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1.
Anaerobe ; 60: 102107, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31647977

RESUMO

BACKGROUND: The optimal and practical laboratory diagnostic approach for detection of Clostridioides difficile to aid in the diagnosis of C. difficile infection (CDI) is controversial. A two-step algorithm with initial detection of glutamate dehydrogenase (GDH) or nucleic acid amplification test (NAAT) alone are recommended as a predominant method for C. difficile detection in developed countries. The aim of this study was to compare the performance of enzyme immunoassays (EIA) detecting toxins A and B, NAAT detecting the toxin B gene, and GDH compared to toxigenic culture (TC) for C. difficile as the gold standard, in patients prospectively and actively assessed with clinically significant diarrhea in 12 medical facilities in Japan. METHODS: A total of 650 stool specimens were collected from 566 patients with at least three diarrheal bowel movements (Bristol stool grade 6-7) in the preceding 24 h. EIA and GDH were performed at each hospital, and NAAT and toxigenic C. difficile culture with enriched media were performed at the National Institute of Infectious Diseases. All C. difficile isolates recovered were analyzed by PCR-ribotyping. RESULTS: Compared to TC, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of EIA were 41%, 96%, 75% and 84%, respectively, and for NAAT were 74%, 98%, 91%, and 92%, respectively. In 439 specimens tested with GDH, the sensitivity, specificity, PPV, and NPV were 73%, 87%, 65%, and 91%, and for an algorithm (GDH plus toxin EIA, arbitrated by NAAT) were 71%, 96%, 85%, and 91%, respectively. Among 157 isolates recovered, 75% of isolates corresponded to one of PCR-ribotypes (RTs) 002, 014, 018/018", and 369; RT027 was not isolated. No clear differences in the sensitivities of any of EIA, NAAT and GDH for four predominant RTs were found. CONCLUSION: The analytical sensitivities of NAAT and GDH-algorithm to detect toxigenic C. difficile in this study were lower than most previous reports. This study also found low PPV of EIAs. The optimal method to detect C. difficile or its toxins to assist in the diagnosis of CDI needs further investigation.


Assuntos
Técnicas Bacteriológicas , Clostridioides difficile/genética , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/microbiologia , Toxinas Bacterianas/genética , Técnicas Bacteriológicas/métodos , Técnicas Bacteriológicas/normas , Clostridioides difficile/classificação , Clostridioides difficile/isolamento & purificação , Infecções por Clostridium/epidemiologia , Feminino , Humanos , Japão/epidemiologia , Masculino , Reação em Cadeia da Polimerase , Estudos Prospectivos , Ribotipagem , Sensibilidade e Especificidade
2.
Anaerobe ; 60: 102011, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30872073

RESUMO

Clostridioides (Clostridium) difficile is the leading cause of healthcare-associated infectious diarrhea in the developed world. Retrospective studies have shown a lower incidence of C. difficile infection (CDI) in Japan than in Europe or North America. Prospective studies are needed to determine if this is due lack of testing for C. difficile or a true difference in CDI epidemiology. A prospective cohort study of CDI was conducted from May 2014 to May 2015 at 12 medical facilities (20 wards) in Japan. Patients with at least three diarrheal bowel movements (Bristol stool grade 6-7) in the preceding 24 h were enrolled. CDI was defined by positive result on enzyme immunoassay for toxins A/B, nucleic acid amplification test for the toxin B gene or toxigenic culture. C. difficile isolates were subjected to PCR-ribotyping (RT), slpA-sequence typing (slpA-ST), and antimicrobial susceptibility testing. The overall incidence of CDI was 7.4/10,000 patient-days (PD). The incidence was highest in the five ICU wards (22.2 CDI/10,000 PD; range: 13.9-75.5/10,000 PD). The testing frequency and CDI incidence rate were highly correlated (R2 = 0.91). Of the 146 isolates, RT018/018″ was dominant (29%), followed by types 014 (23%), 002 (12%), and 369 (11%). Among the 15 non-ICU wards, two had high CDI incidence rates (13.0 and 15.9 CDI/10,000 PD), with clusters of RT018/slpA-ST smz-02 and 018"/smz-01, respectively. Three non-RT027 or 078 binary toxin-positive isolates were found. All RT018/018" isolates were resistant to moxifloxacin, gatifloxacin, clindamycin, and erythromycin. This study identified a higher CDI incidence in Japanese hospitals than previously reported by actively identifying and testing patients with clinically significant diarrhea. This suggests numerous patients with CDI are being overlooked due to inadequate diagnostic testing in Japan.


Assuntos
Clostridioides difficile , Infecções por Clostridium/epidemiologia , Infecções por Clostridium/microbiologia , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Clostridioides difficile/classificação , Clostridioides difficile/efeitos dos fármacos , Clostridioides difficile/genética , Geografia Médica , Humanos , Incidência , Japão/epidemiologia , Testes de Sensibilidade Microbiana , Tipagem Molecular , Vigilância em Saúde Pública , Estudos Retrospectivos , Ribotipagem
3.
BMJ Case Rep ; 20162016 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-27335367

RESUMO

A 23-year-old Japanese woman, previously a commercial sex worker, presented with a 2-day history of right upper quadrant (RUQ) abdominal pain, worse on deep inspiration. She had noticed increased vaginal discharge 2 months earlier and had developed dull, lower abdominal pain 3 weeks prior to presentation. Although pelvic examination and transvaginal ultrasonography revealed neither a tubal nor ovarian pathology, abdominal CT scan with contrast demonstrated early enhancement of the hepatic capsule, a finding pathognomonic for Fitz-Hugh-Curtis syndrome (FHCS). Cervical discharge PCR assay confirmed Chlamydia trachomatis infection. This case highlights that normal gynaecological evaluation may be insufficient to rule out FHCS, for which physicians should have a high index of suspicion when seeing any woman of reproductive age with RUQ pain.


Assuntos
Dor Abdominal/diagnóstico por imagem , Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Infecções por Chlamydia/diagnóstico , Chlamydia trachomatis/isolamento & purificação , Doxiciclina/uso terapêutico , Hepatite/diagnóstico , Doença Inflamatória Pélvica/diagnóstico , Peritonite/diagnóstico , Dor Abdominal/etiologia , Adulto , Infecções por Chlamydia/tratamento farmacológico , Infecções por Chlamydia/microbiologia , Busca de Comunicante , Aconselhamento Diretivo , Quimioterapia Combinada , Feminino , Hepatite/tratamento farmacológico , Hepatite/microbiologia , Humanos , Doença Inflamatória Pélvica/diagnóstico por imagem , Doença Inflamatória Pélvica/tratamento farmacológico , Doença Inflamatória Pélvica/microbiologia , Peritonite/tratamento farmacológico , Peritonite/microbiologia , Trabalho Sexual , Tomografia Computadorizada por Raios X , Resultado do Tratamento
4.
Intern Med ; 54(13): 1661-4, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26134202

RESUMO

The absence of meningeal signs and symptoms is rare in patients with bacterial meningitis and may lead to a delay in diagnosis and treatment. Furthermore, the onset of bacterial meningitis associated with pneumocephalus is a rare complication of ear infections. We herein report a rare case of otogenic meningitis complicated by pneumocephalus that was initially missed due to the absence of typical meningeal signs and symptoms and later diagnosed correctly based on a thorough review of the patient's systems.


Assuntos
Bacteriemia/diagnóstico , Bacteriemia/microbiologia , Meningites Bacterianas/diagnóstico , Meningite Pneumocócica/diagnóstico , Pneumocefalia/diagnóstico , Adulto , Antibacterianos/administração & dosagem , Bacteriemia/tratamento farmacológico , Bacteriemia/etiologia , Dexametasona/administração & dosagem , Humanos , Masculino , Meningite Pneumocócica/complicações , Meningite Pneumocócica/tratamento farmacológico , Meropeném , Pneumocefalia/tratamento farmacológico , Pneumocefalia/etiologia , Tienamicinas/administração & dosagem , Resultado do Tratamento , Vancomicina/administração & dosagem
5.
BMC Med Educ ; 15: 75, 2015 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-25890189

RESUMO

BACKGROUND: The Multiple Mini-Interview (MMI) mostly uses 'Situational' Questions (SQs) as an interview format within a station, rather than 'Past-Behavioural' Questions (PBQs), which are most frequently adopted in traditional single-station personal interviews (SSPIs) for non-medical and medical selection. This study investigated reliability and acceptability of the postgraduate admissions MMI with PBQ and SQ interview formats within MMI stations. METHODS: Twenty-six Japanese medical graduates, first completed the two-year national obligatory initial postgraduate clinical training programme and then applied to three specialty training programmes - internal medicine, general surgery, and emergency medicine - in a Japanese teaching hospital, where they underwent the Accreditation Council for Graduate Medical Education (ACGME)-competency-based MMI. This MMI contained five stations, with two examiners per station. In each station, a PBQ, and then an SQ were asked consecutively. PBQ and SQ interview formats were not separated into two different stations, or the order of questioning of PBQs and SQs in individual stations was not changed due to lack of space and experienced examiners. Reliability was analysed for the scores of these two MMI question types. Candidates and examiners were surveyed on this experience. RESULTS: The PBQ and SQ formats had generalisability coefficients of 0.822 and 0.821, respectively. With one examiner per station, seven stations could produce a reliability of more than 0.80 in both PBQ and SQ formats. More than 60% of both candidates and examiners felt positive about the overall candidates' ability. All participants liked the fairness of this MMI when compared with the previously experienced SSPI. SQs were perceived more favourable by candidates; in contrast, PBQs were perceived more relevant by examiners. CONCLUSIONS: Both PBQs and SQs are equally reliable and acceptable as station interview formats in the postgraduate admissions MMI. However, the use of the two formats within the same station, and with a fixed order, is not the best to maximise its utility as an admission test. Future studies are required to evaluate how best the SQs and PBQs should be combined as station interview formats to enhance reliability, feasibility, acceptability and predictive validity of the MMI.


Assuntos
Educação de Pós-Graduação em Medicina , Entrevistas como Assunto/métodos , Critérios de Admissão Escolar , Adulto , Feminino , Hospitais de Ensino , Humanos , Entrevistas como Assunto/normas , Japão , Masculino , Análise Multivariada , Reprodutibilidade dos Testes
6.
Clin Transplant ; 29(3): 227-32, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25580999

RESUMO

INTRODUCTION: Acinetobacter baumannii can cause serious infection in susceptible patients, but little has been published regarding risk factors for infection and outcomes in solid organ transplant (SOT) recipients. METHODS: We identified A. baumannii infection among adult SOT recipients that occurred between January 2001 and March 31, 2008 at a Chicago transplant center and evaluated characteristics of these infections and outcomes. RESULTS: Thirty-three individuals developed A. baumannii infection during the study period. Seventy-nine percent had healthcare-associated infection with respiratory tract as the most common site of infection (64%). Eighty-two percent of patients had received antibiotics within two wk prior to A. baumannii infection and multidrug resistance (MDR) or extensive resistance (XDR) occurred in 85%. The median time to onset of infection was five months after transplant. The 30-d mortality was 24% and was associated with XDR. Administration of an appropriate antibiotic within three d was associated with lower 30-d mortality (OR 0.16, p = 0.047). All isolates tested against colistin were susceptible. CONCLUSION: SOT recipients with A. baumannii infection had high mortality associated with delay in appropriate antibiotic therapy and XDR organisms. The use of colistin-containing treatment regimens should be considered in these patients when A. baumannii infection is suspected or identified in patients who have received prior antibiotics.


Assuntos
Infecções por Acinetobacter/etiologia , Acinetobacter baumannii , Hospedeiro Imunocomprometido , Transplante de Órgãos , Complicações Pós-Operatórias/etiologia , Infecções por Acinetobacter/tratamento farmacológico , Infecções por Acinetobacter/epidemiologia , Infecções por Acinetobacter/imunologia , Adulto , Idoso , Antibacterianos/uso terapêutico , Colistina/uso terapêutico , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/etiologia , Infecção Hospitalar/imunologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/imunologia , Estudos Retrospectivos , Fatores de Risco
7.
BMC Med Educ ; 13: 156, 2013 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-24289320

RESUMO

BACKGROUND: The study of communication skills of Asian medical students during structured Problem-based Learning (PBL) seminars represented a unique opportunity to assess their critical thinking development. This study reports the first application of the health education technology, content analysis (CA), to a Japanese web-based seminar (webinar). METHODS: The authors assigned twelve randomly selected medical students from two universities and two clinical instructors to two virtual classrooms for four PBL structured tutoring sessions that were audio-video captured for CA. Both of the instructors were US-trained physicians. This analysis consisted of coding the students' verbal comments into seven types, ranging from trivial to advanced knowledge integration comments that served as a proxy for clinical thinking. RESULTS: The most basic level of verbal simple responses accounted for a majority (85%) of the total students' verbal comments. Only 15% of the students' comments represented more advanced types of critical thinking. The male students responded more than the female students; male students attending University 2 responded more than male students from University 1. The total mean students' verbal response time for the four sessions with the male instructor was 6.9%; total mean students' verbal response time for the four sessions with the female instructor was 19% (p < 0.05). CONCLUSIONS: This report is the first to describe the application of CA to a multi-university real time audio and video PBL medical student clinical training webinar in two Japanese medical schools. These results are preliminary, mostly limited by a small sample size (n = 12) and limited time frame (four sessions). CA technology has the potential to improve clinical thinking for medical students. This report may stimulate improvements for implementation.


Assuntos
Competência Clínica , Estudantes de Medicina/psicologia , Pensamento , Comunicação , Feminino , Humanos , Masculino , Aprendizagem Baseada em Problemas/métodos
8.
Kansenshogaku Zasshi ; 87(4): 446-50, 2013 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-23984595

RESUMO

We report herein on a case of Plasmodium malariae malaria with more than a 4-month incubation period. A 35-year-old Japanese man who first presented to our clinic with fever and history of travel to Papua New Guinea was suspected of having Plasmodium vivax malaria based on peripheral smear results. We admitted him and initiated treatment with mefloquine. After two days of therapy, he became afebrile. We discharged him, and P. vivax was later confirmed with PCR. We started mefloquine prophylaxis for a planned trip to Papua New Guinea. After his return, a standard dose of primaquine (15 mg x 14 days) was prescribed for a radical cure of P. vivax. About 4 months after his last visit to Papua New Guinea, he returned to our clinic with fever. We suspected a relapse of P. vivax malaria and admitted him for a second time. After two days of mefloquine therapy, his symptoms improved. We discharged him and restarted a higher dose of primaquine (30 mg x 14 days) therapy for a radical cure of P. vivax. Subsequently, the PCR test revealed the parasite was P. malariae and not P. vivax. Only 13 cases of Plasmodium malariae malaria have been reported in Japan during the past 10 years. Blood-stage schizonticides such as mefloquine is not active against the liver stage. Therefore, the use of these drugs for prophylaxis will not be effective for prevention of malaria if its liver stage is longer than the duration of effective chemoprophylaxis. Although the incubation period of P. malariae is typically 13 to 28 days, it occasionally lasts for months or even years. Careful attention should be given to the possibility that P. malariae occasionally has a long incubation period even in the absence of the hypnozoite stage.


Assuntos
Malária Vivax/diagnóstico , Malária/diagnóstico , Plasmodium malariae , Adulto , Diagnóstico Diferencial , Humanos , Período de Incubação de Doenças Infecciosas , Masculino , Recidiva
10.
Hawaii Med J ; 66(9): 236-9, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20879467

RESUMO

BACKGROUND: Previous studies suggest that Asians may be less likely to develop venous thromboembolism (VTE) than Caucasians. While inherited thrombophilias occur infrequently among Asians, the distribution of other VTE risk factors in these populations remains unclear. OBJECTIVE: To identify VTE risk factors in a Japanese population. PATIENTS AND METHODS: We evaluated 131,060 patients admitted to Okinawa Chubu Hospital in Japan (January 1987-December 1999). Patients with VTE were identified through discharge diagnoses using the hospital database. Medical records were reviewed for information on demographics, potential VTE risk factors, and diagnostic modalities. Controls were randomly selected from the same database, matched 1:1 to cases on age, sex, year of hospital admission, and nearest medical record number We used conditional logistic regression to examine potential VTE risk factors. RESULTS: We identified 141 cases of newly diagnosed VTE (128 with deep vein thrombosis, 41 with pulmonary embolism). In multivariable analyses adjusting for all measured potential risk factors, statistically significant VTE risk factors included lower extremity paralysis [odds ratio (OR), 3.07; 95% CI, 1.01-9.33], immobilization >7 days (OR, 4.96; 95% CI, 2.26-10.9), diagnosis of an acquired hypercoagulable state (OR, 19.1; 95% CI, 1.75-209.2), body mass index > or = 25.0 kg/nm2 (OR, 2.35; 95% CI, 1.13-4.89), and prior VTE (OR, 22.37; 95% CI, 2.35-213.4). CONCLUSION: The VTE risk factors identified in this Japanese population are similar to those previously described among Caucasians. Further study is needed to define how the distribution of VTE risk factors in Asian populations may influence appropriate preventive strategies.


Assuntos
Imobilização/efeitos adversos , Paraplegia/complicações , Embolia Pulmonar/etiologia , Trombofilia/complicações , Trombose Venosa/etiologia , Idoso , Idoso de 80 Anos ou mais , Povo Asiático , Índice de Massa Corporal , Estudos de Casos e Controles , Feminino , Hospitais de Ensino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Razão de Chances , Sobrepeso/complicações , Embolia Pulmonar/etnologia , Fatores de Risco , Trombose Venosa/etnologia
11.
Thromb Haemost ; 93(5): 876-9, 2005 May.
Artigo em Inglês | MEDLINE | ID: mdl-15886803

RESUMO

Limited data suggest that Asian Americans may have a lower risk of venous thromboembolism (VTE) than Caucasians. However, the actual prevalence of VTE among Asians remains controversial, and has not been described in Japan. We studied all 131,060 patients hospitalized at a single medical centre in Japan (January 1987 - December 1999). Patients with VTE were identified through discharge diagnoses. Hospital records were reviewed for information on patient demographics, risk factors, and diagnostic modalities. VTE occurred in 0.11% of admissions (n=141, 95%CI 0.09-0.13%). Mean age (+/-SD) was 64+/-17 years, 70% were women, 91% had deep vein thrombosis, and 29% pulmonary embolism. Among hospitalized patients 50-69 years old, VTE was significantly more common among women than men (0.31% vs. 0.08%; OR 3.88; 95%CI 1.45-6.31). We found a low prevalence of VTE in Japan compared to that reported in the US. Future studies are needed to clarify the reasons for our findings.


Assuntos
Tromboembolia/diagnóstico , Tromboembolia/epidemiologia , Trombose Venosa/diagnóstico , Trombose Venosa/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais de Ensino , Humanos , Incidência , Japão , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Prevalência , Fatores de Risco , Fatores Sexuais
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