1996 epidemiological survey of dermatophytoses in Japan. Epidemiological Investigation Committee for Human Mycoses in the Japanese Society for Medical Mycology]

An epidemiological investigation on dermatophytoses in Japan for the year 1996 was carried out with the following results. The number of dermatomycoses patients visiting the fifteen cooperating institutes that year was 8,402. New outpatients with this condition accounted for 13.1% of all new outpatients in these institutes. Dermatophytoses patients numbered 7,395 and were composed of: tinea pedis 4,764 (64.4%), tinea unguium 1,487 (20.1%), tinea corporis 558 (7.5%), tinea cruris 369 (5.0%), tinea manuum 195 (2.6%), tinea capitis 11, kerion Celsi 7, tinea barbae 1 and other forms 3. Of these, 113 were children under 15 years of age. Species and incidences of the 2,615 strains isolated from the patients with dermatophytoses were as follows: Trichophyton (T.) rubrum 1,828 (69. 9%), T. mentagrophytes 743 (28.4%) Epidermophyton floccosum 20 (0. 8%), Microsporum (M.) canis 13 (0.5%), M. gypseum 5, T. violaceum 2, and 4 undetermined strains. Candidiasis was found in 722 individuals: intertrigo 299, erosio interdigitalis 95, erythema infantum 89, oral candidiasis 63, paronychia et onychia 56, genital candidiasis 56, onychomycosis 24, chronic mucocutaneous candidiasis 1 and other atypical forms of candidiasis 39. Patients with tinea versicolor numbered 265 and those with Malassezia folliculitis 15. There were five cases of deep dermal mycoses: three of sporotrichosis, one of chromomycosis and one of aspergillosis. The results of superficial dermatophytoses for the year 1996 differed from those of 1991-92 in the following points: Tinea corporis and tinea cruris were lower in number, while tinea unguium had increased in ratio and number. M. canis infection tended to decrease gradually. In the age-distribution of tinea, in every clinical form the peak of distribution curve shifted to a more elderly age group.     

Prevention of dermatophytoses]

Preventive measures against tinea pedis were discussed based on our mycological studies using foot-press method and house dust cultures. 1) Untreated patients with tinea pedis frequently disseminate pathogenic fungi into the environment, but dissemination could be easily controlled by simple application of antifungal agents. 2) A high proportion of dermatophytes disseminated in house dust perished naturally within a month under dry conditions, while under moist conditions they survived several months or more. Therefore, humid areas such as the floor and carpet of a bathroom should be cleaned or washed regularly. 3) Adhesion of dermatophytes onto healthy feet usually happens in public spaces where people enter without shoes. Wearing socks cannot prevent dermatophyte adhesion. Cleaning the feet by wiping with a towel or washing with soap seemed to be an effective prophylactic measure after stepping into such spaces.     

Epidemiological survey of the imported mycoses in Japan.

The authors surveyed the present situation for imported (introduced) mycoses from papers published in Japan as of the end of October, 1998. There were 16 cases of coccidioidomycosis, 22 of histoplasmosis, 13 of paracoccidioidomycosis and one of penicilliosis marneffei. In coccidioidomycosis the ages ranged from 17 to 55, for 14 males and two females. There were eight cases of primary pulmonary coccidioidomycosis and the remaining eight were of the disseminated type, of which two were fatal. For histoplasmosis, the ages ranged from 17 to 74 of which five cases were female and 17 male. They consisted of 13 pulmonary histoplasmosis, seven disseminated type and two cutaneous type. All cases of the disseminated type died. All of the patients with paracoccidioidomycosis were infected in Latin American countries. They consisted of 12 males and one female, and the ages ranged from 34 to 68. The clinical types were dominated by mucocutaneous-lymphangitic paracoccidioidomycoses (10 cases). A single case of penicilliosis marneffei (38 years old, male) was reported very recently. The case was complicated by AIDS and became critical. Blastomycosis has not yet been reported. This survey indicates that the number of the imported mycoses in Japan is increasing. It is necessary for the responsible authorities to take counter measures to cope with this situation.     

An epidemiological survey of dermatomycoses in Japan, 2002]

An epidemiological survey of dermatomycoses and the causative fungus flora of dermatophytoses in Japan for 2002 was made on a total number of 72,660 outpatients who visited 14 dermatological clinics throughout Japan. The results were as follows: 1) Dermatophytosis was the most prevalent cutaneous fungal infection (7,994 cases) seen in these clinics, followed by candidiasis (755 cases) and then Malassezia infections (220 cases). 2) Among dermatophytoses, tinea pedis was the most frequent (4,813 cases: male 2,439, female 2,374), then in decreasing order, tinea unguium (2,123 cases: male 1,093, female 1,030), tinea corporis (497 cases: male 281, female 216), tinea cruris (299 cases: male 249, female 50), tinea manuum (248 cases: male 144, female 104) and tinea capitis including kerion (14 cases, male 6, female 8). 3) Tinea pedis and tinea unguium are seen to increase in summer season, among the aged population and among males in each clinic. When compared to the previous surveys (1992 and 1997) by clinical form, t. unguium patients increased from 1.9% of total outpatients in 1992, to 2.0% in 1997, then to 2.9% in 2002. 4) As the causative dermatophyte species, Trichophyton rubrum was the most frequently isolated among all dermatophyte infections except tinea capitis. 5) T. rubrum was isolated from 63.3%(1,431/2,262) of tinea pedis lesions, followed by Trichophyton mentagrophytes (36.6%, 829/2,262), and also 88.8% (325/366) of t. corporis, 95.4% (185/194) of t. cruris and 85.6% (462/540) of t. unguium. 6) Cutaneous candidiasis was seen in 755 cases (1.0%) of 72,660 outpatients. Intertrigo (347 cases) was the most frequent clinical form, followed by erosio interdigitalis (103 cases) and diaper candidiasis (102 cases). It has a tendency to affect the aged being complicated with topical predisposing factors. 7) Cutaneous Malassezia infections and other superficial fungal infections are seen in 220 cases, without any characteristic features by gender or clinical form.     

Current types of human dermatophytoses transmitted from animals]

Microsporum canis, Trichophyton verrucosum and T. mentagrophytes are the most common dermatophytes isolated from human and animals. M. canis infection in human is closely related to companion animals such as cats and dogs. According to a recent epidemiological survey in Japan, human M. canis infection is decreasing. T. verrucosum is usually transmitted from cows to human. T. verrucosum infection in human is not restricted to daily farming prefectures, however, suggesting that this species has already been spread widely in Japan. T. mentagrophytes is one of the most common pathogens in human tinea. Recent molecular methods show the infection is caused by one teleomorph of T. mentagrophytes, Arthroderma benhamiae, which has already been spread throughout Japan by companion animals. This pathogen is believed not to have existed in Japan until 1980. The chance of human fungal infection caused by unusual pathogens is increasing because of the changes in types of companion animals. Animal dermatophytoses is now an important issue not only for veterinary doctors but also for dermatologists.     

Epidemiological survey of Trichophyton tonsurans infection in Tohoku district and its clinical problems]

To research the current status of Trichophyton tonsurans infection in Tohoku District, I sent out a questionnaire to the main dermatology clinics in the Tohoku district. The results showed this infection was found first in spring, 2001 in Miyagi prefecture, and gradually spread from southern to northern districts; the total number of patients is now 162. The number in each prefecture is as follows: Yamagata; 88, Miyagi; 68, Akita; 4, Aomori; 2. In Iwate and Fukushima, however, no cases were reported. By age distribution high school students accounted for 117 (75%), elder patients for 29 (19%), lower age children only 10, and 6 cases were uncertain. Judo players accounted for 113 (70%) and wrestlers for 39 (24%). Family infections were found in two cases. Latent infections were found in several cases, and in one case the infection continued for 2.5 years without clinical symptoms. In my clinic 30 cases were observed beginning in 2001: high school boys accounted for 11, students of a professional school 14, college student 1, adults 3, and those involved in judo 27, wrestling 2 and mixed grappling sports 2. A family infection between a father and his daughter was found. According to the observations in our cases, this fungus easily invaded the hair roots from the early stage of infection, but was not noticed by common external clinical observations. Thus, microscopic examinations are necessary throughout the therapeutic process and to make certain of a complete cure. I think also necessary is the systemic administration of terbinafine or itraconazole for 4 or 6 weeks or more even for tinea corporis. Additionally, I emphasize that culture study is indispensable to confirm the infection by this fungi.     

Quality control survey implemented by Japan Medical Association and standardization of external quality assessment in Japan]

International Final Draft on quality management of medical laboratory by International Organization for Standardization (ISO) will be published soon. According to this draft, the accreditation of the laboratories should be given by the third party on the basis of objective matter, and the external quality control survey results is thought to be the most important indices for the accreditation. Although variety of external quality control surveys are now implementing in Japan, most of those surveys are done only once a year. Therefore, we could not evaluate the laboratories performance by any of those survey results. If those quality control surveys are done with the standardized system, summative results from different survey could give us fair evaluation on each participating laboratories. Japan Medical Association (JMA) is now making final draft on standardized method for quality assessment system with the consensus between the JMA, Japanese Society of Laboratory Medicine (JSLM, former Japan Society of Clinical Pathology), Japanese Association of Laboratory Medical Technologists (JALMT) and Japan Registered Clinical Laboratories Association (JRCLA). When this quality assessment system actually starts, Japanese people may receive great benefit from the laboratory tests.     

Epidemiological study of hepatitis B and C virus in Okinawa and Kyushu, Japan]

Epidemiological studies of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection in Okinawa and Kyushu have been conducted since 1970. Early in the study period, the prevalence of HBsAg on Iriomote and Hateruma islands in Okinawa was 9.0% and 6.1%, respectively, which were significantly higher than the 2.4% in Kyushu. Prevalence of anti-HBc on Iriomote island was 59.8% and that on Hateruma island 70.9%, also which were significantly higher than the 30.9% in Kyushu. Prevalence of HBV infection has been observed in both Okinawa and Kyushu with prevalences of HBsAg in Okinawa decreasing from 11.6% in 1970 to 3.8% in 1988 and in Kyushu from 2.1% in 1980 to 0.7% in 1991. Prevalence of anti-HCV in Okinawa was only 0.7%, while the prevalence was 3.4% in Kyushu when measured by C100-3 and anti-GOR. In Kyushu, the prevalence of anti-HCV advanced with age and reached a peak in the population 60 years of age. HCV transmission occurs mainly by blood transfusion. We investigated the systems of blood supply in Okinawa and Kyushu. In Japan, including Kyushu, paid blood was mainly used from 1955 to 1969, but in Okinawa it was donated by relatives and friends. The difference in blood supply between these areas may be a cause of the differing of HCV infection.     

Diagnosis of dermatophytoses: conventional methods and recent molecular biological methods]

Dermatophytoses such as tinea pedis and tinea unguium are very common diseases in the field of dermatology. The diagnosis of dermatophytoses is usually performed by direct microscopy and culture. The identification of species is based on morphological features of giant culture and slide culture. However, in some cases, it is difficult to identify the species clearly because the culture shows an atypical appearance or is false negative. Therefore, several molecular biological methods have been developed for precise identification of a species. The analysis of patterns of random amplification of polymorphic DNA (RAPD) and restriction fragment length polymorphisms (RFLP) of mitochondrial DNA is useful for identifying isolates which are not clearly identifiable by conventional biological techniques. The phylogenetic analysis of dermatophytes was made by using DNA direct sequencing of nuclear ribosomal internal transcribed spacer 1 (ITS1). Sequence analysis of chitin synthase 1 (CHS 1) is a rapid tool for species level identification. We attempted the identification and viability assessment of dermatophytes based on the quantitative measurement of dermatophyte actin (ACT) mRNA. An internal fragment of the ACT, 725 to 762 bp, was isolated by PCR from the genomic DNA of dermatophytes and sequenced. ACT intron based primers were dermatophyte species-specific and primer pairs crossing the intron were dermatophyte genus-specific. The results indicated that quantification of dermatophyte ACT mRNA correlated with the results of culture and KOH examination. It is important that the identification of dermatophyte be done by combining conventional methods with molecular biological methods. In some cases results of the two methods do not correspond, and is those the fungal species needs to be re-examined.     

昆明市情感障碍流行病学调查

目的:了解昆明市情感障碍患病率。方法:采用分层容量比例概率随机抽样法,应用中文版复合性国际诊断交谈检查2.1版(CIDI-2.1)对该市≥15岁的居民5033人进行访谈,调查情感障碍的患病率,分析影响情感障碍的相关因素、起病年龄及共病情况。结果:情感障碍30天患病率为0.98%,12个月患病率为1.22%,终生患病率为1.89%,单因素分析结果显示,城镇居民、离婚/分居/丧偶人群、无业者、受教育程度较高者更易患抑郁症。多因素分析结果显示,家居农村、男性可能是情感障碍的保护因素。不同情感障碍亚型起病年龄不同,90%的双相情感障碍患者在25岁以前起病,情感恶劣在50岁以前存在起病风险,重性抑郁的起病风险持续终生。患有焦虑障碍和疼痛障碍可以增高情感障碍的患病风险。结论:情感障碍患病率低于国外同类研究而与国内研究接近,城镇居民、女性、独身、无业,受教育程度较高者有较高的患病风险,是干预的重点人群。     

Clinico-microbiological study of dermatophytoses.

In the present series, 80 cases of dermatophytoses were subjected to mycological examination including microscopy and culture the mycological findings were correlated with clinical presentation of the patients. The isolation rate was 62.5 percent. Fungal culture was successful in 36.25 percent of cases, Trichophyton rubrum being the commonest etiological agent accounting for 55.18 percent of cases.     

湖北地区新生儿烧伤相关因素的流行病学调查

目的分析新生儿烧伤发生的流行病学特征,为减少或防止新生儿烧伤的发生提供预防对策。方法对我院2004年1月至2009年12月收治的68例新生儿烧伤患者的年龄段、致伤因子、烧伤部位、受伤地点及地域分布进行分析。结果新生儿烧伤致伤因子中热液烧伤占61.8%;受伤部位中臀部和会阴部烧伤占29.6%;在家中受伤比例为77.9%,医源性烫伤占22.1%;在烧伤地域分布中农村占64.7%。结论通过对湖北地区新生儿流行病学的调查发现新生儿烫伤与其监护人或照顾者安全防范意识和知识缺乏有密切关系,也与当地经济和卫生条件落后有关。因此教育和指导监护人在日常生活中树立预防意识是降低新生儿烫伤关键。     

阳江市一起基孔肯雅热暴发疫情流行病学调查

目的了解基孔肯雅热的流行特征,探索有效的防控策略,为今后防控工作提供依据。方法根据病例定义进行病例搜索,对符合病例定义的病例进行流行病学调查;采用酶联免疫吸附试验方法检测登革热病毒IgM和IgG抗体;采用实时荧光定量逆转录聚合酶链反应方法检测登革热病毒核酸和基孔肯雅热病毒核酸。结果 2010年9月12日至10月21日,阳江市某建筑工地发生基孔肯雅热病27例,总罹患率为11.07%（27/244）;其中男性17例,占62.96%,女性10例,占37.04%;检测15份恢复期病例血样登革热病毒IgM和IgG抗体,其中2份病例血样IgM抗体阳性,其余13份为阴性,15份病例血样IgG抗体均为阴性;检测5份现症病例血样,登革热病毒核酸均为阴性,2份基孔肯雅热病毒核酸阳性。结论这是一起基孔肯雅热暴发疫情,加强出入境检疫、开展医疗机构症状监测和控制传播疾病的媒介密度是预防控制孔肯雅热的重要措施。     

深圳市间歇性暴发性障碍的流行病学调查

目的:了解深圳市间歇性暴发性障碍的患病率及分布特点。方法:以世界卫生组织-世界精神健康联盟(WHO-WMH)提供的复合性国际诊断访谈表(Composite International Diagnostic Interview,CIDI3.1)为访谈工具,采用多阶段分层随机抽样方法对7134名受访人进行面对面调查。结果:(1)间歇性暴发性障碍的加权终生患病率、加权12个月患病率和加权30天患病率分别为3.32%、2.39%和1.34%。男性终生患病率高于女性(3.62%vs.2.24%,OR=0.61,95%CI=0.46~0.81),非户籍人口终生患病率明显高于户籍人口(3.58%vs.2.30%;OR=1.58,95%CI=1.19~2.09)。(2)间歇性暴发性障碍的平均发病年龄为(15.1±7.2)岁,平均病程为(14.1±8.2)年;每年暴发次数的中位数为12次,每年因冲动行为砸毁财物所造成的经济损失中位数为950.0元。(3)间歇性暴发性障碍的共病率为66.67%,共病的主要类型是抑郁症、强迫症和恐惧症,分别为30.48%、24.29%和23.81%。(4)间歇性暴发性障碍的总就诊率为4.76%。(5)间歇性暴发性障碍患者社会功能有中度和重度妨碍者大约各占15%。结论:间歇性暴发性障碍是一种常见的心理疾病,该病发病年龄低、病程较长、共病率高及就诊率低,给患者的社会功能造成较大的影响,应该得到社会广泛的关注。