Yoko Nukui

Cryptococcus gattii Genotype VGIIa Infection in Man, Japan, 2007

We report a patient in Japan infected with Cryptococcus gattii genotype VGIIa who had no recent history of travel to disease-endemic areas. This strain was identical to the Vancouver Island outbreak strain R265. Our results suggest that this virulent strain has spread to regions outside North America.

High plasma linezolid concentration and impaired renal function affect development of linezolid-induced thrombocytopenia

OBJECTIVES Thrombocytopenia is sometimes observed during linezolid therapy. Here, we aimed to investigate the factors affecting linezolid-induced thrombocytopenia. METHODS A prospective observational study was performed between October 2009 and February 2011; 30 patients were included. Plasma linezolid trough concentrations were measured on days 3, 7 and 14 after initial drug administration. Platelet counts and haemoglobin levels were also monitored. RESULTS Thrombocytopenia occurred in 17 patients (56.7%). Median linezolid trough concentrations on day 3 were significantly higher in patients with renal impairment (creatinine clearance <60 mL/min) than in patients without renal impairment (14.7 versus 4.8 mg/L; P < 0.0001). Median linezolid trough concentrations on day 3 in patients who developed thrombocytopenia were also significantly higher than those in patients who did not (13.4 versus 4.3 mg/L, P < 0.0001). Development of thrombocytopenia occurred significantly more frequently in patients with linezolid trough concentration >7.5 mg/L (OR, 90.0; P < 0.0001) and renal impairment (OR, 39.0; P = 0.0002). The Kaplan-Meier plot showed that the median time from the initiation of therapy to development of thrombocytopenia was 11 days. CONCLUSIONS Patients with renal impairment are more likely to have a high plasma linezolid concentration. In addition, a high plasma linezolid concentration and renal impairment significantly affected the development of linezolid-induced thrombocytopenia. Further studies are required to evaluate whether therapeutic drug monitoring-guided dosage adjustment of linezolid decreases the adverse effects while maintaining treatment efficacy in patients with renal dysfunction.

Prevalence of measles, rubella, mumps, and varicella antibodies among healthcare workers in Japan

OBJECTIVES To evaluate the immune status of healthcare workers (HCWs) against measles, rubella, mumps, and varicella in Japan, and to promote an adequate vaccination program among HCWs. SETTING University of Tokyo Hospital. PARTICIPANTS Eight hundred seventy-seven HCWs. DESIGN Serologic screening for measles, rubella, mumps, and varicella was performed on HCWs. Antibodies against measles, rubella, and mumps were detected using hemagglutination inhibition (HI) assay (

Unadjuvanted pandemic H1N1 influenza vaccine in HIV-1-infected adults

4.20 per test). If serum was negative by HI assay, enzyme-linked immunosorbent assay (EIA) was performed (

Pandemic 2009 influenza A (H1N1) virus among Japanese healthcare workers: seroprevalence and risk factors.

12.60 per test). Anti-varicella antibodies were detected by EIA only. RESULTS Among tested HCWs, 98.5%, 90.4%, 85.8%, and 97.2% had immunity to measles, rubella, mumps, and varicella, respectively. All those born before 1970 were seropositive for measles. However, individuals susceptible to rubella, mumps, and varicella were present in all age groups. The sensitivities and negative predictive values of HI assay compared with EIA were 86.6% and 11.3% for measles, 99.1% and 92.2% for rubella, and 47.8% and 24.1% for mumps, respectively. For measles and mumps, prevaccination screening by HI assay in combination with EIA led to significant savings compared with EIA only. In contrast, it was estimated that prevaccination screening using only HI assay would be more economical for rubella. CONCLUSIONS Aggressive screening and vaccination of susceptible HCWs was essential regardless of age. Prevaccination serologic screening using a combination of HI assay and EIA was more economical for measles and mumps.

Atypical Osteomyelitis of the Skull Base and Craniovertebral Junction Caused by Actinomyces Infection

We evaluated the immune response to a 2009 influenza A (H1N1) unadjuvanted vaccine in HIV-infected patients and assessed the boosting effect of a second dose. HIV-infected adults were enrolled and scheduled to receive the H1N1 unadjuvanted vaccine containing 15μg of A/California/7/2009 haemagglutinin. Anti-H1N1 antibody titers were measured at enrollment and 4-8 weeks after each vaccination by using haemagglutination inhibition (HI) and virus neutralization (NT) assays. One hundred and four patients were analyzed. Seroconversion, as measured by using HI and NT assays, was observed in 52 (50.0%) patients and 49 (47.1%) patients, respectively, after the first dose. Seroconversion rate evaluated by using NT, but not HI, antibody titers was associated with HIV RNA levels of <400copies/ml (odds ratio, 3.21; 95% CI, 1.15-8.96). Other parameters, including CD4 cell count, were not associated with seroconversion. In a cohort that received two vaccine doses at a 4-8-week interval (n=54), the seroconversion rate and geometric mean titer for HI antibodies were 44.4% (95% CI, 30.8-58.1%) and 30.5 (95% CI, 19.9-46.9) after the first dose, respectively, and 48.1% (95% CI, 34.4-61.9%) and 39.0 (95% CI, 26.1-58.2) after the second dose, respectively. Among HIV-infected patients, the seroconversion rate was around 50% after the first dose of unadjuvanted vaccine. A second dose of vaccine had a limited boosting effect on immunity in this patient cohort.

Dengue hemorrhagic shock and disseminated candidiasis.

OBJECTIVE To evaluate the seroprevalence and risk factors for 2009 influenza A (H1N1) virus infection among healthcare personnel. DESIGN Observational cross-sectional study. PATIENTS AND SETTING Healthcare workers (HCWs) in an acute care hospital. METHODS Between September 14 and October 4, 2009, before 2009 H1N1 vaccination, we collected serological samples from 461 healthy HCWs. Hemagglutination-inhibition antibody assays were conducted. To evaluate the risk factors of seropositivity for 2009 H1N1 virus, gender, age, profession, work department, usage of personal protective equipment, and seasonal influenza vaccination status data were gathered via questionnaires. RESULTS Our survey showed that doctors and nurses were at highest risk of seropositivity for the 2009 H1N1 virus (odds ratio [OR], 5.25 [95% confidence interval {CI}, 1.21-22.7]). An increased risk of seropositivity was observed among pediatric, emergency room, and internal medicine staff (adjusted OR, 1.98 [95% CI, 1.07-3.65]). Risk was also higher among HCWs who had high titers of antibodies against the seasonal H1N1 virus (adjusted OR, 1.59 [95% CI, 1.02-2.48]). CONCLUSIONS Seropositivity for the 2009 H1N1 virus was associated with occupational risk factors among HCWs.