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Harada Y, Iwashita H, Moriyasu T, Nagi S, Saito N, Sugawara-Mikami M, Yoshioka K, Yotsu R. The current status of neglected tropical diseases in Japan: A scoping review. PLoS Negl Trop Dis 2024; 18:e0011854. [PMID: 38166156 PMCID: PMC10786391 DOI: 10.1371/journal.pntd.0011854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 01/12/2024] [Accepted: 12/11/2023] [Indexed: 01/04/2024] Open
Abstract
Little attention has been paid to neglected tropical diseases (NTDs) in high-income countries and no literature provides an overview of NTDs in Japan. This scoping review aims to synthesize the latest evidence and information to understand epidemiology of and public health response to NTDs in Japan. Using three academic databases, we retrieved articles that mentioned NTDs in Japan, written in English or Japanese, and published between 2010 and 2020. Websites of key public health institutions and medical societies were also explored. From these sources of information, we extracted data that were relevant to answering our research questions. Our findings revealed the transmission of alveolar echinococcosis, Buruli ulcer, Chagas disease, dengue, foodborne trematodiases, mycetoma, scabies, and soil-transmitted helminthiasis as well as occurrence of snakebites within Japan. Other NTDs, such as chikungunya, cystic echinococcosis, cysticercosis, leishmaniasis, leprosy, lymphatic filariasis, rabies, and schistosomiasis, have been imported into the country. Government agencies tend to organize surveillance and control programs only for the NTDs targeted by the Infectious Disease Control Law, namely, echinococcosis, rabies, dengue, and chikungunya. At least one laboratory offers diagnostic testing for each NTD except for dracunculiasis, human African trypanosomiasis, onchocerciasis, and yaws. No medicine is approved for treatment of Chagas disease and fascioliasis and only off-label use drugs are available for cysticercosis, opisthorchiasis, human African trypanosomiasis, onchocerciasis, schistosomiasis, and yaws. Based on these findings, we developed disease-specific recommendations. In addition, three policy issues are discussed, such as lack of legal frameworks to organize responses to some NTDs, overreliance on researchers to procure some NTD products, and unaffordability of unapproved NTD medicines. Japan should recognize the presence of NTDs within the country and need to address them as a national effort. The implications of our findings extend beyond Japan, emphasizing the need to study, recognize, and address NTDs even in high-income countries.
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Affiliation(s)
- Yuriko Harada
- Department of Hygiene and Public Health, Tokyo Women’s Medical University, Tokyo, Japan
| | - Hanako Iwashita
- Department of Hygiene and Public Health, Tokyo Women’s Medical University, Tokyo, Japan
| | - Taeko Moriyasu
- Office for Global Relations, Nagasaki University, Nagasaki, Japan
| | - Sachiyo Nagi
- Department of Hygiene and Public Health, Tokyo Women’s Medical University, Tokyo, Japan
- Department of Parasitology, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | - Nobuo Saito
- Department of Microbiology, Faculty of Medicine, Oita University, Oita, Japan
| | - Mariko Sugawara-Mikami
- West Yokohama Sugawara Dermatology Clinic, Kanagawa, Japan
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| | - Kota Yoshioka
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Interfaculty Initiative in Planetary Health, Nagasaki University, Nagasaki, Japan
| | - Rie Yotsu
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Tropical Medicine and Infectious Disease, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
- Department of Dermatology, National Center for Global Health and Medicine, Tokyo, Japan
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Inoue T, Mori A, Yoshinaga N, Mori N. Intrinsic Factors Associated with Dietary Toxin Quantity and Concentration in the Nuchal Glands of a Natricine Snake Rhabdophis Tigrinus. J Chem Ecol 2023; 49:133-141. [PMID: 36881327 DOI: 10.1007/s10886-023-01415-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023]
Abstract
The snake Rhabdophis tigrinus sequesters cardiotonic steroids, bufadienolides (BDs), from ingested toads and stores them in the nuchal glands as defensive toxins. It has previously been shown that there are individual differences in the total quantity of BDs stored in the nuchal glands of adult R. tigrinus and that BD quantities and profiles of R. tigrinus exhibit geographic variation. However, no previous study has examined the total quantity of BDs as a percentage of body mass (relative BD quantity) and the concentration of BDs in the nuchal gland fluid (BD gland concentration). In addition, intrinsic factors that are associated with relative BD quantity and BD concentration have not been examined within a single population. We collected 158 adult snakes from an area of central Japan from May to October and analyzed their BD quantities by UV analysis. We assessed individual differences in BD quantity, relative BD quantity and BD gland concentration. We found that 1) in approximately 60% of the 158 individuals, the BD gland concentration was greater than 50%; 2) body length and body condition are positively correlated with relative BD quantity and BD gland concentration; 3) even in a single population, individual differences of BD quantity are large, and are greater in females than in males; and 4) relative BD quantity and BD gland concentration of females during the gestation season are lower than those during the non-gestation season.
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Affiliation(s)
- Takato Inoue
- Division of Applied Life Science, Graduate School of Agriculture, Kyoto University, Sakyo, Kyoto, 606-8502, Japan.
| | - Akira Mori
- Department of Zoology, Graduate School of Science, Kyoto University, Sakyo, Kyoto, 606-8502, Japan
| | - Naoko Yoshinaga
- Division of Applied Life Science, Graduate School of Agriculture, Kyoto University, Sakyo, Kyoto, 606-8502, Japan
| | - Naoki Mori
- Division of Applied Life Science, Graduate School of Agriculture, Kyoto University, Sakyo, Kyoto, 606-8502, Japan
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Hifumi T, Sakai A, Yamamoto A, Morokuma K, Otani N, Takahashi M, Ato M. Rhabdophis tigrinus (Yamakagashi) Bites in Japan Over the Last 50 Years: A Retrospective Survey. Front Public Health 2022; 9:775458. [PMID: 35083190 PMCID: PMC8785397 DOI: 10.3389/fpubh.2021.775458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/30/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction:Rhabdophis snakes, which include 27 species, are rear-fanged venomous snakes that are widely distributed from India to East Asia and Russia. Severe envenomation by R. tigrinus (Yamakagashi snake) in Japan and R. subminiatus in Southeast Asia has been reported. The epidemiology of R. tigrinus bites, such as geographical features, the incidence, and changes in the number of bites over time have not been comprehensively examined. Hence, we intended to clarify the epidemiological features of R. tigrinus bites through a careful review of scientific data over the last 50 years in Japan. Methods: Patient records of R. tigrinus bites between 1971 and 2020 at the Japan Snake Institute were examined retrospectively. The following were ascertained: patient characteristics, clinical symptoms, laboratory data, treatment-related factors, and hospital mortality. These variables were compared in the antivenom and the without-antivenom groups. Results: Over the 50-year study period, 43 R. tigrinus bites, including five fatal cases, were encountered. Severe cases of R. tigrinus bites have been treated with antivenom since 1985; however, fatalities occurred in 2006 and 2020. R. tigrinus bite cases have been well-distributed in the western part of Japan since 2000. The mortality rate in the antivenom group was significantly lower in the patient group that was not administered the antivenom (0 vs. 23.8%, p = 0.048). Conclusion: This study clarified the epidemiology of R. tigrinus bites in Japan over a 50-year period. Almost all severe cases of R. tigrinus bites have been treated with the antivenom in the current situation, and fatalities occurred in cases not treated with the antivenom. It is important to diagnose R. tigrinus bites in the early phase of the clinical course. The antivenom, the definitive treatment for R. tigrinus bites, is an unapproved drug. Hence, approval needs to be obtained for the drug.
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Affiliation(s)
- Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | | | - Akihiko Yamamoto
- Management Department of Biosafety and Laboratory Animal, National Institute of Infectious Disease, Tokyo, Japan
| | - Kazunori Morokuma
- Toxin and Biologicals Research Laboratory, Kumamato Health Science University, Kumamoto, Japan.,Kikuchi Quality Control Department, KM Biologics Co., Ltd., Kumamoto, Japan
| | - Norio Otani
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Motohide Takahashi
- Toxin and Biologicals Research Laboratory, Kumamato Health Science University, Kumamoto, Japan
| | - Manabu Ato
- Leprosy Research Center, National Institute of Infectious Diseases, Tokyo, Japan
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Snakebite envenomings in the Republic of Korea from the 1970s to the 2020s: A review. Toxicon 2021; 196:8-18. [PMID: 33781797 DOI: 10.1016/j.toxicon.2021.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/22/2021] [Accepted: 03/22/2021] [Indexed: 11/23/2022]
Abstract
Snakebite envenomings remain a neglected disease across the globe causing severe injuries and death. An understanding of regional snakebite patterns is a necessary prerequisite for public health programs aimed at reducing snakebite risks. However, such regional knowledge is poorly documented or lacking in many countries where the risk of snakebite envenomings receive little medical attention, and the Republic of Korea is one of these countries. Here, we reviewed the literature on snakebites published between 1970 and 2020 as well as public healthcare data recorded between 2010 and 2019 to determine the patterns of snakebite envenomings in the Republic of Korea. Our results, based on literature data, show Gangwon province as a hotspot of snakebite occurrences and identify middle-aged males living in rural areas as the demographic group at highest risk of venomous snakebites. We also highlight major limitations for further understanding snakebite patterns in the country, most notably the lack of proper species identification for snakes and conflicting patterns of envenomings revealed by different sources of data. Our study provides baseline information on venomous snakebites occurring in the Republic of Korea, thereby filling a gap in the knowledge of snakebite trends in the country.
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Reisinger A, Rabensteiner J, Hackl G. Diagnosis of acute intoxications in critically ill patients: focus on biomarkers - part 2: markers for specific intoxications. Biomarkers 2020; 25:112-125. [PMID: 32011177 DOI: 10.1080/1354750x.2020.1725787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
In medical intensive care units, acute intoxications contribute to a large proportion of all patients. Epidemiology and a basic overview on this topic were presented in part one. The purpose of this second part regarding toxicological biomarkers in the ICU setting focuses on specific poisons and toxins. Following the introduction of anion and osmol gap in part one, it's relevance in toxic alcohols and other biomarkers for these poisonings are presented within this publication. Furthermore, the role of markers in the blood, urine and cerebrospinal fluid for several intoxications is evaluated. Specific details are presented, amongst others, for cardiovascular drug poisoning, paracetamol (acetaminophen), ethanol, pesticides, ricin and yew tree intoxications. Detailed biomarkers and therapeutic decision tools are shown for carbon monoxide (CO) and cyanide (CN-) poisoning. Also, biomarkers in environmental toxicological situations such as mushroom poisoning and scorpion stings are presented.
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Affiliation(s)
- Alexander Reisinger
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Jasmin Rabensteiner
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Gerald Hackl
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Park KH, Shin H, Kang H, Kim C, Choi HJ, Yoo K, Oh J, Lim TH. Effectiveness of repeated antivenom therapy for snakebite-related systemic complications. J Int Med Res 2019; 47:4808-4814. [PMID: 31446819 PMCID: PMC6833386 DOI: 10.1177/0300060519870012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Objective This study aimed to determine the effect of repeated antivenom therapy compared with that of single antivenom therapy for treating snakebite-related systemic complications. Methods A retrospective medical record review from January 2008 to September 2016 was performed. Patients with snakebite injury who visited the Emergency Department in one tertiary center of Korea were included. The primary outcome was the survival rate. The secondary outcome was the effect of repeated antivenom therapy for treating snakebite-related systemic complications compared with that of single antivenom therapy on hospital length of stay. Results A total of 110 patients with snakebites were included. All patients survived to discharge. Twenty-nine (26.4%) patients had snakebite-related systemic complications. Of these, nine patients received repeated antivenom therapy and 20 patients received single antivenom therapy. The length of stay was significantly longer in those who received repeated antivenom therapy compared with those who received single antivenom therapy (10.0 [4.0–11.0] vs. 3.5 [0–7.0] days). Conclusion We were unable to demonstrate any superiority of repeated versus single antivenom therapy. However, repeated antivenom therapy is associated with a longer hospital stay. The reason for this finding is unknown.
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Affiliation(s)
- Kyung Hoon Park
- Department of Emergency Medicine, College of Medicine, Hanyang University Seoul Hospital, Seoul, Republic of Korea
| | - Hyungoo Shin
- Department of Emergency Medicine, College of Medicine, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Hyunggoo Kang
- Department of Emergency Medicine, College of Medicine, Hanyang University Seoul Hospital, Seoul, Republic of Korea
| | - Changsun Kim
- Department of Emergency Medicine, College of Medicine, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Hyuk Joong Choi
- Department of Emergency Medicine, College of Medicine, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Kyunghun Yoo
- Department of Emergency Medicine, College of Medicine, Hanyang University Seoul Hospital, Seoul, Republic of Korea
| | - Jaehoon Oh
- Department of Emergency Medicine, College of Medicine, Hanyang University Seoul Hospital, Seoul, Republic of Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, College of Medicine, Hanyang University Seoul Hospital, Seoul, Republic of Korea
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Ichiki T, Kohda F, Hiramatsu T, Saiki R, Sakai A, Furue M. Early pathology in venom-induced consumption coagulopathy by Rhabdophis tigrinus (Yamakagashi snake) envenomation. Clin Toxicol (Phila) 2019; 57:668-671. [PMID: 30689439 DOI: 10.1080/15563650.2018.1540045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Rhabdophis tigrinus (Yamakagashi in Japanese) is a venomous non-front-fanged colubroid snake capable of inflicting envenoming with life-threatening defibrinating coagulopathy. However, because of the uncommon incidence of bites and tendency for late development of symptoms/signs, the early effects of the venom on the coagulation system are poorly known. Case report: We describe a boy bitten by a wild R. tigrinus and report his clinical course starting at 30 min after the bite. Results: At 30 min after envenomation, only the thrombin-antithrombin complex (TAT) level was elevated. At 90 min after envenomation, laboratory data revealed a prolonged activated partial thromboplastin time (APTT) and increased prothrombin time international normalized ratio (PT-INR) with elevated fibrinogen degeneration product (FDP). At 5.5 h after envenomation, APTT and PT-INR increased beyond a measurable range, and fibrinogen levels dropped below the detection limit. We administered recombinant human soluble thrombomodulin and antivenom prepared against R. tigrinus antivenom. Venom-induced consumption coagulopathy (VICC), which is sometimes reported as disseminated intravascular coagulation (DIC), subsequently improved rapidly. Discussion: We found that TAT is the earliest marker to detect R. tigrinus envenomation and subsequent VICC occurrence. Although rTM was effective in this case, further studies are necessary to prove its safety and efficacy.
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Affiliation(s)
- Toshio Ichiki
- a Department of Dermatology , Aso Iizuka Hospital , Iizuka , Japan
| | - Futoshi Kohda
- a Department of Dermatology , Aso Iizuka Hospital , Iizuka , Japan
| | - Toshiki Hiramatsu
- b Department of Intensive Care Medicine , Aso Iizuka Hospital , Iizuka , Japan
| | - Reo Saiki
- c Department of Paediatrics , Aso Iizuka hospital , Iizuka , Japan
| | | | - Masutaka Furue
- e Department of Dermatology, Graduate School of Medical Science , Kyushu University , Fukuoka , Japan
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Takeda S, Tatebe M, Sakai A, Hirata H. Two cases of unidentified acute compartment syndrome. BMJ Case Rep 2018; 2018:bcr-2017-222377. [PMID: 29610114 PMCID: PMC5884265 DOI: 10.1136/bcr-2017-222377] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Acute compartment syndrome (ACS) is a surgical emergency that requires urgent fasciotomy to prevent irreversible sequelae. We report two cases of unidentified ACS, which did not result from traumatic injuries such as fractures or crush injury, iatrogenic injury or diseases such as haematological malignancies. Both patients complained of severe pain and swelling of their extremity. No bite marks, blisters or skin necrosis was noted. They also complained of marked symptoms of third cranial nerve injury, including divergent squint and diplopia. The diagnosis of ACS was made following continuous intracompartmental pressure measurement, and both patients underwent urgent fasciotomy with partial incision. Considering the season and location of the injuries, together with the rapid progression of signs and symptoms that included thrombocytopaenia, acute renal failure, rhabdomyolysis and especially that of third cranial nerve injury, we postulate that these two cases may have developed following mamushi (Gloydiusblomhoffii) bites.
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Affiliation(s)
- Shinsuke Takeda
- Hand and Microsurgery Center, Anjo Kosei Hospital, Anjo, Japan.,Department of Hand Surgery, Nagoya University, Nagoya, Japan
| | - Masahiro Tatebe
- Department of Hand Surgery, Nagoya University, Nagoya, Japan
| | | | - Hitoshi Hirata
- Department of Hand Surgery, Nagoya University, Nagoya, Japan
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Hifumi T, Kondo Y, Shimazaki J, Oda Y, Shiraishi S, Wakasugi M, Kanda J, Moriya T, Yagi M, Ono M, Kawahara T, Tonouchi M, Yokota H, Miyake Y, Shimizu K. Prognostic significance of disseminated intravascular coagulation in patients with heat stroke in a nationwide registry. J Crit Care 2017; 44:306-311. [PMID: 29253838 DOI: 10.1016/j.jcrc.2017.12.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 12/02/2017] [Accepted: 12/07/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE Heat stroke (HS) induces disseminated intravascular coagulation (DIC); however, the prognostic significance of DIC in patients with HS has not yet been fully assessed in large populations. The aim of this study was to examine the prognostic significance of DIC in patients with HS using a nationwide registry. MATERIALS AND METHODS Data regarding HS were obtained and analyzed from three prospective, observational, multicenter HS registries (HSRs): 2010, 2012, and 2014. Univariate and multivariate analyses were performed to identify independent predictors of hospital death. DIC was diagnosed according to the Japanese Association for Acute Medicine (JAAM) diagnostic criteria, with a total score≥4 implying a DIC diagnosis. RESULTS In total, 705 (median age, 68years; 501 men) were included in this study. Hospital mortality was 7.1% (50 patients). Multiple regression analysis revealed that hospital mortality was significantly associated with presence of DIC (odds ratio [OR], 2.16; 95% confidence interval [CI], 1.09-4.27; p=0.028). Mortality worsened as the DIC score increased, and increased remarkably to approximately 10% when the DIC score was 2. CONCLUSIONS Presence of DIC was an independent prognostic factor of hospital mortality in patients with HS. Hematological dysfunction represents potential target for specific therapies in HS.
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Affiliation(s)
- Toru Hifumi
- Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa 761-0793, Japan.
| | - Yutaka Kondo
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, United States
| | - Junya Shimazaki
- Trauma and Acute Critical Care Center, Osaka University Hospital, 2-15 Yamadaoka Suita, Osaka 565-0871, Japan
| | - Yasutaka Oda
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University School of Medicine, 1-1-1 Minami Kogushi, Ube, Yamaguchi 755-8505, Japan.
| | - Shinichiro Shiraishi
- Emergency and Critical Care Center, Aidu Chuo Hospital, 1-1, Tsurugamachi, aiduwakamatushi, Fukushima 965-8611, Japan.
| | - Masahiro Wakasugi
- Emergency and Critical Care Center, Toyama University Hospital, 2630 Sugitani, Toyamashi, Toyama 930-0152, Japan.
| | - Jun Kanda
- Department of Emergency Medicine, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi-Ku, Tokyo 173-8606, Japan.
| | - Takashi Moriya
- Emergency Department, Saitama Medical Center Jichi Medical University, 1-847 Amanuma, Oomiya, Saitamashi, Saitama 330-8503, Japan.
| | - Masaharu Yagi
- Department of Emergency and Critical Care Medicine, Urasoe General Hospital, 4-16-1, Iso, Urasoe, Okinawa 901-2132, Japan
| | - Masaji Ono
- National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba-City, Ibaraki 305-8506, Japan.
| | - Takashi Kawahara
- Japan Sport Council, 2-8-35 Kita-Aoyama Minato-ku, Tokyo 107-0061, Japan
| | - Michihiko Tonouchi
- Japan Meteorological Business Support Center, To-nen Bld.,3-17 Kanda-Nishikicho, Chiyoda-ku, Tokyo 101-0054, Japan.
| | - Hiroyuki Yokota
- Advanced Medical Emergency and Critical Care Center, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo, Tokyo 113-8603, Japan.
| | - Yasufumi Miyake
- Department of Emergency Medicine, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi-Ku, Tokyo 173-8606, Japan.
| | - Keiki Shimizu
- Emergency and Critical Care Center, Tokyo Metropolitan Tama Medical Centre, 2-8-29 Musashidai, Fuchu-shi, Tokyo 183-8524, Japan
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Comparative Study of Biological Activities of Venom from Colubrid Snakes Rhabdophis tigrinus (Yamakagashi) and Rhabdophis lateralis. Toxins (Basel) 2017; 9:toxins9110373. [PMID: 29149042 PMCID: PMC5705988 DOI: 10.3390/toxins9110373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 11/14/2017] [Accepted: 11/15/2017] [Indexed: 11/17/2022] Open
Abstract
Rhabdophis lateralis, a colubrid snake distributed throughout the continent of Asia, has recently undergone taxonomic revisions. Previously, Rhabdophis lateralis was classified as a subspecies of R. tigrinus (Yamakagashi) until 2012, when several genetic differences were discovered which classified this snake as its own species. To elucidate the toxicity of venom from this poorly studied colubrid, various biological activities were compared between the venom from the two snake species. The components of their venom were compared by the elution profiles of reversed-phase HPLC and SDS-PAGE, and gel filtrated fractions were tested for effects on blood coagulation. Proteolytic activities of these fractions were also assayed by using synthetic substrates, fibrinogen, and matrix proteins. Similar to the R. tigrinus venom, the higher molecular weight fraction of R. lateralis venom contained a prothrombin activator. Both prothrombin time (PT) and activated partial thromboplastin time (APTT) of human plasma were shortened by the addition of R. lateralis and R. tigrinus venom. The thrombin formation was estimated by the uses of SDS-PAGE and chromogenic substrates. These venom fractions also possessed very specific proteinase activity on human fibrinogen, but the substrates for matrix metalloproteinase, such as collagen and laminin, were not hydrolyzed. However, there were some notable differences in reactivity to synthetic substrates for matrix metalloproteinase, and R. tigrinus venom possessed relatively higher activity. Our chemical investigation indicates that the components included in both venoms resemble each other closely. However, the ratio of components and proteolytic activity of some ingredients are slightly different, indicating differences between two closely-related snakes.
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Endless forms most beautiful: the evolution of ophidian oral glands, including the venom system, and the use of appropriate terminology for homologous structures. ZOOMORPHOLOGY 2016. [DOI: 10.1007/s00435-016-0332-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Nelwan EJ, Adiwinata R, Handayani S, Rinaldi I. Severe coagulopathy and transient hypertension following a Rhabdophis subminiatus bite: a case report. Rev Soc Bras Med Trop 2016; 49:520-2. [DOI: 10.1590/0037-8682-0314-2015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 01/07/2016] [Indexed: 11/21/2022] Open
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Hifumi T, Okazaki T, Manabe A, Hamaya H, Egawa S, Fujimi S, Yamamoto A, Koido Y, Abe Y, Kawakita K, Umezawa K, Kuroda Y. A national survey examining recognition, demand for antivenom, and overall level of preparedness for redback spider bites in Japan. Acute Med Surg 2016; 3:310-314. [PMID: 29123805 DOI: 10.1002/ams2.189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 12/16/2015] [Indexed: 11/07/2022] Open
Abstract
Aim Redback spiders are rapidly becoming a nationwide problem in Japan. The domestic production of antivenom for redback spider bites has been started because of extremely low supply. The purpose of this study was to investigate the ability of emergency physicians to recognize redback spider bites and to examine the demand for antivenom and identify the ideal choice for storage. Methods Questionnaires examining the ability to recognize redback spider bites, the demand for antivenom, and overall level of preparedness were sent to 271 emergency medical service centers in Japan in March 2015. Results Completed questionnaires were returned by 156 medical institutions (58%). Only 25% of the institutes correctly answered regarding the recognition of redback spider bites. A demand for the new, domestically produced antivenom was reported by 55% of the institutes. Antivenom demand was high and increased with the ability to recognize redback spider bites (0 correct answers, n = 24 [42.9%]; 1-2 answers, n = 32 [55.2%]; three answers, n = 28 [71.8%]; P = 0.02). The storage of antivenom within their prefectures or regions was the best option for initial supply planning. Approximately 90% of the emergency centers showed an ability to use the antivenom safely. Conclusion The recognition of redback spider bites was low; however, the demand for antivenom was high. The storage of antivenom within their own prefectures or regions was considered to be the best option for initial supply planning. Emergency medical service centers are also good candidates for storage and safe use of antivenom.
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Affiliation(s)
- Toru Hifumi
- Emergency Medical Center Kagawa University Hospital Kagawa Japan
| | - Tomoya Okazaki
- Emergency Medical Center Kagawa University Hospital Kagawa Japan
| | - Arisa Manabe
- Emergency Medical Center Kagawa University Hospital Kagawa Japan
| | - Hideyuki Hamaya
- Emergency Medical Center Kagawa University Hospital Kagawa Japan
| | - Satoshi Egawa
- Emergency Medical Center Kagawa University Hospital Kagawa Japan
| | - Satoshi Fujimi
- Departments of Emergency and Critical Care Osaka General Medical Center Osaka Japan
| | - Akihiko Yamamoto
- Department of Biosafety National Institute of Infectious Disease Tokyo Japan
| | - Yuichi Koido
- Division of Critical Care Medicine and Trauma National Hospital Organization Disaster Medical Center Tokyo Japan
| | - Yuko Abe
- Emergency Medical Center Kagawa University Hospital Kagawa Japan
| | - Kenya Kawakita
- Emergency Medical Center Kagawa University Hospital Kagawa Japan
| | - Kazuo Umezawa
- Department of Emergency and Critical Care Medicine Tokai University School of Medicine Kanagawa Japan
| | - Yasuhiro Kuroda
- Emergency Medical Center Kagawa University Hospital Kagawa Japan
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14
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Hifumi T, Sakai A, Kondo Y, Yamamoto A, Morine N, Ato M, Shibayama K, Umezawa K, Kiriu N, Kato H, Koido Y, Inoue J, Kawakita K, Kuroda Y. Venomous snake bites: clinical diagnosis and treatment. J Intensive Care 2015; 3:16. [PMID: 25866646 PMCID: PMC4393627 DOI: 10.1186/s40560-015-0081-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 03/09/2015] [Indexed: 11/21/2022] Open
Abstract
Snake bites are life-threatening injuries that can require intensive care. The diagnosis and treatment of venomous snake bites is sometimes difficult for clinicians because sufficient information has not been provided in clinical practice. Here we review the literature to present the proper management of bites by mamushi, habu, and yamakagashi snakes, which widely inhabit Japan and other Asian countries. No definite diagnostic markers or kits are available for clinical practice; therefore, definitive diagnosis of snake-venom poisoning requires positive identification of the snake and observation of the clinical manifestations of envenomation. Mamushi (Gloydius blomhoffii) bites cause swelling and pain that spreads gradually from the bite site. The platelet count gradually decreases due to the platelet aggregation activity of the venom and can decrease to <100,000/mm(3). If the venom gets directly injected into the blood vessel, the platelet count rapidly decreases to <10,000/mm(3) within 1 h after the bite. Habu (Protobothrops flavoviridis) bites result in swelling within 30 min. Severe cases manifest not only local signs but also general symptoms such as vomiting, cyanosis, loss of consciousness, and hypotension. Yamakagashi (Rhabdophis tigrinus) bites induce life-threatening hemorrhagic symptoms and severe disseminated intravascular coagulation with a fibrinolytic phenotype, resulting in hypofibrinogenemia and increased levels of fibrinogen degradation products. Previously recommended first-aid measures such as tourniquets, incision, and suction are strongly discouraged. Once airway, breathing, and circulation have been established, a rapid, detailed history should be obtained. If a snake bite is suspected, hospital admission should be considered for further follow-up. All venomous snake bites can be effectively treated with antivenom. Side effects of antivenom should be prevented by sufficient preparation. Approved antivenoms for mamushi and habu are available. Yamakagashi antivenom is used as an off-label drug in Japan, requiring clinicians to join a clinical research group for its use in clinical practice.
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Affiliation(s)
- Toru Hifumi
- />Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793 Japan
| | - Atsushi Sakai
- />The Japan Snake Institute, Yabuzuka 3318, Ota, Gunma, 379-2301 Japan
| | - Yutaka Kondo
- />Department of Emergency Medicine, Graduate School of Medicine, University of the Ryukyus, 207, Uehara, Nishihara, Okinawa, 903-0215 Japan
| | - Akihiko Yamamoto
- />Department of Bacteriology II, National Institute of Infectious Disease, Gakuen 4-7-1, Musashimurayama, Tokyo, 208-0011 Japan
| | - Nobuya Morine
- />Okinawa Prefectural Institute of Health and Environment, 2085 Ozato, Ozato, Nanjo, Okinawa, 901-1202 Japan
| | - Manabu Ato
- />Department of Immunology, National Institute of Infectious Disease, Toyama 1-23-1, Shinjuku, Tokyo, 162-8640 Japan
| | - Keigo Shibayama
- />Department of Bacteriology II, National Institute of Infectious Disease, Gakuen 4-7-1, Musashimurayama, Tokyo, 208-0011 Japan
| | - Kazuo Umezawa
- />Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193 Japan
| | - Nobuaki Kiriu
- />Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midoricho, Tachikawa, Tokyo, 190-0014 Japan
| | - Hiroshi Kato
- />Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midoricho, Tachikawa, Tokyo, 190-0014 Japan
| | - Yuichi Koido
- />Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midoricho, Tachikawa, Tokyo, 190-0014 Japan
| | - Junichi Inoue
- />Division of Critical Care Medicine and Trauma, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimicho, Kofu, Yamanashi, 400-8506 Japan
| | - Kenya Kawakita
- />Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793 Japan
| | - Yasuhiro Kuroda
- />Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793 Japan
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15
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Hifumi T, Murakawa M, Sakai A, Ginnaga A, Yamamoto A, Ato M, Kato H, Koido Y, Kawakita K, Hagiike M, Kuroda Y. Potentially fatal coagulopathy secondary to yamakagashi ( Rhabdophis tigrinus) bites that completely recovered with antivenom treatment. Acute Med Surg 2014; 2:123-126. [PMID: 29123706 DOI: 10.1002/ams2.69] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 06/11/2014] [Indexed: 11/06/2022] Open
Abstract
Case A healthy 40-year-old man was admitted with severe coagulopathy that developed after Rhabdophis tigrinus bites. On admission, he showed significantly elevated levels of thrombin-antithrombin III complex (60 ng/mL), plasmin-alpha 2-plasmin inhibitor complex (22.3 μg/mL), and fibrinogen degradation products (592 μg/mL). He subsequently developed severe hypofibrinogenemia (50 mg/dL). Outcome Antivenom was given 28 h after the patient was bitten, following which his hemorrhagic symptoms resolved. By day 3 of admission, scabs had formed over the bite wounds. Furthermore, his fibrinogen levels increased to >100 mg/dL, while his thrombin-antithrombin III complex, plasmin-alpha 2-plasmin inhibitor complex, and fibrinogen degradation product levels normalized. He was discharged on day 6 of admission. Conclusion Rhabdophis tigrinus bites induced disseminated intravascular coagulation with a fibrinolytic phenotype, which completely recovered with antivenom treatment.
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Affiliation(s)
- Toru Hifumi
- Emergency Medical Center Kagawa University Hospital Kagawa Japan
| | | | | | - Akihiko Ginnaga
- The Chemo-Sero-Therapeutic Research Institute Kumamoto Japan
| | - Akihiko Yamamoto
- Department of Bacteriology II National Institute of Infectious Disease Tokyo Japan
| | - Manabu Ato
- Department of Immunology National Institute of Infectious Disease Tokyo Japan
| | - Hiroshi Kato
- Division of Critical Care Medicine and Trauma National Hospital Organization Disaster Medical Center Tokyo Japan
| | - Yuichi Koido
- Division of Critical Care Medicine and Trauma National Hospital Organization Disaster Medical Center Tokyo Japan
| | - Kenya Kawakita
- Emergency Medical Center Kagawa University Hospital Kagawa Japan
| | - Masanobu Hagiike
- Emergency Medical Center Kagawa University Hospital Kagawa Japan
| | - Yasuhiro Kuroda
- Emergency Medical Center Kagawa University Hospital Kagawa Japan
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16
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Silva A, Hifumi T, Sakai A, Yamamoto A, Murakawa M, Ato M, Shibayama K, Ginnaga A, Kato H, Koido Y, Inoue J, Abe Y, Kawakita K, Hagiike M, Kuroda Y. Rhabdophis tigrinus is not a pit viper but its bites result in venom-induced consumptive coagulopathy similar to many viper bites. J Intensive Care 2014; 2:43. [PMID: 25520845 PMCID: PMC4267603 DOI: 10.1186/s40560-014-0043-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 06/20/2014] [Indexed: 11/22/2022] Open
Abstract
As a response to the recent article by Hifumi et al. published in the Journal of Intensive Care, the present correspondence clarifies the family-level taxonomy of the yamakagashi (Rhabdophis tigrinus). Further, the relevance of the term ‘venom-induced consumptive coagulopathy,’ instead of disseminated intravascular coagulation, in describing the procoagulant coagulopathy of R. tigrinus is highlighted.
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Affiliation(s)
- Anjana Silva
- Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Saliyapura 50008 Sri Lanka
| | - Toru Hifumi
- Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa 761-0793 Japan
| | - Atsushi Sakai
- The Japan Snake Institute, Yabutsuka 3318, Ota, Gumma 379-2301 Japan
| | - Akihiko Yamamoto
- Department of Bacteriology II, National Institute of Infectious Disease, Gakuen 4-7-1, Musashimurayama-shi, Tokyo 208-0011 Japan
| | - Masahiro Murakawa
- Department of Internal Medicine, Kaizuka Hospital, Hakosaki 7-7-27, Higashi-ku, Fukuoka 812-0053 Japan
| | - Manabu Ato
- Department of Immunology, National Institute of Infectious Disease, Toyama 1-23-1, Shinjuku-ku, Tokyo 162-8640 Japan
| | - Keigo Shibayama
- Department of Bacteriology II, National Institute of Infectious Disease, Gakuen 4-7-1, Musashimurayama-shi, Tokyo 208-0011 Japan
| | - Akihiko Ginnaga
- The Chemo-Sero-Therapeutic Research Institute (KAKETSUKEN), 1-6-1 Okubo, Kita-ku, Kumamoto-shi, Kumamoto 860-8568 Japan
| | - Hiroshi Kato
- Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo 190-0014 Japan
| | - Yuichi Koido
- Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo 190-0014 Japan
| | - Junichi Inoue
- Division of Critical Care Medicine and Trauma, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimicho, Kofu, Yamanashi 400-8506 Japan
| | - Yuko Abe
- Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa 761-0793 Japan
| | - Kenya Kawakita
- Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa 761-0793 Japan
| | - Masanobu Hagiike
- Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa 761-0793 Japan
| | - Yasuhiro Kuroda
- Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa 761-0793 Japan
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17
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Hifumi T, Sakai A, Yamamoto A, Murakawa M, Ato M, Shibayama K, Kato H, Koido Y, Inoue J, Abe Y, Kawakita K, Hagiike M, Ginnaga A, Kuroda Y. Effect of antivenom therapy of Rhabdophis tigrinus (Yamakagashi snake) bites. J Intensive Care 2014; 2:44. [PMID: 25520846 PMCID: PMC4267595 DOI: 10.1186/s40560-014-0044-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 06/23/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rhabdophis tigrinus (Yamakagashi snake) is a rear-fanged colubrid snake present throughout Russia and Asia. Its venom induces life-threatening hemorrhagic symptoms and severe disseminated intravascular coagulation with a fibrinolytic phenotype. R. tigrinus antivenom manufactured by the immunization of horses to neutralize the venom has the risk of adverse events such as anaphylaxis and serum sickness disease. It should be used when benefit is greater than the risk of adverse effects; however, its efficacy has not been well evaluated. Although our previous survey of nine cases demonstrated that seven of all cases treated with antivenom survived, the clinical characteristics and prognosis without antivenom administration remained unclear. We assumed that R. tigrinus antivenom administration overlaps self-recovery with supportive care. We aimed to determine the association between antivenom administration and outcome with further analyzed cases. METHODS We retrospectively reviewed the records of the Japan Snake Institute between January 1, 1973 and December 31, 2013. Antivenom and without antivenom groups were compared with regard to baseline demographic features, treatment-related factors, and outcomes. RESULTS In total, 34 patients were analyzed (97% male, median age 37.5 years). Twenty-five patients were further examined from our previous study. On admission, the median levels of fibrinogen and fibrinogen degradation products were 35 mg/dL and 200 μg/mL, respectively, and platelet counts were 107,000/mm(3). The median disseminated intravascular coagulation score (defined by the Japanese Association of Acute Medicine) was 5. Antivenom was administered to 19 patients, with a median interval of 32 h between bite and antivenom administration. The in-hospital mortality rate was 12%. In univariate analysis, baseline characteristics and laboratory data were not significantly different between the antivenom and without antivenom groups. Hospital mortality in the antivenom group was significantly better than that in the without antivenom group (0% vs. 26.7%, P = 0.03). Moreover, the number of patients developing renal failure requiring hemodialysis was significantly lower in the antivenom group (5.3% vs. 40.0%, P = 0.03). CONCLUSIONS In our small retrospective study, antivenom administration was likely to be effective in the management of R. tigrinus bites. Apparently, further research is required to confirm its efficacy.
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Affiliation(s)
- Toru Hifumi
- Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki Kita, Kagawa 761-0793 Japan
| | - Atsushi Sakai
- The Japan Snake Institute, Yabutsuka 3318, Ota Gumma, 379-2301 Japan
| | - Akihiko Yamamoto
- Department of Bacteriology II, National Institute of Infectious Disease, Gakuen 4-7-1, Musashimurayama-shi, Tokyo 208-0011 Japan
| | - Masahiro Murakawa
- Department of Internal Medicine, Kaizuka Hospital, Hakosaki 7-7-27, Higashi-ku, Fukuoka 812-0053 Japan
| | - Manabu Ato
- Department of Immunology, National Institute of Infectious Disease, Toyama 1-23-1, Shinjuku-ku, Tokyo 162-8640 Japan
| | - Keigo Shibayama
- Department of Bacteriology II, National Institute of Infectious Disease, Gakuen 4-7-1, Musashimurayama-shi, Tokyo 208-0011 Japan
| | - Hiroshi Kato
- Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo 190-0014 Japan
| | - Yuichi Koido
- Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo 190-0014 Japan
| | - Junichi Inoue
- Division of Critical Care Medicine and Trauma, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimicho, Kofu, Yamanashi 400-8506 Japan
| | - Yuko Abe
- Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki Kita, Kagawa 761-0793 Japan
| | - Kenya Kawakita
- Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki Kita, Kagawa 761-0793 Japan
| | - Masanobu Hagiike
- Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki Kita, Kagawa 761-0793 Japan
| | - Akihiko Ginnaga
- The Chemo-Sero-Therapeutic Research Institute (KAKETSUKEN), 1-6-1 Okubo, Kita-ku, Kumamoto-shi, Kumamoto 860-8568 Japan
| | - Yasuhiro Kuroda
- Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki Kita, Kagawa 761-0793 Japan
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