Three-year study (April 1979 to May 1982) was carried out on Campylobacter enteritis in sporadic cases of diarrhea. Stool cultures taken from 1114 patients with acute diarrhea resulted in 13.6% and 8.6% isolation of Campylobacter in children and adults, respectively. The frequency of isolation of Campylobacter was superior in numbers to that of other enteropathogens among the same 1114 patients with diarrhea. Stool cultures were also taken from 6815 asymptomatic subjects including pregnant women and infants, and only 1% of the cultures were positive for Campylobacter.The age distribution of 111 patients with Campylobacter enteritis indicated an excess of infection in children: the excess, however, may mean that children withdiarrhea are more likely to be taken to hospital and that sampled are adults. Males were infected more often than females.
The symptoms included diarrhea, abdominal pain, and fever which were not specific in Campylobacter enteritis.It was noticed that occurrence of gross or occult blood in stool specimens and in the microscopy of stools presence of neutrophiles and red cells and campylobacters showing specific morphology and motility yielded valuable information for the diagnosis of Campylobacter enteritis. Apparent rising antibody titers of sera from convalescent patients and a long term positive stool cultures (2 to 7 weeks) were also confirmend as important features of the enteritis.
Biochemical characteristics and enzyme profiles of human isolates of Campylobacter were studied. Although insignificant differences of some enzymatic activities were observed among the isolates, all but 2 were determined to be Campylobacter jejuni.The two hippurate negative isolates were likely to be C. coli.
Two selective media, Skirrow's agar and Butzler's agar modified by adding 40u./ml of colistin, for the isolation of Campylobacter were compared using 48 positive stool specimens. It was appeared that the modified Butzler's agar was superior to the former in selectivity and isolation of C. jejuni and C. coli.

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Ninety five stool specimens from diarrheal patients were collected from 17 clinicsin the vicinity of Osaka and Kobe cities during the period from February 1979 to April 1980. An examination for these specimens showed that 8 cases were suffered from enterotoxigenic Escherichia coli infection. These patients have not been abroad during the last 6 months. In addiation, there is no close relation between the location of their residents and the date of onsets of the disease. Thus it is concluded that they were sporadic cases of enterotoxigenic Escherichia coli diarrhea infected in this country.

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Untreated human gamma globulin (Ig), pepsin-treated Ig and purified F (ab') 2 were examined for their protective effects on experimental bacterial infections in mice. All these preparations were similarly effective in protecting mice from death after intraperitoneal administration of Streptococcus pneumoniae NCTC 7465, Escherichia coli 81 or Serratia marscescens OH 942. The protective effect of pepsin-treated Ig decreased significantly when the Ig was absorbed with the bacteria used for infection of mice, suggesting that the protective effect of Ig is due to a specific antibody. Administration of Ig preparations inhibited growth of bacteria in the blood stream of infected animals. In vitro experiments with a macrophage cell line showed that treatment of bacteria with Ig preparations including F (ab') 2 stimulated phagocytic activity of the macrophages.

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The present report deals with epidemiological study of a food-borne epidemic of streptococcal phryngitis.
This outbreak occurred from July 17 to July 20 in 1969, at Oukunugi primary school (107 children) and Oukunugi Junior hign school (97 children), Hikigun, Saitama.
1) Number of patients by date of onset were 4 persons on July 17th, 44 on 18th, 15 on 19th, 6 on 20th, suggesting this outbreak being occurred by single exposure.
2) There found sixty nine patients (34%) out of 204 school children with following clinical signs; fever (94.2%), headache (91.3%), sore throat (66.7%), nausea (26.0%) and abdominal pain (23.1%).
3) As the results of the throat culture of 7 patients with paticulary severe clinical signs, Group A, T type 12 Streptococcus were isolated from 6 patients.
4) Sample of each foods of school-feeding from July 16 to July 18 were kept in a refrigator atprimary school. As the results of the bacteriological examination of those specimens, Group A, T type 12 Streptococcus were isolated from chow mein (YAKISOBA) supplied July 17.
The evidence suggested that chow mein of school-feeding was vehicle of infection.
5) The throat culture, the measurement of ASO titers and T antibodies of primary school children were carried out Augest 8 (23rd day after the onset of the outbreak). As the results, Group A, T type 12 Streptococcus were isolated from ten (10.6%) out of the 94 children. The rate of ASO titers elevated more than 166 Todd-unit were 92.3% in the patients and 38.5% in the healthy childrem. T antibodies had found in twenty nine (31.2%) out of the 93 children, however, only one case of T type 12 antibody could be found among them.
6) Carrier rate of Group A Streptococcus in the both school children were 26.7% in primary schooland 35.9% in junior high school about 6 months after the outbreak. Types of Group A Streptococcus isolated were T type 12 (88.5%), T type 4 (1.6%) and untypable (9.8%).
On the Distribution of ASO titers of 104 primary school children and 90 junior high school children there showed one peak at 166 Todd-unit in the both school children. Number of children who acquired T type 12 antibodies during these 6 months increased to eleven (18.6%) in primary school.
These findings indicate that the outbreak is a food-borne epidemic of pharyngitis due to Group A, T type 12 Streptococcus.

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The therapeutic effectiveness, safety and usefulness of CLINORIL (generic name: sulindac), a nonsteroidal anti inflammatory/analgesic agent, were evaluated in 72 patients with acute upper respiratory tract infections by an open trial.
The patients were administered of CLINORIL in a daily dose of 300mg given in b.i.d. for 4 days. The study period was from November, 1981 to January, 1982. As for the effectiveness a slight to marked improvement in pain symptoms (pharynx, swallowing, joint and muscle pain and headache) was attained in 62.2-75.0% on the 3rd day and in 69.2-92.5% on the 5th day. Antipyretic effect was showen in all the 25 patients with fever on the 3rd day. On the other hand, the improvement of fatigue and respiratory symptoms was poor being 29.4-55.6% throughout an observation period of 5 days. Symptoms of local inflammation, namely, redness and swelling of the pharynx, and the tonsil were improved in 52.8-65.0% on the 3rd day, likewise in 72.4-100% on the 5the day. Only 2 patients experienced adverse reactions of stomach discomfort.
Doctor's overall evalution on the usefulness of CLINORIL revealed that the treatment was quite useful in 19 (26.4%) of the 72 patients, moderately useful in 26 (36.1%), slightly useful in 22 (30.6%), ambiguous in 5 (6.9%), namely, of the 72 patients received CLINORIL those rated as slightly to quite useful were 67 (93.1%).

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The effect of several immunoglobulin preparations was investigated using an in vivo experimental model of infection in mice, inoculated with P. aeruginosa, K. pneumoniae or S. marcescens by intraperitoneal infection. Several immunoglobulin preparations (Pep-Ig, PEG-Ig, S-Ig) and antibiotics (cefotaxime, piperacillin and tobramycin) were administered to the infected mice and the therapeutic efficacy of each drug in monotherapy or in combination (antibiotic+immunoglobulin) was examined.
Ther results were as follows:
1) Pep-Ig, PEG-Ig and S-Ig administered alone intraperitoneally were all effective against P. aeruginosa infection.
2) Pep-Ig and PEG-Ig were more effective when administered intraperitoneally than intravenously. The survival rate rose with an increase in the dose of Pep-Ig, while it decreased when the inoculum size was increased. A certain concentration of the immunoglobulin seems to be necessary to achive thera peutical success.
3) Pep-Ig combined with each of the antibiotic showed a synergistic effect against all organisms.
4) Antibody titers of the immunoglobulin perparations were measured against each organism. Pep-Ig and PEG-Ig preparations had almost the same titer, while S-Ig showed slightly less values against P. aeruginosa and K. pneumoniae.
5) The effectiveness of Pep-Ig in the treatment of infection is apparently related to its antibody titer, influence on phagocytosis, and activation of the complement system.
The results of this study showed that a combined therapy with an antibiotic and Pep-Ig is effective in treating infections by P. aeruginosa, K. pneumoniae and S. marcescens.

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Whilst development of antibiotics is remarkable, there are only few reports available concerning their change in intestinal flora by administration of antibiotics. Moreover, pseudomembranous colitis and bleeding tendency considered to be caused by Vitamin K deficiency are current topics in antibiotics therapy. Therefore, mono, di and tetra contaminated mice were produced from ICR 4-6 week old male germ free mice, and the change in intestinal flora by intramuscular administration of antibiotics were discussed.
The results were as follows:
1) No change was observed both in the number of organisms and Minimal Inhibitory Concentration (MIC) by administration of Gentamicin and Cephalothin.
2) No change was observed in the number of organisms when Ampicillin (ABPC) was administered to mice mono contaminated with E. coli. MIC of ABPC against E. coli rose from 6.25μg/ml to more than 100μg/ml from the 2nd day. In mice di-contaminated with E. coli and Lactobacillus (Lacto.), aslight decrease in both organisms was seen, but no change was observed in MIC of ABPC against E. coli. In mice tetra-contaminated with E. coli, Lacto., St. faecalis and Bacteroides fragilis (Bacteroides), a slight decrease was observed only in Lacto. in feces, but a marked decrease in all kinds of bacteria was observed in the middle and lower parts of the small intestine.
3) A marked decrease in E. coli and a slight decrease in Lacto. were observed when Cefazolin was administered to mono, di and tetra contaminated mice. In tetra contaminated mice cases, a marked or a slight decrease in Bacteroides were observed.
4) A marked decrease was observed in E. coli and Bacteroides, and these bacteriae could not be detected from the 4th day when Cephems such as Cefmetazole (CMZ), Latamoxef (LMOX) and Cefmenoxime (CMX) were administered to tetra-contaminated mice. No change was observed in the number of St. faecalis. A slight decrease was observed in Lacto. by administration of CMZ. and LMOX. On the other hand, a marked decrease was observed by administration of CMX.
5) A decrease in sensitive organisms and an increase in resistant organisms were observed by parenteal administration of antibiotics such as Cephems, in which Bacterial spectrum is broadened and large quantities are discharged from bile.

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Epiphenomenon such as superinfection and opportunistic infection, which were caused by administration of broadened spectrum antibiotics, makes it difficult to treat infectious disease. Considering that superinfection often occurs in intestinal flora, the change in intestinal flora by administration of antibiotics in clinical cases was discussed. Also the relation between the frequency of superinfection in Urinary Tract Infection (UTI) and the fluctuation of bacteriae in feces by administration of antibiotics was discussed.
The results were as follows:
1) No change in the number of organisms was observed by administration of Cephalothin (CET).
2) By administration of Ampicillin (ABPC), a remarkable decrease in ABPC sensitive St. faecalis and Clostridium was observed. On the other hand, no change was observed in the number of other kinds of bacteria. By administration of Cefazolin (CEZ), no change was observed in thenumber of organisms except for a decrease in E. coli.
3) By administration of Cephems such as Cefmetazole (CMZ), Latamoxef (LMOX) and Cefmenoxime (CMX), a remarkable decrease was observed from 3rd-4th day in all kinds of organisms except for St. facealis and Yeast. Especially by administration of CMX, only St. faecalis was detected. Viable cell count of anaerobic bacteria, especially the Clostridium group, returned to the previous level soon after the discontinuance of Cephems. As for cell count of aerobic bacteria, especiallyE. coli, it returned slowly.
4) Diarrhea was often observed during the administration of Cephems, and it never stopped until the administration of Cephems was discontinued, especially in infants cases. From this result, it can be considered that the relation between diarrhea and the change in intestinal florais very close.
5) Frequency of super-infection occurring during antibiotics therapy of UTI was discussed from the investigation of 38 patients during the period of 5 years. The results were the following: 0/16 by administration of CET and Aminoglycosides, giving few influence on intestinal flora. On the other hand, 2/10 (20%), 0/2, 4/11 (36%) by administration of ABPC, CEZ and Cephems, respectively. The results suggest that superinfection occurs more frequently during the administration of antibiotics, which give much influence on intestinal flora.

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Clostridium difficile was isolated from blood culture from a 86-year old woman suffering from SBPC induced colitis. Enterobacter and Klebsiella were also isolated from the blood and C. diff'iicile was also isolated from the stool. She developed septic shock and DIC, and died 12 days after C. difficile had been isolated.

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A 63-year-old man was admitted on January 5, 1981, complaining of headache, cough and a lowgrade fever. Neurological examination revealed neck stiffness and papilloedema. Chest X rays showed infiltrative shadows with a large irregular cavity in the right upper lung. Lumbar pressure disclosed an opening pressure of 320 mmH₂O. The CSF and sputum smears revealed numerous cryptococci. A CT-scan of the brain showed a low-density area in the left basal ganglion. He was diagnosed as having pulmonary cryptococcosis and cryptococcal meningitis with cerebral cryptococ coma. He was treated intravenously with amphotericin B and orally with flucytosine for 2 months. This combined therapy partially improved the cough, headache and CSF findings, but side effects caused by the amphotericin B's toxicity appeared, i.e., polyuria, hypokalemia, a fall in creatinine clearance, anorexia, anemia and general malaise. Because of these problems with the amphotericin B therapy, the miconazole therapy was begun at 200mg intravenously every 6 hours and 20mg intrathecally every 3 days. In order to inject miconazole into the ventricle an Ommaya reservoir was inserted into the anterior horn of the right temporal ventricle on April 9, 1981. The miconazole therapy was continued intravenously (1200mg per day) and intraventricularly (10mg per day). He tolerated the miconazole therapy well, with no side effects, and gradually the cough, sputum and headache were improved. After 8 months, the CSF pressure returned to the normal level and the infiltrative shadows in the chest radiograph disappeared. Miconazole thus proved to be an effective and only weakly toxic drug in the treatment of cryptococcal meningitis.

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