Published Papers - YAMAMOTO KAZUKO

Cloverleaf-like Nuclei and Cytoplasmic Tails in Hypersensitivity Pneumonitis.

Arakaki W, Kinjo T, Ikemiyagi N, Yamamoto K

Internal medicine (Tokyo, Japan) ( 一般社団法人 日本内科学会 )  65 ( 1 ) 193 - 193   2026.01

Type of publication: Research paper (scientific journal)

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Asymptomatic Cytomegalovirus Pneumonia Presenting as Pulmonary Nodules.

Otsuki M, Kami W, Doi M, Yamamoto K

Internal medicine (Tokyo, Japan) ( 一般社団法人 日本内科学会 )  advpub ( 0 )   2026

Type of publication: Research paper (scientific journal)

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A Case of Tracheobronchial Fistula with Conservative Antimicrobial Therapy Selected by Careful Bronchoscopy

Zukeyama Haruka, Kami Wakaki, Nakayama Yuri, Miyagi Kazuya, Yamamoto Kazuko

Respiratory Endoscopy ( 一般社団法人 日本呼吸器内視鏡学会 )  3 ( 1 ) 54 - 55   2025.03

Type of publication: Research paper (scientific journal)

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2) Drug resistance and treatment strategies for pneumonia in the elderly

Yamamoto Kazuko

Nihon Naika Gakkai Zasshi ( The Japanese Society of Internal Medicine )  114 ( Suppl ) 114b - 115a   2025.02

Type of publication: Research paper (scientific journal)

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4) Lifestyle-related Diseases and Respiratory Infections: Tips for Diagnosis, Treatment, and Prevention

Yamamoto Kazuko

Nihon Naika Gakkai Zasshi ( The Japanese Society of Internal Medicine )  113 ( 3 ) 396 - 401   2024.03

Type of publication: Research paper (scientific journal)

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Low humoral immune response to the BNT162b2 vaccine against COVID-19 in nursing home residents undergoing hemodialysis: a case–control observational study

Mineaki Kitamura, Takahiro Takazono, Kazuko Yamamoto, Takashi Harada, Satoshi Funakoshi, Hiroshi Mukae, Tomoya Nishino

Renal Replacement Therapy ( Springer Science and Business Media LLC )  8 ( 1 ) 8 - 8   2022.12 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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Abstract Background Patients on hemodialysis (HD) face a high mortality risk from coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and they are therefore prioritized for vaccination. However, the efficacy of vaccination in this vulnerable population has not been confirmed. Although age is negatively correlated with serum immunoglobulin (Ig) levels, humoral responses to vaccination in elderly patients undergoing HD have not been investigated. To address this issue, we evaluated the anti-SARS-CoV-2 spike protein antibodies in nursing home residents on HD after BNT162b2 vaccine administration. Methods Patients on HD from a nursing home and care workers (controls) receiving two doses of the BNT162b2 vaccine between April and May 2021 were enrolled in this study. Those with a prior history of COVID-19 were excluded. Anti-spike protein antibodies were measured with the Elecsys (Roche) immunoassay system. Results The study included 26 nursing home residents (41% male; median age, 86 years) and 184 care workers (28% male; median age, 45 years). The median HD vintage was 51 months. After two doses of BNT162b2, 73% of the nursing home residents and 99.5% of the control group developed sufficient anti-spike protein antibodies (> 29 U/mL) to neutralize SARS-CoV-2. Three weeks after the second dose, median IgG titers of the residents and care workers were 83 [interquartile range (IQR) 17–511] and 1365 (IQR 847–2245) U/mL, respectively (p < 0.001). Conclusions The humoral response to BNT162b2 among elderly HD patients was relatively low; therefore, the optimal vaccination strategy for this population should be studied further to avoid COVID-19 outbreaks in healthcare facilities.

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Evaluation of a Triage Checklist for Mild COVID-19 Outpatients in Predicting Subsequent Emergency Department Visits and Hospitalization during the Isolation Period: A Single-Center Retrospective Study

Yasuhiro Tanaka, Kazuko Yamamoto, Shimpei Morimoto, Takeshi Nabeshima, Kayoko Matsushima, Hiroshi Ishimoto, Nobuyuki Ashizawa, Tatsuro Hirayama, Kazuaki Takeda, Hiroshi Gyotoku, Naoki Iwanaga, Shinnosuke Takemoto, Susumu Fukahori, Takahiro Takazono, Hiroyuki Yamaguchi, Takashi Kido, Noriho Sakamoto, Naoki Hosogaya, Shogo Akabame, Takashi Sugimoto, Hirotomo Yamanashi, Kosuke Matsui, Mai Izumida, Ayumi Fujita, Masato Tashiro, Takeshi Tanaka, Koya Ariyoshi, Akitsugu Furumoto, Kouichi Morita, Koichi Izumikawa, Katsunori Yanagihara, Hiroshi Mukae

Journal of Clinical Medicine ( MDPI AG )  11 ( 18 ) 5444 - 5444   2022.09 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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Managing mild illness in COVID-19 and predicting progression to severe disease are concerning issues. Here, we investigated the outcomes of Japanese patients with mild COVID-19, and identified triage risk factors for further hospitalization and emergency department (ED) visits at a single tertiary hospital. A triage checklist with 30 factors was used. Patients recommended for isolation were followed up for 10 days for subsequent ED visits or hospital admission. Overall, 338 patients (median age, 44.0; 45% women) visited the clinic 5.0 days (median) after symptom onset. Thirty-six patients were immediately hospitalized following triage; others were isolated. In total, 72 non-hospitalized patients visited the ED during their isolation, and 30 were hospitalized after evaluation for oxygen desaturation. The median ED visit and hospitalization durations after symptom onset were 5.0 and 8.0 days, respectively. The checklist factors associated with hospitalization during isolation were age > 50 years, body mass index > 25 kg/m2, hypertension, tachycardia with pulse rate > 100/min or blood pressure > 135 mmHg at triage, and >3-day delay in hospital visit after symptom onset. No patients died. Altogether, 80% of patients with mild COVID-19 could be safely isolated at home. Age, BMI, underlying hypertension, date after symptom onset, tachycardia, and systolic blood pressure at triage might be related to later hospitalization.

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Efficacy of <i>Lactococcus lactis</i> strain plasma (LC-Plasma) in easing symptoms in patients with mild COVID-19: protocol for an exploratory, multicentre, double-blinded, randomised controlled trial (PLATEAU study)

Kazuko Yamamoto, Naoki Hosogaya, Tsuyoshi Inoue, Kenta Jounai, Ryohei Tsuji, Daisuke Fujiwara, Katsunori Yanagihara, Koichi Izumikawa, Hiroshi Mukae

BMJ Open ( BMJ )  12 ( 9 ) e061172 - e061172   2022.09 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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Introduction The COVID-19 pandemic has been a major concern worldwide; however, easily accessible treatment options for patients with mild COVID-19 remain limited. Since the oral intake of Lactococcus lactis strain plasma (LC-Plasma) enhances both the innate and acquired immune systems through the activation of plasmacytoid dendritic cells (pDCs), we hypothesised that the oral intake of LC-Plasma could aid the relief or prevention of symptoms in patients with asymptomatic or mild COVID-19. Methods and analysis This is an exploratory, multicentre, double-blinded, randomised, placebo-controlled trial. This study was initiated in December 2021 and concludes in April 2023. The planned number of enrolled subjects is 100 (50 subjects×2 groups); subject enrolment will be conducted until October 2022. Patients with asymptomatic or mild COVID-19 will be enrolled and randomly assigned in a 1:1 ratio to group A (oral intake of LC-Plasma-containing capsule, 200 mg/day, for 14 days) or group B (oral intake of placebo capsule, for 14 days). The primary endpoint is the change in subjective symptoms measured by the severity score. Secondary endpoints include SARS-CoV-2 viral loads, biomarkers for pDC activation, serum SARS-CoV-2-specific antibodies, serum cytokines, interferon and interferon-inducible antiviral effectors and the proportion of subjects with emergency room visits to medical institutions or who are hospitalised. Ethics and dissemination The study protocol was approved by the Clinical Research Review Board of Nagasaki University, in accordance with the Clinical Trials Act of Japan. The study will be conducted in accordance with the Declaration of Helsinki, the Clinical Trials Act, and other current legal regulations in Japan. Written informed consent will be obtained from all the participants. The results of this study will be reported in journal publications. Trial registration number Japan Registry of Clinical Trials (registration number: jRCTs071210097).

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Clinical Differentiation of Severe Fever with Thrombocytopenia Syndrome from Japanese Spotted Fever

Nana Nakada, Kazuko Yamamoto, Moe Tanaka, Hiroki Ashizawa, Masataka Yoshida, Asuka Umemura, Yuichi Fukuda, Shungo Katoh, Makoto Sumiyoshi, Satoshi Mihara, Tsutomu Kobayashi, Yuya Ito, Nobuyuki Ashizawa, Kazuaki Takeda, Shotaro Ide, Naoki Iwanaga, Takahiro Takazono, Masato Tashiro, Takeshi Tanaka, Seiko Nakamichi, Konosuke Morimoto, Koya Ariyoshi, Kouichi Morita, Shintaro Kurihara, Katsunori Yanagihara, Akitsugu Furumoto, Koichi Izumikawa, Hiroshi Mukae

Viruses ( MDPI AG )  14 ( 8 ) 1807 - 1807   2022.08 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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Severe fever with thrombocytopenia syndrome (SFTS) and Japanese spotted fever (JSF; a spotted fever group rickettsiosis) are tick-borne zoonoses that are becoming a significant public health threat in Japan and East Asia. Strategies for treatment and infection control differ between the two; therefore, initial differential diagnosis is important. We aimed to compare the clinical characteristics of SFTS and JSF based on symptomology, physical examination, laboratory data, and radiography findings at admission. This retrospective study included patients with SFTS and JSF treated at five hospitals in Nagasaki Prefecture, western Japan, between 2013 and 2020. Data from 23 patients with SFTS and 38 patients with JSF were examined for differentiating factors and were divided by 7:3 into a training cohort and a validation cohort. Decision tree analysis revealed leukopenia (white blood cell [WBC] &lt; 4000/μL) and altered mental status as the best differentiating factors (AUC 1.000) with 100% sensitivity and 100% specificity. Using only physical examination factors, absence of skin rash and altered mental status resulted in the best differentiating factors with AUC 0.871, 71.4% sensitivity, and 90.0% specificity. When treating patients with suspected tick-borne infection, WBC &lt; 4000/µL, absence of skin rash, and altered mental status are very useful to differentiate SFTS from JSF.

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A Case of Pulmonary Langerhans Cell Histiocytosis That Progressed From a Single-system to a Multisystem Form Despite Smoking Cessation: A Case Report.

Hiroshi Ishimoto, Noriho Sakamoto, Mutsumi Ozasa, Takeharu Katoh, Hidehiro Itonaga, Makoto Wataya, Daisuke Takao, Atsuko Hara, Takashi Kido, Hiroyuki Yamaguchi, Kazuko Yamamoto, Yasushi Obase, Yuji Ishimatsu, Yasushi Miyazaki, Hiroshi Mukae

Internal medicine (Tokyo, Japan)   62 ( 6 ) 877 - 880   2022.08 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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A 36-year-old Japanese man presented with cavities and nodular shadows in the lower lobes of his lungs and osteolytic lesions in the thoracic spine. He was diagnosed with multisystem Langerhans cell histiocytosis (LCH). Three years earlier, he had been noted to have small cavities and granular lesions noted in the upper lobes of his lungs, which later improved with smoking cessation. It was likely that his single-system pulmonary LCH (PLCH) progressed to multisystem LCH despite smoking cessation. Relapse or progression may occur in cases where PLCH lesions improve after smoking cessation. Thus, close follow-up is vital.

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A comparison of liposomal amphotericin B alone and in combination with flucytosine in the treatment of non-HIV Cryptococcal meningitis: A nationwide observational study.

Takahiro Takazono, Yusuke Hidaka, Shimpei Morimoto, Masato Tashiro, Nobuyuki Ashizawa, Tatsuro Hirayama, Kazuaki Takeda, Naoki Iwanaga, Naoki Hosogaya, Kazuko Yamamoto, Kiyohide Fushimi, Katsunori Yanagihara, Hiroshi Mukae, Koichi Izumikawa

Mycoses ( Mycoses )  65 ( 9 ) 897 - 902   2022.07 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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BACKGROUND: Cryptococcal meningitis (CM) is an opportunistic infectious disease that occurs in immunocompromised hosts, not only in patients living with HIV, but also in patients without HIV. The evidence regarding the treatment for CM in patients without HIV is mainly found in small retrospective studies and is extremely limited. OBJECTIVES: In the present study, we compared the efficacy of liposomal amphotericin B (L-AMB) alone and in combination with flucytosine (5-FC) for the induction treatment of CM in patients without HIV. PATIENTS/METHODS: Data was gathered from the Japanese Diagnosis Procedure Combination database obtained from hospitals throughout Japan. The study included 517 patients without HIV but having CM who fulfilled the inclusion and exclusion criteria. We analyzed the average effect of adding 5-FC to L-AMB treatment using the survival time within 14 days of the diagnosis after adjustment of the baseline clinical characteristics with associations with both selections of the treatment and the prognosis. RESULTS: A total of 146 and 217 CM patients received L-AMB and L-AMB with 5-FC, respectively, within 7 days of diagnosis. L-AMB with 5-FC showed better prognosis than L-AMB on day 14 (mortality 6% vs. 11%, hazard ratio, 0.5775; 95% confidence interval, 0.2748-1.213; p = 0.1, Wald test). CONCLUSIONS: From the results of this real-world database study, we revealed that the combination therapy of 5-FC on L-AMB for induction therapy might have an advantage on the survival time of NHNT patients with CM as well as PLHIV patients with CM.

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Pulmonary and Intestinal Involvement in a Patient with Myeloperoxidase-specific Antineutrophil Cytoplasmic Antibody-positive Hermansky-Pudlak Syndrome.

Takatomo Tokito, Noriho Sakamoto, Hiroshi Ishimoto, Daisuke Okuno, Takuto Miyamura, Atsuko Hara, Takashi Kido, Kazuko Yamamoto, Hiroyuki Yamaguchi, Yasushi Obase, Yuko Akazawa, Ken Okamura, Tamio Suzuki, Yuji Ishimatsu, Hiroshi Mukae

Internal medicine     2022.06 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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A 26-year-old Japanese woman was admitted with a 1-month history of diarrhea, a high fever for a few days, and exacerbation of dyspnea. She was treated with an antifibrotic drug and long-term oxygen therapy for Hermansky-Pudlak syndrome-related pulmonary fibrosis. New ground-glass attenuation appeared on chest computed tomography (CT), and a colon biopsy showed an inflammatory cell accumulation with a high titer of myeloperoxidase (MPO)-specific anti-neutrophil cytoplasmic antibodies (ANCA). Systemic inflammation related to MPO-ANCA titer elevation was suspected. Steroid pulse therapy and intravenous cyclophosphamide improved chest CT findings and diarrhea. Therefore, immunosuppressant treatment should be considered for systemic inflammation related to MPO-ANCA.

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Parameters affecting prognosis after hemodialysis withdrawal: experience from a single center.

Kosei Yamaguchi, Mineaki Kitamura, Takahiro Takazono, Kazuko Yamamoto, Junichiroh Hashiguchi, Takashi Harada, Satoshi Funakoshi, Hiroshi Mukae, Tomoya Nishino

Clinical and experimental nephrology   26 ( 10 ) 1022 - 1029   2022.06 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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INTRODUCTION: Withdrawal from maintenance hemodialysis is unavoidable in some patients due to their poor general condition; however, their survival days vary depending on their health status. The factors associated with life prognosis in the terminal phase in patients undergoing hemodialysis remain unclear. METHODS: Patients who died after withdrawal from hemodialysis between 2011 and 2021 at Nagasaki Renal Center were included. Patient background data were collected, and the association between the patients' clinical features and survival duration was analyzed. RESULTS: The withdrawal group included 174 patients (79.8 ± 10.8 years old; 50.6% male; median dialysis vintage, 3.6 years). The most common reason for withdrawal (95%) was that hemodialysis was more harmful than beneficial because of the patient's poor general condition. The median time from withdrawal to death was 4 days (interquartile range, 3-10 days). Multivariable Cox proportional regression analysis showed that oral nutrition (hazard ratio (HR), 1.98; 95% confidence interval (CI), 1.12-3.50; P = 0.03), hypoxemia (HR, 2.32; 95% CI, 1.55-3.47; P < 0.01), ventilator use (HR, 0.26; 95% CI, 0.11-0.58; P < 0.01), and pleural effusion (HR, 1.54; CI, 1.01-2.37; P = 0.04) were associated with increased survival duration. In contrast, antibiotics and vasopressor administration were not associated with the survival duration. CONCLUSION: In this study, we explored the parameters affecting the survival of patients who withdrew from hemodialysis. Physicians could use our results to establish more accurate predictions, which may help the patient and their family to emotionally accept and implement the desired care plan.

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Macrophage activation syndrome after BNT162b2 mRNA vaccination successfully treated with corticosteroids.

Nobuyuki Ashizawa, Takahiro Takazono, Masataka Umeda, Kazuko Yamamoto, Atushi Kawakami, Hiroshi Mukae

Clinical and experimental rheumatology ( Clinical and Experimental Rheumatology )  40 ( 5 ) 1060 - 1060   2022.05 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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Interstitial Pneumonia with HLA-B54 Antigen that Responded Well to Erythromycin: A Case Report.

Hiroshi Ishimoto, Noriho Sakamoto, Atsuko Hara, Takashi Kido, Hiroyuki Yamaguchi, Kazuko Yamamoto, Yasushi Obase, Yuji Ishimatsu, Hiroshi Mukae

Internal medicine (Tokyo, Japan)     2022.04 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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A 65-year-old Japanese man with interstitial pneumonia demonstrated honeycomb lung with thickened walls on chest high-resolution computed tomography (HRCT) and predominance of neutrophils in the cell fraction of the bronchoalveolar lavage fluid. Although there were no centrilobular nodular or branching shadows on chest HRCT suggestive of diffuse panbronchiolitis, he exhibited sinusitis and had the HLA-B54 antigen. With long-term macrolide therapy, the cough and sputum production markedly improved, wall thickening of the honeycomb lung on chest HRCT decreased, and the forced vital capacity increased. Confirming the presence of HLA-B54 antigen may help determine the indication for long-term macrolide therapy in interstitial pneumonia patients.

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Serum Cytokines Usefulness for Understanding the Pathology in Allergic Bronchopulmonary Aspergillosis and Chronic Pulmonary Aspergillosis.

Yuya Ito, Takahiro Takazono, Yasushi Obase, Susumu Fukahori, Nobuyuki Ashizawa, Tatsuro Hirayama, Masato Tashiro, Kazuko Yamamoto, Yoshifumi Imamura, Naoki Hosogaya, Chizu Fukushima, Yoshitomo Morinaga, Katsunori Yanagihara, Koichi Izumikawa, Hiroshi Mukae

Journal of fungi   8 ( 5 )   2022.04 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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Allergic bronchopulmonary aspergillosis (ABPA) and chronic pulmonary aspergillosis (CPA) are important fungal infections caused by Aspergillus species. An overlap of ABPA and CPA has been reported; therefore, it is critical to determine whether the main pathology is ABPA or CPA and whether antifungals are required. In this study, we investigated whether the serum cytokine profile is useful for understanding the pathology and for differentiating between these diseases. We compared the various serum cytokine levels among healthy subjects and patients diagnosed with asthma, ABPA, or CPA at Nagasaki University Hospital between January 2003 and December 2018. In total, 14 healthy subjects, 19 patients with asthma, 11 with ABPA, and 10 with CPA were enrolled. Interleukin (IL) -5 levels were significantly higher in patients with ABPA than in those with CPA, and IL-33 and tumor necrosis factor (TNF) levels were significantly higher in patients with CPA than in those with asthma (p &lt; 0.05, Dunn's multiple comparison test). The sensitivity and specificity of the IL-10/IL-5 ratio (cutoff index 2.47) for diagnosing CPA were 70% and 100%, respectively. The serum cytokine profile is useful in understanding the pathology of ABPA and CPA, and the IL-10/IL-5 ratio may be a novel supplemental biomarker for indicating the pathology of CPA.

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Favorable Humoral Response to Third Dose of BNT162b2 in Patients Undergoing Hemodialysis.

Mineaki Kitamura, Takahiro Takazono, Kosei Yamaguchi, Hideshi Tomura, Kazuko Yamamoto, Takashi Harada, Satoshi Funakoshi, Hiroshi Mukae, Tomoya Nishino

Journal of clinical medicine   11 ( 8 )   2022.04 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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Patients undergoing hemodialysis are known to exhibit low humoral responses to vaccines against severe acute respiratory syndrome coronavirus 2. In this study, we aimed to elucidate the humoral response to the third dose of BNT162b2 (Pfizer) in patients undergoing hemodialysis. We included 279 patients undergoing hemodialysis (69 ± 11 years, 65% male, median dialysis vintage: 69 months) and 189 healthcare workers (45 ± 13 years, 30% male) who received the third dose of BNT162b2. Anti-spike immunoglobulin G (anti-S IgG) antibody levels were measured 3-4.5 months after the second dose and 3 weeks after the third dose and were compared. Despite a significant difference in anti-S IgG antibody levels after the second dose between the two groups (patients: median 215 U/mL and healthcare workers: median 589 U/mL; p &lt; 0.001), no significant difference in anti-S IgG antibody levels after the third dose was observed (patients: median 19,000 U/mL, healthcare workers: median 21,000 U/mL). Except for dialysis vintage (ρ = 0.209, p &lt; 0.001), no other factors correlated with anti-S IgG antibody levels after the third vaccine dose in patients undergoing hemodialysis. Therefore, a favorable response to the third dose of BNT162b2 was observed in patients undergoing hemodialysis, irrespective of their backgrounds.

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Autoimmune pulmonary alveolar proteinosis exacerbated by steroid therapy due to misdiagnosis as anti-aminoacyl-tRNA synthetase (ARS) antibody positive- interstitial pneumonia: a case report.

Hiroshi Ishimoto, Noriho Sakamoto, Hirokazu Yura, Atsuko Hara, Takashi Kido, Hiroyuki Yamaguchi, Kazuko Yamamoto, Yasushi Obase, Yuji Ishimatsu, Minoru Satoh, Hiroshi Mukae

BMC pulmonary medicine ( BMC Pulmonary Medicine )  22 ( 1 ) 120 - 120   2022.03 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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BACKGROUND: Anti-aminoacyl-tRNA synthetase (anti-ARS) antibodies are myositis-specific autoantibodies that have been identified in a subset of patients with interstitial pneumonia who do not present with dermatomyositis or polymyositis. Anti-ARS antibody-positive interstitial pneumonia is commonly treated with steroids or immunosuppressive agents and is usually responsive to these therapies. Here, we present in detail a case in which respiratory failure of a patient diagnosed with anti-ARS antibody-positive interstitial pneumonia was exacerbated by treatment with steroids and immunosuppressive agents. Further examination revealed misdiagnosis of this patient and a subsequent diagnosis of autoimmune pulmonary alveolar proteinosis. CASE PRESENTATION: A 66-year-old man presented to the hospital with dyspnea on exertion, which resulted in the detection of interstitial pneumonia. Serum anti-ARS antibodies were detected; however, there were no other findings suggestive of myositis. Pulmonary alveolar proteinosis (PAP) was suspected based on the marked increase in serum KL-6 and chest computed tomography findings. The bronchoalveolar lavage revealed no milky changes in the lavage fluid. After treatment with steroids and initiation of immunosuppressive agents for anti-ARS antibody-positive interstitial pneumonia, respiratory failure and chest imaging findings showed worsening of the condition. Bronchoscopy was repeated, and milk-like alveolar lavage fluid was collected; serum anti-granulocyte macrophage colony-stimulating factor antibody was identified. Steroids and immunosuppressive agents were gradually tapered and discontinued, and the patient's condition stabilized after repeated alveolar lavage under general anesthesia. CONCLUSION: Due to similar presentation, PAP can be misdiagnosed as interstitial pneumonia. If pulmonary lesions due to interstitial pneumonia are exacerbated by immunosuppressive treatment, physicians should reconsider the diagnosis and include PAP in the differential diagnosis.

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Comparison of intra-familial transmission of influenza virus from index patients treated with baloxavir marboxil or oseltamivir using an influenza transmission model and a health insurance claims database.

Shogo Miyazawa, Takahiro Takazono, Naoki Hosogaya, Kazuko Yamamoto, Hideaki Watanabe, Masakazu Fujiwara, Satoki Fujita, Hiroshi Mukae

Clinical infectious diseases ( Oxford University Press (OUP) )  75 ( 6 ) 927 - 935   2022.02 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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BACKGROUND: Influenza affects approximately a billion people globally, including >10 million Japanese individuals every year. Baloxavir marboxil (baloxavir [BXM]; a selective cap-dependent endonuclease inhibitor) is approved for influenza treatment in Japan. We compared the incidence of intra-familial transmission of influenza between BXM and oseltamivir (OTV) treatments using a simulation model. METHODS: Using the JMDC claims database, we identified index case (ICs) as the first family member diagnosed with influenza during the 2018-2019 influenza season, and classified the families into BXM or OTV group per the drug dispensed to ICs. Using a novel influenza intra-familial infection model, we simulated the duration of influenza infection in ICs based on agent-specific virus shedding periods. Intra-familial infections were defined as non-IC family members infected during the agent-specific viral shedding period in ICs. The virus incubation periods in the non-IC family members were considered to exclude secondary infections from potentially external exposure. The primary endpoint was proportion of families with intra-familial infections. For between-group comparisons, we used a multivariate logistic regression model. RESULTS: The median proportion of families with intra-familial transmission was 9.57% and 19.35% in the BXM (N=84,672) and OTV (N=62,004) groups, respectively. The multivariate odds ratio of 1.73 (2.5th-97.5th percentiles, 1.68-1.77) indicated a substantially higher incidence of intra-familial infections in the OTV group versus the BXM group. Subgroup analyses by ICs' age category, virus type, and month of onset revealed similar trends favoring BXM. CONCLUSION: BXM treatment of ICs may contribute to a greater reduction in intra-familial influenza transmission than OTV treatment.

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Associations between Chest CT Abnormalities and Clinical Features in Patients with the Severe Fever with Thrombocytopenia Syndrome

Hiroki Ashizawa, Kazuko Yamamoto, Nobuyuki Ashizawa, Kazuaki Takeda, Naoki Iwanaga, Takahiro Takazono, Noriho Sakamoto, Makoto Sumiyoshi, Shotaro Ide, Asuka Umemura, Masataka Yoshida, Yuichi Fukuda, Tsutomu Kobayashi, Masato Tashiro, Takeshi Tanaka, Shungo Katoh, Konosuke Morimoto, Koya Ariyoshi, Shimpei Morimoto, Mya Myat Ngwe Tun, Shingo Inoue, Kouichi Morita, Shintaro Kurihara, Koichi Izumikawa, Katzunori Yanagihara, Hiroshi Mukae

Viruses ( MDPI AG )  14 ( 2 ) 279 - 279   2022.01 [ Peer Review Accepted ]

Type of publication: Research paper (scientific journal)

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Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by the SFTS virus. It involves multiple organ systems, including the lungs. However, the significance of the lung involvement in SFTS remains unclear. In the present study, we aimed to investigate the relationship between the clinical findings and abnormalities noted in the chest computed tomography (CT) of patients with SFTS. The medical records of 22 confirmed SFTS patients hospitalized in five hospitals in Nagasaki, Japan, between April 2013 and September 2019, were reviewed retrospectively. Interstitial septal thickening and ground-glass opacity (GGO) were the most common findings in 15 (68.1%) and 12 (54.5%) patients, respectively, and lung GGOs were associated with fatalities. The SFTS patients with a GGO pattern were elderly, had a disturbance of the conscious and tachycardia, and had higher c-reactive protein levels at admission (p = 0.009, 0.006, 0.002, and 0.038, respectively). These results suggested that the GGO pattern in patients with SFTS displayed disseminated inflammation in multiple organs and that cardiac stress was linked to higher mortality. Chest CT evaluations may be useful for hospitalized patients with SFTS to predict their severity and as early triage for the need of intensive care.

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