Polar bear "Flocke"

Polar bear "Flocke" in 11 January, 2008
 Polar bear "Flocke" in 29 January, 2008.

"Flocke" was born December 2007 in Nuremburg zoo in Germany.  

On January 8th, the zoo decided to separate the baby from mother 

to protect from "carnivores -----  eating her own baby " .

Look the homepage of Nuremburg zoo.

   →   Photo and Video clips of the growth of Polar bear

Kawasaki disease

Typical face of Kawasaki disease: strawberry tongue, red &

cracked lips, red eyes and skin rash.

Edema & erythema of hand, skin rashes
Edema & erythema of foot, maculo-rash also noted.
Skin desquamation(peeling) begin fingertips at convalescent stage

In 1967, Dr. Tomisaku Kawasaki(Japanese Red Cross Central Hospital of Tokyo)

reported the first cases of Kawasaki disease in a Japanese Journal(1). I think,

this paper is one of the best papers in clinical medicine. He described in the

details of the symptoms, signs and clinical course of patients with many photos.

Later, in 1974, he reported a paper of MLNS(=Kawasaki disease) in the official

Journal of American Academy of Pediatrics(2). However, this English version

was not well described, as comparing to the Japanese one.

Since started as pediatrician in 1975, I have been interesting the etiology of

Kawasaki disease. One day in 1992, Human herpesvirus-6 was isolated from

blood sample of 4-month-old patients, but not another patients(3). The case

might have been co-incidental.

Today in Japan, the total numbers of patients is around 6.000 ~ 9,000 cases/year.

The searches for the causative microbe such as bacterias, viruses and fungus

have been failed.

1) Kawasaki T.,: Febrile ocuro-oro-cutaneous -acrodesquamatous syndrome

with or without acute non-suppurative cervical lymphadenitis in infancy and

childhood : clinical observations of 50 cases.

Jap.J.Allergy 16(39:178-222, 1967. ( in Japanese)

2) Kawasaki T, Kosaki F, Okawa S, Shigematsu I, Yanagawa H.: A new

infantile acute febrile Mucocutaneous lymph node syndrome(MLNS)

prevailing in Japan. Pediatrics 54(3);271-276,1974.

3) Hagiwara K, Yoshida T, Komura H, Kishi F, Kajii T.,: Isolation of

human herpesvirus-6 from an infant with Kawasaki disease.

Eur. J. Pediatr. 152(2)176,1993.

Any questions: write to Keiji Hagiwara MD,

E-mail: keijihagiwara@gmail.co

Brussels

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|||||||||||||||||||||||||||||||||||A party at ICP, UCL, Brussels Belgium in 1985.
||||||||||||||||||||||||||||||||||Lab. members at MEXP, ICP, UCL Brussels. 1985.
|||||||||||||||||||||||||||||||||||King Boudouin of Belgium visited the MEXP, Christian de

|||||||||||||||||||||||||||||||||||Duve Institute of Cellular Pathology,UCL, Brussels.

|||||||||||||||||||||||||||||||||||Professor Masson made a mini-lecture in the front of the particle

|||||||||||||||||||||||||||||||||||counting immunoassay apparatus in October 1985.

|||||||||||||||||||||||||||||||Princess Fabiola of Belgium visited Christian de Duve Institute of

|||||||||||||||||||||||||||||||Cellular Pathology in October 1985.

||||||||||||||||||||||Right; Dr. de Duve (Nobel Laureate in Physiology or Medicine in 1974).

Those are old photos. In the beginning of October 1985, King Boudouin and

Princess Fabiola visited the medical research center, named " Christian de

Duve Institute of Cellular Pathology ", Universite Catholique de Louvain,

Brussels, Belgium, where I had been working as a guest investigator.

King Bouduin made a short stop in the front of me, and

||||||||||||||||||||||||||||||||said ------ " Are you come from Japan ? "

|||||||||||||||||||||||||||||||||||||||||------ " Yes, Ube city, Yamaguchi, Japan.

||||||||||||||||||||||||||||||||||||||||||||||||||||||||Yamaguchi University School of Medicine "

Then, I followed the King with my camera and looked round the institute.

It's lucky chance to take the photo of King Bouduin. The Belgian are polite.

Nobody took photographs. However, afterward , many requests of photo's

reprints came upon me from the members of Catholic University of Louvain.

I studied a sugar-binding protein(lectin) Jacalin. Jacalin bind to

human immunoglobulin A1 molecule, but not bind to immunoglobulin A2,

immunoglobulin G, M, D, and E. Jacalin specifically bind to beta 1-3 Gal-GalNac.

and human IgA1 contain its carbohydrate. Nowaday, Jacalin is available from

commercial compamy such as Sigma-Aldrich.

1) Hagiwara K, Collet-Cassart D, Vaerman J-P, Masson PL,: Application of

||||||the quantitative latex agglutination assay to study glycoprotein- lectin

||||||interaction. In, Lectins: Biology, Biochemistry, Clinical Biochemistry.

||||||Vol 6: 505- 511. Sigma Chem. Co., St Louis, Missouri, U.S.A.1988.

2) Hagiwara K, Collet-Cassart D, Kobayashi K, Vaerman J-P; Jacalin:

||||||isolation, characterization and influence of various factors on its interaction

||||||with human IgA1, as assessed by precipitation and latex agglutination.

||||||Molec. Immunol. 25(1):69-83. 1988.

Any questions: write to Keiji Hagiwara MD,
|||||||||||||||||||||||||||||||||||||||||||||||||||E-mail: keijihagiwara@gmail.com

Chlamydia pneumoniae infection

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-----------------------------------------------------------------------------------------------

In the summer of 1994, I experienced an epidemic of whooping cough like

illness at an Junior high school in Yamaguchi Prefecture. I had consulted,

performed the physical examination, collected the sera, and taken the swabs

for the cultures of viruses and bacterias from the students with severe cough.

|||||Photo: one classroom of Mito Junior High school, Ooda, Yamaguchi. 1994.

|||||||||||||||||||||||||||||Photo: Epidemic curve of Mito junior high school.

(1) a case of upper respiratory infection(Case No 32).

|||||||A 13 year-old boy had started the cough, rhinorrea and sore throat on

|||||||June21 and gradually increased following 3 days. The cough was associated

|||||||with chest pain and was worsening during night without whooping.

|||||||During June 22 and 23, he had fever with maximum temperature of 38.4°C.

||||||||The physical examination on June 25 showed normal findings including

||||||||throat , chest auscultation. The white blood cell count was 7100/mm3 with

||||||||1% band, 60% segmented, 3% eosinophils, 1% basophils, 1% monocytes

||||||||and 34% lymphocytes. The C-reactive protein was negative. The cold

||||||||agglutinin titres were 1:32 (normal range <1:32).

|||||||||The Minocycline and cough remedies were prescribed upon a diagnosis

|||||||||of M. pneumoniae infection. The cough continued to July10. The cultures

|||||||||for Bordetella species, viruses and M. pneumoniae were negative. The serum

|||||||||antibody titers against M. pneumoniae were negative in both acute and

|||||||||convalescent sera.

i) Antibody titers against Chlamydia pneumoniae

-------------------------------IgM---------IgG

------------------------------------------------------------

June 29 (day 9)|||||||||||||||| <1:81 -------1:512

July 15 (day25) |||||||||||||||<1:8||||||||||||||||1:2048

-----------------------------------------------------------

ii) Chlamydia pneumoniae-specific DNA
-----------------------------------------------

July 6 -------------(day16) (+)

August 9----------(day25) (-)

September 1------(day38) (-)

-----------------------------------------------

|||||||||||||||||||||||||||||||||||Detection of Chlamydia pneumoniae- specific DNA

(2) A case of pneumonia (No.13)

A 15 year-old boy started the coughing on June 8. During June 9

and 11,he had fever with maximum temperature of 39.3°C. The cough

was associated with chest pain,nausea or vomiting and worsened night

without whoop. On June 20, he consulted a pediatrician of local hospital.

On physical examination, moist rale was audible in right lower lung.

The chest radiograph showed the infiltration in perihilar and right lower

area.

|||||||||||||||||||||||||||||||||||Chest X-Ray showed bronchopneumonia. 15-year-old.

The white blood cell count was 6,300/mm3 with 2% band, 41%

segmented, 1% monocytes, 56% Lymphocytes. The C-reactive protein

was 4.7mg/dl. The cold agglutinin titers was 1:128.

Clarithromycin and cough remedies were prescribed with a tentative

diagnosis of Mycoplasma pneumoniae infection. The cough was waned

gradually and lasted to July 6. The culture of Bordetella species,

Mycoplazma pneumoniae and viruses were all negative.

1) Antibody titres against Chlamydia pneumoniae

---------------------------------IgM ------IgG

------------------------------------------------------------

June 20th-------(days 13) 1:16-------1:128

September 1th (days 85) <1:8------1:1024

------------------------------------------------------------

2) Detection of Chlamydia pneumoniae specific DNA

------------------------------------------

June 6th------(days 29) : (+)

August 19th (days 60) : (-)

------------------------------------------

References:

1) Hagiwara K, Ouchi K, Tashiro N, Azuma M, Kobayashi K.

|||||||An epidemic of a pertussis-like illness caused by Chlamydia

|||||||pneumoniae. Pediatr Infect Dis J 18(3):271-275,1999.

2) Grayston JT, Kuo CC, Wang SP,: A new Chlamydia psittaci

|||||||strain, TWAR, isolated in acute respiratory tract infection.　

|||||||New Engl J Med 315(3);161-168,1986.

|||||||→ Dr. Grayston JT( School of Public Health and Community

||||||||||Medicine, University of Washington, Seattle) found that

||||||||||Chlamyia pneumoniae cause the respiratory tract infection in

||||||||||human.

3) Pether JVS, Wang San-Pin, Grayston JT:Chlamydia pneumoniae strain

|||||||TWAR, as the cause of an outbreak in a boys' school previously called

|||||||psittacosis. Epidem. Inf. 103:395-400. 1989.

|||||||→ From May to July 1980, 20 students and 4 staff were suffered from

|||||" bad cold" at a school in England. Antibody titers against Chlamydia

|||||psittaci were positive. But the extensive research failed to the transmission

|||||route. Nine years later, In 1989, Dr. Grayston examined the students sera

|||||and showed that it epidemic was caused by Chlamydia pneumoniae.

Any questions: write to Keiji Hagiwara MD keijihagiwara@gmail.com

An epidemic of a pertussis-like illness caused by Chlamydia pneumoniae

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In the beginning of June 1994. A telephone call from a school doctor of Mito

Junior High School, to my laboratory room, when I had been working as a

lecturer in the Department of Pediatrics, Yamaguchi University School of

Medicine.

Said ------- “ A numbers of students have been suffering from severe

||||||||||||||||||||||||||||coughing illness in my school. It is something different

||||||||||||||||||||||||||||from that of mycoplasma infection. Do you suggest me other idea ? “

It was summer, hot weather in Yamaguchi. It is curious phenomenonto such an

epidemic was occurred among junior high school students. After the phone call,

I decided to investigate this epidemic and to determine the causative microbe.

||||||||||||||||||||||Photo: Mito Junior High School, Ooda, Yamaguchi, Japan. 1994.

My first thought of causative microbes was a type of adenoviruses, bordetella

pertussis, or parapertussis. However, the culture for viruses, bacterias were all

negative. And finally, Chlamydia pnuemoniae was identified by the methods of

antibody titres and PCR analysis with the aids of Dr. Kazunobu Ouchi ( 2nd

department of Pediatrics, Kawasaki Medical School).

→　http://www.kawasaki-m.ac.jp/pediatrics2/

This was unexpected for me. Because previous reports of Chlamydia pneumoniae

infection showed that the clinical picture was similar to that of Mycoplazuma

pneumoniae infection. But in this epidemic the character of cough was different

from any other coughing illness.

I named this coughing illness as " chlamydia cold ", or "chlamydia flu".

||||||||||||||||||||||||||||||||||||||||||||||-----------------------------
||||||||||||||||||||||||||||||||||||||||||||||Summery of epidemic

|||||||||||||||||||||||||||||||||||||||||||||------------------------------

1) When: June-July (summer in Japan), 1994.

2) Place: Mito town (Population: 6,500, Major industry: Agriculture),

||||||||||||||||||||Low mountain area, near Akiyoshi Limestone Plateau.

||||||||||||||||||||Yamaguchi Prefecture, Japan.

3) Setting: Junior high school, Total students: 230

|||||||||||||||||||||||(12-14 years old, Male: female=114:116)

4) Type of disease: a pertussis-like illness.

||||||||||||||||||||||The cough occurred continuously and worsened during the night

||||||||||||||||||||||and early in the morning. The cough became more severe during

||||||||||||||||||||||the first week, but no patients had whooping or cough paroxysms.

||||||||||||||||||||||The mean duration of cough in cases with URI was 17.4 days and

||||||||||||||||||||||that in cases with bronchitis and pneumonia was 30.4 days.

5) Numbers of ill students:

|||||||||||||||||||||Pneumonia(1case)

|||||||||||||||||||||Bronchitis(9cases),

|||||||||||||||||||||Upper respiratory infection(126cases)

|||||||||||||||||||||Hospitalized students: 2 cases (exacerbation of Bronchial Asthma) .

|||||||||||||||||||||Five of the 19 teachers, and 54 members of 32 families of ill students .

6) Causative microorganism: Chlamydia pneumoniae.

|||||||||||||||||||||Cultures and /or serology for Mycoplasma pneumoniae ,

||||||||||||||||Bordetella pertussis, Bordetella parapertussis and viruses were

|||||||||||||||||||||all negative except for one case of adenovirus-type 1.

||||Photo: presentation at ICCAC meeting, The Moscone Center, September 1995.

References:

1) Hagiwara K., Tashiro N, Ouchi K.: Outbreak of Chlamydia pneumoniae

|||||||infection in a junior high school; its symptomatology and detection of

|||||C. pneumoniae by PCR. The 35th Interscience Conference on

||||||Antimicrobial Agent and Chemotherapy. San Francisco, The Moscone

||||||Convention Center. September 1995.

2) Hagiwara K, Ouchi K, Tashiro N, Azuma M, Kobayashi K. An epidemic

||||||of a pertussis-like illness caused by Chlamydia pneumoniae.

||||||Pediatr Infect Dis J 18(3):271-275,1999.

Any questions: write to Keiji Hagiwara MD, E-mail: keijihagiwara@gmail.com