Toshihiro Mitsuda

DEMONSTRATION OF MOTHER-TO-INFANT TRANSMISSION OF HEPATITIS B VIRUS BY MEANS OF POLYMERASE CHAIN REACTION

To investigate the failure of vaccines to prevent mother-to-infant transmission of hepatitis B virus (HBV), serum, cord blood, and colostrum samples from eleven mothers, known to be carriers of hepatitis B surface antigen, and their infants were examined by means of a highly sensitive polymerase chain reaction (PCR) method. HBV-specific DNA was detected in ten maternal serum samples, eight samples of colostral whey, eight samples of colostral cells, and one cord blood sample. Four infants of mothers with HBV-DNA-positive colostrum showed low responsiveness to hepatitis B vaccine. The infant whose cord blood was positive for HBV DNA showed low responsiveness to hepatitis B vaccine and subsequently became an HBV carrier. These results suggest the need for further study to evaluate whether breastfeeding is advisable for HBV carriers.

Demonstration of mother-to-infant transmission of Staphylococcus aureus by pulsed-field gel electrophoresis

We assessed mother-to-infant transmission ofStaphylococcus aureus. Anterior nares swabs of 466 pregnant women, vaginal swabs of 305 of these women and anterior nares swabs of 305 6-day-old infants were examined for the presence ofS. aureus. The results showed that 7.5% of the vaginal swabs from the pregnant women and 10.1% of the anterior nares swabs from the infants were positive forS. aureus. Six of the 466 pregnant women (1.3%) and 12 of the 305 infants (3.9%) carried methicillin-resistantS. aureus (MRSA) in the anterior nares site, but none of the vaginal specimens were positive for MRSA. Analysis ofSmaI digested chromosomal DNA analysis using pulsed-field gel electrophoresis (PFGE) showed that methicillin-sensitiveS. aureus (MSSA) strains obtained from four pairs of pregnant women and their infants were completely identical, which strongly suggesting mother-to-infant transmission ofS. aureus.ConclusionThis study elucidated the prevalence ofS. aureus carriage among pregnant women and newborn infants. Mother-to-infant infection ofS. aureus was demonstrated phenotypically and genetically. PFGE is a useful tool to detect infection routes including mother-to-infant-infection.

Household Transmission of Streptococcus pneumoniae among Siblings with Acute Otitis Media

ABSTRACT Nasopharyngeal transmission of Streptococcus pneumoniae was evaluated among 23 siblings with acute otitis media (AOM). Restriction fragment length polymorphism revealed that the nasopharyngeal strains were identical between siblings in 12 of 13 clusters of AOM experienced in 11 families. This study demonstrated person-to-person transmission of S. pneumoniae, especially drug-resistant strains, among siblings with AOM.

Mizoribine as an effective combined maintenance therapy with prednisolone in child-onset systemic lupus erythematosus

Background : Systemic lupus erythematosus (SLE) is one of the major collagen diseases in childhood. However, the pathogenesis of this disease still remains unknown. The disease is known as a chronic inflammatory disease. Since oral and intravenous corticosteroid therapy has been introduced into the treatment of SLE, the prognosis of patients has improved significantly. However, it has now become clear that there are limitations in the effectiveness, as well as adverse reactions when corticosteroids therapy is administered for a long‐term period. Therefore, we have been attempting to improve the maintenance therapy of child‐onset SLE.

Japanese Guidelines for the Management of Respiratory Infectious Diseases in Children 2007 with focus on pneumonia

Members of the Japanese Society of Pediatric Pulmonology and the Japanese Society for Pediatric Infectious Diseases developed the Guidelines for the Management of Respiratory Infectious Diseases in Children with the objective of facilitating the appropriate diagnosis and treatment of childhood respiratory infections. To date, a first edition (2004) and a revised edition (2007) have been issued. Many problems complicate the diagnosis of the pathogens responsible for bronchopulmonary infections in children. The Guidelines were the first pediatric guidelines in the world to recommend treatment with antimicrobials suited to causative pathogens as identified from cultures of sputum and other clinical specimens collected from infection sites and satisfying assessment criteria. The major causative microorganisms for pneumonia in infants and children were revealed to be Streptococcus pneumoniae, Haemophilus influenzae and Mycoplasma pneumoniae. This manuscript describes the Guidelines for the Management of Respiratory Infectious Diseases in Children in Japan 2007, with a focus on pneumonia.

Incidence Rate of Needlestick and Sharps Injuries in 67 Japanese Hospitals: A National Surveillance Study

Background Determining incidence rates of needlestick and sharps injuries (NSIs) using data from multiple hospitals may help hospitals to compare their in-house data with national averages and thereby institute relevant measures to minimize NSIs. We aimed to determine the incidence rate of NSIs using the nationwide EPINet surveillance system. Methodology/Principal Findings Data were analyzed from 5,463 cases collected between April 2009 and March 2011 from 67 Japanese HIV/AIDS referral hospitals that participated in EPINet-Japan. The NSI incidence rate was calculated as the annual number of cases with NSIs per 100 occupied beds, according to the demographic characteristics of the injured person, place, timing, device, and the patients’ infectious status. The NSI incidence rates according to hospital size were analyzed by a non-parametric test of trend. The mean number of cases with NSIs per 100 occupied beds per year was 4.8 (95% confidence interval, 4.1–5.6) for 25 hospitals with 399 or fewer beds, 6.7 (5.9–7.4) for 24 hospitals with 400–799 beds, and 7.6 (6.7–8.5) for 18 hospitals with 800 or more beds (p-trend<0.01). NSIs frequently occurred in health care workers in their 20 s; the NSI incidence rate for this age group was 2.1 (1.6–2.5) for hospitals having 399 or fewer beds, 3.5 (3.0–4.1) for hospitals with 400–799 beds, and 4.5 (3.9–5.0) for hospitals with 800 or more beds (p-trend<0.01). Conclusions/Significance The incidence rate of NSIs tended to be higher for larger hospitals and in workers aged less than 40 years; injury occurrence was more likely to occur in places such as patient rooms and operating rooms. Application of the NSI incidence rates by hospital size, as a benchmark, could allow individual hospitals to compare their NSI incidence rates with those of other institutions, which could facilitate the development of adequate control strategies.

Perinatal hepatitis B virus infection caused by antihepatitis Be positive maternal mononuclear cells.

To investigate the infectivity of hepatitis B virus (HBV) from mothers to their newborn offspring, HBV-DNA in plasma and peripheral mononuclear cells from 28 antihepatitis Be positive, hepatitis B surface antigen positive carrier mothers was examined by a highly sensitive polymerase chain reaction/Southern hybridisation technique. HBV specific DNA was detected in three maternal mononuclear cell samples, but was absent in plasma. Two of four infants born to the three mothers with HBV-DNA positive mononuclear cells developed acute or fulminant hepatitis within three months after birth. Two infants were effectively prevented from infection with HBV by combined hepatitis B immunoglobulin/HBV vaccine administration. The 25 infants born to the HBV-DNA negative mothers were free of HBV infection within the next seven months to 3.5 years. These results suggest that latent infection with HBV in maternal mononuclear cells is responsible for perinatal HBV infection.

Mixed connective tissue disease in childhood: A nationwide retrospective study in Japan

Sixty‐six children with mixed connective tissue disease (MCTD) were analyzed by a nationwide prospective study. The diagnostic significance of Raynauds phenomenon and positive anti‐RNP antibody was confirmed, and additional symtoms including swelling of fingers, facial erythema, and polyarthralgia, and laboratory findings such as positive rheumatoid factor, hypergammaglobulinemia, and increased levels of myogenic enzymes, were variably positive. These clinical and laboratory characteristics of MCTD were critically different from those of systemic lupus erythematosus, indicating that MCTD is an independent entity of disease.

Whole blood interferon‐γ assay for tuberculosis in children in Japan

Background:  Whole blood interferon‐γ assay QuantiFERON‐TB2G (QFT‐2G), which is a new specific method for diagnosing tuberculosis (TB), has been developed and used in the clinical field. The aim of the present study was to assess the usefulness of QFT‐2G as an indicator, both for diagnosing childhood TB and for assessing therapeutic effectiveness.

Transient remission of intractable systemic-type of juvenile rheumatoid arthritis after chickenpox in a 2-year-old boy.

collagen diseases in children.1 However, the pathogenesis of the disease remains unclear. We sometimes experience intractable cases with a systemic-type of JRA, which is refractory to several antirheumatic drugs, including acetyl salicylic acid (ASA), prednisolone (PSL), gold, methotrexate (MTX) and even cyclosporine A (CsA). In contrast, chickenpox is a common infectious disease in children. Chickenpox rarely presents with any severe complications, such as hemophagocytic syndrome.2 Recently, we experienced a case of intractable systemictype JRA, who went into transient remission after contracting chickenpox. To our knowledge, this type of phenomenon in JRA has not been previously reported and this case may contribute to the understanding of the pathogenesis of the disease, including the importance of the balance between T helper (Th) 1 and Th2 cells in JRA, and to develop a new therapeutic strategy for the treatment of the condition.