Using techniques of whole blood microculture assay, activity of lymphocyte transformation (LTF) to C-polysaccharide of group A streptococci was studied in 6 groups. These groups were:(1) 12 newborn babies (cord blood), (2) 21 normal children, (3) 91 normal adults, (4) 33 patients with scarlet fever (SF) on adomission, (5) same patients on discharge, and (6) 10 patients with acute glomerulonephritis (AGN) or acute rheumatic fever (ARF). The degree of LTF activity measured by uptake of ³H-thymidine and expressed by stimulation index (SI). A stimulation index of ≥3.0 was considered a significant response (SR). Among these groups, the highest activity was obtained from normal adults (mean SI=11.0, SR rate 57.1%), and moderate activity was recognized in cord blood (mean SI=3.5, SR rate 41.7%), patients with SF on discharge (mean SI=3.6, SR rate 33.3%), and patients with AGN or ARF (mean SI=5.5, SR rate 30.0%), and the lowest activity was seen in patients with SF on adomission (mean SI=1.6, SR rate 9.1%) as well as normal children (mean SI=1.2, SR rate 9.5%). No statistically significant difference was recognized in moderate response groups as compaired with normal children, however, a significant increase of LTF response was shown in patients with SF on discharge (p<0.05). In 5 of 12 cord blood specimens significant response was detected. Not only T but also B lymphocytes were stimulated. These findings suggest that both a specifici and a nonspecific response are involved in this LTF activity to Cpolysaccharide of group A streptococci.

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1. Two successive epidemics of streptococcus infection occurred in nursery schools and kindergartens of 0 town in Toyama prefecture during the latter half of 1980. The first outbreak, to June to July, total number of patients being 77, was among children of A nursery school and B kindergarten in 0 primary school zone of this town. The second one, from September to November, total number of patients being 21, occurred among children of C and D nursery schools and E kindergarten in K primary school zone adjacent to the district where the first epidemic occurred. The causative agent of the former epidemic was type M12 group A streptocococcus resistant to erythromycin, and of the latter, the same serotype but sensitivie to erythromycin. During the second outbreak, sporadic cases of streptococcus infection caused by type B3264 and scarlet fever caused by type M1 were also detected.
2. Examinations on background populations with regard to carrier states of streptococcus revealed that there were significant number of healthy. carriers of the same serotype and antibiotic sensitivity as the epidemic strains in accordance with each peak of epidemics. However, carriers of the epidemic serotype gradually decreased among children in both 0 and K school zones. Instead, type M1 carriers increased in both school zones in December the same year, when two sporadic cases of scarlet fever due to type Ml were reported.
3. Follow-up examinations conducted next year (1981) revealed that there were few carriers of the epidemic serotype among children in both 0 and K school zones with exception of one class in C nursery school, where several carriers of the epidemic serotype (A M12 sensitive to erythromycin) were found in July and October. A few carriers of type M1, however, were still found among children in both school zones.

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The present paper is concerned with the results from an epidemiological investigation of group A streptococci in Nishime Town with high incidence rate (201.3 per 100, 000) of scarlet fever and in Jumonji Town with low incidence rate (3.6) in Akita Prefecture.
During the period June 1972 to January 1975, 699 children of two elementary schools and a kindergarten (Nishime) in the two districts were tested for 9 times, once every 3 to 5 months. Group A streptococci were isolated from 320 (5.3%) out of 6, 206 throat swab specimens, and255 (36.5%) out of 699 children were positive for the streptococci at least once in nine isolation tests.However, no significant differences between recovery rates in the two districts were observed because the rates were 5.4% in Nishime and 4.9% in Jumonji, respectively. Whereas 39 patients with scarlet fever occurred in Nishime within the above mentioned period, in spite of no patients in Jumonji.
Recovery rates that were well correlated with seasonal incidence of scarlet fever in the prefecture, were higher in winter to early summer than in autumn. Although age distribution pattern of patients with scarlet fever in the prefecture had the highest peak in aged 4 to 6 years group, the highest recovery rates of the streptococci was indicated in aged 8 to 9 years group. That is, children aged 8 to 9 years carried out an important transmissionable part of the streptococci.
Ten serotypes were recognized among 299 (71.6%) out of 320 isolates, as follows: type 12 (24.4%), B 3264 (22.5%), 1 (9.1%), 5 (7.2%), 4 (5.6%), 6 (0.9%), 11 (0.9%), 3 (0.3%), 22 (0.3%) and 25 (0.3%). Recovery rates of type 12 and type 5 streptococci in Nishime were significantly higher than in Jumonji, and the rates of type B3264 and type 1 streptococci in Jumonji were significantly higher than in Nishime.

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Epidemiological study on infections due to hemolytic streptococci isolated from throat swabs of school children was carried out every two months from Novemver, 1980 to Novemver, 1982.
The grouping was predetermined at first by Phadebact Streptococcus test followed by the agglutination test using immunized rabbit serum and the strains were classified into A, B, C and G groups.
Detection rates of hemolytic streptococci ranged from about 15 to 80%. The mode of the rates was between 40 and 50%.
Group A streptococci were most frequently detected and occationally group B streptococci were highly detected.
Group C streptococci were very rare.
The monthly detection rate of the group A was in the following order: type T-12, T-6, T-B3264 and T-13.
Among school-classes, type T-12 was found in ex-6th graders and 6th graders, type T-6 in 5th and 4th graders, type T-13 in 3rd graders, type T-13 and T-B3264 in 2nd graders, type T-B3264 in first grader, and type T-8 in the freshmen.
Group B streptococcoi were detected in a higher rate compared with those reported previously by other researchers.
Among the group B, type Ia and III were most frequently detected.
However, no significant difference was found in a frequency between types BIa and III in each month and each school-class.
The relations between the detection rate of group A streptococci and numbers of positive school children were studied among school-classes.
As a result, the numbers of the positive children more in second graders and 5th graders who were detected were group A streptococci were at a high rate.
The same tendency was observed in group B streptococci.

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Group A, B, C and G hemolytic streptococci isoltaed from healthy school children in Osaka city were studied on their susceptibility to various kind of antibiotics.
Among antibiotics of penicillin group tested, penicillin G was the most active against all groups of hemolytic streptococci, and then ampicillin and amoxycillin followed.
Cicracillin and sulbenicillin were less active compared with the other penicillins against all streptococci studied, but no resistant strains were found to these antibiotics.
In the cephalosporin group tested, cephaloridine was found to be the most active against all groups of streptococci. On the other hand cefaclor and cephalexin were less active to all groups of streptococci. However all streptococcal strains tested were susceptible to these antibiotics. Group B hemolytic streptococci were rather resistant to cephalosporin group antibiotics such as cephaloridine, cephalothin, cefazolin, cephalexin and cefaclor compared with the other groups of streptococci.
In the macrolide group, erythromycin, oleandomycin and josamycin were studied on their growth inhibition against group A, B, C and G streptococci. The all antibiotics showed a broad distribution of MIC and resistant strains were found in group A, B and G.
Tetracyclin showed a broad MIC for all bacteria studied and the resistant strains were found.
Chloramphenicol was similar to tetracycline in activity against group A and B streptococci. Some resistant strains to chloramphenicol were seen in group A and B streptococci, but not in group C and G.
Resistances to various combination of drugs in group A, B, C and G were studied. Judging from the results, type T-12 group A streptococci were resistant to tetracycline, chloramphenicol or the both drugs.
Resistance to tetracycline was found in type T-4, T-12 and T-13 group A hemolytic streptococci and type Ia, Ib, Ic, II, III and III/R of group B hemolytic streptococci. Although resistance to chloramphenicol was found in type T-4 and T-12 group A streptococci and type Ia group B strepatococci, both type T-12 group A streptococci and type Ia, Ib group B streptococci was resistant to the combination of tetracycline and chloramphenicol, respectively. In the type Ic, group B hemolytic streptococci, a resistant strain to the combination of erythromycine, oleandomycine josamycine, tetracycline and chloramphenicol could be found.

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Agglutinin titers of ninety-eight sera from healthy school children were determined by using trypsindigested cells and pepsin-digested cells of group A streptococcus strain T2, and the titers were compared with those obtained by ASP reagent. Trypsin-digested cells, pepsin-digested cells and ASP reagent revealed significantly different mean-titers of agglutination, i.e. 33, 188, and 425, respectively. On the other hand, there was good correlation between the results by any pair of the three agglutinating antigens.

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The antibodies of patients with hemolytic streptococcal infections and healthy children to extracellular or intracellular substances produced by the hemolytic stretococcus has been studied by many investigators.
The four kinds of antibodies ASO, ASK, anti-hyaluronidase (AHD) and anti-NADase (ANAD), were assessed in this study. AHD and ANAD were determined by new microtiter methods.
In result, in 479 healthy children from 6 to 15 years old, ASO titers were less than 320 in 83.3% of them, ASK titers less than 2560 in 76.4%, AHD titers less than 128 in 82.7% and ANAD titers less than 80 in 89.6%.
The correlation coefficients were 0.705 on between ASO and ASK, 0.702 on between ASO and ANAD and 0.467 on between ASO and AHD.
In the children in E-elementary school we isolated strains of group A streptococci from their throats every two month for a year. We had high titers of antibodies in sera of children from whom group A streptococci were isolated for several times. To the contrally, we had low titers in sera of children isolated no or a few times. In addition, we found high ASK and AHD titers in 25.0% and a high ANAD titer in 7.1% of cases with both low ASO titer and positive group A streptococci in a swab culture test.
In 21 cases of streptococcal infectious diseases the cases with elevated titers were found in 16 in ASO and ASK, 14 in AHD and 10 in ANAD. We had 3 cases with an elevated titer of AHD only among 4 antibodies.

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We have studied the reappearance of group A streptococci in scarlet fever patients after 10 day administration of antibiotics.
The patients were 294 cases hospitalized in five city hospitals during a 6 month, December, 1980 to May, 1981.
Antibiotics mainly employed were ACPC (35.7%), TAPC (25.2%), ABPC (13.3%), CEX (6.1%), and PC-G (6.1%). Medication dosis was most frequently 31-40mg/kg. Medication started most frequently from 3rd day of illness.
Group A streptococci were isolated from 153 cases at the onset of medication, and in every case, they completely disappeared during the therapy.
Reappearance of the organisms after the end of 10-day therapy was found in 9 cases (5.9%).
Reappearance rated with respect to individual drugs were 14.3%, 11.5% and 6.8% in the cases of PC-G, ABPC, and ACPC, respectively. Reappearance was not met with the other drugs.
The reappearance rate, 5.9%, was not significantly different from the rate, 5.0%, obtained by 7-day administration therapy reported previously.

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