Molecular characteristics of outbreaks of nosocomial infection with influenza A/H3N2 virus variants.

OBJECTIVE: To describe outbreaks of nosocomial influenza infection with molecular methods and to elucidate the viral linkages among outbreak case patients including both inpatients and healthcare workers (HCWs). SETTING: A 180-bed acute and long-term care hospital in Japan. METHODS: Retrospective observational study of nosocomial outbreaks of infection with influenza A/H3N2. Together with information about onset dates and vaccination history, we obtained nasopharyngeal swab samples from individuals with cases of influenza or influenza-like illness (ILI). The hemagglutinin genes of the recovered viruses were sequenced and compared, along with those of community-circulating strains, for similarity by phylogenetic tree analysis. RESULTS: The outbreaks occurred from February 26 through April 3, 2007, during the 2006-2007 epidemic season, and they involved 11 patients and 13 HCWs. The 2 outbreaks involved 2 different genotypes of influenza A/H3N2 viruses. These virus variants were closely related to the influenza strains that were circulating in the community during the same epidemic season. CONCLUSION: This study showed the dissemination of highly homologous influenza virus variants among inpatients and HCWs within a short period, as a result of nosocomial transmission. These strains were also similar to influenza strains that were circulating in the community.

[Chronic intestinal pseudo-obstruction as a paraneoplastic presentation of limited-stage small cell lung cancer].

A 53-year-old woman with chief complaints of vomiting and constipation was given a diagnosis of ileus and admitted to a local hospital. The origin of the ileus was unknown despite intensive examinations. However, her chest X-ray film and CT showed left hilar and mediastinal lymphadenopathy. Her pro-gastrin-releasing peptide (ProGRP) levels were elevated. After transfer to our hospital, the diagnosis of small cell lung cancer (SCLC) was confirmed by transbronchial aspiration cytology. Since no cause of ileus was found on laparotomy, her symptoms were considered to indicate chronic intestinal pseudo-obstruction (CIPO), a manifestation of paraneoplastic neurological syndrome. Serum anti-Hu antibody testing was positive. Chemoradiotherapy induced complete remission and her abdominal symptoms markedly improved. This is a very rare case of CIPO accompanied with SCLC, which improved after immediate anti-tumor therapy for lung cancer.