Survey of veterinary professionals for antibodies to Bartonella henselae in Japan.

The seroprevalence of Bartonella henselae among veterinary professionals in Japan was investigated by means of an immunoperoxidase (IP) test that used protein A-horseradish peroxidase conjugate. Sera were obtained from 233 veterinary professionals in the Tokyo and Chiba areas. As negative control group, sera from 155 healthy individuals (all medical students) were used. As positive control group, sera from 5 patients highly suspected of cat scratch disease (CSD) by clinical symptoms were tested. Serum antibody titers of > or = 200 to B. henselae were presumed seropositive, because the titer at which about 95.5% of all healthy individuals (148 of the 155) were negative, and 2 of the 5 suspected CSD patients' serum antibody titers were > or = 200. Of the individuals in the veterinary professionals group tested, 35 of the 233 (15.0%) were seropositive for B. henselae. Females were nearly twice as likely as males to have antibodies to B. henselae in the veterinary professionals group. Our data suggest that Japanese veterinary professionals, and in particular younger females who are veterinary assistants and animal beauticians are more often infected by B. henselae.

A study on task-analysis of clinical pathologists as medical consultants in Nihon University Hospital--a Japanese perspective by comparison with current status in the USA.

To identify our role and the customers' satisfaction, the on-call consultation service records of the Department of Clinical Pathology, Nihon University School of Medicine, Itabashi Hospital (NUIH), were analyzed. Between 1995 and 1998, 1,789 consultation services were recorded, and approximately 40% were from physicians, and 50% were from medical technologists. During office hours, many physicians made contact with us at the office of clinical pathology, the clinical laboratory and other places in the hospital by various means. They asked us to interpret multidisciplinary laboratory data, and to provide the specific information that might affect clinical management. Medical technologists asked for clinical information of patients with extreme measured values and requested that we contact with physicians. In contrast, on weekends/holidays or after routine working hours, physicians sometimes requested non-automated laboratory tests such as peripheral blood smears/bone marrow smears or Gram stains. The major contents of our responses to medical technologists were concerned with blood banking and handling of instruments not to be operated in routine work. These results reconfirm that we are still required to have clinical competence for common laboratory procedures and to have the capability of interpretation of multidisciplinary laboratory data in the university hospital. Traditionally, most Japanese clinical pathologists have been focused their attention on bench work in research laboratories. However, the present study shows that the clinical pathologists need to bridge the real gap between laboratory technology and patient care. Our on-call service system can enhance the education of clinical pathologists, and improve not only laboratory quality assurance but also patient care. In addition, in response to a need for customer access to this service with a shortage of clinical pathologists, a more effective method would be to set up a proactive systemic approach in a more rigorous academic environment adopting advances in medical informatics.

[Two cases of pasteurellosis accompanied by exudate with semen-like odor from the wound].

We encountered two cases of Pasteurella multocida subsp. septica isolation from exudates with seminal fluid-like odor from dog scratch and cat bite. Case 1: A 78-year-old male who had been diagnosed as having diabetes mellitus five years ago was scratched by the claw of a pet dog (Pekinese) on the back of the right hand. Since inflammation ascended to the arm, the patient visited Nihon University Itabashi hospital for a medical examination. Case 2: A 51-year-old female without a specific past history other than hyperlipidemia was bitten by a pet cat at the medical and lateral sides of the left carpus. The patient immediately opened the wound and washed it with tap water, followed by disinfection using a non-iodine disinfectant at home. Two hours later, the patient felt an unpleasant sensation and smelled a seminal fluid-like odor at the wound. The next morning, the entire left arm swelled and pain worsened, then the patient sought medical attention. The patients were treated with antibiotics and the wound completely healed on the 16 days from on set in Case 1 and on the 10 days from onset in Case 2. From these two cases, Pasteurella multocida subsp. septica was isolated from the exudate, suggesting that when wounds caused by animals smell like seminal fluid, the wound is infected with Pasteurellae. This finding may be an important clue for differentiation in clinical diagnosis.

Detection of Coxiella burnetii specific DNA in blood samples from Japanese patients with chronic nonspecific symptoms by nested polymerase chain reaction.

The nested polymerase chain reaction (PCR) was used for direct species-specific detection of Coxiella burnetii in blood samples from 52 patients with chronic nonspecific symptoms, but no diagnostic or treatment history of Q fever. All patients had been in ill-health with general fatigue, muscle and joint pain, headache, etc., for one to more than 10 years. Seventeen (33%) showed evidence of C. burnetii infection, based on amplification of 438-bp fragments specific to C. burnetii by nested PCR, and 94% of positive patients reported close contact with animals. In contrast, five (9.6%) of 52 samples from healthy adult controls and two (2.8%) of 70 cord blood samples were positive by nested PCR. These data suggest a high prevalence of infection among adult patients with long term, nonspecific complaints who live in close contact with animals and the possible existence of a chronic post-acute Q fever syndrome in Japan.

[A study on wounds caused by cats as basic materials of cat scratch disease].

Between October, 1992 and March, 1993, the incidence of bite or scratch by the cat, was surveyed by questionnaire in 1,619 peoples who were veterinarians, veterinary technicians, students and the general population (male 652, female 967). The wound rate by cat: Veterinarians, veterinary technicians, students of veterinary college, students of veterinary technician school were significantly higher than the general population. Incidence of bite or scratch in the cat owner were significantly higher than the non cat owner, and the incidence of wounds in cat owners was more than 90%. Most injuries for veterinarians were of the occupational nature. Their injuries clearly differed from those of the other groups. In our survey 33 cases were suspected to have CSD; 19 of 102 veterinarians, 4 of 45 veterinary technicians, 2 of 517 students of veterinary college, 1 of 400 students of veterinary technicians, 7 of 555 in the general population. Of the seven cases suspected for CSD among the general population, four were proven to have cat-scratches, suggesting that injuries can be prevented by clipping the cat's nails at home. However, most of the injuries suffered by veterinarians are caused by bites, prevention poses a more serious problem. It is therefore important to educate people in all fields to fully understand sanitation and zoonosis including CSD, and teach them to handle their pets appropriately.

[Studies on respiratory infection with Pasteurella multocida].

A questionnaire style survey on Pasteurella multocida infection was conducted at on 528 laboratories of hospitals. The questionnaire included the detection of Pasteurella multocida from sputum, the age distribution, underlying disease etc. of the patients. In Japan, infectious diseases caused by Pasteurella multocida were found in 179 cases in 67 (26.0%) of the 258 hospitals. The incidence of the infections tends to increase, 18 cases in 1989, 25 cases in 1990, 18 cases in 1991 (Jan.-Jul.). These 179 cases were broken down into 44 males (from 1 year old to 85 years old, mean 58.9 years old), 45 females (from 18 years old to 85 years old, mean 60.2 years old), and 90 patients whose sex was unknown. Underlying diseases were recognized in 72 cases. Diseases related to the respiratory organ were 61 (84.7%) cases. The cases of hemo-sputum had to be differentiated from malignant tumors Recurrent Pasteuralla multocida infections were recognized in 4 males and 4 females. And the 4 cases had been handling animals. There were only 26 cases who had contact with animals, the others were unknown. This result suggested that contact with animals may cause these infections. Recently, the detection of Pasteurella multocida from the sputum tends to increase. The elderly patient with chronic pulmonary disease, who is handling animals must be educated on hygiene and zoonosis.

[Current status of Pasteurella multocida infection in Japan].

Recently, the case reports of Pasteurella multocida infection has been increasing in Japan. In 1989, the Japanese Government, Veterinary Sanitation Division, Ministry of Health and Welfare officially communicated this infection as a zoonosis to related institutions. The current status of Pasteurella multocida infection is not well known in Japan. Because of this, a nation wide questionnaire survey on Pasteurella multocida was conducted to clarify the status. A questionnaire was sent to 380 laboratories of the hospitals, and 258 (67.9%) replied. An infectious disease caused by Pasteurella multocida was found in Japan in 369 cases in 115 (44.6%) of 258 hospitals, or an average of 3.2 cases per hospital. The 369 cases were broken down into 123 males (from 1 month old to 87 years old), 118 females (from 7 months old to 88 years old), and 128 patients whose sex was unknown. The incidence of the infections tends to increase year by year. This incidence is higher than our expectation. It is considered that the contact with pets will in increase the infection with this agents. The organism was isolated in as many as nineteen different body specimens, including the appendix and urine, which in Japan has not been reported as organs harboring this organism. Some of the nineteen cases were severely infected. This organism was isolated most often from the sputum (48.5%). Pus was the next most common site (27.1%). This order was reversed in the U.K. and the U.S.. Possible explanations for the reversal are given below.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of cat scratch disease: from the clinical pathological point of view].

We described a forty-four-year-old female who was scratched by her cat, and developed lymphadenopathy. Cat scratch disease skin-test was positive. Cat scratch disease is well known, but there are not many reports in Japan. Reports of cat scratch disease will increase as the pathogen was recently detected. Attention must be drawn to zoonosis containing cat scratch disease.

Questionnaire surveys of cases of tick bite and Lyme borreliosis in hunters in Hokkaido with reference to detection of anti-Borrelia burgdorferi antibody.

An epidemic of Lyme borreliosis on Hokkaido island, Japan, was surveyed by questionnaire in 587 hunters. The 308 returns (52.4%) revealed episodes of tick bite (usually 2 or more) in 210 cases. Skin rashes appeared in 164 cases. Associated itching, pain, etc., but not skin rash, were more frequent after 2 or more tick bite. Previous determinations of anti-Borrelia burgdorferi antibody titers in these subjects and in controls suggested an association with outdoor activities other than hunting, and among 33 cases of dermatological symptoms and 23 of articular symptoms, 4 and 2, respectively, were antibody-positive. Most of these antibody-positive subjects had suffered tick bite at least twice, but had had no antibiotic treatment. Three subjects with joint disorders were antibody-positive. These findings suggested that the many hunters exposed to Borrelia burgdorferi frequently carried latent infections, and that some had latent form of arthritis, dermatitis and other disorders.

[Detection of intestinal parasites from dogs in Tochigi-City in 1979 and 1991].

To clarify whether sanitary and hygienic conditions surrounding humans and pet animals have improved or not, we examined feces from dogs for intestinal parasites in Tochigi in 1979 and 1991. Intestinal parasites were detected from 109 of the 262 dogs (41.9%) in 1979 and 86 of the 260 dogs (32.8%) in 1991. Among the parasites. Ancylostoma caninum, Tirchuris vulpis and Toxocara canis were most commonly detected, and their detection rates were higher in 1979. On the contrary, Dipylidium caninum, Strongyloides stercoralis, Isospora spp., which are important causes of human diseases, were detected at higher rates in 1991. In the dogs of outdoor feeding, the detection rates of parasites were markedly decreased, but slightly increased in the dogs of indoor feeding in 1991. These results suggest that sanitary conditions surrounding pet animals have not been sufficiently improved, in spite of the fact that humans are in more contact with their pet animals.

[Studies on the giardiasis as the zoonosis. III. Prevalence of Giardia among the dogs and the owners in Japan].

To obtain the basic data on the route of Giardia infection as zoonosis, of many regions in Japan, the feces from 2218 dogs were examined for detection of Giardia cysts. Giardia cysts were detected in 239 of the 2218 dogs (10.9%), which was the same as previous reports from America. None were found from the owners of 51 dogs in which Giardia cysts were detected. The detection rates of each facilities were, 68 of 366 (18.6%) from the breeder's kennels, 169 of 1811 (9.3%) in individual houses, 2 of 42 (4.9%) from research institutes. The detection rate of the breeder's kennels was higher than the other two facilities (p less than 0.05, p less than 0.001). The detection rates of Kanagawa and Shizuoka prefectures among 17 regions in Japan were higher than the others (p less than 0.001, p less than 0.05). Especially in Shizuoka, the rate of the individual houses was higher than from breeder's kennels. In kanagawa the rates of the individual houses and the breeders kennels were higher than the mean in Japan (p less than 0.001). Therefore one must instruct the breeders when teaching health education to included zoonosis, and that the detection rate of the age groups of less than 3 years old was high-221 of 1276 (17.3%). Since the detection rates of Giardia cysts in the dogs were low, the possibility that human infection acquired from dogs was low. However, some of patients with giardiasis we encountered had never been abroad, and it is not yet clear whether Giardia is strictly host specific or not, so attention should be paid to the possibility of cross-infection between man and animals.

[Clinicobacteriological study of Pasteurella multocida infection as a zoonosis. (2)--Comparisons of P. multocida separated from patients and their pet dogs and cats].

A total of 17 strains of Pasteurella multocida, of which 13 were isolated from patients treated at Nihon University Itabashi Hospital or Nihon University Surugadai Hospital between April, 1984 and March, 1991 and 4 from 1 dog and 3 cats kept by the patients, were evaluated with respect to their biochemical properties, sensitivity to drugs, and serotype. The isolated strains were all considered to be Pasteurella multocida subsp. multocida because of the agreement of their responses to indole, sorbitol and dulcitol with those of this subspecies, except for 1 sorbitol-negative strain of Pasteurella multocida subsp. septica isolated from 1 patient who had been bitten by a cat. All the isolated strains showed high sensitivities to various drugs. The serotype was capsular type A, which is often observed in cats and dogs, in 7 strains, which consisted of 6 of the 7 strains derived from the airway of the patients and 1 of the 6 strains derived from bit or scratch wound. The remaining strains could not be classified. Five morphological types, namely 1, 3, 3.8, 6, and 8 were observed. In 2 patients, Pasteurella multocida subsp. multocida of the same serotype was also isolated from their cats. One of these patients had intimate contact with the cat including kissing. Our findings suggest that: 1) Pasteurella multocida subsp. multocida has been responsible for most conventional cases of Pasteurella multocida infection. 2) Strains isolated from patients differ in the capsular type according to the disease.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinicobacteriological study of Pasteurella multocida as a zoonosis (1). Condition of dog and cat carriers of Pasteurella, and the influence for human carrier rate by kiss with the pets].

Pasteurella multocida is a gram-negative short rod-shaped bacteria, which is a part of the indigenous flora of the oral cavity of many animals other than man. The number of reports on cases of infections with this bacterium due to animal bites and/or scratches, bacterial infections of the respiratory tract, sepsis due to this organism and death caused by the bacteria have been increasing in recent years. We investigated P. multocida in the hair and oral cavity of 3 dogs and 29 cats according to the classification of Mutters et al.. We also studied the relationship between the carrier rate for Pasteurella in the oral cavity and kissing of pets in 24 pet owners (3 dogs and 11 cats). No P. multocida was isolated from the hair of neither dogs nor cats. One strain of P. multocida subsp. multocida and two strains of P. stomatis, were isolated from the oral cavity of dogs, and 35 strains of Pasteurella were isolated from the oral cavity of cats. Two strains of P. multocida subsp. multocida, whose biochemical properties were different, were detected in the oral cavity of one cat. In three cats, Pasteurella other than P. multocida subsp. multocida was isolated from the same oral cavity. No Pasteurella was detected in the oral cavity of 19 pet owners who had not kissed their cats, whereas P. stomatis was isolated from the oral cavity of one of 2 pet owners who had kissed their cats and in 2 of 3 pet owners who had kissed their dogs (the same bacteria was isolated from a dog that was being kept by some of these positive pet owners).(ABSTRACT TRUNCATED AT 250 WORDS)

[The first report of human chronic sinusitis by Pasteurella multocida subsp. multocida in Japan].

A 53-year-old male visited our hospital due to nasal obstruction persisting for 6 months and constant rhinorrhea. Pasteurella multocida subsp. multocida was isolated from his nasal discharge and lavage fluid of the maxillary sinus, and also from the oral cavity of the dog he kept. The bacterial strains isolated from the patient and dog were identical in terms of biochemical properties, and drug sensitivity. Although serotype was different, the strain from the patient showed (A:6) and that from his dog showed (A:5). The microorganism is not present in the general environment. The patient had contact with his dog such as he kissed it frequently, gave it food with his chopsticks et al.. From the mouth of the people who kiss one's dog, we detected Pasteurella of the same character of bacteria as from the mouth of the dog. We detected two Pasteurella multocida of different character from only one mouth of a cat. Pasteurella multocida was checked in only one colony for sero type. Sero type A is the popular type for dogs and cats. The above suggest that their was a high possibility that the Pasteurella multocida subsp. multocida found in the patient was from his dog. In Japan, the incidence of Pasteurella multocida subsp. multocida infection has been increasing. In 1969, the Japanese Ministry of Health and Welfare officially communicated this infection as a zoonosis to related institutions. At both medical and surgical departments, wither the patient keeps a pet should be confirmed during interview, and guidance of pet keeping methods is important in some cases from the aspect of clinical bacteriology.(ABSTRACT TRUNCATED AT 250 WORDS)

[Study of the anti Borrelia burgdorferi antibody of hunters in Hokkaido].

We examined the sera of 587 hunters in Hokkaido (Japan's northernmost island) for the antibody to Borrelia burgdorferi (B. burgdorferi) by enzyme immunoassay, clarified the conditions related to antibody positivity in these subjects according to region, and studied the effects of factors such as age and lifestyle on the antibody titer. In contrast with an anti-B. burgdorferi antibody positive rate of 7.1% in control sera, that in the hunters' sera was 16.0%. Among those positive for the anti-B. burgdorferi antibody, the antibody positive rate in sera excluding those testing positive in the serological test for syphilis was 5.5% in the controls, and 15.4% in the hunters, the latter rate being significantly higher (p less than 0.05). In both hunters and control groups, the antibody-positive rate tended to be higher in older subjects, but the antibody titer showed no correlation with their age, or the duration of their hunting experience. Examination of the hunters' occupations revealed a tendency toward high titers in those engaged in dairy farming. The antibody positivity of those who went gathering edible wild plants was significantly higher than those did not (p less than 0.05). These observations suggested that the high antibody-positive rate in hunters may have been due largely to the effect of activities other than hunting as sources of infection by Borrelia.

[A case of Pasteurella multocida subsp. multocida complicated with diabetes mellitus].

We report a case of sepsis who died caused by Pasteurella multocida subsp. multocide sepsis. A 68-year-old male was admitted to Azusawa Hospital because of disturbance of consciousness. He had been suffering from diabetes mellitus combined with gangrene, but received no treatment. The patient died 24 h after hospitalization, and Pasteurella multocida subsp. multocida was isolated from his blood. Laboratory tests showed that CRP; 5+ WBC; 15,400/microliters, TP; 5.2 g/dl. Although Pasteurella multicida subsp. multocida seemed to cause mild infection in healthy subjects, it can cause severe systemic illnesses such as sepsis and meningitis in compromised hosts. It should be considered that the contact with pets will increase the incidence of systemic severe infection with this agents.

[Anti-Borrelia burgdorferi antibody in dogs: Lyme disease as zoonosis].

To obtain epidemiological data on human Lyme disease (LD) in Japan, anti Borrelia burgdorferi (Borrelia) antibody was measured in dogs by enzyme-linked immunosorbent assay (ELISA). The anti-Borrelia antibody titer was high in 106 (27.3%) of 387 clinically healthy dogs that may have a chance of tick bite but not in any of 31 negative control dogs not exposed to ticks; the difference of the antibody titer between two groups was significant. However, no signs of arthritis were observed in any of the 106 dogs with a high anti-Borrelia antibody titer. The antibody titer was also significantly differed between the age groups less than 1 year old and 1 year old or more, the group maintained indoors and that maintained outdoors, the group with tick bites and that without tick bites, and hounds and the other dogs but not between males and females or the group vaccinated and that unvaccinated with leptospires. According to districts, high antibody titers were observed in 20% of the dogs or more in Hokkaido, Saitama, Kanagawa, Niigata, Kyoto, Kochi, and Fukuoka Prefectures. These districts were nearly consistent with the distribution of the ticks. Western blot analysis of serum samples with a high anti-Borrelia antibody titer showed 31-, 41-, 66-, and 83-Kd bands, which are also observed in sera of human patients with LD. Though no dog had clinical signs of LD, dogs serologically positive for Borrelia were detected throughout the country. The data suggested that there were the dogs infected by Borrelia burgdorferi in Japan. The data on anti-Borrelia antibody in dogs obtained by ELISA may be very useful for studying the epidemiology of LD in humans.