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Volume 86 (2012)
- Issue 6 Pages 715-
- Issue 5 Pages 555-
- Issue 4 Pages 393-
- Issue 3 Pages 274-
- Issue 2 Pages 103-
- Issue 1 Pages 1-
Volume 86, Issue 3
Displaying 1-7 of 7 articles from this issue
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Original Article
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Kunio EDA, Shigeru OTAGURO, Takashi MATSUSHIMA, Atsuhiko SHINAGAWA, Hi ...2012 Volume 86 Issue 3 Pages 274-281
Published: May 20, 2012
Released on J-STAGE: April 12, 2013
JOURNAL FREE ACCESSAn epidemic situation of pandemic (H1N1) 2009 was investigated from August 1 to March 31 in Iki City, an isolated island with a population of about 30,000. All members of the Iki Physiciansʼ Association participated in the investigation. Daily reports of patients with influenza were made to the local health center. During the outbreak, 2,024 individuals were clinically diagnosed as having influenza, or with the rapid diagnostic test. The prevalence was highest among patients 10-19 years of age (26.8%), followed by patients 9 years and under (21.3%). The prevalence was lowest in patients over 60 years (0.4%). Of the 2,024 patients, 1,443 (71.3%) were 19 years of age or younger. Only seven of the 2,024 were admitted to the hospital, and there were no deaths. When the first outbreak occurred, many individual classes and some schools were closed, and subsequently the number of cases rapidly decreased. A second outbreak occurred three weeks later. The same procedures were taken and the outbreak came to an end. A vaccination program for A (H1 N1) pdm09 virus was implemented according to the Japanese National Ministry of Health guidelines, one time for persons aged 13 years or over and twice for those 12 years or younger. To test for antibodies to pandemic A (H1N1) pdm09 after the outbreak, 358 serum samples were collected from Aug to Nov 2009, and the HI titer was measured. 205 (57.3%) were HI titer ≧1 : 40. The factor most closely related to a 40 HI titer ≧1 : 40 was A (H1N1) pdm09 vaccination, followed by symptomatic influenza. Asymptomatic influenza accounted for 11%.
In conclusion, 71.3%of 2,024 A (H1N1) pdm09 patients were 19 years of age or younger. From an epidemiological perspective, school and class closures were considered to be very effective in controlling the spread of the disease.View full abstractDownload PDF (766K)
Case Report
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Kensuke FUKUMITSU, Yujiro SUZUKI2012 Volume 86 Issue 3 Pages 282-286
Published: May 20, 2012
Released on J-STAGE: April 12, 2013
JOURNAL FREE ACCESSA 30-year-old woman was admitted to our hospital with high fever and chest pain. She had a ventricular septal defect, but was asymptomatic and had not undergone surgical repair. She also had had atopic dermatitis since childhood that had not been adequately treated. Chest computed tomography showed multiple peripheral nodules and infiltrates in both lungs. A transthoracic echocardiogram detected vegetation on the wall of the right ventricle, and Staphylococcus aureus was cultured from a peripheral blood sample. She was diagnosed as having a septic pulmonary embolism associated with right-sided infective endocarditis caused by S. aureus. She was treated with Cefazolin, resulting in gradual improvement of laboratory and chest radiographic findings. Recent studies have revealed that atopic dermatitis is one of the risk factors for infective endocarditis. In this case, uncontrolled atopic dermatitis might have caused the right-sided infective endocarditis.View full abstractDownload PDF (484K) -
Hirofumi KATO, Naoki YANAGISAWA, Shugo SASAKI, Tomohiro HOSODA, Akihik ...2012 Volume 86 Issue 3 Pages 287-290
Published: May 20, 2012
Released on J-STAGE: April 12, 2013
JOURNAL FREE ACCESSWe report a case of a 45-year-old Japanese man with AIDS-associated Kaposiʼs sarcoma (KS) involving skin, liver, and lungs. Antiretroviral therapy was started in conjunction with pegylated liposomal doxorubicin (PLD). A clinical response was observed initially, but symptoms recurred following cessation of medication. The chemotherapeutic agent was changed to paclitaxel (PTX), since the therapeutic response to PLD was reduced and the total dose reached the maximum dose of 500mg/m2. The patient had a good response to PTX and tolerated the medication well. Symptoms did not recur after completing 8 courses of chemotherapy. PTX should be considered as an alternative agent in treating KS when there are problems with the use of PLD.View full abstractDownload PDF (469K) -
Yukihiro YOSHIMURA, Natsuo TACHIKAWA, Takayuki OOSAWA, Youko KOSUGE, K ...2012 Volume 86 Issue 3 Pages 291-294
Published: May 20, 2012
Released on J-STAGE: April 12, 2013
JOURNAL FREE ACCESSParacoccidioidomycosis (PCM) is the most common systemic fungal disease in central-south America,but is rare in Japan. We experiensed a case of PCM in a patient, who came from Bolivia and presented with mouth pain and reduced dietary intake but no fever. Adrenal insufficiency was diagnosed with extremely high serum adrenocorticotropic hormone (ACTH) and was resolved with hormone supplementation. The PCM was treated with trimethoprim-sulfamethoxazole which was switched to itraconazole and improvement was achieved.View full abstractDownload PDF (564K) -
Naoki IWANAGA, Shigeki NAKAMURA, Akitaka TANAKA, Yuichi FUKUDA, Yoshif ...2012 Volume 86 Issue 3 Pages 295-299
Published: May 20, 2012
Released on J-STAGE: April 12, 2013
JOURNAL FREE ACCESSA 73-year-old man was admitted to our hospital with a high fever and left paresis. A rapid diagnosis test was positive for influenza A was positive by rapid diagnosis test and diffusion-weighted MRI imaging of the brain showed a high intensity lesion of the right cerebral peduncle. The patient was therefore diagnosed as having influenza A virus infection complicated with lacunar infarction. In spite of initial treatment with oseltamivir and anticoagulant therapy, he lost consciousness eight hours after admission. The high intensity lesion of the cerebral peduncle enlarged and new lesions in the thalamus, hippocampus and calcarine cortex were detected with brain MRI. Additionally, an electroencephalographic study showed an entire slow wave and as the other causative pathogens of central nerve system infection were not detected, the likely diagnosis was influenza-associated encephalitis. We administered a high dose of intravenous immunoglobulin since the low-grade fever and mild unconscious state had continued in spite of the treatment with methylprednisolone pulse therapy. His consciousness was restored and body temperature became normal immediately. We could confirm the efficacy of our treatment by measurement of IL-6 levels in the serum and cerebrospinal fluid during the entire clinical course. In conclusion, a high dose of intravenous immunoglobulin therapy might be one of the effective treatments for influenza-associated encephalitis.View full abstractDownload PDF (564K) -
Minako MORI, Tomoya KITAGAWA, Yuya SASAKI, Kazuyo YAMAMOTO, Takashi ON ...2012 Volume 86 Issue 3 Pages 300-305
Published: May 20, 2012
Released on J-STAGE: April 12, 2013
JOURNAL FREE ACCESSA 63-year-old man had been treated with intensive chemotherapy for acute myeloid leukemia. On the 49th hospital day, he had febrile neutropenia after the second course of induction chemotherapy. On the 53rd hospital day, he presented with hemoptysis and developed acute respiratory failure requiring ventilator support within several hours. On the 54th hospital day, the patient died with hemorrhagic respiratory infection. Stenotrophomonas maltophilia was detected in bacterial cultures of his blood, bronchoalveolar lavage, and sputum. To our knowledge, nine cases of fatal hemorrhagic pneumonia causedby S. maltophilia have been reported in the literature. All the patients had hematological neoplasms and were severely neutropenic after one or two intensive chemotherapy regimens. They died shortly (within 3 days) after the onset of the hemorrhagic pneumonia. Management of the infection caused by S. maltophilia is hampered by high-level intrinsic resistance to multiple antibiotics and the increasing occurrence of acquired resistance to co-trimoxazole and fluoroquinolones. It would be important to keep in mind that hemorrhagic respiratory infection caused by S. maltophilia may lead to a fulminant and lethal course in severely neutropenic patients with hematological neoplasms and to recognize which antibiotic agents are more sensitive to S. maltophilia in each institution.View full abstractDownload PDF (660K) -
Hiroyuki YAMASHITA, Yo UEDA, Yuko TAKAHASHI , Akio MIMORI2012 Volume 86 Issue 3 Pages 306-309
Published: May 20, 2012
Released on J-STAGE: April 12, 2013
JOURNAL FREE ACCESSThe patient was a 74-year old male who presented with a skin rash, cough, and impaired consciousness. Adiffuse, systemic, dark red rash was observed and he was admitted. Varicella infection was diagnosed based on the varicella-zoster virus (VZV)-IgM levels. The extremely high VZV- IgG levels observed were unlikely to be present inaninitial infection and the infection was thought to be a reoccurrence. Diffuse nodular shadows measuring ≤5mm indiameter were observed on chest computed tomography (CT) ; this was consistent with the typical imaging findings of varicella pneumonia.
The cerebrospinal fluid (CSF) was positive for CSF VZV-IgM antibody, CSF VZV-PCR, and CSF antibody titer index. A diagnosisofvaricella meningitis was made. When both respiratory and neurological symptoms are observed inpatients with varicella infection, it is necessary to consider a combined diagnosis of varicella pneumonia and varicella meningitis/encephalitis and perform chest imaging and a CSF examination. Repeated asymptomaticre-infection isconsidered necessary in order to maintaina life long immunity to varicella ; however, the opportunities for asymptomaticre-infection are decreasing with the declining birth rate and trend toward small families. As a result, reoccurrences of varicella infection in the elderly are expected to increase with rapidlyincreasing longevity.View full abstractDownload PDF (329K)
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