Outbreak of aseptic meningitis due to ECHO-9 in northern Kyushu island in the summer of 1997.

An outbreak of aseptic meningitis caused by echovirus type 9 (ECHO-9) occurred between June and August 1997 in the Chikugo area, Fukuoka, Japan. Clinical manifestations and laboratory data of 317 children with aseptic meningitis were analyzed. The age of the patients ranged from 1 month to 12 years with the highest incidence in 4 years old children. The male: female ratio was 2.0:1.0. Symptoms of the meningitis included fever (100%), headache (89.5%) and nausea and/or vomiting (85.6%). Skin rash was not frequent (2.2%) in contrast to previous reports of ECHO 9 infections. The number of white blood cells (WBC) in cerebrospinal fluid (CSF) ranged from 10 to 3,493 cells/microliter (median; 412 cells/microliter). The neutrophils were more than 50% of the WBC in CSF in one-fourth of the patients at diagnosis. Enteroviruses were identified from CSF utilizing virus culture and enterovirus-specific RT-PCR, and ECHO-9 infection was determined by antibody titer of paired sera. Finally 44 patients were diagnosed virologically or serologically as aseptic meningitis caused by ECHO-9. Sequence analysis revealed that two strains of ECHO-9 isolated from CSF in this epidemic were closely related to ECHO-9 virulent strain Barty.

Aspergillus osteomyelitis in a child who has p67-phox-deficient chronic granulomatous disease.

Here we describe Aspergillus osteomyelitis of the tibia in a 9-year-old boy who has an autosomal recessive form of chronic granulomatous disease (CGD). The patient showed a p67-phagocyte oxidase (phox) deficiency, which is rare type of CGD in Japan. The initial treatment which consisted of surgical debridement and antibiotic therapy with amphotericin B (AMPH), did not control the infection. Aspergillus fumigatus (A. fumigatus) pure isolated from drainage fluid and necrotic bone tissue demonstrated less susceptible to antifungal agents, including AMPH, fluconazole and flucytosine. Recombinant interferon gamma was then administrated, and it was effective in controlling the course of severe invasive aspergillosis. This report indicates the use of interferon gamma might be helpful in control for Aspergillus osteomyelitis of the tibia in a child with CGD demonstrated p67-phox deficiency refractory to conventional therapy with AMPH.

[Plasmodium falciparum infection in a 8-year old boy].

A 8-year old Japanese boy who returned from Tanzania was admitted to our hospital because of fever, vomiting, and headache. He was diagnosed as a Plasmodium falciparum infection verified by a blood smear. He was treated with quinine and halofantrine, and recovered completely. Malaria infection should be considered when patients return from Malaria endemic areas.