論文 - 金城　武士

Analysis of bronchoalveolar lavage samples collected from 30 patients with drug-induced pneumonitis.

Yamauchi M, Haranaga S, Parrott G, Kinjo T, Yamashiro T, Tsubakimoto M, Ohtsu H, Ueda S, Fujita J

Respiratory investigation ( Respiratory Investigation )  58 ( 3 ) 204 - 211   2020年05月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

　概要を見る

Background: Drug-induced pneumonitis is a disease encountered by pulmonologists in the clinical setting. The diagnosis generally considers the patient's clinical course and the results of peripheral blood tests, radiological examinations, and often bronchoscopic examinations. However, few studies have reported the association between radiological patterns such as ground-glass opacity (GGO) or consolidation, and bronchoalveolar lavage fluid (BALF) cell fractions. This study aimed to clarify this association. Methods: Patients with a Naranjo's score of probable or definite were enrolled, and all 30 patients were categorized under probable. Data such as patient background, blood examination results, radiological findings, and BALF cell fractions were retrospectively collected. The association between BALF cell fractions and other factors such as chest computed tomography (CT) findings was evaluated. Results: The most common radiological finding in patients with lymphocyte-dominant BALF was GGO, with only one patient exhibiting consolidation. However, patients with eosinophil-dominant BALF were more likely to have consolidation; only three cases showed crazy paving and one showed GGO. In addition, patients with a GGO-dominant pattern on CT had an increased lymphocyte fraction of 41.0%; those with a consolidation-dominant pattern showed a relatively high eosinophil fraction of 5.2%; and those with a crazy paving pattern showed elevated eosinophil and neutrophil fractions of 19.1% and 9.9%, respectively. Conclusions: In this study, a remarkable difference in radiological findings was observed among different BALF patterns.

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レボフロキサシン投与が診断遅れの要因となったと考えられる介護施設における結核集団感染事例

平井潤, 原永修作, 柴原大典, 金城武士, 百瀬匡, 與那覇忠宏, 与那覇翔, 涌川朝雅, 本永英治, 藤田次郎

結核   95 ( 2 ) 67 - 72   2020年03月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

レボフロキサシン投与が診断遅れの要因となったと考えられる介護施設における結核集団感染事例

平井潤, 原永修作, 柴原大典, 金城武士, 百瀬匡, 與那覇忠宏, 与那覇翔, 涌川朝雅, 本永英治, 藤田次郎

結核 ( (一社)日本結核・非結核性抗酸菌症学会 )  95 ( 2 ) 67 - 72   2020年03月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

　概要を見る

誤嚥性肺炎の診断でレボフロキサシン(LVFX)が投与された症例が初発患者と推測される介護施設での結核集団感染事例を経験したので報告する。80代男性(症例1)が発熱を主訴に受診。当初誤嚥性肺炎として治療されたが,最終的に肺結核と判明し抗結核薬で治療を行った。その1ヵ月後,症例1と同室の80代女性(症例2)が7ヵ月前から繰り返す発熱・咳嗽の精査で来院。胸部画像で多発空洞を認め,精査後に肺結核と診断された。症例2は過去7ヵ月間に複数回誤嚥性肺炎の診断でLVFX投与が行われていたことが判明し,臨床経過・画像などから初発患者と判断した。その後の接触者健診で,入所者11人,職員30人の結核感染が判明し,症例2を含む肺結核と診断された入所者3名に対し誤嚥性肺炎の診断でLVFXの投与が行われていた。LVFX投与により発熱・咳嗽などの症状が一時的に軽快し,結核感染の発見が遅れ集団感染へとつながったと推測された。本邦の新登録結核患者は80代以上で最も多い状況のため,特に高齢者が入所する施設においては安易にフルオロキノロン系薬剤(FQ)の使用は避けるべきであり,「FQを使用する際には必ず結核を除外する」ことを厳守する必要がある。(著者抄録)

寝たきり高齢者における肺結核の胸部CT所見の検討

平井潤, 原永修作, 柴原大典, 金城武士, 百瀬匡, 與那覇忠宏, 与那覇翔, 涌川朝雅, 本永英治, 藤田次郎

結核   95 ( 3 ) 93 - 98   2020年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

The First Case of Community-Acquired Pneumonia Due to Capsular Genotype K2-ST86 Hypervirulent <i>Klebsiella pneumoniae</i> in Okinawa, Japan: A Case Report and Literature Review.

Hirai J, Sakanashi D, Kinjo T, Haranaga S, Fujita J

Infection and drug resistance ( Infection and Drug Resistance )  13   2237 - 2243   2020年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

　概要を見る

Hypervirulent Klebsiella pneumoniae (HV-KP) typically causes pyogenic liver abscess and bacteremia with metastatic infections. Community-acquired pneumonia (CAP) due to HV-KP is uncommon and details of its clinical and microbiological features are limited. We report the first case of CAP due to capsular genotype K2-ST86 HV-KP in Okinawa, Japan and review infections caused by the K2-ST86 strain. A 79-year-old woman presenting with fever and productive cough persisting for the past three days was admitted to hospital. Her vital signs indicated septic shock. Lung examination by auscultation revealed holo-crackle and lobar pneumonia in chest radiography, and Streptococcus pneumoniae was suspected. However, sputum and blood cultures revealed Gram-negative coccus identified as K. pneumoniae. Genetic analysis identified the isolated strain as the K2 serotype harboring rmpA, iutA, entB, and mrkD. Therefore, we identified the isolated strain as hypervirulent. The isolate belonged to ST86 as determined by multilocus sequence typing. The case was not complicated by predisposing factors such as diabetes mellitus and malignancy related to HV-KP infection; thus, this CAP-causing HV-KP strain may differ from the typical HV-KP strain that induces liver abscess. A literature review identified only nine cases with CAP due to HV-KP. In all cases, the disease mainly occurred in older males with diabetes mellitus, which makes the present case unusual, and had high rates of septic shock and death. No case, including ours, was complicated by metastatic infection, suggesting that CAP due to HV-KP poses little distant metastasis risk, even in patients with bloodstream infection. In our review, consistent with our case, K2-ST86 was the most common strain of HV-KP in patients with CAP. Therefore, studies are needed to elucidate the clinical and microbiological features of HV-KP CAP, with a focus on the K2-ST86 strain. Physicians should always consider K. pneumoniae in cases of sepsis CAP with lobar pneumonia.

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Diagnostic performance of serum interferon gamma, matrix metalloproteinases, and periostin measurements for pulmonary tuberculosis in Japanese patients with pneumonia.

Yamauchi M, Kinjo T, Parrott G, Miyagi K, Haranaga S, Nakayama Y, Chibana K, Fujita K, Nakamoto A, Higa F, Owan I, Yonemoto K, Fujita J

PloS one ( PLoS ONE )  15 ( 1 ) e0227636   2020年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Serum markers that differentiate between tuberculous and non-tuberculous pneumonia would be clinically useful. However, few serum markers have been investigated for their association with either disease. In this study, serum levels of interferon gamma (IFN-γ), matrix metalloproteinases 1 and 9 (MMP-1 and MMP-9, respectively), and periostin were compared between 40 pulmonary tuberculosis (PTB) and 28 non-tuberculous pneumonia (non-PTB) patients. Diagnostic performance was assessed by analysis of receiver-operating characteristic (ROC) curves and classification trees. Serum IFN-γ and MMP-1 levels were significantly higher and serum MMP-9 levels significantly lower in PTB than in non- PTB patients (p < 0.001, p = 0.002, p < 0.001, respectively). No significant difference was observed in serum periostin levels between groups. ROC curve analysis could not determine the appropriate cut-off value with high sensitivity and specificity; therefore, a classification tree method was applied. This method identified patients with limited infiltration into three groups with statistical significance (p = 0.01), and those with MMP-1 levels < 0.01 ng/ mL and periostin levels ≥ 118.8 ng/mL included only non-PTB patients (95% confidence interval 0.0-41.0). Patients with extensive infiltration were also divided into three groups with statistical significance (p < 0.001), and those with MMP-9 levels < 3.009 ng/mL included only PTB patients (95% confidence interval 76.8-100.0). In conclusion, the novel classification tree developed using MMP-1, MMP-9, and periostin data distinguished PTB from non- PTB patients. Further studies are needed to validate our cut-off values and the overall clinical usefulness of these markers.

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Case Report of Primary Lung Abscesses Due to Hypervirulent <i>Klebsiella pneumoniae</i> (Serotype K2, Sequence Type 375): an Emerging Isolate in Okinawa, Japan.

Hirai J, Sakanashi D, Momose M, Koga T, Kinjo T, Haranaga S, Motonaga E, Fujita J

Infection and drug resistance ( Infection and Drug Resistance )  13   1691 - 1695   2020年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Hypervirulent Klebsiella pneumoniae (HV-KP) is typically associated with community-acquired liver abscess and bacteremia with metastatic infection; however, primary lung abscess (PLA) caused by HV-KP is rare, with only one such case report to date. A 69-year-old man with a history of diabetes mellitus (DM) was admitted to hospital complaining of slight bloody sputum. Chest imaging showed multiple consolidations with cavities in both lung fields. A culture of bronchoalveolar lavage fluid confirmed the presence of K. pneumoniae. Genetic analyses identified the isolate as serotype K2 and sequence type 375 (K2-ST375), and that it harbored the rmpA gene. The patient was an Asian middle-aged male with DM, all of which are risk factors for HV-KP infection. Although complicating DM and the presence of the rmpA gene are more likely to induce disseminated infection, metastatic infections were not found in this patient. The clinical and microbiological characteristics of our patient were different from those of a previous reported case, although in both cases the patient was from Asia and had DM. Therefore, DM appears to be one of the predisposing factors for HV-KP lung abscesses and physicians should pay attention to emerging HV-KP lung abscess infection, particularly in Asian countries. Previous studies have also revealed that K2-ST375 is one of the major clones causing HV-KP infection, and that it is mainly isolated from patients with liver abscess. Interestingly, including the present case, most of the infectious cases caused by K2-ST375 have been reported from Okinawa Prefecture in Japan. Therefore, the trend of the K2-ST375 strain should be carefully monitored, particularly in Okinawa, Japan. The serotype of HV-KP that causes PLA is still unknown and further study is needed to elucidate the etiology of PLA due to HV-KP and the relationship between the strain K2-ST375 and PLA.

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A Case Report of Cerebral Meningitis Caused by Penicillin-Non-Susceptible Group B <i>Streptococcus</i> in an Immunocompromised Adult Patient.

Hirai J, Kinjo T, Haranaga S, Fujita J

Infection and drug resistance ( Infection and Drug Resistance )  13   2155 - 2160   2020年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Streptococcus agalactiae, also known as Group B Streptococcus (GBS), is the leading cause of bacteremia and meningitis in neonates; however, it also causes meningitis in adults, although much less frequently. After the detection of penicillin-non-susceptible GBS (PRGBS) for the first time in 2008 by Japanese researchers, clinical PRGBS isolates have been reported worldwide. These isolates need to be given due attention for being non-susceptible to multiple drugs. Herein, we present the first clinical report of meningitis caused by PRGBS. A 41-year-old Japanese male receiving an immunosuppressant visited hospital complaining of fever. Although he did not have meningitis-related symptoms or physical findings, determination of the cause of fever by Gram-staining of the spinal fluid revealed gram-positive cocci in pairs and chains. Initially, he was hospitalized on the diagnosis of cerebral meningitis caused by Streptococcus pneumoniae. However, culture of the spinal fluid revealed the β-hemolytic colonies on blood agar. Biochemical testing and mass spectrometry revealed the isolated organism as GBS (serotype Ib). The minimum inhibitory concentration (MIC) of penicillin G for the isolated strain was 0.5 μg/mL, which is greater than the MIC criteria for "susceptibility" to penicillin G for beta-hemolytic streptococci according to Clinical and Laboratory Standards Institute standards. The isolated strain was also resistant to macrolide (MIC ≥ 8 μg/mL) and fluoroquinolone (MIC ≥ 8 μg/mL). The patient recovered without neurologic sequelae upon treatment with ceftriaxone, vancomycin, and corticosteroids for 4 days, and subsequently with ampicillin for 17 days. The rate of isolation of PRGBS in the clinics has gradually increased, particularly in Japan. Although PRGBS isolated in the present case was susceptible to ampicillin and cephalosporins, strains not susceptible to ampicillin, cefotaxime, and ceftriaxone have already been isolated, indicating the prospects for limited range of effective antibiotics against PRGBS infections, including meningitis, in the near future.

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Chest Computed Tomography Abnormalities and Their Relationship to the Clinical Manifestation of Respiratory Syncytial Virus Infection in a Genetically Confirmed Outbreak.

Nabeya D, Kinjo T, Parrott GL, Nakachi S, Yamashiro T, Ikemiyagi N, Arakaki W, Masuzaki H, Fujita J

Internal medicine (Tokyo, Japan) ( 一般社団法人 日本内科学会 )  59 ( 2 ) 247 - 252   2020年

掲載種別: 研究論文（学術雑誌）

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<p>Studies reporting chest images of respiratory syncytial virus (RSV)-induced lower respiratory tract infection (LRTI) in an outbreak setting and their relationship to the clinical manifestation are limited. During a genetically confirmed RSV outbreak, eight patients underwent both chest X-ray and computed tomography (CT). Among these, 5 cases had newly appearing abnormalities on CT, although chest X-ray was able to detect abnormalities in only 2 cases (40%). Although bronchial wall thickening was common, other findings and their distribution were variable, even in an outbreak setting. All patients with both a history of anticancer chemotherapy against hematological cancer and lower respiratory symptoms, such as wheezing, sputum, and hypoxemia, had abnormalities on CT, suggesting that these two factors might be important for predicting the existence of LRTI in RSV-infected patients. </p>

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寝たきり高齢者における肺結核の胸部CT所見の検討

平井潤, 原永修作, 柴原大典, 金城武士, 百瀬匡, 與那覇忠宏, 与那覇翔, 涌川朝雅, 本永英治, 藤田次郎

結核 ( (一社)日本結核・非結核性抗酸菌症学会 )  95 ( 3 ) 93 - 98   2020年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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[目的]単一老健施設において肺結核のアウトブレイクを経験したため,寝たきり高齢者(入所者)と健常者(職員)における胸部CT画像所見の比較を行う。[対象]X年10月〜X+1年9月に,肺結核を発症し,胸部CTを撮影した入所者と職員。[方法]患者背景や胸部CT所見を後方視的に検討した。[結果]対象は入所者7例,職員9例の合計16例。職員との比較で,入所者は発熱や体重減少,炎症反応高値を示す傾向を認めた。胸部CTでは,入所者は気管支壁肥厚,気管支拡張症,結節影を全例に認め,職員は小葉中心性結節影を全例に認めた。入所者は全例で両側びまん性に陰影を呈し,職員よりも下葉に陰影を呈する傾向を認めた。[考察]本検討と過去の報告から,低栄養,PS不良の場合には,典型的な肺尖部優位の陰影は呈さず,下葉や両側びまん性に陰影を呈する傾向にあることが示唆された。また,高齢者の肺結核は高齢者の市中肺炎や医療介護関連肺炎と比べて,結節影やtreein-budの所見が多く,びまん性に陰影を示す傾向を認めた。[結論]寝たきり高齢者の肺結核は下葉にも高頻度で起こるため誤嚥性肺炎との鑑別を有し,細菌性肺炎と比較して多数の肺野に陰影を呈する傾向を示す。(著者抄録)

Development of Lung Emphysema Due to APRV.

Kami W, Kinjo T, Miyagi K, Fujita J

Internal medicine (Tokyo, Japan) ( 一般社団法人 日本内科学会 )  58 ( 20 ) 3061 - 3061   2019年10月

掲載種別: 研究論文（学術雑誌）

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Spontaneous Pneumomediastinum in a Previously Healthy Patient.

Hashioka H, Kinjo T, Shinzato A, Fujita J

Internal medicine (Tokyo, Japan) ( 一般社団法人 日本内科学会 )  58 ( 20 ) 3063 - 3063   2019年10月

掲載種別: 研究論文（学術雑誌）

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呼吸器内科でのシングルユースビデオ気管支鏡の使用経験

當銘 玲央, 宮城 一也, 喜友名 朋, 金城 武士, 原永 修作, 健山 正男, 藤田 次郎

気管支学 ( 特定非営利活動法人 日本呼吸器内視鏡学会 )  41 ( 4 ) 411 - 416   2019年07月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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<p><b>背景．</b>シングルユース（単回使用）の気管支鏡はその特性から集中治療室や救急部での使用経験が報告されているが，呼吸器内科での使用経験の報告は少ない．当院でシングルユースビデオ気管支鏡を使用した症例について報告する．<b>症例．</b>2016年4月から2017年3月の間に，11例延べ14件に対しシングルユースビデオ気管支鏡が使用された．代表的な2例を示す．症例7は77歳男性．右膿胸の治療中に喀血にて挿管となった．シングルユースビデオ気管支鏡を用いて血餅除去を行ったが気管粘膜と血塊の判別が難しく，通常の気管支鏡へ変更とした．症例9は63歳男性．両側誤嚥性肺炎，左膿胸の診断で入院となった．左右主気管支内に多量の喀痰が貯留するため数日おきに吸痰を行ったが，時間外はシングルユースビデオ気管支鏡を使用した．上記2例を含め，14件中7件は緊急または時間外使用であった．<b>結論．</b>シングルユースビデオ気管支鏡は通常の気管支鏡に取って代わるものではないが，軽量で設定も簡便なため特に緊急時に有用であった．また，気管支鏡の損傷を気にせず手技を行うことができ，交差感染が起きないことも利点である．</p>

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Pseudomonas asiatica sp. nov., isolated from hospitalized patients in Japan and Myanmar.

Tohya M, Watanabe S, Teramoto K, Uechi K, Tada T, Kuwahara-Arai K, Kinjo T, Maeda S, Nakasone I, Zaw NN, Mya S, Zan KN, Tin HH, Fujita J, Kirikae T

International journal of systematic and evolutionary microbiology ( Microbiology Society )  69 ( 5 ) 1361 - 1368   2019年05月

掲載種別: 研究論文（学術雑誌）

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POM-1型メタロ-β-ラクタマーゼ産生を有するPseudomonas otitidisを分離した6例

西山直哉, 上地幸平, 當銘高明, 下地真里有, 大城健哉, 仲松正司, 金城武士, 健山正男, 藤田次郎

日本臨床微生物学会雑誌   29 ( 2 ) 73 - 77   2019年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

Comprehensive subspecies identification of 175 nontuberculous mycobacteria species based on 7547 genomic profiles.

Matsumoto Y, Kinjo T, Motooka D, Nabeya D, Jung N, Uechi K, Horii T, Iida T, Fujita J, Nakamura S

Emerging microbes & infections ( Informa UK Limited )  8 ( 1 ) 1043 - 1053   2019年

掲載種別: 研究論文（学術雑誌）

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POM-1型メタロ-β-ラクタマーゼ産生を有するPseudomonas otitidisを分離した6例

西山直哉, 上地幸平, 當銘高明, 下地真里有, 大城健哉, 仲松正司, 金城武士, 健山正男, 藤田次郎

日本臨床微生物学会雑誌   29 ( 2 ) 73 - 77   2019年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

Clinical Features of Human Metapneumovirus Pneumonia in Non-Immunocompromised Patients: An Investigation of Three Long-Term Care Facility Outbreaks.

Karimata Y, Kinjo T, Parrott G, Uehara A, Nabeya D, Haranaga S, Higa F, Tateyama M, Miyagawa K, Kishaba T, Otani K, Okamoto M, Nishimura H, Fujita J

The Journal of infectious diseases ( Journal of Infectious Diseases )  218 ( 6 ) 868 - 875   2018年08月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Distribution of cytomegalovirus genotypes among ulcerative colitis patients in Okinawa, Japan.

Nahar S, Hokama A, Iraha A, Ohira T, Kinjo T, Hirata T, Kinjo T, Parrott GL, Fujita J

Intestinal research ( Intestinal Research )  16 ( 1 ) 90 - 98   2018年01月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Comparison of two screening tests for HIV-Associated Neurocognitive Disorder suspected Japanese patients with respect to cART usage.

Kami-Onaga K, Tateyama M, Kinjo T, Parrott G, Tominaga D, Takahashi-Nakazato A, Nakamura H, Tasato D, Miyagi K, Maeda S, Arae H, Uehara H, Miyagi K, Haranaga S, Fujita J

PloS one ( PLoS ONE )  13 ( 6 ) e0199106   2018年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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In this study, we demonstrated the pervasiveness of HIV-associated neurocognitive disorders (HAND) among a selection of Japanese patients as well as evaluated and compared the Mini Mental State Examination (MMSE) and the International HIV Dementia Scale (IHDS) for use as a screening tool among combination anti-retroviral therapy (cART)-naïve and cART experienced patients. The MMSE and the IHDS have both been used as HAND screening tests around the world with variable success. It has been reported the increased usage of cART the utility of these screening tests may have been diminished due to the decreased severity of impairment and the altered pattern of neurocognitive impairments in cART era HAND patients. It is therefore possible the MMSE and the IHDS may still be useful among cART-naïve patients even in the cART era. However, only one study has investigated and compared the screening results of the IHDS among cART-naïve and cART experienced patients. All HIV positive patients who visited, or were admitted, to the Ryukyu University Hospital between January 2009 and March 2014 were evaluated for inclusion. Selected patients (n = 49) had data without omission for all tests. The overall prevalence of HAND in our cohort was 44%. The area under the curve (AUC), for all subjects using the MMSE and the IHDS, were 0.60 and 0.69, respectively. However, the AUC among cART-naïve patients were 0.58 and 0.76 for the MMSE and the IHDS, respectively. Whereas, cART experienced patients had an AUC of 0.60 and 0.61, respectively. Overall, the MMSE demonstrated a poor screening ability for HAND, regardless of cART usage (the cut-off value of 27 had a Youden's J-Index of 0.1, in all groups). Alternatively, the IHDS was moderately useful for HAND screening among cART-naïve patients (the cut-off value of 11 had a Youden's J-Index of 0.4), but performed poorly as a screening test among cART experienced patients (the cut-off value of 11 had a Youden's J-Index of 0.1).

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