Jiro Fujita

University of the Ryukyus, Okinawa, Okinawa, Japan

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Publications (497)1216.45 Total impact


  • No preview · Article · Feb 2016
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    ABSTRACT: This study evaluated the prevalence of Strongyloides stercoralis infection and human T-cell lymphotropic virus type 1 (HTLV-1) infection in the population. In addition, this study investigated the relationship between S. stercoralis infection or HTLV-1 infection and a patient's risk of developing related cancers. This is a retrospective cohort study of 5,209 patients. The prevalence of S. stercoralis infection was 5.2% among all patients. The prevalence among men (6.3%) was significantly higher than among women (3.6%, P < 0.001). The prevalence of HTLV-1 infection among this population was 13.6% and the prevalence among women (15.5%) was significantly higher than that of men (12.3%, P < 0.001). HTLV-1 seroprevalence was higher in patients with liver cancer (P = 0.003, odds ratio [OR]: 1.91, 95% confidence interval [CI]: 1.24, 2.95) and in those with lymphoma other than adult T-cell leukemia/lymphoma (ATLL) (P = 0.005, adjusted OR: 7.76, 95% CI: 1.36, 5.62) if compared with patients without any neoplasm. The prevalence of both S. stercoralis and HTLV-1 in the Okinawan population has been steadily decreasing over the past 24 years. HTLV-1 infection significantly increases the odds of developing liver cancer and lymphomas other than ATLL.
    No preview · Article · Nov 2015 · The American journal of tropical medicine and hygiene
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    ABSTRACT: AIM: To evaluate a multiplex PCR assay for the detection of bacterial and viral enteropathogens in stool samples from patients with ulcerative colitis (UC). METHODS: We prospectively analyzed 300 individuals, including immunocompetent patients, immunocompromised patients, and patients with UC. Stool samples were collected from the recto-sigmoid region of the colon by endoscopy. The samples were qualitatively analyzed for bacterial and viral enteropathogens with a multiplex PCR assay using a Seeplex® Kit. Additional clinical and laboratory data were collected from the medical records. RESULTS: A multiplex PCR assay detected 397 pathogens (191 bacteria and 206 viruses) in 215 samples (71.7%). The most frequently detected bacteria were Escherichia coli H7, 85 (28.3%); followed by Aeromonas spp., 43 (14.3%); and Clostridium perfringens , 36 (12.0%) samples. The most prevalent viruses were Epstein-Barr virus (EBV), 90 (30.0%); followed by human herpes virus-6 (HHV-6), 53 (17.7%); and cytomegalovirus (CMV), 37 (12.3%) samples. The prevalence rate of CMV infection was significantly higher in the immunocompromised group than in the immunocompetent group (p < 0.01). CMV infection was more common in patients with UC (26/71; 36.6%) than in the immunocompetent patients excluding UC (6/188; 3.2%) (p < 0.01). CMV infection was more prevalent in UC active patients (25/58; 43.1%) than in UC inactive patients (1/13; 7.7%) (p < 0.05). Among 4 groups which defined by the UC activity and immunosuppressive drugs, the prevalence rate of CMV infection was highest in the UC active patients with immunosuppressive drugs (19/34; 55.8%). Epstein- Barr virus (EBV) infection was more common in the immunocompromised patients excluding UC (18/41; 43.9%) than in the immunocompetent patients excluding UC (47/188; 25.0%) (p < 0.05). The simultaneous presence of CMV and EBV and/or HHV6 in UC active patients (14/58; 24.1%) was greater than in immunocompromised patients excluding UC (5/41; 12.2%) (p < 0.05). CONCLUSION: The multiplex PCR assay that was used to analyze the stool samples in this study may serve as a non-invasive approach that can be used to exclude the possibility of CMV infection in patients with active UC who are treated with immunosuppressive therapy. © The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
    Full-text · Article · Nov 2015 · World Journal of Gastroenterology
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    ABSTRACT: A 65-year-old man, who recently returned from Liberia, visited a clinic complaining of fever, and azithromycin was prescribed. The patient presented to a general hospital 5 days after the onset of symptoms, however, a blood smear examination failed to detect malaria. Contrary to the blood smear result, a rapid antigen test in our hospital was strongly-positive for falciparum malaria, indicating a high level of malarial antigen in the blood. Moreover, laboratory examinations on admission showed a tendency for improvement. We assumed that the administration of azithromycin partially treated malaria, thus complicating the blood smear diagnosis. We should be careful in prescribing azithromycin, which is widely used in clinics, to travelers returning from malaria-endemic countries.
    No preview · Article · Oct 2015 · Internal Medicine
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    ABSTRACT: We herein describe the case of a 63-year-old man who died from relapsed epidermal growth factor receptor gene (EGFR) exon 19 deletion lung adenocarcinoma treated with erlotinib. According to the autopsy results, he was confirmed to have small cell carcinoma without the EGFR T790M mutation in his pancreas and left kidney metastatic specimens, while the adenocarcinoma metastatic lesion in his right kidney had the EGFR T790M mutation; both retained the somatic EGFR exon 19 deletion. We herein report an autopsy case of resistance to an EGFR tyrosine kinase inhibitor via small cell carcinoma transformation and the EGFR T790M mutation in separate metastatic organs.
    Preview · Article · Oct 2015 · Internal Medicine
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    ABSTRACT: We report a case of KL-6 producing peritoneal malignant mesothelioma. A 56-year-old woman was referred to our hospital on November 2005 with severe abdominal distention. Peritoneal malignant mesothelioma with epithelioid type was diagnosed by clinical symptoms, laboratory investigations, imaging studies, and immunohistochemical examination of known tumor markers. In addition, high serum and ascitic KL-6 levels were observed and the immunostaining of the tumor for KL-6 was evident. We thus consider KL-6 to be a potential novel marker for peritoneal malignant mesothelioma with epithelioid type.
    Preview · Article · Sep 2015 · Rare tumors
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    Preview · Article · Sep 2015 · Internal Medicine

  • No preview · Article · Sep 2015 · European Respiratory Journal
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    ABSTRACT: To study the early stages of hyaline membrane (HM) formation, diffuse alveolar damage (DAD) was thoroughly investigated using immunohistochemical methods in 15 autopsy cases, which consisted of various types of interstitial pneumonias and pulmonary diseases derived from nonmalignant or malignant diseases. Alveolar mouths (AMs) that were presumed to be normal were ultrastructurally examined in detail, by using pulmonary tissues in the pneumothorax. It is interesting to note that during the initial stages of HM formation in AMs, fragmented eosinophilic masses were closely attached to AMs as irregular fragments or by a cap-like structure. The ultrastructure revealed some distance between the capillary spaces and surface epithelium of the AMs, indicating that the epithelial cells at the AMs might be often easily damaged even by minor stimuli; they can be considered as "locus minoris resistentiae." HMs were found to be formed initially at the site of AMs derived from fragmented eosinophilic masses in not only pulmonary but also extrapulmonary diseases, including both nonmalignant and malignant diseases. These irregular eosinophilic masses, representing the early shape of HMs, were immunohistochemically positive for the epithelial membrane antigens, namely, surfactant protein A and factor VIII antigen, and occasionally for KL-6 and cytokeratins. These results suggested that fragmented irregular masses represent the initial phase of HM formation. Five of 15 cases were focally negative for KL-6 at the initial irregular mass of HMs. Because KL-6 is one of the fundamental components of pulmonary surface elements, it needs to be studied further by detailed clinicopathological examination. © The Author(s) 2015.
    No preview · Article · Jul 2015 · International Journal of Surgical Pathology
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    ABSTRACT: We report a case of fatal pneumonia and viremia due to human parainfluenza virus type 1 (HPIV-1) in a 65-year-old male patient with adult T-cell leukemia-lymphoma (ATL) treated with mogamulizumab, a brand-new therapeutic agent for ATL. To our knowledge, this is the first report describing viremia due to HPIV-1. After administering mogamulizumab, lymphocyte count in the blood was drastically decreased and the patient suffered from complicated infections including gram-negative bacterial sepsis, cytomegalovirus antigenemia and aspergillosis. Although these infections were successfully controlled by broad spectrum antimicrobial therapy, patchy ground-grass opacities in the both lungs were gradually worsened. He finally died due to acute respiratory failure. Since findings of the chest CT was consistent with typical patterns of viral pneumonia, we screened major respiratory viruses in the peripheral blood with multiplex PCR, and it turned out that RNA of HPIV-1 was positive. Although ATL cells were not detected in the autopsied lungs and a variety of other tissues, cytoplasmic inclusion bodies, which are commonly observed in RNA viral infection, were abundantly observed in the autopsied lung tissue. These findings suggest that mogamulizumab accomplished complete remission of ATL, while the chemotherapy-induced prolonged lymphopenia caused fatal pneumonia and viremia due to HPIV-1. As it has been well recognized that community respiratory viruses including HPIV-1 often cause fatal pneumonia in patients with leukemia, but also there is no specific treatment for HPIV-1, we have to enforce standard precautions especially when we treat leukemic patients with intensively immunosuppressive agents such as mogamulizumab. Copyright © 2015 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
    No preview · Article · Jul 2015 · Journal of Infection and Chemotherapy
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    ABSTRACT: A 72-year-old man was hospitalized in Okinawa due to a high fever and rash, after returning from Bali, Indonesia, in February 2014; dengue was clinically suspected, and IgM for dengue is positive in commercial kit. Serologically, the patient showed secondary sero-reactivity. Significant rises in neutralization titers (N-titers) against all four serotypes of dengue virus (DENV) and Japanese encephalitis virus (JEV) strains were recognized between acute- and convalescent-phase sera. N-titer against dengue virus serotype 1 (DENV-1) was the highest among those for all serotypes of DENV. Interestingly, N-titers against JEV strains, were significantly higher than those against all types of DENV. Virus was isolated from the acute-phase serum, and identified as DENV-1 designated as RD14/Okinawa. The symptoms of the case were due to DENV-1 infection. Phylogenetic analysis by sequencing indicated that isolate RD14/Okinawa furthermore belongs to genotype I of DENV-1, which is closely related to Southeast Asian strains and isolates during the dengue outbreak in Japan in 2014. We should undertake control measures against dengue in Okinawa, which is a subtropical area with Aedes albopictus activity throughout year.
    Preview · Article · Jun 2015
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    ABSTRACT: A 66-year-old man presented with diarrhea, borborygmus, and abdominal distension. Enhanced computed tomography revealed the thickening of the colonic wall. F-18 fluorodeoxyglucose positron emission tomography showed uptake in the thickened colonic wall. Colonoscopy revealed granular and edematous appearance of the hepatic colon, circumferential ulcer with dirty necrotic materials of the sigmoid colon, and a polyp of the rectum with smooth surface. Capsule endoscopy showed edematous villi and cracked mucosa of the small intestine. Pathology examination of the resected polyp revealed proliferation of small- to medium-sized atypical lymphocytes into the colonic mucosa. In immunohistochemistry, tumor cells were positive for CD3 and CD8, partially positive for CD56, and negative for CD4, CD5, and CD20. Consequently, he was diagnosed with type II enteropathy-associated T-cell lymphoma. He received chemotherapy at the Department of Hematology in our hospital and has been under treatment for eight months since the diagnosis.
    No preview · Article · Jun 2015 · Gastroenterological Endoscopy
  • J. Fujita · S. Haranaga · F. Higa · M. Tateyama
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    ABSTRACT: Structurally, viruses are simple and do not produce toxins or proteases; thus, the pathogenesis of severe viral pneumonia is attributable to a host-mediated cytokine storm. In addition, severe epithelial damage resulting in the regeneration of alveolar type II cells, proliferation of smooth muscle cells, and an increase in collagen fibers at the tip of alveolar orifices is observed. Consequently, the clinical diagnosis of severe viral pneumonia is acute respiratory distress syndrome with the main pathological observation being diffuse alveolar damage. Based on these findings, the appropriate treatment strategy for severe viral pneumonia will be established.
    No preview · Article · May 2015
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    ABSTRACT: A 44-year-old man with diffuse pulmonary lesions, systemic lymphadenopathy, and elevations in serum C-reactive protein (CRP), ImmunoglobulinG (IgG), and Interleukin-6 (IL-6) levels was diagnosed with multicentric Castleman's disease (MCD) by lymph node biopsy. While considering treatment options, he developed a high fever and pancytopenia Bone marrow aspirates revealed hemophagocytosis, which was suspected to have resulted from MCD. After treatment with corticosteroids, his fever, pancytopenia and lymphadenopathy improved. Although CRP and IgG levels were improved only temporarily, they improved after additional treatment with tocilizumab. This case, which revealed hemophagocytosis in MCD, seemed to be valuable.
    No preview · Article · Apr 2015
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    ABSTRACT: A 62-year-old woman complained of diarrhea and vomiting after receiving chemotherapy for cervical cancer in association with high doses of corticosteroids. Two months later, the patient developed acute respiratory distress syndrome, and numerous Strongyloides stercoralis parasites were found in the intrabronchial discharge. Ivermectin was administered daily until nematodes were no longer detected in the sputum, and the patient's condition was successfully rescued. Antibodies for human T-cell lymphotropic virus-1 (HTLV-1) were positive. HTLV-1 infection and the administration of corticosteroids are known risk factors for strongyloides hyperinfection syndrome. Therefore, physicians should consider this disease in the differential diagnosis of patients from endemic areas who present with gastrointestinal symptoms under these risk factors.
    Full-text · Article · Mar 2015 · Internal Medicine
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    ABSTRACT: Pneumonia cases can vary in both severity and chest X-ray findings. Elevated C-reactive protein (CRP) levels may be an indicator of disease severity. We retrospectively evaluated factors correlated with the extent of chest X-ray infiltration both in community-acquired pneumonia (CAP) and a subgroup of cases with pneumococcal pneumonia. In a clinical study that evaluated the efficacy of sitafloxacin, 137 patients with CAP had been previously enrolled. In our study, 75 patients with pneumococcal pneumonia were identified among these 137 CAP patients. The extent of chest X-ray infiltration was scored and correlations with age, sex, body temperature, white blood cell (WBC) count, and CRP levels were analyzed using multivariate analysis with logistic regression. Significant correlations were observed between the extent of chest X-ray infiltration and CRP levels in both CAP and pneumococcal pneumonia. Our data indicates that CRP is a valuable and informative resource that could reflect the severity of pneumonia in cases of both CAP and pneumococcal pneumonia. Copyright © 2015. Published by Elsevier Ltd.
    Full-text · Article · Feb 2015 · Journal of Infection and Chemotherapy
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    Akira Hokama · Chiharu Kobashigawa · Jiro Fujita

    Preview · Article · Feb 2015 · Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine
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    ABSTRACT: Influenza virus infection in hospitals is a very important clinical issue. The objective of this study was to describe the effect of oseltamivir in controlling a nosocomial influenza virus infection with an observational study and case report. Intervention was carried out in a ward of the University of the Ryukyus Hospital. Symptomatic staff members were sent home for one week, and the infected inpatients were isolated. In addition, in an episode of influenza infection among the staff members and inpatients, oseltamivir (75 mg once a day for 7 days) was administered to all staff members as well as inpatients who had had close contact with the influenza patients. In the hospital ward, eight staff members (nurses and doctors) and ten hospitalized patients were definitively diagnosed with influenza A viral infection based on results of a rapid diagnostic test. Although a relatively large number of the staff members and inpatients had an influenza virus infection, it was possible that the use of oseltamivir efficiently minimized a nosocomial outbreak. It was very difficult to diagnose influenza A virus infection based on clinical symptoms. It was possible to minimize and end the outbreak immediately by using oseltamivir prophylaxis. With a review of the literature, it is considered that prophylaxis with anti-influenza drugs are highly recommended in hospital settings.
    Preview · Article · Jan 2015
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    ABSTRACT: In our hospital, Legionella monitoring in the shower water of bathrooms is conducted every year. Legionella was detected in only one of the sink taps of the fifth floor psychiatric ward bathroom in 2010, but Legionella was also detected in several showers and sink taps of the fourth floor obstetrics and gynecology ward, Maternity and Perinatal Care Center, and NICU in 2011. Furthermore, L. pneumophila serogroup 1 was detected in several components of the water system equipment except for bathrooms. Hoses were exchanged and water drained to eradicate Legionella, and rechecking was negative in all locations except the sink of the interview room in the Maternity and Perinatal Care Center. According to interviews with nurses, water drainage was not fully performed. We considered the departmental cooperative activities supporting the system of Legionella infection control in the hospital, and the arrangement and use of water system equipment at this time. We thought that the risk of Legionella becomes high with low frequency in use of water system equipment, because the infection center was on the fourth floor that is the bottom of the arrangement of water system equipment, and infection spread mostly from water system equipment with low frequency use in that location. The arrangement of a water supply system must be carefully examined, and the frequency of use of water system equipment monitored as part of measures against Legionella. For this reason, prompt cooperation between the infection control committee, responsible staff, and the equipment division, and information exchange are essential. We propose a guidance plan to ensure cooperation and exchange of information.
    Preview · Article · Jan 2015 · Japanese Journal of Environmental Infections
  • J. Fujita · S. Sunagawa

    No preview · Article · Jan 2015

Publication Stats

4k Citations
1,216.45 Total Impact Points

Institutions

  • 2006-2015
    • University of the Ryukyus
      • • Faculty of Medicine
      • • Graduate School of Medicine
      • • First Department of Internal Medicine
      Okinawa, Okinawa, Japan
    • The University of Okinawa
      Okinawa, Okinawa, Japan
  • 2013
    • Azabu University
      • Department of Veterinary Medicine
      Sagamihara, Kanagawa, Japan
  • 2010-2013
    • Toyonaka Municipal Hospital
      Toyonaka, Ōsaka, Japan
  • 1989-2009
    • Kagawa University
      • • Faculty of Medicine
      • • Department of Radiology
      Takamatu, Kagawa, Japan
  • 2004
    • Vanderbilt University
      • Department of Surgery
      Nashville, MI, United States
  • 2001
    • Okayama Rosai Hospital
      Okayama, Okayama, Japan
  • 1993-2000
    • Kagawa Prefectural Central Hospital
      Takamatu, Kagawa, Japan
  • 1997
    • Kochi Medical School
      Kôti, Kōchi, Japan
  • 1990-1991
    • Nagai Internal Medicine Clinic
      Okayama, Okayama, Japan
    • University of Nebraska Medical Center
      • Department of Internal Medicine
      Omaha, Nebraska, United States