From June 1970 to November 1975, the frequency and organs of infection in the induction and the maintenance phase of hemodialysis (HD) were investigated in 118 chronic HD patients who had undergone hemodialysis at the Division of Artificial Dialysis, Kinki University Hospital.
The frequency of infection was as follows; during all phase of HD, 22.0%(26/118) in the induction phase of HD, 21.1%(18/85); and in the maintenance phase of HD, 7.7%(9/117). Infections in the induction phase of HD were more frequent than that in the maintenance phase of HD. Of the 18 patients with infection in the induction phase of HD, 14 had been already taken infection before starting the induction hemodialysis.
The frequency of infection on cause of chronic renal failure was as follows; chronic glomerulonephritis, 11.3%(7/62) in the induction phase of HD, 3.3%(3/91) in the maintenance phase ofHD: diabetic nephro pathy, 50%(3/6), 42.9%(3/7); polycystic kidney, 100%(6/6), 28.6%(2/7); and malignancy, 100 (2/2), 33.3%(1/3). In the both phase of HD, the frequency of infection in patients with diabetic nephropathy, polycystic kidney and malignancy ws higher than chronic glomerulonephritis.
The infected organs were as follows; in the induction phase of HD, urinary tract, 12 episodes (66.7%), respiratory tract, 2 episodes (11.1%), tuberclosis, 1 episode (5.6%); in the maintenance phase of HD, respiratory tract, 4 episodes (44.4%), urinary tract, 3 episodes (33.3%) and gastrointestinal tract, 1 episode (11.1%). However, there was no bacteremia or hepatitis in any patient.

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From January through December, 1979, 1, 225, 395 travellers were quarantined at Osaka Airport Quarantine Station and 3, 022 travelers reported that they were (or had been) suffering from diarrhoea. Bacteriological examination of stools of 819 patients was carried out and the following results were obtained.
1) Various enteric bacteria were isolated from 49.5% of the cases examined. The enteric bacteria isolated, number of cases and rate of isolation (in parentheses) were as follows: Salmonella, 128 case (15.6%); Vibrio parahaemolyticus, 118 cases (14.4%);Shigella, 29 cases (3.5%) and NAG vibrio, 22 cases (2.7%).Isolation of enterotoxigenic Escherichia coli was initiated in May 1979 and 120 cases were identified among 602 patients examined. The rate of isolation was 19.9%, which was thehighest among all the pathogens isolated.
2) There was no apparent seasonal variation in the rate of isolation of these enteric pathogens.
3) The rate of isolation was higher in older persons (more than 30 years old) than in younger ones (less than 20 years old)
4) When the period of travel was shorter (less than 6 days) V.parahaemolyticus and NAG vibrio were most frequently isolted;when the period of travel was about 1-2 weeks enterotoxigenic E.coli were frequently isolated;when the period of stay overseas was more than 1 month, the rate of isolation of Shigella and Salmonella were high.
5) The suspected regions.for infection with V.parahaemolyticus and NAG vibrio were South-East and.East-Asia, whereas those for other pathogens were various countries in Asia, the Near-East and Africa.
6) Several pathogens were isolated from the same patient in 52 cases.
7) Sixty-seven cases were healthy carriers of various pathogens.
8) The serovars and antibiotic sensitivities of the isolated pathogens were examined.

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Ten cases of Pneumocystis carinii pneumonia occurred during an 18-month period from October 1979 to March 1981 on the 40-bed hematology ward of Medicine III, Kanazawa University Hospital, where this infection had not been diagnosed previously despite appropriate studies. P.carinii pneumonia complicated 4 cases of acute leukemia in remission induction and 6 cases of acute leukemia and malignant lymphoma treated by bone marrow transplantation. The diagnosis was made at autopsy on 4 cases and by lung biopsy on 6 cases (open lung biopsy 1 and transbronchial lung biopsy 5). Clusters of 4 and 5 cases were observed during 2 quarterly intervals from October to December 1979 and from January to March 1981, respectively. The incidence of P.carinii pneumonia in all the patients at risk hospitalized during these 2 quarterly intervals was 12 and 14%, respectively. The patients with P.carinii pneumonia had been hospitalized on the ward in adjacent beds and rooms prior to their deaths or development of clinical signs of the infection. Especially during the first quarterly interval of 1981, the 5 patients developed P.carinii pneumonia within 2 to 3 weeks of one another. Moreover, 5 (56%) of 9 patients with allogeneic bone marrow transplantation, who survived more than a month posttranplant, and 1 (17%) of 6 with autologous bone marrow transplantation developed P.carinii pneumonia on the ward. The incidence in allogeneic transplantation was much higher than those so far reported. On the other hand, the risk of P.carinii pneumonia appeared to be correlated with increased intensity of immunosuppressive therapy. Thus, the outbreak of P.carinii pneumonia reported here suggested two possibilities: one, man to man transmission in acquisition of the infection and the other, activation of already latent infection related to more intensive immunosuppression.
Transbronchial lung biopsy proved to be useful for early diagnosis of P.carinii pneumonia. When the clinical situation is strongly suggestive of P.carinii pneumonia, lung biopsy should be performed promptly unless contraindicated by severe bleeding tendency.
Four of 6 cases of P.carinii pneumonia, on whom premortem diagnosis was made, were successfully treated with trimethoprim-sulfamethoxazole, but skin rash was seen in one.

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From January 1978 through December 1979, stools of 1, 193 patients with travellers' diarrhoea were examined at Osaka Airport Quarantine Station and Vibrio parahaemolyticus was isolated from 221 cases, the rate of its isolation being 18.5%, which was the highest of all the pathogens examined, such as Salmonella, Shigella, NAG vibrio and Vibrio cholerae. The following results were obtained in examinations.
1) Suspected countries of infection were the Phillipines, Thailand, Korea, Hong Kongand Taiwan, order of frequency of isolation of the organism. In most cases, infection originated in South-East and East-Asian countries.
2) No seasonal variation was noted, but infection in Korea occurred mostly from J une to October.
3) Other enteric pathogens besides V. parahaemolyticus were isolated in 33 cases.
4) The main symptoms of the patients were diarrhoea, abdominal cramps, vomiting and fever. Thirty-four cases passed diarrhoeal stools more than 10 times a day.
5) Most of the isolated strains were serotyped, but 44 of 224 strains could not be serotyped with available K-typing sera. A strain with a new 0-antigen was also isolated.

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The efficacy of Miloxacin (MLX), a new synthetic antibacterial agent, was compared with that of Ampicillin (ABPC) for the treatment of bacillary dysentery patients or carriers in a double-blind trial.
MLX and ABPC were administered in a dosage of 2.0/day for a period of 5 days respectively.
Of 176 cases studied, 44 were excluded from the analysis of clinical evaluation.
The subjects of analysis were 132 cases; 62 received MLX and 70 ABPC.
There was no significant difference between the two groups in terms of the background factors, patients characteristics, serotype of Shigellae and resistance pattern, showing comparability of both groups.
The results obtained were as follows:
1) With respect to the efficacy for symptoms as evaluated by the effect on defervescence, disappearance of bloody stool, decrease of number of defecation and improvement in stool character, MLX group was found to be significantly superior to ABPC group in all of these symptoms but defervescence.
2) Effect on bacterial discharge:
Bacteriologically, 95.2% of the cases for MLX group and 54.3% for ABPC group were rated as effective, with significant difference favouring MLX group.
Among the subjects showing ABPC resistance, 100% of the cases for MLX group were rated as effective as compared to 35.7% for ABPC group
Among the subjects susceptible to ABPC, the rate of effective cases was 92.1 % for MLX group and 66.7% for ABPC group.
Thus, bacteriological superiority of MLX group to ABPC group was shown with significant difference.
3) Clinical symptoms as side effects were observed in one case of those receiving MLX (1.1%) and 4 cases receiving ABPC (4.5%).
No major abnormalities of laboratory data due to the drug therapy were observed except for increase of BUN and serum creatinine values in one case receiving ABPC.
The incidence of side effects showed no significant difference begween the two groups.
From these results, MLX is considered to be very useful in the treatment of patients with bacillary dysentery or carriers.

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Shizuoka prefecture is one of the districts where endemic cases of scrub typhus have been seen. But all the cases were reported only in the eastern part of the prefecture. Recently, we experienced a case of scrub typhus infected in the western part of the prefecture.
The patient was a 46 years old male, a lumber dealer, who had walked around the mountainsides in the western part of the prefecture. He had had no history to step out of the western prt of the prefecture at least for a few months before the onset of the illness.
He had complained of high fever, general skin rash and enlarged left inguinal 1pmph nodes since November 21, 1980 and was admitted on December 1, 1980. On admission there was an ulcer covered with a black eschar on the left lower leg which was supposedly caused by a mite bite.
Weil-Felix reaction to Proteus OXK was negative, but the indirect immuno-fluorescent antibody titer rose up to 640x to Karp strain on the 23rd day after the onset.
There is possibility of occurrence of the illness even in the “un-infected” areas because Rickettsia tsutstigamushi is endemic in scattered areas throughout Japan.
Quick diagnosis of scrub typhus can be provided by clinical features, mainly typical ulcer caused by a mite bite, although the diagnosis is confirmed by isolation of the rickettsia or laboratory examinati on of immunofluorescent antibody titer.

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