Takehiko Kaneko

Antimicrobial susceptibility and molecular characteristics of 857 methicillin-resistant Staphylococcus aureus isolates from 16 medical centers in Japan (2008–2009): nationwide survey of community-acquired and nosocomial MRSA

This study is a nationwide survey of all clinical methicillin-resistant Staphylococcus aureus (MRSA) isolates, including community-acquired MRSA (CA-MRSA), in Japan. A total of 857 MRSA clinical isolates were collected from the 16 institutions throughout Japan that participated in the survey (2008-2009). The drug susceptibility and staphylococcal cassette chromosome mec (SCCmec) typing and the presence of specific pathogenic genes were evaluated. The isolates comprised SCCmec type II (73.6%), type IV (20%), and type I (6%). The percentage of SCCmec type IV isolates was significantly higher in outpatients than in inpatients. Most of the isolated strains were sensitive to vancomycin (VCM, MIC ≤2 μg/mL), linezolid (MIC ≤4 μg/mL), and teicoplanin (MIC ≤8 μg/mL). Although most strains were sensitive to VCM, the MIC value of VCM for SCCmec type II strains was higher than that for SCCmec type IV strains. Only 4 (2.3%) of 171 SCCmec type IV strains were Panton-Valentine leukocidin (lukS/F-PV)-positive. Thus, this result indicates a unique feature of SCCmec type IV strains in Japan. The information in this study not only is important in terms of local public health but will also contribute to an understanding of epidemic clones of CA-MRSA.

Hereditary angioedema in Japan: Genetic analysis of 13 unrelated cases

Introduction:The molecular bases and clinical features of hereditary angioedema (HAE) have not been systematically documented in Japan or in other Asian countries. Thus, the authors researched the genetic and clinical characteristics of Japanese patients with HAE. Methods:The authors analyzed the CIINH gene for mutations in 13 unrelated Japanese patients with HAE by means of the polymerase chain reaction and nucleotide sequencing. In addition, the authors searched the literature from January 1969 to October 2010 on Japanese patients with HAE. Results:Seven of the mutations found were novel, including 4 missense mutations (8728T>G, 8831C>A, 16661T>G and 16885C>A), 2 frameshift mutations (2281_2350del70, 14158delT) and 1 large deletion (at least 1 kb-length deletion including exon 4), whereas 6 mutations had previously been reported in European populations. Conclusions:The genetic and clinical characteristics in Japanese patients with HAE may be similar to those in Western patients although our sample size is small and the authors identified 7 novel mutations.

Interferon‐α (INF‐α) and Etretinate in the Treatment of Mycosis Fungoides

A combination therapy of mycosis fungoides (MF) with interferon‐α (INF‐α) and etretinate was reported. A 53‐year‐old patient suffering from MF was treated with intramuscular administration of INF‐α at a dosage of 9 × 106 IU daily; skin lesions poorly responded to the treatment. After oral etretinate with a dosage of 50 mg daily was combined with INF‐α, marked clinical improvement was seen in skin lesions with minor side effects. INF‐α in combination with etretinate can have beneficial effects in the treatment of MF.

Epidermodysplasia verruciformis with keratoacanthoma, Bowen's disease and squamous cell carcinoma: isolation of high‐risk types of HPV 5 and unknown type of human papillomavirus

1 Kobner H. Zur aetologie der psoriasis. Vrtljscher F Dermat Syph 1876; 8: 559. 2 Boyd AS, Neldner KH. The isomorphic response of Koebner. Int J Dermatol 1990; 29: 401–410. 3 Chan LS, Cooper KD, Rasmussen JE. Koebnerization as a cutaneous manifestation of immune complexmediated vasculitis. J Am Acad Dermatol 1990; 22: 775–781. 4 Green ST, Natarajan S. The Koebner phenomenon in anaphylactoid purpura. Cutis 1986; 38: 56–57. 5 Papi M, Didona B, Chinni LM et al. Koebner phenomenon in an ANCA-positive patient with pyoderma gangrenosum. J Dermatol 1997; 24: 583–586. 6 Karp SJ, Winter RJ, Ridley CM. Immune complexmediated cutaneous vasculitis in a scarthe importance of local anatomical factors. Postgrad Med J 1985; 61: 265–266.

Combined analysis of cell growth and apoptosis-regulating proteins in HPVs associated anogenital tumors

BackgroundThe clinical course of human papillomavirus (HPV) associated with Bowenoid papulosis and condyloma acuminatum of anogenital tumors are still unknown. Here we evaluated molecules that are relevant to cellular proliferation and regulation of apoptosis in HPV associated anogenital tumors.MethodsWe investigated the levels of telomerase activity, and inhibitor of apoptosis proteins (IAPs) family (c-IAP1, c-IAP2, XIAP) and c-Myc mRNA expression levels in 20 specimens of Bowenoid papulosis and 36 specimens of condyloma acuminatum in anogenital areas. Overall, phosphorylated (p-) AKT, p-ribosomal protein S6 (S6) and p-4E-binding protein 1 (4EBP1) expression levels were examined by immunohistochemistry in anogenital tumors both with and without positive telomerase activity.ResultsPositive telomerase activity was detected in 41.7% of Bowenoid papulosis and 27.3% of condyloma acuminatum compared to normal skin (p < 0.001). In contrast, the expression levels of Bowenoid papulosis indicated that c-IAP1, c-IAP2 and XIAP mRNA were significantly upregulated compared to those in both condyloma acuminatum samples (p < 0.001, p < 0.001, p = 0.022, respectively) and normal skin (p < 0.001, p = 0.002, p = 0.034, respectively). Overall, 30% of Bowenoid papulosis with high risk HPV strongly promoted IAPs family and c-Myc but condyloma acuminatum did not significantly activate those genes. Immunohistochemically, p-Akt and p-S6 expressions were associated with positive telomerase activity but not with p-4EBP1 expression.ConclusionCombined analysis of the IAPs family, c-Myc mRNA expression, telomerase activity levels and p-Akt/p-S6 expressions may provide clinically relevant molecular markers in HPV associated anogenital tumors.

Cluster analysis of Microsporum canis isolated from a patient with tinea corporis and an infected cat based on the DNA sequences of nuclear ribosomal internal transcribed spacer 1

Microsporum canis has been sometimes isolated from patients with tinea capitis and ⁄ or corporis. The infection may be acquired not only from dermatophyte-infected animals with cutaneous lesions but also from asymptomatic carriers. In recent years, the molecular biological analysis of these dermatophytes has achieved rapid development. The mutual phylogenetic relationships of dermatophytes of the genera Trichophyton, Microsporum and Epidermophyton have been demonstrated by using internal transcribed spacer 1 (ITS1) of ribosomal DNA sequences (Makimura K et al. J Clin Microbiol 1999; 37: 920–4). Furthermore, the cluster analysis of ITS1 has gradually elucidated human and animal pathogenic Microsporum species and their teleomorphic states, Arthroderma species including Arthroderma otae-related species (Makimura K et al. Microbiol Immunol 2001; 45: 209–16). However, this search strategy using clinical isolates has not yet been fully verified. Therefore, we used M. canis (isolated from a patient with tinea corporis; she had been infected from her cat reared as a companion animal) in an attempt to elucidate not only its morphological but also molecular features.

Primary lymphocutaneous nocardiosis due to Nocardia brasiliensis which was successfully treated with only oral potassium iodide

may be observed after the feast of sacrifice in Muslim countries. During this religious feast, many families sacrifice a sheep or goat, and viral contamination from an infected lamb may occur easily. The hands are the most common site of orf, with other sites such as the face only occasionally being involved. Prompt diagnosis of orf is easily made by obtaining a complete patient history and by considering orf as a differential diagnosis when an unusual lesion is seen in an individual who has had contact with sheep or goats. The disease progresses through six distinct clinical and histopathologic stages. The maculo-papular stage consists of an erythematous macule or papule. In the target stage, the lesion has a red center, a central white ring, and an outer red halo. The acute stage consists of an erythematous weeping nodule. In the regenerative stage the lesion is dry with small black dots on the outside surface. The papillomatous stage is characterized by papillomas appearing on the surface. A dry crust characterizes the regressive stage. Residual scarring is unusual. In our case, we observed all the stages of the disease. Orf lesions generally heal without complications, even though complications such as lymphangitis, adenitis, erythema multiforme, erysipelas, papulovesicular eruption, Pseudomonas aeruginosa infection, swan-neck deformity, and bullous pemphigoid are rarely reported. It is important to consider orf as a differential diagnosis of hand lesions to prevent over treatment and complications. The veterinary control of the animal health, preventive measures and controlled slaughtering of animals by professional workers are very important to prevent orf, especially during the Feast of Sacrifice in Muslim countries. Every year, an outbreak of orf is observed in Turkey, occurring 2 or 3 weeks after the Feast. The case reported herein presented to our clinic in the period following the Feast.

Patient with Churg–Strauss syndrome complicated by acute progressive neuropathy who was successfully treated by prompt administration of an oral corticosteroid

Figure 2. Photomicrograph of a biopsy section of purpura on the dorsum of foot showing severe infiltration of eosinophils in the dermis and necrotizing vasculitis in small vessels (arrows) (hematoxylin–eosin stain, original magnification ·200). Figure 1. Swelling and purpuras on the lower extremities. Dear Editor, Churg–Strauss syndrome (CSS) is characterized by bronchial asthma, eosinophilia and systemic necrotizing vasculitis. CSS sometimes presents with acute neuropathy which mimics Guillain–Barré syndrome (GBS). Here, we report on a patient with CSS complicated by progressive neuropathy, for whom the prompt administration of an oral corticosteroid was successful. A 48-year-old woman presented to our department by ambulance because of dysbasia. The patient had a 10-day history of lower extremity swelling with severe fatigue, purpura and dysesthesias, followed by rapidly progressive weakness of the lower limbs and left drop hand (Fig. 1). The patient’s body temperature and bodyweight were found to be 37 C and 58 kg, respectively; she had not recently noted any particular tendency for bodyweight loss. She had a 4-year history of asthma, and hematochemistry revealed white blood cells (21 700 ⁄lL; 59.5% eosinophils), C-reactive protein (4.24 mg ⁄dL), immunoglobulin E (5502 IU ⁄mL), positive rheumatoid factor, and negative antineutrophil cytoplasmic antibody. Platelet count (38.2 · 10 ⁄lL) was normal, and no laboratory data suggesting a particular tendency for bleeding was found. Chest X-ray and cerebrospinal fluid analysis were normal. The peripheral nerve conduction rates in the left median, radial and peroneal nerves decreased, suggesting mononeuritis multiplex (MM). Histologically, purpura showed severe infiltration of eosinophils in the dermis and necrotizing vasculitis in small vessels (Fig. 2). A diagnosis of CSS was made based on the Japanese criteria. Prednisolone (60 mg daily) was started 4 days after the development of neurological symptoms, followed by improvement of the neurological deficit. Six months

Evaluation of telomerase activity in non-genital Bowen's disease.

Abstract

Bowen's disease with high telomerase activity

We describe an 81‐year‐old Japanese woman who had a palm‐sized, erythematous plaque with a nodular lesion on the lateral abdomen. The biopsy specimens taken from the erythematous plaque and reddish nodule show that bowenoid changes were present in the epidermis and epidermis to dermis, respectively. A sentinel lymph node biopsy (SNB) was performed with blue dye and radioisotope in her right groin region and two lymph nodes were found to be occupied by many atypical cells. The erythematous plaque with nodular lesion was completely removed with a 3‐cm margin under general anesthesia, and complete regional lymph node dissection was also performed. In addition, high telomerase activity was seen in the erythema plaque while using a telomeric repeat amplification protocol assay. In conclusion, some instances of Bowens disease might have high telomerase activity in the atypical cells and can progress to Bowens carcinoma. The SNB was regarded as a useful method to detect early lymph node metastases in this case.