Rainy season

From June to July is a rainy season（梅雨 ）in Japan, Korea and eastern china.

Rice seedling

The backyard of my Clinic is the small land for rice.
Today, rice seedlings are done by automatic rice transplanter machine.

Measles: An epidemic of Measles in Yamaguchi, 1991.

1) An epidemic of Measles in Yamaguchi Prefecture:
---In the past, an epidemic of Measles was noted in 1991(the peak was May) in
---Yamaguchi Prefecture (Population=1,560,000).

--------------------------- Reported numbers of Measles in Yamaguchi from 1991~1993.

---------Since then, no epidemics were occurred, except for small outbreaks, 

--------- in Yamaguchi prefecture.

2) The complication of Measles:

----Here, an example of the Measles's cases, who were hospitalized at Yamaguchi

--- University Hospital in 1991, with;

--------------- i) Pneumonia: 17 cases ( one case needed artificial ventilation)

-------------- ii) Encephalomyelitis: 5 cases

------------- iii) Croup: one case

------------- iv) Febrile convulsion: one case

Measles: 16 year old

~~~~~~~~~~~~~~~~~~
Measles: 16 year old boy
~~~~~~~~~~~~~~~~~~
He received Measles vaccine at 1 year old. So in this case, vaccine immunity
was disappeared.


1991.
January 14: started fever
----------15: high fever
----------16: high fever
----------17: Skin rash appeared from face, then upper trunk and extrimity.
----------18: Hospitalization. WBC 2,700(44%band. 22%seg, 20%lym.14% mon)，
--------------- CRP=3.3mg/dl
----------19: high fever, cough. Skin rashes appeared all over the body.
---------------------------------------But conjunctivitis was not severe.
---------------------------------------taken the photos;
-----------------------------1) Face:

-----------------------------------2) chest;

------------------------3) chest: enlarged

----------------------4) Koplik's spot: not so clear one.

----------------- January 20th:  skin rash of the arm.

        
------------------January 26:  skin pigmentation of arm. 10 yen coin for reference.

Measles:4 year old

Here show the case of Measles : 4 year old.

-----------Day 1:  fever start

ーーーーDay 2:  fever, cough and nasal discharge.

ーーーーDay 3:  Koplik spot appeared at night.

ーーーーDay 4:  Skin Rash appeared at Face.

ーーーーDay 5:  Rash from upper trunk and extremity to lower. 

------------------- WBC 7,000(Lym39%, Mon9%, Seg 45% ,Band7% ), CRP 0.43mg/dl.

ーーーーDay 6:  peak of Rashes.

ーーーーDay 8: no fever.  WBC 5,900(Atypical cells 36%, Lym 44%, Mon2%, Band5%, ーーーーーーーーーEos4%)

ーーーーDay 9: skin pigmentation.

Measles

I have seen no patients with Measles since 1999. In April, 1997, I opened
my clinic and only 3 infants with Measles until 1999.



What is Measles?

1) Etiology:  Measles virus

2) A typical case of measles begins with fever, cough, runny nose, red eyes, 

------- and sore throat.  2~3 days after, tiny white spots (Koplik’s spots) may

------- appear inside the mouth.

------- 3~5 days after, a red or reddish-brown rash appears. 

------- The rash usually begins on a person’s face at the hairline and 

------- spreads downward to the neck, trunk, arms, legs, and feet. 

------  When the rash appears, a person’s fever may spike to more than 

------- 104 degrees Fahrenheit.

------- After a few days, the fever subsides, the rash fades and 

------- skin pigmentation appear.

3) Clinical course of Measles:

麻疹＝Measles, 体温=Body Temperature, 発疹=skin rash，

コプリック斑=Koplik's spots,  結膜炎=conjunctivitis

はなかぜ=nasal congestion，せき=cough

4) Complications: 

------ i)  Pneumonia:  frequently in infant. usually, caused by bacteria

-------------------------such as H. influenzae or streptococcus pneumoniae.

------ ii) Otitis media: freuently in infant and toddler.

------ iii) Croup: acute laryngitis.

------ iv) Measles encephlo-myelitis: 6~15 year old are at risk.

---------- usually occur in recovery phase. Urinary and walking disturbance

---------- are the early sigh. Don't worry . Most cases recover without of 

-----------neurological sequerae

------ v)  Encephlitis:  1/1,000

------ vi) keratitis:  infant in the countries with vitamin A deficiency

------ vii) SSPE:  vary rare

Here, show the old photos of Measles:

1) high fever, cough, eye dischrges and skin rash:

2) Koplik's spot: look like candida infection.

3) skin pigmentation.

Hepatitis A vaccine

Hepatitis A virus is transmitted by the fecal-oral route (An object contaminated with
the stool of a person with hepatitis A is put into another person's mouth.)

I recommend the persons who travel or live in the countries of Central America,
South America, Mexico, Asia (except for Japan), Africa, and Eastern Europe.
→ more information
➞ http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/hepatitis-a.aspx

Hepatitis A vaccine:  
----------------1) inactivated Hepatitis A virus, which are cultured the cells , 
------------------ derived from the kidney cells of African green monkey. 
------------------ manufactured by Kaketsuken.1-6-1 Okubo, Kumamoto-shi, 
------------------ Kumamoto 860-8568, Japan.
----------------2) more than 16 year old.
----------------3) 3 times(0, 2~4 weeks and 6-month)0.5ml subcutaneously or 
                             intramuscularly.
                            　　　　　　　

Tetanus vaccine

~~~~~~~
Tetanus
~~~~~~~
Tetanus (lockjaw) is a serious disease that causes painful tightening of the muscles,
usually all over the body. It can lead to "locking" of the jaw so the victim cannot
open his mouth or swallow. Tetanus leads to death in about 1 in 10 cases.
Several vaccines are used to prevent tetanus among children, adolescents, and adults
including DTaP, Tdap, DT, and Td(Centers for Disease Control and Prevention)

Etiology: The bacteria(Clostridium tetani) live in soil and grow in oxygen free
----------- environment. The bacteria enter the body from the injured skin, such as 

-----------car accidents and skin incision site.

American Society for Microbiology, Microbe Library.

Vaccine:  Tetanus toxoid,
------------- 0.5ml, subcutatenously or intramuscularly.

------------- 2 times(3~8 weeks interval)

In childhood, Tetanus vaccine are administered 4 times as DTaP and again at 

11 year old as DT vaccine.  However, after 10 years the antibody titer against

Tetanus is declined.  This is the reason why doctors administer Tetanus vaccine

in the case of deep skin injuries.

Tunis, Tunisia(2)

Time stayed : November 21~24, 1987
Place : Tunis(capital), Tunisia
Major languages: Arabic (official); French
Monetary unit: Tunisian dinar


1) from Hotel (November 23, 1987)

2) the center of Tunis:

3) Sidi Bou Said is a town, which is located only 20 km from Tunis.
---------- The walls of houses is white and the window is Tunisian blue

                                      

Cartag, Tunisia

View Larger Map

Time stayed : November 21~24, 1987
Place : Tunis(capital), Tunisia
Major languages: Arabic (official); French
Monetary unit: Tunisian dinar

The total numbers of Japanese in Tunis: 70(10 children).

Cartage: Carthage is located on the eastern side of Lake Tunis across 

------------from the centre of Tunis.

                                      
                                     
                                     

Rabat to Casablanca

The road from Rabat to Casablanca:  good highway.

Rabat, Morocco

Time：November 18〜19
Place：Rabat, Morocco
Language： Arabic (official), Berber, French, Spanish
Monetary unit: Dirham

The Japanese in Rabat: 61 (+8 child). 
2 child was born in Dr. Benjelloun Hassan, Prof. Agrègè de Gynècologie-Obstètrique, 
du C.H.U. de Rabat 11, Rue de Meknès-Rabat. 
The lunch was served in Ambassador's residence.

Mausoleum of Mohammed V：

                                  

                                         

                                         

Hand, Foot, and Mouth disease

April 30th. 3-year-old boy came to my clinic.
--------- Hand-Foot- Mouth disease is small epidemic in a kindergarten.

Usually this disease is epidemic in Summer.  Recent weather in Ube city, 
is unpredictable; one day---- summer, next day---- autumn----- 
hot summer ------ .

1) Hand: small vesicles with no itching and no pain.

2) Foot:

3) Mouth:  sores(+) ------ cause pains---- sorry no photos.

Casablanca, Morocco

Time : November 16~18, 20~21, 1987.
Place: Casablanca, The Kingdom of Morocco
Major languages: Arabic (official), Berber, French, Spanish
Major religion : Islam
Monetary unit : Dirham = 100 centimes
Main exports : Minerals, seafood products, citrus fruit

The total numbers of Japanese, who live 3 months more = 50(+5 children).

We done health consultations of attaches, Embassy of Japan and other Japanese.

                           

the center of Casablanca

                                     

from hotel window

Rabies vaccine

Rabies vaccine(Kaketsuken)

1) Transmission: Bitten by rabies-infected dogs.
-------------------The most common wild reservoirs of rabies are raccoons, skunks, 

------------------- bats, foxes,coyotes, cats and cattle.
2) Rabies vaccine: Inactivated Tissue Culture Rabies Vaccine.

------------------ Rabies virus(HEP Flury strain), culture in Chicken embryo cells.
3) Manufacture:    Kaketsuken, Kumamoto 860-8568, Japan
4) Dosage :
----------- 1) pre-exposure: 3 times( 0, 4 weeks later, 6~12 months later)

------------------------------- subcutaneously( not intramuscular).
---------- -2) post-exposure: 6 times.

Any questions: write to Keiji Hagiwara, MD
---------------------------------Kami-Ube Pediatric Clinic,
---------------------------------Ube 755-0097, Japan
---------------------------------keijihagiwara@gmail.com

Herpes zoster (Shingles)

1) What is Herpes zoster (Shingles)  ?

small blisters with itching and burning pain

----- a stripe or belt-like pattern along with rib.

2)  Commonly occurs on the torso(65%), but can appear on the face, eyes (20%)
-------or other parts of the body(15%).  

Herpes zoster(the orbit of the eye and frontal head;

 the ophthalmic division of the trigeminal nerve)

 --------------✳ Ramsay Hunt syndrome: if affect the facial nerve to the 

vestibulocochlear nerve, resulting the hearing loss and vertigo.

Herpes zoster(back region)

Herpes zoster(Thigh region)

3)  The causative agent: Varicella zoster virus (=VZV )

Electron-microscopic image(white bar=100nm)

Herpes zoster occurs only in person who suffered from Chickenpox.  

After recovered, the virus live in the spinal nerve ganglia( There are 8 cervical nerves, 

12 thoracic nerves, 5 lumbar nerves and 5 sacral nerves) adjacent to the spinal cord.
When a person have a stress or aging, the VZV is reactivated and go through the
nerve and rise to the skin regions.

4) Age: the majority of sufferers are older persons. Rare in infant.

5) Treatment )   i) Topical ointment: the mixture of 10% Zinc oxide and 2% phenol.

---------------- -ii) Antiviral drugs:  Acyclovir, Valaciclovir

----------------- ☆ The rash and pain usually subside within one month in child, but 

--------------------- some elderly patients develops a painful condition. In such case,
----------------------Please ask doctors.

Any questions:    write to      Keiji Hagiwara, MD
---------------------------------Kami-Ube Pediatric Clinic,
---------------------------------Ube 755-0097, Japan
---------------------------------keijihagiwara@gmail.com

Mumps vaccine

Mumps vaccine( The Kitasato Institute Research Center for Biologicals)

Mumps vaccine:  a live attenuated vaccine.  

Age ::   one year old or older.

Side effect of vaccine:  aseptic meningitis(1/5,000~1/10,000 ??)

➞ MMR vaccine contain Mumps, Measles and Rubella viruses.

Mumps

Mumps: The swelling start from the site, under the Earlobe,

where parotid gland is there. Submandlbuiar glands are also

swelling.  At 2~3 year old, it is sometimes difficult to notice.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Mumps (Parotitis due to Mumps virus):
~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1) incubation period: 2~3 weeks
2) causative agent: Mumps virus
4) ages: 2~3 year and older.
5) complication:
------ i) After puberty, Orchitis occur, resulting the decrease of testicular Sperm's numbers.
------ ii) Aseptic meningitis: it's frequency may be 1/30~~1/300)
------ iii) Deafness: 1／10,000~20,000.

---- if your child suffered 2 or more times of Parotitis---- it is " recurrent parotitis".
----- Parotitis due to Mumps virus is suffered only one time.

6) prevention:  Mumps vaccine( MMR vaccine contain this vaccine)