Relationship between home environment and the prevalence of respiratory disease of infantile wheezing

幼児期の喘息・喘鳴の有病率を明らかにし,生活環境との関連を検討することを目的に,1.6 歳児,3歳児健診を受診した母親を対象に自記式質問紙調査を行った.調査内容は,ATS-DLD 日本版・改訂版を修正した20項目,家族歴,栄養法,住環境などの12項目,属性5項目であった.有効回収数899名(92.8%).① A市の喘息の有病率は,1.6歳児8.4%(95%信頼区間confidence interval(CI),5.9～10.8%),3歳児13.7%(95% CI,10.4～17.1%)であった.② 3歳児では喘息など診断あり群が,診断なし群より家族歴があり(p<0.05),55.3%が他のアレルギー疾患を合併していた.③ 1.6歳児は,母親の喫煙(p<0.05),祖母の喫煙(p<0.01)と有病とに関連を認めたが,部屋の絨毯使用や,ペット飼育との関連は認めなかった.これらから,家族は,ダニ対策は認識していても,喫煙が乳幼児に及ぼす影響を理解していないと考えた.今後,受動喫煙の広報や禁煙指導などを強化することで,喘息や喘鳴の有病率を低下させる可能性があると考える.This study aims at identifying the relationship between home environment and the prevalence of infantile wheezing symptoms. Mothers of young children aged 1.6 and 3 years were sampled. A questionnaire, prepared by the researcher, including 20 items based on the Japanese Revised Edition of the ATS-DLD, 12 items on family history, nutrition and dietary principles and home environment, and 5 items on demographic characteristics, was used for data gathering. Data from 899 (92.8%) samples were confirmed as appropriate for the analysis. ① The prevalence rate of infantile wheezing symptoms as revealed to be 8.4% (95% confidence interval (CI), 5.9～10.8%) in the 1.6 years cohort, and 13.7% (95% CI, 10.4～17.1%) in the 3 years cohort, respectively. ② A family history of wheezing symptoms on the paternal and / or maternal side, as well as a history of other allergic symptoms, were identified in the 3 years cohort with infantile wheezing symptoms. ③ A significant relationship was found between mother's and grandmother's smoking and infantile wheezing symptoms in the 1.6 year group (p<0.05), while carpet and pet revealed no significance. It was clearly identified that family members, including grandparents, were reluctant to recognize the relationship between their smoking and the prevalence of wheezing symptoms in their children. Thus, the development of appropriate strategies for family members to ‘stop smoking' in a household with infants and young children is inevitable

Sex- and Age-Related Differences in Morbidity Rates of 2009 Pandemic Influenza A H1N1 Virus of Swine Origin in Japan

BACKGROUND: The objective of the present study was to determine whether the morbidity rates of the 2009 pandemic influenza A H1N1 virus (pdmH1N1) varied by age and/or sex. METHODS AND FINDINGS: Retrospective analysis of 2,024,367 cases of pdmH1N1 was performed using the national surveillance data from influenza sentinel points in Japan. The male-to-female morbidity ratios (M/F ratios) in nineteen age groups were estimated as the primary outcome. The M/F ratios for pdmH1N1 influenza were: >1 in age groups <20 years and ≥80 years (p<0.001); <1 in age groups 20-79 years (p<0.001). This data suggests that males <20 years of age may be more likely to suffer from pdmH1N1 influenza than females in the same age categories. When the infection pattern for pdmH1N1 was compared with that of seasonal influenza outbreaks between 2000 and 2008, the M/F ratio for pdmH1N1 influenza was higher in ages 3-29 years and lower in ages 40-79 years. Because the present study was based on the national surveillance, it was impossible to estimate the morbidity rate for the Japanese population. It is also likely that the data did not capture asymptomatic or mild infections. CONCLUSIONS: Although exposure to the pdmH1N1 virus is assumed to be similar in both boys and girls, M/F ratios were >1 in those younger than 20 years. The subsequent reversal of the M/F ratio in the adult generation could be due to several possibilities, including: greater immunity among adult males, more asymptomatic infections among males, less reporting of illness by males, or differences in exposure to the virus and probability of visiting a clinic. These results suggest that the infection and virulence patterns of pdmH1N1 are more complex than previously considered

A Case of Kikuchi’s Disease Without Cervical Lymphadenopathy

Background. Kikuchi’s disease with only extracervical lymphadenopathy is rare. Case Presentation. A 15-year-old male has presented with a fever lasting more than 1 week and right axillary lymphadenopathy. An axillary lymph node biopsy revealed coagulation necrosis, nuclear decay products, infiltration of histiocytes, and enlarged lymphocytes; he was diagnosed with Kikuchi’s disease. The only four adult patients with Kikuchi’s disease presenting without cervical lesions have been previously reported. Conclusion. This is the only pediatric case of Kikuchi’s disease presenting without cervical lymphadenopathy. Kikuchi’s disease should be included in the differential diagnosis even in cases of extracervical lymphadenopathy alone

Distinct Aggregation of ␤ -and ␥ -Chains of the High-affinity IgE Receptor on Cross-Linking

S U M M A R Y The high-affinity IgE receptor (Fc ε RI) on mast cells and basophils consists of a ligand-binding ␣ -chain and two kinds of signaling chains, a ␤ -chain and disulfide-linked homodimeric ␥ -chains. Crosslinking by multivalent antigen results in the aggregation of the bound IgE/ ␣ -chain complexes at the cell surface, triggering cell activation, and subsequent internalization through coated pits. However, the precise topographical alterations of the signaling ␤ -and ␥ -chains during stimulation remain unclarified despite their importance in ligand binding/signaling coupling. Here we describe the dynamics of Fc ε RI subunit distribution in rat basophilic leukemia cells during stimulation as revealed by immunofluorescence and immunogold electron microscopy. Immunolocalization of ␤ -and ␥ -chains was homogeneously distributed on the cell surfaces before stimulation, while crosslinking with multivalent antigen, which elicited optimal degranulation, caused a distinct aggregation of these signaling chains on the cell membrane. Moreover, only ␥ -but not ␤ -chains were aggregated during the stimulation that evoked suboptimal secretion. These findings suggest that high-affinity IgE receptor ␤ -and ␥ -chains do not co-aggregate but for the most part form homogenous aggregates of ␤ -chains or ␥ -chains after crosslinking

Correction: Age-Specific Sex-Related Differences in Infections: A Statistical Analysis of National Surveillance Data in Japan

BACKGROUND: To prevent and control infectious diseases, it is important to understand how sex and age influence morbidity rates, but consistent clear descriptions of differences in the reported incidence of infectious diseases in terms of sex and age are sparse. METHODS AND FINDINGS: Data from the Japanese surveillance system for infectious diseases from 2000 to 2009 were used in the analysis of seven viral and four bacterial infectious diseases with relatively large impact on the Japanese community. The male-to-female morbidity (MFM) ratios in different age groups were estimated to compare incidence rates of symptomatic reported infection between the sexes at different ages. MFM ratios were >1 for five viral infections out of seven in childhood, i.e. male children were more frequently reported as infected than females with pharyngoconjunctival fever, herpangina, hand-foot-and-mouth disease, mumps, and varicella. More males were also reported to be infected with erythema infectiosum and exanthema subitum, but only in children 1 year of age. By contrast, in adulthood the MFM ratios decreased to <1 for all of the viral infections above except varicella, i.e. adult women were more frequently reported to be infected than men. Sex- and age-related differences in reported morbidity were also documented for bacterial infections. Reported morbidity for enterohemorrhagic Escherichia coli infection was higher in adult females and females were reportedly more infected with mycoplasma pneumonia than males in all age groups up to 70 years. CONCLUSIONS: Sex-related differences in reported morbidity for viral and bacterial infections were documented among different age groups. Changes in MFM ratios with age may reflect differences between the sexes in underlying development processes, including those affecting the immune, endocrine, and reproductive systems, or differences in reporting rates

“Spike” in acute asthma exacerbations during enterovirus D68 epidemic in Japan: A nation-wide survey

Background: In September 2015, Japan experienced an unusual increase in acute asthma hospitalizations of children that coincided with an enterovirus D68 (EV-D68) epidemic. The objective of this study is to investigate whether EV-D68 had a causal relationship with the spike in asthma hospitalizations. Methods: A nation-wide retrospective survey of asthma hospitalizations of children was performed for the period from January 2010 through October 2015. The Japanese Society of Pediatric Allergy and Clinical Immunology asked its affiliated hospitals to report monthly numbers of hospitalizations, ICU admissions and mechanical ventilations due to acute asthma exacerbation. The data were retrieved from medical databases using predefined search criteria: diagnosis of asthma or asthmatic bronchitis, admission, and age <20 years. Monthly numbers of EV-D68 detection were also obtained from the Infectious Disease Surveillance Center of Japan. A Granger causality test was used to analyze the association of EV-D68 detections for asthma exacerbation. Results: A total of 157 hospitals reported 87,189 asthma hospitalizations, including 477 ICU admissions and 1193 mechanical ventilations, during the survey period of 5 years and 10 months. The numbers of these events increased drastically in September 2015. The Granger causality test verified the association between EV-D68 and asthma hospitalizations/mechanical ventilations. The most-affected age group was 3–6 years old. Conclusions: The spike in pediatric asthma hospitalizations in Japan in September 2015 was found to be associated with the EV-D68 epidemic. Respiratory pathogens can cause “epidemics” of asthma exacerbation. Coordinated surveillance of infectious diseases and asthma may be beneficial for prevention and better control of both illnesses