Details of a Researcher - Uwamino, Yoshifumi

Papers - Uwamino, Yoshifumi

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カンジダ血症におけるCare Bundle「ACTIONs BUNDLE 2014」チェックリストの有効性の検討

上蓑義典, 長谷川直樹, 猪瀬里夏, 青木渉, 永田美香, 荒美幸, 昆亜紀子, 上遠野保裕, 宇野俊介, 岩田敏, 村田満

日本臨床微生物学雑誌 ((一社)日本臨床微生物学会) 27 ( Suppl. ) 274 - 274 2016.12

ISSN 0917-5059

Clinical characteristics of pulmonary Mycobacterium scrofulaceum disease in 2001–2011: A case series and literature review

Shoji Suzuki, Eriko Morino, Makoto Ishii, Ho Namkoong, Kazuma Yagi, Takanori Asakura, Takahiro Asami, Hiroshi Fujiwara, Yoshifumi Uwamino, Tomoyasu Nishimura, Sadatomo Tasaka, Tomoko Betsuyaku, Jin Takasaki, Satoshi Iwata, Naoki Hasegawa

Journal of Infection and Chemotherapy (Elsevier B.V.) 22 ( 9 ) 611 - 616 2016.09

ISSN 1437-7780

Background Mycobacterium scrofulaceum is a well-known pathogen associated with cervical lymphadenitis in children. However, pulmonary M. scrofulaceum disease is a rare condition with unknown clinical features. The present study aimed to clarify the clinical features of pulmonary M. scrofulaceum disease described in recent cases and reports. Methods We reviewed the medical records of all adult patients with pulmonary M. scrofulaceum disease at Keio University Hospital and the National Center for Global Health and Medicine Center Hospital between 2001 and 2011. We also conducted a review of the PubMed database to identify additional cases of pulmonary M. scrofulaceum disease in adults. Results Our study identified 8 cases of pulmonary M. scrofulaceum disease at the 2 identified institutions during our study period. Most cases were diagnosed in middle-aged and elderly men with underlying pulmonary diseases such as chronic obstructive pulmonary disease and Mycobacterium avium complex lung disease, as well as those with a history of pulmonary tuberculosis. In contrast, most previously reported cases identified through our literature review had a history of dust inhalation or underlying silicosis. Three of 8 cases at our institutions and 20 of 23 cases from the literature were treated with combination therapies. Conclusions We conclude that in the recent histories of our institutions, pulmonary M. scrofulaceum disease has mainly occurred in patients with chronic pulmonary diseases. We further conclude that combination therapies that include clarithromycin might yield better patient outcomes.

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Clinical characteristics of pulmonary Mycobacterium scrofulaceum disease in 2001-2011: A case series and literature review.

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy (ELSEVIER SCIENCE BV) 22 ( 9 ) 611 - 6 2016.09

ISSN 1341-321X

BACKGROUND: Mycobacterium scrofulaceum is a well-known pathogen associated with cervical lymphadenitis in children. However, pulmonary M. scrofulaceum disease is a rare condition with unknown clinical features. The present study aimed to clarify the clinical features of pulmonary M. scrofulaceum disease described in recent cases and reports. METHODS: We reviewed the medical records of all adult patients with pulmonary M. scrofulaceum disease at Keio University Hospital and the National Center for Global Health and Medicine Center Hospital between 2001 and 2011. We also conducted a review of the PubMed database to identify additional cases of pulmonary M. scrofulaceum disease in adults. RESULTS: Our study identified 8 cases of pulmonary M. scrofulaceum disease at the 2 identified institutions during our study period. Most cases were diagnosed in middle-aged and elderly men with underlying pulmonary diseases such as chronic obstructive pulmonary disease and Mycobacterium avium complex lung disease, as well as those with a history of pulmonary tuberculosis. In contrast, most previously reported cases identified through our literature review had a history of dust inhalation or underlying silicosis. Three of 8 cases at our institutions and 20 of 23 cases from the literature were treated with combination therapies. CONCLUSIONS: We conclude that in the recent histories of our institutions, pulmonary M. scrofulaceum disease has mainly occurred in patients with chronic pulmonary diseases. We further conclude that combination therapies that include clarithromycin might yield better patient outcomes.

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Middle-aged to elderly women have a higher asymptomatic infection rate with Mycobacterium avium complex, regardless of body habitus.

Tomoyasu Nishimura, Yukiko Fujita-Suzuki, Masaaki Mori, Stephen M Carpenter, Hiroshi Fujiwara, Yoshifumi Uwamino, Eiko Tamizu, Ikuya Yano, Hiroshi Kawabe, Naoki Hasegawa

Respirology (Carlton, Vic.) (WILEY-BLACKWELL) 21 ( 3 ) 553 - 5 2016.04

ISSN 1323-7799

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ドルテグラビルによる薬剤性肝障害の2例について

藤原宏, 長谷川直樹, 須藤弘二, 加藤真吾, 上蓑義典, 南宮湖, 岩田敏

感染症学雑誌 ((一社)日本感染症学会) 90 ( 臨増 ) 341 - 341 2016.03

ISSN 0387-5911

Clinical Features of Community-Acquired Helicobacter cinaedi Bacteremia.

Yoshifumi Uwamino, Kiyoharu Muranaka, Ryota Hase, Yoshihito Otsuka, Naoto Hosokawa

Helicobacter (WILEY-BLACKWELL) 21 ( 1 ) 24 - 8 2016.02

ISSN 1083-4389

BACKGROUND: There are growing numbers of reports concerning the clinical and pathological features of Helicobacter cinaedi (H. cinaedi) bacteremia; however, few reports have discussed the features of this condition in healthy individuals. PATIENTS AND METHODS: A retrospective observational study was conducted at a Japanese tertiary care hospital to assess the clinical features of community-acquired H. cinaedi. All patients in whom H. cinaedi was isolated between January 2009 and March 2014 were identified from the hospital database. RESULTS: Of the 28 patients included in the study, 12 had community-acquired H. cinaedi bacteremia. The most common clinical feature was cellulitis (n = 17). However, nearly half of the patients with healthcare-associated or nosocomial-associated bacteremia displayed no symptoms with the exception of fever. Most patients were successfully treated with a 14-day regime of third-generation cephalosporins or tetracycline. CONCLUSIONS: Our results show that H. cinaedi infections are quite common in immunocompetent community-dwelling individuals.

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Health-related quality of life is inversely correlated with C-reactive protein and age in Mycobacterium avium complex lung disease: A cross-sectional analysis of 235 patients

Takanori Asakura, Yohei Funatsu, Makoto Ishii, Ho Namkoong, Kazuma Yagi, Shoji Suzuki, Takahiro Asami, Tetsuro Kamo, Hiroshi Fujiwara, Yoshifumi Uwamino, Tomoyasu Nishimura, Sadatomo Tasaka, Tomoko Betsuyaku, Naoki Hasegawa

Respiratory Research (BioMed Central Ltd.) 16 ( 1 ) 2015.12

ISSN 1465-993X

Background: Mycobacterium avium complex (MAC) lung diseases generally cause chronic disease in immunocompetent hosts. Although a few studies have examined health-related quality of life (HRQL) in patients with MAC lung disease, there have been no large studies. This study aimed to evaluate HRQL and its correlation with clinical outcomes in MAC lung disease. Methods: A cross-sectional study was conducted at Keio University Hospital to investigate the factors associated with HRQL in pulmonary nontuberculous mycobacterial diseases. MAC lung diseases were diagnosed according to the 2007 ATS/IDSA guidelines for nontuberculous mycobacterial diseases. The 36-item short form health survey (SF-36) was administered to assess clinical outcomes. Clinical variables included treatment status, latest haematological data, and bacterial smear and culture results. Results: The SF-36 scores for the 235 patients (median age, 69years
45 men and 190 women) with MAC lung disease, except for the bodily pain and mental health subscale scores, were significantly lower than the Japanese population norms. In the multivariable analyses, current treatment for MAC and a positive sputum smear or culture within the past year were significantly associated with lower SF-36 scores. C-reactive protein (CRP) and age showed stronger inverse correlations with SF-36 scores. Conclusions: HRQL, especially the physical component, was impaired in patients with MAC lung diseases
this appears to be related with current treatment status, positive sputum smear or culture within the previous year, and particularly CRP and age. Further studies including qualitative assessments are needed to investigate the efficacy of CRP as a marker for progression or treatment response in MAC lung disease. Trial registration: Clinical trial registered with UMIN (UMIN000007964 ).

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Health-related quality of life is inversely correlated with C-reactive protein and age in Mycobacterium avium complex lung disease: a cross-sectional analysis of 235 patients.

Respiratory research 16 145 - 145 2015.12

ISSN 1465-9921

BACKGROUND: Mycobacterium avium complex (MAC) lung diseases generally cause chronic disease in immunocompetent hosts. Although a few studies have examined health-related quality of life (HRQL) in patients with MAC lung disease, there have been no large studies. This study aimed to evaluate HRQL and its correlation with clinical outcomes in MAC lung disease. METHODS: A cross-sectional study was conducted at Keio University Hospital to investigate the factors associated with HRQL in pulmonary nontuberculous mycobacterial diseases. MAC lung diseases were diagnosed according to the 2007 ATS/IDSA guidelines for nontuberculous mycobacterial diseases. The 36-item short form health survey (SF-36) was administered to assess clinical outcomes. Clinical variables included treatment status, latest haematological data, and bacterial smear and culture results. RESULTS: The SF-36 scores for the 235 patients (median age, 69 years; 45 men and 190 women) with MAC lung disease, except for the bodily pain and mental health subscale scores, were significantly lower than the Japanese population norms. In the multivariable analyses, current treatment for MAC and a positive sputum smear or culture within the past year were significantly associated with lower SF-36 scores. C-reactive protein (CRP) and age showed stronger inverse correlations with SF-36 scores. CONCLUSIONS: HRQL, especially the physical component, was impaired in patients with MAC lung diseases; this appears to be related with current treatment status, positive sputum smear or culture within the previous year, and particularly CRP and age. Further studies including qualitative assessments are needed to investigate the efficacy of CRP as a marker for progression or treatment response in MAC lung disease. TRIAL REGISTRATION: Clinical trial registered with UMIN ( UMIN000007964 ).

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Pseudomonas psychrotolerans菌血症の1例

上蓑義典, 橋本幸平, 戸口明宏, 大塚喜人, 細川直登

日本臨床微生物学雑誌 ((一社)日本臨床微生物学会) 25 ( 1 ) 52 - 56 2014.12

ISSN 0917-5059

下咽頭癌にて治療中の62歳男性が嚥下困難の増悪により入院した。入院33日目に発熱し,その際に採取された血液培養2セット中2セットよりグラム陰性桿菌の検出を認めた。検出した桿菌は黄色色素産生性のコロニーを形成し,16S rRNA解析により,Pseudomonas psychrotoleransと同定された。菌血症の他には明らかな感染巣を認めず,Piperacillin/Tazobactamおよび,ClindamycinとCiprofloxacinの併用療法により軽快した。P.psychrotoleransは,我々が検索した限りでは過去に小動物や環境からの検出報告はあるが,ヒトからの検出報告はない。本例はヒトにおけるP.psychrotolerans感染症の初報告である。(著者抄録)

[The first trial of OPAT (outpatient parenteral antimicrobial therapy) with continuous infusions in Japan].

Ryota Hase, Naoto Hosokawa, Shunsuke Uno, Takahiro Mikawa, Yoshifumi Uwamino, Kiyoharu Muranaka

Kansenshogaku zasshi. The Journal of the Japanese Association for Infectious Diseases 88 ( 3 ) 269 - 74 2014.05

ISSN 0387-5911

OPAT (Outpatient Parenteral Antimicrobial Therapy) is widely utilized in various countries. Although once-daily parenteral antimicrobials are often prescribed in outpatient clinics, the term "OPAT" is not commonly used, and no well-organized OPAT practice has been reported in Japan. We implemented OPAT with continuous infusion using elastomeric infusion devices, which are commonly used in Australia and Singapore. We collected data about diseases, organisms, antimicrobials, treatment duration, bed days saved, outcome, readmission rate and cost reductions of all patients who were treated with OPAT with continuous infusions from July 2012 till June 2013. Ten patients (5 osteomyelitis, 4 abscess and 1 endocarditis) were treated and only one patient discontinued therapy due to the side effects of the antimicrobial. The most commonly targeted organism was Staphylococcus aureus. Cefazolin was the most frequently prescribed antimicrobial. The median OPAT days were 15 (range 4-29 days). Total bed days saved were 159. A peripherally inserted central catheter (PICC) was inserted for all patients and only one had to change the PICC during the treatment. Eight patients were cured and 2 were improved. No patient needed readmission. The estimated medical cost reduction was 1,655,930 yen, that is approximately 16,000 US dollars. Administration with continuous infusion makes it possible to continue the optimal parenteral antimicrobials for outpatients, which avoids prescribing unnecessary once-daily antimicrobials with a broader spectrum. Our experience shows OPAT with continuous infusion is safe and feasible practice not only for improving the QOL of patients but also for efficient bed utilization and medical cost savings.

[Plasmodium malariae malaria with more than a 4-month incubation period: difficult to distinguish from a relapse of Plasmodium vivax malaria].

Ryota Hase, Yoshifumi Uwamino, Kiyoharu Muranaka, Kentaro Tochitani, Misa Sogi, Hidetaka Kitazono, Naoto Hosokawa

Kansenshogaku zasshi. The Journal of the Japanese Association for Infectious Diseases 87 ( 4 ) 446 - 50 2013.07

ISSN 0387-5911

We report herein on a case of Plasmodium malariae malaria with more than a 4-month incubation period. A 35-year-old Japanese man who first presented to our clinic with fever and history of travel to Papua New Guinea was suspected of having Plasmodium vivax malaria based on peripheral smear results. We admitted him and initiated treatment with mefloquine. After two days of therapy, he became afebrile. We discharged him, and P. vivax was later confirmed with PCR. We started mefloquine prophylaxis for a planned trip to Papua New Guinea. After his return, a standard dose of primaquine (15 mg x 14 days) was prescribed for a radical cure of P. vivax. About 4 months after his last visit to Papua New Guinea, he returned to our clinic with fever. We suspected a relapse of P. vivax malaria and admitted him for a second time. After two days of mefloquine therapy, his symptoms improved. We discharged him and restarted a higher dose of primaquine (30 mg x 14 days) therapy for a radical cure of P. vivax. Subsequently, the PCR test revealed the parasite was P. malariae and not P. vivax. Only 13 cases of Plasmodium malariae malaria have been reported in Japan during the past 10 years. Blood-stage schizonticides such as mefloquine is not active against the liver stage. Therefore, the use of these drugs for prophylaxis will not be effective for prevention of malaria if its liver stage is longer than the duration of effective chemoprophylaxis. Although the incubation period of P. malariae is typically 13 to 28 days, it occasionally lasts for months or even years. Careful attention should be given to the possibility that P. malariae occasionally has a long incubation period even in the absence of the hypnozoite stage.

三日熱マラリアの再発との判別が困難であった4ヵ月以上の潜伏期間の後に発症した四日熱マラリアの1例

馳亮太, 上蓑義典, 村中清春, 杤谷健太郎, 曽木美佐, 北薗英隆, 細川直登

感染症学雑誌 ((一社)日本感染症学会) 87 ( 4 ) 446 - 450 2013.07

ISSN 0387-5911

35歳男。パプアニューギニアから帰国後8日目から約1週間持続する発熱と関節痛を主訴に受診し、三日熱マラリアの診断で入院となった。メフロキン内服にて症状は改善た。退院11日後に再度パプアニューギニアへ渡航した。1週間の滞在後帰国し予防内服は4週間継続した。その後、他院にてプリマキンによる根治治療を14日間施行され無症状で経過していたが、最終渡航から約4ヵ月後に2週間持続する間欠的な発熱、咳嗽を認めたため再受診した。ギムザ染色で赤血球内の輪状体を確認した。複数の輪状体を含む赤血球は存在しなかった。輪状体の寄生している赤血球の膨化は明らかではなかった。寄生率は0.06%と低値であった。再びメフロキン内服を開始したが、前回眩暈の副作用が強かったため、投与量を減量した。治療後すぐに解熱し咳嗽も改善したため退院となった。G6PD(グルコース-6-リン酸脱酵素)欠損がないことを確認し、プリマキンを増量して14日間の根治治療を行った。その後、PCR検査にて4日熱マラリアの単独感染であったことが判明した。

[A case of tetanus originating from ulcerated breast cancer].

Daisuke Taniyama, Ryusuke Yamamoto, Yoshifumi Uwamino, Mitsuo Kitahara

Kansenshogaku zasshi. The Journal of the Japanese Association for Infectious Diseases 87 ( 3 ) 385 - 8 2013.05

ISSN 0387-5911

We report herein on a rare case of tetanus originating from ulcerated breast cancer. A 60-year-old homeless woman was admitted to our hospital because of lockjaw. On admission, a physical examination revealed tachypnea, trismus, opisthotonus and an ulcerated right breast. There was no other skin soft tissue damage. A diagnosis of tetanus was entertained from the lockjaw and opisthotonus. Tetanus globulin, tetanus toxoid, penicillin and respiratory support were initiated. Later, a right total mastectomy was performed, and the diagnosis of breast cancer was made, however, gram positive bacilli were not detected and Clostridiuum tetani (C. tetani) was not cultured. It is conceivable that the ulcerated breast was contaminated with C. tetani due to the patients living conditions.

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