Japanese Journal of Infectious Diseases
Online ISSN : 1884-2836
Print ISSN : 1344-6304
ISSN-L : 1344-6304
Advance online publication
Showing 1-50 articles out of 61 articles from Advance online publication
  • Yasuto Fukushima, Yuzo Tsuyuki, Mieko Goto, Haruno Yoshida, Takashi Ta ...
    Article ID: JJID.2020.1086
    Published: June 30, 2021
    [Advance publication] Released: June 30, 2021
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    This study assessed biofilm production ability (BPA) and other microbiological features of Streptococcus canis strains. Companion animal-origin 40 strains from each year (2015/2017) were randomly selected with the host information, and three blood-origin strains from 2 humans/1 dog were included. We measured BPA using crystal violet staining, along with S. canis M-like protein (SCM) allele typing, sequence type (ST) determination, antimicrobial resistance (AMR) phenotyping/genotyping, and virulence-associated gene profiling (gbp-ap1-fp1-brp). BPA measurements revealed that 35 strains with BPA and 48 strains without BPA. There was association of the producer with isolation year (2017). We found association between the non-producer and SCM allele 1/ST9: there was association of the producer with SCM allele 10/ST21. We observed correlation between the producer and presence of AMR genotypes. There was association between the producer and ap1 detection and between non-producer and gbp detection. Our observations suggest the correlation between the producer and other microbiological features (isolation year/SCM allele type 10/ST21/presence of AMR genotypes/ap1 detection).

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  • Yaoyao Zhuge, Chenxi Ding, Xiufang Gong, Dan Hu, Jin Zhu, Changjun Wan ...
    Article ID: JJID.2020.1109
    Published: June 30, 2021
    [Advance publication] Released: June 30, 2021
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    Severe fever with thrombocytopenia syndrome virus (SFTSV) is a newly emerging tick-borne virus with a case fatality rate between 12% and 50%. Currently, effective vaccines or antiviral drugs are not available, and a diagnostic method for detecting SFTSV is urgently needed. The monoclonal (MAb) and polyclonal antibodies (PAb) against SFTSV were prepared by immunizing animals with SFTSV nucleocapsid protein (NP), and using both monoclonal and polyclonal antibodies as capture antibodies against NP, we developed two different double-antibody sandwich enzyme-linked immunosorbent assays (DAS-ELISAs) for detecting the NP of SFTSV. Both methods were applicable for the diagnosis of SFTSV-infected patients, as confirmed by quantitative polymerase chain reaction. Furthermore, the sensitivity and specificity of two assays for diagnosing SFTS were both 100%, and had no reaction to recombinant Dabieshan NP or recombinant Dengue virus NS1 subtype 1 and 2 proteins. In addition, two standard curves were established for quantitative detection of the NP, and the monoclonal antibody-based ELISA (MAb-based ELISA) test had a lower limit of detection than the polyclonal-based ELISA (PAb-based ELISA) test. Therefore, the MAb-based ELISA could be employed for detecting SFTSV in a convenient and effective way.

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  • Xuefei Wang, Fen Yang, Lisong Huang, Ruifeng Chen, Yi Shan, Yiqing Jia ...
    Article ID: JJID.2021.001
    Published: June 30, 2021
    [Advance publication] Released: June 30, 2021
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    This retrospective cross-sectional study included patients with category Ⅲ exposure to the rabies virus at a single center between January and December 2019. Exposure characteristics and clinical data were compared and statistically analyzed among groups willing and unwilling to receive RIG injection, and determinants of its administration were identified by stepwise multivariate logistic regression analyses. In total, 1,757 patients with category Ⅲ exposure were enrolled: 845 males (48.1%) and 912 females (51.9%; median age: 28 [9-50] years). Among them, 1,297 (73.8%) received RIG injection (median age: 28 [8-50] years) and 460 (26.2%) refused to receive the injection (median age: 25 [15-48] years). Patients aged 16-25 years (odds ratio [OR]=3.006, 95% confidence interval [CI]=1.957-4.619), 26-45years (OR=2.940, 95% CI=2.011-4.298), 46-55 years (OR=3.647, 95% CI=2.233-5.959) and over 56 years (OR=6.660, 95% CI=4.009-11.062); those with injuries caused by cats (OR=1.937, 95% CI=1.476- 2.542); and people with scratch (OR=3.319, 95% CI= 2.510-4.390), minor (OR=35.281, 95% CI=18.524-64.198), and moderate (OR=12.711, 95% CI=7.221-22.375) injuries were more likely to refuse injection. The RIG administration level in the settings studied herein is insufficient. Educational and awareness programs should be considered for rabies prevention, especially those targeted at people not injured by dogs, people with minor injuries, and the elderly.

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  • Taichiro Muto, Nami Nakamura, Yu Masuda, Shingo Numoto, Shunsuke Kodam ...
    Article ID: JJID.2021.003
    Published: June 30, 2021
    [Advance publication] Released: June 30, 2021
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    To investigate the usefulness of quenching probe polymerase chain reaction (Q-probe PCR) for detection of macrolides-resistant Mycoplasma pneumoniae (MP), we retrospectively analyzed the clinical course of 21 children with MP infection. The rate of macrolides resistant MP was 66.7%. The duration of pyrexia after the initial antibiotics treatment was longer in patients with macrolides-resistant MP infection than in those with macrolides-sensitive MP infection. The duration of pyrexia after Q-probe PCR was not significantly different between patients with macrolides-resistant MP infection and those with macrolides-sensitive MP infection. These results suggest that antibiotic use based on Q-probe PCR will reduce duration of pyrexia. Q-probe PCR contributes to determine appropriate antibiotics and to improve the clinical course of MP infections.

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  • Alexandra Sashova Alexandrova, Daniela Rosenova Pencheva, Ivan Gergov ...
    Article ID: JJID.2021.106
    Published: June 30, 2021
    [Advance publication] Released: June 30, 2021
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    Streptococcus pneumoniae is still a leading bacterial pathogen of acute otitis media (AOM), despite the available pneumococcal conjugate vaccines (PCVs). We conducted a study on the population structure, antibiotic nonsusceptibility, serotype distribution, and presence of pilus in middle ear fluids - S. pneumoniae isolates recovered from PCV10-vaccinated children with suppurative АОМ in Bulgaria. Non-susceptibility was revealed in 68.75% (n=33) of the isolates. Multidrug-resistance (MDR) has been detected in 60.4%. The dual macrolide resistance mechanism was predominant. Most widespread were non-PCV10 serotypes 3 (27.1%, n=13), 19A (25.0%, n=12), and VT 19F (23.0%, n=11). A total of 64.6% were non-PCV10-serotypes. Presence of Pilus type I was observed mostly in PCV10-serotypes. We disclosed a strong association between CCs, serotype, and antimicrobial resistance. The MLST revealed the presence of four CCs: CC320 (39.6%), CC505 (12.5%), CC1377 8.3%), and CC230 (8.3%), respectively. The most abundant CC320 comprised MDR 19A and 19F isolates. CC230 clustered MDR isolates from serotype 19A, 6C, and 14. CC505 and CC1377 covered serotype 3 susceptible isolates. The vaccine-induced changes and trends in antimicrobial resistance and clonality must be an object of systematic investigations.

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  • Jayathilake Sarangi, Nao Matsuo, Rina Nonogaki, Michiko Hayashi, Kumik ...
    Article ID: JJID.2021.141
    Published: June 30, 2021
    [Advance publication] Released: June 30, 2021
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    The Enterobacter cloacae complex (ECC) is one of the most common causes of bacteremia and leads to poor clinical outcomes. The aim of this study was to clarify the antimicrobial susceptibility profiles and genetic backgrounds of non-carbapenemase-producing reduced-carbapenem-susceptible (RCS) ECC blood isolates in Japan using agar dilution antimicrobial susceptibility testing, whole-genome sequencing, and quantitative polymerase chain reaction for assays of ampC, ompC and ompF transcripts. Forty-two ECC blood isolates were categorized into RCS and carbapenem-susceptible groups based on imipenem minimum inhibitory concentration. RCS ECC blood isolates belonged to distinct species and sequence types and produced varying class C β-lactamases. The E. roggenkampii, E. asburiae, and E. bugandensis isolates belonged only to the RCS group. Some E. hormaecheii ssp. steigerwaltii isolates of the RCS group exhibited AmpC overexpression caused by amino acid substitutions in AmpD and AmpR along with ompF gene downregulation. These findings suggest that non-carbapenemase-producing RCS ECC blood isolates are genetically diverse.

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  • Subhabrata Sarkar, Radha Kanta Ratho, Meenu Singh, Mini Pritam Singh, ...
    Article ID: JJID.2021.151
    Published: June 30, 2021
    [Advance publication] Released: June 30, 2021
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    Both Human Respiratory Syncytial virus (RSV) and Human Metapneumovirus (hMPV) cause immune-mediated under-five acute respiratory infections (ARI), but differences in their disease pathogenesis, if any, are not well-known. This study was undertaken to analyze the epidemio-clinico-immunological features of RSV and hMPV infections. Naso-pharyngeal aspirates from children (aged two months to five years) with ARI presenting to our tertiary care center between December 2013 to March 2016 were subjected to real-time polymerase chain reaction for detection of RSV and hMPV. Positive samples were analyzed for co-infections and levels of cytokines. Of 349 naso-pharyngeal aspirates, RSV was detected in 40.68% (142/349), hMPV in 6.59% (23/349) and both in 1.4% (5/349). Co-infections were common, rhinovirus being the commonest co-offender. The demographical and clinical parameters of RSV- and hMPV-infected children were comparable. MMP-9/TIMP-1 ratio was significantly higher in RSV-mediated ARI and IFN-γ in hMPV-mediated ARI. Both RSV and hMPV are common among north Indian children with ARI and coinfections are not uncommon. Their clinical features being non-discriminatory, molecular diagnosis should be utilized to ascertain their individual epidemiology. The differences in their immune-pathogenesis (MMP-9/TIMP-1 ratio in RSV and IFN-γ in hMPV) could serve as useful tools for developing newer drugs.

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  • Kübra Evren, Rukiye Berkem, Mihriban Yücel
    Article ID: JJID.2021.164
    Published: June 30, 2021
    [Advance publication] Released: June 30, 2021
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    We analyzed the performance parameters of the traditional and the reverse algorithms to find out which one is more convenient for serodiagnosis of syphilis. In total, 4789 serum samples were obtained in a cross-sectional study. Venereal Disease Research Laboratory (VDRL), Treponema pallidum Haemagglutination Assay (TPHA) and Chemiluminescent Microparticle Immunoassay (CMIA) tests were performed for every serum sample. In case of discordance between results, the TPHA was applied as a second treponemal test. Overall, 207 patients were serodiagnosed with syphilis. Among 4789 subjects tested, 125 (2.6%) and 206 (4.3%) were positive using the traditional algorithm and the reverse algorithm, respectively. The missed diagnosis rate of the traditional algorithm was 42.5%. The reverse algorithm had higher sensitivity than the traditional algorithm. Sensitivity levels of the traditional and the reverse algorithms were 57.49% and 99.85% respectively. The false positivity of the reverse algorithms was 0.02%.

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  • Kazuya Shirato, Shutoku Matsuyama, Makoto Takeda
    Article ID: JJID.2021.213
    Published: June 30, 2021
    [Advance publication] Released: June 30, 2021
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    Various variants of severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2) began emerging worldwide from the end of 2020 to the beginning of 2021. The variants GRY/VOC202012/01 (B1.1.7), GH/N501Y.V2 (B1.351), and GR/N501Y.V3 (P1) are characterized by N to Y amino acid substitution at position 501 in the S protein. The variant containing L to R substitution at position 452 in the S protein G/L452R.V3 (B1.617) was endemic to India. The heightened concern regarding these variants is related to their increased viral infectivity. Information about nucleotide mismatch(es) on the primer/probe sequence is important for maintaining good performance of real-time PCR assays. In this study, real-time RT-PCR assays developed by the National Institute of Infectious Diseases, Japan (NIID-N2 and NIID-S2 assays), were reviewed to analyze nucleotide mismatches of variants in primer/probe sequences. The frequency of mismatched sequences in three variants (GRY/VOC202012/01, GH/N501Y.V2, and GR/N501Y.V3) was lower than that in all SARS-CoV-2 sequences. The mismatch, that G to C substitution at nucleotide 8 in reverse primer of S2 set, elevated to about 16.3% in G/L452R.V3, however the substitution did not affect the analytical sensitivity of assay. Therefore, the study indicates that the NIID-N2 and NIID-S2 sets detect VOCs of SARS-CoV-2 with reliable efficiency.

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  • Siriporn Kowaboot, Wilarat Puangmanee, Surachet Benjathummarak, Khwanc ...
    Article ID: JJID.2020.1071
    Published: May 31, 2021
    [Advance publication] Released: May 31, 2021
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    Mouse antibodies specific to dengue NS1 have been widely studied for their cross-reactivity with several human molecules. This is the first cross-reactivity study of dengue NS1 specific human monoclonal antibodies (HuMAbs), isolated from DENV2 infected patients. Nine anti-NS1 HuMAbs derived mainly from convalescent-phase patients with secondary DENV-2 infections were characterized. Their cross-reactivity with plasminogen, thrombin, and endothelial cells was investigated, and then plasmin-formation assays were performed. All anti-NS1 HuMAbs were cross-reactive with human plasminogen (Plg), but not thrombin and endothelial cells. Moreover, all HuMAbs that showed cross-reactivity with Plg converted Plg to plasmin in a plasmin-formation assay. These results suggest the implications and drawbacks of anti-NS1 antibodies for immunotherapy.

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  • Kei Kubota, Ken-ichi Nagakura, Motohiro Ebisawa, Goro Kaneda, Noriyuki ...
    Article ID: JJID.2020.1090
    Published: May 31, 2021
    [Advance publication] Released: May 31, 2021
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    Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is spreading worldwide and is a public health problem. Although real-time reverse-transcription polymerase chain reaction (RT-PCR) is gold standard for diagnosing coronavirus disease (COVID-19) and there are many reports discussing it, reports about loop-mediated isothermal amplification (LAMP) tests for SARS-CoV-2, especially in children, are limited. We report the test results of three children with COVID-19 in a family cluster and assess the results of LAMP tests. The LAMP results of these children showed a sensitivity and specificity of 63.6% and 100%, respectively, that was relative to the RT-PCR results. LAMP tests using nasopharyngeal swab (NPS) and RT-PCR were almost consistent throughout hospitalization in the school children, except in the very early stage of infection. The preliminary results suggest that salivary samples would be less sensitive than NPS for LAMP testing in the late stage of infection, and that LAMP would not provide accurate results in neonates.

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  • Jun Li, Hui Shen, Ting Yu, Xiao-Yan Tao, Yong-Mei Hu, Hai-Chen Wang, M ...
    Article ID: JJID.2020.1096
    Published: May 31, 2021
    [Advance publication] Released: May 31, 2021
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    The aim of this study was to investigate the clinical features, distribution and antimicrobial susceptibility of Nocardia species isolated from pulmonary nocardiosis cases in tertiary hospital in China. The species were collected from January 1, 2018 to May 31, 2019 and identified using MALDI-TOF MS or PCR. Antimicrobial susceptibility testing was performed using the broth microdilution method. Within the 44 Nocardia species, N. farcinica was the most frequently identified species (n = 36), followed by N. nova (n = 5), N. otitidiscaviarum (n = 1), N. cyriacigeorgica (n = 1), and N. transvalensis (n = 1). The top three predisposing factors of pulmonary nocardiosis were chronic obstructive pulmonary disease (45.5%), hypertension (34.1%), and tuberculosis (31.8%). All 44 Nocardia strains were susceptible to amikacin, trimethoprim / sulfamethoxazole, and linezolid. The resistance rates of Nocardia to amoxicillin-clavulanic acid, ciprofloxacin, clarithromycin, ceftriaxone, tobramycin, and imipenem were 4.5%, 9.1%, 79.5%, 72.7%, 63.6%, and 38.6%, respectively. Two Nocardia strains had decreased sensitivity to trimethoprim / sulfamethoxazole. In conclusion, N. farcinica was the most frequently isolated Nocardia species in the First Hospital of Changsha. All isolated clinical Nocardia strains showed susceptible to amikacin, trimethoprim / sulfamethoxazole, and linezolid, suggesting that these drugs can be primary therapeutic choices for treating Nocardia infections.

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  • Ye-Ling Liu, Tian-Ao Xie, Geng-Ling Lin, Wei Deng, Qin-Rong Lin, Zhi-Y ...
    Article ID: JJID.2020.987
    Published: May 31, 2021
    [Advance publication] Released: May 31, 2021
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    Xpert Xpress Flu/RSV is a fast and automated real-time nucleic acid amplification tool for detecting influenza virus and respiratory syncytial virus (RSV). The aim of this study was to verify the accuracy of Xpert Xpress Flu/RSV in detecting influenza virus and RSV. PubMed, EMBASE, Cochrane Library, and Web of Science were searched up to October 2020. The quality of original research was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 guidelines. Meta-DiSc 1.4 software was used to analyze the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and Summary receiver operating characteristic curve. Deek’s funnel plot asymmetry test was used to evaluate the publication bias by Stata 12.0. Ten studies with 25 fourfold tables were included in this analysis. The sensitivity of Xpert Xpress Flu/RSV in detecting influenza A, influenza B, and RSV was 0.97, 0.98, 0.96, respectively, and the specificity was 0.97, 1.00, 1.00, respectively. Compared with other common clinical real-time reverse transcriptase PCR (RT-PCR), Xpert Xpress Flu/RSV is a valuable tool for diagnosing influenza virus and RSV with high sensitivity and specificity.

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  • Amjad Ahmadi, Atefeh Mousavi, Himen Salimizand, Manouchehr Ahmadi Heda ...
    Article ID: JJID.2021.006
    Published: May 31, 2021
    [Advance publication] Released: May 31, 2021
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    Neisseria gonorrhoeae (N. gonorrhoeae) is one of the causing factors of sexually transmitted diseases (STDs). This bacterium infects the epithelial cells of the cervix of women and urethra of men. However, the symptoms in the lower genitalia are found only in a small percentage of people. The aim of this study was comparing the frequency of N. gonorrhoeae genital infection among two groups of pregnant women (spontaneous abortion and normal pregnancy).This cross-sectional study was performed in the west of Iran. This study was performed on 417 women who consisted of 109 spontaneous abortions, 109 normal deliveries, 100 fertilities and 99 infertile women. Specific primers were used and DNA was extracted by endocervical swabs; then a Polymerase chain reaction (PCR) test was done for detection of N. gonorrhoeae. Data analysis was carried out using Chi-Square Test and t-Test. In all of the above-said steps, a level of 5% was considered significant.The average age in women with normal delivery (27.8±4.87) in women with spontaneous abortion (29.6±5.9) in fertile women (32.1±5.1) and in infertile women were (29.1±6.3). The total frequency of N. gonorrhea infection was 0 (0%). Prevalence of N. gonorrhoeae infection was zero; also it was not associated with spontaneous abortion and infertility.

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  • Yutaro Akiyama, Noriko Kinoshita, Kenji Sadamasu, Mami Nagashima, Isao ...
    Article ID: JJID.2021.018
    Published: May 31, 2021
    [Advance publication] Released: May 31, 2021
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    It is known that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be detected in the stools of patients with the coronavirus disease 2019 (COVID-19) and that the virus can be transmitted by oral-fecal route. However, there are few reports on the viral load in stools. This pilot study aimed to evaluate the clinical characteristics and viral load of SARS-CoV-2 in the stools of 13 patients with confirmed COVID-19 using as control the pepper mild mottle virus, which was proposed as a potential indicator of human fecal contamination of environmental water. SARS-CoV-2 RNA was detected in stool samples from four patients (31%), among whom three presented diarrhea symptoms. One patient experiencing long-term diarrhea (22 days) had high levels of viral RNA in the stools (8.28 log10 copies/g). However, we could not isolate the SARS-CoV-2 in the stool of any patients, using VeroE6/TMPRESS2 cells for four weeks. Our results suggest that SARS-CoV-2 RNA may be detected in the stools of patients with the diarrhea symptoms. Further studies evaluating the relationship between SARS-CoV-2 viral load in stools and diarrhea symptoms in larger patient cohorts and upon adjusting for other causative factors and virus infectivity are still needed.

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  • Fatima Kanani, Saba Jamal, Saira Khowaja, Bushra Kaleem, Sabiha Anis, ...
    Article ID: JJID.2021.031
    Published: May 31, 2021
    [Advance publication] Released: May 31, 2021
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    The correct and rapid diagnosis of COVID-19 is vital for proper care and identification of affected individuals. This led to the early availability of many serological assays in the market but with limited validations. This study aimed to assess the validation of the serological assays based on different techniques. We evaluated fifteen assays based on four different immunoassay techniques on 235 patients. The most sensitive kit employing different techniques were as follows: immunochromatography (Zybio SARS CoV-2 IgM/IgG Antibody Assay Kit: 83%), ELISA (Aeskulisa SARS-CoV-2 NP IgG –88.1%), chemiluminescence (Alinity SARS-CoV-2 IgG – 82.2%) and immunofluorescence (Lifotronic FA160 [Shenzhen SARS-CoV-2 Assay Kit (IgG)] –88.9%). 100% specificity was seen in kits by Uniper (Singuway Biotec COVID-19 IgM/IgG Presumptive Kit), Genrui 2019-nCoV IgM/IgG Test Kit, Wondfu SARS CoV-2 Antibody Test and Aeskulisa SARS-CoV-2 NP IgG while IgG assay on Lifotronic FA160 (Shenzhen SARS-CoV-2 Assay Kit) showed the lowest specificity at 58%. Maximum agreement was observed between Aeskulisa SARS-CoV-2 NP IgG and Alinity SARS-CoV-2 IgG at 94%. Serological tests are practical alternatives but their reliability requires critical validation. The pandemic pointed a need for investment in health research on both national and international levels.

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  • Cunye Yan, Yue Chen, Chenyu Sun, Mubashir Ayaz Ahmed, Chandur Bhan, Zh ...
    Article ID: JJID.2021.074
    Published: May 31, 2021
    [Advance publication] Released: May 31, 2021
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    Previous researches on the association between proton pump inhibitors (PPIs) use and the treatment and prevention of COVID-19 has generated inconsistent findings. Therefore, this meta-analysis was conducted to clarify the outcome in patients who take PPIs. Eight articles with more than 268,683 subjects were included. PPI use was not associated with increased or decreased risk of COVID-19 infection (OR:3.16, 95% CI=0.74-13.43, P=0.12) or mortality risk of COVID-19 patients (OR=1.91, 95% CI=0.86-4.24, P=0.11). While it can add risk of severe disease (OR=1.54, 95% CI=1.20-1.99, P<0.001;) and secondary infection (OR=4.33, 95% CI=2.57-7.29). In summary, PPI use is not associated with an increased risk of infection and may not change the mortality risk of COVID-19, but appeared to be associated with an increased risk of progression to severe disease and secondary infection. However, more original studies to further clarify the relationship between PPI and COVID-19 are still urgently needed.

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  • Xiaohua Wang, Lu Lu, Jin Miao, Jian Ma, Nana Wu, Yun Cao, Chuanqing Wa ...
    Article ID: JJID.2021.099
    Published: May 31, 2021
    [Advance publication] Released: May 31, 2021
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    This study aimed to determine the cause behind the outbreak of nosocomial adenoviral conjunctivitis in the Neonatal Intensive Care Unit (NICU) and the impact of infection control measures. The objectives of the present study include investigation of the hospital-borne infection associated with adenoviral conjunctivitis, analysis of the possible risk factors, setting bundle infection control measures, which were adjusted according to the control effect. The present study also aims to observe the effect of different intervention measures on controlling adenoviral conjunctivitis. During the first and second intervention periods, overall 635 and 597 NICU patients were enrolled, respectively. Ophthalmoscopy was conducted among 188 (in the first intervention) and 184 (in the second intervention) patients (P>0.05). The times of ophthalmoscopy the patients received were 417 and 457 (P<0.001). During the first intervention, 13 patients suffered from adenoviral conjunctivitis, while no patients with adenoviral conjunctivitis were found during the second intervention (P<0.001). All adenoviral conjunctivitis cases were reported 6-27 days (mean 12 days) after ophthalmoscopy. The hydrogen peroxide disinfection bundle measures can effectively restrict the prevalence of adenoviral conjunctivitis associated with ophthalmoscopy in premature infants.

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  • Gabriela de Almeida Oliveira Evangelista, Rejane Hughes Carvalho, Gabr ...
    Article ID: JJID.2020.1000
    Published: April 30, 2021
    [Advance publication] Released: April 30, 2021
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    Etiology of viral meningoencephalitis is frequently unidentified. Chikungunya virus (CHIKV) and Zika virus (ZIKV) have been known to affect the central nervous system, and should, therefore, be considered for diagnosis of meningoencephalitis since its outcome may be influenced by the etiologic agent, age and immunological condition of the patient. In this study we aimed to determine if CHIKV and ZIKV were the etiological agent of viral encephalitis in meningoencephalitis patients admitted to the main hospital of infectious disease in the city of Salvador, Brazil. From 1049 patients with neurological symptoms who were admitted to the hospital during the time of this study, 149 were enrolled and 20 (13.34%) tested positive for ZIKV (12%) or CHIKV (1.34%). No specific clinical manifestations were observed to be associated to the ZIKV or CHIKV infection. Determination of the etiology of meningitis’ and encephalitis’ causing agent is important for patient management and correct treatment.

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  • Shoko Kawai, Kazuaki Fukushima, Makiko Yomota, Akito Fukuda, Sho Fujiw ...
    Article ID: JJID.2020.1009
    Published: April 30, 2021
    [Advance publication] Released: April 30, 2021
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    Coronavirus disease 2019 (COVID-19) and influenza may infect a person simultaneously; hence, adequate measures must be prepared for the next winter in Japan. In preparation for the future, this study aimed to clarify the rate of influenza coinfection in patients with COVID-19 in previous winter. We conducted a retrospective study of the medical records of 193 patients diagnosed as having COVID-19 between January 31, 2020, and April 23, 2020, in a single hospital. We measured the rate of coinfection with COVID-19 and influenza. We found no patient was coinfected with influenza using rapid diagnostic testing. The occurrence of coinfection with influenza and COVID-19 seems to be rare in the past winter in Japan.

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  • Katsuo Koshi, Makiko Noda, Yukiko Kadokura, Yoshihiko Kameyama
    Article ID: JJID.2020.1060
    Published: April 30, 2021
    [Advance publication] Released: April 30, 2021
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    To investigate the molecular epidemiological characteristics of Mycobacterium tuberculosis strains collected in Gifu Prefecture, Japan, 483 M. tuberculosis clinical isolates were used for Japan Anti-Tuberculosis Association (JATA) 18-variable number tandem repeats (VNTR) analysis during 20152019. To estimate the lineages of M. tuberculosis strains, JATA18-VNTR profiles were applied to a maximum a posteriori method. The results revealed that the ancient Beijing subfamily, accounting for 57.3% (277/483) was the most prevalent M. tuberculosis strain. Furthermore, 18 clusters (GC-1–GC-18) were found by minimum spanning tree analysis. The proportion of clustering strains was 9.9% (48/483), and epidemiological links to these clusters were unclear without GC-6 and GC-18. Meanwhile, interestingly, VNTR profiles of GC-7–GC-9 and GC-14 were indistinguishable from the regional epidemic strains of Nagoya City, which has a strong socioeconomic relationship with Gifu Prefecture, but did not match the nationwide epidemic strains. This study suggests that coordinated analyses within prefectures with strong socioeconomic relationships are important.

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  • Elok Puspita Rini, Michihito Sasaki, Dwi Astuti, Vetnizah Juniantito, ...
    Article ID: JJID.2020.769
    Published: April 30, 2021
    [Advance publication] Released: April 30, 2021
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    Coxiella burnetii (C. burnetii) is a bacterial agent causing Q fever which is widespread all over the world. Livestock such as cattle, goat, and sheep are the main sources of infection for this disease. Infection of C. burnetii causes abortion of livestock, resulting in economic damage. Q fever is zoonotic disease and potential public health hazard. To date, little is known about the infection of C. burnetii in livestock in Indonesia. The objective of this research is to screen the genome of C. burnetii bacteria in beef cattle in West Java, Indonesia. Organ tissue samples were collected from cattle slaughtered in slaughterhouses, West Java. C. burnetii genome was detected from cattle samples in all three samplings area by nested PCR (nPCR) targeting com1 gene of C. burnetii. Sequencing analysis of 16S rRNA gene revealed the amplicons showed 99.9% nucleotide identity to C. burnetii strains Heizberg, 1843, 2574, 701CbB1, and 14160-001. Our results indicate that the infection of C. burnetii occurs in Indonesian beef cattles and highlight the risk of exposure to C. burnetii infection in human.

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  • Ruizhao Cai, Miao Zhen, Zhiguang Guan, Menghe Li, Qiangyun Liao, Xing ...
    Article ID: JJID.2020.843
    Published: April 30, 2021
    [Advance publication] Released: April 30, 2021
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    Vibrio vulnificus (V. vulnificus) infection is rare but potentially fatal. This study explored the new atypical manifestations and prognostic factors of V. vulnificus-infected patients throughout hospitalization. we retrospectively reviewed 33 patients diagnosed as having V. vulnificus infection in Guangdong Province, China between 2010 and 2020. Medical records were analyzed. Multiple logistic regression and receiver operating characteristic (ROC) curve analyses were performed. New atypical manifestations were found, including cholangitis, urinary tract infection, and suppurative otitis media. Eleven of thirty-three (33.3%) V. vulnificus-infected patients died eventually. By univariate analysis, patients with cardio-cerebro-vascular diseases, lower platelet counts, higher levels of C-reactive protein and procalcitonin (PCT) had a statistically higher mortality. However, multivariate analysis showed that only PCT (P = 0.036) reached statistical significance. Also, the area under the ROC value estimate for PCT was 0.8816 (95% CI, 0.759-1.000; P = 0.0009). More than half of patients with V. vulnificus infection would die when PCT >20 ng/ml, while no patient dies when PCT ≤ 20 ng/ml. This study found new atypical manifestations of V. vulnificus infection. Also, PCT is an effective and independent predictor of mortality of V. vulnificus infection, and is suitable for clinicians to make early risk stratification and best therapeutic strategies.

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  • Yumani Kuba, Ayako Shingaki, Minoru Nidaira, Tetsuya Kakita, Noriyuki ...
    Article ID: JJID.2020.943
    Published: April 30, 2021
    [Advance publication] Released: April 30, 2021
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    From February 14 to May 31, 2020, the Okinawa prefecture confirmed 142 cases of coronavirus disease (COVID-19). Among them, 78 were the first cases of a household, with 174 household contacts. Of the 174 contacts, 21 contracted infection, indicating a secondary attack rate of 12.1% (95% confidence interval (CI) 7.6–17.9%). No significant differences were observed in the demographics and quantitative reverse transcription polymerase chain reaction (qRT-PCR) test results between first cases who became the source of infection to the household members or not. The secondary attack rates per various characteristics of the household members were significantly different: aged > 69 years (40.9% [95% CI 20.7–63.6%]) and those with underlying diseases (36.0% [95% CI 18.0–57.5%]). When the period from the onset to the isolation of the first household case was within 3 days, the secondary attack rate was low (4.5% [95% CI 0.1–22.8%]). Among the 21 secondary cases, 11 (52.4%) developed within 5 days from symptom onset in the first case within the same household. This indicates that secondary infection within the household occurred immediately after symptom onset in the first case. Thus, isolation of a suspected patient is a solution to reduce secondary household infections.

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  • Ferhan Kerget, Buğra Kerget
    Article ID: JJID.2021.046
    Published: April 30, 2021
    [Advance publication] Released: April 30, 2021
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    SARS-CoV-2 (COVID-19) has infected over 100 million people since it appeared in Wuhan, China just 1 year ago. This study aimed to evaluate the relationship between interleukin-6 (IL-6)gene polymorphisms -174G/C and -597G/A and COVID-19 course. The study included a total of 70 patients aged 18–45 years who were hospitalized in our hospital and diagnosed with COVID-19 in Turkey between March and November 2020. Of these, 40 patients required intensive care admission due to macrophage activation syndrome (MAS) and 30 patients did not develop MAS or acute respiratory distress syndrome. The frequency of IL-6-174G/C -and 597G/A polymorphisms was determined. There were statistically significant differences between the groups in terms of -174G/C allele and genotype frequency and comparison with Hardy-Weinberg distribution (χ2=10.029, df=1, p=0.002 and χ2=9.998, df=1, p=0.002, respectively). The frequency of the GG genotype was significantly higher in the MAS group compared to the non-MAS group (p=0.002). The G allele was also significantly more frequent in the MAS group compared to the non-MAS group (p=0.032). Analysis of the -174G/C polymorphism in patients with MAS showed that the G allele may be a risk factor for increased serum IL-6 levels and progression to MAS.

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  • Shunji Suzuki, Shin-ichi Hoshi, Akihiko Sekizawa, Yoko Sagara, Katsuyu ...
    Article ID: JJID.2021.097
    Published: April 30, 2021
    [Advance publication] Released: April 30, 2021
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    The current study was conducted to examine the number of human T-cell leukemia virus type 1 (HTLV-1) carrier and how horizontal transmission affects the prevalence of HTLV-1 carrier in pregnant Japanese women in 2019. We requested 2,214 obstetrical facilities to provide information of HTLV-1 tests in pregnant women who delivered in 2019. The estimated number of HTLV-1 carrier in pregnant Japanese women was 952. At least 10% or more of the HTLV-1 carriers were those due to horizontal transmission.

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  • Wenjing Zhang, Michiyo Kataoka, Hai Yen Doan, Fang-Tzy Wu, Naokazu Tak ...
    Article ID: JJID.2021.100
    Published: April 30, 2021
    [Advance publication] Released: April 30, 2021
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    A human hepatocarcinoma cell line, PLC/PRF/5, is susceptible to hepatitis E virus (HEV) infection and is used for isolating this virus. It is difficult to use this cell line for the isolation of HEV directly from fecal specimens of swine or wild boar contaminated with porcine sapelovirus (PSV), because PSV infection results in rapid and extensive cytopathic effects in PLC/PRF/5 cells, interrupting the growth of HEV. Herein, we used a PSV infection-resistant cell line, N1380 derived from PLC/PRF/5 cells, and we successfully isolated an HEV-4b strain from a PSV-positive swine fecal specimen. Our results indicate that N1380 cells are a useful tool for the isolation of HEV from swine or wild boar fecal specimens, even when they are co-infected with PSV.

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  • Mitsuo Uchida
    Article ID: JJID.2021.122
    Published: April 30, 2021
    [Advance publication] Released: April 30, 2021
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    The “Go To Travel” campaign in Japan, which encouraged people to travel throughout the country, was started in July 2020 to revitalize economic activity that was sluggish due to COVID-19. Although risks of infection spread have been reported for tourists crossing prefectural borders, the spread of infection among residents living in sightseeing resort areas is unclear. This study evaluated the number of COVID-19 cases in residents of sightseeing resort areas in Gunma Prefecture using the descriptive epidemiological method. Data about infected individuals were obtained from open data on the prefectural official homepage. Evaluation of epidemic curves showed that the number of infected cases increased slightly after the start of the campaign, with numbers affected by the occurrence of clusters. Toward the end of 2020, the number of affected cases increased in both resort areas and non-resort areas, with the increase being smaller in resort areas. Thus, the increased occurrence of infection during the campaign suggested a need to take additional preventive measures more so for tourists than for resort area residents.

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  • Takanori Hirayama, Ram Sharan Gopali, Bijay Maharjan, Kenichi Shibasak ...
    Article ID: JJID.2019.375
    Published: March 31, 2021
    [Advance publication] Released: March 31, 2021
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    This descriptive cross-sectional study collected data of the prevalence of diabetes mellitus (DM) among tuberculosis (TB) at the Urban DOTS (Directly observed treatment, short-course) Centers in the Kathmandu, Bhaktapur, and Lalitpur districts of Nepal. The prevalence of DM was assessed in 67 previously treated TB cases (PTTB) and 214 new TB cases. DM was diagnosed in 8 PTTB and 20 new TB patients. Clinical interviews identified 14 cases of DM, the rapid blood glucose test diagnosed 4 cases, and the oral glucose tolerance test (OGTT) diagnosed 4 cases. Impaired glucose tolerance and impaired fasting glycemia were found in 8 and 5 cases, respectively. The 18-24 age group had the largest number of new TB cases (82; 38.3%). However, the comorbidity of DM and TB was higher in the 35 years and older age group and was found in 24.2% of PTTB and in 23.1% of new TB cases. To provide the evidence of impacts of DM screening for TB cases, larger number of samples should be analyzed. The DM screening for TB patients is expected to start in developing countries. It should be initiated by clinical interview about DM and glucose tests by rapid kits.

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  • Kazuki Matsuura, Yuki Terasaka, Dai Miyazaki, Yumiko Shimizu, Yoshitsu ...
    Article ID: JJID.2020.1019
    Published: March 31, 2021
    [Advance publication] Released: March 31, 2021
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    To understand the clinical course of human adenoviral (HAdV) conjunctivitis for establishing a better treatment regimen, thirty-eight eyes of 19 patients with HAdV-54 conjunctivitis for less than one week from onset were evaluated for clinical signs and symptoms and DNA copy numbers. It is observed that a viral load of 104–105 is required to develop symptoms of HAdV conjunctivitis, as symptoms were present in all the eyes whose viral load was ≥104 at least once during the course. Next, it is observed that asymptomatic infections in contralateral eyes are common as the virus was detected in most eyes that did not develop conjunctivitis. Furthermore, there was no rapid decrease of the viral load in healed eyes, on the contrary, the viral load in healed eyes on day 15 was significantly higher than in unhealed eyes. This was likely due to corticosteroid instillation that rapidly alleviated symptoms but prolonged the duration of viral shedding. Recently, combination treatment with iodine and corticosteroids has been recommended for HAdV conjunctivitis. Assessing changes in viral load as well as clinical symptoms would be helpful to better understand the clinical course of this disease.

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  • Junji Seto, Yoko Aoki, Kenichi Komabayashi, Yoko Ikeda, Mika Sampei, N ...
    Article ID: JJID.2020.1073
    Published: March 31, 2021
    [Advance publication] Released: March 31, 2021
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    Public health interventions have served an important role in controlling coronavirus disease 2019 (COVID-19), a rapidly spreading infectious disease. To contribute to future COVID-19 countermeasures, we aimed at verifying the results of countermeasures achieved by public health centers (PHCs) against the first wave of COVID-19 in Yamagata Prefecture, Japan. During January–May 2020, 1,253 patients suspected of SARS-CoV-2 infection were invited for testing. Simultaneously, based on retrospective contact tracings, PHCs investigated the infection sources and transmission routes of laboratory-confirmed COVID-19 cases and tested 928 contacts. Consequently, 69 cases were confirmed during March 31 – May 4, 58 (84.1%; 95% confidence interval 75.5–92.7) of whom were found from contacts. The spread of infection was triggered by cases harboring epidemiological links outside of Yamagata. Then, the number of cases increased rapidly. However, PHCs identified epidemiological links in 61 (88.4%; 95% confidence interval 80.8–96.0) of the 69 cases and transmission chains up to the fifth generation. Finally, the spread of infection ended after approximately one month. Our results indicate that the identification of infection sources and active case finding from contacts based on retrospective contact tracing was likely to be an effective strategy to end the first wave of COVID-19 in Yamagata.

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  • Yuichiro Yahata, Hajime Kamiya, Matthew M Griffith, Yuuki Tsuchihashi, ...
    Article ID: JJID.2020.489
    Published: March 31, 2021
    [Advance publication] Released: March 31, 2021
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    Neonatal pertussis has the potential for severe complications, even death. Mothers have been identified as the most frequent source of neonatal pertussis. Almost a dozen countries have implemented pertussis vaccination programs for pregnant women to protect neonates, but Japan has not yet done so. The aim of this questionnaire-based study was to ascertain the willingness of women to be vaccinated during pregnancy and the factors associated with willingness. Subjects were 977 pregnant women who visited either of two selected hospitals for maternity health checks. Most of the women were in their first pregnancy (96%) and about half considered a physician to be the most reliable source of information about vaccination (481/977, 49%). “Willingness to receive pertussis vaccination” was significantly associated with the factors “no fear of receiving vaccination” (odds ratio [OR]=3.10, 95% confidence interval [CI]: 2.21–4.34), “necessary to prevent pertussis” (OR=8.70, 95% CI: 6.17–12.28), “effective in pregnancy”(OR=5.46, 95% CI: 3.94–7.56), and “no concern about side effects after vaccination”(OR=3.03, 95% CI: 1.66–5.55). Pregnant women are likely to consider vaccination if they have a good understanding of the disease and its outcomes. Physicians are well positioned to improve knowledge and attitudes toward pertussis vaccination during pregnancy.

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  • Kazuya Tone, Takashi Tamura, Shigehiro Hagiwara, Kazuyoshi Kuwano, Koi ...
    Article ID: JJID.2020.652
    Published: March 31, 2021
    [Advance publication] Released: March 31, 2021
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  • Miyuki Fujioka, Sho Yoshioka, Masahiko Ito, Chowdhury Rafiqul Ahsan
    Article ID: JJID.2020.858
    Published: March 31, 2021
    [Advance publication] Released: March 31, 2021
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  • Bhagwan Maharjan, Jeewan Thapa, Dhirendra Kumar Shah, Bhabana Shrestha ...
    Article ID: JJID.2020.921
    Published: March 31, 2021
    [Advance publication] Released: March 31, 2021
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    Sputum microscopy and Xpert MTB/RIF are the primary rapid diagnostic methods for tuberculosis (TB) in Nepal. Disagreements among Xpert, microscopy, and culture, for example, cases with Xpert positive and microscopy negative, were frequently observed in Nepal including in our reference laboratory. The objective of this study was to compare the effectiveness of Xpert with culture and microscopy for TB diagnosis in Nepal. A total of 125 TB suspected sputum samples were processed for Xpert, microscopy, and culture. The Xpert results when compared with culture showed 100% sensitivity and 97.4% specificity with an excellent agreement (kappa = 0.96), whereas microscopy showed the sensitivity and specificity of 43.2% and 98.7%, respectively, with a moderate agreement (kappa = 0.4). The sensitivity and specificity of microscopy, when compared with Xpert, were 43.5% and 100%, respectively. The majority of Xpert positive samples of a medium MTB detection and all samples of low and very low MTB detection were missed by microscopy. Our study showed that Xpert MTB/RIF is a reliable tool for the diagnosis and management of TB in Nepal. Because of its high cost and sustainability, alternative simple and rapid diagnostic methods with a similar efficiency would be helpful for TB control in Nepal.

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  • Ryuji Kawahara, Masanori Watahiki, Yuko Matsumoto, Kaoru Uchida, Makik ...
    Article ID: JJID.2020.926
    Published: March 31, 2021
    [Advance publication] Released: March 31, 2021
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    Genes conferring carbapenem resistance have spread worldwide among gram-negative bacteria. Subtyping of these genes has epidemiological value due to the global cross-border movement of people. Subtyping of blaIMP genes that frequently detected in Japan appears to be important in public health settings; however, there are few useful tools for this purpose. We developed a subtyping screening tool based on PCR direct sequencing, which targets the internal sequences of almost all blaIMP genes. The tool used bipartite multiplex primers with M13 universal sequences at the 5’-end. According to in silico analysis, among the 78 known IMP-type genes, except for blaIMP-81, 77 detected genes were estimated to be differentiated. In vitro evaluation indicated that sequences of amplicons of IMP-1, IMP-6, IMP-7, and IMP-20 templates were identical to their respective subtypes. Even if the amplicons were small or undetectable through the first PCR, sufficient amplicons for DNA sequencing were obtained through a second PCR using the M13 universal primers. In conclusion, our tool can be possibly used for subtype screening of blaIMP, which is useful for the surveillance of bacteria with blaIMP in clinical and public health settings or environmental fields.

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  • Jeonghyun Chang, Heungsup Sung, Kyung-Wook Jo, Tae Sun Shim, Mi-Na Kim
    Article ID: JJID.2020.978
    Published: March 31, 2021
    [Advance publication] Released: March 31, 2021
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    This study aimed at evaluating performance of Xpert MTB/RIF (Xpert) regarding detection of pulmonary tuberculosis compared to acid-fast bacilli (AFB) smear and culture, and concordance of rifampin resistance with drug susceptibility test. Specimens simultaneously referred for AFB smear, culture, and Xpert during April 2015 to March 2018 were retrospectively reviewed. Sensitivity, specificity, and mean cycle-threshold (Ct) values of Xpert and rifampin resistance results were analyzed. Results of Xpert for pulmonary tuberculosis were evaluated by AFB smear grade. Among the total of 3,840 specimens, 491 were positive in Xpert and 626 were positive in culture. Sensitivity and specificity of Xpert was 75.6% and 99.4%, respectively. Sensitivity of Xpert in smear-positive/culture-positive specimens was 98.6% and those of smear-negative and trace/culture-positive was 63.1%. Positivity of Xpert in culture-positive specimens were 89.9%/98.6%/95.7%/100.0%/100.0% in smear grade trace/1+/2+/3+/4+. Ct values of 491 specimens significantly lowered as AFB smear grade increased (p<0.0001). Ct of smear-positive/smear-trace/smear-negative specimens were 21.7 ± 4.2/26.5 ± 3.9/27.4 ± 3.6, respectively. Rifampin resistance tested by Xpert and culture was 98.3% concordant. Region covered by probe E was the most frequently mutated (50.0%). Xpert showed reliable performance in detecting pulmonary tuberculosis in smear-positive/culture-positive specimens and further improvements are needed for smear negative/culture positive specimens.

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  • Shigeki Ochiai, Yuichi Kama, Kota Hirai, Hidetoshi Yano, Ayumi Tada, C ...
    Article ID: JJID.2021.019
    Published: March 31, 2021
    [Advance publication] Released: March 31, 2021
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    Coronavirus disease 2019 (COVID-19) pneumonia in children characteristically has a milder clinical presentation, with milder inflammatory biomarkers and radiological findings. Accumulating evidence indicates a difference in chest computed tomography (CT) features and duration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) shedding between children and adults. Here, we report a family case of COVID-19 pneumonia in which two brothers (age 14 years and 2 years) had different findings. On admission, the 2-year-old had few symptoms with no sign of pneumonia, whereas the older brother had presented with pneumonia on admission. Both were positive for SARS-CoV-2 infection on polymerase chain reaction. They both had obvious characteristic signs of COVID-19 pneumonia on chest CT. However, CT findings in the younger brother were non-specific and similar to other pneumonias. The older brother required longer treatment because of a longer shedding period of SARS-CoV-2 detected in nasopharyngeal samples. Both boys were discharged without complications. This family case suggests that the clinical features of COVID-19 pneumonia might differ between younger and older children.

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  • Sumeyye Kazancioglu, Fatma Meric Yilmaz, Aliye Bastug, Bahadir Orkun O ...
    Article ID: JJID.2021.020
    Published: March 31, 2021
    [Advance publication] Released: March 31, 2021
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    It is important to determine the inflammatory biomarkers in the severity of Coronavirus Disease 2019 (COVID-19) with the emergence of the pandemic. Galectins and prostaglandins play important roles in the regulation of immune and inflammatory responses. Therefore, this study aimed to investigate Galectin-1 (Gal-1), Galectin-3 (Gal-3), and prostaglandin E2 (PGE2) levels in patients with COVID-19. Gal-1, Gal-3, and PGE2 serum concentrations were measured using enzyme-linked immunosorbent analysis (ELISA) on 84 COVID-19 patients (severe=29 and nonsevere=55) and 56 healthy controls. In this study, the increased levels of Gal-1 (median, 9.86, 6.35, 3.67 ng/ml), Gal-3 (median, 415.31, 326.33, 243.13 pg/ml)and PGE2 (median, 193.17, 192.58, 124.62 pg/ml) levels were found in patients with COVID-19 than healthy controls (p<0.001 for all). In the severe group, Gal-3 levels were higher while there were no differences in Gal-1 and PGE2 levels (p=0.011, p=0.263, p=0.921, respectively). There was a positive correlation between serum Gal-1 and Gal-3 levels (ρ=0.871, p<0.001). Gal-3, C-reactive protein, lymphocyte count, and age were found as independent predictors of the disease severity (p=0.002, p=0.001, p=0.007, and p=0.003, respectively). With the emergence of effective drug needs in the COVID-19 pandemic, differentiation of severe disease is important. Gal-3 could be a potential prognostic biomarker of COVID-19.

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  • Serkan Surme, Ahmet Buyukyazgan, Osman Faruk Bayramlar, Ayse Kurt Cina ...
    Article ID: JJID.2020.1065
    Published: February 26, 2021
    [Advance publication] Released: February 26, 2021
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    We aimed to determine the predictors of intensive care unit (ICU) admission or death in patients with Coronavirus Disease 2019 (COVID-19) pneumonia. This retrospective and single-center study includes patients aged ≥18 years who were diagnosed with COVID-19 pneumonia (laboratory and radiologically confirmed) between March 9 and April 8, 2020. Our composite endpoint was ICU admission or in-hospital death. To evaluate the factors in the composite endpoint, univariate and multivariate logistic regression analyses were performed. A total of 336 patients with COVID-19 pneumonia were recorded. The median age was 54 years [interquartile range (IQR): 21] and 187 (55.7%) were male. Fifty-one (15.2%) patients were admitted to the ICU. In-hospital death occurred in 33 (9.8%) patients. In univariate analysis, 17 parameters were associated with the composite endpoint and procalcitonin had the highest ODDs ratio (OR=36.568 CI=5.145-259.915). Our results revealed that body temperature (OR=1.489 CI=1.023-2.167, p=0.037), peripheral capillary oxygen saturation (SpO2) (OR=0.835 CI=0.773-0.901, p<0.001), and consolidation (>25%) in chest computed tomography (OR=3.170 CI=1.218-8.252, p=0.018) at admission were independent predictors. As a result, increased body temperature, decreased SpO2, a high level of procalcitonin, and degree of consolidation in chest computed tomography may predict a poor prognosis and have utility in the management of patients.

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  • Kazuya Shirato, Yuriko Tomita, Hiroshi Katoh, Souichi Yamada, Shuetsu ...
    Article ID: JJID.2020.1079
    Published: February 26, 2021
    [Advance publication] Released: February 26, 2021
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    Soon after the December 2019 outbreak of coronavirus disease 2019 in Wuhan, China, a protocol for real-time RT-PCR assay detection of severe acute respiratory syndrome coronavirus (SARS-CoV-2) was established by the National Institute of Infectious Diseases (NIID) in Japan. The protocol used Charité’s nucleocapsid (Sarbeco-N) and NIID’s nucleocapsid (NIID-N2) assays. During the following months, SARS-CoV-2 spread causing a global pandemic, and a variety of SARS-CoV-2 sequences were registered to public databases, such as the Global Initiative on Sharing All Influenza Data (GISAID). In this study, we evaluated the newly developed S2 assay (NIID-S2) to replace the Sarbeco-N assay and the performance of NIID-N2 and NIID-S2 assays, referring mismatches in the primer/probe targeted region. We found the analytical sensitivity and specificity of the NIID-S2 set were comparable to the NIID-N2 assay, and the detection rate for clinical specimens was identical to that of the NIID-N2 assay. Furthermore, among available sequences (approximately 192,000), the NIID-N2 and NIID-S2 sets had 2.6% and 1.2% mismatched sequences, respectively, although most of these mismatches did not affect the amplification efficiency, with the exception of the 3′ end of the NIID-N2 forward primer. These findings indicate that the previously developed NIID-N2 assay remains suitable for the detection SARS-CoV-2 with support of the newly developed NIID-S2 set.

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  • Hiraku Sasaki, Tomoko Fukunaga, Ai Asano, Mayu Tsumita, Yoshio Suzuki, ...
    Article ID: JJID.2020.542
    Published: February 26, 2021
    [Advance publication] Released: February 26, 2021
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    In Japan, several rubella outbreaks in adults have erupted due to insufficient immunity against rubella virus (RUBV). Although selective immunization is being promoted in addition to a routine rubella vaccine program as a rubella eradication strategy, serosurveillance against RUBV needs to be implemented in the generations corresponding to the transition period of vaccination. In this study, a survey of anti-rubella immunoglobulin G (IgG) antibody titers was conducted among young adults involved in the transitional periods of the routine rubella vaccine program. Serosurveillance was performed in 370 healthy young adults aged 18–20 years, and their serum samples were analyzed using an enzyme immunoassay to determine rubella-specific IgG antibody titers. Although multiple regression analysis revealed significant differences only in medical history, more than 90% of participants exhibited seropositivity, excluding those who received single-dose vaccine alone. Based on elapsed periods after the last vaccination, rubella-specific IgG antibody titers in less than a 6-year period were higher compared to that in the more than 10-year period. Although almost all study participants in the transitional period had seropositivity, the results may indicate that the persistence of seropositivity is related to past rubella outbreaks.

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  • Choon-Mee Kim, Geon Park, Young Jin Ko, Seong-Ho Kang, Sook Jin Jang
    Article ID: JJID.2020.765
    Published: February 26, 2021
    [Advance publication] Released: February 26, 2021
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    Various mechanisms underlying antimicrobial resistance in Acinetobacter baumannii have been reported. There exists controversy regarding the relationships between efflux pump activity, biofilm formation, and antimicrobial resistance in A. baumannii. In this study, we investigated the relative expression of RND efflux pump genes, H33342 efflux activity, and biofilm-forming activity in 120 A. baumannii clinical isolates, examined their potential relationships with one another, and then statistically analyzed their effects on antibiotic resistance. High adeB expression and high H33342 efflux activity were correlated with low biofilm-forming activity. High adeB expression was significantly correlated with resistance to tigecycline and cefotaxime, but not with the multidrug resistance (MDR) phenotype. Importantly, only high adeJ expression was significantly correlated with the MDR phenotype, and was observed to be correlated with resistance to various antibiotics. However, we found no significant correlation between adeJ expression and biofilm-forming activity. Further, adeG expression was found to not be correlated with antibiotic resistance and biofilm-forming activity. The results of multivariate analysis showed that adeB overexpression and high H33342 efflux activity are related to biofilm-forming activity, and only adeJ overexpression is significantly associated with the MDR phenotype, highlighting the importance of adeJ overexpression.

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  • Tadashi Maeda, Katsuhito Kashiwagi, Sadako Yoshizawa, Takahiro Sato, K ...
    Article ID: JJID.2020.799
    Published: February 26, 2021
    [Advance publication] Released: February 26, 2021
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    Most COVID-19 patients are mild or asymptomatic; a substantial minority of patients develop severe or critical disease. There are many reports on potential risk factors for severe disease, but few reports have reported a relationship between antibody titer and severity in Japan. Antibody-dependent enhancement (ADE) is one such factor theorized to affect the worsening of disease. We have been evaluating IgG responses in COVID-19 patients at our tertiary hospital. A measure of interest is the IgG index, we assigned 1.4 as the cutoff value for a positive result according to the manufacturer indication and observed that patients could be categorised into two distinct groups: early elevation of IgG and late elevation of IgG (IgG elevated in the first 7 days ± 2 days or more than 10 days after symptom onset). We defined the former as early-IgG responders (N=7) and the latter as late-IgG responders (N=14) and compared them. C-reactive protein and D-dimer levels were significantly higher on admission (HD 0) and the respiratory rate was higher, lymphocytes were lower significantly on day 7 of hospitalization (HD 7) in the early-IgG responders. These results might implicate that early production of anti-severe acute respiratory syndrome coronavirus 2 IgG may be associated with clinical indicator for severity.

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  • Satoshi Ide, Kayoko Hayakawa, Kei Yamamoto, Shinya Tsuzuki, Junko Tanu ...
    Article ID: JJID.2020.813
    Published: February 26, 2021
    [Advance publication] Released: February 26, 2021
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    Despite the increase in COVID-19 cases worldwide, the number of cases in Japan has been relatively low, and an explosive surge in the prevalence has not occurred. Since March 2020, the Ministry of Health, Labour and Welfare (MHLW) in Japan recommended original criteria for considering polymerase chain reaction (PCR) testing, although there was a lack of clear evidence for appropriate targets for COVID-19 testing. This study aimed to evaluate COVID-19 positive ratio and pre-screening criteria in Tokyo immediately after insurance-covered SARS-CoV-2 polymerase chain reaction testing became available in Japan. We tested 277 individuals (positive: 9.0%) from March 9–29, 2020. In total, 277 patients with mild symptoms in metropolitan Tokyo underwent SARS-CoV-2 PCR testing. The results revealed that 25 (9.0%) patients were PCR positive. The sensitivity and specificity of the MHLW criteria were 100% and 10.7%, respectively. When the criteria excluded nonspecific symptoms, fatigue, and dyspnea, sensitivity slightly decreased to 92%, and specificity increased to 22.2%. Specificity was highest when the fever criterion was ≥37.5°C for ≥4 days, and exposure/travel history, including age and underlying comorbidities, was considered. Our findings suggest that MHLW criteria, including symptoms and exposure/travel history, could support COVID-19 pre-screening.

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  • Junji Seto, Junko Amemura-Maekawa, Mika Sampei, Kyoko Araki, Misao End ...
    Article ID: JJID.2020.815
    Published: February 26, 2021
    [Advance publication] Released: February 26, 2021
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  • Tomohiro Oishi, Tetsuro Muratani, Takaaki Tanaka, Masahisa Sato, Urara ...
    Article ID: JJID.2020.824
    Published: February 26, 2021
    [Advance publication] Released: February 26, 2021
    JOURNALS FREE ACCESS ADVANCE PUBLICATION

    To improve our current understanding of normal flora in children, we investigated bacterial isolates from pharynx and nasopharynx of 173 and 233 healthy children, respectively. The bacterial isolation rates were compared among three age groups: infants (<1 year), toddlers (1–5 years), and school-age children (6–15 years). Gram-positive cocci (GPC) were the predominant bacteria in the pharynx (Streptococcus mitis/oralis, 87.3%; Streptococcus salivarius, 54.3%; Rothia mucilaginosa, 41.6%; Staphylococcus aureus, 39.3%). Among infants, Streptococcus salivarius and Neisseria subflava, which are related to the development of teeth, were significantly lower than in the other age groups (p<0.0001, S. salivarius; p<0.01, N. subflava). Gram-negative rods (GNR) predominated the nasopharynx (Moraxella catarrhalis, 32.1%; and Moraxella nonliquefaciens, 28.3%) except for Corynebacterium pseudodiphtheriticum (44.2%) of gram-positive rods. Among toddlers, Moraxella catarrhalis and Streptococcus pneumoniae, which are the most common pathogens in acute otitis media, were significantly higher than in the infant group (p<0.05 for both). Among bacterial species implicated in pediatric respiratory infection, Streptococcus pyogenes was isolated in 3.5% of pharyngeal samples. S. pneumoniae and Haemophilus influenzae were isolated in 22.3% and 17.2% of nasopharyngeal samples, respectively. In conclusion, normal flora of the respiratory tract differs not only by sampling site but also by age group.

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  • Mya Myat Ngwe Tun, Rohitha Muthugala, Lakmali Rajamanthri, Takeshi Nab ...
    Article ID: JJID.2020.854
    Published: February 26, 2021
    [Advance publication] Released: February 26, 2021
    JOURNALS FREE ACCESS ADVANCE PUBLICATION

    During the 2017 outbreak of severe dengue in Sri Lanka, dengue virus (DENV) serotypes 2, 3 and 4 were co-circulating. Based on our previous study on the 295 patients from the National Hospital Kandy in Sri Lanka between March 2017-January 2018, the dominant infecting serotype was DENV-2. Here, we aimed to characterize the DENV-3 strains from non-severe and severe dengue patients from our previous study population. Patients’ clinical records and previous laboratory tests including dengue-specific nonstructural protein 1 antigen rapid test, IgM-capture and IgG enzyme-linked immunosorbent assays, were analyzed together with the present results of real-time reverse transcription polymerase chain reaction, and next-generation sequencing of DENV-3. Based on complete genome analysis, DENV-3 isolates belonged to two different clades of genotype I and were genetically close to the strains from Indonesia, China, Singapore, Malaysia and Australia. There were sixteen amino acid changes among DENV-3 isolates, and the greater number of changes was found in nonstructural than structural proteins. The emergence of DENV-3 genotype I was noted for the first time in Sri Lanka. Continuous monitoring of this newly emerged genotype and other DENV serotypes/genotypes are needed to determine their effects on future outbreaks and to understand the molecular epidemiology of dengue.

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  • Masahiro Miyoshi, Rika Komagome, Hiroki Yamaguchi, Shima Yoshizumi, Se ...
    Article ID: JJID.2021.021
    Published: February 26, 2021
    [Advance publication] Released: February 26, 2021
    JOURNALS FREE ACCESS ADVANCE PUBLICATION
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  • Yumiko Nakagawa, Yasuyuki Shimada, Yohei Kawasaki, Haruhito Honda, Tak ...
    Article ID: JJID.2019.273
    Published: January 29, 2021
    [Advance publication] Released: January 29, 2021
    JOURNALS FREE ACCESS ADVANCE PUBLICATION

    To assess the rate and risk factors of postoperative complications following tooth extraction in HIV-infected patients by CD4 count. The study subjects were 231 HIV-infected patients who underwent tooth extraction at our institution between January 2007 and December 2011. Results of blood test, underlying diseases, surgical site, extraction method, and postoperative complications were obtained from the medical records. The risk factors potentially involved in postoperative complications were analyzed by multivariate logistic regression. Patients were divided into two groups, 61 (26%) patients with CD4 count of <200 /μL, and 170 (74%) patients with ≥200 /μL. Of the 231 patients, 12 (5.2%) developed postoperative complications (alveolar osteitis, n=10; surgical site infection, n=2). The rate of complications was not different between the CD4<200 /μL group (1.6%), and the CD4≥200 /μL group (6.5%) (adjusted odds ratio (aOR): 9.328, 95% confidence interval (CI): (0.470, 185.229), p=0.1431). Surgical extraction method with bone excavation, but not CD4 count, were identified as risk factors for post-extraction complications (aOR: 22.037, 95%CI: (1.519, 319.617), p=0.0234). A low CD4 count is not a risk factor for post-extraction complications in HIV-infected patients. We advise that tooth extraction should be performed based on dental/oral condition, rather than delayed until improvement of CD4 count.

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