Laboratory methods of serological grouping and typing of the hemolytic streptococci, surveys on type distribution and alternation of predominant types of group A strains in Japan as part of a world-wide type distribution survey, comparisons of Kobayashi's hemolysis inhibition test and Maxted's bacitracin sensiti vity test at the screening level of the group A streptococci, and comparisons of the results of typing by Tagglutination and M-precipitation method are reviewed.
The present studies were undertaken to investigate some causes of discrepancy between sensitivity of a causative organism to the antibacterial agent, with which the patient is being treated, and clinical response. The following result were obtained. 1) The analysis of 542 cases with bacillary dysentery showed that there were many cases with poor or no response to the antibiotic given, to which the causative organisms were sensitive, among seriously ill and/or infant or aged patients and that, in contrast, there were many cases with good response to the antibiotic given, to which the causative organisms were resistant, among mildly ill and/or younger patients. These findings suggest an importance role of defence mechanism of the host. 2) Of various factors for discrepancy, the infecting bacteria, population of which may consist of resistant as well as sensitive cells, has to be taken into account. In view of this consideration, a new method to determine sensitivity distribution of the population was worked out. Reliability of the method was confirmed by testing the experimentally mixed culture of resistant and sensitive strains, and at the same time, the sensitivity of this experimentally mixed strain was tested by the ordinary sensitivity test procedures. By the one-concentration disk methods imcomplete inhibitory zone, indicating the presence of resistant and sensitive cells, was obtained, while by the agar dilution methods the presence of sensitive and resistant cells in the mixed strains mixture could sometimes be presumed by comparing the minimum inhibitory concentrations obtained both in large and small inoculum amount. However, both of these were not reliable. According to the data obtained by the same procedure for the organisms isolated from lesions, sensitivity of single cells fell in narrow range, in comparison with the experimentally mixed culture, and the distribution pattern varied considerably by spieces and by antibiotics. It was particularly so in the case of tetracycline where sensitivity of each single cells fluctuated considerably in wide range. It was entirely impossible by either the disk nor agar dilution method to detect the coexistance of resistant and sensitive cells in the case of clinically isolated organisms. These findings suggest that it is impossible by ordinary laboratory tests, except the case that double ringed inhibitory zone in the disk method is observed, to point out the coexistance of cells with various degree of sensitivity. It is, therefore, advisable to think of the fact that the strains tested consist of both the sensitive and resistant cells, together with other possible factors, in case in which the discrepancy between data of sensitivity test and clinical effect is observed.
Enteroviruses were detected during April to December, 1968, on 290 samples of cerebrospinal fluids, throat swabs and feces materials of 221 patients visiting medical practitioner's offices or general hospitalsin Matsue city, Shimane prefecture and giving suspicion of viral infections. Most of the samples were from the department of pediatrics of Matsue Red Cross Hospital and Dr. Nishino's office. In some of them, neutralization tests for Cox. B5 were paralleled by paired sera. Besides, the results of a serological survey carried out in Decembeir, 1967, the previous year, on a number of Children.at the age, 0-14, were presented as a discussion for 1968's prevalence of aseptic meningitis in this city. The summary is as follows: 1) Of all 290 materials, 84 were revealed as enterovirus positive; 25 out of 66 cerebrospinal fluids, 6 out of 58 throat swabs and 53 out of 166 feces materials. Thus, 60 patients out of 221 were virologically positive, the rate being 27.1%. 2) Isolation rate in every clinical diagnosis was 72.5% in aseptic meningitis, 33.3% in myalgia, 19.2% in what was tentatively diagnosed as fever disease, and 6.7% in herpangina. No viruses were isolated in 21 cases of pharyngitis, 1 case of stomatitis aphthosa, two cases of hand-foot-and-mouth disease, and other 10 cases. 3) The viruses were most frequently isolated in July and August. Ages of the cases were mostly within 0-7. 4) In aseptic meningitis, isolation rate is particularly high (51.8%) in cerebrospinal fluids. 5) No particular relation between cell count of cerebrospinal fluid and virus isolation rate is reognized. 6) Isolation rate was visibly higher in the case of specimens sent from the medical practitioners' than from the general hospitals. The gap was particularly wide in the case of cerebrospinal fluid. One of the reasons seemed to be procedural deficiency, such as delay in transportation, on the part of the general hospitals. 7) Neutralization tests for Cox. B5 were paralleled in 8 cases; 3 of them were Cox. B5-positive aseptic meningitis, 3 were virus-negative aseptic meningitis and two others were virus negative. Except one virusnegative aseptic meningitis case who had already shown positive at 16 folds in tht earlier serum, the later sera of all cases rose 4 times or over than the earlier ones in the antibody titer. 8) In serological investigations performed in December, 1967, the antibody possessing rate for Cox. B5 was null in the healthy children tested of 0-3 years age and low even in the age group 4-14. This fact is thought to be one of the main causes of 1968' prevalence of aseptic meningitis in this city.
Following the remarkable success of KM-AB. PC combination shown by Takahashi in the treatment of resistant (to usual antibiotics) bacillary dysentery, the authors would like to present in this paper another work by the use of Kanendomycin-AB. PC combination in dysenteric diseases putting main emphasis upon bacillary dysentery. This is in line with our arguing point that combination of poorly and readily absorbable antibiotics from the intestine can be regarded as the best of all medication, methods now available in this field. Kanendomycin (KDM), regarded as poorly absorbable antibiotic, is said to be equal to or sometimes superior over KM in antimicrobial activity in single use except for tuberculosis bacilli. The great expectation to this combination was to be allowed from the theoretical viewpoint. This expectation has not been betrayed. Case and method were: Cases were 60 of bacillary dysentery (19 of bacilli-positive clinical cases, 16 of bacilli-positive nonmanifested, cases, 25 of bacilli-negative but rectoscopically convincing cases), 13 of salmonellosis (7 of bacilli- positive, 6 of bacilli-positive but not manifested cases), 3 of pathogenic coli infections and 2 of staphy lococcus-isolated diarrheal cases, a total being 78 in number. In adults, the dosis was total 2g (KDM 1g and AB. PC 1g) divided into as 4 times a day; in infants, 1/2 of adult dosis was a rule. Medication time was 5 days except 2-4 weeks for salmonella carriers. Strains and resistant patterns were: All of isolated shigellae were 35, 21 Sonne and 14 Flexner, almost all of which were multiple (CP, TC, SM, SA) resistant but highly sensitive to KDM and AB. PC, respectively. All 13 salmonellae were also highly sensitive to KDM and AB. PC, but different from the shigellae, mostly resistant only to SM and SA. One pathogenic coli was sensitive to KDM and AB. PC, and resistant to TC and SM. The results of clinical applications were: Effects of the medication were viewed from stool frequency and appearance, eradicating effects to causatives, and rectoscopic mucus appearance. The effects were compared with those of singly-used-, KDM (2g daily) and singly-used AB. PC (2g daily). Recovery of stool frequency and appearance in bacillary dysentery was much the same between thecombination and the single use, about 80% being normalized within either 3 or 5 days in the both. Bacilli eradicating effects were best in the case of the combination (88.6% were turned negative within 3 days), followed by AB. PC (81.6%) and KDM (77.8%). Discharge rate was also lowest in the combination (redischarge cases plus continuingly discharge cases over 6 days were 5.7%), followed by AB. PC (10.6%) and KDM (29.6%). Rectoscopic recovery rate was best in the case of the combination (cases in which no ulcers remained at the end of 3rd week of illness were 84.4%), followed by KDM (78.6%) and AB. PC (70.0%). Through these experiments an impression was obtained that the dosis to infants set for by the authors was somewhat too small. It has to be studied further. Although relatively good effects were obtained in the case of salmonellosis and pathogenic coli infections, decisive comparison had to be reserved because of the scarcity of case numbers. At any rate, 5-day medication was not enough for these diseases.