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Naito T, Tanei M, Ikeda N, Ishii T, Suzuki T, Morita H, Yamasaki S, Tamura J, Akazawa K, Yamamoto K, Otani H, Suzuki S, Kikuchi M, Ono S, Kobayashi H, Akita H, Tazuma S, Hayashi J. Key diagnostic characteristics of fever of unknown origin in Japanese patients: a prospective multicentre study. BMJ Open 2019; 9:e032059. [PMID: 31748308 PMCID: PMC6886908 DOI: 10.1136/bmjopen-2019-032059] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To identify the key diagnostic features and causes of fever of unknown origin (FUO) in Japanese patients. DESIGN Multicentre prospective study. SETTING Sixteen hospitals affiliated with the Japanese Society of Hospital General Medicine, covering the East and West regions of Japan. PARTICIPANTS Patient aged ≥20 years diagnosed with classic FUO (axillary temperature≥38.0°C at least twice within a 3-week period, cause unknown after three outpatient visits or 3 days of hospitalisation). A total of 141 cases met the criteria and were recruited from January 2016 to December 2017. INTERVENTION Japanese standard diagnostic examinations. OUTCOME MEASURES Data collected include usual biochemical blood tests, inflammatory markers (erythrocyte sedimentation rate (ESR), C reactive (CRP) protein level, procalcitonin level), imaging results, autopsy findings (if performed) and final diagnosis. RESULTS The most frequent age group was 65-79 years old (mean: 58.6±9.1 years). The most frequent cause of FUO was non-infectious inflammatory disease. After a 6-month follow-up period, 21.3% of cases remained undiagnosed. The types of diseases causing FUO were significantly correlated with age and prognosis. Between patients with and without a final diagnosis, there was no difference in CRP level between patients with and without a final diagnosis (p=0.121). A significant difference in diagnosis of a causative disease was found between patients who did or did not receive an ESR test (p=0.041). Of the 35 patients with an abnormal ESR value, 28 (80%) had causative disease identified. CONCLUSIONS Age may be a key factor in the differential diagnosis of FUO; the ESR test may be of value in the FUO evaluation process. These results may provide clinicians with insight into the management of FUO to allow adequate treatment according to the cause of the disease.
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Affiliation(s)
- Toshio Naito
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Mika Tanei
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Nobuhiro Ikeda
- Department of General Medicine, Eiju General Hospital, Tokyo, Japan
| | - Toshihiro Ishii
- Department of General Medicine, Oita University Faculty of Medicine, Oita, Japan
| | - Tomio Suzuki
- Department of General Medicine, Osaka Medical College Hospital, Osaka, Japan
| | - Hiroyuki Morita
- General Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Sho Yamasaki
- General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Jun'ichi Tamura
- General Medicine, Gunma University Graduate School of Medicine School of Medicine, Maebashi, Japan
| | - Kenichiro Akazawa
- Internal Medicine, Shonan Fujisawa Tokushukai Hospital, Fujisawa, Japan
| | | | - Hiroshi Otani
- General Medicine, Tachikawa Sogo Hospital, Tachikawa, Tokyo, Japan
| | - Satoshi Suzuki
- Division of General Medicine, Tone Chuo Hospital, Gunma, Japan
| | - Motoo Kikuchi
- Department of General Medicine, Nagoya City West Medical Center, Nagoya, Japan
| | - Shiro Ono
- General Medicine, Nara Medical University, Nara, Japan
| | | | - Hozuka Akita
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, Tamba, Japan
| | - Susumu Tazuma
- Department of General Internal Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Jun Hayashi
- Kyushu General Internal Medicine Center, Haradoi Hospital, Fukuoka, Japan
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Fujibayashi K, Takahashi H, Tanei M, Uehara Y, Yokokawa H, Naito T. A New Influenza-Tracking Smartphone App (Flu-Report) Based on a Self-Administered Questionnaire: Cross-Sectional Study. JMIR Mhealth Uhealth 2018; 6:e136. [PMID: 29875082 PMCID: PMC6010834 DOI: 10.2196/mhealth.9834] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/19/2018] [Accepted: 04/22/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Influenza infections can spread rapidly, and influenza outbreaks are a major public health concern worldwide. Early detection of signs of an influenza pandemic is important to prevent global outbreaks. Development of information and communications technologies for influenza surveillance, including participatory surveillance systems involving lay users, has recently increased. Many of these systems can estimate influenza activity faster than the conventional influenza surveillance systems. Unfortunately, few of these influenza-tracking systems are available in Japan. OBJECTIVE This study aimed to evaluate the flu-tracking ability of Flu-Report, a new influenza-tracking mobile phone app that uses a self-administered questionnaire for the early detection of influenza activity. METHODS Flu-Report was used to collect influenza-related information (ie, dates on which influenza infections were diagnosed) from November 2016 to March 2017. Participants were adult volunteers from throughout Japan, who also provided information about their cohabiting family members. The utility of Flu-Report was evaluated by comparison with the conventional influenza surveillance information and basic information from an existing large-scale influenza-tracking system (an automatic surveillance system based on electronic records of prescription drug purchases). RESULTS Information was obtained through Flu-Report for approximately 10,094 volunteers. In total, 2134 participants were aged <20 years, 6958 were aged 20-59 years, and 1002 were aged ≥60 years. Between November 2016 and March 2017, 347 participants reported they had influenza or an influenza-like illness in the 2016 season. Flu-Report-derived influenza infection time series data displayed a good correlation with basic information obtained from the existing influenza surveillance system (rho, ρ=.65, P=.001). However, the influenza morbidity ratio for our participants was approximately 25% of the mean influenza morbidity ratio for the Japanese population. The Flu-Report influenza morbidity ratio was 5.06% (108/2134) among those aged <20 years, 3.16% (220/6958) among those aged 20-59 years, and 0.59% (6/1002) among those aged ≥60 years. In contrast, influenza morbidity ratios for Japanese individuals aged <20 years, 20-59 years, and ≥60 years were recently estimated at 31.97% to 37.90%, 8.16% to 9.07%, and 2.71% to 4.39%, respectively. CONCLUSIONS Flu-Report supports easy access to near real-time information about influenza activity via the accumulation of self-administered questionnaires. However, Flu-Report users may be influenced by selection bias, which is a common issue associated with surveillance using information and communications technologies. Despite this, Flu-Report has the potential to provide basic data that could help detect influenza outbreaks.
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Affiliation(s)
- Kazutoshi Fujibayashi
- Department of General Medicine, School of Medicine, Juntendo University, Tokyo, Japan
| | - Hiromizu Takahashi
- Department of General Medicine, School of Medicine, Juntendo University, Tokyo, Japan
| | - Mika Tanei
- Department of General Medicine, School of Medicine, Juntendo University, Tokyo, Japan
| | - Yuki Uehara
- Department of General Medicine, School of Medicine, Juntendo University, Tokyo, Japan
| | - Hirohide Yokokawa
- Department of General Medicine, School of Medicine, Juntendo University, Tokyo, Japan
| | - Toshio Naito
- Department of General Medicine, School of Medicine, Juntendo University, Tokyo, Japan
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Hosoda T, Uehara Y, Matsuda N, Kawase' Y, Tanei M, Haba Y, Nakamura A, Tabe Y, Naito T, Ohsaka A. Performance Evaluation of a Novel Fully Automated Real-Time Reverse Transcriptase-Polymerase Chain Reaction Kit for the Detection of Norovirus. Rinsho Byori 2016; 64:1347-1352. [PMID: 30653896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Rapid and accurate detection of norovirus is essential for the prevention and control of the out- breaks. The aim of this study is to compare the fully automated real-time reverse transcriptase-polymerase chain reaction method (EV-kit) with the conventional immunochromatography method (IC) for diagnosis of norovirus, using one-tube reverse transcriptase-polymerase chain reaction (RT-PCR) analysis as the gold standard. METHODS Between November 2013 and March 2014, clinical data and fecal specimens (53 bulk stools, 41 rectal swabs) were collected from 94 patients who visited the Department of General Medicine, Juntendo University Hospital for acute diarrhea. The sensitivity and specificity of each study test was determined by comparing with RT-PCR, and reproducibility was analyzed by determining Cohen's kappa coefficients. RESULTS Of 94 specimens, 35(37%, 26 bulk stools, 9 rectal swabs) were positive for norovirus antigen by RT-PCR. The sensitivity, specificity, and Cohen's kappa coefficient of the EV-kit were 91% (32/35), 88% (52/59), and 0.778, respectively; those of the IC were 54% (19/35), 90% (53/59), and 0.468, respectively. For rectal swab testing, the sensitivity was 89% (8/9) for the EV-kit and 33% (3/9) for IC, ana that for bulk stool testing was 92% (24/26) for the EV-kit and 62% (16/26) for IC. CONCLUSIONS Use of the EV-kit was significantly more sensitive than was IC testing, taking RT-PCR analy- sis as the gold standard. Rectal swab or bulk stool specimens may be adequate for the detection of norovirus antigen when the EV-kit is used. [Original].
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Naito T, Torikai K, Mizooka M, Mitsumoto F, Kanazawa K, Ohno S, Morita H, Ukimura A, Mishima N, Otsuka F, Ohyama Y, Nara N, Murakami K, Mashiba K, Akazawa K, Yamamoto K, Tanei M, Yamanouchi M, Senda S, Tazuma S, Hayashi J. Relationships between Causes of Fever of Unknown Origin and Inflammatory Markers: A Multicenter Collaborative Retrospective Study. Intern Med 2015; 54:1989-94. [PMID: 26278289 DOI: 10.2169/internalmedicine.54.3313] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Although inflammatory markers, such as the white blood cell (WBC) count, erythrocyte sedimentation rate (ESR) and levels of C-reactive protein (CRP) and procalcitonin, are widely used to differentiate causes of fever of unknown origin (FUO), little is known about the usefulness of this approach. We evaluated relationships between the causes of classical FUO and the levels of inflammatory markers. METHODS A nationwide retrospective study including 17 hospitals affiliated with the Japanese Society of Hospital General Medicine was conducted. PATIENTS This study included 121 patients ≥18 years old diagnosed with "classical FUO" (axillary temperature ≥38.0°C at least twice over a ≥3-week period without elucidation of the cause on three outpatient visits or during three days of hospitalization) between January and December 2011. RESULTS The causative disease was infectious diseases in 28 patients (23.1%), non-infectious inflammatory disease (NIID) in 37 patients (30.6%), malignancy in 13 patients (10.7%), other in 15 patients (12.4%) and unknown in 28 patients (23.1%). The rate of malignancy was significantly higher for a WBC count of <4,000/μL than for a WBC count of 4,000-8,000/μL (p=0.015). Among the patients with a higher WBC count, the rate of FUO due to NIID tended to be higher and the number of unknown cases tended to be lower. All FUO patients with malignancy showed an ESR of >40 mm/h. A normal ESR appeared to constitute powerful evidence for excluding a diagnosis of malignancy. In contrast, the concentrations of both serum CRP and procalcitonin appeared to be unrelated to the causative disease. CONCLUSION The present study identified inflammatory markers that should be considered in the differential diagnosis of classical FUO, providing useful information for future diagnosis.
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Affiliation(s)
- Toshio Naito
- Department of General Medicine, Juntendo University School of Medicine, Japan
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Naito T, Matsuda N, Tanei M, Watanabe Y, Watanabe A. Relationship between public subsidies and vaccination rates with the 23-valent pneumococcal vaccine in elderly persons, including the influence of the free vaccination campaign after the Great East Japan Earthquake. J Infect Chemother 2014; 20:450-3. [DOI: 10.1016/j.jiac.2014.03.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 03/01/2014] [Accepted: 03/14/2014] [Indexed: 10/25/2022]
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Tanei M, Yokokawa H, Murai K, Sakamoto R, Amari Y, Boku S, Inui A, Fujibayashi K, Uehara Y, Isonuma H, Kikuchi K, Naito T. Factors influencing the diagnostic accuracy of the rapid influenza antigen detection test (RIADT): a cross-sectional study. BMJ Open 2014; 4:e003885. [PMID: 24384898 PMCID: PMC3902527 DOI: 10.1136/bmjopen-2013-003885] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of the rapid influenza antigen detection test (RIADT) and determine which symptoms are relevant to results. DESIGN Single-centre, cross-sectional study. SETTING Primary care centre, Tokyo, Japan. PARTICIPANTS 82 consecutive outpatients presenting with upper respiratory symptoms and fever ≥37°C at any time from symptom onset, between December 2010 and April 2011. MAIN OUTCOME MEASURES Results of history and physical examination including age, sex, temperature, time of test from symptom onset, vaccination record and current symptoms (sore throat, arthralgia and/or myalgia, headache, chills, cough and/or throat phlegm, nasal discharge) were recorded. The RIADT and a fully automated respiratory virus nucleic acid test (Verigene Respiratory Virus Plus; VRV), the latter being the gold standard, were performed. Patients were divided into four groups: false negative (FN), RIADT- and VRV+; true positive (TP), RIADT+ and VRV+; true negative (TN), RIADT- and VRV-; and false positive, RIADT+ and VRV-. Groups were compared regarding age, sex, temperature, time of test from symptom onset, vaccination record and symptoms. RESULTS RIADT sensitivity, specificity, positive predictive value and negative predictive value were 72.9% (95% CI 61.5% to 84.2%), 91.3% (79.7% to 102.8%), 95.6% (89.5% to 101.6%) and 56.8% (40.8% to 72.7%), respectively. Time from symptom onset to test was shorter for the FN group than the TP group (p=0.009). No significant differences were detected for the other factors assessed. Results revealed higher temperatures for FN than TN patients (p=0.043), and more FN than TN patients had chills (p=0.058). CONCLUSIONS The RIADT sensitivity was low, due to early administration of the test. In the epidemic season, the RIADT should not be used for suspected influenza until 12 h after symptom onset. A positive RIADT firmly supports the influenza diagnosis; a negative result does not confirm its absence. High fever and chills might indicate influenza, but additional tests are sometimes necessary.
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Affiliation(s)
- Mika Tanei
- Department of General Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Hirohide Yokokawa
- Department of General Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Murai
- Department of General Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Rino Sakamoto
- Department of General Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Yu Amari
- Department of General Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Soushin Boku
- Department of General Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Akihiro Inui
- Department of General Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazutoshi Fujibayashi
- Department of General Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Yuki Uehara
- Department of General Medicine, Juntendo University School of Medicine, Tokyo, Japan
- Department of Infection Control Science, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hiroshi Isonuma
- Department of General Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Ken Kikuchi
- Department of General Medicine, Juntendo University School of Medicine, Tokyo, Japan
- Department of Infection Control Science, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Toshio Naito
- Department of General Medicine, Juntendo University School of Medicine, Tokyo, Japan
- Department of Infection Control Science, Juntendo University Faculty of Medicine, Tokyo, Japan
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Boku S, Naito T, Murai K, Tanei M, Inui A, Nisimura H, Isonuma H, Takahashi H, Kikuchi K. Near point-of-care administration by the attending physician of the rapid influenza antigen detection immunochromatography test and the fully automated respiratory virus nucleic acid test: contribution to patient management. Diagn Microbiol Infect Dis 2013; 76:445-9. [PMID: 23743175 DOI: 10.1016/j.diagmicrobio.2013.04.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 04/04/2013] [Accepted: 04/26/2013] [Indexed: 11/13/2022]
Abstract
Rapid influenza antigen detection tests (RIADTs) using immunochromatography are the most readily available tools for the diagnosis and management of influenza. This study was designed to assess whether near point-of-care administration by primary care physicians of the RIADT and a fully automated respiratory virus nucleic acid test (Verigene Respiratory Virus Plus®; RV+) would contribute to improved patient management. When viral culture and RT-PCR/bi-directional sequencing were used as the gold standard, sensitivities and specificities for RIADT and RV+ were 58.3% and 90.9%, and 97.2% and 100%, respectively. Within 12 hours from onset of fever, sensitivities were 44.4% and 94.4%, respectively, for RIADT and RV+. In clinical situations where a higher-sensitivity test is needed, such as during pre-admission evaluations, for testing of hospital employees during the prodromal phase of infection, during the therapeutic decision-making process, and during outbreaks, we suggest that patients testing negative by the RIADT can be reassessed with the RV+ test to achieve maximal diagnostic accuracy.
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Affiliation(s)
- Soushin Boku
- Department of General Medicine, Juntendo University Nerima Hospital, Tokyo, Japan.
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Ota S, Wada T, Tanei M, Yamagishi M, Yokoyama H, Tomosugi N, Takabatake T, Kobayashi K. [A case of Waldenstrom macroglobulinemia with pulmonary lymphocyte infiltration treated with alpha interferon]. Nihon Naika Gakkai Zasshi 1993; 82:283-5. [PMID: 8492034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Aburano T, Shuke N, Yokoyama K, Tonami N, Hisada K, Tanei M, Terada M, Unoura M, Kobayashi K. Discordant hepatic uptake of Tc-99m NGA and Tc-99m PMT in a patient with hepatoma. Clin Nucl Med 1992; 17:793-6. [PMID: 1330392 DOI: 10.1097/00003072-199210000-00006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The authors report discordant hepatic uptake of Tc-99m NGA and Tc-99m PMT in a patient with hepatoma. Tc-99m PMT uptake was delayed and Tc-99m NGA concentrated in another area, thereby demonstrating that the uptake mechanisms for Tc-99m NGA and Tc-99m PMT are different. Tc-99m NGA imaging may be useful in characterizing the focal hepatic lesion of Tc-99m IDA or Tc-99m PMT concentration.
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Affiliation(s)
- T Aburano
- Department of Nuclear Medicine, Kanazawa University Hospital, Japan
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Ohno H, Noda Y, Takemori Y, Ueno K, Shima K, Ohta G, Tanei M. [A case of severe emphysematous cholecystitis with extension to the intrahepatic bile duct--trial of percutaneous transhepatic cholecystodrainage]. Nihon Shokakibyo Gakkai Zasshi 1989; 86:2255-9. [PMID: 2685426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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