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Japanese spotted fever (JSF) is a tick-borne rickettsiosis caused by Rickettsia japonica. Although the number of JSF cases has been increasing, exceeding 300 per year since 2017, clusters of cases are rare. Here, we report a cluster of seven JSF cases, the first nonfamilial cluster of the disease documented in the Japanese literature, and describe the management of the outbreak through prompt investigation and control-and-prevention measures performed collaboratively by members from the clinical, laboratory, and public health fields. All seven cases in the cluster had visited a cemetery in September or October of 2019. R. japonica was detected in whole-blood and/or skin samples from six patients and in the larvae of Haemaphysalis hystricis collected in a field survey. The evidence suggested that this cluster of cases was caused by the conjunction of two circumstances within a short period of time: an increase in the number of visitors to a cemetery during a Buddhist event and an increase in the number of infectious tick larvae in the cemetery through hatching (vertical transmission from infected females). Delays in the treatment of JSF can lead to severe manifestations. Early interventions through collaborative efforts among members from the clinical, laboratory, and public health fields are important for controlling outbreaks, raising the awareness of the public, and diagnosing and treating patients.

Introduction In response to global outbreaks of infectious diseases, the need for support from organizations such as the World Health Organization Global Outbreak Alert and Response Network (GOARN) is increasing. Identifying the obstacles and support needs for applicants could increase GOARN deployments from Japan. Methods This cross-sectional study involved a web-based, self-administered questionnaire survey targeting Japanese participants in the GOARN Tier 1.5 training workshop, held in Tokyo in December 2019. Results All 47 Japanese participants in the workshop responded to the survey. Most responders were male and in their 30s and 40s. Participants specialized in case management (42.6%), infection prevention and control (25.6%), epidemiology and surveillance (19.1%). Only two participants (4.6%) had experienced a GOARN deployment. Their motivations for joining the GOARN training workshop were “Desire to be part of an international emerging infectious disease response team” (44.6%), “Interest in making an international contribution” (19.1%), and “Interest in working for the Japanese government in the field of international infectious diseases” (14.9%). Obstacles to GOARN deployments were “Making time for deployments” (45.7%) and “Lack of required professional skills and knowledge” (40.4%). The support needs for GOARN deployments constituted “Periodic simulation training” (51.1%), “Financial support during deployments” (44.7%), and “Technical support for deployments” (40.4%). Conclusions Our study revealed the obstacles and support needs of Japanese candidates for GOARN deployment. Making time and upskilling for GOARN deployment were the main obstacles. More practical training (like GOARN Tier 2.0) with other supports are needed. The national framework is desirable to realize these supports.

Radiation protection glasses is a useful tool for dose reduction of eye lens. However, the method to evaluate the dose of eye lens, which is covered with radiation protection glasses in actual radiation management situation, has not been established. We invented the easy-to-use procedure to estimate the dose of eye lens inside of radiation protection glasses for occupationally exposed person using an X-ray shielding material and an additional personal dosimeter for trunk of the body. The objective of this study was to evaluate the feasibility of the new method.The radiation field in interventional radiology (IR) was reconstructed. A personal dosimeter was set to the eye position and neck position of medical staff phantom. Each dosimeter was covered by radiation protection glasses or X-ray shielding material, and the 1 cm or 70 mm dose equivalent quantity in the neck position was compared to the 3 mm dose equivalent quantity in the eye position.The dose equivalent quantity measured inside of X-ray shielding material in the neck position was similar to that of inside radiation protection glasses. Thus, the X-ray attenuation by radiation protection glasses was able to be simulated using the X-ray shielding material.It was suggested that the dose of eye lens inside of radiation protection glasses could be easily estimated by covering the conventional personal dosimeter for trunk of the body with the X-ray shielding material.

Postpartum thyroiditis (PPT) is characterized by mild thyrotoxicosis occurring within one year of parturition commonly followed by transient hypothyroidism. Having genetic background of autoimmune thyroid disorders is a risk factor for it because the immune reactivation during postpartum period is a trigger for PPT. Pandemic of COVID-19: caused by SARS-CoV-2 infection is a global health problem, and occurrence of Graves' disease and Hashimoto's thyroiditis after the viral infection have been reported but occurrence of PPT with COVID-19 has never been reported. A 29-year-old woman developed general fatigue four and a half months after parturition, and was diagnosed as having PPT: one month before, she had COVID-19. Hereafter, we define the date of delivery as Day 0 to make timeline clear. SARS-CoV-2 infection was diagnosed by PCR on Day 103, its disappearance from the upper airway confirmed on Day 124, and the thyroiditis diagnosed on Day 136. She had been euthyroid on Day 0 and 95, but thyrotoxic on Day 136. Serum thyroglobulin (Tg) concentration was normal in the presence of anti-Tg antibody, other thyroid-related autoantibodies were negative, and by ultrasonography, the thyroid gland was normal in size and no evidence of increased vascularity. Thyroid function returned to normal by Day 172 without any specific drug therapy. In conclusion, although a clear causal relationship could not be found, we documented the world's first case of PPT developed following COVID-19.

Most radiation protection items made from modern lead contain 210Pb. This study estimated the impact on eye lens of radiation derived from the 210Pb in three types of radiation protection glasses. The counts from the glasses were measured using a Geiger–Müeller survey meter. The net count rate was 92 ± 1 cpm at a distance of 0.5 cm for one type of glasses. Additionally, we conducted a qualitative γ-ray spectrum analysis using a high-purity germanium semiconductor detector. The absorbed dose in the eye lens was related to 210Pb and its daughter radionuclide, 210Bi; this dose was calculated by applying dose conversion coefficients provided by the International Commission on Radiological Protection. The absorbed dose rate in eye lens was conservatively calculated to be on the order of 10 nGy/h for the type of glasses containing the most 210Pb. The dose from β-rays accounted for >99%. In addition, we investigated the dose-reduction effect using a thin acrylic plate. The count rate approximately decreased to background level by inserting a plate with a thickness of 1 mm. We conclude that the impact of 210Pb contained in radiation protection glasses is negligibly small, particularly considering the usefulness of the significant external exposure reduction.

Background Awareness of pre-travel consultations (PTCs) and prevention methods for overseas travel-related diseases, and the understanding of PTCs among Japanese travelers and medical professionals remains low in Japan. A multicenter registry was established to examine PTCs in Japan. This study assessed the PTC implementation rate and examined the indicators of PTCs that can be used as criteria for evaluating quality. Methods Clients who presented for their PTCs at 17 facilities and were registered between February 1, 2018, and May 31, 2020, were included. Medical information was extracted retrospectively via a web-based system. Correlations between vaccination risk categories and advice/intervention proportions by the facility were evaluated using Spearman’s ordered phase relations (α = 0.05). Results Of the 9700 eligible clients (median age, 32 years; 880 [9.1%] aged Conclusions Although the characteristics of the travelers differed, the quality of the PTCs should be improved to address, for example, the lower rate of acceptance of malaria prophylaxis in Japan.

We describe the clinical features of a 75-year-old man who presented to our hospital with frequent urination for 3 months. Retrograde urethrography showed extended and continuous narrowing of the stricture in the anterior urethra. Cystourethroscopy showed extended narrowing of the urethral lumen without normal membrane. Urine acid-fast bacillus culture and polymerase chain reaction assays indicated a diagnosis of urethral tuberculosis. Anti-tuberculosis therapy was initiated. Urethral tuberculosis is a very rare cause of urethral stricture in developed countries that can be diagnosed by cystourethroscopy. Urethral tuberculosis should be considered in the differential diagnosis of urethral stricture.

We report a case series of 6 patients with confirmed coronavirus disease 2019 (COVID-19) in Wakayama prefecture, Japan. All 6 of the patients tested positive via pharyngeal swab polymerase chain reaction (PCR) tests, and 2 of the 6 were still positive at 3 weeks after onset. All of the patients exhibited bilateral ground glass opacities on computed tomography (CT). This article also reports narrative information on the spectrum of symptoms collected directly from the patients. It would be difficult to triage patients with COVID-19 based on the typical symptoms of fever and/or cough, although PCR and CT are definitive in diagnosis.

To evaluate the diagnostic performance of chest CT to differentiate coronavirus disease 2019 (COVID-19) pneumonia in non-high-epidemic area in Japan. This retrospective study included 21 patients clinically suspected COVID-19 pneumonia and underwent chest CT more than 3 days after the symptom onset: six patients confirmed COVID-19 pneumonia by real-time reverse-transcription polymerase chain reaction (RT-PCR) and 15 patients proved uninfected. Using a Likert scale and its receiver operating characteristic curve analysis, two radiologists (R1/R2) evaluated the diagnostic performance of the five CT criteria: (1) ground glass opacity (GGO)-predominant lesions, (2) GGO- and peripheral-predominant lesions, (3) bilateral GGO-predominant lesions; (4) bilateral GGO- and peripheral-predominant lesions, and (5) bilateral GGO- and peripheral-predominant lesions without nodules, airway abnormalities, pleural effusion, and mediastinal lymphadenopathy. All patients confirmed COVID-19 pneumonia had bilateral GGO- and peripheral-predominant lesions without airway abnormalities, mediastinal lymphadenopathy, and pleural effusion. The five CT criteria showed moderate to excellent diagnostic performance with area under the curves (AUCs) ranging 0.77–0.88 for R1 and 0.78–0.92 for R2. The criterion (e) showed the highest AUC. Chest CT would play a supplemental role to differentiate COVID-19 pneumonia from other respiratory diseases presenting with similar symptoms in a clinical setting.

Toxocariasis causes a variety of symptoms. We experienced a case of toxocariasis which was initially treated with steroids for Eosinophilic Granulomatosis with Polyangitis (EGPA). A 53-year-old woman with the past medical history of bronchial asthma presented at the outpatient department in the middle of August. She complained of chest discomfort lasting for one week. Ischemic heart disease was initially suspected due to ST depression on ECG and positive Troponin I. However coronary angiography did not reveal any abnormality. Her symptoms continued and after one month she presented at the hospital again with an elevated eosionophil count. Chest computed tomography showed ground glass opacities on both lungs. She was diagnosed as having EGPA based on her clinical symptoms and the results of the blood test which were consistent with the diagnostic criteria of EGPA. After prednisolone was prescribed, her symptoms and eosinophilia dramatically improved. However, we found that the histology of the lung and kidney was not compatible with EGPA and the result of serum parasite antibodies turned out to be strongly positive for toxocariasis after initiating predonisolone. Based on this result, we concluded that our patient had a case of toxocariasis and prescribed albendazole in addition to prednisolone. The patient completed a 3-week course of albendazole and a 3-month course of prednisolone without any problems. In general, steroids are not commonly used as a treatment of toxocariasis, however it seems to have been effective in this case. Toxocariasis shows a variety of symptoms and can be misdiagnosed as other diseases such as EGPA.

The largest ever outbreak of Ebola virus disease has been spreading in West Africa. The authors were deployed to Liberia and Sierra Leone as short-term consultants for the World Health Organization. Our mission was to ensure clinical management and infection prevention and control priorities in frontline treatment centres. This paper describes how the disease is spread, its symptoms and progression, measures currently taken to ensure both infection control and the best possible care, and the significance of infections among health care workers. We adopted an approach which is detailed in the WHO Clinical Management of Patients with Viral Haemorrhagic Fever. Areas within the treatment centres were divided into either a "hot zone" or a "cold zone". Patients were interviewed, and those patients who met the criteria for suspected, probable or confirmed cases were moved to hot zones. All health care workers wore personal protective equipment when entering a hot zone and washed hands with a hypochlorite solution after each patient encounter. Among the problems which we encountered was a fundamental mismatch in the numbers of patients and nurses. The nurses often had to work alone in hot zones in protective equipment which limited physical movement and blurred vision. These factors contributed to fatigue due to prolonged outbreak response and may have resulted in infections among the nursing staff. In conclusion, we present the current situation in West Africa in regard to the recent outbreak of Ebola virus disease, specifically the clinical picture based on our observation. We further propose steps to be taken to handle the patient care safely and effectively. We hope our experience will contribute to national discussions on how to respond to the Ebola virus disease.

While ebola virus disease (EVD) outbreak in West Africa seemed to be subsided, there are still some sporadic cases reported from the field. Many studies were conducted during the outbreak. It was identified that the virus can survive for a long period in certain areas of the survivors and they can be a reservoir. But the mechanism is still unknown. Currently no specific drug for EVD is established and classic supportive therapy was the mainstay of the treatment. A new ebola vaccine candidates appear to be highly effective for post-exposure prophylaxis. Rapid diagnostic tests are under development. In West Africa, Ebola response and recovery efforts to achieve and to sustain a "resilient zero" are ongoing. The situation in the communities is stabilized but ebola survivors are still suffering both from stigma and sequelae.EVD outbreak damaged affected countries' health, economic and education systems. The risk of re-outbreak is still remained. It is important to strengthen comprehensive public health system to prevent the future emerging disease outbreaks.

Erysipelothrix rhusiopathiae is a major causative organism of swine erysipelas, but the infection has rarely occurred in humans. A soft-tissue infection with this organism is described as “erysipeloid.” Most reported cases in human are related to occupational exposure. Endocarditis is a common complication of E. rhusiopathiae bacteremia in human.We report the case of a previously healthy 52-year-old Japanese female who presented with fever and an inflamed hand after being bitten by a stray cat. Blood culture was positive for E. rhusiopathiae, but no sign of infective endocarditis was observed. It may be prudent to consider E. rhusiopathiae infection in patients with animal bites. Keywords: Erysipelothrix rhusiopathiae, Animal bites, Bacteremia

A 32-year-old Japanese woman admitted November 1 for a 4-day fever and who had traveled in India October 14-22 was found to have no abnormal findings except for fever and luekocytopenia and thrombocytopenia. Negative rapid-test anti-dengue virus IgM antibody findings, however, became positive on hospital 2, with hemophagocytic cells found in the bone marrow, yielding a definitive diagnosis of dengue fever with viral-associated hemophagocytic syndrome. Some such cases with hemophagocytic syndrome have been reported in patients with sever dengue fever, but the rarity of the need for bone marrow examination means that it is unknown whether hemophagocytic syndrome occurs in mild dengue fever or whether our case was unusual.

During an epidemiologic investigation of pandemic influenza (H1N1) 2009 virus infection in May 2009 in Osaka, Japan, we found 3 clusters in which virus transmission occurred during the presymptomatic phase. This finding has public health implications because it indicates that viral transmission in communities cannot be prevented solely by isolating symptomatic case-patients.

A hepatic central bisegmentectomy was performed on a 36-year-old Iranian man with suspected cystic echinococcosis. Hepatic computed tomography (CT) scan findings showed a large cystic lesion, which included many small round shaped cystic lesions. The diagnosis of hepatic cystic echinococcosis was confirmed during surgery. The aforementioned CT scan findings may be specific findings for cystic echinococcosis, in spite of a low appearance rate.

A 30-year-old Japanese woman with falciparum malaria was hospitalized because of fever and renal failure, and prolonged anemia was identified despite the eradication of malaria parasites through anti-malaria therapy. Bone marrow aspiration revealed the presence of macrophages with hemophagocytosis, and serum interleukin (IL)-18 and tumor necrosis factor (TNF)-alpha levels were high in the anemic phase. Hemophagocytosis was confirmed for at least 3 weeks, and prolonged hemophagocytic syndrome is thought to be one of the causes of prolonged anemia in patients with falciparum malaria.

A 56-year-old previously healthy man was admitted to our hospital for disordered consciousness, anuria, and severe jaundice. The patient had not travelled recently, but he worked at a fish market in Tokyo. From his history and clinical observation we suspected Weil's disease and started the corresponding treatment. Leptospira infection was ultimately confirmed by a serological study. Our report raises the awareness that leptospirosis is not only a tropic disease, but also it can be a disease in an urban setting in Japan for people who are at risk of exposure.

A 30-year-old Japanese woman with falciparum malaria was hospitalized because of fever and renal failure, and prolonged anemia was identified despite the eradication of malaria parasites through anti-malaria therapy. Bone marrow aspiration revealed the presence of macrophages with hemophagocytosis, and serum interleukin (IL)-18 and tumor necrosis factor (TNF)-alpha levels were high in the anemic phase. Hemophagocytosis was confirmed for at least 3 weeks, and prolonged hemophagocytic syndrome is thought to be one of the causes of prolonged anemia in patients with falciparum malaria.