Associations between capsular serotype, multilocus sequence type, and macrolide resistance in Streptococcus agalactiae isolates from Japanese infants with invasive infections.

SUMMARY Streptococcus agalactiae (group B streptococcus; GBS) isolates (n = 150) from infants with invasive infections between 2006 and 2011 were analysed for capsular serotype, multilocus sequence type, and antibiotic susceptibility. In cases with late-onset disease (n = 115), primary meningitis was predominant (62.6%), but represented only 39.1% in cases with early-onset disease (n = 23). The most common serotype was III (58.7%), followed by Ia (21.3%) and Ib (12.7%). Sequence types (STs) of serotype III strains included ST17 (50.0%), ST19 (26.1%), ST335 (18.2%), ST27 (4.5%), and ST1 (1.1%). Predominant STs of serotypes Ia and Ib were ST23 (81.3%) and ST10 (84.2%), respectively. No penicillin-resistant strains were detected, but 22·0% of strains had mef(A/E), erm(A), or erm(B) genes, which mediate macrolide resistance. A new ST335, possessing an mef(A/E) gene belonging to clonal complex 19 gradually increased in frequency. Improved prevention of invasive GBS infections in infants requires timely identification, and ultimately vaccine development.

Serotype and antibiotic resistance of isolates from patients with invasive pneumococcal disease in Japan.

Invasive pneumococcal disease (IPD) is of concern in Japan, where the heptavalent pneumococcal conjugate vaccine (PCV7) is unavailable. We determined serotypes, genotypes indicating beta-lactam resistance, and antibiotic susceptibilities of 496 isolates from normally sterile sites in patients (193 children, 303 adults) from 186 institutions between August 2006 and July 2007. Disease presentations included sepsis (46.2%), pneumonia (31.5%), and meningitis (17.5%). Mortality was 1.4% in children and 22.1% in adults, many of whom had underlying diseases. In children, serotype 6B (22.5%) was followed by 19F (14.1%), and 14 (13.1%); potential coverages of PCV7 and PCV13 were 75.4% and 93.7%, respectively. In adults, serotype 12F (14.3%) was followed by 3 (11.3%), and 6B (10.3%); 23-valent polysaccharide vaccine (PPV23) coverage was 85.4%. Most serotype 12F strains were gPISP, with pbp2b gene alteration; carbapenem had an excellent MIC90. PCV7 is recommended for children and PPV23 for adults to increase prevention against IPD.

Increased macrolide resistance of Mycoplasma pneumoniae in France directly detected in clinical specimens by real-time PCR and melting curve analysis.

OBJECTIVES: Mycoplasma pneumoniae is a common aetiological agent of community-acquired respiratory tract infections for which macrolides are the treatment of choice. In France, only two macrolide-resistant isolates were reported in 1999. In contrast, several recent data reported that macrolide-resistant M. pneumoniae isolates have been spreading since 2000 in Japan. Mutations A2058G (Escherichia coli numbering), A2058C, A2059G, A2062G, C2611A and C2611G in domain V of the 23S rRNA gene were associated in vivo or in vitro with this resistance. The aim of this study was to determine whether macrolide resistance of M. pneumoniae is emerging in France. PATIENTS AND METHODS: We developed a duplex real-time PCR for the detection of the six 23S rRNA mutations associated with macrolide resistance in M. pneumoniae and a simplex real-time PCR for the identification of the A2058G mutation, the most common one. Both methods rely on fluorescence resonance energy transfer coupled to melting curve analysis and are directly applicable to clinical samples. The duplex real-time PCR assay, first validated on 40 genetically characterized M. pneumoniae strains, was then applied directly on 248 French respiratory tract clinical samples. RESULTS: Among M. pneumoniae-positive specimens collected before 2005, no macrolide-resistant M. pneumoniae isolate was detected. In contrast, among 51 samples collected between 2005 and 2007, five (9.8%) yielded a resistant genotype, suggesting a recent increase in macrolide-resistant M. pneumoniae isolates in France. CONCLUSIONS: The epidemiological monitoring of macrolide resistance in this species has become necessary in France and Europe, and will be made easier by using these PCR assays.

Nosocomial infection by human bocavirus and human rhinovirus among paediatric patients with respiratory risks.

BACKGROUND: Nosocomial infections by respiratory viruses undetected by rapid tests are not often diagnosed. For paediatric patients with background diseases, nosocomial infection could be fatal. AIM: To determine the relationship between developing symptoms by respiratory viruses undetectable by rapid tests and respiratory risks and to improve the management of infection control. METHODS: Two episodes of nosocomial infection by human bocavirus (HBoV) and human rhinovirus (HRV) were retrospectively investigated in a tertiary hospital paediatric ward in Japan. Viruses were identified by polymerase chain reaction to determine infection control management. When viruses of the same species were detected from different patients, the virus homology was investigated. The relationship between respiratory risks and developing symptoms was statistically investigated. FINDINGS: Three and four patients with respiratory risks in the HBoV and HRV outbreaks, respectively, developed respiratory symptoms. The nucleotide sequences of two patients in the HBoV outbreak and all four patients in the HRV outbreak were phylogenetically close. In both outbreaks, the patients with respiratory risks developed significantly more symptoms than those without any risk (P = 0.035 and 0.018, respectively). After the patients with respiratory infection were separated from those with respiratory risks, no additional nosocomial infection occurred. CONCLUSION: Patients with respiratory risks easily develop respiratory symptoms and acquire severe symptoms of nosocomial infection by those viruses. In a paediatric ward, we should adopt not only standard precautions but also isolation management of the patients with respiratory symptoms, even if they have negative results in rapid tests.

Comparison of the in vitro and in vivo anti-herpes activities of 1-beta-D-arabinofuranosylthymine and its 5'-monophosphate.

In vitro and in vivo anti-herpes activities of 1-beta-D-arabinofuranosylthymine 5'-monophosphate (ara-TMP) were compared with those of 1-beta-D-arabinofuranosylthymine (ara-T). On a molar basis ara-TMP was almost as active as ara-T against six strains of herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) as monitored by a cytopathogenicity-inhibition and a plaque reduction assay in human embryonic lung fibroblast cells. When tested against experimental encephalitis in mice inoculated intracerebrally with HSV-1, intraperitoneal or intravenous treatment with 150 mg/kg/day of ara-TMP or 100 mg/kg/day of ara-T, for 5 days was effective in increasing in the mean survival time of mice. For a single dose of ara-TMP, intravenous administration was more effective than intraperitoneal or oral administration. However, oral administration of ara-T was the most effective of the treatment regimens used. Substantial plasma levels of ara-T were detected for a longer time after oral administration of ara-T than after intravenous administration of ara-TMP or ara-T, suggesting that the efficacy of oral administration of ara-T may be correlated with the maintenance of the substantial blood drug levels.

Antiviral activities of nucleotide heterodimers against human immunodeficiency virus type 1 in vitro.

Nucleotide heterodimers were synthesized and examined for their inhibitory effects on the replication of human immunodeficiency virus type 1 (HIV-1), including HIV-1 reverse transcriptase (RT) inhibitor-resistant mutants. 3'-Azido-3'-deoxythymidilyl-(5')-phospho-(5')-6-[(3', 5'-dimethylphenyl)thio]-5-ethyl-1-[(2-hydroxyethoxy)methyl]uracil (AZT-P-E-HEPU-dM) and 3'-azido-3'-deoxythymidilyl-(5')-phospho-(5')-2', 3'-dideoxyinosine (AZT-P-ddI) proved to be highly potent and selective inhibitors of HIV-1 (IIIB strain) in MT-4 cells. The mechanism of inhibition by these heterodimers may be attributed to their degradation and the formation of each constituent. AZT-P-E-HEPU-dM was also markedly inhibitory to an AZT-resistant mutant (HIV-1-IIIB/AZT) and an E-HEPU-dM-resistant mutant (HIV-1-IIIB-R). However, AZT-P-ddI was found to have a less inhibitory effect on HIV-1-IIIB/AZT than on HIV-1-IIIB. The heterodimers of (5',5') AZT and ribavirin (AZT-P-Ribavirin) and (5',5') ddI and ribavirin (ddI-P-Ribavirin) were also synthesized: AZT-P-Ribavirin inhibited HIV-1 replication, but ddI-P-Ribarvirin did not.

Treatment of canine intervertebral disc displacement with chondroitinase ABC.

STUDY DESIGN: This study demonstrated the therapeutic value of chemonucleolysis with chondroitinase ABC to canine intervertebral disc displacement. OBJECTIVES: To determine the efficacy of Chondroitinase ABC in the management of canine intervertebral disc displacement. SUMMARY OF BACKGROUND DATA: No previous study has assessed the chemonucleolysis with chondroitinase ABC in the displaced discs. The changes of intervertebral disc syndrome were evaluated in this study. METHODS: Fifty-nine dogs with symptoms and signs of intervertebral disc displacement were treated with Chondroitinase ABC by a single intradisc injection. The changes in symptoms and signs of disc herniation in the dogs were followed from 7 days to 3 years after treatment. RESULTS: Forty-eight dogs were evaluated for the efficacy of the chemonucleolytic treatment with chondroitinase ABC. At 1 week after injection, 45 of 48 dogs showed some improvement in symptoms and signs. No adverse reactions were observed. There was no recurrence of symptoms in nine dogs who were observed from 14 months to 3 years after injection. CONCLUSION: Chemonucleolytic treatment with chondroitinase ABC is an effective and safe method for the management of canine intervertebral disc displacement.

Computed tomography and magnetic resonance findings in two dogs and a cat with intracranial lesions.

Two dogs and a cat with intracranial lesions were evaluated by both computed tomography (CT) and magnetic resonance (MR) imaging. In a dog with vestibular syndrome, better quality images of the medulla oblongata surrounded by thick bones were obtained by MR than by CT, on which the appearance of artifacts impeded the clear image of the area. In a dog with multiple brain metastases of lymphoma, contrast CT delineated lesions more clearly than MR, which was performed one week after CT. During that week dexamethasone which might affect the clarity of MR images of the lesion was administered to reduce brain edema. In a cat with meningeal syndrome of lymphocytic leukemia, only contrast MR imaging identified the width and site of the lesion. These results indicate that it is necessary to select either one of these imaging methods according to the type and site of lesions that are suspected in a particular case.

Computed tomography and magnetic resonance findings of meningeal syndrome in a leukemic cat.

A 3-year-old Japanese domestic cat with a diagnosis of lymphocytic leukemia showed severe generalized seizures in the course of chemotherapy after leukemic condition was improved clinically. Computed tomography (CT) and magnetic resonance (MR) imaging of the brain were carried out. Both contrast procedures disclosed enhancements at the falx cerebri and the margin of cerebral cortex. Among these procedures contrast MR imaging demonstrated the lesion most clearly. Cytological examination of cerebrospinal fluid obtained by spinal puncture showed the infiltration of malignant cells and the diagnosis of meningeal syndrome associated with lymphocytic leukemia was defined. Intrathecal administration of cytosine arabinoside partially improved the neurologic dysfunction. Autopsy and histopathological examination confirmed the infiltration of leukemic cells in the areas of meningeal lesion demonstrated with contrast CT and MR imaging. Thus these imaging techniques, especially contrast MR imaging, are useful tools for rapid and precise diagnosis of meningeal syndrome.

Narcolepsy in a hypocretin/orexin-deficient chihuahua.

A two-year-old male chihuahua suffered attacks of muscle weakness and immobility, although it had no family history of paroxysmal attacks. No neurological or blood biochemical abnormalities were recorded when it was first examined. The attacks were typically elicited by stimulation, such as feeding, and a case of sporadic narcolepsy-cataplexy was therefore suspected. Treatment orally three times a day with 1 mg/kg imipramine, was effective in reducing the attacks. The concentration of hypocretin-1/orexin A in the dog's cerebrospinal fluid was less than 80 pg/ml (22.5 pmol/litre), compared with normal canine levels of 250 to 350 pg/ml (70.0 to 98.3 pmol/litre), supporting a diagnosis of hypocretin-deficient narcolepsy.

A comparison between effects of pyruvate and herb medicines in preventing experimental oxalate urolithiasis in rats.

Sodium pyruvate, choreito (a herbal preparation), and urajirogashi (a herb) were added to a calcium-oxalate lithogenic diet (a glycolic-acid diet) to determine their effects in preventing lithogenicity. Male Wistar-strain rats which had been fed the glycolic-acid diet developed marked urinary calculi within 4 weeks. Rats in the groups fed a pyruvate diet had, however, almost no stones in the urinary system. The choreito and urajirogashi were slightly less effective than the pyruvate. Urinary oxalate excretion was high in all the groups during the experiment, especially in the pyruvate and the glycolic-acid groups, but, it was relatively lowered in the herb groups, especially towards the end of the experiment (p less than 0.05). Urinary citrate excretion was high in the pyruvate group, but it was significantly low in the other groups. In the choreito group, remarkable increases in urinary volume and magnesium excretion were observed; however, they were statistically non-significant and urinary calcium excretion was higher than in the glycolic-acid group during the experiment. Therefore, it can be concluded that choreito and urajirogashi may have some beneficial effect though any such effect is inferior to that of pyruvate, in preventing calculi formation, partly by decreasing the urinary oxalate excretion; increased urine volume and magnesium excretion may also have some other, additional effects in the choreito group.

Comparative study of the effects of pyruvate and CG-120 in preventing experimental oxalate urolithiasis in rats.

Male Wistar-strain rats which had been fed a calcium-oxalate lithogenic diet (a glycolate diet) developed urinary calculi in 4 weeks. Sodium pyruvate or CG-120 (a mixture of citrate salts) had been added to this diet to determine its effect in preventing lithogenicity. Rats in the group fed a pyruvate diet had, however, almost no stones in the urinary system. Rats in the CG-120 group showed results somewhat similar to those in the pyruvate group. Increased urinary citrate excretion was observed in both groups and could be implicated as the main inhibitory factor in stone formation. Therefore, it can be concluded that CG-120 exerts a beneficial effect close to that of pyruvate in preventing calculi formation and that both substances cause a high citrate excretion in urine.

[Statistics of genitourinary tumors at Mito Saiseikai Hospital].

The statistics of genitourinary tumors proved by histology as benign or malignant were analyzed for a total of 7,705 patients at the Mito Saiseikai Hospital from 1974 to 1984. The prostate, the bladder, and the kidney were the organs from which the tumors originated most frequently, in that order. Among the benign tumors, benign prostatic hyperplasia (55 cases) was the most frequent. Among the malignant tumors, bladder tumor (22 cases), prostate carcinoma (20 cases), and renal tumor (9 cases) were the most frequent. The overall 5-year survival rate was 50%. The survival of patients with bladder tumor was similar to that of the patients with renal pelvic or ureteral tumors of a transitional-cell origin. The worst survival was observed in penile carcinoma. It can be concluded that the incidence and survival of genitourinary tumors in the Mito area were not significantly different from those reported in other parts in Japan.

Effects of sodium citrate, potassium citrate, and citric acid in preventing experimental calcium oxalate urolithiasis in rats.

Male Wistar-strain rats which had been fed a glycolic-acid diet developed severe nephrocalcinosis with urinary calculi within 4 weeks. Rats fed the same diet with citrate salts added had, however, either slight or no nephrocalcinosis without any stones in the urinary system. Nephrocalcinosis intermediate between those in the citrate groups and the glycolic-acid group, with some urinary calculi, was observed in the citric-acid group. During the experiment, the urinary oxalate concentration increased markedly and was higher in the citrate and citric-acid than in the glycolic-acid group. The urinary citrate concentration was significantly higher in the citrate groups and lower in the citric acid and glycolic-acid groups. Therefore, citrate salts can be concluded to inhibit nephrocalcinosis and calculi formation as a result of decreased urinary saturation by means of increase in urinary citrate, in spite of a slight increase in the urinary oxalate.

[Evaluation of the enzymatic method using oxalate oxidase for urinary oxalate assay].

The principle of this kit method is that urinary oxalate is extracted and subsequently assayed by measuring the amount of hydrogen peroxide produced in an oxidation reaction catalyzed by oxalate oxidase. The reproducibility and accuracy of the method were tested: the within-run and day-to-day coefficients of variation were 5.4-20.0% and 16.1-18.0%, respectively, and the overall recovery rate of the added oxalate (5-25 mg/l) was 40-50%. These abnormally low recovery rates may be related to the presence of sulfate and phosphate in the extracted fluid. Therefore, the above method was modified by performing a recovery test by adding 25 mg/l oxalate to all urine samples. By the modified method, the correlation coefficient obtained between this method and the ion-chromatographic method was 0.851 (p less than 0.01). Urinary pretreatment with either acid ferric chloride or EDTA yields a higher recovery than with HCl. However, a good correlation of oxalate values is consistently observed for HCl-processed urine as measured by the above two methods. If the interference of ascorbic acid is negligible, no special urinary treatment except for HCl is necessary. The 24-hour urinary oxalate excretions were 24.4 +/- 9.1 mg (mean +/- SD) in 8 healthy males and 19.9 +/- 10.3 mg in 24 calcium-stone formers (21 males and 3 females).

[Transitional cell carcinoma developed in association with renal stone and ureter catheter: report of two cases].

Chronic irritation or infection may cause a neoplastic change in the uroepithelium. Our recent experience with two cases of transitional cell carcinoma associated with such stimuli is reported. A 58-year-old woman was found to have a staghorn stone in the left kidney and underwent nephrectomy because of an atrophic kidney. Transitional cell carcinoma was incidentally identified microscopically on the renal pelvis of the removed kidney. Subsequently surgery was elected to remove the residual ureter and the retroperitoneal lymph nodes, both of which turned out to be non-malignant. Then, she was treated by combination chemotherapy with CTX, ADR and CDDP. The second case was a 77-year-old woman who had had a 15-year history of an indwelling ureter catheter after gynecological surgery. Because of purulent discharge without any urine production, she underwent nephrectomy for a contracted kidney. Histology revealed transitional cell carcinoma on the pelviureteral junction. The postoperative courses were uneventful in both cases: they were followed up for 6 months and 9 months respectively without any recurrence of the disease. 90 cases of renal pelvic tumors associated with renal stones were collected from the Japanese literature and reviewed.

[Report of two cases of advanced renal cell carcinoma and our experience at Mito Saiseikai General Hospital].

A tumor thrombus in the vena cava (infrahepatic) was identified in a 70-year-old male with chronic obstructive lung disease, and right nephrectomy and thrombectomy were performed successfully. Therefore, he enjoyed good health for 6 months until he developed bone metastasis in the vertebrae and upper gastrointestinal bleeding. In another case of a 51-year-old male who presented with a mass in the posterior part of the chest; the biopsy specimen of the mass was reported to at least resemble renal-cell carcinoma. Subsequently, he underwent right nephrectomy and thoracotomy to remove the mass. He has since led an uneventful life without tumor recurrence. In our hospital from 1971 to 1980, 9 cases of renal-cell carcinoma have been experienced, including the above 2 cases. Their average age was 49.4 years, with ages ranging from 34 to 70 years. Seven patients presented with gross hematuria, and 2 patients, with flank pain. All 9 cases, all of whom underwent radical nephrectomy, were diagnosed pathologically as having renal cell carcinoma. The right side was involved in 3 cases, and the left, in 6 cases. The upper pole of the kidney was involved in 2 cases the middle in 1 case, and the lower in 5 cases. The mean 5-year survival rate was 69.2% and was closely associated with the tumor stage.

[Urachal carcinoma accompanied with calcification: report of a case].

Carcinoma of urachus accompanied with calcification is rarely encountered. A 37-year-old man presented with the complaint of mucus discharge on voiding. A plain X-ray film of his abdomen showed the presence of calcification at the urinary bladder. A hemispheric tumor at the top of the urinary bladder was seen on cystoscopic examination. The results of urine cytology and cold-punch biopsy supported the diagnosis; carcinoma of urachus. En bloc segmental resection was performed. Histopathologically, the tumor was composed of moderately differentiated adenocarcinoma producing mucus. Now, he is alive and has no evidence of recurrence. This is the 9th report on carcinoma of urachus with calcification in the Japanese literature.

[Adrenal cyst: report of a case].

This is a case report of an adrenal cyst which developed in a 36-year-old man. The patient experienced sudden abdominal pain, accompanied by sweating. The diagnosis was established by ultrasound-sonography and CT-scan. The adrenal cyst was removed surgically; it measured 20 X 10 X 10 cm and contained 1,900 ml of a white, cloudy fluid. Histological examination showed that the cyst wall was lined with mesothelial cells and was of congenital origin. The cyst was endocrinologically non-functioning, for all the endocrinological data were within normal limits. After surgery, however, hypertension has persisted and has been diagnosed as being essential in origin. This is the 63rd case reported in the Japanese literature.

[Pheochromocytoma in an elderly patient: report of a case].

This is a case report of a pheochromocytoma which developed in a 67-year-old man. The patient presented himself with a productive cough and orthopnea, both of which were subsequently proved to be due to hypertensive heart failure. The diagnosis of a pheochromocytoma originating from the left adrenal gland was established endocrinologically and roentgenologically. Transperitoneal adrenalectomy was undertaken, and a tumor weighing 300 g was obtained. Histopathologically, the tumor was composed of two elements: cells with profuse cytoplasma having chromaffin-positive granules, and other cells consisting of spindle cells with mitosis. Surgical exploration could not identify another tumor or metastasis, and his blood pressure returned to normal, with normal catecholamine levels, after surgery. This is the first reported case of an elderly person with a pheochromocytoma complicated by congestive heart failure and renal insufficiency preoperatively; however, it was controlled well, and he underwent surgery successfully. This case constitutes the 64th report on a pheochromocytoma in persons over 60 years of age in the Japanese literature.