Injuries to staff engaged in foot-and-mouth disease eradication in Japan.

BACKGROUND: In April 2010, a large-scale outbreak of foot-and-mouth disease, a highly infectious disease affecting cloven-hoofed animals, was reported in Miyazaki prefecture in Japan. Many staff were dispatched to the epidemic area to undertake containment measures. Various injuries were reported among the dispatched staff. AIMS: To study the characteristics of injuries that occurred during containment measures and to identify the characteristics of those injured. METHODS: We analysed records of injuries that occurred among staff dispatched from national organizations and prefectures other than Miyazaki prefecture. Based on these records, a qualitative analysis was conducted for veterinarians and non-veterinarian support staff as each group played a different role during the outbreak. RESULTS: Forty-seven veterinarians and 183 support staff were injured. The injury risk was significantly higher for support staff (13%) than for veterinarians (5%; P < 0.001). The most frequently reported injury resulted from exposure to disinfectant and the next was abrasions caused by friction from protective clothing and rubber boots. Among veterinarians, needlestick accidents were also frequently reported. CONCLUSIONS: Applying a less hazardous disinfectant and improving protective equipment to prevent skin abrasion may be effective in reducing the risk of these injuries among staff conducting containment measures. Reducing injuries among staff in such circumstances will assist effective control measures.

Suppressive effects of neutrophil by Salp16-like salivary gland proteins from Ixodes persulcatus†Schulze tick.

Salp16, a 16-kDa tick salivary gland protein, is known to be the molecule involved in the transmission of Anaplasma phagocytophilum, an obligate intracellular pathogen causing zoonotic anaplasmosis, from its mammalian hosts to Ixodes scapularis. Recently, the presence of A. phagocytophilum was documented in Japan and Ixodes persulcatus was identified as one of its vectors. The purpose of this study was to identify Salp16 genes in I. persulcatus and characterize their function. Two cDNA clones encoding the Salp16-like sequences were obtained from the salivary glands of fed female I. persulcatus ticks and designated Salp16 Iper1 and Iper2. Gene expression analyses showed that the Salp16 Iper genes were expressed specifically in the salivary glands and were up-regulated by blood feeding. These proteins attenuated the oxidative burst of activated bovine neutrophils and inhibited their migration induced by the chemoattractant interleukin-8 (IL-8). These results demonstrate that Salp16 Iper proteins contribute to the establishment of blood feeding as an immunosuppressant of neutrophil, an essential factor in innate host immunity. Further examination of the role of Salp16 Iper in the transmission of pathogens, including A. phagocytophilum, will increase our understanding of the tick-host-pathogen interface.

Two novel Salp15-like immunosuppressant genes from salivary glands of Ixodes persulcatus Schulze tick.

Salp15, a 15-kDa tick salivary gland protein, is known for several suppressive activities against host immunity and critical functions for the transmission of Lyme borrelia in Ixodes scapularis and Ixodes ricinus, the major vectors found in North America and Western Europe. Salp15 inhibits the activation of cluster of differentiation (CD)4(+)T-cells through the repression of T-cell receptor (TCR)-triggered calcium fluxes and interleukin (IL)-2 production. Furthermore, Salp15 adheres to the spirochaeta and specifically interacts with its outer surface protein C. The binding of Salp15 to Borrelia burgdorferi protects it from antibody-mediated killing in vitro. The aim of this study is to identify the Salp15 genes in Ixodes persulcatus Schulze, the specific vector for human Lyme borreliosis in Japan. Two cDNA clones encoding the Salp15-like sequence were obtained from salivary glands of fed female ticks. These genes encode 135- and 132-amino acid proteins, designated Salp15 Iper-1 and Salp15 Iper-2, respectively, both having signal peptide sequences and predicted to be secretory proteins. Salp15 Iper-1 and -2 showed 51.8 and 68.2% similarity to I. scapularis Salp15, respectively. Reverse transcriptase PCR analysis showed that Salp15 Iper genes were expressed specifically in the salivary glands throughout life cycle stages of the ticks and were up-regulated by blood feeding. In the I. persulcatus-derived sequences, the C-terminal part, which is the binding domain to the CD4 molecule of T-cells in I. scapularis Salp15, was well conserved. In the future, it will be necessary to analyse immunosuppressive functions of I. persulcatus Salp15 and their interaction with Borrelia spp. in Japan.

Decreased level of ceramides in stratum corneum of atopic dermatitis: an etiologic factor in atopic dry skin?

Stratum corneum lipids are an important determinant for both water-retention function and permeability-barrier function in the stratum corneum. However, their major constituent, ceramides, have not been analyzed in detail in skin diseases such as atopic dermatitis that show defective water-retention and permeability-barrier function. In an attempt to assess the quantity of ceramides per unit mass of the stratum corneum in atopic dermatitis, stratum corneum sheet was removed from the forearm skin by stripping with cyanoacrylate resin and placed in hexane/ethanol extraction to yield stratum corneum lipids. The stratum corneum was dispersed by solubilization of cyanoacrylate resin with dimethylformamide, and after membrane filtration, the weight of the stratum corneum mass was measured. The ceramides were quantified by thin-layer chromatography and evaluated as microgram/mg stratum corneum. In the forearm skin of healthy individuals (n = 65), the total ceramide content significantly declined with increasing age. In atopic dermatitis (n = 32-35), there was a marked reduction in the amount of ceramides in the lesional forearm skin compared with those of healthy individuals of the same age. Interestingly, the non-lesional skin also exhibited a similar and significant decrease of ceramides. Among six ceramide fractions, ceramide 1 was most significantly reduced in both lesional and non-lesional skin. These findings suggest that an insufficiency of ceramides in the stratum corneum is an etiologic factor in atopic dry skin.

A case of bullous pemphigoid induced by tiobutarit (D-penicillamine analogue).

A 61-year-old woman with severe rheumatoid arthritis developed bullous lesions on the trunk, conjunctiva, and oral mucosa during treatment with tiobutarit, a new antirheumatic drug analogus to D-penicillamine. Histology showed a subepidermal blister, and circulating antibodies to the basement membrane zone were detected. The bullous lesions improved rapidly after discontinuation of tiobutarit. However, 3 years later, she was re-exposed to tiobutarit and the bullous lesions recurred within a week. This is the first confirmed case of tiobutarit-induced BP.

Malignancy and interstitial pneumonitis as fatal complications in dermatomyositis.

By sending questionnaires to the major dermatological clinics in Japan, we examined the outcome and causes of death in 182 cases of dermatomyositis (DM) observed between 1983 and 1987. The mortality rate in adults was 26.7%. Associated malignancy occurred in 47 cases (25.8% of adults), and 16 of them died of neoplasms. In contrast to 43 carcinomas, only 1 patient died of lymphoma. Associated interstitial pneumonitis (IP) appeared in 31 cases. IP started simultaneously or within 6 months after the diagnosis of DM in the majority of these cases. Of the 13 fatal cases due to IP, 8 died of respiratory failure within two months of the onset of lung disease. In the malignancy group, periungual erythema was noted in a higher proportion. Raynaud's phenomenon was more frequently noted in the IP group. DM overlapped with other collagen diseases in 14 cases.

Clinical, histological, and immunohistological studies of postoperative erythroderma.

We report 7 cases of acute fatal illness characterized by fever, diffuse erythematous rash, and progressive leukopenia occurring 10 days after surgical operation. The outcome was uniformly fatal. The biopsy findings consisted of eosinophilic individual necrosis of epidermal cells, satellite cell necrosis, basal liquefaction degeneration, and scanty cell infiltration into the dermis. T lymphocytes were found in the epidermis but Langerhans cells disappeared. These findings are compatible with acute graft-vs-host disease following blood transfusion. Explanations based upon drug allergy, infection, toxic shock syndrome, or toxic epidermal necrolysis seem less reasonable.

Pedunculated pigmented eccrine poroma of the scalp with increased urinary excretion of 5-S-cysteinyldopa.

We describe a 52-year-old man with a pedunculated pigmented eccrine poroma mimicking a nodular malignant melanoma in the occipital region. The tumor was once resected but soon recurred. Histologically, the tumor mass extended from the epidermis downwards into the dermis and contained melanin granules in some areas. The tumor cells were uniformly cuboidal in appearance and had round, deeply basophilic nuclei. Initially, the urinary excretion level of 5-S-cysteinyldopa (5-S-CD) was high, but, after resection of the tumor, the level of 5-S-CD returned to normal.

Basal cell carcinoma with eccrine differentiation.

We describe a light, electron microscopic, and immunohistochemical study of basal cell carcinoma with eccrine differentiation. The cytoplasm did not stain with fat stain on cryostat sections, but contained numerous gland-like structures. Immunohistochemistry on formalin fixed, paraffin embedded tissues using antibodies to human involucrin, thirteen kinds of cytokeratin, S-100 protein, and carcinoembryonic antigen (CEA) was performed. We found that tumor cells were positive for keratin, PKK1, MA-903, No 8, No 19, AE 1, AE 3, and 5 + 8. Tumor cells were negative for S-100 protein, CEA, and the other antigens examined. Electron microscopy demonstrated short microvilli and amorphous materials within the intracytoplasmic cavity. We concluded that this tumor is basal cell carcinoma with eccrine differentiation.

The coexistence of psoriasis vulgaris, Sjögren's syndrome, and Hashimoto's thyroiditis.

A 52-year-old woman presented with psoriasis vulgaris, Sjögren's syndrome, and Hashimoto's thyroiditis with a 5-year history. She had a number of immunological abnormalities and typical psoriatic plaques over her entire body. The relationship between psoriasis, Sjögren's syndrome, and Hashimoto's thyroiditis is discussed from the viewpoint of immunology, and similar cases in the literature are reviewed. This is the first report of a coexistence of psoriasis vulgaris, Sjögren's syndrome, and Hashimoto's thyroiditis.

A case of lymphadenosis benigna cutis of the earlobe: an immunohistochemical study.

We report a 38-year-old woman who developed an erythematous nodule on her earlobe after wearing pierced-type 18-carat gold earrings. Biopsy specimens revealed dense cellular infiltration predominantly composed of lymphocytes and plasma cells in the dermis and subcutaneous tissue with formation of lymph follicles. Morphological and immunohistochemical analyses were compatible with lymphadenosis benigna cutis.

[Diagnosis of varicella-zoster virus (VZV) infection by using FITC-labeled monoclonal antibodies].

Anti-varicella zoster virus (VZV) mouse monoclonal antibodies conjugated with fluorescein isothiocyanate were evaluated for their usefulness as a practical diagnostic tool in the clinical field by examining cells infected with isolated herpes viruses and 431 clinical samples. The kit stained clearly the cells infected with 14 isolated VZV strains without cross reaction to 15 isolated herpes simplex virus type-1 strains (HSV-1) and 14 type-2 (HSV-2) strains. In clinical specimens, viral antigens of VZV were detected in 92/105 (87.6%) cases of varicella and in 176/190 (92.6%) cases of herpes zoster. Specific fluorescence of VZV was also observed in 5 out of 96 cases diagnosed as HSV infections, although these samples had no specific reaction to HSV when tested by the commercially available diagnostic kit. In 24 cases which could not be clinically diagnosed as herpes zoster or herpes simplex, the VZV antigen was demonstrated in 9 cases. All 109 VZV-positive cases in virus isolation by culture were also judged VZV-antigen positive by the kit, while all 69 HSV-positive cases in virus isolation were VZV-antigen negative. Furthermore, the VZV antigen was detected by the kit in 53/60 clinical diagnoses of varicella or herpes zoster without successful virus isolation. These results clearly indicate the usefulness of the kit as a practical VZV diagnostic reagent, especially in terms of specific sensitivity and easy technical manipulation.

[Congenital hemihypertrophy associated with cutaneous pigmento-vascular, cerebral, visceral and bone abnormalities]. / Hémihypertrophie congénitale associée à des anomalies cutanées pigmento-vasculaires, cérébrales, viscérales et squelettiques.

A case of hemihypertrophy associated with multiple anomalies of the skin, bone and visceral organs is presented. A 31-year-old female was admitted for evaluation of her skin conditions. Her family history is noncontributory, while her past history discloses operations for syndactyly of the right foot, tonsillar hypertrophy, anal prolapse and ovarial cyst. Erythemas of the face and the left upper extremity were noticed during the neonatal period and hypertrophy of the right side of the body started at age 2 months. On admission, hemihypertrophy was observed in the face, trunk and extremities. Multiple faint nevi flammei were seen on the right half of the face and on the left side of the trunk and extremities. Telangiectasis and nevus anemicus were seen in the upper chest. The left upper extremity showed diffuse brown patches that was histologically basal pigmentation with some giant melanosomes. Visceral anomalies consisted of fibromatous tumors of the tip of the tongue and mitral prolapse. Angiography and computed tomography revealed a possible arteriovenous malformation of the right occipital region, small hemangiomas around the patella, dilation of the lateral ventricle, and calcification of the choroid plexus. Tortuous superficial veins were noted in the right leg. She had no seizure, but her IQ was 68. The bone disorders consisted of scoliosis, short forth metacarpus, hypoplastic mandible and peroneal exostosis. Examination revealed a slight diminution of urinary corticosteroid, but no other endocrinological disorders were found. The hemihypertrophy in this case is at least partially due to an arteriovenous shunt, suggested by elevated oxygen saturation of the blood obtained from the internal saphenous vein.(ABSTRACT TRUNCATED AT 250 WORDS)

[Pyoderma gangraenosum and cardio-vasculopathies, particularly Takayasu arteritis. Review of the Japanese literature (author's transl)]. / Pyoderma gangrenosum et caridovasculopathies, en particulier artérite de Takayasu. Revue de la littérature japonaise.

Three cases of pyoderma gangraenosum were associated with Takayasu arteritis (pulseless disease), characterized by disappearance of pulse, hypertension and/or aortic insufficiency. Another 11-year-old boy, suffering from a serious congenital heart malformation, presented skin lesions of pyoderma gangraenosum. In spite or rather low incidence of association of ulcerative colitis (10.4 p. 100), Japanese cases show frequent association of cardiovascular diseases, especially Takayasu arteritis (27.1 p. 100).

[Friction melanosis]. / Mélanose de friction.

We describe 23 cases of unusual brownish pigmentation occurring over the bony tissues such as clavicle, scapula or vertebrae. There were 19 females and 4 males. The age ranged from 18 to 59, mostly between 20 and 35 years. Since the first observation in 1977, cases gradually increased. The pigmentation usually showed ripple pattern on the upper back and clavicular region, zebra-like pattern over the ribs and postage-stamp-like macule over the vertebral column. Although there was no inflammatory sign such as itching or scaling, histology revealed postinflammatory melanin deposit in the upper dermis. Exceptional detection of amyloid deposit in the papillary layer in one case could be secondary to the slight epidermal damage actually disappeared. The general condition was not affected, and laboratory data remained within normal limits. This unique melanosis should be separated from other pigmentary disorders and macular amyloidosis. We would like to propose the name of friction melanosis, because this condition should be intimately related with the repeated friction by nylon towel or brush, widely used by young peoples in the bathroom.

[Pseudoxanthoma elasticum associated with Marfan syndrome (author's transl)]. / Pseudo-xanthome élastique associé a la maladie de Marfan.

We described a 26-year-old man whose brother has a mottled fundus. Many maternal relatives suffer from myopia and heart disease, and one cousin has arachnodactylia. The patient is very tall and shows various abnormalities such as arachnodactylia, highly arched palate, funnel chest and scoliosis. He also shows hyperextensibility of joints, inguinal hernia, dissecting aneurysm of ascending aorta, dilatation of aortic ring, aortic and mitral insufficiency, myopia and striae distensae. These findings are that of Marfan's syndrome. At the same time, we noticed yellowish papules on the neck, axillae, inguinal region and inner aspect of thighs. Brown patches were found around umbilicus. These skin lesions as well as angioid streaks of fundus are typical for pseudoxanthoma elasticum. This case should be an association by chance of these two genetic affections.

Analysis of risk factors associated with bovine leukemia virus seropositivity within dairy and beef breeding farms in Japan: a nationwide survey.

This cross-sectional study evaluated risk factors associated with farm-level bovine leukemia virus (BLV) seropositivity in 563 dairy and 490 beef farms throughout Japan. Twenty randomly selected cattle on each farm were serologically tested, and farm epidemiologiocal information was obtained through face-to-face interviews. Due to the large number of zero-prevalence dairy and beef farms, data analysis was performed using a zero-inflated negative binomial model, which revealed that the common risk factors associated with higher within-farm seroprevalence were past detection of clinical leukemia and presence of blood-sucking insects. Loose housing on dairy farms and direct contact between calves and adult cattle on beef farms were also identified as risk factors. With regard to farm-level presence of BLV, the presence of purchased cattle was found to be a risk factor in both sectors. Sending heifers to a common ranch was identified as an additional risk factor for dairy farms.