Obesity-associated severe asthma in an adult Japanese population.

BACKGROUND: Severe asthma is increasingly being recognized as an important public health issue. Obesity has been identified as a risk factor for poor asthma control and for worsening of asthma severity. However, most studies investigating obese patients with asthma have been performed in Western countries. Reports on the characteristics of obese Japanese individuals with severe asthma are lacking. Herein, we investigated the clinical characteristics of patients with obesity-associated severe asthma in a Japanese population and the association between obesity and poor asthma control. METHODS: We conducted a retrospective observational study of adult patients with severe asthma. Patients were classified into two groups based on the definition of obesity recommended by the Japan Society for the Study of Obesity: obese (OB) group (body mass index [BMI] ≥25 kg/m2) and non-obese (NOB) group (BMI <25 kg/m2). The two groups were compared. The characteristics of obesity and the metabolic functions are known to differ between males and females; therefore, we analyzed male-only and female-only cohorts separately. RESULTS: A total of 492 patients were enrolled. Age, smoking history in terms of number of pack-years, daily controller medications use, and spirometric data were not significantly different between the OB and NOB groups in either cohort. In the female cohort, the annual exacerbation ratio and the percentage of frequent exacerbators were significantly higher in the OB group compared to the NOB group. A multivariate logistic regression analysis showed that obesity was independently associated with frequent asthma exacerbations in the female cohort. CONCLUSIONS: Our study revealed that obesity, defined as a BMI ≥25 kg/m2, was independently associated with poor asthma control (including acute exacerbations) in adult Japanese females with severe asthma.

A case of falciparum malaria: Acute hearing loss as the initial symptom.

A 49-year-old healthy woman, who returned from Burkina Faso, visited an ear, nose, and throat clinic with complaints of left hearing loss, tinnitus, and dizziness. Pure tone audiometry demonstrated bilateral mild sensorineural hearing loss. Three days later, she was transported in an ambulance to a general hospital due to high fever and disturbance of consciousness. Plasmodium falciparum was found in the peripheral blood smear. After diagnosing severe falciparum malaria with cerebral involvement, quinine hydrochloride, clindamycin, and artemether/lumefantrine were administered. After recovery of consciousness, she was followed up at our department with bilateral hearing loss. After taking prednisolone for 10 days, there was improvement to normal hearing level. Furthermore, no neurologic sequelae were observed. In this case, acute sensorineural hearing loss occurred before administration of the antimalarial drug. Therefore, hearing loss was not drug-induced, but was caused by the malaria itself. In patients with acute hearing loss and who have history of travel to tropical regions, physicians should include malaria and other causes of acute deafness in the differential diagnoses.

[A Case of Dengue Fever and Subsequent Long-lasting Depression Accompanied by Alopecia in a Japanese Traveler Returning from Bali, Indonesia].

Recovery from dengue fever is generally rapid and uneventful. However, recuperation is often prolonged and may be accompanied by noticeable depression. We present herein on a traveler to Indonesia who developed long-lasting depression after the classic symptoms of dengue fever such as fever, arthralgia, and macropapular rash had resolved. A previously healthy 42-year old japanese woman presented to the Travel Clinic of Seirei Yokohama Hospital with complaints of 4 days of fever, joint aches, bone pain, and a macropapular rash on her torso. She had returned from Bali 5 days previously. During her 1-week stay, one day was spent in rural, mountainous areas where she was exposed to several mosquito bites. The 1st serum sample collected 4 days after the disease onset gave positive result in the rapid dengue IgM antibody test and the rapid dengue NS1 antigen immunechromatographic test. The DENV-1 genome was detected with RT-PCR. Her 13-year old son, who had accompanied her, was also diagnosed as having dengue fever and he recovered without event. The Above-mentioned symptoms resolved within one week. However, the patient suffered from prolonged depression. She also noticed loss of hair 3 months after the disease onset Administration of a Serotonin-Noradrenalin Reuptake Inhibitor and a minor tranquillizer required to allow her requied to lead a normal life. Although she gradually felt better, it took approximately 2 years until she had recovered completely without taking any antidepressant and minor tranquillizer. It is a well-known fact in endemic countries that dengue fever could have an significant impact on the patients' mental well-being. However, it appears that physicians in non-endemic countries are not fully aware of the prolonged depression, which can occur subsequent to the acute illness. Follow-up consultations of returing travelers who have recoverd from dengu fever should be arranged to monitor their mental and emotional states closely.

[Clinical and microbiological features of patients with pulmonary nontuberculous mycobacterial infection].

BACKGROUNDS: The prevalence of pulmonary nontuberculous mycobacterial infection (pNTM) is currently increasing. Furthermore, its clinical feature is reported to be gradually changing. However, few reports to clarify the current features of pNTM have been published. The aim of this study is to investigate microbiological and clinical features of pNTM. PATIENTS AND METHODS: This study was a retrospective observational study. Patients with pNTM visited to Dokkyo Medical University Koshigaya Hospital between January 2009 and December 2010 were enrolled. All patients fulfilled the diagnostic criteria in Japanese guidelines for nontuberculous mycobacterial pulmonary disease published in 2008. Medical records were reviewed to obtain information about the enrolled patients. RESULTS: Total 143 patients (49 males and 94 females, age 67 +/- 10 yrs) were enrolled in this study. Only 11.9% of patients had malignant diseases and 5.6% had diabetes mellitus whereas 79% had no comorbidity. Nearly 60% of patients showed normal BMI. At the time of diagnosis, 52.0% of patients had no symptom whereas 22.3% had cough and/or sputum, and 7.1% had hemoptysis. The results of smear examination with acid-fast staining were negative in 80.4%, +/- in 9.8%, 1 + in 7.7% and 2 + in 2.1%. Causative pathogens detected with acid-fast bacillus culture were Mycobacterium avium (M. avium) (74.8%), M. intracellulare (14.0%), M. fortuitum (3.5%), M. abscessus (2.8%), M. kansasii (2.8%) and others. CONCLUSION: This study showed that majority of patients had no symptoms and/or negative results of smear examination with acid-fast staining. It is crucial to consider these facts when a diagnostic test of pNTM is performed.

[A case of Plasmodium ovale malaria--morphological diagnostic difficulty and utility of rapid diagnostic tests].

A 46-year-old Japanese man was referred to our travel clinic because of high fever for the past 7 days. He worked as an engineer for a month in Zambia and returned to Japan 2 days ago. He had a high-grade fever of 40.5 degrees C. Examination of the palpebral conjunctiva showed no evidence of anemia. Liver and spleen were not palpable. Blood sample was collected at the time of the febrile paroxysm. Malaria parasites were detected by examination of Giemsa-stained thin blood films. The dominant feature of parasite was early trophozoit with a low parasitemia (0.0469%, 1,857.6/microL). The James' stippling was absent. Schizonts and gametocytes were scarce. As ring morphology was quite variable, identification of species might not be possible. Identification of species is more difficult than usual, on the grounds that: 1) the blood sample contains rare early trophozoites, 2) the level of parasitemia is low, and 3) it is quite possible for parasites to be transformed due to the inappropriate treatment. Finally, the diagnosis was confirmed by nested PCR. Examination of Giemsa-stained blood films is the "gold standard" for detection and identification of organisms. However, in non-endemic countries, trained laboratory personnel are scarce and the most may be inexperienced in malaria diagnosis. It is recommended that personnel continue to gain experience by participating in external quality assurance schemes, and that routine laboratories utilize rapid diagnostic tests (RDTs) concurrently. The availability of simple and accurate RDTs could aid the diagnosis in no-endemic countries.

Efficacy and safety of atovaquone-proguanil compared with mefloquine in the treatment of nonimmune patients with uncomplicated P. falciparum malaria in Japan.

Malaria treatment is becoming increasingly difficult due to the widespread drug resistance of Plasmodium falciparum. In Japan, only three antimalarials are approved for treatment: oral quinine, sulfadoxine-pyrimethamine, and mefloquine. Recently, however, the Research Group on Chemotherapy of Tropical Diseases introduced atovaquone-proguanil for treating drug-resistant P. falciparum malaria. This research group had also introduced mefloquine before it was licensed nationally. Using data obtained from the research group, we analyzed the efficacy and safety of atovaquone-proguanil, as compared with mefloquine, in nonimmune patients with uncomplicated P. falciparum malaria. Cures were attained in all (100%) of 20 atovaquone-proguanil-treated and 49 (98%) of 50 mefloquine-treated adults. The mean fever clearance time (FCT) and parasite clearance time (PCT) appeared to be longer in the atovaquone-proguanil group than in the mefloquine group, but the differences were not statistically significant. Three (15%) of the 20 atovaquone-proguanil-treated adults had adverse events (AEs), all of which were transient elevations of liver enzymes, while 19 (38%) of the 50 mefloquine-treated adults had AEs, including dizziness in 8 (16%) and nausea/vomiting in 7 (14%). All 3 children treated with atovaquone-proguanil were cured without developing AEs. Despite the limitations of this study in not being a formal clinical trial, atovaquone-proguanil seemed to be at least equal to, or even better than, mefloquine for the treatment of uncomplicated P. falciparum malaria in nonimmune patients, including children. Its marketing in Japan could be beneficial in offering an alternative therapeutic option. However, vigilance should be maintained on the possible occurrence of rare but severe AEs, and also of the possible spread of drug resistance.

Acute disseminated encephalomyelitis following dengue fever.

A58-year-old man suffered from acute disseminated encephalomyelitis (ADEM) after dengue fever. ADEM has not been described as the cause of neurological complications in dengue fever. However, the increasing use of magnetic resonance imaging in endemic areas may help to identify ADEM as being responsible for neurological complications in dengue fever.