担当区分：責任著者   記述言語：英語  

Neonatal gonorrhea, caused by Neisseria gonorrhoeae, is an uncommon but important disease to prevent because its complications, such as gonococcal ophthalmia neonatorum (GON) causes blindness if untreated. Neonatal gonococcal nasopharyngitis is a rare, but important clinical manifestation to suspect gonococcal infection in a neonate. Herein we report a case of neonatal gonococcal nasopharyngitis, presented with purulent nasal discharge. A full-term male neonate without perinatal complications developed purulent eye discharge on the 7th day of life. N. gonorrhoeae was isolated from the eye discharge culture; however, he did not receive the standard regimen. Subsequently, he presented to our hospital with fever and nasal discharge on the 20th day of life. N. gonorrhoeae was also isolated from nasal discharge and nasopharyngeal swabs without any evidence of chlamydia or syphilis. He received intravenous cefotaxime until disseminated gonococcal infection was ruled out and was discharged without any sequelae. Rhinorrhea in newborns requires consideration of mother-to-child transmission of various microorganisms, not only common respiratory viruses, but also rare, serious preventable infections such as gonorrhea or syphilis. Along with the recent syphilis patients on the rise in Japan, gonorrhea is an important disease to recognize, and the incidence could increase. Clinical manifestations of neonatal gonococcal infections, including nasopharyngitis, need to be recognized to suspect the diagnosis and initiate appropriate treatment to prevent serious complications.

DOI： 10.1016/j.jiac.2023.08.005

PubMed

researchmap

担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Human rhinovirus (HRV) was predominant and persistent during the coronavirus disease 2019 (COVID-19) pandemic despite nonpharmaceutical interventions. The data whether HRV persistence also occurred in neonates and young infants were very limited. METHODS: This prospective observational study was conducted in Niigata, Japan, between January 2020 and September 2022. The participants were hospitalized neonates and infants aged less than 4 months with fever. We excluded patients with evidence of bacterial infection or obvious sick contact with influenza or respiratory syncytial virus infection, as confirmed by rapid antigen detection tests. COVID-19 diagnosed by polymerase chain reaction (PCR) or rapid antigen detection tests were also excluded. Parechovirus and enterovirus were examined by PCR using serum and/or cerebrospinal fluid. FilmArray Respiratory Panel v1.7 was conducted on nasopharyngeal swabs. If HRV was positive, the genotype was identified. RESULTS: We included 72 patients (median age, 54 days; interquartile range, 28.5-79 days), and sepsis was diagnosed in 31 (43.1%) patients. In total, 27 (37.5%) patients had had positive multiplex PCR tests. These patients were more likely to have rhinorrhea (P = 0.004), cough (P = 0.01), and sick contact (P < 0.001) than those who with negative multiplex PCR. HRV was the most frequently detected virus (n = 23, 85.2%), and species A (n = 15, 71.4%) and C (n = 6, 28.6%) were genotyped. No seasonality or monthly predominance of the specific HRV types was observed. CONCLUSIONS: HRV was an important cause of fever in neonates and young infants during the COVID-19 pandemic, 2020 to 2022.

DOI： 10.1097/INF.0000000000004139

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Wiskott-Aldrich syndrome (WAS) is a rare X-linked disorder characterized by combined immunodeficiency, eczema, microthrombocytopenia, autoimmunity, and lymphoid malignancies. Gene therapy (GT) to modify autologous CD34+ cells is an emerging alternative treatment with advantages over standard allogeneic hematopoietic stem cell transplantation for patients who lack well-matched donors, avoiding graft-versus-host-disease. We report the outcomes of a phase 1/2 clinical trial in which 5 patients with severe WAS underwent GT using a self-inactivating lentiviral vector expressing the human WAS complementary DNA under the control of a 1.6-kB fragment of the autologous promoter after busulfan and fludarabine conditioning. All patients were alive and well with sustained multilineage vector gene marking (median follow-up: 7.6 years). Clinical improvement of eczema, infections, and bleeding diathesis was universal. Immune function was consistently improved despite subphysiologic levels of transgenic WAS protein expression. Improvements in platelet count and cytoskeletal function in myeloid cells were most prominent in patients with high vector copy number in the transduced product. Two patients with a history of autoimmunity had flares of autoimmunity after GT, despite similar percentages of WAS protein-expressing cells and gene marking to those without autoimmunity. Patients with flares of autoimmunity demonstrated poor numerical recovery of T cells and regulatory T cells (Tregs), interleukin-10-producing regulatory B cells (Bregs), and transitional B cells. Thus, recovery of the Breg compartment, along with Tregs appears to be protective against development of autoimmunity after GT. These results indicate that clinical and laboratory manifestations of WAS are improved with GT with an acceptable safety profile. This trial is registered at clinicaltrials.gov as #NCT01410825.

DOI： 10.1182/blood.2022019117

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Parechovirus-A (PeV-A) causes emerging infection in children, and clinical presentation depends on genotype. The virus has been investigated mainly in developed countries; however, data from developing countries, especially in Asia, are sparse. This study investigated whether PeV-A circulated in children in Myanmar. This retrospective study evaluated PeV-A in nasopharyngeal samples from children aged 1 month to 12 years who were hospitalized with acute lower respiratory infection at Yankin Children Hospital, Yangon, Myanmar, during the period from May 2017 to April 2019. Real-time polymerase chain reaction (PCR) was used to detect PeV-A, and PCR-positive samples were used for genotyping and phylogenetic analysis. In total, 11/570 (1.9%) of samples were positive for PeV-A; 7 were successfully genotyped by sequencing the VP3/VP1 region, as follows: PeV-A1 (n = 4), PeV-A5 (n = 1), PeV-A6 (n = 1), and PeV-A14 (n = 1). Median age was 10.0 months (interquartile range 4.0-12.0 months), and other respiratory viruses were detected in all cases. Phylogenetic analysis showed that all detected PeV-A1 strains were in clade 1 A, which was a minor clade worldwide. Four PeV-A genotypes were detected in Myanmar. The clinical impact of PeV-A in children should be evaluated in future studies.

DOI： 10.1002/jmv.28964

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Purpose of ReviewParechovirus-A (PeV-A) is an important emerging virus. Clinical manifestations of pediatric PeV-A infection vary by genotype and range from mild acute illness to severe disease. This review discusses the global epidemiological profile of pediatric PeV-A infection and the relationship of PeV-A genotype to severe disease in neonates and young infants.Recent FindingsIn neonates and young infants the most important PeV-A3-associated conditions are sepsis and meningoencephalitis, which have been reported in many countries. The high morbidity of encephalitis due to PeV-A3 is a serious concern. Although rare, severe PeV-A-associated diseases due to other genotypes have also been reported in children. The pandemic of coronavirus disease 2019 significantly affected PeV-A3 detection.PeV-A, especially PeV-A3, is an important emerging virus that causes severe disease in children. PeV-A genotyping will improve our understanding of the epidemiology of PeV-A and the relationship of PeV-A genotype with severe disease. Specific antiviral therapies are needed to treat severe diseases caused by PeV-A.

DOI： 10.1007/s40588-023-00197-3

Web of Science

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants has dramatically altered the clinical profile of pediatric coronavirus disease 2019 (COVID-19). In Japan, we experienced a pandemic of omicron subvariant BA.1/BA.2 from January through June 2022. However, after the emergence of BA.5 in early July 2022, the number of children hospitalized with COVID-19 increased dramatically in Japan. METHODS: We collected data on monthly numbers of cases and clinical characteristics of hospitalized children with COVID-19 in 13 hospitals, the total number of pediatric COVID-19 cases, and COVID-19 vaccination rates in Niigata, Japan, for the period from January 2020 through August 2022. We compared clinical presentation during the periods of BA.1/BA.2 predominance (January-June 2022) and BA.5 predominance (July-August 2022) and estimated vaccine effectiveness (VE) against hospitalization during the BA.5-predominant period. RESULTS: Between January 1, 2020, and August 31, 2022, 49,387 children (19,085 children/100,000 population) were newly diagnosed as having COVID-19, and 393 were hospitalized for COVID-19. Hospitalization for febrile seizure, especially complex seizure, was significantly higher during BA.5 predominance than during BA.1/BA.2 predominance (27.9% vs. 7.0%, P < 0.01). VE against hospitalization during BA.5 predominance was estimated to be 75% (95% confidence interval, 48%-88%, P < 0.01). CONCLUSIONS: The emergence of BA.5 significantly affected children in Japan; the number with complex febrile seizure who required hospitalization was higher than during BA.1/BA.2 predominance. The COVID-19 vaccination rate in children must be increased to prevent hospitalization for COVID-19 and to prepare for current and future variant outbreaks.

DOI： 10.1097/INF.0000000000003894

PubMed

researchmap

記述言語：日本語   出版者・発行元：(公社)日本小児科学会  

国内の地域偏在を調整後に無作為に抽出した小児科1次医療施設100施設、2次医療施設100施設と全ての3次医療施設119施設を候補として、2020年4月(I期)、2020年10月(II期)、2021年4月(III期)の各時点における診療体制についてインターネットを介してアンケート調査した。回答があったのは1次医療施設27施設(回答率27%)、2次医療施設19施設(回答率19%)、3次医療施設72施設(回答率61%)であった。発熱患者の診療応需についてはコロナウイルス感染症2019(COVID-19)接触歴を有する場合、1次医療施設で応需困難となったのはI期で29.6%であったが、II期22.2%、III期14.8%と経時的に減少した。COVID-19患者の診療体制はIII期においても3次医療施設の約半数で軽症・無症状患者の診療が応需されていた。面会制限は大多数の施設で導入され、面会禁止とした施設がIII期においても2次医療施設の63.2%、3次医療施設の38.9%で存在した。

researchmap

担当区分：責任著者   記述言語：英語  

Early-onset sepsis (EOS) is a serious and fatal illness in neonates, Group B Streptococcus and Escherichia coli are major causative pathogens. We report a case of EOS and pneumonia caused by E. coli in a preterm neonate with multiple pneumatoceles and lung abscesses. A male neonate weighing 1670g was delivered at 33 6/7 weeks' gestation by a mother with clinical chorioamnionitis. He showed respiratory distress soon after birth and developed septic shock. He was intubated and mechanical ventilation was started. E.coli was detected in blood culture obtained from both the patient and his mother. He developed multiple pneumatoceles and lung abscesses. Surgical drainage was complicated, cefotaxime was thus continued until day 74. Pneumatoceles and lung abscesses are complications of neonatal pneumonia, rarely reported by E. coli. Multiple lung abscesses in our patient are distinct from single abscesses in previous case studies of neonatal lung abscesses. We speculate that bacteremia along with pneumatoceles led to multiple lung abscesses in our patient. These complications require long-term antibiotic therapy, to minimize morbidity and mortality, and should thus be considered when managing EOS caused by E. coli.

DOI： 10.1016/j.jiac.2022.12.015

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: A decrease in pediatric hospitalizations during the COVID-19 pandemic has been reported worldwide; however, few studies have examined areas with a limited number of COVID-19 cases, where influenced by viral interference by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is minimum. METHODS: We conducted an epidemiological study of pediatric hospitalizations on Sado, an isolated island in Niigata, Japan, that was unique environment with few COVID-19 cases and reliable pediatric admissions monitoring. We compared numbers of monthly hospitalizations and associated diagnoses for the periods April 2016 to March 2020 (pre-pandemic period) and April 2020 to March 2021 (pandemic period). RESULTS: Data were analyzed for 1,144 and 128 patients in the pre-pandemic and pandemic periods, respectively. We observed only three adults and no pediatric COVID-19 cases during the pandemic period. The number of monthly admissions was significantly lower in the pandemic period (median [interquartile ranges (IQR)]: 11.0 [7.0-14.0]) than in the pre-pandemic period (23.0 [20.8-28.3]; P < 0.001). Similar decreases were observed for hospitalizations due to respiratory tract infection (P < 0.01), but not for asthma exacerbation (P = 0.15), and gastrointestinal tract infection (P = 0.33). CONCLUSIONS: Pediatric hospitalizations during the pandemic significantly decreased on an isolated Japanese island where COVID-19 was not endemic and all pediatric admissions were ascertainable. This observation highlights the impact of decreased travel and increased awareness of infection control measures on pediatric hospitalizations due to infectious diseases, not by the SARS-CoV-2 viral interference.

DOI： 10.1111/ped.15326

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The clinical features of coronavirus disease 2019 (COVID-19) in children have been changing because of the emergence and rapid spread of variants of concern (VOC). The increase in cases infected with VOC has brought concern with persistent symptoms after COVID-19 in children. This survey aimed to analyze the clinical manifestations and persistent symptoms of pediatric COVID-19 cases in Japan. METHODS: We analyzed the clinical manifestations of pediatric COVID-19 cases reported between February 2020 and April 2022 in Japan, using a dedicated database updated voluntarily by the members of the Japan Pediatric Society. Using the same database, we also analyzed persistent symptoms after COVID-19 in children who were diagnosed between February 2020 and November 2021. RESULTS: A total of 5411 and 1697 pediatric COVID-19 cases were included for analyzing clinical manifestations and persistent symptoms, respectively. During the Omicron variant predominant period, the percentage of patients with seizures increased to 13.4% and 7.4% in patient groups aged 1-4 and 5-11 years, respectively, compared with the pre-Delta (1.3%, 0.4%) or Delta period (3.1%, 0.0%). Persistent and present symptoms after 28 days of COVID-19 onset were reported in 55 (3.2%). CONCLUSIONS: Our survey showed that the rate of symptomatic pediatric COVID-19 cases increased gradually, especially during the Omicron variant predominant period, and a certain percentage of pediatric cases had persistent symptoms. Certain percentages of pediatric COVID-19 patients had severe complications or prolonged symptoms. Further studies are needed to follow such patients.

DOI： 10.1097/INF.0000000000003792

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本小児感染症学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Infantile central nervous system infections (CNSIs) can be life-threatening and cause severe sequelae. However, the causative microorganism remains unknown in >40% of patients with aseptic infections. This study aimed to analyze the metagenome for detection of pathogens and the transcriptome for host immune responses during infection in a single cerebrospinal fluid (CSF) sample using 2 different next-generation sequencing (NGS) platforms, Nanopore and Illumina. Methods: Twenty-eight CNSIs patients (<12 months) were enrolled, and 49 clinical samples (28 CSF and 21 blood) were collected. The DNA extracted from all 49 samples was sequenced using the Illumina sequencer for the detection of pathogens. Extracted RNA was obtained in sufficient quantities from 23 CSF samples and subjected to sequencing on both Nanopore and Illumina platforms. Human-derived reads subtracted during pathogen detection were used for host transcriptomic analysis from both Nanopore and Illumina sequencing. Results: RNA metagenomic sequencing using both sequencing platforms revealed putative viral pathogens in 10 cases. DNA sequencing using the Illumina sequencer detected 2 pathogens. The results of Nanopore and Illumina RNA sequencing were consistent; however, the mapping coverage and depth to the detected pathogen genome of Nanopore RNA sequencing were greater than those of Illumina. Host transcriptomic analysis of Nanopore sequencing revealed highly expressed genes related to the antiviral roles of innate immunity from pathogen-identified cases. Conclusions: The use of Nanopore RNA sequencing for metagenomic diagnostics of CSF samples should help to elucidate both pathogens and host immune responses of CNSI and could shed light on the pathogenesis of these infections.

DOI： 10.1093/ofid/ofac504

PubMed

researchmap

担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

This review provides updates on coronavirus disease 2019 (COVID-19) in children in Japan by summarizing published data. By the end of March 2022, Japan had experienced 6 waves of COVID-19 outbreaks. Over this time, the clinical features presented among children have changed in the context of the predominant variants. Although the COVID-19 pandemic affected children in terms of medical, physical and psychosocial aspects, the clinical outcomes have been favorable in Japan compared with those in some European countries and the United States, which may be partly due to a lower incidence of multisystem inflammatory syndromes in children and obesity. The COVID-19 vaccine has been available for children; however, the vaccination rate in children 5-11 years of age is lower than that in older children due to the government's lack of an active approach in this specific population. Further action is needed to improve the overall vaccination rates in children.

DOI： 10.1097/INF.0000000000003641

PubMed

researchmap

記述言語：日本語   出版者・発行元：日本臨床ウイルス学会  

新型コロナウイルス感染症2019(COVID-19)流行開始以降、多くの小児の市中感染症は減少した。一方で、ヒトヘルペスウイルス6型と7型(human herpesvirus type-6/7:HHV-6/7)による突発性発疹の患者数は、新潟県の感染症発生動向調査において、2016〜2019年と比較して2020年はほぼ同等であった。さらに、近年指摘されている突発性発疹罹患年齢の上昇も経年的に認めた。しかし、突発性発疹罹患者における乳児の割合は、COVID-19パンデミックの始まった2020年前半は例年と変わらなかった。これは、2020年前半の学校閉鎖や外出自粛のために同胞や両親の家庭内滞在時間が長くなり、乳児が家庭内でHHV-6/7に曝露する機会が増えたためと考えられた。HHV-6/7の伝播様式は正確には不明とされているが、ウイルスが感染すると体内に潜伏し、唾液中から排泄される。そのため、同胞や両親の唾液中に含まれるウイルスに曝露された乳幼児が感染し、突発性発疹を発症すると考えられてきた。COVID-19流行下でも突発性発疹の発生率の減少がみられなかったこと、乳児の患者数の2020年の前後半における差異は、HHV6/7のおもな感染経路は市中ではなく家庭内であることを示唆し、従来の伝播様式の仮説を支持した。(著者抄録)

researchmap

担当区分：筆頭著者,　責任著者   記述言語：英語  

DOI： 10.1007/s10875-022-01300-x

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Spread of variants of concerns (VOCs) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to an increase in children with coronavirus disease 2019 (COVID-19). In February 2021, clusters of the Alpha variant of SARS-CoV-2 started to be reported in Niigata, Japan, including a large nursery cluster. We investigated the transmission routes and household secondary attack rates (SARs) in this cluster. METHODS: Epidemiologic data related to a nursery cluster in Niigata, Japan, particularly child-origin and adult-origin SARs, were analyzed. VOCs were confirmed by whole-genome sequencing of virus from patients. RESULTS: In total, 42 persons (22 children and 20 adults) in the cluster were infected with the Alpha variant. In the nursery, 13 of 81 children (16.0%) and 4 of 24 teachers (16.7%) were infected. SARS-CoV-2 later spread to 25 persons (10 children and 15 adults) outside the nursery. Child-origin and adult-origin household SARs were 27.7% (13/47) and 47.0% (8/17) (P = 0.11), respectively, which were higher than rates attributable to non-VOCs in previous studies. CONCLUSIONS: As compared with non-VOCs, the Alpha variant of SARS-CoV-2 exhibited high transmissibility among children and adults and may pose a high risk for household secondary transmission from SARS-CoV-2-infected children. Increased transmissibility of current or future VOCs could lead to greater transmission from children to adults or other children.

DOI： 10.1097/INF.0000000000003607

PubMed

researchmap

担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Parechovirus-A3 (PeV-A3), first reported in 2004 in Japan, is an emerging pathogen that causes sepsis and meningoencephalitis in neonates and young infants. Although PeV-A3 has been identified worldwide, its epidemiological characteristics differ by region. To investigate the molecular evolution and epidemiology of PeV-A3, we performed genetic analyses of 131 PeV-A3 strains from the years 1997-2019 in Niigata, Japan. During 2016-2019, annual numbers remained steady, in contrast to the PeV-A3 epidemic interval of every 2-3 years that was observed in Japan from 2006. Bayesian evolutionary analysis of the complete viral protein 1 region revealed alternate dominant clusters during years of PeV-A3 epidemics. The branch including the oldest and first isolated PeV-A3 strains in Japan has been disrupted since 2001. The year of PeV-A3 emergence was estimated to be 1991. Continuous surveillance with genetic analyses of different regions will improve understanding of PeV-A3 epidemiology worldwide.

DOI： 10.1093/infdis/jiac213

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Acute lower respiratory infection (ALRI) remains the leading cause of death in children worldwide, and viruses have been the major cause of ALRI. In Myanmar, ALRI is associated with high morbidity and mortality in children, and detailed information on ALRI is currently lacking. METHODS: This prospective study investigated the viral aetiologies, clinical manifestations, and outcomes of ALRI in hospitalised children aged 1 month to 12 years at the Yankin Children Hospital, Yangon, Myanmar from May 2017 to April 2019. The sample size was set to 300 patients for each year. Two nasopharyngeal swabs were obtained for the patients with suspected viral ALRI; one for rapid tests for influenza and respiratory syncytial virus (RSV), and the other for real-time PCR for the 16 ALRI-causing viruses. Pneumococcal colonization rates were also investigated using real-time PCR. Clinical information was extracted from the medical records, and enrolled patients were categorised by age and severity for comparison. RESULTS: Among the 5463 patients admitted with a diagnosis of ALRI, 570 (10.4%) were enrolled in this study. The median age of the patients was 8 months (interquartile range, 4-15 months). The most common symptoms were cough (93%) and difficulty in breathing (73%), while the most common signs of ALRI were tachypnoea (78%) and chest indrawing (67%). A total of 16 viruses were detected in 502 of 570 patients' samples (88%), with RSV B (36%) and rhinovirus (28%) being the most commonly detected. Multiple viruses were detected in 221 of 570 samples (37%) collected from 570 patients. Severe ALRI was diagnosed in 107 of 570 patients (19%), and RSV B and human rhinovirus were commonly detected. The mortality rate was 5%; influenza virus A (29%) and RSV B (21%) were commonly detected, and stunting and lack of immunization were frequently observed in such cases. Additionally, 45% (259/570) of the patients had pneumococcal colonization. CONCLUSIONS: Viral ALRI in hospitalised children with a median of 8 months has significant morbidity and mortality rates in Myanmar. RSV and rhinovirus were the most commonly detected from nasopharyngeal swabs, while influenza virus and RSV were the most frequently associated with fatal cases.

DOI： 10.1186/s12879-022-07342-1

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Kawasaki disease (KD) is an acute, febrile, systemic vasculitis of unknown etiology that primarily affects the coronary arteries and generally occurs at around 1 year of age. Although the diagnosis of KD is generally not difficult, it is challenging in cases of incomplete KD lacking characteristic clinical manifestations. The incidence of incomplete KD is higher in infants younger than 6 months of age. Pneumonia is an extremely rare complication of KD and can be misinterpreted as atypical pneumonia rather than KD. Herein, we report a neonate with atypical KD and severe pneumonia who required mechanical ventilation. CASE PRESENTATION: Japanese one-month-old infant had only fever and rash on admission (day 1), and he was transferred to the intensive care unit for severe pneumonia on day 2. Although pneumonia improved following intensive care, he was diagnosed with KD on day 14 because of emerging typical clinical manifestations such as fever, bulbar nonexudative conjunctival injection, desquamation of the fingers, and coronary artery aneurysm. KD symptoms improved after three doses of intravenous immunoglobulin plus cyclosporine. However, small coronary aneurysms were present at the time of discharge. In a retrospective analysis, no pathogens were detected by multiplex real-time PCR in samples collected at admission, and the serum cytokine profile demonstrated prominent elevation of IL-6 as well as elevation of neopterin, sTNF-RI, and sTNF-RII, which suggested KD. CONCLUSIONS: The patient's entire clinical course, including the severe pneumonia, was caused by KD. As in this case, neonatal KD may exhibit atypical manifestations such as severe pneumonia requiring mechanical ventilation.

DOI： 10.1186/s12887-022-03203-7

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Incidences of community-acquired infectious diseases other than COVID-19 decreased during the coronavirus disease 2019 pandemic; however, exanthema subitum incidence before (2016-2019) and during the pandemic (2020) in Niigata, Japan, did not substantially differ, although the proportion of age less than 1-year-old was lower in 2020. These findings suggest that exanthema subitum is transmitted mainly among family members, not in the community.

DOI： 10.1097/INF.0000000000003430

PubMed

researchmap

記述言語：日本語   出版者・発行元：(公社)日本小児科学会  

researchmap

担当区分：責任著者   記述言語：英語  

Pediococcus spp. have been reported to cause infections in patients with underlying conditions. However, the pathogenicity of this bacteria is unclear. Herein, we describe the first case of Pediococcus acidilactici bacteremia, which occurred in a 16-year-old male with dasatinib-induced hemorrhagic colitis during maintenance therapy for leukemia and resolved without antibiotic treatment. P. acidilactici bacteremia might be self-limiting, even in immunocompromised patients receiving chemotherapy.

DOI： 10.1016/j.idcr.2022.e01384

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本小児感染症学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本小児感染症学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本小児感染症学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本小児感染症学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本小児感染症学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本小児感染症学会  

researchmap

担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: School closures are a subject of debate during the present coronavirus disease 2019 (COVID-19) pandemic. Because children are not the main driver of COVID-19 transmission in the community, school education must be prioritized in conjunction with appropriate infection prevention and control measures, as determined by local COVID-19 incidence. METHODS: We investigated the causes and transmission routes of a primary school cluster of COVID-19 that occurred during November and December 2020 in Niigata, Japan. RESULTS: In the cluster, the virus spread among teachers, then from teachers to students, and then to their family members. This primary school cluster comprised 26 infected patients and included teachers (13/33, 39%), students (9/211, 4%), and family members (4/65, 6%). The secondary attack rate from the 3 index teachers to the remaining 30 teachers was 33%; however, the rate to students was only 4%. Factors contributing to cluster formation include the fact that 2 of the index teachers continued working while symptomatic and that the environment and infection prevention measures in the teachers' room were inadequate. CONCLUSIONS: To open schools safely and without interruption, adequate measures to prevent COVID-19 infection in schools should be emphasized not only for children but also for teachers and their environment.

DOI： 10.1097/INF.0000000000003292

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Enterovirus D68 (EV-D68) causes a range of clinical manifestations, including asthma-like illness, severe respiratory disease, and acute flaccid myelitis. EV-D68 has caused worldwide outbreaks since 2014 and is now recognized as a re-emerging infection in many countries. EV-D68-specific PCR assays are widely used for the diagnosis of EV-D68 infection; however, assay sensitivity is a concern because of genetic changes in recently circulated EV-D68. To address this, we summarized EV-D68 sequences from previously reported world outbreaks from 2014 through 2020 on GenBank, and found several mutations at the primer and probe binding sites of the existing EV-D68-specific PCR assays. Subsequently, we designed two novel assays corresponding to the recently reported EV-D68 sequences: an EV-D68-specific real-time and semi-nested PCR. In an analysis of 22 EV-D68-confirmed cases during a recent EV-D68 outbreak in Japan, the new real-time PCR had higher sensitivity than the existing assay (100% vs. 45%, P < 0.01) and a lower median Ct value (27.8 vs. 32.8, P = 0.005). Sensitivity was higher for the new non-nested PCR (91%) than for the existing semi-nested PCR assay (50%, P < 0.01). The specificity of the new real-time PCR was 100% using samples from non-EV-D68-infected cases (n = 135). In conclusion, our novel assays had higher sensitivity than the existing assay and might lead to more accurate diagnosis of recently circulating EV-D68. To prepare for future EV-D68 outbreaks, EV-D68-specific assays must be continuously monitored and updated.

DOI： 10.1128/JCM.01151-21

PubMed

researchmap

担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has greatly affected daily life. COVID-19 often causes asymptomatic or mild disease in children; however, delayed routine childhood immunization is a concern, as it could increase the risk of vaccine-preventable disease. No study has evaluated the status of childhood vaccinations in Japan during the COVID-19 pandemic. METHODS: This retrospective observational study evaluated the number of vaccine doses administered to children in 4 Japanese cities (2 cities in the Tokyo metropolitan area and 2 cities far from Tokyo) during the period from 2016 to 2020. Vaccine doses administered between January and September 2020 during the COVID-19 pandemic were compared, by month, with those given during 2016-2019. Age-stratified demographic data were collected to determine whether factors other than change in the child population over time affected vaccination trends. RESULTS: In all cities the decrease in vaccine doses administered was most apparent in March and April 2020, i.e., just before or coincident with the declaration of a nationwide COVID-19 emergency on April 7, 2020. The decrease started as early as February in the Tokyo metropolitan area. As child age increased, the decrease became more apparent. Before the lift of national emergency on May 25, catch-up of the vaccination was observed in all age groups in all cities. Vaccine doses persistently increased in older age groups but not in infants. The overall vaccination trends did not differ significantly among the 4 cities. CONCLUSIONS: The COVID-19 pandemic significantly affected routine childhood immunization in Japan. Thus, a nationwide electronic surveillance system and announcements for guardians to encourage timely routine immunization are warranted.

DOI： 10.1016/j.vaccine.2021.05.050

PubMed

researchmap

記述言語：日本語   出版者・発行元：日本臨床ウイルス学会  

researchmap

記述言語：日本語   出版者・発行元：日本臨床ウイルス学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 2-year-old girl with fever and seizures was diagnosed as having clinically mild encephalitis/encephalopathy with a reversible splenial lesion, as indicated by magnetic resonance imaging. Virologic analysis identified human rhinovirus A49 in her serum. Although human rhinovirus rarely involves the central nervous system, such involvement could result in mild encephalitis/encephalopathy with a reversible splenial lesion.

DOI： 10.1097/INF.0000000000002995

PubMed

researchmap

記述言語：英語  

Parechovirus A1 (PeV-A1) often causes mild respiratory or gastrointestinal disease. Herein we report a case of acute heart failure due to dilated cardiomyopathy exacerbated by acute PeV-A1 infection in a 10-month-old infant. He was brought to our hospital with acute respiratory distress and compensated shock. Echocardiogram showed a dilated left ventricle and severe mitral regurgitation, consistent with dilated cardiomyopathy. PeV-A1 infection was confirmed by (1) positive PCR test results for PeV-A in multiple anatomical sites, including blood, stool, and throat, (2) the genetic sequence of viral protein, and (3) an increase in paired serum PeV-A1-specific neutralizing antibody titers. A few, scattered case reports in infants and young children also indicate the association between myocarditis and/or dilated cardiomyopathy and PeV-A1 infection. In conclusion, PeV-A1 infection could be associated with exacerbation of myocardial diseases in infants and young children; thus PeV-A1 needs to be evaluated as a viral cause of such a condition.

DOI： 10.1016/j.ijid.2021.01.021

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: While there have been studies in adults reporting discordant empiric antibiotic treatment associated with poor outcomes, this area is relatively unexplored in children and neonates despite evidence of increasing resistance to recommended first-line treatment regimens. METHODS: Patient characteristics, antibiotic treatment, microbiology, and 30-day all-cause outcome from children <18 years with blood-culture-confirmed bacterial bloodstream infections (BSI) were collected anonymously using REDCap™ through the Global Antibiotic Prescribing and Resistance in Neonates and Children network from February 2016 to February 2017. Concordance of early empiric antibiotic treatment was determined using European Committee on Antimicrobial Susceptibility Testing interpretive guidelines. The relationship between concordance of empiric regimen and 30-day mortality was investigated using multivariable regression. RESULTS: Four hundred fifty-two children with blood-culture-positive BSI receiving early empiric antibiotics were reported by 25 hospitals in 19 countries. Sixty percent (273/452) were under the age of 2 years. S. aureus, E. coli, and Klebsiella spp. were the most common isolates, and there were 158 unique empiric regimens prescribed. Fifteen percent (69/452) of patients received a discordant regimen, and 7.7% (35/452) died. Six percent (23/383) of patients with concordant regimen died compared with 17.4% (12/69) of patients with discordant regimen. Adjusting for age, sex, presence of comorbidity, unit type, hospital-acquired infections, and Gram stain, the odds of 30-day mortality were 2.9 (95% confidence interval: 1.2-7.0; P = 0.015) for patients receiving discordant early empiric antibiotics. CONCLUSIONS: Odds of mortality in confirmed pediatric BSI are nearly 3-fold higher for patients receiving a discordant early empiric antibiotic regimen. The impact of improved concordance of early empiric treatment on mortality, particularly in critically ill patients, needs further evaluation.

DOI： 10.1097/INF.0000000000002910

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Human parechovirus 3 (HPeV-3) and enteroviruses (EV) are commonly detected viruses in febrile neonates and young infants and are usually diagnosed by PCR. However, in this population, data on detection rates for samples from different anatomical sites are limited. OBJECTIVES: To determine PCR detection rates for HPeV-3 and EVs in serum and cerebrospinal fluid (CSF) samples from febrile neonates and young infants. STUDY DESIGN: This prospective study identified viruses in serum and CSF samples collected from febrile neonates and young infants (age <4 months) in Niigata, Japan, during 2014-2018. HPeV-3 or EV infection was defined as a positive quantitative real-time PCR result for the virus in serum or CSF. Genotypes were identified by sequence analyses of the viral protein 1 region. RESULTS: Among 216 patients, we identified 56 HPeV-3-infected (26 %) and 48 EV-infected patients (22 %). All (56/56; 100 %) HPeV-3-infected patients had a positive PCR result for serum, and 49/56 (88 %) had a positive result for CSF. In EV-infected patients, 40/48 (83 %) were positive for serum, and 34/48 (71 %) were positive for CSF, and 22/48 (46 %) were positive for serum (n = 14) or CSF (n = 8). If only a CSF sample had been obtained, 7 (12 %) HPeV-3 infections and 14 (29 %) EV infections would have been undiagnosed. Detection rates in serum and CSF differed by genotype in EV-infected patients. CONCLUSIONS: Viral RNA detection rates differed between serum and CSF in HPeV-3- and EV-infected neonates/infants. Combined evaluation of serum and CSF samples is important for accurate viral diagnosis in this population.

DOI： 10.1016/j.jcv.2021.104736

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Enterovirus D68 (EV-D68) causes asthma-like respiratory infection in children. Several EV-D68 outbreaks have been reported worldwide since the largest outbreak occurred in the United States in 2014. We experienced an accumulation of pediatric cases with asthma-like respiratory illness in Niigata, Japan, in 2018. STUDY DESIGN: To determine whether EV-D68 was responsible for the case accumulation, this prospective observational study evaluated children hospitalized in 1 of 8 hospitals with asthma-like respiratory illness in Niigata, Japan, during October and November 2018. Diagnoses were made by EV-D68-specific RT-PCR using nasopharyngeal samples. The clade was identified by sequence analyses, and a phylogenetic tree was created. To evaluate seasonal variation, data from pediatric cases with asthma-like respiratory illness in 2018 were retrospectively analyzed. RESULTS: In 2018, 114 children were hospitalized with asthma-like respiratory illness in October and November, and 47 nasopharyngeal samples were collected. EV-D68 was detected in 22/47 (47%) patients during the study period. The phylogenetic tree revealed that all strains belonged to the clade B3 branch, which has been detected worldwide every 2 years since 2014. CONCLUSIONS: EV-D68 was the associated pathogen for asthma-like respiratory illness in children in Japan in 2018. Clade B3, the dominant clade in outbreaks worldwide, was responsible for the outbreak. Detection and detailed virologic analysis of EV-D68 is important as part of worldwide surveillance, as it will aid in understanding the epidemiologic characteristics of EV-D68 infection.

DOI： 10.1097/INF.0000000000002889

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/ped.14374

PubMed

researchmap

担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Family history is one key in diagnosing inborn errors of immunity (IEI); however, disease status is difficult to determine in deceased relatives. X-linked anhidrotic ectodermal dysplasia with immunodeficiency is one of the hyper IgM syndromes that is caused by a hypomorphic variant in the nuclear factor kappa beta essential modulator. We identified a novel IKBKG variant in a 7-month-old boy with pneumococcal rib osteomyelitis and later found that his mother has incontinentia pigmenti. Genetic analysis of preserved umbilical cords revealed the same variant in two of his deceased maternal uncles. Analysis of preserved umbilical cord tissue from deceased relatives can provide important information for diagnosing IEI in their descendants.

DOI： 10.3389/fimmu.2021.786164

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/S1473-3099(20)30684-8

PubMed

researchmap

記述言語：日本語   出版者・発行元：日本臨床ウイルス学会  

researchmap

記述言語：日本語   出版者・発行元：日本臨床ウイルス学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Parechovirus (PeV)-A3 and enteroviruses (EV) are the most common viruses causing sepsis and meningoencephalitis in neonates and young infants. Clinical manifestations of PeV-A3 infection are more severe than those of EV infection, and no pleocytosis with a positive polymerase chain reaction (PCR) result for PeV-A3 in cerebrospinal fluid (CSF) are characteristic findings. We hypothesized that innate immune responses to PeV-A3 and EV are distinct in serum and CSF. METHODS: We evaluated 22 cytokines/chemokines in serum and CSF from PeV-A3- or EV-infected patients younger than 4 months in Niigata, Japan, from 2015 through 2018. Infection was diagnosed with real-time PCR followed by sequencing. Febrile neonates and infants with sepsis-like syndrome who had negative bacterial culture and viral PCR for both PeV-A and EV were also included (non-PeV-A/EV patients). RESULTS: Among 192 febrile patients, we evaluated 16 PeV-A3-infected, 15 EV-infected, and 8 non-PeV-A/EV patients. Serum pro-/anti-inflammatory cytokine/chemokine levels were higher in PeV-A3-infected patients than in EV-infected patients (P < .02). Although most cytokine/chemokine were elevated in CSF from EV-infected patients, levels were low or undetectable in PeV-A3-infected and non-PeV-A/EV patients (P < .001). CONCLUSIONS: Distinct cytokine/chemokine patterns in serum and CSF may explain the different clinical manifestations of PeV-A3-infected and EV-infected neonates and young infants.

DOI： 10.1093/infdis/jiaa131

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/ped.14197

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Febrile neonates and young infants presenting with seizure require immediate evaluation and treatment. Herein we experienced two young infants with parechovirus-A3 (PeV-A3) encephalitis, initially presented with focal seizure suspecting herpes simplex virus (HSV) encephalitis. CASES: We have experienced 2 infantile cases, initially presented with focal seizure. At presentation, HSV encephalitis was strongly suspected and empiric acyclovir therapy was started; however, serum and/or cerebrospinal fluid (CSF) PCR for HSV were negative. Instead, serum and/or CSF PCR for parechovirus-A was positive. PeV-A3 infection was confirmed by genetic sequence analyses. Both cases required multiple anticonvulsant therapy and intensive care for intractable seizure. Diffusion-weighted imaging of brain magnetic resonance imaging (MRI) showed distinct findings; high-intensity lesions in the gray matter of parietal and occipital lobes in Case 1, and bilateral decreased diffusion of the deep white matter and corpus callosum in Case 2. We have followed two cases more than four years; Case 1 developed epilepsy, has been on an anticonvulsant to control her seizure. Case 2 has significant neurodevelopmental delay, unable to stand or communicate with language. CONCLUSIONS: PeV-A3 encephalitis needs to be in differential diagnosis when neonates and young infants present with focal seizure, mimicking HSV encephalitis. Special attention may be necessary in patients with PeV-A3 encephalitis given it could present with intractable seizure with high morbidity in a long-term.

DOI： 10.1016/j.jiac.2020.02.003

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Parechovirus-A3 (PeV-A3) and the enteroviruses (EVs) are the most common viral pathogens responsible for sepsis and meningoencephalitis in neonates and young infants; however, differences in the clinical presentations of two infections are not well described. OBJECTIVES: To describe the clinical presentations of PeV-A3- and EVs-related diseases and develop a novel scoring system to differentiate two diseases. STUDY DESIGN: This prospective study used real-time PCR and genetic sequencing to evaluate viral etiologies of febrile neonates and infants <4 months with suspected sepsis or meningoencephalitis in Niigata area, Japan, in 2014-2016. The clinical manifestations of PeV-A3- and EVs-infected patients were compared, and a novel scoring system was developed after identifying the most distinguishable clinical findings, followed by the external cohort validation. RESULTS: In 210 patients evaluated, we identified 56 PeV-A3-infected (27%) and 43 EVs-infected (20%) patients. The following clinical manifestations were significant in PeV-A3-infected patients, as compared with EVs-infected patients; a higher body temperature (38.9°C vs. 38.5°C, P < .01) and heart rate (181/min vs. 168/min, P = .01), cold extremities (72% vs. 34%, P < .01) and skin mottling (65% vs. 23%, P < .01), lower white blood cell count (5,200/μL vs. 8,900/μL, P < .01) and incidence of cerebrospinal fluid (CSF) pleocytosis (2% vs. 63%, P < .01). Using some of these significant findings, the scoring system successfully distinguished the diseases (accuracy: 86% and 83% for the derivative and external validation cohorts, respectively). CONCLUSIONS: We found significant clinical manifestations in PeV-A3-infected patients compared to EVs-infected patients. The scoring system may be helpful to distinguish two infections, especially at onset of outbreak.

DOI： 10.1016/j.jcv.2019.104256

PubMed

researchmap

記述言語：日本語   出版者・発行元：(公社)日本小児科学会  

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Parechovirus A (PeV-A) is an important cause of sepsis and meningoencephalitis in neonates and young infants. Thus, identifying the source of PeV-A is essential for prevention; however, little is known regarding the spread of PeV-A among family members of PeV-A-infected neonates and young infants. METHODS: In this prospective study, we evaluated stool samples from family members of PeV-A-infected neonates and infants younger than 4 months who presented with sepsis, meningoencephalitis, or both in Niigata, Japan, in 2016. Because of a simultaneous outbreak, enteroviruses (EVs) were also evaluated during this period. Real-time polymerase chain reaction followed by sequence analysis was used for viral diagnosis using serum and/or cerebrospinal fluid samples. RESULTS: Among 54 febrile patients, the stool samples of 14 (26%) and 12 (22%) patients tested positive for PeV-A and EV, respectively. Stool samples from 54 family members (38 adults and 16 children) of 12 PeV-A-infected patients were available. The rate of PeV-A positivity in these samples was higher among the children (88% [14 of 16]) than the adults (34% [13 of 38]). Among family members with a PeV-A-positive stool sample, 29% (4 of 14) of the children and 77% (10 of 13) of the adults were asymptomatic. Similarly, among 53 stool samples from family members (31 adults and 22 children) of 11 EV-infected patients, the rate of EV positivity in the stool samples was higher among the children (91% [20 of 22]) than among the adults (42% [13 of 31]). The asymptomatic-patient rates were 45% (9 of 20) among the children and 85% (11 of 13) among the adults in family members with EV-positive stool. CONCLUSIONS: Similar to EVs, PeV-A was detected frequently in stool samples from family members of PeV-A-infected patients. Among family members with PeV-A-positive stool, adults were more likely than children to be asymptomatic and therefore could be an important source of PeV-A infection.

DOI： 10.1093/jpids/piy079

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/ped.13979

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Saffold virus (SAFV) is a novel human cardiovirus that was identified in 2007. Recently, SAFV has been isolated from nasal and stool specimens of infants presenting with respiratory and gastrointestinal symptoms and from cerebrospinal fluid (CSF) specimens of children with central nervous system infection. However, little is known regarding clinical characteristics of SAFV in children. METHODS: We reviewed 5412 specimens from the database of the infectious agents surveillance system in Niigata prefecture, Japan, between January 2006 and December 2013, and identified SAFV-infected patients. Subsequently, we retrospectively reviewed their medical records and evaluated their clinical characteristics. RESULTS: We identified 9 SAFV-infected patients (median age: 5 years; range: 2-16 years). Seven patients were diagnosed with pharyngitis, one with meningitis and one with fever of unknown origin. Dominant symptoms were high fever, appetite loss and headache. The median duration of the fevers was 2 days in patients with pharyngitis; however, the patient with meningitis remained febrile for 5 days. All blood tests available in this case series revealed leukocytosis with a predominance of neutrophils. CSF profiles showed mild lymphocytic pleocytosis. All patients recovered fully without complications. CONCLUSIONS: A few clinical characteristics of SAFV infection were clarified, including high fever of short duration in patients with pharyngitis, and neutrophil-dominant leukocytosis. The clinical course and CSF profiles of a case of meningitis were similar to those of other aseptic meningitis. SAFV needs to be included in the differential diagnosis of pharyngitis or meningitis when commonly identified viruses are not identified in such patients.

DOI： 10.1097/INF.0000000000002298

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

This 3-year follow-up study evaluated neutralizing antibody titers (NATs) against parechovirus-A3 (PeV-A3) in neonates and young infants who developed PeV-A3 infection. All children had low NATs at disease onset and high NATs after infection during infancy. At age 3 years, all 16 patients tested had high NATs (≥1:512) against PeV-A3 indicating that specific PeV-A3 NATs persist into childhood.

DOI： 10.1097/INF.0000000000002245

PubMed

researchmap

記述言語：日本語   出版者・発行元：(株)日本小児医事出版社  

Chlamydia trachomatis(以下C.trachomatis)は、産道感染により新生児肺炎の病原微生物となり得る。症例は周産期異常のない日齢29の男児。日齢19から咳嗽と多呼吸が出現し、胸部X線像で両側の肺野に網状影を認めた。Clarithromycinによる治療で呼吸状態は改善した。C.trachomatis IgM陽性、後鼻腔スワブC.trachomatis PCR(polymerase chain reaction)陽性の検査結果からC.trachomatis肺炎と診断した。妊娠5週の妊婦健康診査(妊婦健診)ではC.trachomatisの腟分泌物PCR検査は陰性であった。児の診断を受けて母とパートナーに対してもC.trachomatisの治療をした。C.trachomatisは妊婦健診の検査が陰性でも偽陰性や妊娠中に感染する可能性があり、新生児肺炎の起因菌として鑑別すべきである。(著者抄録)

researchmap

担当区分：筆頭著者   記述言語：英語  

DOI： 10.1097/INF.0000000000002273

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/ped.13847

PubMed

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本小児感染症学会  

researchmap

担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

We conducted an antimicrobial stewardship program in a pediatric intensive care unit. An interrupted time-series analysis revealed a significant reduction in level and trend of days of therapy per 1000 patient-days for antipseudomonal agents. No increase in adverse patient outcomes was found.

DOI： 10.1093/jpids/piy031

PubMed

researchmap

記述言語：日本語   出版者・発行元：日本小児感染症学会  

マラリアは、熱帯・亜熱帯地域のアフリカ、アジア、南米などを中心にみられる蚊媒介感染症である。特に熱帯熱マラリアは重症化すると致死的となる可能性があり、かつ有効な治療薬があるため、渡航者発熱では必ず鑑別疾患にあげて除外する必要がある。今回、熱帯熱マラリアと卵形マラリアの稀な混合感染の症例を経験した。症例は4歳女児、発熱、嘔吐、下痢が16日間遷延し前医外来で経過観察されていた。渡航歴聴取を契機にマラリア感染が疑われ当院に転院となった。両親は西アフリカのギニア国籍で6年前に来日し、児は日本で出生した。入院3ヵ月前にギニアに渡航し、滞在中マラリアに感染し治療されていた。迅速検査、血液ギムザ染色の結果から熱帯熱マラリアと診断し、アトバコン・プログアニルの内服を行った。さらに血液スメアで卵形マラリアを疑う原虫が観察され、血液PCRも陽性であり、卵形マラリアの混合感染が判明した。卵形マラリアの肝内休眠体に対してプリマキンによる追加内服治療を行った。マラリアは症状が非特異的であり、診断には詳細な渡航歴の聴取が重要である。また肝内休眠体への治療は異なるので注意が必要である。(著者抄録)

researchmap

記述言語：日本語   出版者・発行元：日本小児感染症学会  

先天性皮膚洞の発生頻度は2,500人に1人と言われており、6割が中枢神経感染症を契機に発見されたという報告がある。先天性皮膚洞感染症に続いて、皮膚洞に連続した腫瘍の感染や髄膜炎を起こすことで下肢の麻痺や膀胱直腸障害を合併することがあり早期診断が肝要となる。しかし、皮膚の所見は軽微なことがあり、診断が遅れることも稀ではない。われわれは遷延する発熱の原因が先天性皮膚洞感染症であった3症例を経験した。それぞれ症状出現から診断までに127日、32日、29日を要した。いずれの症例も皮膚所見が軽微であったり、被髪部に存在し発見が困難であったりしたため、先天性皮膚洞を想起して感染症の診断に至るのが困難であった。原因不明の遷延性発熱をみた場合には、先天性皮膚洞の感染症を鑑別の一つにあげ、背部正中軸に沿った皮膚所見を丁寧に診察することで早期発見の手がかりとなる。軽微でも皮膚の異常所見を認めれば、積極的に先天性皮膚洞の診断のための画像検査を進めることが重要である。診断した際には、速やかに抗菌薬治療とタイミングをみて外科的治療を行う。(著者抄録)

researchmap

記述言語：日本語   出版者・発行元：日本小児感染症学会  

本邦の小児における侵襲性肺真菌症の検査診断に関する報告は少なく、その特徴を後方視的に検討した。2010年3月〜2017年3月の侵襲性肺真菌症の15例を対象とした。真菌の内訳はアスペルギルス属が10例、接合菌が2例、Pneumocystis jiroveciiが2例であった。清潔部位の培養検査で診断した確定例は3例であった。推定例は10例で、うち6例は抗原検査で診断した。アスペルギルス属では、培養検査で診断した症例は3例で、うち1例はガラクトマンナン抗原が陰性、2例は(1→3)-β-D-グルカン(beta-D-glucan:BDG)が陰性であった。ガラクトマンナン抗原で診断した症例は5例で、うち3例はBDGが陰性であった。Polymerase chain reaction(PCR)法で診断した症例は2例で、いずれも真菌抗原は陰性であった。P.jiroveciiは2例ともBDGが300pg/mL以上であり、著増しやすい傾向が示唆された。侵襲性肺真菌症は抗原検査が陰性であっても培養検査やPCR法が陽性となる例もあり、複数の検査を組み合わせて総合的に診断することが重要であると考えられた。(著者抄録)

researchmap

記述言語：日本語   出版者・発行元：日本小児感染症学会  

小児における侵襲性A群溶血性レンサ球菌(以下、GAS)感染症の臨床像とemm型の関連に関するデータは少ない。2010年4月から2017年3月までの期間に東京都立小児総合医療センターで診療を行った侵襲性GAS感染症について、年齢、性別、基礎疾患、診断、emm型、入院期間、抗菌薬感受性、予後を後方視的に調べた。16例の侵襲性GAS感染症を認め、13例でemm型分析が可能であった。emm型の内訳は、emm1.0が5例(31%)、emm89が3例(19%)、emm12が3例(19%)、emm28が1例(6%)、emm3が1例(6%)であった。診断の内訳は、化膿性関節炎5例(31%)、膿瘍4例(25%)、皮膚軟部組織感染症3例(19%)、骨髄炎3例(19%)、肺炎・膿胸2例(13%)、腹膜透析関連腹膜炎1例(6%)、カテーテル関連血流感染症1例(6%)であった。臨床像とemm型の間に明らかな相関関係は認められなかった。本研究におけるemm型は、本邦での溶連菌トキシックショック症候群調査の上位3つの型と一致した。現在開発中のワクチンはMタンパクを抗原として作られており、調査対象と数を拡大して本邦における侵襲性GAS感染症のemm型が明らかになれば、将来ワクチン導入に際して有効性の評価の基盤となるデータとなることが期待される。(著者抄録)

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Parvovirus B19 (PB19) is an important human pathogen that results in a wide spectrum of clinical outcomes, from mild, self-limiting erythema infectiosum in immunocompetent children and arthralgia in adults to lethal cytopenia in immunocompromised patients and intrauterine fetal death. However, there have been few reports of PB19 infection in neonates or young infants (aged 28-90 days), and no previous reports contained descriptions of PB19 infection as a cause of sepsislike syndrome in this age group. We report a case of sepsislike syndrome caused by PB19 infection in a 56-day-old infant whose mother had polyarthralgia at the time of his admission. PB19 infection was diagnosed on the basis of positive polymerase chain reaction results for PB19 DNA in the serum and cerebrospinal fluid. Positive immunoglobulin M and negative immunoglobulin G for PB19 suggested acute infection. He was admitted to the ICU because of poor peripheral circulation, but fully recovered without antibiotic administration. After excluding other possible pathogens, PB19 should be suspected as a cause of sepsislike syndrome in young infants, especially those who have close contact with PB19-infected individuals.

DOI： 10.1542/peds.2017-1435

PubMed

researchmap

記述言語：日本語   出版者・発行元：日本小児感染症学会  

ヒトポリオーマウイルスに属するBKウイルスは、小児期にほとんどが無症候性または軽症の自然感染をする。造血幹細胞移植後などの免疫抑制下で再活性化し、出血性膀胱炎や尿管狭窄を起こすが、本邦での尿中BKウイルスを検出した小児報告例は少ない。2013年4月から2016年6月に東京都立小児総合医療センターで、血尿を呈し尿中BKウイルスのリアルタイムPCRを施行した症例において、BKウイルス陽性群と陰性群の臨床像の比較を行った。施行したのは17例で年齢中央値は9歳であった。17例中7例でBKウイルスが検出され、いずれも血液腫瘍疾患・固形腫瘍・原発性免疫不全症などの基礎疾患を有していた。BKウイルス陽性のうち4例(57%)が造血幹細胞移植後であり、移植後症例はいずれも免疫抑制薬を投与中であった。BKウイルス陽性例と陰性例の比較では、臨床像の特徴に有意な差は認められなかったが、陽性例で年齢が高く、CRPが低い傾向が認められた(p<0.1)。出血性膀胱炎に対しては支持療法を行ったが、血小板輸血に至った3例は、いずれも造血幹細胞移植後であった。免疫不全児の血尿では、BKウイルスが鑑別として重要である。(著者抄録)

researchmap

記述言語：英語  

BACKGROUND: Sibling visits to the neonatal intensive care unit (NICU) are a part of family-centered care, which is now being increasingly endorsed as a positive development in patient care. Sibling visits, however, pose a risk of viral infection, and hence many NICU in Japan impose strict limits on the practice. The aim of this study was therefore to assess whether sibling visits to the NICU are related to an increase in the nosocomial viral infection rate. METHODS: This retrospective study was conducted between April 2012 and March 2017 at Tokyo Metropolitan Children's Medical Center in Japan. Sibling visits were implemented after screening for symptoms of viral illness. Symptomatic patients in the NICU were tested for common viruses on rapid antigen test and polymerase chain reaction. The number of sibling visits and the rate of nosocomial viral infections were examined on Spearman's correlation test. RESULTS: The total number of sibling visits and rate of nosocomial viral infection in the NICU was 102 and 0.068 per 1,000 patient-days during the study period, respectively. The number of enterovirus, respiratory syncytial virus, human metapneumovirus, influenza virus A, and Herpes simplex virus infections was 3, 2, 1, 1, 1, and 1, respectively. No infections were identified after sibling visits. The number of sibling visits and the rate of nosocomial viral infections were not correlated (correlation coefficient, -0.1; P = 0.873). CONCLUSION: Sibling visits to the NICU did not result in an increase in the nosocomial viral infection rate.

DOI： 10.1111/ped.13470

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: The impact of pediatric antimicrobial stewardship programs (ASP) on antimicrobial resistance (AMR) remains largely unknown. This study aimed to evaluate the AMR for carbapenem of Gram-negative bacilli (GNB) and carbapenem use with infectious diseases consultation after the implementation of an ASP. METHODS: This quasi-experimental study was conducted at Tokyo Metropolitan Children's Medical Center in Japan. The pre- and post-intervention periods were April 2010 to September 2011 and October 2011 to March 2017, respectively. The pre-intervention phase consisted of consultations with the infectious diseases service alone. The ASP was implemented during the post-intervention phase. The carbapenem resistance rates of GNB were calculated. The correlation between carbapenem resistance rates and carbapenem day of therapy (DOT) was examined. The outcome metrics were compared by average length of hospitalization, all-cause mortality, and infection-related mortality. RESULTS: A positive correlation was observed between the carbapenem resistance rate in Pseudomonas aeruginosa and DOT (0.76, p=0.04). The carbapenem resistance rate in P. aeruginosa (p<0.01) and DOT (p<0.01) decreased significantly in the post-intervention period. The length of hospitalization (p<0.01) and infection-related mortality (p=0.05) decreased in the post-intervention period. CONCLUSIONS: A sustained ASP with additional consultation with the infectious disease service reduced carbapenem use and resistance in P. aeruginosa, leading to favorable outcomes in terms of length of hospitalization and infection-related mortality.

DOI： 10.1016/j.ijid.2017.09.012

PubMed

researchmap

記述言語：日本語   出版者・発行元：グローバルヘルス合同大会事務局  

researchmap

記述言語：日本語   出版者・発行元：日本小児感染症学会  

黄色ブドウ球菌は病原性が高く、病原因子の一つは菌の産生する外毒素である。SE(staphylococcal enterotoxin)、TSST-1(toxic shock syndrome toxin-1)、ET(exfoliative toxin)などが毒素作用およびスーパー抗原として特定の疾患の原因となる。外毒素と疾患との関連については報告が少なく、本研究では2010年9月から2016年3月に東京都立小児総合医療センターを受診した、黄色ブドウ球菌感染症症例を対象に検討を行った。230症例のうち62.2%で1種類以上の毒素が検出され、SE陽性例が46.1%、TSST-1陽性例が26.5%、ET陽性例は13.5%であった。各疾患群で比較すると、骨関節感染症ではSEA(staphylococcal enterotoxin type A)の陽性率が31.3%と高く、皮膚軟部組織感染症ではETA(exfoliative toxin type A)の陽性率が4.8%、ETB(exfoliative toxin type B)の陽性率が19.8%と高かった。また、ET陽性例は全例が皮膚軟部組織感染症症例であった。(著者抄録)

researchmap

担当区分：筆頭著者   記述言語：英語   出版者・発行元：ELSEVIER SCIENCE BV  

Human parechoviruses (HPeVs) are RNA viruses that have characteristics similar to those of enteroviruses and usually cause mild respiratory or gastrointestinal symptoms. Human parechovirus type 3 (HPeV3), first reported in 2004, is exceptional because it can provoke sepsis and meningoencephalitis leading to neurological sequelae, and even death, in neonates and young infants. Pediatricians and researchers are increasingly aware that HPeV3 is responsible for serious disease in neonates and young infants. Retrospective studies and several reports of epidemics of HPeV3 infection have provided data on epidemiology, clinical symptoms and signs, laboratory findings, and outcomes. However, the pathogenesis of HPeV3 infection remains unclear, which explains the lack of specific antiviral therapy and effective prevention measures. Maternal antibodies are important in protection against severe HPeV3-related disease, and this may be a clue regarding its pathogenesis. HPeV3 epidemics are likely to continue, and because the clinical manifestations of HPeV3 are severe, determining the pathogenesis of HPeV3 infection and establishing specific antiviral therapies are important goals for future research. (C) 2017 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jiac.2017.04.009

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

researchmap

担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE BV  

Background: Human parechovirus type 3 (HPeV3) is an emerging virus that causes sepsis and meningoencephalitis in neonates and young infants. Correct diagnosis of HPeV3 infection is critical in determining appropriate management and predicting patients' clinical course. Real-time reverse transcription PCR (RT-PCR) analysis of serum and/or cerebrospinal fluid (CSF) has been used to diagnose HPeV3 infection; however, the assay detection limits have not been fully evaluated.
Objectives: We tested the hypothesis that droplet digital RT-PCR (RT-ddPCR) a novel technique that precisely quantitates low-copy target genes by diluting and partitioning samples into compartments increases the detection rate of HPeV3 RNA as compared with real-time RT-PCR.
Study design: Using samples with predetermined HPeV3 copy numbers, we evaluated one-step and two-step RT-ddPCR. Then, we tested two-step RT-ddPCR and real-time RT-PCR, using clinical samples with low copy numbers. Finally, we used two-step RT-ddPCR to evaluate clinical samples obtained from HPeV3-infected patients with positive serum but negative CSF, as determined by real-time RT-PCR.
Results: Two-step RT-ddPCR was less variable and more specific than one-step RT-ddPCR. Two-step RT-ddPCR detected HPeV3 RNA in all six CSF samples; four samples (67%) were reproducibly positive and the other two samples (33%) were positive at least once in four replicates. Finally, no nonspecific droplet was positive by two-step RT-ddPCR.
Conclusions: Two-step RT-ddPCR may enhance the rate of HPeV3 RNA detection from samples with low viral loads, thereby improving diagnosis and management of HPeV3-infected patients. (C) 2016 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.jcv.2016.09.009

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

Four infants born prematurely presented with multiple apnea episodes caused by human parechovirus type 3 (HPeV3) infection. All patients required oxygen supplementation, and one patient required mechanical ventilation. HPeV3 infection might be included in the differential diagnosis of apnea in neonates and young infants, especially those born prematurely.

DOI： 10.1111/ped.12869

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：(公社)日本小児科医会  

ヒトパレコウイルス3型(Human Parechovirus Type 3:HPeV3)感染症は新生児、生後3ヵ月未満の早期乳児に敗血症、髄膜脳炎などの重症感染症を起こし、神経学的後遺症や死亡の転帰をとることがあり、注目を集めている新興感染症である。日本では2006年以降2、3年おきに流行を繰り返しており、2014年にも日本各地から患者発生の報告があった。発熱に加えて心拍数200回/分を超える高度な頻脈と全身の網状チアノーゼを伴うことが典型的であり、腹部膨満、臍の突出や掌蹠の紅斑を伴うことが特徴的である。診断は血清、髄液を用いたリアルタイムPCR法やウイルス分離によって行われる。特異的な治療法は現時点では存在せず、対症療法が主である。我々は正期産児の臍帯血、HPeV3重症感染症と診断された新生児、早期乳児の中和抗体価を測定し、母体からの移行抗体が発症において重要な役割を果たすこと、約40%の新生児がHPeV3に対する移行抗体を持たず、HPeV3重症感染症に感受性があることを見出した。(著者抄録)

researchmap

担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：W B SAUNDERS CO LTD  

During the 2014 human parechovirus type 3 (HPeV3) epidemic in Niigata, Japan, this prospective observational study identified HPeV3 from 43/85 (51%) febrile young infants &lt;4 months using PCR analysis of serum (n = 42) and/or cerebrospinal fluid (CSF) (n = 32) and genetic sequencing of the VP1 region of HPeV3. HPeV3-infected patients (median age, 32 days; range, 4-113 days) were diagnosed as having sepsis (79%), sepsis-like syndrome (19%), or encephalitis with septic shock (2%). Other than fever, mottled skin (67%) was significantly more frequent in HPeV3-infected patients than other virus-infected patients (P = 0.005). The rate of HPeV3 RNA detection in CSF without pleocytosis was high (88%; 28/32). Among the 32 patients whose serum and CSF samples were available, all patients were positive for serum PCR; however, 4 (12%) patients were negative for CSF PCR. Serum HPeV3 RNA level on admission was associated with younger age (P = 0.002), bad temper (P = 0.041), and grunting (P = 0.008). Among 6 patients with sequential data on serum HPeV3 RNA level, levels decreased rapidly without specific therapy. In conclusion, serum samples at disease onset are the most useful compared to CSF in detection of HPeV RNA and serum HPeV3 RNA level on admission was associated with important clinical manifestations in HPeV3-infected patients. (C) 2015 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.jinf.2015.10.010

Web of Science

PubMed

researchmap

記述言語：英語   出版者・発行元：TAYLOR & FRANCIS INC  

Intradermal (ID) vaccination induces a more potent immune response and requires lower vaccine doses as compared with standard vaccination routes. To deliver ID vaccines effectively and consistently, an ID delivery device has been developed and is commercially available for adults. The clinical application of ID vaccines for infants and children is much anticipated because children receive several vaccines, on multiple occasions, during infancy and childhood. However, experience with ID vaccines is limited and present evidence is sparse and inconsistent. ID delivery devices are not currently available for infants and children, but recent studies have examined skin thickness in this population and reported that it did not differ in proportion to body size in infants, children, and adults. These results are helpful in developing new ID devices and for preparing new vaccines in infants and children.

DOI： 10.1080/21645515.2016.1176652

Web of Science

PubMed

researchmap

担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：CENTERS DISEASE CONTROL  

Human parechovirus type 3 (HPeV3) is an emerging pathogen that causes sepsis and meningoencephalitis in young infants. To test the hypothesis that maternal antibodies can protect this population, we measured neutralizing antibody titers (NATs) to HPeV3 and other genotypes (HPeV1 and HPeV6) in 175 cord blood samples in Japan. The seropositivity rate (&gt;= 1:32) for HPeV3 was 61%, similar to that for the other genotypes, but decreased significantly as maternal age increased (p&lt;0.001). Furthermore, during the 2014 HPeV3 epidemic, prospective measurement of NATs to HPeV3 in 45 patients with severe diseases caused by HPeV3 infection showed low NATs (&lt;= 1:16) at onset and persistently high NATs (&gt;= 1:512) until age 6 months. All intravenous immunoglobulin samples tested elicited high NATs to HPeV3. Our findings indicate that maternal antibodies to HPeV3 may help protect young infants from severe diseases related to HPeV3 and that antibody supplementation may benefit these patients.

DOI： 10.3201/eid2111.150267

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：(株)医学書院  

researchmap

記述言語：日本語   出版者・発行元：日本臨床ウイルス学会  

2014年新潟県おける新生児・早期乳児のヒトパレコウイルス3型(HPaV3)感染症の流行について検討した。敗血症症疑いで入院した生後3ヵ月以下の新生児、早期乳児85例を対象とした。54例でウイルスを同定し、HPeV3 43例、EVs 8例、HPeV4 1例、HSV1 1例、HSV2 1例であった。BPeV3例の年齢は中央値32生日で、41例が生後3ヵ月未満であった。全ての症例で発熱があり、哺乳不良、活気不良、発疹、不機嫌も70%程度の高い割合で認めた。臨床診断名は、敗血症34例がその殆どで、敗血症様症候群8例、敗血症性ショック・脳炎1例であった。4例が集中治療を要した。リアルタイムPCR法によって42例は血清で診断され、髄液のみが入手可能であった1例は髄液で診断した。VP1領域の塩基配列を同定した42株を用いた系統樹解析では、二つのクラスターに分かれた。

researchmap

担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE BV  

Background: Human parechovirus type 3 (HPeV3) epidemics occur worldwide and can lead to severe disease in neonates and young infants. Little is known about the source of HPeV3 infection.
Objectives: To investigate the source of HPeV3 infection and the role of asymptomatic children in the families of infected children.
Study design: During a 2014 HPeV3 epidemic in Niigata, Japan, we analyzed (1) clinical information on sick contacts for 43 neonates and young infants with HPeV3-related disease diagnosed by PCR analysis of serum and/or cerebrospinal fluid and (2) stool samples from symptomatic and asymptomatic siblings/cousins of index patients. To confirm transmission, the P1 (VP0, VP3, and VP1) and 3D(pol) regions of HPeVs were sequenced and analyzed.
Results: Sick contact with family members was confirmed for 51% (n = 22) of patients. Among the 30 symptomatic family members, 67% (n = 20) were siblings, 20% (n = 6) were mothers, and 13% (n = 4) were other relatives. Stool samples from symptomatic and asymptomatic siblings/cousins of 4 HPeV3-infected patients yielded positive results for HPeVs on PCR analysis. Furthermore, the P1 and 3Dpol nucleotide sequences of family members were 100% identical to those of the respective index cases.
Conclusions: Identification of genetically identical virus from HPeV3-infected patients and asymptomatic children in their families suggests that the latter are a source of infection in neonates and young infants with HPeV3-related diseases. (C) 2015 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.jcv.2015.07.300

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCI LTD  

As compared with standard intramuscular and subcutaneous vaccines, intradermal (ID) vaccines elicit a more potent immune response in both adults and children, with equivalent dosage or antigen dose sparing.
Recently, various devices for ID injection have been developed; the length of needles ranges in 0.6-1.5 mm. However, skin thickness must be measured to determine optimal needle length for ID vaccines. Use of ID vaccines in infants and children is appealing because children require more vaccines than do adults; however, information on skin thickness in infants and children is limited. We used ultrasound echography to measure skin thickness in Japanese infants aged 2 months (n = 78) and adolescents aged 13-15 years (n = 82). Mean (range) deltoid and suprascapular skin thickness was 1.67 mm (1.16-2.39 mm) and 1.83 mm (1.24-2.60 mm), respectively, in infants and 1.81 mm (1.25-3.00 mm) and 2.43 mm (1.51-3.95 mm), respectively, in adolescents. Among infants who underwent re-measurement of skin thickness at age 6 months (n = 11), mean deltoid skin thickness (1.84 mm) was significantly greater than at age 2 months (1.60 mm) (P &lt; 0.001). In contrast, no significant difference was observed in suprascapular skin thickness (1.79 mm vs. 1.67 mm, respectively; P = 0.17). Gender was not associated with skin thickness in either age group. Skin thickness was positively correlated with body weight in adolescents (r = 0.43, P &lt; 0.001 in deltoid region; r = 0.30, P = 0.01 in suprascapular region). In conclusion, this is the first study to evaluate skin thickness in different age groups of children, including at age 2 months. Skin thickness gradually increased from age 2 months to age 13-15 years, but no consistent trend was noted in analysis stratified by measurement site, gender, or age. These findings suggest that an appropriate length of ID device needle for infants and children is likely to be less than 1.2 mm and a special device with shorter length of needle is warranted for infants and children. (C) 2015 Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.vaccine.2015.04.081

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

researchmap

記述言語：英語   出版者・発行元：(公社)日本小児科学会  

researchmap

記述言語：日本語   出版者・発行元：(公社)日本小児科学会  

researchmap

記述言語：日本語   出版者・発行元：日本臨床ウイルス学会  

researchmap

記述言語：日本語   出版者・発行元：日本臨床ウイルス学会  

researchmap

担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MICROBIOLOGY SOC  

Loop-mediated isothermal amplification (LAMP) is a cost-effective and rapid method for identifying Mycoplasma pneumoniae (MP). We investigated the utility of the LAMP assay in diagnosing MP pneumonia among children in a clinical setting. In this prospective study, the cause of community-acquired pneumonia was evaluated in 111 patients for whom MP was the suspected pathogen. All participants were patients at a city hospital in Japan between April 201 2 and September 2012. Throat swabs for the LAMP assay were obtained at admission, and paired serum samples to measure antibody titres to MP by particle agglutination were obtained at admission and during convalescence. Overall, 45 of 111 (41 %) patients had a fourfold or greater increase in MP titres and received a diagnosis of MP pneumonia. Among them, 43 (96%) patients (median age, 9 years) were positive on the LAMP assay and had a fourfold or greater increase in MP titres. The median interval from fever onset to collection of throat swabs was 7 days (range, 4-10 days). As compared with paired serum titres, the LAMP assay enabled quicker diagnosis of MP (median interval, 13 vs. 7 days), thereby allowing early initiation of appropriate antimicrobial therapy.

DOI： 10.1099/jmm.0.068288-0

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：(有)科学評論社  

researchmap

記述言語：日本語   出版者・発行元：(株)医学書院  

researchmap

その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J01440&link_issn=&doc_id=20131022050074&doc_link_id=10.11477%2Fmf.1402107142&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1402107142&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：CENTERS DISEASE CONTROL  

We describe a case of rhabdomyolysis in a patient infected with antimicrobial drug resistant Mycoplasma pneumoniae The patient's acute-phase serum levels of interleukin-18 and tumor necrosis factor-alpha were high, which suggests a pathogenic role for M. pneumoniae. In an era of increasing antimicrobial drug resistance, a system for rapidly identifying resistant M. pneumoniae would be beneficial.

DOI： 10.3201/eid1805.111149

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：日本臨床ウイルス学会  

エンテロウイルスD68(enterovirus(EV)-D68)は、気管支喘息様呼吸器疾患の原因ウイルスである。国外では2014年から周期的に流行し、国内では2015年に流行した。2018年9月に新潟県内で小児喘息様発作患者の報告が相つぎ、EV-D68の流行の有無について前方視的疫学調査を行った。同年10〜11月に新潟県内8施設に気管支喘息様呼吸器疾患で入院した小児患者(n=47)から鼻咽頭拭い液を採取した。EV-D68感染症の診断はviral protein 1(VP1)領域を標的とした特異的PCRを用い、陽性検体にはVP1領域のPCRで塩基配列を同定した。2014年以降に各国で流行した株とともに系統樹解析を行った。47検体のうち、22検体(47%)でEV-D68が陽性であった。系統樹解析では、すべての株がclade B3に分類され、2014年以降世界的に流行したものと同一であった。今回の小児喘息発作患者の急増において、EV-D68clade B3の流行を認めた。EV-D68 clade B3は国内外で周期的な流行を認めており、今後も継続的なサーベイランスが必要である。(著者抄録)

researchmap

記述言語：日本語   出版者・発行元：日本臨床ウイルス学会  

パレコウイルスA3(parechovirus-A3、以下PeV-A3)とエンテロウイルス(enterovirus、以下EV)は、新生児・早期乳児に敗血症や髄膜炎をきたす代表的なウイルスである。PeV-A3感染症は、EV感染症とくらべ、重症感が強いが髄液細胞数の増多をみることは少ない。今回、これら臨床像の違いについて、血清と髄液のサイトカインを測定し、自然免疫の観点から検討した。PeV-A3患児16例、EV患児15例のサイトカインをMILLIPLEX MAP bead panelを用いて測定した。ウイルス量はリアルタイムPCR法で測定した。結果、血清サイトカインはPeV-A3患児で高値(P≦.011)、髄液ではEV患児で高値であった(P≦.036)。ウイルス量は、血清でPeV-A3患児で高値(P=.004)、髄液ではEV患児で高値であった(P=.02)。また、EV患児で髄液サイトカインと髄液細胞数に正の相関を認めた(r>.54、P<.05)。PeV-A3患児は、血清ウイルスゲノム量が多く、サイトカインが高いことが重症感に関与していると示唆された。PeV-A3患児とEV患児では、血清と髄液で異なる自然免疫反応が起こり、その異なる病態生理に寄与している可能性がある。(著者抄録)

researchmap

記述言語：日本語   出版者・発行元：日本小児感染症学会  

researchmap

記述言語：日本語   出版者・発行元：日本小児感染症学会  

researchmap

記述言語：日本語   出版者・発行元：日本小児感染症学会  

researchmap

記述言語：日本語   出版者・発行元：日本小児感染症学会  

researchmap

記述言語：日本語   出版者・発行元：日本臨床ウイルス学会  

researchmap

記述言語：日本語   出版者・発行元：日本臨床ウイルス学会  

researchmap

記述言語：日本語   出版者・発行元：日本臨床ウイルス学会  

researchmap

記述言語：日本語   出版者・発行元：日本臨床ウイルス学会  

researchmap

記述言語：日本語   出版者・発行元：日本臨床ウイルス学会  

researchmap

記述言語：日本語   出版者・発行元：日本臨床ウイルス学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

researchmap

記述言語：日本語   出版者・発行元：(公社)日本小児科学会  

researchmap

記述言語：日本語   出版者・発行元：(公社)日本小児科学会  

researchmap

記述言語：日本語   出版者・発行元：日本内科学会-関東地方会  

researchmap

記述言語：日本語   出版者・発行元：(株)東京医学社  

researchmap

記述言語：日本語   出版者・発行元：(株)近代出版  

ヒトパレコウイルスのうち、特に3型は生後4ヵ月未満の早期乳児に敗血症、髄膜脳炎をきたす、小児科医の間で注目を集めている新興ウイルス感染症である。特異的な臨床症状や徴候が明らかになりつつある一方で、疫学や病態生理はまだ不明な点が多い。(著者抄録)

researchmap

記述言語：日本語   出版者・発行元：(一社)日本小児救急医学会  

症例は5歳男児。当科受診2日前から発熱、咳嗽を認め、第2病日に近医を受診したが、鼻咽頭拭い液のインフルエンザウイルス(Influenza virus:flu)迅速抗原キット検査は陰性で、自宅での経過観察を指示された。しかし、同日夜に喘鳴が出現し、第3病日昼からは呼吸困難も訴え、14時に当科へ救急搬送された。搬入2時間後、気管挿管した直後に鋳型の粘液栓が吸引されて、鋳型気管支炎と診断した。ベラミビル、ステロイド投与、肺理学療法により第17病日に退院となり、以後の再発はない。来院直後の当科での鼻咽頭拭い液のflu迅速抗原キット検査は陰性であったが、同日の検体を用いたリアルタイムPCRではfluBが気管吸引痰、鼻咽頭拭い液ともに陽性で、前者でウイルス量がより多かった。下気道感染症の診断は上気道検体の迅速抗原キット検査のみでは確定できない場合があり、下気道検体を用いた検査の重要性を再認識した。(著者抄録)

researchmap

記述言語：日本語   出版者・発行元：日本小児感染症学会  

researchmap

記述言語：日本語   出版者・発行元：日本小児感染症学会  

researchmap

記述言語：日本語   出版者・発行元：(株)羊土社  

researchmap

記述言語：日本語   出版者・発行元：(株)診断と治療社  

researchmap

記述言語：日本語   出版者・発行元：(株)診断と治療社  

●パレコウイルスA3は日本各地に分布している新興感染症である。●新生児、早期乳児の中で母親からの移行抗体が低値のパレコウイルスA3感染症のハイリスクグループが存在する。●従来2〜3年おきに流行すると考えられていたが、変化の兆しがある。(著者抄録)

researchmap

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J00642&link_issn=&doc_id=20190603050008&doc_link_id=%2Fae4shond%2F2019%2F008206%2F009%2F0733-0737%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fae4shond%2F2019%2F008206%2F009%2F0733-0737%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：日本臨床ウイルス学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本環境感染学会  

researchmap

記述言語：日本語   出版者・発行元：日本小児感染症学会  

researchmap

記述言語：日本語   出版者・発行元：日本小児感染症学会  

researchmap

記述言語：日本語   出版者・発行元：日本小児医事出版社  

CiNii Article

researchmap

記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

researchmap

記述言語：日本語   出版者・発行元：日本小児感染症学会  

Exophiala dermatitidisは広く環境中に存在している黒色真菌であり、主に皮膚感染症の原因となる。免疫抑制者を中心に血流関連感染症の報告もあるが、小児における血流感染症の報告は、日本国内では存在しない。今回Exophiala dermatitidisによるカテーテル関連血流感染症の小児例を経験した。症例は2歳女児、後腹膜奇形腫術後に短腸症候群となり、中心静脈栄養を行っていた。入院3日前から発熱し、血液培養から酵母様真菌が陽性となり入院した。当初カンジダ血症を考えて治療を開始したが、時間経過とともにコロニーが黒色化したことや鏡検で菌糸を形成したことからExophiala属による感染が疑われ、シーケンスにより同定された。リポソーマルアムホテリシンBの投与と中心静脈カテーテルの抜去により軽快した。Exophiala属の同定は一般の医療機関では困難であるが、培養の過程で時間経過に伴うコロニーの黒色化や菌糸の形成がみられた場合には、Exophiala属を鑑別にあげることが重要である。(著者抄録)

researchmap

記述言語：日本語   出版者・発行元：日本小児感染症学会  

Exophiala dermatitidisは広く環境中に存在している黒色真菌であり、主に皮膚感染症の原因となる。免疫抑制者を中心に血流関連感染症の報告もあるが、小児における血流感染症の報告は、日本国内では存在しない。今回Exophiala dermatitidisによるカテーテル関連血流感染症の小児例を経験した。症例は2歳女児、後腹膜奇形腫術後に短腸症候群となり、中心静脈栄養を行っていた。入院3日前から発熱し、血液培養から酵母様真菌が陽性となり入院した。当初カンジダ血症を考えて治療を開始したが、時間経過とともにコロニーが黒色化したことや鏡検で菌糸を形成したことからExophiala属による感染が疑われ、シーケンスにより同定された。リポソーマルアムホテリシンBの投与と中心静脈カテーテルの抜去により軽快した。Exophiala属の同定は一般の医療機関では困難であるが、培養の過程で時間経過に伴うコロニーの黒色化や菌糸の形成がみられた場合には、Exophiala属を鑑別にあげることが重要である。(著者抄録)

researchmap

記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本環境感染学会  

researchmap

記述言語：日本語   出版者・発行元：(公社)日本小児科学会  

researchmap

記述言語：日本語   出版者・発行元：(公社)日本小児科学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

researchmap

記述言語：日本語   出版者・発行元：日本小児臨床薬理学会  

researchmap

記述言語：日本語   出版者・発行元：日本小児臨床薬理学会  

researchmap

記述言語：日本語   出版者・発行元：日本感染症学会  

CiNii Article

researchmap

記述言語：日本語   出版者・発行元：グローバルヘルス合同大会事務局  

researchmap

記述言語：日本語   出版者・発行元：日本小児感染症学会  

日齢22の男児が入院前日からの発熱を主訴に来院し、体幹と四肢に網状チアノーゼを認め、敗血症様症候群と診断された。血清のリアルタイムPCRと遺伝子解析により、ヒトパレコウイルス4型(human parechovirus type 4:HPeV4)が同定された。さらに、HPeV4に対するペア血清で中和抗体価の上昇を確認し、診断を確定した。同定された17の遺伝子型の内、ヒトパレコウイルス3型(human parechovirus type 3:HPeV3)は新生児に敗血症や髄膜脳炎など、重症感染症を引き起こすことが知られているが、HPeV4は軽症の胃腸炎や呼吸器感染症の患者の便からの報告がほとんどである。HPeV4が敗血症様症候群を呈した症例報告は世界でも数例であり、この症例は国内初の報告である。ヒトパレコウイルスの異なる遺伝子型の感染症の臨床像を明らかにするためには、遺伝子型の同定が必要であり、また、症例の集積が重要である。(著者抄録)

researchmap

記述言語：日本語   出版者・発行元：(公社)日本小児科学会  

researchmap

記述言語：日本語   出版者・発行元：診断と治療社  

CiNii Article

CiNii Books

researchmap

記述言語：日本語   出版者・発行元：(株)日本小児医事出版社  

CiNii Article

researchmap

記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本外来小児科学会  

2010年11月〜2016年4月に東京都立小児総合医療センターを受診した19例(男10例、女9例)を対象とした。全例が紹介受診であり、発症時年齢の中央値は2歳3ヵ月、有熱期間の中央値は5日、発熱周期の中央値は28日であった。家族歴は6例(32%)に認めた。随伴症状は咽頭炎(扁桃炎)17例(89%)、アフタ性口内炎15例(79%)、頸部リンパ節腫脹4例(21%)に認め、3症状すべてを満たした症例は4例(21%)であった。診断目的でプレドニゾロンを単回投与した16例は全例が24時間以内に解熱した。治療と転帰は、シメチジン投与18例のうち著効2例(11%)、有効4例(21%)、無効11例(58%)であり、シメチジンによる治療効果不良のためコルヒチンへ変更した9例のうち著効3例(33%)、無効5例(56%)であり、扁桃摘出術に至った症例は2例(10%)であった。治療期間の中央値は8ヵ月であった。

CiNii Article

researchmap

記述言語：日本語   出版者・発行元：(一社)日本環境感染学会  

researchmap

記述言語：日本語   出版者・発行元：日本小児科学会  

症例1(在胎37週0日に出生した2590gの男児)。日齢7より哺乳時にチアノーゼが認め近医を受診、体重増加不良、無呼吸発作を指摘され、日齢10に著者らの施設へ紹介となった。症例2(在胎40週0日に出生した2935gの男児)。日齢29に発熱、意識レベル低下、四肢振戦を認めるようになり、日齢30に前医を受診、細菌性髄膜炎を疑われ、入院加療を受けるも無呼吸が出現したため、日齢31に著者らの施設へ転院となった。両症例とも新生児敗血症様症状で発症し、血清AST、LDH、フェリチン、sIL-2Rの上昇や凝固機能障害ほか、脳MRIでは大脳白質障害を呈していた。治療として、症例1は挿管・人工呼吸管理、症例2は経鼻持続気道陽圧呼吸が行われた。ステロイド治療は施行されなかったが、明らかな神経学的後遺症なく、症状の改善が得られた。尚、患者それぞれの血清、髄液から逆転写PCRでHPeVゲノムが検出され、本症例は新生児ヒトパレコウイルス感染症の診断に至った。

CiNii Article

researchmap

記述言語：日本語   出版者・発行元：日本小児医事出版社  

CiNii Article

researchmap

記述言語：英語   出版者・発行元：TAYLOR & FRANCIS INC  

DOI： 10.1080/21645515.2016.1257231

Web of Science

researchmap

記述言語：日本語   出版者・発行元：医学書院  

DOI： 10.11477/mf.1412204554

CiNii Article

CiNii Books

researchmap

記述言語：日本語   出版者・発行元：金原出版  

CiNii Article

CiNii Books

researchmap

記述言語：日本語   出版者・発行元：日本小児医事出版社  

CiNii Article

CiNii Books

researchmap

記述言語：日本語   出版者・発行元：日本ウイルス学会  

ヒトパレコウイルス（Human parechoviruses: HPeVs）はピコルナウイルス科パレコウイルス属に分類され，1本のプラス鎖RNAをゲノムとして持つウイルスである．1999年にエコーウイルス22, 23がヒトパレコウイルス1型，2型（HPeV1, 2）に再分類され，HPeVsは急性胃腸炎や呼吸器感染症の原因ウイルスと考えられていたが，2004年のヒトパレコウイルス3型（HPeV3）の報告を契機にHPeVsに対する見方が大きく変わった．なぜなら，HPeV3が新生児や生後3か月以下の早期乳児に敗血症，髄膜脳炎などの重症感染症をきたし，神経学的後遺症を残したり死亡することが報告されたからである．現在，小児科領域で注目を集めている新興感染症の1つである．日本では2006年から2, 3年おきに流行を繰り返しており，2014年夏にも流行があった．典型的な臨床所見は，高熱，高度な頻脈，活気低下，食欲低下などを呈し，腹部膨満，臍突出，掌蹠の紅斑，網状チアノーゼなどを伴う．診断には，血清や髄液などの無菌的部位からの検体を用いたPCR法，咽頭，糞便などの検体を用いたウイルス培養などが用いられる．なぜ，新生児，早期乳児に重症感染症をきたすかについてのメカニズムは明確でないが，HPeV3に対する母体からの移行抗体の欠如，もしくは低値が関与していることが示唆されている．現時点では特異的治療はなく対症療法が中心である．今後もHPeV3感染症の流行は繰り返すことが予想され，病態の解明と特異的治療法，そしてその予防法など，多くの課題が残されている．

DOI： 10.2222/jsv.65.17

CiNii Article

CiNii Books

researchmap

記述言語：日本語   出版者・発行元：診断と治療社  

CiNii Article

CiNii Books

researchmap

記述言語：日本語   出版者・発行元：診断と治療社  

CiNii Article

CiNii Books

researchmap

記述言語：日本語   出版者・発行元：日本小児医事出版社  

CiNii Article

CiNii Books

researchmap

記述言語：日本語   出版者・発行元：日本小児医事出版社  

CiNii Article

CiNii Books

researchmap

記述言語：日本語   出版者・発行元：日本小児医事出版社  

CiNii Article

CiNii Books

researchmap

記述言語：日本語   出版者・発行元：日本小児医事出版社  

CiNii Article

CiNii Books

researchmap

記述言語：日本語   出版者・発行元：新潟医学会  

CiNii Article

CiNii Books

researchmap

researchmap

researchmap

researchmap

researchmap