Ninety-four patients of tick bite from hard ticks (Acari: Ixodidae) who visited 8 medical institutions in Gifu Prefecture from 1990 to 2015 were summarized. The patients group included 41 males and 51 females, and the average age was 55.0. Most patients visited from April to July. In this study, the most common species was Amblyomma testudinarium, which was rarely reported in the adjacent prefectures, Toyama and Ishikawa. Among the ticks, 47.4%, 32.8%, and 18.1%, were nymphs, adult females, and larvae, respectively. Ticks were found widely on the trunk, head/neck, lower extremities, and genital/inguinal parts. Although one patient had cellulitis-like swelling; and another had a fever, they recovered without any sequelae.
A 41-year-old Japanese man presented with a blue nodule on the dorsum of the left foot and left lower leg that had been first observed 11 years earlier; it had been diagnosed as pseudo-Kaposi's sarcoma based on a skin biopsy. There had been no significant changes for 10 years, but multiple bluish-purple nodules appeared on his left sole 2 months before presenting to our clinic. These lesions were ulcerated with uncontrolled hemorrhages. Purpura and bluish papules also appeared on the dorsum of the left foot and lower leg. He was diagnosed histopathologically with angiosarcoma. The tumor progression was not inhibited by weekly treatment with paclitaxel or oral pazopanib. The patient died 5 months after the diagnosis was made. We reevaluated the skin sample taken 11 years earlier. Histopathologically, dilated vascular structures in the dermis lined by hobnail endothelial cells were observed, suggesting retiform haemangioendothelioma or papillary intralymphatic angioendothelioma. These diseases are classified as intermediate grade in the World Health Organization classification. It appears that this intermediate-grade vascular tumor transformed into angiosarcoma, a high-grade malignant vascular tumor.
We reviewed 1,700 burn patients (male: 820, female: 880) who visited our hospital from April 2012 to March 2015. Among this group, 133 seriously injured patients (male: 78, female:55) had to be hospitalized. The causes of injury were scald burns (50%), contact burns (29%), and flame burns (11%), in order of prevalence. The majority of patients were children aged 0-2 years old (33%). Although scald burns were the most frequent cause of injuries at all ages, contact burns caused by items such as kerosene heaters and irons were relatively more frequent in childhood. Patients over 60 years old were more likely to suffer from severe injurirs caused by flame burns. The burn index (full thickness total burn surface area [TBSA]+1/2 partial thickness TBSA) of hospitalized patients scored 11 points< it had decreased 7 points from previous survey results in our hospital between 1998 and 2000.
Because Shimane is one of the prefectures in which rickettsiosis commonly occurs, an screening system for early diagnosis should be established as early as possible in each hospital in Shimane prefecture. The aim of this study is to establish such a screening system using polymerase chain reaction (PCR) for early diagnosis of rickettsiosis that would be available for clinical practice. Real-time PCR and nested PCR with DNA extracted from buffy coats, skin biopsy tissues, and crusts were utilized for the detection of the pathogen's specific genes in order to identify the pathogens using phylogenetic tree analysis. Ten cases of rickettsiosis were identified among eleven suspicious cases provided for analysis between September, 2011 and December, 2014. Early diagnosis using PCR and intervention with effective antibiotics in the early phase allowed nine out of the ten cases to be cured promptly. In contrast, the tenth case consulted a medical institution with a delay from the onset and ended up dying despite intensive care. It is necessary to establish the screening system for early diagnosis of rickettsiosis in clinical practice.