A Case of Glandular Fever (Infectious Mononucleosis) in Hiroshima Prefecture

Isolation of the Causative Agent

Abstract

A patient with glandular fever was experienced by the authors in October 1959, in Nohmi Island, Hiroshima Prefecture with success of isolation of the causative agent.
The patient, Yoshimoto, a thirty years old male, a member of an agricultural cooperative association, was admitted to Hiroshima Red Cross Hospital on October 28, 1959, with the chief compliants of fever, malaise and headache. For a period of two' days before the development of acute symptoms he had headache. Sixteen days before. admission he had fever and headache and his temperature rose to- 39.4° on the followingday. He was treated for grippe or tonsillitis with administration of penicillin. But his remittent fever continued, and malaise, severe- headache, anorexia and sleeplessness were induced. All the symptoms had become progressively worse. On the eleventh day of the illness he noticed that the lymph nodes in his neck were swollen. On the sixteenth day he entered the hospital because of his continued symptoms.
At the time of admission, his temperature was 37.5°. No icterus, hemorrhage, orexanthem of the skin and of the mucous membrane was noted. The throat- was reddend and tonsills were slightly swollen. There was seen marked enlargement: of the cervical lymph nodes and of the right retroauricular lymph nodes, and the axillary and inguinal lymph nodes were also enlarged. The examination of the peripheral blood showed a white cell count 9, 600, of which 61.0% were lymphocytes (15.0% small lymphocytes, 34.5 large lymphocytes, 11.5% atypical lymphocytes), 2.0% monocytes. On the twentyfourth day of the illness the heterophile agglutination titer was 1: 56, and the agglutinin titer for Proteus OXK was 1: 80 and the titers for OXis, and for OX2 were negative.
On the eighteenth day of the illness his veneous blood was injected intraperitoneally into three mice and on the following day the emulsified excised retroaulicular lymph node from the patient was also injected into three mice. The infected mice began to die from thirteen days after the inoculation. At necropsy they showed remarkable generalized lymph node swelling and splenomegaly. Microscopic examination of impression smears made from the peritoneal fluid and stained by Giemsa's method revealed the presenceof numerous rickettsiae in protoplasm of cells.
The strain YOSHIMOTO was identified as Rickettsia sennetsu from the morphological, biological and immunological points of view.
Since Masao and Kobayashi isolated the first strain of R. sennetsu as the causative agent of infectious mononucleosis in 1953, they and some other investgators have isolated many strains of R. sennetsu from the patients with infectious mononucleosis, but it has been limited in Kyushu District.
The strain, YOSHIMOTO, is the first strain which was isolated on the outside of Kyushu District.