Norio Ohmagari - Academia.edu (original) (raw)
Papers by Norio Ohmagari
Global Health & Medicine, 2019
includes "International Cooperation" as a unique 6th pillar additionally set in reference to the ... more includes "International Cooperation" as a unique 6th pillar additionally set in reference to the 5 pillars of the Global Action Plan, and a goal, strategy and countermeasures have been set for each area (Figure 1). Current status and challenges of antibiotic treatment in Japan The use of antibiotics in Japan is not particularly higher compared to that in Europe or the USA. However, in Japan oral antibiotics account for 92.4% of the total daily usage, and consists of third generation cephalosporins, macrolides and fluoroquinolone derivatives, which are so-called broad-spectrum antibiotics. Therefore, it is considered that the problem in Japan is the use of such broad-spectrum oral antibiotics (1). Higashi, et al. examined the national prescription database for the period from January to March 2005 and reported that approximately 60% of patients with non-bacterial upper respiratory tract infections were given antibiotics. The breakdown of the prescriptions was third generation cephalosporins (46%), macrolides (27%) and quinolones (16%) in descending order of frequency, and were prescribed more often at clinics than hospitals (2). Antibiotics may be prescribed to patients with the common cold for the purpose of pneumonia prophylaxis. Regarding this, a study was conducted to investigate how many patients with acute respiratory tract infection, including those with the common cold, need to be treated with antibiotics to prevent one patient from developing complications including pneumonia (3). The results showed that one case of complications could be prevented if 4,000 patients with acute respiratory tract infection would be given antibiotics. Considering the cost of antibiotics prescribed to 4,000 patients and the risks of adverse drug reactions and resistant bacteria, the prophylactic use of antibiotics to (71)
Nihon Naika Gakkai Zasshi, May 10, 2011
Journal of Infection and Chemotherapy, 2016
Chikungunya fever (CHIK) and Zika virus (ZIKV) infection have similar endemic areas and clinical ... more Chikungunya fever (CHIK) and Zika virus (ZIKV) infection have similar endemic areas and clinical manifestations. We report a case of CHIK at 1 year after a ZIKV infection in Bora Bora (French Polynesia), which we diagnosed based on IgM to the CHIK virus and neutralizing antibodies to ZIKV.
Nihon Naika Gakkai Zasshi, 2011
Antimicrobial agents and chemotherapy, Nov 6, 2016
Forty clinical isolates of multidrug-resistant Pseudomonas aeruginosa were obtained in a medical ... more Forty clinical isolates of multidrug-resistant Pseudomonas aeruginosa were obtained in a medical setting in Hanoi, Vietnam. Whole genomes of all 40 isolates were sequenced by MiSeq (Illumina), and phylogenic trees were constructed from the single nucleotide polymorphism (SNP) concatemers. Of these 40 isolates, 24 (60.0%) harbored metallo-β-lactamase encoding genes, including blaIMP-15, blaIMP-26, blaIMP-51, and/or blaNDM-1 Of them, 12 isolates harbored blaIMP-26 and belonged to ST235. Escherichia coli expressing blaIMP-26 was significantly more resistant to doripenem and meropenem than E. coli expressing blaIMP-1 and blaIMP-15 IMP-26 showed higher catalytic activity against dorimepen and meropenem than IMP-1, and against all carbapenems tested, including doripenem, imipenem, meropenem and panipenem, than IMP-15. These data suggest that clinical isolates of multidrug-resistant ST235 P. aeruginosa producing IMP-26 with increased carbapenem-hydrolyzing activities are spreading in medic...
![Research paper thumbnail of [Clinical experience of primaquine use for treatment of vivax and ovale malaria in Japanese travelers]](https://attachments.academia-assets.com/58590248/thumbnails/1.jpg)
](Kansenshogaku Zasshi the Journal of the Japanese Association For Infectious Diseases, 2013
The American journal of tropical medicine and hygiene, Jan 27, 2016
We report six cases of Salmonella enterica serotype Paratyphi A infections in travelers returning... more We report six cases of Salmonella enterica serotype Paratyphi A infections in travelers returning from Myanmar. In 2015, 31 cases of paratyphoid fever were reported in Japan, and 54.8% of those traveled to Myanmar. Among them, six patients presented to our hospital. They had traveled to Myanmar from July 2014 to August 2015 for business purposes. All six isolates were phage type 1, and they were resistant to nalidixic acid.
Japanese Journal of Infectious Diseases, 2013
We present the first reported case of systemic infection with Neisseria meningitidis serogroup W-... more We present the first reported case of systemic infection with Neisseria meningitidis serogroup W-135 sequence type (ST)-11 in Japan. A 44-year-old woman presented with high fever, sore throat, and fatigue and was diagnosed with N. meningitidis bacteremia. The causative strain was identified as serogroup W-135 ST-11 by polymerase chain reaction and multilocus sequence typing. Approximately 1 month after treatment, she developed high fever, dyspnea, chest pain, and shoulder pain due to pericarditis, polyarthritis, and tenosynovitis, which are all relatively common immunoreactive complications of W-135 ST-11 meningococcal infections. This causative strain was the same as that responsible for an outbreak of meningitis among Hajj pilgrims in 2000. The strain is now found worldwide because it can attain a high carriage rate and has a long duration of carriage. We suspect that our patient's infection was acquired from an imported chronic carrier.
BMC Research Notes, 2016
An increasing number of reports have documented the emergence of daptomycin-nonsusceptible Entero... more An increasing number of reports have documented the emergence of daptomycin-nonsusceptible Enterococcus in patients during daptomycin therapy. Even though several mechanisms for daptomycin-nonsusceptibility have been suggested, the potential genetic mutations which might contribute to the daptomycin-nonsusceptibility are not fully understood. We isolated a vancomycin-susceptible, daptomycin nonsusceptible Enterococcus faecium strain from a patient with acute lymphocytic leukemia who received high-dose daptomycin therapy for E. faecium endocarditis. Whole-genome sequencing analysis revealed mutations within genes encoding DNA repair proteins MutL and RecJ of the daptomycin-nonsusceptible Enterococcus strain which might have facilitated its emergence. We identified the mutations of DNA mismatch repair genes in a clinical isolate of daptomycin nonsusceptible E. faecium which emerged in spite of high-dose daptomycin therapy. The finding implicates the possible association of DNA repair mechanism and daptomycin resistance. Careful monitoring is necessary to avoid the emergence of daptomycin non-susceptible isolates of E. faecium and particularly in cases of long-term daptomycin use or in immunocompromised patients.
The incidence of human brucellosis in Kyrgyzstan has been increasing in the last years and was id... more The incidence of human brucellosis in Kyrgyzstan has been increasing in the last years and was identified as a priority disease needing most urgent control measures in the livestock population. The latest species identification of Brucella isolates in Kyrgyzstan was carried out in the 1960s and investigated the circulation of Brucella abortus, B. melitensis, B. ovis, and B. suis. However, supporting data and documentation of that experience are lacking. Therefore, typing of Brucella spp. and identification of the most important host species are necessary for the understanding of the main transmission routes and to adopt an effective brucellosis control policy in Kyrgyzstan. Overall, 17 B. melitensis strains from aborted fetuses of sheep and cattle isolated in the province of Naryn were studied. All strains were susceptible to trimethoprim-sulfamethoxazole, gentamicin, rifampin, ofloxacin, streptomycin, doxycycline, and ciprofloxacin. Multilocus variable number tandem repeat analysis showed low genetic diversity. Kyrgyz strains seem to be genetically associated with the Eastern Mediterranean group of the Brucella global phylogeny. We identified and confirmed transmission of B. melitensis to cattle and a close genetic relationship between B. melitensis strains isolated from sheep sharing the same pasture.
Journal of travel medicine, 2016
A live attenuated yellow fever (YF) vaccination is required of all travellers visiting countries ... more A live attenuated yellow fever (YF) vaccination is required of all travellers visiting countries where YF virus is endemic. Although the risk of serious adverse events (AEs) after YF vaccination is known to be greater in elderly people than in younger people, information about other AEs among elderly travellers is lacking. A prospective observational questionnaire study was conducted to investigate the occurrence of AEs after YF vaccination in travellers who attended a designated YF vaccination centre in Tokyo, Japan, from 1 November 2011 to 31 October 2012. A questionnaire enquiring about any AEs experienced in the 2 weeks following YF vaccination was distributed to all vaccinees enrolled in this study, and responses were collected subsequently by mail or phone. For child vaccinees, their parents were allowed to respond in their stead. Of the 1298 vaccinees who received the YF vaccine, 1044 (80.4%) were enrolled in the present study and 666 (63.8%) responded to the questionnaire. O...
The American journal of tropical medicine and hygiene, Jul 9, 2016
Owing to the increase in Salmonella strains with decreased fluoroquinolone susceptibility in the ... more Owing to the increase in Salmonella strains with decreased fluoroquinolone susceptibility in the endemic areas, we have been treating enteric fever with intravenous ceftriaxone empirically since 2007. In this study, we reevaluated our treatment protocol. This retrospective cohort study was conducted at a single institute in Tokyo, Japan, between January 2006 and December 2013. Enteric fever was defined as isolation of Salmonella Typhi or Salmonella Paratyphi A, B, and C from the blood and/or stool of patients with fever. Of the 35 patients with imported enteric fever, 28 (80%) had returned from south Asia. Ciprofloxacin-susceptible strains were detected in only 12% of the cases. The isolates showed excellent susceptibility to ampicillin (91%), chloramphenicol (94%), ceftriaxone (97%), and azithromycin (97%). One case of Salmonella Paratyphi B was excluded, and of the remaining 34 patients, 56% were treated with ceftriaxone alone, 26% with ceftriaxone then fluoroquinolone, and 9% wit...
Japanese Journal of Infectious Diseases, 2012
The aim of this study was to evaluate the in vitro combination effects of aztreonam (AZT) and ami... more The aim of this study was to evaluate the in vitro combination effects of aztreonam (AZT) and aminoglycosides against multidrug-resistant (MDR) Pseudomonas aeruginosa strains in Japan. We investigated 47 MDR P. aeruginosa strains collected from 8 facilities. We selected the aminoglycosides amikacin (AMK), gentamicin (GM), and arbekacin (ABK) to examine their effects when combined with AZT using the checkerboard method. Of the 47 MDR P. aeruginosa strains, 41 tested positive for metallo-β-lactamase (MBL). In all combinations, aminoglycosides decreased the minimum inhibitory concentrations of AZT in a dose-dependent manner, and there was no apparent antagonism. The combination effects were scored on a scale of 0 to 4, and statistical analysis was performed using the Wilcoxon signed-rank test. In all 47 strains, AZT + ABK (mean score, 2.02) had the highest score, followed by AZT + AMK (1.68) and AZT + GM (1.38) (ABK versus GM, P < 0.0001). In 41 MBL-positive strains, AZT + ABK (mean score, 2.05) had the highest score, followed by AZT + AMK (1.56) and AZT + GM (1.37) (ABK versus AMK, P = 0.02, and ABK versus GM, P < 0.0001). AZT + ABK was the most promising combination regimen against MDR P. aeruginosa strains; the other promising combinations were AZT + AMK and AZT + GM.
![Research paper thumbnail of [Second Japanese case of relapsing fever]](https://attachments.academia-assets.com/58590235/thumbnails/1.jpg)
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ABSTRACT Background: To the best of our knowledge, there are limited reports of enteric fever cas... more ABSTRACT Background: To the best of our knowledge, there are limited reports of enteric fever cases in returning travelers. Following the revision of levofloxacin and ciprofloxacin breakpoints by the Clinical Laboratory Standard Institute (CLSI) in 2012, we determined clinical characteristics, antibiotics susceptibility, and relapse risk factors for enteric fever in Japan. Methods: The retrospective cross-sectional study was conducted in a single institute in Tokyo, Japan between January 2006 and December 2013. Enteric fever was defined as isolation of Salmonella Typhi or S. Paratyphi from blood and/or stool in a patient with fever. Results: Of the 35 cases of enteric fever that were diagnosed during the study period, 28 (80%) patients had returned from South Asia and 6 (17%), from Southeast Asia. Only 8 (23%) patients had a pre-travel consultation, including 4 (11%) with a typhoid vaccination in previous 2 years. Only 16 (47%) of 34 fulfilled the criteria for sepsis, while 19 (90%) of 21 cases experienced relative bradycardia. Of 35 cases, rose spots were observed in only 2 (6%) cases and eosinopenia (0-1%) was present in 34 (97%). Of 32 cases with image findings observations include splenomegaly (n=17, 52%), paraileocecal lymph node swelling (n=8, 24%), and ileoceccal thickening (n=4, 11%). All cases were sensitive to ceftriaxione except for 1 case of ESBL producing Enterobacteriaceae. None of the detected bacteria from South Asia were susceptible to fluoroquinolone according to the CLSI 2012 breakpoint (Table1). The relapse rate was 8.6% with no significant risk for relapse related to days from onset to treatment (P = 0.28) or sepsis (P = 0.71). However, >7 days to reach defervescence was a significantly relapse risk factor (P = 0.035). Conclusion: Fluoroquinolones are not recommended as empiric treatment for enteric fever in travelers returning from South Asia. While there are no concerns for relapse based on the time to start treatment and the severity at the initial presentation, there are for prolonged duration (>7 days) to reach defervescence. Table 1. Relationship between isolate source and fluoroquinolone sensitivity (n=29) Isolate source Antibiotics susceptibility South Asia (n=24),n (%) Southeast Asia (n=5), n (%) Susceptible 0 (0) 4 (80) Intermediate 18 (75) 1 (20) Resistant 6 (25) 0 (0)
![Research paper thumbnail of [Malaria cases treated with artemether/lumefantrine in Japanese travelers]](https://attachments.academia-assets.com/58590253/thumbnails/1.jpg)
](Kansenshōgaku Zasshi the Journal of the Japanese Association For Infectious Diseases, Nov 1, 2014
Artemisinin-based combination therapy (ACT) has been the standard treatment for uncomplicated mal... more Artemisinin-based combination therapy (ACT) has been the standard treatment for uncomplicated malaria. Although not licensed in Japan, artemether/lumefantrine (AL), one type of ACT, has been administered to patients with malaria since 2002 by the Research Group on Chemotherapy of Tropical Diseases. Herein, we reviewed malaria cases treated with AL in Japanese travelers. A retrospective study was conducted at the National Center for Global Health and Medicine from October 2005 to March 2013. There were 19 malaria patients treated with AL, and 10 falciparum malaria patients treated with AL only. In these 10 patients treated with AL only, the median time of fever clearance was 25.0 hours (range:14-66 hours), and the median time of parasite clearance was 36.0 hours (range:16-62 hours). There was a positive correlation between parasitemia and time from the start of therapy to the disappearance of the parasites. Parasitemia was higher (4.05% vs. 0.24%; p = 0.044) and parasite clearance time was longer (55.5 hours vs. 31.5 hours; p = 0.044) in the cases of recrudescence than non-recrudescence, respectively. Three of the 19 malaria patients showed recrudescence of malaria after treatment with AL. The reason that treatment failure was more frequently observed in this study than in previous reports may be related to poor absorption of lumefantrine owing to gastrointestinal symptoms, insufficiently ingested fatty foods, or high parasitemia on admission. The World Health Organization recommends that intravenous antimalarials should be administered in cases of severe malaria however, this is not applicable in Japan. Further studies are needed to distinguish patients with malaria who are treatable with ACT from those who should be treated initially with other intravenous antimalarials.
ABSTRACT Background: The rubella epidemic in Japan has escalated since 2012. Clinical manifestati... more ABSTRACT Background: The rubella epidemic in Japan has escalated since 2012. Clinical manifestations of pediatric rubella are well known, but those of adults have not been fully described. This study was a comprehensive analysis of adult rubella from 2011 to 2013 in Japan. Methods: This was a descriptive, retrospective review of all medical records of adult patients with suspected rubella seen from April 2011 to March 2013. Serological confirmation criteria included either strong positivity for rubella-specific IgM in one sample, weak positivity for IgM plus a low titer of IgG in one sample, or a ≥4× increase of IgG titer in acute and convalescent samples. Criteria for clinical confirmation included weakly positive or negative IgM in an initial, single serum sample in the setting of classic manifestations. Without serological data, if two or more clinicians diagnosed rubella, the case was classified as possible rubella. Results: There were 45 patients who met the inclusion criteria. Of these, 31 were classified as &quot;serologically confirmed&quot; and 14 were &quot;clinically possible.&quot; Mean age was 30.5 (range, 18-60) years, and the sex distribution was 37 males and 8 females. Signs included rash (100%), swollen lymph nodes (93.3%), and fever &gt;37.9C° (57.8%). Overall, 38/39 (97.4%) had reddish eyes and 4 were hospitalized for severe constitutional symptoms. Involved lymph nodes included posterior cervical (28, 62.2%), pre/post-auricular (20, 44.4%), and suboccipital (11, 24.4%). In some, the exanthem was not mild, was partially confluent, and did not fade within a few days. False positivity for measles-specific IgM was demonstrated in 11/37 (29.7%). Conclusion: High-grade fever, reddish eyes, and prolonged, confluent rash were distinctive features observed. Adult rubella shares clinical characteristics with measles. False positivity for measles IgM can occur acutely in rubella; therefore, clinicians should be careful to differentiate rubella from measles when adults present with fever and rash.
Emerging Infectious Diseases, Mar 1, 2015
After 70 years with no confirmed autochthonous cases of dengue fever in Japan, 19 cases were repo... more After 70 years with no confirmed autochthonous cases of dengue fever in Japan, 19 cases were reported during August-September 2014. Dengue virus serotype 1 was detected in 18 patients. Phylogenetic analysis of the envelope protein genome sequence from 3 patients revealed 100% identity with the strain from the first patient (2014) in Japan.
Global Health & Medicine, 2019
includes "International Cooperation" as a unique 6th pillar additionally set in reference to the ... more includes "International Cooperation" as a unique 6th pillar additionally set in reference to the 5 pillars of the Global Action Plan, and a goal, strategy and countermeasures have been set for each area (Figure 1). Current status and challenges of antibiotic treatment in Japan The use of antibiotics in Japan is not particularly higher compared to that in Europe or the USA. However, in Japan oral antibiotics account for 92.4% of the total daily usage, and consists of third generation cephalosporins, macrolides and fluoroquinolone derivatives, which are so-called broad-spectrum antibiotics. Therefore, it is considered that the problem in Japan is the use of such broad-spectrum oral antibiotics (1). Higashi, et al. examined the national prescription database for the period from January to March 2005 and reported that approximately 60% of patients with non-bacterial upper respiratory tract infections were given antibiotics. The breakdown of the prescriptions was third generation cephalosporins (46%), macrolides (27%) and quinolones (16%) in descending order of frequency, and were prescribed more often at clinics than hospitals (2). Antibiotics may be prescribed to patients with the common cold for the purpose of pneumonia prophylaxis. Regarding this, a study was conducted to investigate how many patients with acute respiratory tract infection, including those with the common cold, need to be treated with antibiotics to prevent one patient from developing complications including pneumonia (3). The results showed that one case of complications could be prevented if 4,000 patients with acute respiratory tract infection would be given antibiotics. Considering the cost of antibiotics prescribed to 4,000 patients and the risks of adverse drug reactions and resistant bacteria, the prophylactic use of antibiotics to (71)
Nihon Naika Gakkai Zasshi, May 10, 2011
Journal of Infection and Chemotherapy, 2016
Chikungunya fever (CHIK) and Zika virus (ZIKV) infection have similar endemic areas and clinical ... more Chikungunya fever (CHIK) and Zika virus (ZIKV) infection have similar endemic areas and clinical manifestations. We report a case of CHIK at 1 year after a ZIKV infection in Bora Bora (French Polynesia), which we diagnosed based on IgM to the CHIK virus and neutralizing antibodies to ZIKV.
Nihon Naika Gakkai Zasshi, 2011
Antimicrobial agents and chemotherapy, Nov 6, 2016
Forty clinical isolates of multidrug-resistant Pseudomonas aeruginosa were obtained in a medical ... more Forty clinical isolates of multidrug-resistant Pseudomonas aeruginosa were obtained in a medical setting in Hanoi, Vietnam. Whole genomes of all 40 isolates were sequenced by MiSeq (Illumina), and phylogenic trees were constructed from the single nucleotide polymorphism (SNP) concatemers. Of these 40 isolates, 24 (60.0%) harbored metallo-β-lactamase encoding genes, including blaIMP-15, blaIMP-26, blaIMP-51, and/or blaNDM-1 Of them, 12 isolates harbored blaIMP-26 and belonged to ST235. Escherichia coli expressing blaIMP-26 was significantly more resistant to doripenem and meropenem than E. coli expressing blaIMP-1 and blaIMP-15 IMP-26 showed higher catalytic activity against dorimepen and meropenem than IMP-1, and against all carbapenems tested, including doripenem, imipenem, meropenem and panipenem, than IMP-15. These data suggest that clinical isolates of multidrug-resistant ST235 P. aeruginosa producing IMP-26 with increased carbapenem-hydrolyzing activities are spreading in medic...
Kansenshogaku Zasshi the Journal of the Japanese Association For Infectious Diseases, 2013
The American journal of tropical medicine and hygiene, Jan 27, 2016
We report six cases of Salmonella enterica serotype Paratyphi A infections in travelers returning... more We report six cases of Salmonella enterica serotype Paratyphi A infections in travelers returning from Myanmar. In 2015, 31 cases of paratyphoid fever were reported in Japan, and 54.8% of those traveled to Myanmar. Among them, six patients presented to our hospital. They had traveled to Myanmar from July 2014 to August 2015 for business purposes. All six isolates were phage type 1, and they were resistant to nalidixic acid.
Japanese Journal of Infectious Diseases, 2013
We present the first reported case of systemic infection with Neisseria meningitidis serogroup W-... more We present the first reported case of systemic infection with Neisseria meningitidis serogroup W-135 sequence type (ST)-11 in Japan. A 44-year-old woman presented with high fever, sore throat, and fatigue and was diagnosed with N. meningitidis bacteremia. The causative strain was identified as serogroup W-135 ST-11 by polymerase chain reaction and multilocus sequence typing. Approximately 1 month after treatment, she developed high fever, dyspnea, chest pain, and shoulder pain due to pericarditis, polyarthritis, and tenosynovitis, which are all relatively common immunoreactive complications of W-135 ST-11 meningococcal infections. This causative strain was the same as that responsible for an outbreak of meningitis among Hajj pilgrims in 2000. The strain is now found worldwide because it can attain a high carriage rate and has a long duration of carriage. We suspect that our patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s infection was acquired from an imported chronic carrier.
BMC Research Notes, 2016
An increasing number of reports have documented the emergence of daptomycin-nonsusceptible Entero... more An increasing number of reports have documented the emergence of daptomycin-nonsusceptible Enterococcus in patients during daptomycin therapy. Even though several mechanisms for daptomycin-nonsusceptibility have been suggested, the potential genetic mutations which might contribute to the daptomycin-nonsusceptibility are not fully understood. We isolated a vancomycin-susceptible, daptomycin nonsusceptible Enterococcus faecium strain from a patient with acute lymphocytic leukemia who received high-dose daptomycin therapy for E. faecium endocarditis. Whole-genome sequencing analysis revealed mutations within genes encoding DNA repair proteins MutL and RecJ of the daptomycin-nonsusceptible Enterococcus strain which might have facilitated its emergence. We identified the mutations of DNA mismatch repair genes in a clinical isolate of daptomycin nonsusceptible E. faecium which emerged in spite of high-dose daptomycin therapy. The finding implicates the possible association of DNA repair mechanism and daptomycin resistance. Careful monitoring is necessary to avoid the emergence of daptomycin non-susceptible isolates of E. faecium and particularly in cases of long-term daptomycin use or in immunocompromised patients.
The incidence of human brucellosis in Kyrgyzstan has been increasing in the last years and was id... more The incidence of human brucellosis in Kyrgyzstan has been increasing in the last years and was identified as a priority disease needing most urgent control measures in the livestock population. The latest species identification of Brucella isolates in Kyrgyzstan was carried out in the 1960s and investigated the circulation of Brucella abortus, B. melitensis, B. ovis, and B. suis. However, supporting data and documentation of that experience are lacking. Therefore, typing of Brucella spp. and identification of the most important host species are necessary for the understanding of the main transmission routes and to adopt an effective brucellosis control policy in Kyrgyzstan. Overall, 17 B. melitensis strains from aborted fetuses of sheep and cattle isolated in the province of Naryn were studied. All strains were susceptible to trimethoprim-sulfamethoxazole, gentamicin, rifampin, ofloxacin, streptomycin, doxycycline, and ciprofloxacin. Multilocus variable number tandem repeat analysis showed low genetic diversity. Kyrgyz strains seem to be genetically associated with the Eastern Mediterranean group of the Brucella global phylogeny. We identified and confirmed transmission of B. melitensis to cattle and a close genetic relationship between B. melitensis strains isolated from sheep sharing the same pasture.
Journal of travel medicine, 2016
A live attenuated yellow fever (YF) vaccination is required of all travellers visiting countries ... more A live attenuated yellow fever (YF) vaccination is required of all travellers visiting countries where YF virus is endemic. Although the risk of serious adverse events (AEs) after YF vaccination is known to be greater in elderly people than in younger people, information about other AEs among elderly travellers is lacking. A prospective observational questionnaire study was conducted to investigate the occurrence of AEs after YF vaccination in travellers who attended a designated YF vaccination centre in Tokyo, Japan, from 1 November 2011 to 31 October 2012. A questionnaire enquiring about any AEs experienced in the 2 weeks following YF vaccination was distributed to all vaccinees enrolled in this study, and responses were collected subsequently by mail or phone. For child vaccinees, their parents were allowed to respond in their stead. Of the 1298 vaccinees who received the YF vaccine, 1044 (80.4%) were enrolled in the present study and 666 (63.8%) responded to the questionnaire. O...
The American journal of tropical medicine and hygiene, Jul 9, 2016
Owing to the increase in Salmonella strains with decreased fluoroquinolone susceptibility in the ... more Owing to the increase in Salmonella strains with decreased fluoroquinolone susceptibility in the endemic areas, we have been treating enteric fever with intravenous ceftriaxone empirically since 2007. In this study, we reevaluated our treatment protocol. This retrospective cohort study was conducted at a single institute in Tokyo, Japan, between January 2006 and December 2013. Enteric fever was defined as isolation of Salmonella Typhi or Salmonella Paratyphi A, B, and C from the blood and/or stool of patients with fever. Of the 35 patients with imported enteric fever, 28 (80%) had returned from south Asia. Ciprofloxacin-susceptible strains were detected in only 12% of the cases. The isolates showed excellent susceptibility to ampicillin (91%), chloramphenicol (94%), ceftriaxone (97%), and azithromycin (97%). One case of Salmonella Paratyphi B was excluded, and of the remaining 34 patients, 56% were treated with ceftriaxone alone, 26% with ceftriaxone then fluoroquinolone, and 9% wit...
Japanese Journal of Infectious Diseases, 2012
The aim of this study was to evaluate the in vitro combination effects of aztreonam (AZT) and ami... more The aim of this study was to evaluate the in vitro combination effects of aztreonam (AZT) and aminoglycosides against multidrug-resistant (MDR) Pseudomonas aeruginosa strains in Japan. We investigated 47 MDR P. aeruginosa strains collected from 8 facilities. We selected the aminoglycosides amikacin (AMK), gentamicin (GM), and arbekacin (ABK) to examine their effects when combined with AZT using the checkerboard method. Of the 47 MDR P. aeruginosa strains, 41 tested positive for metallo-β-lactamase (MBL). In all combinations, aminoglycosides decreased the minimum inhibitory concentrations of AZT in a dose-dependent manner, and there was no apparent antagonism. The combination effects were scored on a scale of 0 to 4, and statistical analysis was performed using the Wilcoxon signed-rank test. In all 47 strains, AZT + ABK (mean score, 2.02) had the highest score, followed by AZT + AMK (1.68) and AZT + GM (1.38) (ABK versus GM, P < 0.0001). In 41 MBL-positive strains, AZT + ABK (mean score, 2.05) had the highest score, followed by AZT + AMK (1.56) and AZT + GM (1.37) (ABK versus AMK, P = 0.02, and ABK versus GM, P < 0.0001). AZT + ABK was the most promising combination regimen against MDR P. aeruginosa strains; the other promising combinations were AZT + AMK and AZT + GM.
ABSTRACT Background: To the best of our knowledge, there are limited reports of enteric fever cas... more ABSTRACT Background: To the best of our knowledge, there are limited reports of enteric fever cases in returning travelers. Following the revision of levofloxacin and ciprofloxacin breakpoints by the Clinical Laboratory Standard Institute (CLSI) in 2012, we determined clinical characteristics, antibiotics susceptibility, and relapse risk factors for enteric fever in Japan. Methods: The retrospective cross-sectional study was conducted in a single institute in Tokyo, Japan between January 2006 and December 2013. Enteric fever was defined as isolation of Salmonella Typhi or S. Paratyphi from blood and/or stool in a patient with fever. Results: Of the 35 cases of enteric fever that were diagnosed during the study period, 28 (80%) patients had returned from South Asia and 6 (17%), from Southeast Asia. Only 8 (23%) patients had a pre-travel consultation, including 4 (11%) with a typhoid vaccination in previous 2 years. Only 16 (47%) of 34 fulfilled the criteria for sepsis, while 19 (90%) of 21 cases experienced relative bradycardia. Of 35 cases, rose spots were observed in only 2 (6%) cases and eosinopenia (0-1%) was present in 34 (97%). Of 32 cases with image findings observations include splenomegaly (n=17, 52%), paraileocecal lymph node swelling (n=8, 24%), and ileoceccal thickening (n=4, 11%). All cases were sensitive to ceftriaxione except for 1 case of ESBL producing Enterobacteriaceae. None of the detected bacteria from South Asia were susceptible to fluoroquinolone according to the CLSI 2012 breakpoint (Table1). The relapse rate was 8.6% with no significant risk for relapse related to days from onset to treatment (P = 0.28) or sepsis (P = 0.71). However, >7 days to reach defervescence was a significantly relapse risk factor (P = 0.035). Conclusion: Fluoroquinolones are not recommended as empiric treatment for enteric fever in travelers returning from South Asia. While there are no concerns for relapse based on the time to start treatment and the severity at the initial presentation, there are for prolonged duration (>7 days) to reach defervescence. Table 1. Relationship between isolate source and fluoroquinolone sensitivity (n=29) Isolate source Antibiotics susceptibility South Asia (n=24),n (%) Southeast Asia (n=5), n (%) Susceptible 0 (0) 4 (80) Intermediate 18 (75) 1 (20) Resistant 6 (25) 0 (0)
Kansenshōgaku Zasshi the Journal of the Japanese Association For Infectious Diseases, Nov 1, 2014
Artemisinin-based combination therapy (ACT) has been the standard treatment for uncomplicated mal... more Artemisinin-based combination therapy (ACT) has been the standard treatment for uncomplicated malaria. Although not licensed in Japan, artemether/lumefantrine (AL), one type of ACT, has been administered to patients with malaria since 2002 by the Research Group on Chemotherapy of Tropical Diseases. Herein, we reviewed malaria cases treated with AL in Japanese travelers. A retrospective study was conducted at the National Center for Global Health and Medicine from October 2005 to March 2013. There were 19 malaria patients treated with AL, and 10 falciparum malaria patients treated with AL only. In these 10 patients treated with AL only, the median time of fever clearance was 25.0 hours (range:14-66 hours), and the median time of parasite clearance was 36.0 hours (range:16-62 hours). There was a positive correlation between parasitemia and time from the start of therapy to the disappearance of the parasites. Parasitemia was higher (4.05% vs. 0.24%; p = 0.044) and parasite clearance time was longer (55.5 hours vs. 31.5 hours; p = 0.044) in the cases of recrudescence than non-recrudescence, respectively. Three of the 19 malaria patients showed recrudescence of malaria after treatment with AL. The reason that treatment failure was more frequently observed in this study than in previous reports may be related to poor absorption of lumefantrine owing to gastrointestinal symptoms, insufficiently ingested fatty foods, or high parasitemia on admission. The World Health Organization recommends that intravenous antimalarials should be administered in cases of severe malaria however, this is not applicable in Japan. Further studies are needed to distinguish patients with malaria who are treatable with ACT from those who should be treated initially with other intravenous antimalarials.
ABSTRACT Background: The rubella epidemic in Japan has escalated since 2012. Clinical manifestati... more ABSTRACT Background: The rubella epidemic in Japan has escalated since 2012. Clinical manifestations of pediatric rubella are well known, but those of adults have not been fully described. This study was a comprehensive analysis of adult rubella from 2011 to 2013 in Japan. Methods: This was a descriptive, retrospective review of all medical records of adult patients with suspected rubella seen from April 2011 to March 2013. Serological confirmation criteria included either strong positivity for rubella-specific IgM in one sample, weak positivity for IgM plus a low titer of IgG in one sample, or a ≥4× increase of IgG titer in acute and convalescent samples. Criteria for clinical confirmation included weakly positive or negative IgM in an initial, single serum sample in the setting of classic manifestations. Without serological data, if two or more clinicians diagnosed rubella, the case was classified as possible rubella. Results: There were 45 patients who met the inclusion criteria. Of these, 31 were classified as &quot;serologically confirmed&quot; and 14 were &quot;clinically possible.&quot; Mean age was 30.5 (range, 18-60) years, and the sex distribution was 37 males and 8 females. Signs included rash (100%), swollen lymph nodes (93.3%), and fever &gt;37.9C° (57.8%). Overall, 38/39 (97.4%) had reddish eyes and 4 were hospitalized for severe constitutional symptoms. Involved lymph nodes included posterior cervical (28, 62.2%), pre/post-auricular (20, 44.4%), and suboccipital (11, 24.4%). In some, the exanthem was not mild, was partially confluent, and did not fade within a few days. False positivity for measles-specific IgM was demonstrated in 11/37 (29.7%). Conclusion: High-grade fever, reddish eyes, and prolonged, confluent rash were distinctive features observed. Adult rubella shares clinical characteristics with measles. False positivity for measles IgM can occur acutely in rubella; therefore, clinicians should be careful to differentiate rubella from measles when adults present with fever and rash.
Emerging Infectious Diseases, Mar 1, 2015
After 70 years with no confirmed autochthonous cases of dengue fever in Japan, 19 cases were repo... more After 70 years with no confirmed autochthonous cases of dengue fever in Japan, 19 cases were reported during August-September 2014. Dengue virus serotype 1 was detected in 18 patients. Phylogenetic analysis of the envelope protein genome sequence from 3 patients revealed 100% identity with the strain from the first patient (2014) in Japan.