Three-day regimen of oseltamivir for postexposure prophylaxis of influenza in wards.

Inpatients who had been in close contact with patients with influenza were given oseltamivir [75mg capsules once daily for adults or 2mg/kg (maximum of 75mg) once daily for children] for three days as postexposure prophylaxis (PEP). The index patients with influenza were prescribed a neuraminidase inhibitor and were discharged immediately or transferred to isolation rooms. The protective efficacy of oseltamivir for three days was 93% overall [95% confidence interval (CI) 53-99%; P=0.023] and 94% for influenza A (95% CI 61-99%; P=0.017), which is comparable to that of seven- to 10-day regimens of oseltamivir as PEP.

Predominant Dissemination of PVL-Negative CC89 MRSA with SCCmec Type II in Children with Impetigo in Japan.

Background. The ratio of CA-MRSA in children with impetigo has been increasing in Japan. Methods. Antimicrobial susceptibilities of 136 S. aureus isolates from children with impetigo were studied. Furthermore, molecular epidemiological analysis and virulence gene analysis were performed. Results. Of the 136 S. aureus isolates, 122 (89.7%) were MSSA and 14 (10.3%) were MRSA. Of the 14 MRSA strains, 11 belonged to CC89 (ST89, ST91, and ST2117) and carried diverse types of SCCmec: type II (IIb: 3 strains; unknown subtype: 4 strains), type IVa (2 strains), and unknown type (2 strains). The remaining three strains exhibited CC8 (ST-8)-SCCmec type VIa, CC121 (ST121)-SCCmec type V, and CC5 (ST5)-nontypeable SCCmec element, respectively. None were lukS-PV-lukF-PV gene positive. Gentamicin- and clarithromycin-resistant strains were frequently found in both MRSA and MSSA. Conclusions. PVL-negative CC89-SCCmec type II strains are the most predominant strains among the CA-MRSA strains circulating in the community in Japan.

[An epidemiological study of penicillin-resistant Streptococcus pneumoniae in Japan].

In order to investigate penicillin resistance (Pcr) in Streptococcus pneumoniae from clinical sources in Japan, a total 1,127 strains of S. pneumoniae was collected at random from 36 institutions participating to "Working group for Pcr S. pneumoniae" around the country in 1993-1994. These strains were isolated more frequently from sputum (38.2%), throat (31.4%), nasal discharge (16.4%), and otorrhea (5.7%). A small number of isolates from blood (19 strains; 1.8%), cerebrospinal fluid (11 strains; 1.0%), and pleural fluid (2 strains; 0.2%) were included respectively. Patients from whom S. pneumoniae was isolated have mostly been associated with children < or = 12 years of age and adults 60 < or = years olds. These isolates were tested for susceptibility to penicillin G, ampicillin, oxacillin, cefixime, cefdinir, imipenem, panipenem, erythromycin, clindamycin, minocycline, and vancomycin by an agar dilution method using Mueller Hinton agar supplemented with 10% sheep blood. Strains with the MICs > or = 0.125 micrograms/ml for penicillin G were defined as a Pc resistance. Of the 1,127 strains, 471 strains (41.8%) were identified as a Pc resistance. Pcr S. pneumoniae were almost resistant to other beta-lactams, including ampicillin, oxacillin, ceftizoxime, cefixime, cefdinir. Although, the MICs of imipenem and panipenem ragned from 0.004-2.0 micrograms/ml with 2 peaks distributions, these antibiotics inhibited the growth of most of Pcr S. pneumoniae at the lowest concentrations of < or = 0.5 microgram/ml. Only vancomycin resistant strain was not detected in these isolates. Most of the Pcr strains were simultaneously resistant to macrolides and minocycline. Further more, isolation frequencies of Pcr S. pneumoniae in west Japan, were relatively high compared with those of east Japan.

[Automated simultaneous measurements of activity and antigenicity of plasma antithrombin III].

Plasma antithrombin III activity and concentration were measured simultaneously on COBAS MIRA-S by colorimetry using a synthetic substrate and by immunoturbidimetry, respectively, in normal subjects (n = 30), in patients with liver disease (n = 37), and in those with thrombosis (n = 76). The activity/concentration ratio of plasma antithrombin III, in which concentration was represented as the ratio to the mean concentration for normal, was evaluated in each group. Results showed that the ratio was significantly lower in patients with liver diseases (0.76 +/- 0.18, mean +/- SD, p < 0.01) and in thrombotic patients (0.89 +/- 0.18, p < 0.01) than that in normal (1.07 +/- 0.06), demonstrating the predominance of antithrombin III molecules with low activity in the former groups. This simple and rapid (< 10 min) method is applicable for detecting such the constitutional change in plasma antithrombin III.

[Rapid alteration in serum lipoprotein profile after bile drainage in a patient with acute bile duct obstruction: contribution of cholestasis to cholesteryl ester-dominant ApoE-rich HDL accumulation].

Remarkably increased cholesteryl ester-dominant apoE-rich HDL with alpha 2-mobility, similar to the apoE-rich HDL observed in primary biliary cirrhosis, was found in a patient with acute bile duct obstruction due to common bile duct carcinoma. Bile drainage rapidly lowered her serum apoE-rich HDL from 34.1 to 6.1 mg/dl and from 96 to 10 mg/dl in terms of apoE (control; 2.6 +/- 1.5 mg/dl, n = 38) and of cholesterol (control; 6.7 +/- 2.3 mg/dl, n = 38), respectively. Disturbance in hepatic lipoprotein clearance due to the presence of cholestasis without severe liver damage is a possible cause of accumulation of cholesteryl ester-dominant apoE-rich HDL. Hence, plasma cholesteryl ester-dominant apoE-rich HDL level is supposed to be a good indicator of hepatic lipoprotein clearance. The measurement of this lipoprotein and the analysis of its lipid composition, by our convenient method, would be useful for the diagnosis of cholestasis and for the evaluation of hepatic function in cholestatic patients.

Increased plasma apolipoprotein E-rich high-density lipoprotein and its effect on serum high-density lipoprotein cholesterol determination in patients with familial hyperalphalipoproteinemia due to cholesteryl ester transfer activity deficiency.

Plasma apo E-rich HDL was studied in regard to its quantity and chemical composition in the members of a family with cholesteryl ester transfer activity deficiency, exhibiting familial hyperalphalipoproteinemia. The approach involved a simple precipitation method established in our laboratory. Serum apo E-rich HDL concentrations for two homozygous members were elevated up to 66 and 60 mg/dl in terms of cholesterol (normal, 6.7 +/- 2.3 mg/dl, n = 38), and to 9.4 and 10.8 mg/dl in terms of apo E (normal, 2.6 +/- 1.5 mg/dl, n = 38). The cholesterol/apo E ratio (mole/mole) of apo E-rich HDL was higher in two homozygotes (669 and 531) than in two cholestatic patients with elevated apo E-rich HDL (268 and 149) and in normal subjects (242 +/- 115, n = 38). Chromatographic studies of the serum from a homozygote showed enlargement of all HDL subclasses and apo E in the larger HDL subclass. These facts indicate that the increase of apo E-rich HDL in this disease occurs secondarily to the enlargement of HDL particles, which require substances to cover their cores, having expanded due to the accumulation of cholesteryl ester. The sera from the homozygotes gave HDL cholesterol concentrations which were remarkably discrepant among commercial precipitating reagents, because of the difference in recovery of apo E-rich HDL with these reagents.

A rapid and simple quantification of human apolipoprotein E-rich high-density lipoproteins in serum.

A rapid and simple method for the quantitative determination of human serum apo E-rich high-density lipoproteins is described. A sample was divided into two parts; one part was mixed with an equal volume of 13% polyethylene glycol 6000, and the other part was mixed with a solution containing dextran sulfate, sodium phosphotungstate, and Mg2+, respectively. The mixed solutions were centrifuged (2000 g; 15 min). The supernate obtained by the former procedure contained both apo E-rich HDL and apo E-poor HDL, but that obtained by the latter procedure contained solely apo E-poor HDL. The serum apo E-rich HDL concentration in terms of apo E (E) and cholesterol (C), was given by the following equations: E = EP x 2, and C = (CP - CD) x 2, where EP and CP were the concentrations of apo E and cholesterol, respectively, in the supernate obtained with 13% polyethylene glycol, and CD was the concentration of cholesterol in the supernate obtained with the mixture solution of dextran sulfate, sodium phosphotungstate, and Mg2+. Normal serum apo E-rich HDL concentrations were 2.6 +/- 1.5 and 6.7 +/- 2.3 mg/dl (means +/- SD, n = 38) in terms of apo E and cholesterol, respectively. Apo E-rich HDL was increased strikingly in the sera from three patients with hepatobiliary diseases.

Spurious elevation of serum high-density lipoprotein cholesterol in patients with cholestatic liver diseases.

Strikingly discrepant values were obtained by two commercial precipitating reagents for serum HDL cholesterol determination in three patients with cholestatic liver diseases (two patients with primary biliary cirrhosis and one patient with chronic hepatitis). An abnormal alpha 2-migrating lipoprotein (slow alpha-lipoprotein) was observed in agarose gel electrophoresis for each serum. The slow alpha-lipoprotein was partly recovered in the supernatant by precipitation with polyethylene glycol, and was completely precipitated with a polyanion-containing reagent, which well explains the discrepancy. The slow alpha-lipoprotein isolated from one of the cases is notable for (1) having an intermediate particle size between normal LDL and normal HDL, (2) containing apo E as the major apolipoprotein, and (3) being enriched with cholesterol (esterified and free) and phospholipid. Cholesterol accumulation was also found in another HDL subclass, alpha 1-migrating HDL. A severe impediment in the clearance of cholesterol-loaded HDL particles from plasma was implied. Electrophoresis of serum lipoproteins and/or the measurement of serum apo E concentrations are necessary to avoid an erroneous estimation of HDL cholesterol in patients with hepatobiliary diseases.