Vibrio fluvialis has been recently recognized to cause diarrheal disease in man. However, the pathology of the enteritis caused by this agent is still largely obscure. During the past 4 years, this organism was isolated from the feces of 3 (0.2%) of the 1462 patients with diarrhea. On the other hand, none of the 1709 healthy persons had stool cultures positive for the organism. V. fluvialis strains were isolated from ten patients with diarrhea over a 4-year period. While it is possible that there was another pathogen in these cases, V. fluvialis was identified as the only bacterial pathogen in the stool. Nine were detected in summer season, and eight were domestic cases.
The clinical symptoms, including the frequency of watery diarrhea, fever, abdominal pain, and vomiting, resembles that seen in cases associated with V. parahaemolyticus or Aeromonas strain. Four patients noted bloody diarrhea.
A causative food (s) was not determined. However, six of the patients had eaten raw sea-foods such as oyster, shellfish and seafish in the 48 hrs before they became ill. In a tenth case, the patient had eaten seafood, but denied eating it raw in past 48 hrs. This organism was also found in natural water, sea water, sewage water, and various seafoods. Our cases suggest that the various seafoods may be transmitted to man. V. fluvialis isolates were examined for enterotoxic activity in suckling mouse tests and Y1 adrenal cell test. Of these strains tested, eight from different sources gave positive reactions in suckling mouse test.
More data are needed on the epidemiological studies of the role of this organism in acute diarrhea.

View full abstract

Characteristics of tuberculosis with pleural lesion were studied epidemiologically in 7, 274 dialysis patients treated in 161 institutions.
Among them 14 males and 4 females were tuberculosis with pleural lesion. They were between 20s and 60s of age with the maximal age distribution at 50s. Three males and two females died from it. Tuberculosis with pleural lesion occupied 13% of all tuberculosis in dialysis patients. Tuberculous lesions were localized at pleura in a half of the cases. The other half with tuberculous pleuritis were accompanied by tuberculosis of other organs such as lung, peritoneum, kidney, spleen, liver, lymph node, bone etc. Incidences of tuberculosis with solely pleural lesion were 132 case/10⁵ persons·year in male and 70 in female. Incidences of tuberculous pleuritis coexisting with extrapleural tuberculosis were also 132 case/10⁵ persons ·year in male and 70 in female. Prognosis of tuberculosis with solely pleural lesion was good with no died case, however, that of pleural tuberculosis coexisting with extrapleural tuberculosis was serious with the fatality of 56%. Prognosis was worse in female than in male. Onsets of the disease were seen mostly between 3 months before and 18 months after the initiation of dialysis therapy. Sixtyseven percent of patients had a past history of tuberculosis. Organs involved in the past episode were again very often involved in the present tuberculosis. These facts can be interpreted that tuberculous pleuritis in dialysis patients develops frequently as a relapse of tuberculosis. Some causative diseases for renal failure like as uremic state also seem to affect the development of the tuberculosis. Patients with positive PPD skin test were less than a half of the tuberculosis patients.

View full abstract

Fity-eight patients with influenza-like disease were studied during the threeyears from 1978 to 1980. Throat washings, blood (in the acute and convalescent periods), and theepithelial cells of the nasal mucosa were collected from each patient. Attempts were made to detect influenza virus-specific antigens by the fluorescent antibody technique (FAT), in addition to the ordinary for isolating virus and the hemagglutination inhibition (HI) test.
The results are as follows:(1) Despite the HI test antibody value was 1: 64 in the acute period, influenza virus-specific antigen was detected in 71.4% of patients in whom itwas difficult to isolate influenza virus;(2) The positive rate was 58.6% for FAT, 65.5% for the ordinary virus isolation method and 71.4% for the HI test. A combination of the two methods resulted in an increase in the diagnositc rate, that is, 83%;(3) The use of FAT was suggested as a rapid method for early diagnosis of influenza; and (4) Specific fluorescence of the epithlial cells of the nasal mucosa tended to vary with only the nucleus, with the nucleus and the protoplasm, and with only the protoplasm, and the period.

View full abstract

Monoclonal antibodies against causal organisms of Weil's disease were produced by the somatic cell hybridization technique. Leptospira interrogans serovar copenhageni Shiromizu and M 20 strains and serovar icteroharmorrhagiae RGA strain were used as immunogens. Twenty monoclonal antibodies were established; 10 anti-Shiromizu monoclonal antibodies, 5 and-M 20 monoclonal antibodies and 5 anti-RGA monoclonal antibodies. In oder to clarify the immunological characteristics of these antibodies, microagglutination titers of these 20 monoclonal antibodies against the following 12 strains were estimated; serovar copenhageni Shiromizu and M 20, serovar icterohaemorrhagiae RAG and Ictero 1, serovar javanica Verdrat Batavia 46, serovar canicola Hond Utrecht IV, serovar pyrogenes Salinem, serovar autumnalis Akiyami A, serovar Pomona Pomona, serovar australis Ballico, serovar grippotyphosa Moskva V and serovar hebdomadis Ballico, serover grippotyphosa Moskva V and serovar hebdomadis hebdomadis.
According to the patterns of the microagglutination titers, 20 monoclonal antibodies were diviede into following types.
1. Anti-Shiromizu monoclonal antibodies.
1) One monoclonal antibody reacted only to serovar copenhageni.
2) Two monoclonal antibodies reacted to serovar copenhageni in a high titer and serovar icteroharmorohagiae in a low titer.
3) Seven monoclonal antibodies reacted to both serovars in almost the same titer.
2. Anti-M 20 monoclonal antibodies.
1) Three monoclonal antibodies were reactive to serovar copenhageni and serovar icterohaemorrhagiae in almost the same titer. 2) One monoclonal antibody was reactive to serovar copenhageni in a low titer and serovar icterohaemorrhagiae in a high titer.
3) One monoclonal antibody was reactive not only to serogroup Icterohaemorrhagiae but also serovar pyrogenes.
3. Anti-RGA monoclonal antibodies.
1) Two monoclonal antibodies reacted only to serovar icterohaemorrhagiae.
2) Two monoclonal antibodies reacted to serovar icterohaemorrhagiae in a high titer and serovar copenhageni in a low titer.
3) One monoclonal antibody reacted not only to serogroup Icterohaemorrhagiae but also to serovar pyrogenes and serovar canicola.
It is suggested that serovar copenhageni and serovar icterohaemorrhagiae are closely related to serovar pyrogenes and serovar canicola. Serologically, serovar copenhageni has been classified as a complete type and serovar icterohaemorrhagiae has been classified as a incomplete type, but it is indicated that each serovar has it's own antigen (s) and the common antigens.
As for the findings of agglutination, some of these 20 monoclonal antibodies exhibited unique agglutination patterns in which leptospira agglutinated like a long piece of string. Some of these monoclonal antibodies which had a narrow reactive range showed the remarkable prozone phenomenon.
Monoclonal antibodies which react to only serovar copenhageni or serovar icterohaemorrhagiae and monoclonal antibodies which react to these two serovars may be useful for identification of causal organisms of Weil's disease.

View full abstract

Systemic bacterial infection during the neonatal period is often severe and difficult to treat. The intestinal bacterial flora is thought one of the major sources of the causative agents. Generally no bacteria can be found in the feces of newborn infants immediately after birth. This study was designed to clarify the relationship between bacterial infection and the process of intestinal flora formation.
First the intestinal flora of twelve neonates was analyzed. Another ten neonates were administered Bifidobacterium breve, which is non-pathogenic and is found in the feces of many healthy nursing infants. Neonates with abnormal proliferation of specific pathogenic bacteria in the intestinal tract were administered B. breve orally.
The following results were obtained.
1) The formation of the intestinal flora was divided into three types. One type is that in which only intestinal bacteria were detected from the beginning. Another type is that in which some bacteria, such as Acinetobacter or Bacillus, other than intestinal ones were detected transiently. The third type is that in which only certain specific bacteria, for example Pseudomonas aeruginosa or Serratia marcescens colonized continuously and abundantly, causing bacterial infection.
2) Orally administered B. breve could colonize in the gastrointestinal tract of newborn infants when given right after birth.
3) When the neonates with abnormal proliferation of specific bacteria were administered B. breve orally, the B. breve colonized and the specific bacteria disappeared from the digestive tract.

View full abstract

Cefoxitin was administered to a total of 66 patients with various respiratory tract infections and the Cefoxitin was administered to a total of 66 patients with various respiratory tract infections and thefollowing results were obtained:
1) Out of 55 patients who were clinically evaluated, 42 patients (76.4%) showed excellent and goodresponses.
2) The efficacy rate classified by diagnosis was 84.6% for primary pneumonia, 68.8% for secondarypneumonia and 69.2% for acute exacerbation of chronic bronchial tract infection.
3) The efficacy rate classified by severity of illness was 90.9% for mild cases, 76.3% for moderatecases and 50.0% for severe cases.
4) The efficacy rate classified by age was 82.8% for patients younger than 69 years and 69.2% forpatients older than 70 years.
5) Causative organisms were isolated in 13 patients. These organisms were eradicated in 10patients, decreased in number in one patient and replaced by other organisms in 2 patinens. In these 2patients normal flora was replaced by othr organisms during the course of treatment. The organisms thatemerged were P. aeruginosa (2 cases), E. agglomerans (1 case) and K. pneumoniae (1 case).
6) A total of 11 patients who failed to respond to other conventional antibiotic treatment weretreated with cefoxitin and seven patients (63.6%) showed excellent and good responses.
7) Out of 55 patients who were clinically evaluated, 3 patients failed to respond to cefoxitin. Thefirst patient was successfully treated with minocycline, the second with ceftizoxime and the third withcefotaxime.
8) Side effects were observed in 8 out of 63 patients. These were skin eruption (1), elevation ofSGOT (2), elevation of SGOT and BUN (1), elevation of BUN and creatinine (1), elevation of Al-p (1) andleukopenia (2).

View full abstract

Metastatic cerebral abscess is known as one of complications of infective endocarditis. Its prognosisis unfavorable due partly to diagnostic difficulty. We recently encountered two cases of this abscessassociated with infective endocarditis. The intracerebral lesions were detected at an early stage by CTscan, and were healed merely by administering antibiotics.
Case 1. A 45-year-old woman with α-hemolytic streptococcus induced endocarditis affecting AR. During the disease course, the left upper limb became paretic. CT scan after admission disclosed anabscess, recognizable as an iodine enhanced ring, in the right frontal lobe. The patient was given PCG (12 million units/day for 14 days followed by 22 million units/day for 6 days). As this treatment causedallergic reaction, PCG was replaced by CER (4g/day for 25 days). Consequently, the lesion disappeared.Case 2. A 35-year-old man with S. aureus induced endocarditis involving AR and MS. Coluding ofconsciousness accompanied by anisocoria persistent for 24 hours developed during observasion. Nothingremarkable was revealed by CT scan on the next day, but multiple brain abscess were detected 16 dayslater. PCG treatment (20 million units/day for 49 days) led to a complite cure.
Cerebral abscess associated with infective endocarditis has rerely been reported. However, it isrecommended to perform CT scan even in those cases which are clinically judged to be transientcerebral embolism. This may permit early diagnosis of this complication and chemotherapy withoutinvasive surgical measures.

View full abstract

This syndrome was first reported by Todd in 1978 and is now recognized as a new staphylococcalinfectious disease which occurs primarily in young healthy menstrual women usingtampons.
A 21-year-old woman who used a tampon developed fever, myalgia and erythema during hermenstrual period. In a short time, she succumbed to shock and acute renal failure, acute respiratoryfailure, coagulation disturbance, mental disturbance hepatic dysfunction were complicated. Under thesuspicion of septic shock, bacterial cultures of blood, urine, throat and spinal fluid were frequentlyexamined, but no organism were found.
Antibiotics was administered and, mechanical ventilation, hemodialysis, administration of antithrombin-III concentrates and heparin were done.
She was recovered in about a month without any trouble.
Clinical course and laboratory data of this case were well matched to the definition of Toxic shocksyndrome that Shands had shown.

View full abstract