Japanese Journal of Infectious Diseases
Online ISSN : 1884-2836
Print ISSN : 1344-6304
ISSN-L : 1344-6304
Advance online publication
Displaying 1-33 of 33 articles from this issue
  • Huamei Li, Lin He, Bing Wang, Ran Tao, Shiqiang Shang
    Article ID: JJID.2021.742
    Published: July 29, 2022
    Advance online publication: July 29, 2022
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    Vitamin D (VD) plays an important role in infectious and autoimmune diseases. We investigated the association between serum VD levels and active human cytomegalovirus (HCMV) infections in pediatric systemic lupus erythematosus (SLE) patients. From January 2015 to June 2021, one hundred and twenty children diagnosed with SLE and 100 healthy children were enrolled. Using ELISA, serum 25(OH)D levels were detected. Serum anti-HCMV IgM antibodies were measured by a chemiluminescence immunoassay. Comparisons of 25(OH)D levels between SLE patients and healthy children were performed, as well as subgroups of SLE patients with or without active HCMV infections. Serum 25(OH)D levels of SLE patients were significantly lower than those of healthy children (35.3 ± 12.9 vs 49.3 ± 15.3, P < 0.001). VD deficiency ratio was higher in SLE patients (89.2%) than that in healthy children (52.0%). Serum 25(OH)D levels in the positive anti-HCMV IgM group were significantly lower than those of the negative anti-HCMV IgM group (30.6 ± 12.3 vs 38.2 ± 12.5, P < 0.001). The severe VD deficiency ratio was significantly higher in HCMV-IgM(+)-SLE patients (42.2%) than that in HCMV-IgM(-)-SLE patients (13.3%). This study suggested that serum VD level is associated with active HCMV infections in pediatric SLE patients.

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  • Keiko Goto, Kenichi Komatsu, Tsuyoshi Sekizuka, Hiromi Ebisawa, Miki O ...
    Article ID: JJID.2021.841
    Published: July 29, 2022
    Advance online publication: July 29, 2022
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    Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019, is spreading globally. In general, the viral genome becomes undetectable within a couple of weeks after infection. Herein, we report a case of long-term detection of the SARS-CoV-2 genome from the same individual for 106 days. Whole genome sequencing was performed on specimens taken at the onset of the disease and at 2 months after onset, and the B.1.1.7 lineage was detected in both samples. Comparison of the full-length sequences revealed a single-base difference and no amino acid mutations. This is the first case in Japan where the virus was detected over a long time, and the full-length sequences were compared.

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  • Hiroyuki Kishino, Miyuki Sawata, Rie Igarashi, Masayoshi Shirakawa, Al ...
    Article ID: JJID.2022.060
    Published: July 29, 2022
    Advance online publication: July 29, 2022
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    The safety and immunogenicity of V114, a 15-valent pneumococcal conjugate vaccine (PCV), was assessed in a pivotal Phase III trial in healthy adults ≥50 years of age (NCT03950622, Japic-CTI 194845). We report a subgroup analysis of 245 Japanese participants (all ≥65 years of age). Participants were randomized 1:1 to receive a single dose of V114 or 13-valent PCV (PCV13). Immune responses were evaluated at baseline and 30 days post-vaccination. Non-serious and serious adverse events (AEs) were evaluated post-vaccination through 14 days and 6 months, respectively. Proportions of participants experiencing solicited and serious AEs were comparable for both vaccines; all solicited AEs were mild or moderate in severity. Serotype-specific opsonophagocytic activity (OPA) geometric mean titers at 30 days post-vaccination were comparable between groups for all 13 shared serotypes and higher with V114 for the unique serotypes 22F and 33F. Proportions of participants with a ≥4-fold rise in serotype-specific OPA responses from pre-vaccination to 30 days post-vaccination were higher with V114 than PCV13 for serotypes 3, 22F, and 33F. V114 was well tolerated and immunogenic in Japanese adults ≥65 years of age, with safety and immunogenicity profiles consistent with that seen in the overall study population.

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  • Asako Nakamura, Yuki Ashizuka, Takayuki Kobayashi, Saori Ueda, Hiroaki ...
    Article ID: JJID.2022.079
    Published: July 29, 2022
    Advance online publication: July 29, 2022
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    Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first cases confirmed in Japan on January 15, 2020. The Fukuoka Institute of Health and Environmental Sciences conducted testing by polymerase chain reaction (PCR) for SARS-CoV-2 from January 31 to March 4, 2020. Despite collecting 119 samples from 81 patients with fever, cough, fatigue, pneumonia, and other symptoms who were suspected as having SARS-CoV-2 infection, all samples tested during that period were negative. To investigate the pathogens responsible for these symptoms, we conducted multiplex polymerase chain reaction. The results showed that respiratory viruses, human metapneumovirus (hMPV) was detected in 10 patients (12%), human rhinovirus (HRV) in 3 patients (4%), and influenza B virus in 1 patient (1%). In addition, the patients found as having the viruses were significantly older than those not found as having the viruses. Infection with hMPV and HRV has been reported to be associated with the risk of severe illness and death among the elderly. Therefore, differentiating SARS-CoV-2 as well as other respiratory viruses such as hMPV and HRV is necessary to prevent and control the spread of infection, especially in the elderly.

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  • Han Bit Kim, Sangsoo Han, Gi Woon Kim
    Article ID: JJID.2022.081
    Published: July 29, 2022
    Advance online publication: July 29, 2022
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    Community Treatment Centers (CTC) have been set up in South Korea to quarantine and treat COVID-19 patients with mild symptoms. Such CTCs have shown to be successful in terms of management and operation. However, recent incidences of patient deaths at CTCs have brought about concerns and the need to re-examine the administration of CTCs. The following issues include some of the problems of CTCs: failure to monitor patients, recognize emergency situations, and rapidly transfer patients to hospitals, and also the increased fatigue of medical staff. It is necessary to enhance patient safety measures at CTCs by setting up a stronger patient monitoring system, a swifter hospital transfer process and a faster response to emergency situations.

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  • Jiun-Liang Chen, Tsung-Yu Huang, Liang Tseng Kuo, Kuo-Chin Huang, Yao- ...
    Article ID: JJID.2022.087
    Published: July 29, 2022
    Advance online publication: July 29, 2022
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    Monomicrobial necrotizing fasciitis caused by Pseudomonas species is a rare infection. The purpose of this study was to elucidate the specific characteristics and clinical outcomes of necrotizing fasciitis caused by Pseudomonas aeruginosa and Pseudomonas fluorescens. Ten patients with monomicrobial necrotizing fasciitis caused by Pseudomonas species were retrospectively reviewed over an 8-year period. Differences in mortality, patient characteristics, clinical presentations, laboratory data, and clinical outcomes were compared between the death and the survival groups. Two patients died with the mortality rate of 20%. Pseudomonas aeruginosa accounted for 9 patients and Pseudomonas fluorescens for one patient. The most common comorbidity is type 2 diabetes mellitus in 5 patients. We found the death patients had lower albumin level and higher counts of band forms of leukocytes than those of the survival patients. Monomicrobial necrotizing fasciitis caused by Pseudomonas species needs emergent surgical intervention and aggressive intensive care due to high mortality rate. We reported the first case of monomicrobial necrotizing fasciitis with Pseudomonas fluorescens. Severe hypoalbuminemia and increased counts of banded leukocytes in initial laboratory presentations can be considered as poor prognostic factors.

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  • Goro Kurita, Yuzo Tsuyuki, Sachiko Shibata, Mieko Goto, Takahiro Maeda ...
    Article ID: JJID.2022.137
    Published: July 29, 2022
    Advance online publication: July 29, 2022
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    Eye (including cornea) and ear canal are major sources of Streptococcus canis in companion animal practice. We aimed to clarify genotypic and phenotypic features of the eye-origin isolates in 2021 compared to ear-origin isolates in 2021 and eye-origin isolates in 2017. Of the 102 isolates in 2021, nine eye-origin isolates were enrolled, whereas twenty-one ear-origin isolates in 2021 and thirteen eye-origin isolates in 2017 were included as controls. Genotypic analyses included virulence-associated gene (VAG; inl, sagA, slo, scp, lbp, fbp, gbp, ap1, fp1, and brp) profiling, S. canis M-like protein (SCM) allele typing, multilocus sequence typing, and antimicrobial resistance (AMR) genotyping: phenotypic analyses contained hemolytic activity (HA) measurement and AMR phenotyping. There was only one 2017-eye-origin isolate with high-level HA, while the others showed low-level HA. We observed no association of the 2021-eye-origin population with detection rate of each VAG. There was no association of the 2021-eye-origin population with main SCM allele 2. We found significant association of the 2021-eye-origin population with main clonal complex (CC) 46 containing sequence type (ST) 46/ST2. There was significant association of the 2021-eye-origin population with AMR phenotypes/genotypes. Our observations suggest the unique microbiological features (CC46 having AMR phenotypes/genotypes) among the 2021-eye-origin population.

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  • Xin Wu, Xuan Wei, Xiaofeng Li, Jiehua Deng, Jianquan Zhang
    Article ID: JJID.2022.153
    Published: July 29, 2022
    Advance online publication: July 29, 2022
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    The dynamic changes in microbiome during chronic obstructive pulmonary disease (COPD) exacerbations remains unclear. Using 16S ribosomal DNA and fungal internal transcribed spacer DNA sequencing, we described the composition and changes in the bacterial and fungal microbiota of bronchoalveolar lavage fluid (BALF) samples from 15 COPD patients and 7 non-COPD patients. In COPD patients, the dominant bacteria phyla were Proteobacteria, Firmicutes, Bacteroidete and Actinobacteria. The most abundant fungal phyla were Ascomycota and Basidiomycota. In terms of the genera of the bacteria and fungi, the numbers of Veillonella, Prevotella-7, Haemophilus, and Aspergillus were significantly more in COPD compared with the non-COPD patients. In addition, after the progression of COPD, the relative abundances of fungal genera of Aspergillus, Mortierella, Grifola, Thermoascus, Russula, and Thermomyces and the bacteria genera of Proteobacteria increased significantly. Existing analyses demonstrate changes in the diversity of bacterial and fungal communities, which appeared to be related to COPD. Our results demonstrated the potential utility of the microbiota as possible biomarkers for disease progression and provided therapeutic targets for COPD.

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  • Selda Aydin, Okan Derin, Meyha Sahin, Rumeysa Dinleyici, Mesut Yilmaz, ...
    Article ID: JJID.2022.181
    Published: July 29, 2022
    Advance online publication: July 29, 2022
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    Candidemia is an important clinical condition that prolongs the period of hospitalization and increases morbidity, mortality, and hospital costs. In this retrospective study, we aimed to evaluate the epidemiological and microbiological characteristics of patients with candidemia, between January 2013 and December 2019. Two hundred forty-one candidemia episodes were observed in the 230 patients, of whom 45% were female. The median age was 63 and 53.9% of the episodes were in the ICU. Frequently observed predisposing factors for candidemia included the use of antibiotics (71.3%), urinary catheterization (56.3%), Central venous catheter placement (50.3%), total parenteral nutrition (47.9%), solid-organ malignancy (46%), a surgical intervention (48.6%), chemotherapy (37%), steroid treatment (25.5%). The crude mortality rate was 52.7%. A significant difference was found between survivors and non-survivors (p = 0.007) with the Charlson comorbidity index. However, no statistically significant association was found between mortality and age, sex, surgical intervention, catheter-related candidemia, or Candida spp. The most frequently isolated Candida spp. was C. albicans (51%). Overall resistance to fluconazole, voriconazole, caspofungin, micafungin and flucytosine was 3.7%, 0%, 2.5%, 1.8%,1.8%, respectively. Consequently, there is a need for tests that yield higher success rates and rapid in diagnosis candidemia and local epidemiological data for antifungal resistance.

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  • Shuichi Yamamura, Kazuki Kitaoka, Yuki Yamasaki, Kazuki Fudeshima, Kaz ...
    Article ID: JJID.2022.206
    Published: July 29, 2022
    Advance online publication: July 29, 2022
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    The phage lytic spectrum is usually limited to only a few strains of the same bacterial species that it can lyse. Bacterial strains in a species are commonly classified into a sequence type (ST) using the multilocus sequence typing (MLST) approach in clinical molecular epidemiology. The aim of this study is to determine whether the phage lytic spectrum is associated with STs. An MLST analysis of 11 extended-spectrum β-lactamase (ESBL)-producing Escherichia coli clinical isolates revealed that the most common isolates belonged to ST73 or ST131, with four isolates each. Phages were isolated from a sewage sample using various E. coli strains as hosts. The relationship between phage lytic spectra with ESBL-producing E. coli ST73 and/or ST131 isolates and STs was evaluated using Fisher’s exact test. The lytic spectra of phages were found to be significantly dependent on ST classification of ST73 or 131, suggesting that a phage lysing an isolate belonging to a particular ST could lyse other isolates belonging to the same ST. Furthermore, we successfully isolated wide-host-range phages lysing all clinical isolates in this study belonging to two clinically important ST types (ST73 and ST131).

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  • Puren Isik, Ibrahim Inan Harbiyeli, Gokhan Ozturk, Elif Erdem, Meltem ...
    Article ID: JJID.2022.210
    Published: July 29, 2022
    Advance online publication: July 29, 2022
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    The study aimed to evaluate the relationship between clinical findings and viral load in adenoviral keratoconjunctivitis (Ad-Kc). In this cross-sectional study, 30 eyes of 30 patients with Ad-Kc were enrolled. The real-time polymerase chain reaction was performed to detect and quantify adenovirus in all samples. The patient groups were divided into three subgroups according to baseline viral loads (<107, 107-108, >108 HAdV copies/ml). The follow-up duration, HAdV DNA copy number, treatment regimen, and detailed clinical findings including uncorrected visual acuity, eyelid edema, conjunctival hyperemia, chemosis, follicular reaction, corneal involvement, conjunctival pseudomembrane, and subepithelial infiltrates (SEIs) were recorded. The study showed that a high initial viral load was associated with the development of SEIs and pseudomembrane formation (p<0.05). Clinical findings and ocular complications of Ad-Kc were found similar in treatment groups at the final visit (p>0.05). Our results showed that a high initial viral load in Ad-Kc may be predictive of inflammatory sequelae. Determination of the initial viral load in Ad-Kc may be helpful to better understand the clinical course of the disease and prevent complications.

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  • Ozlem Ulusan Bagci, Filiz Guldaval, Can Muftuoglu, Ufuk Mert, Damla Se ...
    Article ID: JJID.2022.288
    Published: July 29, 2022
    Advance online publication: July 29, 2022
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    Lung carcinoma is one the most common cancer and the leading cause of cancer-related death worldwide. Increasing evidences have shown that Cryptosporidium spp., an opportunistic parasite, is associated with cancers, causing a life-threatening infection. The most common clinical form of Cryptosporidium is intestinal infection. However, respiratory cryptosporidiosis has been rarely documented although the parasite infects respiratory epithelium cells as well as GIS epithelium cells. To evaluate respiratory cryptosporidiosis in patients with lung cancer, we investigated Cryptopsoridium spp. in patients with lung cancer (n=69) by comparing with healthy groups (n=40). Sputum and stool samples were tested by microscopic examination and polymerase chain reaction. Two cancer patients were diagnosed with respiratory cryptosporidiosis (2.9%), by PCR examination of the sputum samples. Cryptopsoridium spp. was detected in the stool sample of one patient (1.5%), and two healthy individuals (5.4%), by PCR and microscopy. Firstly, respiratory cryptosporidiosis was documented in two patients with lung cancer. Cryptosporidium is an important agent of respiratory tract infection as well as GIS infection, in cancer patients. These new findings highlight the molecular prevalence of Cryptosporidium spp., an opportunistic infection, in patients with lung cancer, and respiratory cryptosporidiosis should also be considered when patients have respiratory symptoms.

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  • Yixin Kang, Junchang Cui
    Article ID: JJID.2022.289
    Published: July 29, 2022
    Advance online publication: July 29, 2022
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    The objective of this pharmacokinetic (PK)/pharmacodynamic (PD) analysis was to evaluate the efficacy of different dosing regimens of ceftazidime-avibactam (CZA) for the treatment of extensively drug-resistance (XDR) Pseudomonas aeruginosa pulmonary infections by using optimized two-step-administration therapy (OTAT) and traditional infusion (TI). We used Monte Carlo simulations (MCS) to integrate PK parameters with PD parameters to assess the adequacy of ceftazidime-avibactam dosing for critically ill patients with XDR P. aeruginosa pulmonary infections. Dosing models were as follows: 2.5 g q8h, 2.5 g q6h, 4 g q8h, 4g q6h, 1.25 g q8h, 1.25 g q6h, and 0.94 g q12h. MCS showed that the cumulative fraction of response (CFR) of all dosing regimens of OTAT was higher than 90%. The probability of target attainments (PTAs) of all dosing regimens of OTAT at MICs of 16-32 mg/L was higher than those of TI. Based on the models, PK/PD goals were met with OTAT regimens even with high MICs (>16 mg/L) compared with traditional infusion intervals. Our work indicated that OTAT with sufficient pharmacokinetic exposures could improve the efficacy of CZA for critically ill patients with XDR P. aeruginosa pulmonary infections.

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  • Yumani Kuba, Yasuhito Azama, Hisako Kyan, Yoshimune Fukuchi, Noriyuki ...
    Article ID: JJID.2021.808
    Published: June 30, 2022
    Advance online publication: June 30, 2022
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    Severe fever with thrombocytopenia syndrome (SFTS) is an emerging zoonotic tick-borne disease caused by the SFTS virus (SFTSV). SFTSV has a wide spectrum of animal hosts and is thought to circulate in an enzootic tick-vertebrate-tick cycle. A previous seroepidemiological study demonstrated the presence of anti-SFTSV antibodies in wild mongooses (Herpestes auropunctatus) and indicated that outdoor activity is associated with an increased risk of tick bites among Okinawa residents. However, the association of SFTSV between wild mongooses and ticks remains unknown. Thus, to understand the association between ticks and mongooses regarding SFTSV circulation, we investigated the presence of SFTSV RNA in ticks collected from wild mongooses on the main island of Okinawa. A total of 638 ticks, belonging to two genera and three species (Haemaphysalis hystricis, Haemaphysalis formosensis, and Ixodes granulatus), were collected from 22 wild mongooses from 2016 to 2020. SFTSV RNA was detected in two pools of H. hystricis larvae collected from a wild mongoose in the central area of the main island of Okinawa in 2017. Although the prevalence of SFTSV in ticks from wild mongooses is low, endemic circulation of the virus in Okinawa should be carefully monitored in the area to prevent future infections.

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  • Hiroyuki Nagai, Makoto Saito, Eisuke Adachi, Yuko Sakai-Tagawa, Seiya ...
    Article ID: JJID.2022.092
    Published: June 30, 2022
    Advance online publication: June 30, 2022
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    Immunocompromised patients are more likely to develop severe COVID-19 and their mortality is high, while it is hypothesized that chronic infection in these patients can be a risk of developing new variants. We describe a patient with prolonged active infection of COVID-19 who became infected during treatment with anti-CD20 antibody (obinutuzumab) for follicular lymphoma. This patient had persistent RT-PCR positivity and live virus isolation for nine months despite treatment with remdesivir and other potential antiviral therapies. The computed tomography image of the chest showed that the viral pneumonia repeatedly appeared and disappeared in different lobes, as if new infection had occurred continuously. His antibody titer of SARS-CoV-2 was negative throughout the illness, even after two doses of BNT162b2 mRNA vaccine given in the seventh month. Combination of monoclonal antibody therapy against COVID-19 (casirivimab and imdevimab) and antivirals resulted in negative RT-PCR and the virus was no longer isolated. The patient was clinically cured. During the 9-month active infection, no fixed mutations in the S protein were detected and the in vitro susceptibility to remdesivir was retained. Therapeutic administration of anti-SARS-CoV-2 monoclonal antibodies is essential for immunocompromised patients. Measures to prevent resistance against these key drugs are in dire need.

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  • Yong-Peng Sun, Hong-Sheng Qiang, Si-Yu Lei, Xin-Yi Zheng, Hai-Xia Zhan ...
    Article ID: JJID.2022.097
    Published: June 30, 2022
    Advance online publication: June 30, 2022
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    Well-established surveillance and monitoring system for respiratory viruses need be improved and epidemiological data about respiratory viruses is scarce in China. This study aimed to investigate epidemiological characteristics of respiratory viruses among hospitalized children ≤ 2 years old with acute respiratory tract infections (ARTIs) in Xiamen, China from October 2014 to September 2017. The clinical records of 7248 children hospitalized for ARTIs were analyzed retrospectively. Respiratory syncytial virus (RSV) (22.3%) was the most common virus among hospitalized children ≤ 2 years old, followed by parainfluenza (5.0%), adenovirus (3.5%) and influenza (1.7%). RSV-infected children possessed a higher disease burden including higher ICU admission rate (12.7%) and hospital charges ($635.36). Especially, infants < 6 months of age had the highest risk of RSV infection (OR= 2.4, 95% CI: 1.9-2.9) and higher ICU admission rate (12.1% vs. 4.5%, 4.6%) and hospital costs ($923.3 vs. $785.5, $811.7) than other age groups. Therefore, infants aged 0-6 months, especially premature infants and children with congenital diseases, should receive more concern. There is an urgent need to develop effective immunization strategies to protect these infants through the first 6 months of life or RSV season.

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  • Omnia Mohamed Elnabawy Ahmed Taher, Hala Badr Eldin Ali Othman, Shaima ...
    Article ID: JJID.2022.105
    Published: June 30, 2022
    Advance online publication: June 30, 2022
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    Incidence of invasive fungal infections (IFI) has increased due to the rising influx of patients suffering from immunodeficiency. A case-control analysis was performed at Ain Shams University Hospitals, Cairo, Egypt. The cases group (n = 80) included eighty patients diagnosed with hematological malignancies and the control group (n = 20) included twenty patients. All patients were tested for the detection of fungal species using blood culture, pan-fungal Real Time PCR. Fungal species differentiation was made by High Resolution Melting (HRM) PCR. The clinical cases suspected to have IFD were 39 cases out of the 80 patients. Pan-fungal PCR detection rate was 41/80 (51.3 %). HRM-PCR identified the fungal species to be 51.2% Candida albicans, 44% Non-Candida albicans, and 4.9% Mucor. Blood culture was positive in 2 patients with acute myeloid leukaemia (AML). There was a highly significant rate of fungal detection using pan-fungal Real Time PCR technique compared to blood culture technique (p <0.001). Real Time PCR using pan-fungal marker is a sensitive, rapid, and superior to blood culture in detection of IFI and HRM-PCR is a specific test for species identification.

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  • Sakura Kobayashi, Ai Mori, Ryuichi Sugiyama, Tian-Cheng Li, Yoshiki Fu ...
    Article ID: JJID.2022.127
    Published: June 30, 2022
    Advance online publication: June 30, 2022
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    Hepatitis E Virus (HEV) is a causative agent of viral hepatitis E. In Japan, HEV genotype 3 (G3) and G4 are detected predominantly, while G1, mainly imported from countries in continental Asia, is rare. In the present study, we detected a G1 HEV strain from a patient who came to Japan from India. When cells of the PLC/PRF/5 line (subclone 4-21) were inoculated with a stool suspension from this patient, an accumulation of HEV RNA was observed in the spent culture medium, indicating that HEV had been isolated successfully from this specimen. A nearly complete HEV genome was obtained by amplification via RT-PCR. Phylogenetic analyses revealed that the newly isolated HEV strain, designated 9HE36c, belongs to subtype 1g of HEV G1.

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  • Ying Sun, Quanyi Wang, Xiaoli Wang, Shuangsheng Wu, Yi Zhang, Yang Pan ...
    Article ID: JJID.2021.786
    Published: May 31, 2022
    Advance online publication: May 31, 2022
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    To estimate effect of COVID-19 control measures taken to mitigate community transmission in many regions, we analyzed data based on influenza surveillance system in Beijing from week 27th, 2014 to week 26th, 2020. We collected weekly number of influenza-like illness (ILI), weekly positive proportion of ILI and weekly ILI proportion in outpatients and the date of COVID-19 measures. We compared influenza activity indicators of season 2019/2020 with preceding five seasons and built two ARIMAX models to estimate the effective of COVID-19 measures which emergency response declared since 24th January 2020. Based on observed data, compared with preceding five influenza seasons, ILIs, positive proportion of ILI, and duration of influenza epidemic period in season 2019/2020 decreased from 13% to 54%, especially, the number of weeks from the peak to the end of influenza epidemic period, decreased from 12 to one. Based ARIMAX model forecasting, after natural decline considered, weekly ILIs decreased by 48.6% and weekly positive proportion dropped 15% in the second week after emergency response declared, and finally COVID-19 measures reduced 83%. We conclude public health emergency response can interrupt the transmission of influenza markedly.

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  • Takahiro Mitsumura, Tsukasa Okamoto, Mizuho Tosaka, Takashi Yamana, Sh ...
    Article ID: JJID.2022.080
    Published: May 31, 2022
    Advance online publication: May 31, 2022
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    Factors associated with mortality are important for the treatment of coronavirus disease 2019 (COVID-19). The polymerase chain reaction (PCR) test is the gold standard for diagnosing COVID-19 and reflects the viral load in the upper respiratory tract. This study enrolled 523 patients. Four hundred forty-one and 75 patients were performed PCR testing in nasopharyngeal swabs and sputum specimens, respectively, within 20 days from the onset. We investigated the association between RNA copy number and the severity and mortality of COVID-19, and its effect on the predictive performance for the severity and mortality. RNA copy numbers in nasopharyngeal swabs were higher in the non-survivor group than in the survivor group. Multivariate logistic regression analysis identified that the high RNA copy number (≥ 9 log10 /swab) in nasopharyngeal swabs was a factor associated with mortality (odds ratio, 4.50; 95% confidence interval, 1.510 – 13.100; p = 0.008). Furthermore, in severe cases, adding RNA copy number (≥ 9 log10 /swab), which was adjusted by duration from onset to PCR, improved mortality predictive performance based on known factors. The RNA copy number is a factor associated with the mortality of COVID-19 and can improve the predictive performance of mortality in severe cases.

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  • Koichiro Suemori, Yumi Taniguchi, Ai Okamoto, Akiko Murakami, Fumihiro ...
    Article ID: JJID.2022.155
    Published: May 31, 2022
    Advance online publication: May 31, 2022
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    We have conducted two-year seroprevalence surveys of SARS-CoV-2 antibodies among outpatients and healthcare workers (HCWs) at Ehime University Hospital. We collected data for outpatients and HCWs in June 2020 (1st survey), December 2020 (2nd survey), July 2021 (3rd survey) and December 2021 (4th survey) focusing on demographics, occupation, and the seroprevalence of anti-SARS-CoV-2 antibodies. Blood samples were obtained from randomly selected outpatients who visited our hospital for medical care and from HCWs undergoing regular medical checks with opt-out informed consent. SARS-CoV-2 antibody positivity was evaluated using two laboratory-based quantitative tests. The total number of participants enrolled was 6,369 (1st survey: 1000 outpatients and 743 HCWs, 2nd survey: 1000 outpatients and 407 HCWs, 3rd survey: 1000 outpatients and 804 HCWs, 4th survey: 1000 outpatients and 415 HCWs). The prevalence of SARS-CoV-2 antibodies among outpatients and HCWs was 0~0.1% and 0~0.124% during the research period, respectively, and changed little over time. These findings suggest that the magnitude of COVID-19 infection during the pandemic among outpatients and HCWs in this rural hospital might have been small.

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  • Tomomi Soma, Kentaro Fujii, Ayumi Yoshifuji, Taketomo Maruki, Kazuto I ...
    Article ID: JJID.2021.699
    Published: April 28, 2022
    Advance online publication: April 28, 2022
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    Coronavirus disease 2019 (COVID-19) expanded dramatically all over the world. Nafamostat mesylate inhibits the intracellular entry of novel severe acute respiratory syndrome coronavirus 2 and it has been thought as the therapeutic potential of treatment for patients with COVID-19. In the present study, patients with moderate COVID-19 who were admitted to our hospital were retrospectively analyzed. 31 patients received nafamostat mesylate monotherapy and 33 patients received conservative treatment. Nafamostat mesylate was initiated by continuous intravenous infusion for 4.5 days on average. Comparing with conservative treatment group, nafamostat mesylate did not improve the outcomes and laboratory data 5 days after admission. There were also no significant differences in the laboratory data 5 days after admission and outcomes in high-risk patients. Incidence of hyperkalemia was significantly higher in the nafamostat mesylate group, however, none of the patients required additional treatment for hyperkalemia. In conclusion, nafamostat mesylate monotherapy did not improve clinical outcomes in patients with moderate COVID-19. The therapeutic potential of the combination of nafamostat mesylate and other antiviral agents has not been examined in the present study, and further investigation is required. Because of high incidence of hyperkalemia, regular laboratory tests are required during the use of nafamostat mesylate.

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  • Miho Shibamura, Souichi Yamada, Tomoki Yoshikawa, Takuya Inagaki, Phu ...
    Article ID: JJID.2021.726
    Published: April 28, 2022
    Advance online publication: April 28, 2022
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    The neutralizing antibodies (NAb) to HCMV in women are associated with the risk of transplacental infection of the fetus with HCMV in pregnant women. The IgG-positive rate determined with enzyme immunoassay (EIA) or indirect immunofluorescence assay has decreased approximately from 100% to 70% over the past 30 years in Japan. We tested serum samples from 630 women in Japan aged 20 to 49 years from whom blood had been drawn between 1980 and 2015. We measured the IgG titer using an EIA-based assay and the HCMV-NAb titer with neutralization test assay using an HCMV isolate on human retinal epithelial cells. Longitudinal transitions of HCMV-NAb prevalence were clarified. The prevalence of HCMV-EIA-IgG, HCMV-NAb of 16 titer, and HCMV-NAb of 100 titer changed from 96.6 to 78.9%, 93.3% to 85.6%, and 35.5% to 41.1%, respectively, between 1980-1990 and 2010-2015. HCMV NAb prevalence at the titer of 16 decreased by 7.7%, whereas that at the NAb titer of 100 increased by 4.6%. It is expected that HCMV NAb with high titer in pregnant women reduces the risk of intrauterine HCMV transmission from mother to fetus. The association between the risk of congenital HCMV infection and HCMV-NAb prevalence remains to be addressed.

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  • Yukihiro Yoshimura, Hiroaki Sasaki, Nobuyuki Miyata, Natsuo Tachikawa
    Article ID: JJID.2021.834
    Published: April 28, 2022
    Advance online publication: April 28, 2022
    JOURNAL FREE ACCESS ADVANCE PUBLICATION

    We performed this pilot study to assess the immunogenicity and safety of intradermal hepatitis B (HB) virus vaccines in people living with HIV (PLWH). A single-center prospective study was conducted in Yokohama, Japan. Adult PLWH with serum antibodies against hepatitis B surface antigen (anti-HBs) < 10 mIU/mL at all the points after standard HB vaccination were included. We administered hepatitis B surface antigen (total dose 10 μg) at five separate sites intradermally at baseline, 1 month, and 6-9 months and measured anti-HBs 1-3 months after the administration. A total of 11 PLWH were included in this study. The mean age was 36 years, and all patients were male. At baseline, all patients were on anti-retroviral therapy, and the mean CD4 + lymphocyte count was 588 /μL and plasma HIV-RNA was below 20 copies/mL, except for one participant. Anti-HBs levels were elevated over 10 mIU/mL in one participant after one dose, six participants after two doses, and four participants after three doses of the intradermal vaccines. Eight participants experienced grade 1 local adverse event. Additional vaccination via intradermal route induced an anti-HBs level > 10 mIU/mL in all participants without serious adverse events.

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  • Rohitha Muthugala, Kalpa Dheerasekara, Aresha Manamperi, Sunethra Guna ...
    Article ID: JJID.2021.837
    Published: April 28, 2022
    Advance online publication: April 28, 2022
    JOURNAL FREE ACCESS ADVANCE PUBLICATION

    Hantavirus; Hemorrhagic fever with renal syndrome (HFRS) is an emerging zoonotic disease in Euro-Asia which is clinically indistinguishable from leptospirosis. A total number of 1032 patients were included in the analysis from March 2013 to March 2021 with the clinical suspicion of HFRS-like illness. Of them, 168 patients were positive for hantavirus IgM antibodies. Thirty-one patients out of 35 patients had given a four-fold rise IgG antibody titre with paired serum confirming the acute hantavirus infections. Detected antibodies showed a diverse pattern, strongly cross-reacting with Seoul, Hantaan and Puumala virus antigens. All the IgM positive patients had no serological evidence of acute dengue or leptospirosis and had classical features of HFRS; fever, thrombocytopenia and renal involvement. More than 90% of patients had a history of rodent exposure 2-3 weeks prior to the onset of the fever. The highest number of positive cases were diagnosed from the Western and North-Central Provinces of Sri Lanka during the paddy harvesting seasons. A significant number of patients had developed severe complications with a high mortality rate. Therefore, hantavirus infection should be considered as a differential diagnosis for leptospirosis-like illness in Sri Lanka.

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  • Kyota Tatsuta, Yusuke Taki, Eiji Nakatani, Kazuya Higashizono, Erina N ...
    Article ID: JJID.2021.893
    Published: April 28, 2022
    Advance online publication: April 28, 2022
    JOURNAL FREE ACCESS ADVANCE PUBLICATION

    Intra-abdominal infections (IAIs) occur in 2.4%–26.6% of patients who undergo gastrectomy for gastric cancer and are occasionally serious. However, there are few reports on the causative organisms of IAI following upper gastrointestinal tract surgery and the subsequent risk factors for Candida infection. This study aimed to identify the microorganisms causing IAIs after gastrectomy and the risk factors for Candida-related IAI. The records of patients who underwent gastrectomy for gastric cancer between January 2009 and December 2019 at Shizuoka General Hospital were retrospectively collected. Patients with IAIs of grade 2 or higher as measured by the Clavien–Dindo classification were included in the analysis. The selected patients were divided into a Candida group and a non-Candida group according to the presence or absence of Candida as the causative organism. Fifty-six (4.1%) of 1379 patients were diagnosed with IAIs after gastrectomy. Fifty-two patients were included based on culture analyses. A total of 111 strains and 28 bacterial species were isolated in the initial culture test. Candida constituted 7.2% of all the identified pathogens. Regarding the risk factors for Candida-related IAI, a history of antimicrobial use and ≥4 postoperative days of IAI development were independent risk factors for Candida-related IAI.

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  • Saori Fukuda, Yuki Akari, Riona Hatazawa, Manami Negoro, Takaaki Tanak ...
    Article ID: JJID.2022.020
    Published: April 28, 2022
    Advance online publication: April 28, 2022
    JOURNAL FREE ACCESS ADVANCE PUBLICATION

    The emergence of unusual G9P[8]-E2 human rotaviruses in the Tokyo metropolis, Japan in 2018 has been reported. During rotavirus strain surveillance in different regions of Japan (Mie, Okayama, and Chiba prefectures), G9P[8]-E2 strains were detected in diarrheic children in all three prefectures. Here, we characterized the whole genomes of seven representative G9P[8]-E2 strains. On full-genome-based analysis, the seven study strains exhibited a unique genotype configuration having the NSP4 gene of genogroup 2 in a genogroup 1 genomic backbone: G9-P[8]-I1-R1-C1-M1-A1-N1-T1-E2-H1. This genotype constellation is shared by Tokyo G9P[8]-E2 strains. Phylogenetic analysis showed that all the 11 genes, except the NSP4 one, of the seven study strains appeared to have originated from co-circulating Wa-like G9P[8]-E1 strains. On the other hand, the NSP4 gene appeared to have originated from co-circulating DS-1-like G2P[4]-E2 strains. Thus, these study G9P[8]-E2 strains appeared to be derived through reassortment between G9P[8]-E1 and G2P[4]-E2 strains in Japan. Notably, the seven study G9P[8]-E2 strains and Tokyo G9P[8]-E2 strains were revealed to have 11-segment genomes almost indistinguishable from one another in their sequences (99.3-100%), indicating all these G9P[8]-E2 strains had a common origin. To our knowledge, this is the first description of the rapid spread of G9P[8]-E2 strains across a country.

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  • Daisuke Shinoda, Hiroyuki Tsukagoshi, Keiko Komuro, Daisuke Yoshida, T ...
    Article ID: JJID.2022.061
    Published: April 28, 2022
    Advance online publication: April 28, 2022
    JOURNAL FREE ACCESS ADVANCE PUBLICATION

    Respiratory infections are common diseases, the most common causative agent is a virus. In case of novel viral diseases pandemic like the COVID-19, routinely surveillance of respiratory viruses is useful. In this study, to clarify what kind of virus is involved in suspected cases of COVID-19 in the early stages of the pandemic, we attempted to detect various respiratory viruses from 613 specimens that tested negative for SARS-CoV-2 using RT- PCR method. Viruses were detected from 59 (9.6%) patients. Human rhinovirus (HRV), human metapneumovirus (HMPV), human respiratory syncytial virus, and human parechovirus were detected in 29 cases, 25 cases, 3 cases, and 2 cases, respectively. Although this study was conducted in a short period of time and not all specimens were tested, these results indicate that various respiratory viruses, especially HRV and HMPV can be detected even in the early stages of a pandemic, such as COVID-19. Because various respiratory viruses maintain a constant effect during the outbreak of the newly emerged pandemic respiratory virus, to make good use for clinical and public health, from normal period systematic surveillance about respiratory viruses is needed.

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  • Laszlo Irinyi, Michael Roper, Richard Malik, Wieland Meyer
    Article ID: JJID.2022.068
    Published: April 28, 2022
    Advance online publication: April 28, 2022
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    Candida auris, first described from an ear infection in Japan, is the most talked about multidrug resistant emerging pathogenic fungal species. Its environmental niche remained a mystery until its first isolation from wetlands of the Andaman Islands, India in 2020. We screened a subset of the world’s largest sequence repository, the Sequence Read Archive at NCBI using a DNA metabarcoding approach, based on either the ITS1 or ITS2 region of the official primary fungal DNA barcode, to identify potential environmental sources of C. auris. Our search identified 34 matches with partial C. auris ITS sequences from seven metabarcoding studies, providing wider evidence for the presence of C. auris outside human-maintained facilities.

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  • Zhenfei Mo, Chunsun Li, Zhixin Liang, Jiewei Cui, Ling Yu, Liangan Che ...
    Article ID: JJID.2022.141
    Published: April 28, 2022
    Advance online publication: April 28, 2022
    JOURNAL FREE ACCESS ADVANCE PUBLICATION

    Over the past few decades, understanding of the clinical features of pulmonary cryptococcosis (PC) has progressed, yet there is a lack of data on the manifestations of PC over time. To investigate the differences in clinical characteristics of PC across different time periods, we performed a retrospective review of 130 non-AIDS patients diagnosed with pathologically or microbiologically confirmed PC from 1990-2020. Among 130 PC patients, 24 (18.5%) exhibited immunosuppression, and 44 (33.8%) had underlying diseases. In radiology, 118 (90.8%) presented with subpleural lesions, and 68 (53.1%) presented with nodules with diameters ranging from 1-5 cm. Seventy-five patients (57.7%) underwent surgery alone. PC clinical features at different time periods showed that hospitalization days decreased (P=0.009), and patients with symptoms decreased over time. Patients exhibiting isolated lesions decreased (P=0.022), and patients exhibiting subpleural lesions increased (P=0.020). Patients with lesions presenting 3-10 mm nodules increased (P=0.028). In conclusion, more and more patients have been diagnosed of PC in the last 30 years. The timing of PC diagnosis has shifted to early in disease progression. Pulmonary lesions caused by cryptococcosis are easily misdiagnosed and may lead to unnecessary surgical treatment. Further research is needed to identify lung lesions caused by cryptococcosis.

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  • Yumi Kobayashi, Ai Tateishi, Yumi Hiroi, Toki Minakuchi, Haruko Mukouy ...
    Article ID: JJID.2021.643
    Published: March 31, 2022
    Advance online publication: March 31, 2022
    JOURNAL FREE ACCESS ADVANCE PUBLICATION

    In mid-September 2019, a teenage Chinese male student and part time waiter in Tokyo was diagnosed with multidrug-resistant (MDR) sputum smear-positive pulmonary tuberculosis (TB). This study describes the outbreak investigation of his friends and colleagues at the restaurant. We investigated six friends and 15 colleagues, of whom five friends and 13 colleagues underwent interferon-ã release assay (IGRA). Of these, three friends (60.0%) and four colleagues (30.8%) were IGRA-positive. Each one of the friends and colleagues was found to have MDR-TB (20% and 7.7%, respectively). Challenges during the investigation were the unavailability of regimens for latent TB infection (LTBI) for contacts with MDR-TB, budgetary constraints concerning implementing computed tomography (CT) scans for the contacts, frequent address changes of foreign-born patients and contacts, investigation during the coronavirus disease pandemic, and variations of alphabetical expression of the names of the patients and contacts, particularly for those from China. It is recommended that the national government officially adopt prophylaxis regimens for LTBI with MDR-TB, address the budgetary constraints regarding CT-scans, and deploy liaison officer(s) for coordinating investigations involving many foreign-born patients and contacts scattered in multiple municipalities. The names of foreign-born persons could more accurately be identified using both the alphabet and Chinese characters.

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  • Santanu Banerjee, Mihir Bhatta, Srijita Nandi, Shanta Dutta, Malay Kum ...
    Article ID: JJID.2021.720
    Published: March 31, 2022
    Advance online publication: March 31, 2022
    JOURNAL FREE ACCESS ADVANCE PUBLICATION

    For maintaining the performance quality, HIV in-vitro diagnostic (IVD) kits are required to be evaluated by unbiased health regulatory organisation following predefined guidelines. WHO prequalification is one such program for evaluation of in-vitro diagnostic assays. In present systematic review and meta-analysis, we analysed and compared seventeen WHO prequalified public reports of HIV IVDs to yield summarised information for performance parameters. Pooled sensitivity, pooled specificity, Positive Likelihood Ratio (PLR), Negative Likelihood Ratio (NLR) and diagnostic odds ratio (DOR) were used as overall performance evaluation parameters. High (≥98%) and comparable level of sensitivity and specificity were observed for most of the assays. The overall diagnostic efficiency was observed to attain high precision as evident by the value of Area under the curve (AUC) for the hierarchical summary receiver operating characteristic (HSROC) curve (AUC≥0.98).

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  • Wei Luo, Qian Wang, Xiaofang Zhang, Dongmei Gu, Weifeng Zhang, Chunhui ...
    Article ID: JJID.2021.795
    Published: March 31, 2022
    Advance online publication: March 31, 2022
    JOURNAL FREE ACCESS ADVANCE PUBLICATION

    Novel immunodominant antigens are urgently required for diagnosis and vaccine of Helicobacter pylori(HP). FliD, an important colonization factor was cloned and expressed(rFliD) to evaluate the levels of specific-IgG, IgM and IgA antibodies in the serum of patients by ELISA. Rabbit anti-rFliD polyclonal antibody (pAb) was obtained by subcutaneous injections of rFliD. The rFliD-specific IFN-γ and IL-4 of peripheral blood mononuclear cells and CD4+ T cells from human were analyzed by enzyme-linked immunospot and flow cytometry. We found that the levels of rFliD-specific IgG, IgM and IgA were significantly higher in HP-infected-patients compared with healthy controls. IgG, IgM and IgA had diagnostic sensitivities of 92.6, 89.8 and 83.2%; specificities of 91.1, 88.7 and 64.6%; and areas under the receiver operating curves of 0.97, 0.96 and 0.92, respectively. Furthermore, rFliD-pAb was used in the immunohistochemical analysis of gastritis and gastric cancer tissues from patients infected with HP. The levels of rFliD-specific IFN-γ and IL-4 were significantly elevated in HP-infected patients and exhibited a T helper type 1-dominant subtype. These findings indicate that rFliD exhibits high validity as a biomarker in HP diagnosis and may also be a potent antigen for vaccine design due to its high cellular and humoral immune response.

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