Infectious mononucleosis with atypical manifestations accompanied by transient IgM antibody response for cytomegalovirus.

Infectious mononucleosis (IM) is a clinical syndrome caused by primary infection with Epstein-Barr virus (EBV) that is common in adolescents. In adults, particularly in elderly people, the clinical picture of IM tends to be atypical, often leading to a diagnostic challenge. Diagnosis is also complicated because infection with EBV can induce the synthesis of cross-reacting immunoglobulin M antibodies for other herpesviruses. We report an unusual case of infectious mononucleosis in a 34-year-old immunocompetent adult. Epidemiological studies indicate that the average age of primary EBV infection in developed countries is increasing. IM with atypical presentation will be a diagnostic challenge in the future as the number of EBV-naïve adults increases.

Sequence-based spa typing as a rapid screening method for the areal and nosocomial outbreaks of MRSA.

Methicillin-resistant Staphylococcus aureus (MRSA) is the leading cause of nosocomial infection and MRSA outbreaks have become a major problem. Therefore, the rapid and accurate typing of MRSA isolates is important for epidemiological surveys and nosocomial infection control. Pulsed-field gel electrophoresis (PFGE) is considered as the gold standard technique for MRSA typing, because of its high discriminatory power, but its procedure is rather complicated and time-consuming. The spa gene encodes a cell wall component of Staphylococcus aureus protein A, and exhibits polymorphism. Sequencing the spa gene is expected superior to PFGE in speed and data interpretation. In the present study, we evaluated whether spa typing of MRSA is useful for nosocomial outbreak analysis and epidemiological investigations. We analyzed 19 nosocomial outbreak isolates from 4 separate hospitals and 26 isolates from outpatients of Toyama University Hospital. Either PFGE or spa typing revealed a single nosocomial strain that appears unique to each hospital. Indeed, spa typing confirmed the four different strains, but PFGE demonstrated only 3 strains. With the total 45 isolates, PFGE showed 16 different patterns and spa typing showed 12 patterns. Moreover, we were able to analyze the spa gene in about 2 days, from sampling to obtaining the results, whereas it took about 7 days with PFGE. In conclusion, sequence-based spa typing shows comparable sensitivities to PFGE, and is a rapid and easy handling method. The sequence-based spa typing can be used as the rapid screening test when MRSA outbreak is suspected in areas and hospitals.

[Generalized tetanus with intractable autonomic cardiovascular instability in an aged woman].

Tetanus is characterized by tetanic convulsions related to the actions of tetanospasmin produced by Clostridium tetani. Another important characteristic of tetanus is the instability of the cardiovascular system related to sympathetic hyperactivity in the autonomic nervous system, and it may be an important prognostic factor. We report a patient with tetanus in whose unstable circulatory kinetics made circulation management difficult. A 77-year-old woman who injured in a fall, 11 days after trismus appeared and 3 day after convulsion appeared. It was not severe case in the acuity classification. However, repeated generalized convulsions and autonomic imbalance involving the cardiovascular system were observed clinically, suggesting a severe case. Because of the unstable circulatory kinetics, the patient was carefully managed was performed in the intensive care unit (ICU), and she improved. ICU management may be essential for treating severe tetanus with cardiovascular complications. Acquired immunity is not achieved after the onset of tetanus, and since elderly people, in particular, as in our own caset, are easily injured when they fall, we recommend vaccination.

The radiotoxicity of 131I therapy of thyroid cancer: assessment by micronucleus assay of B lymphocytes.

UNLABELLED: We investigated cytologic radiation damage in thyroid cancer after (131)I therapy using micronucleus assay (MNA) of B lymphocytes exclusively, as opposed to our previous study in which MNA of all lymphocyte subsets was used. METHODS: We studied 22 thyroid cancer patients treated with 3.7 GBq of (131)I. Peripheral lymphocytes were harvested, and B lymphocytes were isolated by an immunomagnetic method and assayed for the frequency of micronuclei. RESULTS: The frequency of micronuclei among B cells after (131)I therapy was significantly increased relative to that in untreated control subjects, and the (131)I-induced increase in micronuclei frequency among B cells was significantly greater than that among all lymphocytes. CONCLUSION: Compared with the MNA of all lymphocytes, the MNA among specifically B cells may more sensitively detect cytologic radiation damage associated with (131)I therapy of thyroid cancer.

An idiopathic skin eruption resembling a butterfly rash in a septic patient with disseminated intravascular coagulation following bone marrow transplantation.

A 31-year-old man who underwent chemotherapy and bone marrow transplantation to treat acute myeloblastic leukemia was admitted to our department complaining of high fever and hypotension. His physical examination revealed warm shock state, eruptions resembling that seen in systemic lupus erythematosus on his face and cyanosis in his fingers. We diagnosed septic shock and idiopathic skin eruption on his face. Following treatment with blood transfusion, anticoagulant, antibiotics, respirator and continuous arteriovenous hemofiltration and dialysis, the patient's condition gradually improved. The eruptions on his face first observed at admission progressed with a worsening of his disseminated intravascular coagulation (DIC), and subsided with an improvement in his DIC. A biopsy of the eruption was taken and pathological findings of the eruption revealed multiple micro-fibrin depositions of the dermis. The skin necrosis in purpura fulminans often begins in the distal extremities. But our patient developed this uncommon skin eruption on his face. Patients with an idiopathic skin eruption resembling a butterfly rash in a septic patient should be considered to complicate DIC as in the present case.

Landing preference of Aedes albopictus (Diptera: Culicidae) on human skin among ABO blood groups, secretors or nonsecretors, and ABH antigens.

We demonstrated in this study that blood group O subjects attracted more Aedes albopictus than other blood groups (B, AB, and A) but were only significantly more attractive than blood group A subjects in 64 human landing tests. We collected saliva from the subjects and tested it for agglutination inhibition, categorized the subjects into secretors or nonsecretors, and studied mosquitoes' landing preferences for those groups. The mean relative percent landing on blood group O secretors (83.3%) was significantly higher than on group A secretors (46.5%). We also compared the attraction to subjects according to blood groups using forearm skin treated with ABH antigens. Blood group O disaccharide (H antigen) attracted significantly more Ae. albopictus than did blood group A trisaccharide (A antigen), and subjects treated with blood group A disaccharide attracted significantly more Ae. albopictus than did subjects treated with blood group B trisaccharide (B antigen), but ABH antigens did not, in general, influence the landing preference of mosquitoes among ABO blood groups.

Landing sites on the human body preferred by Aedes albopictus.

The landing sites on the human body preferred by Aedes albopictus were examined. Five male volunteers wearing only shorts stood in a mosquito net enclosure containing 120 proboscis-amputated Ae. albopitus. In separate tests, 9 male volunteers and 1 female volunteer lay supine during the test. The number of mosquitoes landing on each site of the volunteer's body was counted, and after completion of the test, his or her body temperature was recorded. When the subject was upright, the landing site most preferred by mosquitoes was the foot. When volunteers were supine, the foot also was the most preferred landing site, but the proportion of mosquitoes landing on the foot in this position in comparison with other sites was lower than when the Volunteer was in the upright position. The 2nd most preferred landing site was the hand, followed by the face. No correlation was found between preferred landing sites and body temperature. Factors other than temperature (e.g., human emanation) may influence mosquito behavior and landing site.

[The epidemiology of SIRS.sepsis in Japan].

We outline the epidemiology of the systemic inflammatory response syndrome (SIRS), sepsis and severe sepsis among intensive care unit (ICU) patients in Japan. One survey conducted in the ICU of a university hospital suggested that the prevalence of SIRS reached 84% among all ICU patients, and that about 8% of patients with SIRS progressed to severe sepsis. Gram-positive cocci were the most common isolates (58%) from ICU patients with sepsis. Moreover, a graded severity was noted from SIRS to sepsis and severe sepsis, with total in-hospital mortality of 6%, 20% and 63%, respectively. Thus, every effort should be made to decrease the risk of sepsis in ICU patients.

Photomanipulation of antibiotic susceptibility and biofilm formation of Escherichia coli heterologously expressing photoactivated adenylyl cyclase.

A cyaA-deficient Escherichia coli strain was transformed by a plasmid carrying the gene for BsPAC, a photoactivated adenylyl cyclase identified from a Beggiatoa sp., and was subjected to an antibiotic susceptibility assay and biofilm formation assay under a light or dark condition. Cells expressing BsPAC that were incubated under blue light (470 nm) were more susceptible to fosfomycin, nalidixic acid and streptomycin than were cells incubated in the dark. Cells expressing BsPAC formed more biofilms when incubated under the light than did cells cultured in the dark. We concluded from these observations that it is possible to determine the importance of cAMP in antibiotic susceptibility and biofilm formation of E. coli by photomanipulating the cellular cAMP level by the use of BsPAC. A site-directed mutant of BsPAC in which Tyr7 was replaced by Phe functioned even in the dark, indicating that Tyr7 plays an important role in photoactivation of BsPAC. Results of mutational analysis of BsPAC should contribute to an understanding of the molecular basis for photoactivation of the protein.

An infected pseudoaneurysm following a modified Blalock-Taussig shunt.

A two-month-old male infant with tetralogy of Fallot underwent a right-sided modified Blalock-Taussig shunt using a 4 mm expanded polytetrafluoroethylene graft through a right thoracotomy. Five months later, the patient developed otitis media, followed by repeated relapses of pneumonia and fever of unknown origin. Multidetector-row computed tomography and angiography, performed at 12 months of age, revealed a pseudoaneurysm of the subclavian artery at the insertion of the modified Blalock-Taussig shunt. After 20 days of antibiotic therapy, the pseudoaneurysm and infected graft were successfully resected through a median sternotomy approach. This report describes the treatment strategy of this rare but potentially fatal complication after a modified Blalock-Taussig shunt operation.