The history of and perspectives on hospital infection control and prevention : from hand hygiene to actions to combat antimicrobial resistant bacteria

Recently, hospital infections have been receiving growing importance. Action plans for nosocomial infection control and prevention were originally developed in modern Western countries, including the US. The introduction of this concept in Japan was accelerated from the beginning of the 2000’s. With the legal and financial support from the government, the level of nosocomial infection control is now comparable to that of Western countries. Moreover, the Japanese approach to this field is unique in that it adopted team-based medicine and regional alliances between hospitals. To combat antimicrobial resistance in bacteria, which is a growing problem worldwide, we should utilize our uniquely constructed approach for hospital infection control and prevention. In this review, we provide a general view of the history of and perspectives on hospital infection control and prevention in Japan

Splenic Infarction in Acute Cytomegalovirus and Human Parvovirus Concomitant Infection

We present a case report of a 35-year-old woman who had splenic infarction. She had persistent high fever, systemic joint pain, and abnormal liver function. She was diagnosed with cytomegalovirus and human parvovirus B19 concomitant infection. Her coagulopathy test revealed no abnormal results. She was treated with intravenous ganciclovir for 13 days; consequently, her splenic infarction improved after 7 weeks. As per our knowledge, this is the first case of cytomegalovirus and parvovirus B19 coinfection complicated by splenic infarction. Cytomegalovirus and parvovirus B19 may induce a hypercoagulation state during the acute phase

Interstitial Pneumonia Developed in HTLV-I Carriers: Report of Two Cases

Two carriers of human T-cell lymphotropic virus type I (HTLV-I) with interstitial pneumonia are described. The first case, a 60-year-old man, was admitted with cough and dyspnea on exertion. Light microscopy of a lung specimen obtained by a transbronchial lung biopsy (TBLB ) showed thickening of the alveolar walls with infiltration of lymphocytes and fibrosis of the pulmonary parenchyma. Immunohistochemical analysis of the TBLB specimen showed positive staining in the lymphocytes for UCHL-1. This case was suspected as HTLV-I associated bronchiolo-alveolar disorder. The second case, a 74-year-old man, visited our hospital because of a persistent productive cough and dyspnea on exertion. Light microscopy of the TBLB showed a slight thickening of the alveolar walls and fibrosis of the pulmonary parenchyma with minimal infiltration of lymphocytes. Only 2.2% of the bronchoalveolar lavage fluid consisted of lymphocytes. The findings of the second case suggest that some factors other than T-lymphocytes may be related with the development of interstitial pneumonia in HTLV-I carriers. Interstitial pneumonia in HTLV-I carriers may be caused by as yet undiscovered mechanisms. A cohort study involving residents of an area where HTLV-I is endemic should be conducted to clarify the mechanism of pulmonary involvement in HTLV-I carriers

Membrane Humidifier That Does Not Require Addition of Water

We developed a new device called "a membrane humidifier" which does not require an external water supply. Fifteen patients inhaled humidified-oxygen from the membrane humidifier and were asked about their subjective impression. The relative humidity of room air and that of humidified-oxygen from the membrane humidifier or a conventional bubble water humidifier were measured with a digital hygrometer. The relative humidity of the oxygen humidified by humidifiers was measured after the gas was flowed into a partially opened 500-mL container for 30 min. None of the patients experienced dryness of the nose or throat. All patients answered that there was no difference in their subjective impression between breathing oxygen from the membrane humidifier and from the conventional bubble water humidifier. A significant regression was observed between the relative humidity of room air and that of the oxygen humidified from the membrane humidifier. The membrane humidifier was able to produce humidification very well. This new compact device can be used not only in hospitals, but can also be incorporated in home oxygen concentrators. This new device also saves the procedure of changing water

Pulmonary findings without the influence of therapy in a patient with rheumatoid arthritis : an autopsy case

We report the autopsy findings of a 40- year- old woman with lung complications of rheumatoid arthritis. She has been suffering from rheumatoid arthritis and interstitial pneumonia without satisfactory therapies because of her poor compliance. At autopsy, diffuse pleural adhesions and many protruding cysts were observed. The cut surfaces had rich fibrous changes and honey-comb like appearances dominantly in the left lower lobe. Microscopically, remarkable fibrous changes were observed with destruction of the alveolar structure. These fibroses were temporally homogeneous and lacked prominent fibroblastic foci. The histological pattern was consistent with fibrous non- specific interstitial pneumonia. In peripheral pulmonary arterioles, some thrombi were detected with much recanalization. Systemic amyloidosis was observed in the submandibular gland, thyroid, heart, and arterioles of the lung, kidney, and digestive tract. In the left pulmonary artery, a large embolus was detected. This embolism was the direct cause of death. Her pulmonary findings, except for the embolism, were considered sober states of lung complications of rheumatoid arthritis without the influence of therapy

Effect of Cetuximab and EGFR Small Interfering RNA Combination Treatment in NSCLC Cell Lines with Wild Type EGFR and Use of KRAS as a Possible Biomarker for Treatment Responsiveness

[Background] The epidermal growth factor receptor (EGFR) is a therapeutic target for patients with non-small cell lung cancer (NSCLC). Cetuximab is an anti-EGFR monoclonal antibody that inhibits EGFR signaling and proliferation of colorectal cancer and head and neck cancers. Since only few NSCLC patients benefit from cetuximab therapy, we evaluated a novel combination treatment using cetuximab and EGFR small interfering RNA (siRNA) to strongly suppress EGFR signaling and searched for a biomarker in NSCLC cell lines harboring wild-type EGFR. [Methods] Alterations in EGFR and its downstream genes in five NSCLC cell lines (A549, Lu99, 86-2, Sq19 and Ma10) were assessed through sequencing. The protein expression levels of these molecules were assessed through western blotting. The effect of combination treatment was determined through cell proliferation assay, caspase-3/7 assay, invasion assay, and migration assay. [Results] All cell lines were harboring wild-type EGFR, whereas KRAS, PTEN, TP53 and TP53 were mutated in A549 and Lu99; Lu99 and Sq19; Lu99, 86-2, Sq19 and Ma10; and A549, 86-2, and Sq19 cell lines, respectively. PTEN was not expressed in Sq19, and LKB1 was not expressed in both A549 and Sq19. TP53 was not expressed in both A549 and Lu99. The combination of cetuximab and EGFR siRNA significantly suppressed cell proliferation in 86-2, Sq19 and Ma10, which express wild-type KRAS. It induced apoptosis in A549, 86-2 and Ma10 cells, which express wild type PTEN. The combination treatment had no effect either on cell invasion nor migration in all cell lines. [Conclusion] EGFR targeted therapy using the combination of cetuximab and EGFR siRNA is effective in NSCLC cell lines harboring wild-type EGFR. Wild-type KRAS may act as a potential biomarker for response to combination treatment by the induction of apoptosis in cells with wild-type PTEN

Evaluation of antigen-positive toxin-negative enzyme immunoassay results for the diagnosis of toxigenic Clostridium difficile infection

Clostridium difficile (C. difficile)-associated diarrhea (CDAD) is a challenging nosocomial infectious disease. C. DIFF Quik Chek Complete assay is widely used to detect glutamate dehydrogenase (GDH) antigen and toxin A/B of C. difficile simultaneously. However, the interpretation of GDH positive/toxin negative results is problematic.We performed a retrospective study of patients with GDH positive/toxin negative results to determine the probability of detecting toxigenic C. difficile and its risk factors. Between April 2012 and March 2017, we investigated cultures of fecal specimens followed by toxin detection tests. The clinical histories of patients with and without toxigenic C. difficile were compared using univariate- and multivariate-analyses. In total, 2675 patients were examined using C. Diff Quik Chek Complete assay. Among 356 GDH positive/toxin negative patients, cultures were performed in 220 cases and toxigenic C. difficile was recovered from 139 (63.2%) specimens. Patients with toxigenic C. difficile had significantly lower body mass index than those without. Over half the GDH positive/toxin negative patients were infected with toxigenic C. difficile. Lower BMI was a CDAD risk factor in this patient population. These data can be utilized to initiate isolation and clinical interventions before confirmatory test results are available