University of the Ryukyus · Faculty of Medicine · 助教

Research keywordsrespiratory infections・COVID-19・RSV・strongyloidiasis・nontuberculous mycobacteria・bacterial pneumonia・fungal infection・clinical epidemiology

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• 直腸炎を呈した皮疹の有無の異なるエムポックスの2症例2022 · <p>Mpox (formerly known as monkeypox) is caused by monkeypox virus (MPXV), a member of the orthopoxvirus genus of viruses. Historically, it is endemic to Central and West Africa. Since 2022, however, a sharp rise in the number of mpox cases has been reported from non-endemic regions such as Europe and the United States. As compared with the traditional cases of mpox reported from the endemic regions, the majority of the patients in the new cases of mpox from non-endemic regions are gay, bisexual, and/or people living with HIV (PLWH), and anogenital skin lesions are a predominant clinical feature. Herein, we report two cases of mpox in PLWH. While case 1 had typical anogenital skin rashes with hemorrhagic proctitis, case 2 manifested proctitis without a skin rash. MPXV was detected by polymerase-chain reaction of scrapings from the skin rash in case 1, and from an anal swab in case 2. Our cases highlight the fact that in the recent outbreak of mpox, proctitis could be the sole presenting feature. Clinicians should consider the possibility of mpox in patients presenting with proctitis, irrespective of the presence/absence of skin lesions.</p>
• Unseasonal respiratory syncytial virus epidemics during the COVID-19 pandemic: Relationship between climatic factors and epidemic strain switching.2020 · OBJECTIVES: The COVID-19 pandemic has altered respiratory syncytial virus (RSV) epidemic patterns. However, the influence of climatic and virological factors on RSV outbreaks remains unclear. We examined RSV incidence in Okinawa, Japan; Taiwan, China; and Florida, USA before and after the COVID-19 pandemic, focusing on the effects of population mobility and climate. METHODS: We analysed correlations among RSV incidence, human mobility, and climate before and after the pandemic. Additionally, we conducted a phylogenetic analysis of the second variable region of RSV G proteins using viral genomes isolated from patients with acute respiratory tract infections in Okinawa. RESULTS: Annual RSV epidemics in Okinawa were not correlated with post-pandemic human mobility. The temperature and humidity ranges at the onset of RSV epidemics differed between the pre- and post-pandemic periods, with decreased standard deviations. Genetic analysis of RSV strains from 2020 to 2022 revealed a cluster with low genetic diversity, which differed markedly from pre-2019 and 2023 prevalent strains. CONCLUSION: Reduced human migration led to an RSV epidemic caused by an indigenous endemic strain, highlighting the natural relationship between epidemics and climatic factors. These findings could aid in developing effective prediction and control programs for RSV epidemics and optimising vaccine programs.
• Varicella-zoster virus reactivation with severe pneumonia following convalescence from coronavirus disease: A case report and literature review2019 · <p>An association between coronavirus disease 2019 (COVID-19) and concomitant varicella-zoster virus (VZV) reactivation has been proposed. We herein report a case of severe VZV pneumonia in a 73-year-old man who underwent corticosteroid tapering after recovering from COVID-19 and presented with fever, vesicular rashes, and hypoxemia. Chest computed tomography (CT) revealed ground-glass opacities and multiple granular shadows. Varicella-zoster virus was detected in the skin and bronchoalveolar lavage fluid. The patient was diagnosed with disseminated VZV reactivation and thereafter successfully recovered with acyclovir treatment. Physicians should consider the possibility of VZV reactivation when ground-glass opacities or patchy nodular shadows appear during the course of patients with COVID-19. </p>
• 関連情報を調べる PubMed CiNii Research2019

• hsdS遺伝子組換え膜光透過性固定株を用いた侵襲性肺炎球菌感染症のメカニズム解明2021 · 肺炎球菌は，菌膜の光透過性（Opacity）により，不透明（O-type）コロニーと透明（T-type）コロニーに分類される。しかし，成人肺炎におけるその意義は明らかにされていない。我々は，Streptococcus pneumoniae株のOpacityと成人肺炎の臨床的特徴との関連性を検討することを目的とした。肺炎の定義は，肺に新しい浸潤があり，急性呼吸器症状があり，38度以上の発熱があり，白血球数が1万/μl以上または4000/μl未満であることである。カタラーゼを塗布したTripticase寒天培地上のコロニーを実体顕微鏡で観察し，菌株のOpacityを同定した．4病院の成人肺炎患者を集め，後方視的コホート研究を実施した。転帰は，肺炎の重症度，胸部CTにおける肺炎の陰影の面積，菌血症，人工呼吸器の使用，入院中の死亡で評価した。統計解析にはFisher検定（非連続変数）とWilcoxon検定（連続変数）を用いた。72例が抽出され，これらの患者から肺炎球菌株：54株のO型と18株のT型が分離された．成人肺炎患者の2つの異なるOpacity群の間には，年齢，性別，基礎疾患に有意差はなかった．肺炎に罹患した肺葉の数はO型が有意に多かった（p＝0.047）．肺炎の重症度はqSOFA，ADROP，PSIで評価し，いずれもO型で有意に重症化した（それぞれp＝0.028，p＝0.035，p＝0.031）．また，入院中の菌血症，人工呼吸器使用，死亡の発生率はO型で高い傾向にあった（18.8％ vs 8.3，13.0％ vs 0，9.3％ vs 5.6％）が，有意差は認めなかった．結論 成人肺炎球菌による肺炎の重症化には，O型肺炎球菌のコロニー形成が関与していることが示唆された。 マウスで肺炎球菌肺炎を形成する菌株19F型の莢膜変異株を作成し、マウス実験を進行中である。
• 縦隔リンパ節好中球に着目した肺炎球菌肺炎における新しい免疫機構の解明2017 · 肺炎を起こす菌で最も頻度の高い肺炎球菌を用いたマウス肺炎モデルの実験系で、肺の所属リンパ節である縦隔リンパ節で起こる免疫機構について解明した。肺炎球菌肺炎の際に、縦隔リンパ節に好中球が集積し、それが菌血症を防止する役割を果たしていることがわかった。そのメカニズムとして、肺リンパ内皮細胞由来のケモカイン（CXCL1, CXCL5, G-CSF）によって縦隔リンパ節に好中球が集まる経路を証明した。さらに縦隔リンパ節に集簇した好中球は、血液内及び肺内好中球と異なり、MHCクラスIIを発現してリンパ節内で獲得免疫を刺激している可能性が示唆された。

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