Showing papers in "Japanese Journal of Infectious Diseases in 2005"

Mechanisms of broad cross-protection provided by influenza virus infection and their application to vaccines.

Abstract: Mice recovered from influenza A virus infection have been shown to be cross-protected against challenge infection with either drift viruses within a subtype (subtype-specific immunity) or different subtype viruses (heterosubtypic immunity). The mechanisms of broad-spectrum of cross-protection could be explained as follows. (i) Pre-existing S-IgA and IgG antibodies (Abs) induced by infection are involved in the elimination of challenge viruses by forming virus-Ig complexes shortly after re-infection. Due to their polymeric nature, the S-IgA Abs, existing more abundant on the mucosa than are IgG Abs, are strongly cross-reactive with challenge viruses, whereas the IgG Abs are weakly cross-reactive with challenge viruses, due to their monomeric nature. The specificity of Abs is directed mainly at hemagglutinin and neuraminidase. (ii) CD8+ memory T cells induced by infection are involved in the elimination of challenge viruses by the accelerated killing of host cells infected with different subtype viruses from day 3 onwards after re-infection. The specificity of memory T cells is directed against viral internal proteins. (iii) The accelerated IgA and IgG Ab responses, produced by B memory cells after a challenge, are also involved in cross-protection from day 4 onwards after re-infection. (iv) In the epithelial cells of infected mice, dimeric IgA that is trafficked through the epithelial cells can contribute to the prevention of viral assembly by binding to newly synthesized viral proteins. Natural infection is well known to be superior to parenteral inactivated vaccines in inducing the broad-spectrum cross-protection. To improve the efficacy of current inactivated vaccines, many trials have been conducted to mimic natural infection, including intranasal or epidermal administration of inactivated vaccine with or without an adjuvant; such studies are still ongoing. In the near future, some of these trials may provide new, safer and more effective broad-spectrum vaccines than those currently available.

Investigation of an outbreak of scrub typhus in the himalayan region of India.

Abstract: In Indira Gandhi Medical College, Himachal Pradesh, India, during autumn of 2003 (September-November), more than 100 cases of fever of unknown origin (FUO) were reported with 15 ensuing deaths. In addition to all routine investigations and cultures, the Weil-Felix test was incorporated for the investigation of these cases. Antigen was procured from the Central Research Institute, Kasauli. Forty-six percent (45/96) of the cases demonstrated a > or =1:80 titer of agglutinins against OXK antigen. A team from the National Institute of Communicable Diseases, New Delhi, confirmed the antibodies for scrub typhus in some of the serum samples tested for leptospirosis, dengue fever, and rickettsial infections. Twelve blood samples positive for OXK antigen were sent to the Defense Research Development Establishment, Gwalior, for polymerase chain reaction studies, but none of the samples were positive, as all of the patients were already on broad-spectrum antibiotics and had reported to our hospital after 7-10 days of fever. At our institute, the Weil-Felix test has now been rountinely introduced for the investigation of cases of FUO, and the results until April 2004 (150 cases) revealed the presence of other rickettsial infections prevalent in the region. To evaluate the epidemiology and magnitude of the problem, further prospective studies are required.

Prevalence of hepatitis B infection in the southeastern region of Turkey: comparison of risk factors for HBV infection in rural and urban areas.

Abstract: SUMMARY: Although hepatitis B has been well studied, there are still aspects of its epidemiology that remain to be clarified. There are many regions with high seroprevalence, particularly in the developing regions of the world, and these regions are known to have different epidemiologic patterns. Nonetheless, there are currently no data on the differences in hepatitis B seroprevalence between urban and rural areas of Turkey. In the present study, therefore, we used 30-cluster sampling to determine and compare the prevalence of hepatitis B in the urban and rural areas of the least developed region of Turkey, the southeastern region. From 2,888 adults living in the region, blood samples were obtained from house visits, and screened for HBsAg, anti-HBs, and antiHBcIgG. Factors associated with hepatitis B seroprevalence, particularly living in rural areas, were analyzed with multivariate methods. The seroprevalence of HBsAg was 8.2% in the rural and 6.2% in the urban areas. There was a statistically significant difference between urban and rural regions in terms of HBsAg positivity (crude OR: 0.74; 95% CI: 0.55 - 0.98). Exposure to hepatitis B virus (HBV) increased with age both in urban and rural areas. Lower education level was also an important risk factor for hepatitis B seropositivity in urban areas (adjusted OR: 1.66; 95% CI: 1.26 - 2.19) but not in rural ones (adjusted OR: 0.77; 95% CI: 0.36 - 1.69). Familial jaundice history was a statistically significant risk factor for HBsAg positivity in rural areas (adjusted OR: 2.15; 95% CI: 1.30 - 3.56) but not in urban ones (adjusted OR: 1.48; 95% CI: 0.96 - 2.27). This study shows that the prevalence of HBV infection in the southeastern region of Turkey is intermediate among the levels reported for the European region of the World Health Orgnization.

Rapid and Quantitative Detection of Crimean-Congo Hemorrhagic Fever Virus by One-Step Real-Time Reverse Transcriptase-PCR

Abstract: In this article, the development of a new TaqMan-based one-step real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay for detection and quantification of Crimean-Congo hemorrhagic fever virus (CCHFV) RNA is described. Selected oligos targeting the highly conserved S region of CCHFV were designed by using our oligo design and analysis software, Oligoware 1.0. None of the primer sequences showed genomic cross-reactivity with other viruses or cells in a BLAST (NCBI) search analysis. The sensitivity and specificity of the primers and the probe were tested using 18 serum samples from patients from East Anatolian who were suspected of having CCHFV, including 2 samples that had already been confirmed to be positive for CCHFV. Among the 16 previously unconfirmed samples, 5 were positive by TaqMan-based one-step real-time RT-PCR and 1 was positive by non-nested RT-PCR, and these results were confirmed with DNA sequencing analysis. The 2 previously confirmed CCHFV RNA samples were also positive by both TaqMan-based one-step real-time RT-PCR and non-nested RT-PCR tests. To ensure the quantitative reproducibility of TaqMan-based one-step real-time RT-PCR, the procedure was repeated several times and the same results were obtained (SD = 0.84 [maximum value]). The developed assay was able to sensitively quantify the concentration of CCHFV RNA, which ranged from 10(2) to 10(7) copies/ml per reaction, using plasmid standards generated from the CCHFV RNA (correlation coefficiency = 0.989). The results of the one-step real-time RT-PCR assay were more sensitive than those of the non-nested RT-PCR assay. It can be concluded that our one-step real-time RT-PCR assay is a reliable, reproducible, specific, sensitive and simple tool for the detection and quantification of CCHFV.

Pyogenic liver abscess: a retrospective analysis of 107 patients during a 3-year period.

Abstract: Pyogenic liver abscess (PLA) is a potentially life-threatening disease, and early diagnosis may be difficult. In order to provide diagnostic clues and to enhance the prompt management of such cases, we retrospectively investigated the clinical characteristics of PLA during a 3-year period in a tertiary-care hospital. The crude incidence rate of PLA in our study was 446.1 per 100,000 hospital admissions. Male predominance and a mean age of 57.6 +/- 14.4 years were observed. Diabetes mellitus was the most common concomitant disease, and biliary pathologies were the most common predisposing cause of this type of abscess. The most common clinical features were fever, chills, and abdominal pain. Leukocytosis was found in 67.3% of the patients, and the observed C-reactive protein (CRP) values were high. The most common pathogen was Klebsiella pneumoniae. The mortality rate was 6.5%. A complete history, physical examination, evaluation of the white blood cell count and CRP, and the prompt arrangement of imaging studies may lead to an earlier diagnosis. The aggressive performance of image-guided catheter drainage and the appropriate administration of antibiotics may reduce the mortality rate of PLA.

Intensive care unit-acquired infections: incidence, risk factors and associated mortality in a Turkish university hospital.

Abstract: In this prospective study, 93 intensive care unit (ICU)-acquired infections seen in 131 ICU patients were evaluated. Infection rates were found to be 70.9 in 100 patients and 56.2 in 1,000 patient-days. Pneumonia (35.4%) and bloodstream infections (18.2%) were the most common infections; Staphylococcus aureus (30.9%) and Acinetobacter spp. (26.8%) were the most frequently isolated microorganisms. The results of multivariate logistic regression analyses estimating the risk factors for ICU-acquired infections were as follows: length of stay in ICU (>7 days) (odds ratio [OR]: 7.02; 95% confidence interval [CI]: 2.80-17.56), respiratory failure as a primary cause of admission (OR: 3.7; 95% Cl: 1.41-9.70), sedative medication (OR: 3.34; 95% CI: 1.27-8.79) and operation (before or after admission to ICU) (OR: 2.56; 95% CI: 1.06-6.18). In logistic regression analyses, age (>60 years) (OR: 3.65; 95% CI: 1.48-9.0), APACHE II score >15 (OR: 4.67; 95% CI: 1.92-11.31), intubation (OR: 3.60; 95% CI: 1.05-12.39) and central venous catheterization (OR: 7.85; 95% CI: 1.61-38.32) were found to be significant risk factors for mortality. The difference in mortality rates between patients with ICU-acquired infection and uninfected patients was not statistically significant (mortality rates: 42.3 and 45.6%, respectively). A high incidence of nosocomial infections was found, and the risk factors for ICU-acquired infections and mortality were determined.

Correlation between the usage volume of veterinary therapeutic antimicrobials and resistance in Escherichia coli isolated from the feces of food-producing animals in Japan.

Abstract: We compared the overall usage of veterinary therapeutic antimicrobials in Japan to the proportion of antimicrobial-resistant. Escherichia coli isolated from the feces of apparently healthy food-producing animals in 2001. The annual sales volume of veterinary antimicrobials, which is published and accumulated information, was subdivided according to the target animal species (cattle, pigs, broiler chickens, and layer chickens). The antimicrobial susceptibility of the isolates was examined against 7 classes of 11 antimicrobials. The rates of antimicrobial resistance among the isolates were found to correlate significantly with the usage of antimicrobial agents in cattle, pigs, and broiler and layer chickens. Therefore, the overall usage of veterinary antimicrobials appears to contribute to the appearance of antimicrobial resistance in E. coli isolates from apparently healthy food-producing animals.

Changes in antibiotic use, cost and consumption after an antibiotic restriction policy applied by infectious disease specialists.

Abstract: The study was designed to compare antibiotic use, cost and consumption before and after an initiation of an antibiotic-restriction policy in our hospital. The policy was applied in 2003, and the prescription of two groups of antibiotics (intravenously used and expensive antibiotics) was restricted. A prescription for the restricted antibiotics could be obtained with approval by an infectious disease specialist (IDS). All the hospitalized patients who received antibiotics were evaluated by a cross-sectional study with standard criteria. The annual cost and consumption of antibiotics were evaluated. After restriction, the rate of antibiotic use decreased from 52.7 to 36.7% (P < 0.001), and the appropriate use increased from 55.5 to 66.4% (P < 0.05). Appropriate use was higher for restricted antibiotics (88.4%) than for unrestricted ones (58.2%) (P < 0.001), and higher in the presence of ID consultation (97.5%) than in the absence of consultation (55.7%) (P < 0.001). Culture-based treatment was increased, and appropriate use in such cases (93.0%) was higher than empirical treatment (33.3%) (P < 0.001). After the restriction policy, consumption of antibiotics belonging to the restricted groups was decreased by 44.8%. Total expenditure of all antibiotics was decreased by 18.5%, and the savings were US$332,000 per year. This restriction policy was effective in promoting rational antibiotic prescription and lowering antibiotic cost and consumption in our hospital.

Inducible clindamycin resistance in staphylococci isolated from clinical samples.

Abstract: This study aimed to determine the levels of the macrolides-lincosamides-streptogramins B (MLS(B)) resistance phenotype of Staphylococcus aureus and coagulase-negative staphylococci (CNS) isolates from clinical samples. A total of 521 strains of staphylococci, comprising 230 S. aureus and 291 CNS isolates from various clinical samples, were identified by conventional methods. The double-disc test was applied by placing erythromycin and clindamycin discs on these isolates to investigate the inducible and constitutive MLS(B) resistance phenotypes and MS phenotype. Among the S. aureus strains, 24.3% showed the constitutive and 7.8% the inducible phenotype, while there was no MS phenotype. In the CNS strains, 40.2% showed the constitutive and 14.7% the inducible MLS(B) resistance phenotype, and 18.2% had the MS phenotype. In both S. aureus and CNS strains, the constitutive MLS(B) resistance rate was found to be higher than the rate of inducible resistance. By applying double-disc tests on a routine basis to detect inducible MLS(B) resistance, clindamycin can be effectively used on staphylococcal infections. Additionally, it can be used to survey the MLS(B) resistance of staphylococci strains from specific geographical regions or hospitals.

Molecular Characterization of TEM- and SHV-Derived Extended-Spectrum Beta-Lactamases in Hospital-Based Enterobacteriaceae in Turkey

Abstract: TEM- and SHV-derived extended-spectrum beta-lactamases (ESBLs) producing Enterobacteriaceae have been reported from throughout the world, but there has been limited data for the molecular characterization of these enzymes in Turkey. The aim of this study was to investigate and to type the TEM- and SHV-derived ESBLs in 63 ESBL-producing clinical isolates of Enterobacteriaceae, and it included further analysis; transfer experiments, isoelectric focusing, PCR, PCR-restriction fragment length polymorphism, and DNA sequencing. According to PCR results the transconjugant strains included 52.7% TEM, 74.3% SHV, and 32.4% of both the TEM and SHV genes. Using PCR/NheI restriction analysis, 45 of the 46 ESBL detected in transconjugants were determined to be SHV-derived. DNA sequencing was performed for the identification of TEM- and SHV-derived ESBLs for 18 selected transconjugants. SHV-2, SHV-5, and SHV-12 were detected in five, seven, and five samples, respectively. This is the first description of SHV-12 in Turkey.

Antimicrobial susceptibility pattern of blood isolates from a teaching hospital in north India.

Abstract: Bloodstream infections are associated with significant patient morbidity and mortality worldwide. In this study, we examined antimicrobial susceptibility patterns by reviewing the data on 5,704 blood samples that were collected from patients with fever/sepsis admitted to Government Medical College and Hospital, Chandigarh, India, over a period of 1 year from August 2003 to July 2004. Among the 567 qualifying samples, Pseudomonas aeruginosa (19.75%), Escherichia coli (15.17%), Klebsiella pneumoniae (14.99%), and Salmonella enterica serovar Typhi (12.87%) were the most frequently isolated Gram-negative bacteria other than Citrobacter, Acinetobacter, Proteus, and Enterobacter spp. collectively accounting for 80.96% of the isolates. Staphylococus aureus (13.86%) and Enterococcus feacalis (2.35%) were most frequently isolated Gram-positive bacteria other than other Streptococcus and Staphylococcus spp. collectively accounting for 18% of the isolates. Among the antibiotics used for susceptibility testing of Gram-negative isolates, amikacin showed higher activity (76.61%) against Enterobacteriaceae and ciprofloxacin (65.17%) against non-fermenters. However, cefoperazone + sulbactum showed the highest activity (82.66%) among all Gram-negative isolates. For Gram-positive isolates, vancomycin (100%), ciprofloxacin (89.74%) showed the highest activity against Staphylococcus spp. Combinations of antibiotics are often prescribed as emperic therapy for bacteremia, especially for Gram-negative pathogens. Hence the antibiotic susceptibility patterns of blood isolates reported here may be a useful guide for physicians initiating emperic therapy with antibiotics.

Increasing antimicrobial resistance in Escherichia coli isolates from community-acquired urinary tract infections during 1998-2003 in Manisa, Turkey.

Abstract: Urinary tract infections are among the most common infections with an increasing resistance to antimicrobials. The aim of this study was to determine the change in antimicrobial susceptibility of Escherichia coli isolates from patients with community-acquired urinary tract infection (UTI) for the years 1998 through 2003 and to suggest that the current empirical antibiotic therapy used for these patients is inappropriate. During the study period, 7,335 community urine samples of which 1,203 (16.4%) grew bacterial isolates were analyzed. Among the total of 1,203 isolates, 880 (73.2%) were E. coli. The range of resistance of E. coli to ampicillin was 47.8 to 64.6% and that to trimethoprim-sulfamethoxazole was 37.1 to 44.6% during the study period. The susceptibility pattern of E. coli to nitrofurantoin and cefuroxime did not vary significantly over the 6-year period. There was a significant increase in the susceptibility of E. coli to ciprofloxacin (11.3 - 26.7%), amoxicillin-clavulanate (18.4 - 29.2%) and gentamicin (7.0 - 25.6%) (P < 0.05). Empirical initial treatment with ampicillin and trimethoprim-sulfamethoxazole was thus inadequate in approximately half of UTI cases in our region.

Sphingolipids in infectious diseases.

Abstract: Sphingolipids are ubiquitous constituents of membrane lipids in eukaryotes. Sphingolipid metabolites modulate various cellular events including proliferation, differentiation, and apoptosis. In addition, sphingolipids, along with cholesterol, form detergent-resistant membrane microdomains, so called 'lipid-rafts', which are implicated in signal transduction and membrane trafficking. Sphingolipids are also relevant to infectious diseases. Various types of pathogens exploit the sphingolipids of host cells as membrane receptors. Sphingolipid metabolites regulate pathogen infection and host defense: for instance, a specific glycosphingolipid acts as an endogenous ligand for activation of natural killer T cells. Lipid-rafts of host cells serve as platforms also for infection signaling and entry of intracellular parasites. Moreover, some post-infectious autoimmune diseases result from production of antibodies cross-reacting with mammalian sphingolipids. Differences in the pathways of sphingolipid metabolism between mammals and non-mammals are good clues for rational development of new anti-infectious disease drugs. This review summarizes recent advances in sphingolipid biology related to infectious diseases.

Differentiation of Candida albicans and Candida dubliniensis Using a Single-Enzyme PCR-RFLP Method

Abstract: Candida dubliniensis is a novel Candida spp. that is similar to Candida albicans with respect to several phenotypic characteristics. However, they differ from each other with respect to epidemiology, pathogenesis, and the rapid development of resistance to fluconazole. In the present study, we used a single-enzyme PCR-restriction fragment length polymorphism (RFLP) technique to differentiate C. dubliniensis from C. albicans. The amplified ITS region of C. dubliniensis was digested once using the enzyme B1nI, whereas that of C. albicans remained intact. All standard strains tested were identified successfully by this method. None of 140 clinical isolates identified morphologically as C. albicans were recognized as C. dubliniensis based on their PCR-RFLP pattern. Our PCR-RFLP method easily differentiated C. dubliniensis from C. albicans, and this result was also demonstrated with standard strains.

Microsatellite polymorphism in the heme oxygenase-1 gene promoter is associated with susceptibility to cerebral malaria in Myanmar.

Abstract: SUMMARY: Cerebral malaria (CM) is a serious complication of Plasmodium falciparum malaria, and its pathogenesis leading to coma remains unknown. Heme oxygenase-1 (HO-1) catalyzes heme breakdown, eventually generating bilirubin, iron and carbon monoxide. The HO-1 gene promoter contains a polymorphic (GT)n repeat which may influence the expression level of HO-1. To explore the correlation between this (GT)n polymorphism and susceptibility to CM, we analyzed the frequencies of the (GT)n alleles in 120 Myanmarese patients with uncomplicated malaria (UM) and 30 patients with CM. The frequency of homozygotes for the short (GT)n alleles (<28 repeats) in CM patients was significantly higher than those in UM patinets (P < 0.008, OR = 3.14). Thus, short (GT)n alleles represent a genetic risk factor for CM.

Emergence of non-albicans Candida species and antifungal resistance in a tertiary care hospital.

Abstract: The spectrum of candidiasis has changed with the emergence of non-albicans Candida spp. and acquired antifungal resistance, especially in immunocompromised hosts. This changing scenario has necessitated routine antifungal susceptibility testing. In the present work, 102 Candida spp. isolates gathered during 2003 - 2004 were characterized by standard procedures, and antifungal susceptibility testing to amphotericin B, fluconazole and itraconazole was performed by broth macrodilution (BMD)-minimum inhibitory concentration (MIC) and disk diffusion (DD) methods. Among all isolates, 77.4% were from an ICU and 10.8% were obtained from a nursery. The majority of the isolates were C. tropicalis (48%), followed by C. parapsilosis (27.4%) and C. albicans (22.5%). Overall 6.9, 4.9 and 3.9% of all isolates were resistant to amphotericin B, fluconazole and itraconazole, respectively. Out of the 5 (4.9%) isolates resistant to fluconazole, 4 (3.9%) were from patients with AIDS on fluconazole prophylaxis. A discrepancy was observed between the results of susceptibility testing by DD and those by BMD-MIC: 15 (14.7%) isolates were reported to be resistant by DD despite having low MICs. Based on these results, it was concluded that initial antifungal screening of clinical isolates by the DD method followed by confirmation of resistant strains by the broth dilution method is desirable to optimize patient management.

Antimicrobial Resistance of Enterococcal Blood Isolates at a Pediatric Care Hospital in India

Abstract: Enterococci are one of the leading causes of nosocomial infections. In recent years, enterococci have become increasingly resistant to a wide range of antimicrobial agents. From April to October 2001, a study was conducted to speciate and determine the antimicrobial susceptibility of 50 isolates of enterococci from bacteremic children. These isolates were tested for antimicrobial susceptibility to the commonly used antibiotics. Screening for vancomycin resistance was done by the agar screen method, and the results were confirmed by determining the minimum inhibitory concentration (MIC) using the agar dilution method. It was observed that 33 isolates were Enterococcus faecium, followed by E. faecalis (10), E. durans (4), and E. dispar (3). Seventy-two percent of strains were resistant to ampicillin, 46% to amoxicillin + clavulanic acid, 72% to ciprofloxacin, 54% to doxycyclin, and 74% to erythromycin. Sixty-six percent of isolates showed high-level gentamicin resistance and 42% showed high-level streptomycin resistance. Four strains showed raised MIC to vancomycin (8 microg/ml). It was concluded that multidrug resistant E. faecium is emerging as an important agent of bacteremia in children.

Pathogen Occurrence and Antimicrobial Susceptibility of Urinary Tract Infection Cases during a 20-Year Period (1983 - 2002) at a Single Institution in Japan

Abstract: Urinary tract infections are one of the most common infectious diseases diagnosed in outpatients as well as in hospitalized patients. Recently, urinary tract infections have become more complicated and difficult to treat. Therefore, the present study analyzed the occurrence and antimicrobial susceptibility of uropathogens isolated at Kobe University Hospital between 1983 and 2002. This study was performed with three patient groups: urology inpatients, urology outpatients, and inpatients of other departments. During the 20-year study period, we studied 15,925 urine isolates obtained from those patients who were diagnosed with urinary tract infection. Overall, Enterococcus faecalis was the most frequently isolated pathogen, followed by Pseudomonas aeruginosa and Escherichia coli. The frequency of Staphylococcus aureus increased over time, corresponding to an increase in the occurrence of methicillin-resistant S. aureus (MRSA). In addition, the rate of isolation of Serratia marcescens also increased over time, especially among patients with urinary tract catheters. Our results demonstrate that the uropathogens isolated at a single institution have shown a trend of increasing resistance to various classes of antimicrobial agents. In addition, serious problems should be anticipated in the treatment of multidrug-resistant P. aeruginosa, fluoroquinolone-resistant E. coli, and arbekacin-resistant MRSA.

Network based models of infectious disease spread.

Abstract: It has recently become possible to simulate directly dynamics on very large networks. This paper describes a model of epidemiology on a social network, the Epidemiological Simulation System (EpiSims), and offers general speculation on analyzing disease dynamics on networks. We describe the process of building a realistic social network, describe several different definitions of the network, each useful for certain purposes. Finally, we raise some important questions about structural properties of networks and how they influence dynamics.

Which patients are able to adhere to tuberculosis treatment? A study in a rural area in the northwest part of Turkey.

Abstract: The purpose of this study was to investigate various factors, including demographical, socioeconomical, clinical and radiological features, of adherent and nonadherent patients with tuberculosis (TB) who were admitted to a university hospital between 1998 and 2003. One hundred and one patients (65.5%) and 53 patients (34.5%) met the criteria of adherence and nonadherence, respectively. A higher rate of adherence was observed among females than males (79.2 versus 58.4%, respectively, P = 0.012). Older patients were more nonadherent (P = 0.008). The adherence rate in non-smokers was significantly higher than that of smokers (81.4 and 52.4%, respectively, P = 0.000). Patients who underwent "family screening" were more adherent (75.7%) than those (39.5%) who did not (P = 0.000). Patients with pleurisy had higher adherence rates (81.3%), followed by patients with pulmonary TB (65.0%), while patients with extrarespiratory TB had the lowest adherence rates (45.5%) (P = 0.024). The presence of cough was significantly associated with adherence (P = 0.049). A significantly higher adherence rate was observed in patients without hemoptysis (P = 0001). A univariate logistic regression confirmed that age, smoking, family screening, type of TB, cough and hemoptysis had significant independent effects on the adherence to treatment of TB. High-risk patients may be identified and interventions tailored to promote adherence before concluding that the patient is willfully refusing treatment.

Delayed diagnosis of tuberculous arthritis.

Abstract: SUMMARY : Monoarticular tuberculosis (TB) affecting the knee is rare in all forms of TB (01-03%) Wepresent the case of a patient with tuberculous arthritis in whom the diagnosis was belated due to a lack offamiliarity with the disease; here, we emphasize the difficulties associated with the diagnosing joint TB A 20-year-old man was referred to our department due to swelling of the right knee and the presence of persistent,mild pain for 4 years The lack of systemic evidence of this disease, the indolent course of disease, and thepresence of non-specific symptoms renders early recognition of this disease difficult Furthermore, in cases inwhich a diagnosis cannot be reached simply by culturing the synovial fluid, synovial biopsy cultures should beconsidered in the diagnostic process, due to the high rate of positivity of such cultures The diagnosis andtreatment of articular TB are both urgent matters; surgical debridement and strict adherence to antituberculouschemotherapy tend to yield a satisfactory functional outcomeJpn J Infect Dis, 58, 373-375, 2005

Prevalence of coxsackievirus A5, A6, and A10 in patients with herpangina in Aichi Prefecture, 2005.

Abstract: *Corresponding author: Mailing address: Department of Microbiology, Aichi Prefectural Institute of Public Health, 7-6, Nagare, Tsujimachi, Kita-ku, Nagoya, Aichi 462-8576, Japan. Tel: +81-52-910-5674, Fax: +81-52-913-3641, E-mail: tyamashita@ hi-ho.ne.jp Herpangina is caused primarily by coxsackievirus A (CVA) 1, 2, 3, 4, 5 (CV-A5), 6 (CV-A6), 8, 10 (CV-A10), and 22 (1) in the genus Enterovirus of the family Picornaviridae. The illness is characterized by an acute onset of fever and sore throat (2). In Aichi Prefecture, located near the center of Japan’s main island of Honshu, the number of case reports of herpangina increased from the 23rd week of 2005 and resulted in occurrence exceeding 12 cases per sentinel in the 27th week of 2005 (a diagram is available at http://www. pref.aichi.jp/eiseiken/herpan_graph.html). The number was twice as great as the average of the last 5 years. We detected CV-A5, -A6, and -A10 from these patients. Feces and/or throat swabs were collected from 64 herpangina patients who visited 9 pediatric clinics in Aichi Prefecture between April and July 2005. Their ages ranged from 4 months to 7 years. Their samples were suspended in Veal infusion broth and centrifuged at 10,000×g for 20 min. The supernatants were inoculated onto RD cells and used for RT-PCR, as previously described (3). Briefly, the supernatants were mixed with TRIzol and followed by isopropanol precipitation. The pellet was suspended in RNase-free water. RT-PCR was performed using Access Quick RT-PCR System (Promega, Madison, Wis., USA). Primers OL68-1(+) and MD91(-), designed by Olive et al. (4) and Rotbart et al. (5), were used for RT-PCR. Primers OL68-1(+) and EVP4(-), designed by Rotbart et al. (5), were used for the nested PCR. Following the PCR, amplified products were purified and introduced into a pGEM-T vector (Promega). The DNA Laboratory and Epidemiology Communications

Major bacteria of community-acquired respiratory tract infections in Turkey.

Abstract: SUMMARY: To determine the bacterial etiology of lower respiratory tract infections (LRTIs) in Turkey, quantitative cultures of sputum were carried out. The major pathogens for LTRIs were found to be Haemophilus influenzae, followed by Streptococcus pneumoniae and Moraxella catarrhalis. Only 6.1% of the H. inlfuenzae and all strains of M. catarrhalis were β-lactamase producers. An E-test showed that 31.2% of the S. pneumoniae strains had an intermediate resistance to penicillin, and the remaining strains were susceptible; no fully resistant strains were detected. From the perspective of the world community, acquired lower respiratory tract infections (LRTIs) are an important cause of morbidity and mortality for all age groups. Each year, approximately 7 million people die as a direct consequence of acute and chronic respiratory infection (1). LRTIs are very common, with an incidence in the world population of 40 - 50 per 1,000 (2,3). Since the etiological agents of LRTIs cannot be determined clinically, microbiological investigation is critical for both treatment and epidemiological purposes. A quantitative sputum culture is a reliable and noninvasive procedure used for the determination of causative bacteria (4,5). Although a sputum culture has the advantage of high sensitivity, routine laboratories are not able to perform this test for various reasons. Therefore, antimicrobial therapy for LRTIs is frequently empirical, generally presumptive and instituted before the etiology of the specific disease is known. Empirical antimicrobial choice is complicated by the increasing prevalence of resistance of some of the common LRTI pathogens to antibiotics (6). In order to select appropriate antibiotics for empirical therapy, epidemiological studies are critical to identify the actual causative microorganism and to determine whether it is susceptible to antibiotics. To save lives and to reduce mortality with proper treatment, there is no alternative other than to obtain this information for each country. Information in this regard is scarce in Turkey. The present study represents a joint effort between respirologists, infectious disease specialists, and microbiologists to introduce a platform for continued future surveillance. To determine the bacterial etiology of LRTIs, their resistance to antibiotics and β-lactamase production was determined in two major hospitals in Ankara, Turkey, in a prospective study. Between September of 2002 and April of 2003, sputum samples were collected from adult LRTI patients who were attending the inpatient and outpatient clinics of the Ataturk Chest Disease and Chest Surgery Central Education and Research Hospital, and Ibni Sina Hospital, Ankara.

In vitro susceptibility of Candida species isolated from blood culture to some antifungal agents.

Abstract: Fungal infections are among the major causes of morbidity in cancer patients. In order to optimize the treatment of such patients, it is critical to determine the type of fungus causing infection as well as its susceptibility to antifungals. This study was undertaken to the study resistance of Candida spp. isolated from blood cultures of cancer patients to ketoconazole (KET), fluconazole (FLU), amphotericin B (AmpB), and flucytosine (FCU). A modified NCCLS M 27-A method was used to evaluate the activity of the species. Of the 56 Candida albicans isolates, 7 (12.5%) were resistant to FLU (MIC > or = 64 microg/ml), 6 (10.7%) were resistant to KET (MIC > or = 64 microg/ml) and 3 (5.3%) were resistant to FCU (MIC > or = 32 microg/ml). One (14.3%) of 7 C. parapsilosis isolates was resistant to FLU (MIC > or = 64 microg/ml). One (33.3%) of 3 C. tropicalis isolates was resistant to KET (MIC > or = 64 microg/ml). None of the C. guilliermondii or C. pelliculosa isolates was resistant to KET, FLU, AmpB, or FCU. Based on these results, AmpB is an effective antifungal agent that can be used against all Candida isolates.

Prevalence of Salmonella enterica Serovar Typhi in Bile and Stool of Patients with Biliary Diseases and Those Requiring Biliary Drainage for Other Purposes

Abstract: Acute suppurative cholangitis is a serious complication of biliary obstructions due to infection. Salmonella enterica serovar Typhi is an important biliary pathogen. Bile samples from 445 patients with biliary diseases as well as those requiring biliary drainage for other miscellaneous gastrointestinal diseases were investigated bacteriologically with special emphasis on Salmonella. Fecal samples or rectal swabs were also obtained from 402 of these patients. Bactericholia was detected in 68.8% patients and Salmonella in 5.8% of all bile samples. Other strains of salmonellae were also present in a fair number of the samples. Some of the patients had the same type of bacterial isolates from their stool samples as those from their bile samples. Colonization of the biliary system may not be clinically apparent, but is associated with an increased risk of infection.

Immunological detection of severe acute respiratory syndrome coronavirus by monoclonal antibodies

Abstract: In order to establish immunological detection methods for severe acute respiratory syndrome coronavirus (SARS-CoV), we established monoclonal antibodies directed against structural components of the virus. B cell hybridomas were generated from mice that were hyper-immunized with inactivated SARS-CoV virion. By screening 2,880 generated hybridomas, we established three hybridoma clones that secreted antibodies specific for nucleocapsid protein (N) and 27 clones that secreted antibodies specific for spike protein (S). Among these, four S-protein specific antibodies had in vitro neutralization activity against SARS-CoV infection. These monoclonal antibodies enabled the immunological detection of SARS-CoV by immunofluorescence staining, Western blot or immunohistology. Furthermore, a combination of monoclonal antibodies with different specificities allowed the establishment of a highly sensitive antigen-capture sandwich ELISA system. These monoclonal antibodies would be a useful tool for rapid and specific diagnosis of SARS and also for possible antibody-based treatment of the disease.

Infection transmission science and models.

Abstract: Infection transmission systems circulate infection through complex contact patterns related to both contact patterns and patterns of factors that affect the risk of transmission given contact. The nonlinear dynamics of infection transmission cause these patterns to make big differences in population infection levels. A science of infection transmission system analysis is needed to focus on those details that affect the control of infection transmission. This science must have a strong theoretical base because there is little chance that a dominantly data based approach not using mechanistic models of transmission will have any predictive value. The theoretical base should be built on linked transmission system models that are focused on making needed inferences for both building the theoretical base and making infection control decisions. The linking of different models is needed for a strategy of inference robustness assessment that is designed to find the model that is simple enough to effectively analyze the transmission system but not so simple that realistic violation of simplifying assumptions will change an inference. Types of models that should be used in such linked analyses include deterministic and stochastic compartmental models, discrete individual models with individual event histories but structured mass action mixing, network models that provide more detail as to who has contact with whom, and intermediate model forms such as correlation models that address some aspects of contact details while preserving the flexibility of deterministic compartmental models to structure mixing and analyze the system. While transmission system science is currently weak in regards both to its data base and its theory base, many things are now coming together that could make this science flourish. On the data side these include greater ability to detect infectious agent sequences in the environment and greater ability to sequence and genetically relate agents identified at different sites in the transmission system. On the theory sides, new model construction and model analysis methods are providing new potential to use the new sources of data. Also new parameter estimation methods provide new potential to combine models and data in effective analytic strategies.

Polymorphisms of the HLA-B and HLA-DRB1 Genes in Thai Malaria Patients

Abstract: The high degree of polymorphism of human leukocyte antigen (HLA) genes has been suggested to result from natural selection against susceptibility to a variety of infectious pathogens, including malaria. HLA molecules are considered to play a crucial role in the defense of the host against malarial infection, and different HLA class I and class II alleles have been reported to be associated with reduced susceptibility to malaria or the severity of malaria in different populations. To test for associations between HLA alleles and the severity of malaria in a Thai population, polymorphisms of HLA-B and HLA-DRB1 genes were investigated in 472 adult patients in northwest Thailand with Plasmodium falciparum malaria. In this study, malaria patients were classified into three groups: mild malaria, non-cerebral severe malaria, and cerebral malaria. Our results revealed that the allele frequencies of HLA-B46, -B56, and -DRB1*1001 were statistically different between non-cerebral severe malaria and cerebral malaria (P = 0.005), between mild malaria and cerebral malaria (P = 0.032), and between mild malaria and non-cerebral malaria (P = 0.007). However, our results may be showing false positives due to multiple testing. Thus, further study with a larger sample size must be conducted to obtain conclusive evidence of the association of these HLA-B and DRB1 alleles with the severity of malaria in Thailand.

Emergence of Vibrio cholerae O1 Biotype El Tor serotype Inaba in north India.

Abstract: All cases of cholera that have occurred at our center in north India have been due to Vibrio cholerae O1 serotype Ogawa, including the outbreaks in 2002 and 2004. Here we report the emergence of V. cholerae O1 biotype El Tor serotype Inaba for the first time in this region since July 2004. Fifteen Inaba isolates were obtained from 32 patients suffering from cholera-like illness. The patients lived in Chandigarh and the neighboring states of Punjab, Haryana, and Himachal Pradesh. All strains were resistant to nalidixic acid and trimethoprim, and showed moderate sensitivity to amoxycillin. All were sensitive to ciprofloxacin, tetracycline, cefotaxime, amikacin, and gentamicin. All strains were found to be toxigenic when tested with a commercial reverse passive latex agglutination kit. The last reported Inaba isolate dominance in India was observed in Calcutta in 1989. There is a need to closely watch the spread of serotype Inaba, as it may cause outbreaks in other parts of India; molecular studies are warranted to understand the widespread emergence of Inaba in north India.