[Prevalence of human metapneumovirus infection in hospital wards handling patients with severe motor and intellectual disabilities].

Epidemics of infectious diseases often occur in hospital wards handling patients with severe motor and intellectual disabilities. However, the causative pathogens are not identified in half of these epidemics. Recently, an epidemic occurred in 2 wards consecutively in the National Hospital Organization Ehime Hospital in March-April, 2010. In this epidemic, 18 of 40 patients in one ward and 14 of 60 patients in another ward showed symptoms, and human metapneumovirus (HMPV) was detected from pharyngeal and/or nasal swabs of 4 patients. Phylogenetic analysis of the viral genomes showed that the virus belonged to subgroup B2, and the same virus had spread consecutively in 2 wards. High fever lasted for 5.3 days on average in the 32 inpatients, was mostly over 38 degrees C and was accompanied by productive coughs. In the 4 patients in whom human HMPV was detected, the number of peripheral blood lymphocytes decreased but that of monocytes increased. Pneumonia developed in two patients as shown by chest radiography, and an increased number of peripheral blood neutrocytes and increased CRP levels were noted. Of the 151 inpatients, anti-human HMPV antibody was found in the sera of 143 (95%), and the relationship between high fever and antibody titer was not significant, indicating that HMPV infection could recur in spite of the presence of specific antibodies. Because human HMPV is highly prevalent, and causes high fever and pneumonia, hospital staff should be vigilant for any signs of this virus in hospital wards and take steps to prevent infection in long-term inpatients.

Tumor Screening, Incidence, and Treatment for Patients with Severe Motor and Intellectual Disabilities.

BACKGROUND: The increasing age of patients with severe motor and intellectual disabilities (SMID) has become a serious concern. Few studies have investigated tumor treatment in this population. METHODS: Tumor treatments for 12 SMID patients were examined. RESULTS: Blood tests and ultrasonography were useful for screening. With regard to treatment, surgery for SMID patients was performed in the same manner as for patients without SMID, and the results were generally satisfactory, without major complications. Typically, cancer was diagnosed at an advanced stage, and many metachronous double cancers were observed. CONCLUSIONS: Treatment yielded satisfactory results for patients with SMID and their families. Future studies should examine the clinical significance of screening and tumor operative method for patients with SMID.

Alteration in serum levels of inflammatory cytokines during parainfluenza virus type 1 infection in patients with severe multiple disabilities.

An epidemic of parainfluenza virus type 1 (PIV1) infection occurred in a hospital ward housing patients with severe motor and intellectual disabilities. Twenty-three infected patients exhibited persistent high fever for 4-16 days and decreased lymphocyte counts. One-half of the symptomatic patients had increased blood monocyte counts and the other half progressed to bronchitis or pneumonia. We also compared levels of 27 cytokines in the sera of 21 patients during the acute and normal phases of infection. Cytokine levels were measured with a bead immunoassay performed using the Luminex Multiplex System. Serum levels of interleukin (IL)-1Ra, C-C-motif chemokine (CCL) 2, and C-X-C-motif chemokine (CXCL) 10 significantly increased during the acute phase. In contrast, the serum level of CXCL8 decreased slightly. These results suggest the involvement of monocytes/macrophages and respiratory epithelial cells in the initial stage of PIV1 infection. A previous report using nasal wash samples also found a significant increase in levels of CXCL10 during the acute phase. Hence, CXCL10 may be a useful marker of a cytokine storm produced upon viral infection. However, alterations in levels of IL-1Ra, CCL2, and other cytokines differed between the 2 studies, suggesting that the cytokine profile produced systemically at viral infection is different from that produced at mucosal sites. Further analysis is required to clarify the mechanisms underlying cytokine production during PIV1 infections.

Characteristics of human metapneumovirus infection prevailing in hospital wards housing patients with severe disabilities.

Epidemics of infectious diseases often occur at long-term inpatient facilities for patients with severe motor and intellectual disabilities. However, the pathogens causing these infections remain unknown in approximately half of such epidemics. Two epidemics of respiratory tract infection occurred in 2 wards in the National Hospital Organization Ehime Hospital (prevalence 1, 34 infected out of 59 inpatients in the A ward in September 2011; prevalence 2, 8 infected out of 58 inpatients in the B ward in June 2012). Human metapneumovirus (HMPV) was detected from the nasal (and some pharyngeal) swabs from 17 patients. Based on phylogenetic analysis of viral genomes, the virus was grouped in subgroup A2 (prevalence 1) and B2 (prevalence 2). We considered that the viruses had spread through the 2 wards. The average duration of high fever in the 42 patients was 6.8 days, with the majority of fevers exceeding 38℃ (79%) and being accompanied by a productive cough. Ten out of 17 patients (59%) in whom HMPV was detected had decreased lymphocyte and increased monocyte counts in the blood. Eleven cases (65%) had elevated-C reactive protein levels and fever protraction as well as images of bronchitis or pneumonia on chest radiographs approximately 1 week after onset. Anti-HMPV antibody in the blood was positive in 95% of patients (151 of 159 inpatients), indicating no relation between HMPV infection and antibody titer but revealing recurrent infections. In view of the fever protraction and frequent co-occurrence of bronchitis and pneumonia at long-term inpatient facilities for immunocompromised patients such as the ones in this study, the prevalence of HMPV must be carefully monitored, and preventive measures and early-stage treatments are required.

Genotyping and phylogenetic analysis of the major genes in respiratory syncytial virus isolated from infants with bronchiolitis.

We performed the genotyping and phylogenetic analysis of respiratory syncytial virus (RSV) isolated from 17 infants with bronchiolitis in Kanagawa Prefecture, Japan in 2005 and 2006. The major genes in these samples (attachment [G] glycoprotein gene, fusion [F] protein gene, and nucleoprotein [N] gene) were sequenced and analyzed genetically. Phylogenetic analysis of these genes revealed that 7 and 10 strains could be classified into subgroups A and B, respectively. Phylogenetic analysis of the G gene revealed that the subgroup A and B strains were unique genotypes GA2 and BA, respectively. Moreover, the amino acid sequences for these genotypes suggested a relatively high frequency of amino acid substitutions in the G and F proteins in these strains, whereas the N protein was highly homologous. These results suggest that RSV genotypes GA2 and BA may be associated with bronchiolitis in the cases studied here.