died 20 years after the detection of the infection, the total number of deaths was 1,446 in 1990–2016, which was close to 1,532, the total number of deaths in Vital Statistics during the same period.
We investigated the prevalence of Salmonella in 227 small red-eared sliders (Trachemys scripta elegans) from 2006 to 2008. A total of 130 turtles (57.3%) tested positive for S. enterica subsp. enterica. Twenty-two serotypes including S. Montevideo, S. Newport, S. Pomona, S. Braenderup, S. Sandiego, and S. Litchfield were identified. Salmonella strains with closely related pulsed field gel electrophoresis (PFGE) patterns were isolated from several shops located in different areas from 2006 to 2008. Antimicrobial resistance was detected among strains of S. Montevideo, S. Newport, S. Braenderup, S. Sandiego, and S. Litchfield. The relatedness of antimicrobial resistance and PFGE profiles was not observed. The PFGE patterns of S. Poona strains isolated in 2006 and 2008 and the causative strains of turtle-associated salmonellosis in 2006 were identical. These results revealed a high prevalence of Salmonella enterica subsp. enterica in red-eared sliders retailed in Japan. In addition, genetically closely-related strains of turtle-associated Salmonella were repeatedly introduced into Japan over the study period and were distributed widely in Japan. These Salmonella strains present a risk of a widely disseminated outbreak of turtle-associated salmonellosis.
In a cluster of hepatitis A infections that occurred in Nagano Prefecture in 2017, hepatitis A virus (HAV) was detected in asari clams (reference food) and the patients’ fecal samples. Initially, the asari clams were suspected to be the infection source. However, the exact infection route remained unknown because a patient who had not consumed an asari clam dish also developed the disease. Suspecting a secondary infection originating from the asari clams, we investigated the presence of HAV genomes in water used for washing and soaking the frozen asari clams and detected HAV in the soaking water. These results suggest that soaking water is a risk factor for secondary contamination because of the leakage of HAV accumulated in midgut gland of the asari clam. During the asari clam sand removal process, the water used to clean asari clams spread across a wide area in a concentric fashion, raising concerns that this process may aggravate contamination. In addition to HAV, diarrhea viruses, such as norovirus, have often been detected in bivalves, including asari clams. Thus, handling these foodstuffs requires adequate care.
A follow-up serological study was conducted involving 47 subjects who received 4 doses of diphtheria and tetanus toxoids, combined with the acellular pertussis vaccine (DTaP) together with Salk-type inactivated polio vaccine (DTaP-wIPV), until 6 years of age. All antibody levels declined more rapidly than expected within 3 years after the completion of primary vaccination with the 4th booster dose, and titers persisted until 6 years of age. The positive rate of the IgG antibody against pertussis toxin (PT) was 31.9% (15/47) at 4 years of age, 41.0% (16/39) at 5 years of age, and 40.5% (15/37) at 6 years of age. A significant increase in anti-PT antibodies was observed in 6 subjects, suggesting subclinical infection. Positive rates of antibodies against other targets did not decrease; however, titers of neutralizing antibodies against poliovirus type III decreased in a few subjects. These data suggest the need for an additional preschool booster immunization using DTaP-wIPV.
Hepatitis A virus (HAV) is a common infectious etiology of acute hepatitis worldwide. The Philippines remains highly endemic for hepatitis A, but there is still a lack of information about HAV in the country. To evaluate the HAV contamination in environmental water in the Philippines, we conducted the detection and genetic analyses of HAV RNA in samples from river water. Twelve water samples were collected at 6 sampling sites of 3 rivers in Metro Manila, in both the dry and wet seasons in 2012 and 2013. The HAV RNA was detected in all the 6 samples collected in the dry season, and in one sample from the wet season. Phylogenetic analysis confirmed that the HAV strains detected in the river water included multiple sequences belonging to subgenotypes IA and IIIA. This indicates that at least 2 genotypes of the HAV strains are circulating in the environment in the Philippines, posing a risk of HAV infection to not only residents, but also tourists, especially in the dry season.
Antimicrobial resistance (AMR) is one of the top public health issues in Japan. Since Japan published the national action plan on AMR in 2016, its implementation has been a major focus of the Ministry of Health, Labour and Welfare. The ministry recently published the first edition of its Manual of Antimicrobial Stewardship (including an English version), a narrative review with a particular focus on the outpatient setting of primary care and 2 common infectious disease conditions. This is one of the very few occasions in which the ministry has proactively set out clinical guidance for healthcare delivery at the facility level. Implementation of the manual is further supported by a change in Japan’s social health insurance coverage.
The tropical environment of Sudan promotes the spread of mosquito-transmitted diseases such as dengue virus (DENV) infection. The current understanding of the geographical distribution of DENV serotypes and genotypes in Sudan is limited. In this study, molecular techniques (reverse transcriptase [RT]-PCR and sequencing) followed by phylogenetic analysis were used to characterize DENV isolated from the blood samples of suspected dengue patients admitted to Kassala Hospital, Kassala state, Sudan, in 2016 and 2017. We identified DENV infection in 4 patients by RT-PCR. Phylogenetic analysis revealed that the isolated virus sequences belong to the Cosmopolitan genotype of DENV serotype 2. This is the first study to confirm the presence of DENV serotype 2 in Kassala state, Sudan. Our results indicate the need for wider investigations of the DENV serotype composition and studies to evaluate their contribution to ongoing transmission.