Biomedical subjects

Akifumi Imamura

Publications and source records attributed to Akifumi Imamura.

5 recordsLinked to original sources

PubMed2006

Clinical features of 62 imported cases of dengue fever in Japan.

To describe the clinical features of dengue cases in Japan, a retrospective study was conducted on 62 laboratory-confirmed Japanese dengue cases presented to Tokyo Metropolitan Komagome Hospital between 1985 and 2000. Age distribution was from 18 to 62 years old (mean, 31.5 years). All cases were imported from abroad and diagnosed as dengue fever. Clinical manifestations included fever (100%), headache (90%), and skin rash (82%). Laboratory examinations revealed leukocytopenia (71%), thrombocytopenia (57%), elevated levels of serum aspartate aminotransferase (78%), and lactate dehydrogenase (71%). Antibody responses were consistent with that of secondary flavivirus infection in 60% of cases. Severity of symptoms in patients with primary dengue antibody response and those with secondary flavivirus antibody responses didn't show statistical significance. Dengue virus infection should be taken into consideration in the differential diagnosis of febrile patients who recently entered Japan from tropical or subtropical countries.

Adolescent↗

PubMed2005

[A case of chronic mucocutaneous candidasis cured with micafungin].

Chronic mucocutaneous candidasis (CMC) is a chronic intractable infection of skin, nails, and mucous membrane with Candida. Until very recently, the main stay of therapy had been the use of transfer factor or antifungal azole derivatives. Although they show definite benefits, the effects are temporal and recurrences are inevitable. Furthermore, the prolonged use of antifungals will sometimes induce resistant strains, making the treatment more difficult. Recently we experienced a case of CMC caused by resistant Candida spp. and treated it successfully with a new antifungal agent, micafungin (MCFG). The patient is a 37-year-old woman. She was eight month, her tongue was covered with a white coat. Two months later, intractable cutaneous eruptions appeared on the head and back and the diagnosis of CMC was made. Since then she has been treated on multiple occasions with transfer factor, recombinant IL-2, ketoconazole or clotrimazole. She was referred to us because of esophageal candidiasis. On admission, oral and esophageal mucous membranes were thickly coated with white pseudomembranes. The titer of Candida antigen test was less than twice ; plasma beta-D-gulcan was 20.14 pg/mL ; and CD4 was 376/microL. A few Candida albicans and (1+) Candida glabrata were cultured from oral swab. Both species were resistant to itraconazole but sensitive to MCFG and amphotericin B (MIC: < 0.03microg/ml for both). A drip infusion of MCFG (75mg/day) was started and three days later the oral lesions disappeared. At the end of a 2-week course of i. v. MCFG, the interior of the esophagus was clear. No recurrence was noted in one month. Less toxic than amphotericin B, MCFG will be a drug of choice in patients infected with azole-resistant fungi. To avoid the abuse of MCFG and the development of the resistant strains, the susceptibility test is recommended in every case of systemic candidiasis.

Adult↗

PubMed2003

[Kaposi's sarcoma].

Kaposi's sarcoma is a malignant tumor that is one of the major complications with AIDS. This disease is common in male homosexuals, and HHV-8 has been indicated to play a role in its pathogenesis. In treating the lesions that spread over the skin of the entire body, and visceral lesions, mainly of the lung, multidrug chemotherapy has been commonly used, but there are many problems such as myelosuppression and the treatment results are poor in HIV patients with advanced disease. In recent years, however, progress has been made with highly active antiretroviral therapy (HAART), and the prognosis in cases of HIV infection is improving. Moreover, HAART is now coming to be seen as a treatment option for Kaposi's sarcoma itself. In addition, with the use of new drugs such as liposomal doxorubicin, the therapeutic strategy for Kaposi's sarcoma is undergoing great changes.

Acquired Immunodeficiency Syndrome↗

PubMed2002

[Cyclosporiasis: four case reports with a review of the literature].

Four patients infected with Cyclospora cayetanensis who sought medical care at the Tokyo Metropolitan Komagome Hospital are herein presented. All were Japanese males, and their ages ranged from 22 to 50 years of age. One patient, who was HIV-positive with a CD4+ lymphocyte count of 141/microliter, demonstrated no AIDS-defining illness. This patient acquired HIV in some Southeast Asian country/countries through heterosexual contact. This patient presented with watery diarrhea with a frequency of up to 18 times a day for more than two months. The other three cases were not considered to be debilitated hosts. Diarrhea occurring from one to ten times a day continued for 6 to 26 days in all of these three patients. The presumed origin of the infection was considered to be Southeast Asian countries and the season of onset of diarrhea was March to July in all four cases. Treatment with a sulfamethoxazole/trimethoprim compound was performed for both the HIV-infected patient and the other non-debilitated patient. Both symptomatic and parasitologic improvements were quickly observed in these patients. A prospective study was performed using fecal specimens from the diarrheal patients to identify the presence of C. cayetanensis during the period from 1996 to 2001. Protozoa-positive specimens were found in 3 of 410 (0.7%) specimens from patients who had traveled overseas, is one of 148 (0.7%) for HIV-infected (the C. cayetanensis-positive patient also acquired the protozoa in Southeast Asia), and in none of 513 (0%) patients who developed diarrhea in Japan. In summary, C. cayetanensis infection is rare in Japan and most patients infected with this pathogen tend to be overseas travelers and HIV-infected individuals at present.

Adult↗

PubMed2002

[Approach to opportunistic illness in the HAART era].

AIDS-defining opportunistic illness(OIs) are the major cause of mortality among persons infected with HIV. The incidences of many OIs are decreasing because of advances in HIV-related therapy. These decreases have been attributed to successful OI prophylaxis and the use of highly active antiretroviral therapy(HAART). Patients who have responded to HAART and have a sustained increase in CD4+ cell counts appear to be well protected from OIs. Thus, a strategy of discontinuation of chemoprophylaxis for patients whose immunity has improved seems logical. HAART is the most effective approach to preventing OIs. However, OIs are still occurring, especially when patients access care late during the course of disease. Prophylaxis and treatment against specific OIs continues to provide survival benefits even among persons who are receiving HAART.

AIDS-Related Opportunistic Infections↗