Two strains of a small-colony type of Klebsiella were isolated from a throat of a patient with malignant lymphoma, who had received bone-marrow transplantation in the protected environmentprophylactic antibiotic program. Oral antibiotic regimen for intestinal decontamination consisted of gentamicin, vancomycin and nystatin. The small-colony variants were inferred to have arisen from the normal large-colony strain that had been isolated from both throat and stool cultures before the initiation of oral antibiotics, because these strains, including the 2 large-colony revertant strains from each variant, exhibited the same biochemical properties and antigenic constitution. The variants grew almost as actively under anaerobic conditions as their large-colony revertants or the parent strain .The parent strain was initially susceptible to streptomycin, kanamycin, gentamicin and amikacin, while exposure to gentamicin resulted in the subsequent appearance of the small-colony variants that were resistant to all of these antibiotics. Reversion to a large-colony type occurred with concomitant return of susceptibility to the aminoglycosides. It was, therefore, strongly suggested that the induction of such small-colony variants was associated with oral gentamicin intake. There was no evidence of infection due to such variants in our patient. If such infections may occur in patients who have received bone-marrow transplantation, difficult problems involved in their diagnosis and treatment might arise in laboratory and clinical medicine.

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The result of medications given to 8 cases of typhoid carrier, 2 cases of paratyphoid carrier and 2 cases of typhoid fever has been reported. All cases of carrier were female, and age distribution ranged from 41 years to 84 years. Gall stones were demonstrated in 6 cases of typhoid carrier and paratyphoid carrier.
Ampicillin, chloramphenicol, nalidixic acid and tetracycline were given to the carriers singly or by combined use of two of these antibiotics, but the administration of each drug failed in eradication of the bacilli.
Cholecystectomy was performed on one case each of typhoid carrier and paratyphoid B carrier. Following the operation, ampicillin was effectively administered in eradication of the bacilli.
Cefotaxime was given to 7 of remaining 8 carriers, and the administration succeeded in eradication of the microbe in 6 cases. The daily dosis was 3.0 to 4.0 g, and 1.0 g was given intramusculary each time. The period of administration was 7 to 14 days. The one case in which failure in eradication of the bacilli was noted in paratyphoid carrier.
Cefotaxime was given to two cases of typhoid fever. In one case, ampicillin seemed to be more effective than cefotaxime, but in another case, cefotaxime proved to be effective.
Antimicrobial activity of cefotaxime was very strong to the isolated Salmonellae as compared with ampicillin, chloramphenicol and cefazolin. The MICs of cefotaxime to the microbe were less than 0.05 μ/ml in inoculum size of 10⁶.
Severe adverse reaction of cefotaxime was not observed.

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Mycoplasma pneumoniae (M. pneumoniae) was inoculated into the tracheal organ culture of hamster and of human embryo using L-15 medium in order to observe change of the ciliary activity, growth curve of the organism and pathological pictures. Furthermore, the experiments of this organ culture added EM, TC and CP were performed to evaluate the efficacy of antibiotics in the nearest condition to the living body.
As a result, it was found that there was a close relationship between the inoculation dosis of M. pneumoniae and the damage of the ciliary activity; i.e., the more the organism inoculated, the earlier damage of the ciliary activity appeared. It was also found that the grade of ciliary activity was well correlated to the pathological change of epithelial cells.
The similar results was obtained from the experiment of human embryo tracheal culture. Disturbance of ciliary movement was more marked in the tracheal ring of human embryo than that of hamster, and it was suggested that the organism had good affinity to the human.
In another experiment, EM, TC and CP were added to the infected tracheal rings to observe antimycoplasmic activities. In the case where antibiotics were added more than MIC level, the ciliary activity was naturally well, and even in the concentration less than MIC, the ciliary movement was maintained better than of the culture without antibiotics.

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To clarify the infection mechanism of Shigella using experimental animals, we have attempted to obtain metal resistant organisms as the first step of our study.
The procedures and the results of the experiments are asfollows:
1) Cd, Zn resistant Sh. flexneri 3a was obtained by culturing of metal and antibiotic resistant E. coli and sensitive prototrophic Sh. flexneri 3a together and by selecting on Cd or Zn containing agar culture media. The resistant strains proved to be always resistant against both Cd and Zn, and they did not segregate into single metal resistant strain.
2) Between the original strain and the isolated resistant one, no difference was recognized onvirulence as well as immunological findings, but the resistant strain required reduced type sulfurcompound (i.e. Cysteine, Homocysteine, Reduced Glutathione, Na₂S and Na₂S₂O₃) for its growth on artificial media.
3) Measurement of metals in the organisms was carried out after the cultivation of the originaland the resistant strains in broth containing Cd (1 μg/ml) or Zn (10 μ/ml) respectively. There couldhardly be found any difference regarding Zn uptake between these strains, but Cd uptake of theresistant strain was markedly inhibited as compared with that of the original strain. In bacterialcells of both strains the distribution of these uptaken metals was in a quite similar proportion.
4) Non-virulent strain could be obtained by selective isolation from the virulent original strain as well as from the metal resistanct one. These strains retained almost the same biochemical and immunological characters except their virulence.

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KW-1062, a new aminoglycoside antibiotic, was administered at a dose level of 120 mg b.i.d. and the following results were obtained.
KW-1062 120 mg was intramuscularly administered to five healthy adult volunteers. After 30 minutes, they presented 7.28 μg/m1 of peak blood concentration. Mean recovery rate in urine was 84.5% for 24 hours.
When administered to three healthy adult volunteers every 12 hours for 5 days, no accumulation of the drug in blood was observed.
Overall clinical efficacy rate of KW-1062 was 71.6% in the treatment of 95 cases with respiratory tract infections. 72.2% of 36 patients with chronic bronchitis or panbronchitis and 69.0% of 42 patients with pneumonia or bronchopneumonia responded well to the drug.
Side effects were encountered with 11 cases (9.8%). The results obtained suggest that the drug is useful in the treatment of respiratory tract infections due to gram-negative bacilli.

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A 64-year-old man with monocytic leukemia for the past two years was admitted for general fatigue on April 20, 1978. On admission he was afebril and had slight anemia, knock pain at lower sternum and hepatomegaly. Laboratory data showed WBC 20, 600/mm³ with 30% leukemic cells, erythroblast 800/mm³, bleeding time 8 minutes, and erythrocyte sedimentation rate 68 mm in one hour. He was recieved Daunomycin, Cytosine arabinoside, 6-Mercaptopurine and Prednisolone without remission. Prednisolone was continued throughout his hospitalization, because he had had persistent granulocytopenia less than 500/mm³ since August 1978.
On November 25, he became febrile with spiking temperature of 37-39 °C, and complained of right hypochondral pain. Laboratory data showed WBC 97/mm^3, Alkaline phosphatase 38.5 KAu, γ-GTP 196 u and LAP 76 u. On these findings liver abscess was suspected, and chemotherapy of Cephalothin was started. From the blood culture on the next day, an oxidase-positive, glucosefermentative Gram negative rod, later identified as Aeromonas hydrophila, was purely isolated. The organism was sensitive to Chloramphenicol, Tetracycline, Minocycline, Kanamycin, Gentamicin, Tobramycin and Nalidixic acid, and resistant to Ampicillin, Carbenicillin, Cephalothin, Cephaloridine and Colistin. Therefore, Cephalothin was discontinued, and Tobramycin and Minocycline were started on the basis of antibiotic susceptibility. After a week he becamed afebril, but deteriorated gradually, and expired on January 13, 1979. Postmortum examination revealed left thoracic empyema and abscess formation in the liver and the spleen. From these abscess contents Aeromonas hydrophila was isolated again.
Associated with the use of immunosuppressive agents and antibiotics, infections due to various organisms that are not common human pathogens are increasing nowadays. Aeromonas hydrophila has been recently recognized as an opportunistic pathogen.

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We have recently experienced a bone-marrow transplant recipient with ecthyma gangrenosum and septicemia due to Pseudomonas aeruginosa.
An 18-year-old boy with aplastic anemia was treated by bone-marrow transplantation from his HLA-matched sister after conditioning with high-dose cyclophosphamide. He entered the isolation unit and took oral antibiotics for intestinal decontamination consisting of gentamicine, vancomycin and nystatin. (GVN). His stool flora was completely suppressed at leanst during the first week of antibiotic prophylaxis, after which he developed severe nausea and vomiting because of aggravation of preexisting post-transfusion hepatitis probably induced by cyclophosphamide and consequently discontinued GVN ingestion. He still remained in the isolation unit, receiving sterile food. He was also receiving systemic cefazolin and gentamicin. Two days after discontinuation of GVN therapy, however, he suddenly developed ecthyma gangrenosum at the peno-scrotal area, and P. aeruginosa was cultured from the ecthyma and from the blood. He died of septic shock 3 days after onset despite every medical treatment .P. aeruginosa was never cultured from any specimen prior to his entry into the unit.
It is thus emphasized that discontinuation of GVN therapy in severely immunodeficient patients often leads to a risk of life-threatening infection, although such antibiotic prophylaxis is effective to infection prevention.

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