Bilateral hydronephrosis due to obstructive ureteral stone associated with norovirus gastroenteritis.

Recently, cases of urinary tract calculi causing hydronephrosis and postrenal renal failure associated with viral gastroenteritis were documented, yet few were related to norovirus. During norovirus gastroenteritis, observation of oliguria, aciduria, low FENa value, and elevation of blood or urinary uric acid level may necessitate clinical workout for nephrolithiasis.

[Bacteriological Analysis of Pneumococcus Detected from the Sputum of Hospitalized Children].

7-valent pneumococcal conjugate vaccine (PCV7) has been included in the routine immunization schedule since April 2013 in Japan. Serotype replacement - a phenomenon by which serotypes are replaced by non-vaccine serotypes after vaccine introduction - has been reported in invasive pneumococcal disease (IPD). Pneumococcus in sputum samples is one of the major causes of bronchopulmonary infection in children. We tried to verify whether serotype replacement of Pneumococcus occurs in sputum samples in a similar manner as in IPD. From August 2014 to September 2015, we performed antimicrobial susceptibility testing and serotyping of Streptococcus pneumoniae from sputum samples and investigated the history of PCV from hospitalized children with S. pneumoniae bronchopulmonary infection. From the results of our investigation, 80.3% of children have received PCV at least once. Serotypes of Pneumococcus were determined in 92.4% of tested strains and PCV13 strains accounted for only 9.8%. Major isolated serotypes were 15A (21.3%), 35B (19.7%), and 6C (13.1%). Those were not included in PCV13, i.e. serotype replacement occurs in bronchopulmonary infection just as in IPD. The results of antimicrobial susceptibility testing for Penicillin G indicated that penicillin-resistant S. pneumoniae (PRSP) accounted for 4.5%, penicillin-intermediate resistant S. pneumoniae (PISP) accounted for 47.0% and penicillin-susceptible S. pneumoniae (PSSP) accounted for 48.5%. When examining the drug susceptibility by serotypes, 15A, 19A, 23A and 35B showed a high percentage of non-susceptibility. This means there is a difference in the resistant trend by serotypes. In our study, it became clear that verifying of the serotypes of Pneumococcus in sputum is meaningful and surveillance of serotypes is important for evaluation of vaccination as IPD.

Onset and duration of symptoms and timing of disease transmission of 2009 influenza A (H1N1) in an outbreak in Fukuoka, Japan, June 2009.

The first confirmed case of 2009 influenza A (H1N1) in Fukuoka, Japan was reported in early-June 2009. The disease rapidly spread through this area, mainly in schools, until there were no new cases detected 3 weeks later. We describe herein the clinical characteristics of this novel infection that came to light through the investigation of this outbreak. The patient records at hospitals and local public health centers were reviewed, and we defined laboratory-confirmed cases as those of a person who had influenza-like symptoms, such as a fever of 37C or more, cough, sore throat, rhinorrhea, or headache. From May 19 to June 31, 2009, a total of 71 cases were identified. The median age was 11 years, and all the patient took neuraminidase inhibitors and fully recovered. The fevers lasted for 1 to 5 days (median, 2). Cough lasted for 2 to 11 days (median, 7), and in 10 cases (34.5%) cough started before the fever. The incubation period was 2 to 3 days. Infectors transmitted the disease to another person on the day of or the day before fever onset. The findings regarding the onset and duration of symptoms and the timing of disease transmission of 2009 influenza A (H1N1) may be useful for future response.

Cytomegalovirus-associated protein-losing enteropathy resulting from lymphangiectasia in an immunocompetent child.

An immunocompetent 8-year-old boy with cytomegalovirus (CMV)-associated transient protein-losing enteropathy (PLE) is described. Colonoscopic examination revealed lymphoid hyperplasia of the terminal ileum. Histological examination of the biopsied specimens showed marked dilation of the lymphatic vessels. Primary CMV infection was demonstrated by serological test and polymerase chain reaction. The child had complete resolution of the disease without antiviral treatment. The present case suggests the etiologic role of CMV infection in PLE resulting from intestinal lymphangiectasia in childhood.

Infected subdural hematoma in an infant.

We report the case of a 1-year-old boy with an infected subdural hematoma due to Streptococcus pneumoniae identified by latex agglutination test and polymerase chain reaction amplification of a bacteria-specific gene. The present case demonstrated the need to include infected subdural hematoma in the differential diagnosis of suspected subdural empyema, and suggested the usefulness of combining these methods to identify a causative organism.

Neurotrophin-4 and glial cell line-derived neurotrophic factor in cerebrospinal fluid from meningitis/encephalitis patients.

The neurotrophin-4 and glial cell line-derived neurotrophic factor levels were measured in cerebrospinal fluid from 61 patients with bacterial meningitis, viral meningitis, or encephalitis, and other diseases by means of two-site enzyme-linked immunoassay. Elevated cerebrospinal fluid levels of neurotrophin-4 were demonstrated in four of the 11 patients with bacterial meningitis, and seven of the 23 patients with viral meningitis or encephalitis. None of the other patients demonstrated elevation of the neurotrophin-4 level in cerebrospinal fluid. The neurotrophin-4 levels in cerebrospinal fluid were correlated with the numbers of total and mononuclear cells in patients with viral meningitis/encephalitis. In patients with bacterial meningitis, three of the four patients with elevated neurotrophin-4 levels exhibited persistent abnormalities on computed tomography, and one revealed transient subdural effusion. On the other hand, none of the seven patients without neurotrophin-4 elevation had persistent computed tomography abnormalities, and five patients demonstrated transient computed tomography abnormalities. The glial cell line-derived neurotrophic factor levels were below the detection limit, or only slightly higher than the detection limit, in the patients with or without central nervous system infections. Although the precise roles of neurotrophin-4 and glial cell line-derived neurotrophic factor in central nervous system infections remain to be determined, neurotrophin-4 might play a neuroprotective or immunomodulatory role in central nervous system infections.

[The current status of infectious enteritis in Japan--reports of the "Research Group for Infectious Enteric Diseases, Japan" in the last 5 years (1996-2000)].

The patients or carriers with infectious enteritis admitted to the Hospitals for infectious diseases in the last 5 years (1996-2000) were studied. The total number of cases admitted in each year were 969, 1,113, 981, 637 and 573 respectively. A total of 1,527 Shigella spp. strains including 1,078 strains from overseas travelers' cases were isolated. The isolates of Salmonella spp. excluding S. Typhi and S. Paratyphi A were 562 in number. A total of 61 Vibrio cholerae O1 strains including 44 strains from overseas travelers was isolated. These V. cholerae O1 strains were all of El Tor type. Entamoeba histolytica, Giardia lamblia, Cryptosporidium parvum and Isospora belli were detected in 225, 46, 3 and 3 cases respectively. Abdominal pain, nausea and vomiting were frequently observed in the cases caused by Vibrio parahaemolyticus. The highest body temperature and the highest frequency of bowel movements were revealed in the cases caused by Salmonella spp. Bloody stool was observed in 55.3% of the cases due to Escherichia coli, in 40.5% of the cases due to Campylobacter spp. and in 24.1% of cases due to Shigella spp. As for shigellosis and salmonellosis, the clinical symptoms were more serious in the domestic cases than those in travelers. OFLX-resistant strains accounted for 1.7% of Shigella spp. isolates. No strains of Salmonella spp. were resistant to OFLX. The incidence of drug-resistant isolates of Campylobacter jejuni were 26.0% for OFLX and 2.5% for EM.