In order to clarify the effect of aging on tuberculosis in dialysis patients with being immunodeficient, an epidemiological study was done. The subjects were 150 dialysis patients with tuberculosis treated in 161 institutions. Observed incidence, fatality and mortality of tuberculosis were maximal at the 50s of age, at 40s and at 40s respectively, although the expected indices in the general population showed a remarkable increase with age. The resk ratio, observed/expected, of these indices showed a significant decrease with age, including slight exceptions. Male/female ratio was minimal at 40s, and increased both in younger patients and in older ones. Frequency of the extrapulmonary lesions of tuberculosis was higher in middle aged than in younger and in older patients. The frequency of pulmonary tuberculosis with extrapulmonary lesions was also high in middle aged patients. The mean number of organs involved in tuberculosis was grater in middle aged than in the younger and in the older patients. The frequency of causative diseases other than glomerulonephritis for renal failure was higher in middle aged than in other groups. Fatality, female/male ratio, frequency of pulmonary tuberculosis with extrapulmonary lesions, and mean number of involved organs in tuberculosis showed a correlative change with age. It is suggested that these indices would have some causal ralation.
A total of 3, 578 of Salmonella isolated from healthy Tokyoites during the 6-year period from 1976 through 1981 were tested for antibiotic resistance. We tested for transmissible R plasmids in 746 strains of those which offered resistance to antibiotics. The results obtaind are summarized as follows. Transmissible R plasmids appeared in 38% of resistant strains, but the frequency of isolation of Salmonella with transmissible R plasmids tended to decrease year by year. The frequency of strains with resistance to Tetracycline, Kanamycin, Ampicillin or Chloramphenicol mediated by R plasmids were high at about 70% for each, wherease those with resistance to Streptomycin or Sulphafurazole were low at about 40%. Transmissible R plasmids were seen with high frequency in resistant strains of S. enteritidis (100%), S. manhattan (86.5%) and S. panama (75.9%). In contrast, they were seen with low frequency in the resistant strains of S. london (3.8%), S. tennessee (11.1%) and S. give (15.0%). The demonstrated resistant patterns with R plasmids were characterized by serovars. The patterns of Tetracycline and Kanamycin in S. panama, Streptomycin, Tetracycline, Kanamycin and Ampicillin in S. manhattan and Tetracycline, Chloramphencol and Sulphafurazole in S. litchfield were few derived from other serovars. The fi (+) type of R plasmids were found in less than one-fourth of all the R plasmids. However, fi (+) type tended to increase in number, year by year.
Sepsis is known to occur most frequently among children with malignancies mainly leukemia and newborns, but the isolation rate of bacteria is lower in those patients, as it should be. As we have noticed in daily pediatric practice, the results of blood culture come not infrequently negative when the bacteremia is strongly suspected. To expose our present status of bacterial isolation by blood culturing, we reviewed the results of 1, 263 culture bottles, which were obtained during the last 4 years, from children clinically suspected for sepsis. Blood culture was performed 8 to 10 times more frequently among children with malignancies, as compared with infectious children with or without other underground disease entities, and blood culture was positive in 5.0% with BBL culture bottle and in 7.0% with BCB culture bottle. Among bacteria isolated, gram negative bacilli occupied in 65.9%, and K. pneumoniae, S. aureus and E. coli were the commonest bacteria. The artificial contamination was encountered 6 times more frequently with BCB bottle and this was significant statistically with P value of less than 0.005. The contaminants were mainly S. epidermidis and aerobic gram positive bacilli. At the time of diagnosis, WBC was less than 500/mm3 with leukemic children and more than 5, 000/mm3 with newborns.
A total of 54 cultures of coagulase-negative staphylococci were isolated from specimens of urinary tract infections as etiologic agent (≥105 CFU per ml) at Bacteriological Laboratory in Kyorin University Hospital, during a period from March 1980 through July 1982. These isolates were classified to species according to criteria proposed by Kloos and Schleifer. Number of isolates by species were 20 cultures of S. warneri (37.0%), 12 of S. epidermidis (22.2%), 10 of S. saprophyticus (18.5%), 7 of S. xylosus (13.0%), each 2 of S. cohnii, S. haemolyticus and S. hominis (3.7%), and 1 of S. simulans (1.9%), respectivery. The results suggested that S. warneri, S. epidermidis, S. saprophyticus and S. xylosus may be important species in causative coagulase-negative staphylococci in the urinary tract infections. Sensitivity tests of major isolates to 10 antimicrobial agents were performed by the agar plate dilution method. The results revealed that S. epidermidis was resistant to more kinds of antibiotics comparing those of S. warneri and S. saprophyticus. Sensitivity of these three species against each of penicillin G, oxacillin and cefazolin was different in grade. A number of multiple drug-resistant strains among coagulase-negative staphylococcal isolates was as follows: 5 of 14 S. warneri strains (35.7%), 2 of 8 S. epidermidis(25.0%) and 2 of 10S. saprophyticus (20.0%), respectively. None of 5 isolates of S. xylosus was multiple drug-resistant.
To evaluate the clinical efficacy and safety from using reduced and alkylated intravenous immunoglobulin preparation (COG-78) with antibiotics, the clinical studies were performed to patients with severe infections complicated with hematopoietic disease by cross-over method using a dried polyethylene glycol intravenous immunoglobulin preparation (PEG-γ G) as the control. Both test drugs were administrated with a dosage of 100 mg/kg/day respectively. The results were as follow: 1) Of 69 cases studied, the efficacy was evaluated on 54 cases: 44 received COG-78 and PEG-γ G. 2) 20 of 44 cases in COG-78 (45.5%) and 14 of 39 cases in PEG-γ G (35.9%) showed more effective than “GOOD”. 3) The effective difference between them appeared in 13 of 29 cases, in which 7 cases were preferable COG-78 and 6 cases were preferable PEG-γ G. Thus the efficacy of COG-78 and PGE-γ G resulted almost the dame level. 4) Mild rash as incidence of adverse effects was observed in only 1 of 69 cases on each COG-78 and PEG-γ G. Both preparations appeared equally efficacious from the point of clinical trials and adverse effects, so that we deserved COG-78 as one of the effective preparations combining with antibiotics for severe infection treatment.
A case of sepsis with Trichosporon cutaneum, a fungus that causes white piedra, is described. The patient, a 76-year-old male with atypical leukemia, had high fever for a week before his death. He received cytotoxic drug therapy and prednisolone, was severely neutropenic and was being treated with broad spectrum antibiotics. Permission for a postmortem examination could not be obtained. But blood culture before expire showed T. cutaneum.
A case of progressive systemic sclerosis (PSS) which indicated bilateral pulmonary infiltrates, marked hypoxia and respiratory failure associated with Mycoplasma pneumoniae infection was reported. A 35 year-old woman was diagnosed as PSS in 1978 and steroid therapy was done during the same year. She was hospitalized with a three day history of fever and dyspnea in March, 1982, at which time she was taking 10 mg, prednisolone daily. On admission her temperature was 38.0°C; blood pressure, 92/36mmHg; pulse, 132 beats/minute; and respiration, 60 breaths/minute. The chest x-ray showed diffuse infiltrates in the bilateral lung and arterial blood gases on ambient air breathing revealed Po2 of 45mmHg. Therapy with mechanical ventilation was instituted and the level of PEEP providing maximum effective dynamic compliance was 12cmH2O. And her treatment was started with intravenous administration of PIPC and of LCM. Her condition began to rapidly improved. On the 21th day of hospitalization, the passive hemagglutination titer to Mycoplasma was greater than 1: 640, a rise from a level on admission of less than 1:40. The Mycoplasma complement fixation titer rised from less than 1: 4 to 1: 16 on the 29th day. Antibiotic therapy was changed to minocycline and she was discharged on the 41th day. It will be necessary to consider such a patient with adult respiratory distress syndrome as Mycoplasma pneumoniae.