Sadato Ichinohe

Acute disseminated demyelination due to primary human herpesvirus-6 infection

AbstractA previously healthy 19-month-old boy developed acute encephalopathy, thrombocytopenia and hepatic dysfunction. Human herpesvirus-6 (HHV-6) DNA was found in his CSF during the acute stage of the disease by means of the polymerase chain reaction. T2-weighted MRI revealed high signal intensity in the left thalamus and left parieto-occipital deep white matter. The myelin basic protein concentration in the CSF was elevated suggesting acute demyelination. The patient is now 2.5 years old and has no sequelae. Conclusion Since clinical course and neuroimaging after HHV-6 infection are similar to those in acute disseminated encephalomyelitis, clinicians must pay attention to primary HHV-6 infection in patients under 2 years old with white matter lesions.

A Silkworm Larvae Plasma Test for Detecting Peptidoglycan in Cerebrospinal Fluid Is Useful for the Diagnosis of Bacterial Meningitis

The silkworm larvae plasma (SLP) test has been established based on a cascade reaction triggered by either peptidoglycan or (1, 3)‐β‐D‐glucan to produce melanin. We applied this test to the diagnosis of bacterial meningitis. Cerebrospinal fluid (CSF) obtained from patients with bacterial meningitis due to gram‐positive bacteria, gram‐negative bacteria, or fungi, showed positive reactions to the test. In contrast, CSF from patients with viral meningitis or noninfectious illnesses gave negative reactions. Therefore, this test seems to be useful for diagnosis of bacterial and fungal meningitis. When this test was used together with two types of limulus tests, an endotoxin‐specific test, and a conventional test, meningitis was further characterized as gram‐positive, gram‐negative or fungal meningitis. The SLP test requires a computerized instrument for quantitative colorimetric measurement. A qualitative alternative of this test also can be accomplished by visually observing the darkening color. Thus, this method can be applied for simple and rapid diagnosis of meningitis.

Effects of fosfomycin on Shiga toxin-producing Escherichia coli: quantification of copy numbers of Shiga toxin-encoding genes and their expression levels using real-time PCR

Antibiotic therapy for infection with Shiga toxin-producing Escherichia coli (STEC) is not generally recommended, because it is thought to increase levels of released Shiga toxin (Stx), leading to the severe complication of haemolytic uraemic syndrome (HUS) (Tarr et al., 2005). However, the incidence of HUS in children with STEC infection was found not to be higher in Japan than in other countries, despite the use of antibiotics such as fosfomycin (FOM) (Ikeda et al., 1999; IDSC, 2007). Furthermore, early administration of FOM, as well as a new quinolone, norfloxacin (NFLX), and kanamycin, was recommended in the 1997 guidelines for medical treatment of STEC O157 infection issued by the Ministry of Health and Welfare of Japan. Hence, it remains controversial whether the use of antibiotics for STEC infection is effective or harmful (Wong et al., 2000; Bennish et al., 2006; Panos et al., 2006).

A case of infantile spasms: Epileptic apnea as partial seizures at onset

We report a 2-month-old boy who presented with apneic attacks as a manifestation of epileptic seizures at onset and eventually progressed to infantile spasms. At onset, at 2 months of age, apneic attacks were the sole symptom of epileptic fits. Although these seizures were accompanied by cyanosis, bradycardia was not noted. An ictal electroencephalogram showed focal paroxysmal discharges in the temporal area. Treatment with sodium valproate was not effective to control his seizures. By 6 months of age, he progressed to infantile spasms. Although his seizures could be completely controlled with the use of zonisamide, vitamin B6 or high-dose immunoglobulin, his mental and behavioral development was retarded severely. There have been no previously published cases with infantile spasms that evolved from epileptic apnea as partial seizures.

Antimicrobial therapy and shedding time of Shiga toxin-producing Escherichia coli.

Dear Sir Jensen et al. [1] reported the empiric study of antimicrobial therapy of persons who experienced serious social problems due to prolonged, asymptomatic carriage of non-O157 Shiga toxin-producing Escherichia coli (STEC) and concluded that eradication of STEC was successful without complications. This study also revived interest in whether antimicrobial therapy can decrease shedding time of STEC, but did not expound on this particular issue. We have carried out a preliminary investigation of antimicrobial therapy and shedding time of STEC using the records of STEC patients reported to Funabashi Public Health Center during 2004 and 2005. We defined shedding time as the interval between the onset of diarrhea and the first 2 serially negative stool cultures. According to the Infectious Prevention Law in Japan, the 2 serial cultures are collected at an interval of greater than 24 h. Additionally, if antimicrobial therapy is used, at least 1 negative sample is collected 48 h after completion of antimicrobial therapy. The reported cases consist of 18 males and 10 females. The mean age was 19 y (range 2 72 y). The isolated serogroups STEC included 20 of O157, 6 of O26, 1 of O111, and 1 of O121. Toxin types included 15 of Shiga-toxin (STX)1&2, 9 of STX2, and 4 of STX1. Two cases (patients’ ages 2 and 3 y old) were complicated by hemolytic-uremic syndrome (HUS). 24 cases (11 of 11 children B16 y old and 13 of 17 adults ]16 y old) received antimicrobial therapy. The antibiotics used included fosfomycin (13 patients), norfloxacin (5 patients), cephalosporins (5 patients), and tetracycline (1 patient). 22 of the 24 cases received antimicrobial therapy within 7 d after onset of diarrhea, while the 2 HUS patients received antibiotics at a later time. In the 22 patients, shedding time in children (9 cases, mean 11.0 d, range 8 26 d) was longer than that in adults (12 cases, mean 9.0 d, range 6 14 d) but the difference was not statistically significant (Mann-Whitney U-test, p 0.116). Previous studies have not reported shedding time during or after administration of antimicrobial therapy but several different average shedding times without antimicrobial therapy have been reported as 17 d (range 2 62 d) [2], 13 d (range 2 62 d) [3], 29 d (range 11 57 d) [4], and more recently of 25 d (range 11 41 d) [5]. In addition, it has been previously mentioned in the literature that shedding time in children is longer than in adults [6]. Our results showed median duration was 11 d in children, which was similar to that in adults and shorter than has been reported in previous studies without antimicrobial therapy. Taking into account that newer, more sensitive culture methods tend to overestimate shedding time, it is suspected that antimicrobial therapy can decrease shedding time of STEC. Currently, antimicrobial therapy for STEC infection is not generally recommended, because it has been thought to increase incidence of HUS, a severe

妊婦における麻疹中和抗体価, HI抗体価, PA抗体価の相関と各測定法の発症予防レベル

When measles antibody levels among pregnant women were measured with measles hemagglutinin inhibition (HI), 31% of subjects had negative HI antibody titers. When the same blood samples were tested with measles gelatin particle agglutination (PA) and neutralizing (NT), the percentages of those with negative antibody levels were 1% and 3%. We conducted the correlation between antibody titers measured by the three types of titration. Correlation between NT and HI antibody titers higher than 1:8 and that between NT and PA antibody titers were good, but 81% of subjects whose HI antibody titer was below 1:8 and all women with HI antibody of 1:8 were found to have NT antibody titer higher than 1:4. NT antibody titer higher than 1:4 was found in 95% of women having PA antibody titer of 1:256 and in 99% of those with PA antibody titer of 1:512. Based on the relationships to measles NT antibody level, the majority of subjects with HI antibody titer higher than 1:8 or PA antibody level higher than 1:512 was reasonably assumed to be protected against clinical measles. PA seemed superior to HI in finding subjects with insufficient immunity against measles, because the former detects weak immunity more efficiently than the latter.

Measles Antibody Followed after Measles Vaccination

: The immunity status of 37 cases has been tested at 6 weeks and 3.5 years after vaccination by using gelatin beads agglutination (PA), hemagglutination inhibition (HI) and avidity of specific IgG. The geometric mean titer (GMT) of HI antibody was 34.5 at 6 weeks and had fallen to 17.9 over 3.5 years. On the other hand, GMT of PA antibody was 36.5 at 6 weeks and had increased to 286.0 over 3.5 years. Also, the average of measles specific IgG avidity was 4.5% at 6 week and had increased to 45.4% over 3.5 years. The multiple regression analysis was performed in order to investigate the relationship of HI antibody and avidity to PA antibody. The significant involvement of the HI antibody and avidity to PA antibody (standardized partial regression coefficients; 0.612, 0.726) was recognized and the multiple correlation coefficient was 0.880 (p < 0.001). Hence it was strongly suggested that the increase of PA antibody with time could be dependent on that of IgG avidity.