A Salmonella enterica Serovar Oranienburg Clone Caused a Cluster of Bacteremia Cases in Persons With No Recognizable Underlying Diseases in Japan.

Background: Salmonella enterica subspecies enterica serovar Oranienburg (SO) is a foodborne pathogen but rarely causes systemic infections such as bacteremia. Between July and September 2018, bacteremia cases caused by SO were identified in 12 persons without any underlying medical conditions in the southern Kyushu area of Japan. Methods: Randomly amplified polymorphic DNA (RAPD) analysis was performed to investigate the genetic similarity of the 12 bacteremia-related strains and other Japanese isolates. Furthermore, a series of whole-genome sequence (WGS)-based phylogenetic analyses was performed with a global SO strain set (n = 1648). Results: The resolution power of RAPD was insufficient to investigate the genetic similarity between the bacteremia-related strains and other strains. WGS-based phylogenetic analyses revealed that the bacteremia-related strains formed a tight cluster along with 2 strains isolated from asymptomatic carriers in 2018 in the same area, with a maximum within-cluster single-nucleotide polymorphism (SNP) distance of 11. While several strains isolated in the United States and the United Kingdom were found to be closely related to the bacteremia-related strains, 2 strains isolated in 2016 in the southern Kyushu area were most closely related, with SNP distances of 4-11 and 5-10, and had the same plasmids as the bacteremia-related strains. Conclusions: The 12 bacteremia cases identified were caused by a single SO clone. As none of the bacteremia patients had any underlying diseases, this clone may be prone to cause bacteremia. Although further analyses are required to understand its virulence, particular attention should be given to this clone and its close relatives in the surveillance of nontyphoidal salmonellae.

Infective Endocarditis with No Underlying Disease for Which Bacterial Endophthalmitis Have Been the First Symptom.

Bacterial endophthalmitis is a rare complication of infective endocarditis (IE). We herein report a case of IE with no underlying disease for which endophthalmitis could have been the first symptom. A 58-year-old man was admitted to our hospital with a fever, vision disturbances, and pain in the left hand joint. His left eye was removed because fusion on the cornea progressed. Streptococcus agalactiae was detected in blood cultures, fluid cultures from his left hand joint, and the removed eye. Bacterial endophthalmitis may present as the first symptom of IE and develop without underlying disease due to S. agalactiae infection.

Redo living-donor lobar lung transplantation for bronchiolitis obliterans associated with antibody-mediated rejection.

Living-donor lobar lung transplantation (LDLLT) is an established therapy for patients with end-stage lung disease, but living-donor lobar lung retransplantation (re-LDLLT) is rarely reported. We previously reported a case of unilateral antibody-mediated rejection after LDLLT in the presence of newly formed donor-specific antibodies against a right-lobe donor. The same patient developed contralateral bronchiolitis obliterans, resulting in bilateral bronchiolitis obliterans, but re-LDLLT was successful. Pathological findings of the explanted lungs were consistent with the clinical course of the patient. One year after re-LDLLT, the patient is doing well without any anti-human leukocyte antigen antibodies. Four lobes from four different donors were transplanted in this patient. The first two lobes were rejected eventually, but the two lobes implanted later presented no signs of rejection at least for 1 year after the transplant. Herein, we report this rare case and compare the clinical course and pathological findings.

Antibody-mediated rejection of a unilateral donor lung in bilateral living-donor lobar lung transplantation: report of a case.

We report a case of antibody-mediated rejection (AMR) of a unilateral donor lung in the presence of newly formed donor-specific antibodies, 10 months after living-donor lobar lung transplantation (LDLLT). Of note is that the AMR occurred in the unilateral lung. Furthermore, the lung graft was from her husband and HLA analysis on the recipient's daughter revealed the same donor-specific HLA antigens, which strongly suggested pre-sensitization before lung transplantation. Fortunately, we could perform direct crossmatch even 1 year after lung transplantation because of the living donors.

[Clinical review of 1,017 influenza A cases between weeks 30 and 35 weeks in 2009].

Among 1,017 influenza A cases identified from July 20 (week 30) to August 30 (week 35), 2009, at Naha Municipal Hospital, most subjects were under the age of 20, and ranged from 1 month to 79 years (median: 17 years). Of these, 714 (73%) came to the hospital within 12 to 24 hours of symptom onset. Of those under 4-years-old, 88% had had contact with these ill with influenza, in so history taking may aid in correct diagnosis. The most frequent symptoms were fever such as 38 degrees (87%), cough (86.3%), headache (73%), arthralgia (69%), sore throat (65%), chills (61%), myalgia (50%), and nausea, vomiting and diarrhea (18%). In 606 (60%) were prescribed oseltamivir, 78 (8%) zanamivir, 175 (17%) maoto, and 333 (33%) no antiviral medication. The percentage of oseltamivir prescription among teenagers was 30%. Of the 1,017, 12 (1.2%) were hospitalized; 6 (50%) with pneumonia and 4 (33%) with asthma. Among the 12, 6 were over 60-years-old and 2 under 1-year-old. All adult admissions had underlying conditions, and 10 (83%) not prescribed antiviral medication and positive in rapid influenza diagnostic testing at a second hospital visit, all were admitted to treat complications, indicating that antiviral medication is a key in treating those with influenza-like illness in a high risk group.