We described general idea of influenzal pneumonia. and indicated that complication with pneumonia was less than 5% when Asian influenza raged, which was comparatively low. And then we reported our clinical experiences in 13 cases of influenzal pneumonia (12 cases of influenza A, 1 case of influenza B) who were, from 1957 to the first half of 1961, diagnoses at the department of internal medicine in the Sagamihara National Hospital.
Results
1) The cause of 6 cases were considered to be complications, while the other one was regarded as overwork.
2) Attack of the disease always followed the influenza.
3) Body temperature of the patients was 39°C level. Many of them developed congh, phlegm and chest pain. Physical abnormalities were positive in many of the patient's chests.
4) Pneunonia was recognized in lower area of lung; especially of the right lung.
5) While blood count was normal or near normal, and red cell sedimentation rate increased. Bacteriological examination of 7 cases' phlegm revealed staphylococcus in 5 cases, β-hemolytic streptococcus in 1 case and pneumococcus in 1 case.
6) Drugs were administered and effective in 4 cases out of 8, which was assumed the occurence of secondary infection.
7) As for seasonal distribution, this disease was found frequently in spring and next both in fall and in winter.
We also reported one case of influenzal pneumonia and one pneumonia case (mild type) of mixed infection of influenzal virus with bacteria.

抄録全体を表示

We studied on 206 cases of primary atypical pneumonia in broad sense and 283 cases of miscellaneous diseases except acute respiratory infections which attacked the patients from April 1957 to June 1961.
The complementf ixing antibody against adenoviruses of the above cases were examined and the results obtained were as follows:
1) Positive rate of antibody titer 8≤was 39.4% in the group of pneumonia, which was significantly higher than 21.5% in the group of miscellaneous diseases, In the group of miscellaneous diseases positive rates increased with age to 30-39, and had a tendency to decrease in advanced ages. On the other hand significant difference was hardly recognizable in the pneumonia group.
Positive rates in female were significantly higher than in male but with no significant difference. Incidentally we might derive suggestions that adenoviruses were considerably spread among human beings rather than the diseases caused by them were mostly primary atypical pneumonia.
2) In the process of the disease we had an increase or decrease of antibody titer 4≤as the diagnostic critarion of adenoviral infections, and we could detect adenoviral pneumonia in 22 cases (16.1%) out of 140 cases which were given serum tests more than twice.
3) Regarding the occurence of the 22 cases of adenoviral pneumonia, no significant differences were recognized by year. However, a few more cases were found in spring and summer than in the other seasons, but some cases were found in every season.
4) As for distribution by age, the disease was found from age 6-64, that is to say at all ages. Thirteen cases were male and 9 cases female.
5) Clinical picture of the disease was as the following:
The bgeinning symptoms were chill and high temperature which took place all of a sudden and severely. The high temperature came down in 4 or 5 days. One case developed conjunctival hyperemia, 8 cases acute rhinitis, 7 cases acute pharyngitis, 3 cases hoarseness and 3 cases swollen cervical lymphnode. Cough and phlegm always appeared; most phlegm was mucous and disappeared within 20 days. Physical findings in the chest were mild. Rales were ausculated in 11 cases, many of which were crepitant. One case developed diarrhea, and another nausea. Roentgenograms revealed densities mostly at the lower area of lungs, especially in the right lungs, and next on the upper area of right lungs. These densities disappeared in 11-30 days. Red blood cell sedimentation rate increased averaging 59mm and this returned to normal approximately in the 2nd-5th weeks. The white blood cell count was mostly remained normal.
6) Complement fixing antibody titer had a tendency to increase about the end of the 1st week to a maximum in 2nd-3rd week, and then slowly decreased.
7) The chemotherapy generally was ineffective, however, the therapy with antibiotics was found to be effective for cases with secondary infection. There were no deaths.

抄録全体を表示

For the last five years and half, from January 1956 to June 1961 at the Sagamihara National Hospital, using the psittacosis antigen the complement fixation test and hemagglution test were made. The patients examined were consisted of 253 cases with primary atypical pneumonia and 216 cases with miscellaneous diseases excluding acute bronchtis.
Epidemiological Findings:
1) The incidence of the antibody of CF was significantly higher in the group of pneumonia (38.0 per cent) than in the group of the miscellaneous diseases (22.5 per cent). The incidence in the group of patients with pneumonia was already high in the age group of 0-9 years and showed significant difference among the age groups, while the miscellaneous diseases group showed an increase in incidence with age. These findings suggest that the group of pneumonia containins many psittacosis patients. The similar tendency was recognized on the HI antibody titer, too.
2) The incidence of the antibody did not show any difference between male and female.
3) The CF and HI titer was generally low. In the group of miscellaneous diseases no case of CF antibody titer indicates 2.4 ≤ and HI antibody titer 80 ≤. This indicated that the patients with CF antibody titer 2.4 ≤ and HI antibody 80 ≤ had recently been infected with psittacosis.
4) Patients with a definite increase and or decrease in titer or an unusually high titer were found in 16 per cent (42 cases) in the pneumonia group. While in the group of miscellaneous diseases no cases were found. The clinical picture of these patients was in accordance with that psittacosis.
5) In spring and fall more cases with psittacosis are seen than the other seasons of the year. And there is no significant difference between male and female. Among people who have had contact with pet bird, we have more patients with psittacosis than in others.
Clinical Observations:
1) Clinically the above described 42 cases have similar symptoms with those which are described in literatures. In general the symptoms are mild and the complications are hardly encountered.
2) Many mild cases recover spontaneously and the serious cases are treated and cured by administering Penicillin, Chioramphenicol, Tetracycline and Erythromycine, Sulfonamide is nearly ineffective.
3) There were no deaths.

抄録全体を表示

From June 1955 to March 1961, 450 patients with so-called primary atypical pneumonia admitted the Department of Internal Medicine and the Pediatrics of National Chiba Hospital and 67 out of 150 patients indicated positive cold-agglutination reaction.
Investigations were made on their epidemiology, clinical symptoms, laboratory findings as well as their prognosis.
Results
1) The patients were 38 males and 29 females and they were found in their twenties.
2) Seasonal distribution-this disease occurs sporadically throughout the year, but more in fall and winter. The number of cases decreases markedly after spring of 1958.
3) Value of cold-agglutination reaction indicates 64 in many cases, it reaches highest in 1st-3rd week and then decreases gradually.
4) The disease develops gradually. Cough, expectration and fever are the main symptoms. However, no findings involving nose and throat of the patients were noted. Cheest physical findings are mild.
5) Blood picture-erythrocytes count normal. Leucocytes give normal or slightly increase, and half of the cases show increase of neutrophils and decrease of lymphocytes. These blood abnormalities all recover into normal by the end of 2 weeks after the outbreak of the disease.
6) The sedimentation rate is markedly elevated. Particularly the elevation is significant among the patients with severe clinical symptoms or high positive value of the coldagglutination reaction. The sedimentation rate returns to normal before the disappearance of the pulmonary densities.
7) Serum protein always normal. However, there are decrease of albumin, mild increase of alpha-globulin and gamma-globulin and normal beta-globulin.
8) Chest X-ray findings of radiating from hilus to periphery a diffuse and homogenous densities are noted in the lung field Particularly the densities are seen in the right middle or lower lobes. These abnormalities disappear within 30 days.
9) Recurrence of this type of pulmonary infiltration is rare and prognosis is good.

抄録全体を表示

Forty-five cases with positive cold-hemagglutination reaction and transient pulmonary infiltration were investigated clinically.
Cold-like symptoms were shown as general symptoms in one third of the cases. Cough and sputum were seen frequently, but the symptoms in the upper respiratory tract were seen infrequently. Eighty percent of the cases suffered from fever, of which body temperature was mostly 38°C-39°C. Physical findings in the chest indicated minimal abnormality. On red cell sedimentation rate 60% of the cases had middle-graded acceleration higher.
The cold-agglutination value was defined positive above 27, most of the cases showed 27 or 28 at their maximum value, most of which appeared in the 2nd-9th week. The pulmonary infiltration was observed in general in the lower lobes, Especially in the right lower lobe the infiltration was seen in the high rate of 44% and disappeared within the 2nd-9th week. But 73% of them disappeared within the 6th week.

抄録全体を表示

From 1960 to the first half of 1961 we studied 54 cases of primary atypical pneumonia in a broad sense, that were treated at the national hospitals belonging to our unit.
We performed A and B complement fixation reaction, adenovirus infection complement fixation reaction, psittacosis complement fixation reaction and cold hemagglutination reaction. The following are the results of our experiments.

抄録全体を表示

Since 1957 at 14 national hospitals field studies influenza vaccination were carried out 52 times. The student-nurses of the national hospitals were innoculated with Y₅ strain (Q-phase) or A₂ influenza vaccine, which was made from Adachi strain (P-phase of A₂ influenza virus), and hemagglutination inhibition titer (HI titer) before and after innoculation were measured to investigate their preventive effects. For the antibody measurement, at any times, Adachi strain was used as antigen.
Results
1) HI titer to Adachi virus (A2/Adachi/1957) to be able to avoid suffering from A2 influenza.
a) Individual Case
Judging from the results of the experiments which we will mention below, we should be able to conclude that in case of each person, if his HI titer is ≥1: 128, he will protected from contacting influenza. However, if it is ≤1.64 some may be protected and others will not.
(1) When Asian influenza oceured in 1957, at the 1st Tokyo National Hospital among 65 out of 82 student-nurses there was a mass outbreak of influenza.
In regard to the distribution of HI titer to Adachi virus before occurence of thed isease, it was indicated that 7 students had been ≥1: 128 and 75≤1: 64. 7 students with titer ≥1: 128 could prevent the influenza infection while 65 out of 74 students with titer ≤1: 64 could not prevent the infection and only 10 students did not contact the disease.
(2) In the 1st Tokyo National Hospital for a period of 9 months 114 students cought cold 184 times. Among the 84 times were A2 influenza. And their HI titers before the contact were <1: 16 77 times, 1: 16 twice, 1: 32-3 times and 1: 64 twice. These results indicated that the HI titer of each patient was only ≤1: 64.
(3) At the Ureshino National Hospital Nurse School there was an outbreak of influenza and 29 students suffered from A2 influenza. The distribution of the HI titer before contact indicated that 28 students had <1: 16 and 1 had titer 1: 16.
(4) In the Tochigi National Hospital, the 1st Tokyo National Hospital and the Iwakuni National Hospital there were 9 students who suffered from influenza more than two times. The distribution of HI titer before their reinfection was ≤1: 64 one was 1: <64, three 1: 32 and three 1: 64.
b) Case a Group
Even after every one of a group is infected with influenza, we cannot say that each one of them had a titer as high as ≥1: 128.
In both of the 1st National Tokyo Hospital and the Ureshino National Hospital after their group outbreak the distribution of H antibody was summarized as ≥1: 128 for 43.5% of the group while ≥1: 16 for 15.3% of the group.
From these results we are able to conclude that some groups shall able to avoid mass infection by A2 influenza, if the group is under the conditions: a) more than 45% of the members will have HI titer ≥1: 128, b) more than 15% of the members will have HI titer 1: 16, namely more than 85% of the members will have the antibody.
2) Standards available for judging the effect of A2 influenza vaccination after innoculation, if we do not have influenza prevalence at every proper season, we will not be able to investigate its protective effect clinically. For this purpose, before and after the innoculation of a group, we studied the distribution of HI titer, then we compared it with the following standard. This indicated, if someone of the group is found to have higher antibody than the standard, he is recognized to have the protective effect. The standard is as follows:
a) The member with HI titer ≥1: 16 should be more than 85% of the group.
b) The member with HI titer ≥1: 128 should be more than 45% of the group.
3) HI titer before and after the vaccination.
Vaccination can make one's HI titer higher only in the case that the one had more or less antibody, but the vaccination cannot produce one's titer higher because the one had no antibody at all.

抄録全体を表示