A preliminary report of acute hepatitis in 1979 suggested that there were a large number of non-B hepatitis. This paper reports the results of further investigations. The patients were admitted to our hospital as acute sporadic viral hepatitis on clinical and biochemical evidence from April, 1976 through October, 1980. Acute and convalescent sera, stored at-20°C, from 66 patients were available for study. Radioimmunoassay was adopted for hepatitis A. R-PHA for HBsAg and radioimmunoassay for IgM specific anti-HBc were chosen for acute hepatitis B. Patients without serological markers of infection to either hepatitis A or B in both acute and convalescent sera were tested for antibody to EB virus. Transfusion-associated hepatitis was excluded.
Twenty four of the 66 patients tested had evidence of infection with hepatitis A, 19 were positive for HbsAg, and 3 had IgM-specific anti-HBc in the acute serum. There was no patient with the antibody to EB virus. Thus 20 patients were accepted as having non-A, non-B hepatitis.
In non-A, non-B hepatitis the ratio of male to female was 1.2 to 1. Nearly half (9/20) were young adults aged 20 to 29 and there were 2 patients over the age of 60 years. The illness took place through the year and showed a low rate of incidence in the summer. The duration of jaundice was significantly longer than in the patients with hepatitis A (p<0.05) and hepatitis B (p<0.01). A mean of peak serumbilirubin was highest in this form of hepatitis without any significant difference. The abnormal level of GOT continued longer than in hepatitis B (p<0.01). The median peak GOT was higher than in hepatitis A (p<0.01) and lower than in hepatitis B (p<0.05). The median peak TTT was lower than in hepatitis A (p<0.025). Out of the 20 patients 2 became ill in Taiwan and Borneo. There were no addicts and no patients who came in close personal contact with acute non-A, non-B hepatitis. 2 out of 20 showed the prolonged abnormalities of liver function tests in 1.5 and 2.5 years of follow time. It seems reasonable to conclude that acute non-A, non-B hepatitis is severer than acute hepatitis B as judged by duration of jaundice and abnormal GOT level (p<0.01, respectively).

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Lymph nodes are one of the immuno-competent organs. An epidemiological study was performed to clarify the susceptibility to lymph node tuberculosis in dialysis patients who are known to be immunodeficient. The subjects were 7274 dialysis patients in 161 institutions. Among them 27 cases were lymph node tuberculosis. In addition, 13 cases were tuberculosis with coexisting lymph node and other lesions.
Incidences of lymph node tuberculosis in dialysis patients were 112 times higher in males and 75 times higher in females than those in the general population, respectively. The incidence in females was higher than that in males among dialysis patients. Incidence increased in relation to the age with the maximum at 50es. Mortalities of lymph node tuberculosis in dialysis patients were 211 times higher in males and 389 times higher in females than those in the general population. Mortality of the tuberculosis with coexisting lymph node and other lesions was higher than that of lymph node tuberculosis.
Percentages of lymph node tuberculosis among all tuberculosis and among extrapulmonary tuberculosis were higher in dialysis patients than in the general population. Dialysis patients would have higher susceptibility to lymph node tuberculosis than to the other tuberculosis.

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Mortality and characteristics of infection were studied epidemiologically in dialysis patients known to be immunodeficient. The subjects were 7274 dialysis patients in 161 institutions in Japan. Among them 103 males and 61 females died from infections. Mortalities of infection in dialysis patients were 2189 case/10⁵ persons·year in males and 2431 case/10⁵ persons·year in females representing 61 fold in males and 116 fold in females of those among the age and sex adjusted general population. Frequent sites of infection caused deaths were lung, sepsis, peritoneum, liver, fistula and intestine. Primary sites of infection in sepsis were kidney, lung, wound, liver, peritoneum, gallbladder and bile-duct, stomatitis, fistula etc. Gram negative organisms accounted for 78% of isolates. The onsets of infection increased during the 3 months prior to the initiation of dialysis therapy. A remarkable rise in the number of onset of infection was seen during the 3 months after the initiation and the frequency tapered down thereafter although it remained high. Mean survived period was 18.4 days. Age distribution of dialysis patients died from infection was younger than that of the died in the age and sex adjusted control general population. Concerning the causative diseases for renal failure, the frequency of glomerulonephritis was lower and the frequencies of toxaemia of pregnancy, polycystic kidney and diabetes mellitus were higher than those of dialysis patients in all. Diagonostic findings and examinations for infections in dialysis patients were different from those usually seen in some aspects.

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The concentration of antibiotics in cerebrospinal fluid is of great interest in therapeutics, especially for the treatment of infections of the central nervous system. We studied the penetration of Sulfamethoxazole-Trimethoprim into the cerebrospinal fluid in ventricle drainaged cases and cases with meningitis after oral administration. After the administration of the drug (2 tablets) in 5 ventricle drainaged cases, a peak concentration (52μg/ml) of Sulfamethoxazole in the serum was reached at 4 hours, a peak concentration (7.9μg/ml) of Sulfamethoxazole in the cerebrospinal fluid was reached at 7 hours, and thereafter its concentration decreased slowly. CSF/serum ratio at peak was about 15%.
After the administration of the drug (2 tablets) in 5 ventricle drainaged cases, a peak concentration (1.62μg/ml) of Trimethoprim in the serum was reached at 4 hours, a peak concentration (0.65μg/ml) of Trimethoprim in cerebrospinal fluid was reached at 7 hours, and thereafter its concentration decreased. CSF/serum ratio at peak was about 40%.
In cases with meningitis, after the administration of the drug 4 tablets/day, every 12 hours, cerebrospinal fluid was acquired at 4-8 hours after administration by spinal tap. Sulfamethoxazole concentration in cerebrospinal fluid ranged from 2.4μg/ml to 11.6μg/ml and Trimethoprim concentration in cerebrospinal fluid ranged from 0.26μg/ml to 1.23μg/ml. Its concentration in cerebrospinal fluid almost reached the effective concentration especially after 3 days after administration.
Nine of the 10 patients recovered, while 1 died of the complications of severe pneumonia. Thus the penetration of Sulfamethoxazole-Trimethoprim into the cerebrospinal fluid is good, Sulfamethoxazole-Trimethoprim can be useful in therapeutics for the treatment of infections of the central nervous system.

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We studied 80 SLE patients in our clinic and described two patients with terminal infection. The first case, 38-years old female, had suffered from polyarthralgia and discoid eruption. Two years later, she was diagnosed as SLE with marked urine protein and positive serological findings, and was given predonisolone 20mg per day. Two months later, she fell into a convulsive state and was given predonisolone 80mg per day and showed gradual improve clinically and serologically. Six months later, she had dry cough and pleurisy and was diagnosed pleuritis and pericarditis due to SLE and was given a high dose of steroids. But she was not improved, and died of heart failure. In autopsy, many diffuse angitis lesions were revealed in several organs and the lung fresh tuberculomas were found. She had pulmonary tuberculosis as a terminal infection.
The second case, 34-years old female, had suffered from Raynaud's phenomenon and had a grand mal like seizure in 1976. In 1977 she had the same attack of convulsion and was admitted to our clinic. She was diagnosed as SLE clinically and serologically and was gradually improved by steroid therapy. In 1979, urine protein was continuously massive and she re-admitted. But acute respiratory failure was instituted and suddenlly she died. In autopsy, pneumonitis with heavy hemorrhage was found and cytomegalo-inclusion body was microscopically revealed. She might die of pneumonia due to cytomegalovirus infection.
We studied on pulmonary infections of autopsied SLE patients in annual of the pathological autopsy cases in Japan in order to investigate the changes of terminal infections of SLE.
From 1962 to 1965 the number of cases with pneumonia and bronchopneumonia was markedly increase with total doses of steroid hormon production. The frequency of infection by CMV and pneumocystis carinii has increased year by year.
The underlying immunological deficiencies in SLE patients would play a major role in complicating these terminal infections. As these terminal infections are clinically important, we should pay continuous attention on terminal care.

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A case of cholerae infected in Japan and some findings of environmental investigation for vibrios are described. The patient is a 56-years-old man living at Takarazuka as a farmer. He has no special remarks in his family history or past history. He took frozen foods including imported shrimps in his lunch on Sept. 1st, 1981. On the 2nd day, he developed vomiting, diarrhea (rice-washing water), epigastralgia and pain of the gastrocnemius muscle. He was admitted to a certain hospital and operated under the diagnosis of acute appendicitis.
However, his condition became worse and oliguria was developed. Then he was transfered to our hospital and suspected as a case of cholerae. V. cholerae, El Tor was isolated from his feces on the 4th day. Blood examination showed severe dehydration. Intravenous administration of supplementary fluid and antibiotics improved his general conditions and he discharged on the 21st day from a isolated ward. Abnormalities (ventricular extra-systoles) in his electrocardiogram were observed on 5th day. Elevations of serum transaminase, BUN and creatinine, indicating disturbances of liver and kidney, which may be due to toxins produced by V. cholerae were also recorded. These abnormalities improved gradually after treatments.
Several non 0-1, so-called NAG vibrios, were isolated from environment near the patient's house. A strain of NAG vibrios isolated from river showed production of K phage.
As it is reported that NAG vibrios produce cholerae like enterotoxin (s), more attention must be paid to the contamination of environment with vibrios.

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Bacteriological and clinical studies in twenty adult patients with non-tuberculous thoracic empyema, during the past ten years from November 1972 to October 1981, are reported.
Anaerobes were the exclusive pathogens in 4 (20%) of 20 cases, and anaerobes together with aerobic or facultative bacteria were recovered in 8 (40%). An average of 2.5 and 3.8 (2.4 of which were anaerobic) organisms were recovered respectively. A single species of aerobe was isolated in 6, and no organism was isolated in 2 cases.
Total isolates from 18 cases were 50 strains, 29 of which were anaerobic. The predominant organisms, in order of pervalence, were Bacteroides sp. (10 strains), Peptostreptococcus sp. (8), microaerophilic streptococci (6) and Fusobacterium sp. (3).
Putrid odor of pleural fluid was observed in 11 (92%) of 12 cases with anaerobes, but not in any aerobic or culture-negative case. Accumulation of gas in pleural space was showed in 7 (58%) of 12 cases with anaerobes. On the other hand, gas was showed neither in cases with aerobe nor in culture-negative cases, except for one with bronchopleural fistula.
These results indicate that anaerobes play an important role in most cases of pleural empyema, and therefore anaerobic culture is always necessary for bacteriological diagnosis and better antimicrobial selection. Putrid odor of pleural fluid and accumulation of gas in pleural space are reliable clinical findings for presumptive diagnosis of anaerobic empyema, before taking information of anaerobic culture.

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An outbreak of diarrhea occurred in a group of travellers returned from Korea to Fukuoka, in September 1981. In the 27 travellers, 16 persons (59.3%) suffered from illness. Their symptoms were diarrhea (93.8%), abdominal pain (87.5%), fatigue (68.8%), headache (62.5%), mild fever (37.5%), vomiting (12.5%), nausea (6.3%) and chill (6.3%).
In bacteriological examinations, two types of ST-producing Escherichia coli, sero-var (O 34: H 10) and (O untypable: H untypable), were isolated as etiological agents.
This is the first report of outbreak of infection due to plural Enterotoxigenic Escherichia coli in Japan.

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Most strains of Listeria monocytogenes isolated from human listeriosis in Japan so far have been identified as type 1 or lb and 4b.
One case from which type 4d strain isolated was reported in 1974, other case from which type 2 strain isolated was reported in 1977 by T. Nagai, one of the authors. A strain was isolated from bile of cholelithiasis patient (23 years old, female) in Sapporo Medical College Hospital, May, 1980, and this strain was named as “Echizen strain”. Its morphological findings and biochemical properties were identical with those of Listeria monocytogenes.
By serological tests i.e. by cross agglutination test and absorption test using immune serum of standard strains (type 1, 2, 3 and 4b) and Echizen strain, it was identified as Listeria monocytogenes type 3.
This interest case is found to suggest that Listeria monocytogenes latently localize in bile.
This is the first report of Listeria monocytogenes type 3 isolated from human in Japan. The total number of human listeriosis cases in Japan counts 335 (from 1958 to 1981).

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