Jpn. J. Infect. Dis., 59, 2006

Laboratory and Epidemiology Communications

Salmonellosis of Infants Presumably Originating froman Infected Turtle in Nagasaki, JapanHaruki Kaibu*, Kunihiro Iida, Shinsuke Ueki, Hiroko Ehara, Yuuko Simasaki,
Hitosi Anzai1, Yuuichirou Toku2 and Satosi Shirono3
Nagasaki City Laboratory of Public Health and Environment, Nagasaki 852-8104;
Nagasaki City Public Health Center, Nagasaki 850-8685; and 2Department of Pediatrics and3
Department of Clinical Laboratory, Nagasaki Municipal Hospital, Nagasaki 850-8555, Japan1

Communicated by Haruo Watanabe(Accepted June 23, 2006)
The patient was a 6-year-old boy who began to experience
vomiting and diarrhea on November 8, 2005. He consulted ahospital in Nagasaki City on November 10, and on the same
day he was admitted under suspicion of acute gastroenteritis.
On the day of the admission his laboratory data included awhite blood cell count of 5,000/μl and C-reactive protein
level of 2.24 mg/dl, which suggested low level inflammation. A biochemical examination, including serum electrolytes
measurement, showed no abnormalities. The patient remainedstable, but the high fever, vomiting and diarrhea continued.
Suspected of bacterial enteric infection, he received oral
administration of fosfomycin (FOM) and intravenous administration of flomoxef (FMOX). He responded well tothis treatment, gradually recovered and was discharged on
the 8th day after admission. As Salmonella serogroup O4 wasisolated from the fecal specimens collected on the day ofadmission, he was diagnosed with salmonellosis.
H typing conducted in our laboratory identified the isolate
as S. Schleissheim. Because the boy kept a turtle as a pet, weanalyzed a swab sample of the turtle’s body and a sample of
the water remaining in the filter of the aquarium. Serogroups
O4 and O8 Salmonella isolates were obtained from bothspecimens. The serogroup O4 was S. Schleissheim and theserogroup O8 was S. Litchfield. The XbaI-digested DNA
samples of the three S. Schleissheim isolates showed the same
pattern in pulsed-field gel electrophoresis (PFGE), indicating that the boy’s salmonellosis was caused by Salmonella
derived from the turtle (Fig. 1). The antibiotic-sensitivity
pattern was identical for all the three isolates.
We were later informed that, on October 21, several weeks
prior to the above event, his 9-year-old sister had experienced
fever, diarrhea, vomiting and bloody stool, and had been effectively treated with oral administration of FOM; Salmonella
spp. had been isolated from her. The turtle was Trachemys
scripta elegans, which was bought at a street stall on October
9 at a festival in Nagasaki City. The retail route of the turtle
was not clear.
Trachemys scripta elegans, whose original habitat is NorthFig. 1. Pulsed-field gel electrophoresis pattern of isolates. XbaI-digestsof the chromosomal DNA of the isolates were run (6 V/cm; pulse
time 2.2 - 54.2 s) on a 1% agarose gel for 19 h. Line 1, isolate fromthe 6-year-old boy; 2, swab sample of the turtle; 3, water remaining
in the filter of the aquarium. M, lambda DNA ladder as a molecularweight marker.

and South America, is imported into Japan in quantities ofseveral tens of thousands to a million per year, and now is themost common pet turtle in Japan. As salmonellosis tends tobe severe in infants and elderly people, the Nagasaki City
authority has issued a warning and produced a guide on thesanitary handling of pet turtles in families. In addition, the city
authority now collects more information on the activities ofpet shops and other animal handlers, and has intensified thesurveillance and the control of these activities.
We thank Prof. Yoshikura, Emeritus Researcher of the National Institute of Infectious Diseases, for advice on preparing
the manuscript.
This article appeared in the Infectious Agents Surveillance
Report (IASR), vol. 27, p. 71-72, 2006 in Japanese.

*Corresponding author: Mailing address: Nagasaki City Laboratory of Public Health and Environment, Morimachi 2-34, Nagasaki
852-8104, Japan. Fax: +81-95-846-4103, E-mail: kaibu_haruki@city.nagasaki.lg.jp281