Metronidazole is active in vitro against obligate anaerobes such as Bacteroides, Fusobacterium, Veillonella, Peptococcus and Peptostreptococcus, but has no activity against facultative anaerobes. However it is generally less active against non-sporing Gram-positive bacilli such as Actinomyces and Propionibacterium, it is also less active against some species of Peptostreptococcus, but less sensitive strains are usually not truly anaerobic. Metronidazole may, therefore, be a useful tool in differentiation of obligate anaerobic bacteria. And so paper strips each containing 5μg of metronidazole were prepared to differentiate single colonies of obligate from facultative anaerobes on primary plate cultures of mixed bacterial suspensions containing obligate and facultative anaerobes. This suspension was inoculated onto a GAM agar plate to obtain single colonies and a metronidazole strip was placed at right angles to the well of inoculum, so that it extended into the area where single colonies would be expected. After 48 hours of anaerobic incubation, in the area uniformly inoculated, a zone of inhibition around the metronidazole strip with intrazonal growth revealed the presence of an obligate anaerobe together with a facultative anaerobe. The area where this phenomenon is recognized is called “sparser zone”. Complete inhibition of growth around the metronidazole strip indicated that obligate anaerobes only were present. In the area where single colonies were obtained, colonies of facultative anaerobes were recognized even right up to the edge of the strip and colonies of obligate anaerobes were recognized at a distance of 5 to 15 mm at least from the edge of the strip. Therefore it seems to be able to differentiate single colonies of obligate from facultative anaerobes without examining the plate which was incubated aerobically. Facultative anaerobes have little influence on the metronidazole strip method. Although metronidazole was inactivated by certain facultative anaerobes such as Streptococcus faecalis, their presence in mixed culture with obligate anaerobes did not inhibit the activity of metronidazole. This was because of the more rapid bactericidal effect of metronidazole before any significant inactivation by the facultative anaerobes. Therefore the metronidazole strip method is able to detect obligate anaerobes on primary plate cultures of clinical specimens containing 102 to 103 times as many facultative anaerobes as obligate anaerobes so that it is difficult to obtain single colonies of the obligate anaerobes. In this case multiple anaerobic selective media are recommended for the isolation of the obligate anaerobes of all types.
A double-blind comparison of T-1982 (cefbuperazone), a new cephamycin antibiotics and cefmetazole was carried out in the treatment of complicated urinary tract infections.Patients received either 0.5g of T-1982 or 1g of cefmetazole twice a day for 5 days by intravenous injection. All patients had pyuria of 5 or more WBCs per high power field, bacteriuria of 104 or more bacteria per ml of urine and underlying urinary disease. The overall clinical efficacy of the treatment was evaluated by the criteria proposed by the UTI Committee in Japan as excellent, moderate or poor. Of the 241 patients admitted to the study, 119 received T-1982 and 122 received cefmetazole. No significant difference in background characteristics was observed between the two treatment groups.Excellent and moderate responses were obtained in 73.9% of the patients receiving T-1982 and 57.4% of the patients receiving cefmetazole. This difference was statistically significant (p<0.05). Clinical efficacies of T-1982 for the patients infected with Serratia were significantly higher than that of cefmetazole (p<0.01) and when patients infected with Serratia were excluded from both groups, no significant difference of clinical efficacies was observed. Although significant difference was not observed in the overall bacteriological responses, eradication rate of Serratia was significantly higher in T-1982 group (p<0.01). Eradication rate of P.aeruginosa was markedly low in both groups. There was no significant difference between the two treatment groups regarding the incidence of side effects and T-1982 appeared to be as well torelated as cefmetazole. From the results obtained in this study, we concluded that T-1982 was useful in the treatment of complicated urinary tract infections except for those due to P. aeruginosa, especially in the treatment of those due to Serratia.
The phagocytic and bactericidal activity of polymorphonuclear leukocytes (PMNs) in 30 diabetics were determined by the modified method of Quie, and compared with those of 12 controls. In this study Staphylococcus aureus (209P strain) was used and a ratio of the number of bacteria to PMNs was determined at 8. The phagocytic activity in the diabetics was not significantly different from that in the controls. On the other hand, the bactericidal activity in the diabetics was significantly lower than that in the controls. Especially in the poorly-controlled diabetics with high fasting blood glucose (>130mg/dl) or high hemoglobin A1 value (>8%), the bactericidal activity was significantly lower than that in the wellcontrolled group. In the diabetics on insulin or oral hypoglycemic agent, the bactericidal activity was significantly lower than that in the diabetics on diet therapy alone. In the diabetics with retinopathy ornephropathy, the bactericidal activity was relatively lower, although not significantly, than that in the diabetics uncompromised with those complication. Likewise, the activity in the diabetics with a long duration was relatively lower than that in those with a short duration. The bactericidal activity after treatment in the diabetics was significantly higher than that before treatment. These results seem to favor the impaired bactericidal activity as one of the factors accounting for the increased susceptibility to infection in diabetics.
Haemophilus influenzae strains isolated from sputum of patients with respiratory infection of adults were tested for susceptibility to 5 antibiotics. Of the 344 strains examined, 46 (13.4%) showed MICs of 6.25μg or more of ampicillin per ml. Thirty-four of the 46 strains produced β-lactamase, whilst the remaining 12 were negative. All of the β-lactamase producing strains were sensitive to cefotaxime and chloramphenicol, but 15 (44%) were resistant to tetracycline. All of the β-lactamase-non-producing ampicillin resistant strains were sensitive to tetracycline and chloramphecicol, and 9 of 12 strains were sensitive to piperacillin. One strain showed MIC of 50μg/ml of cefotaxime. Infection mixed with ampicillin resistant and sensitive strains of H. influenzae was found in 4 patients with chronic bronchitis.
The superoxide anion (O2-) production by polymorphonuclear leukocytes in 54 diabetics stimulatated by phorbol myristate acetate was determined and compared with those of 25 controls, and the correlation between O2-production and clinical laboratory indices was investigated. The O2- production in diabetics was 30.04±10.93 (mean±SD, nmol per 4×105 cells) at 10 min., 57.18±16.78 at 30 min., and in controls 38.81 8.11 at 10 min., 69.76 12.60 at 30 min., statistically significant differences were observed between these two groups at both 10 min. (p<0.001) and 30 min. (p<0.01). The correlation between O2- producton and 8 clinical labolatories indices (age, sex, kinds of therapy, duration of diabetes mellitus, retinopathy, proteinuria, fasting blood glucose value, hemoglobin A1 value) in 54 diabetics was investigated by multivariate analysis. In simple correlation, all clinical laboratory indices were not found to be related to O2- production at either 10 min or 30 min. In partial correlation, however, O production at 10 min possessed a negative correlation with hemoglobin Al value, (p<0.05). These findings suggest that impaired Oi production might be one of the factors accounting for impaired bactericidal activity of polymorphonuclear leukocytes in diabetics, and that a protracted hyperglycemia might shed some effect on O2- production.
Between 1968 and 1980, a total of 3296 serum samples were collected from healthy subjects in the Yaeyama district of Okinawa (on Ishigaki Island, Iriomote Island and Hateruma Island) and in Kyushu (in Fukuoka City and Nichinan City). These samples were tested for the presence of antibody to hepatitis B core antigen (anti-HBc) by radioimmunoassay (RIA). 2427 of the samples were tested for the presence of hepatitis B surface antigen (HBsAg) by reversed passive hemagglutination (RPHA) and for corresponding antibody (anti-HBs) by passive hemagglutination (PHA) and RIA. The prevalence of and-HBc at Yaeyama (67.2%) (72.8% in Ishigaki Island, 59.8% in Iriomote Island and 71.6% in Hateruma Island) was significantly higher than the prevalence of and-HBc in Kyushu (31.2%) (30.7%in Fukuoka City and 32.0% in Nichinan City). At Ishigaki Island and Iriomote at the Yaeyama district, second samples were collected after intervals of 10 and 12 years, respectively. Over these periods, overall prevalence of and-HBc decreased significantly, especially in lower age groups. This data suggests that hepatitis B virus (HBV) infection among children has declined in recent years and that the higher prevalence of HBV infection in adults may reflect higher rates of infection in their childhood. Overall prevalencies of HBsAg (7.5%) and anti-HBs by PHA (41.0%) and RIA (56.4%) at Yaeyama were significantly higher than prevalencies of HBsAg (2.4%) and anti-HBs by PHA (24.7%) and by RIA (28.1%) in Kyushu. In both areas, anti-HBc was the most frequently detected HBV marker. Prevalence of and-HBc was almost equal to the sum of the prevalencies of HBsAg and anti-HBs by RIA. There were, however, samples in which only anti-HBc was detected and samples in which only anti-HBs was detected.
Antigenic comparison of 27 strains of Japanese encephalitis virus (JEV) was carried out using hemagglutination inhibition (HI) technique with monoclonal antibodies against Nakayama-RFVL strain. Twenty-four JEV strains were isolated from various parts of Japan, and 3 from Singapore, Thailand and Sri Lanka. These strains were isolated from different hosts between 1935 and 1979. Antigens for the test were obtained from suckling mouse brains by the sucrose-acetone method. The hybrid cells were produced by fusing P3X63Ag 8.653 mouse myeloma cell line with spleen cells from BALB/c mice immunized with JEV Nakayama-RFVL strain. According to the HI test against the 5 species-specific monoclonal antibodies, the 27 JEV strains are classified serologically as follows: I-1. Nakayama-RFVL and Nakayama-Yoken strains. I-2. Nakayama-Yakken strain. II. Kalinina, G-1 late, JaGAr 01 and JaGAr 02 strains. III-1. Sekiya, Mochizuki, Nishizono, JaFAr 401465, JaFS 01, Hatano 65, Kamiyama, Sasazaki, Mie 44-1, Fukuoka 7101, Fukuoka 7202, Fukuoka 7309, Fukuoka 7311, Fukuoka 7452, Fukuoka 7463, Fukuoka 7506, Kumamoto 80679 and Chiang Mai strains. III-2. 691004 strain. IV. Muar strain. Although the Nakayama-Yakken strain was derived from the same origin as the Nakayama-RFVL and Nakayama-Yoken strains, it is a mutant strain which had missed out the Nakayama strain-specific antigen.There are significant antigenic differences between the Nakayama strain and the JaGAr 01 strain and the recently isolated strains. NARMA 13 reacted with almost the same titer against the 26 JEV strains as the homologous (Nakayama-RFVL) strain. On the other hand, NARMA 5 only reacted against the Nakayama-RFVL and Nakayama-Yoken strains. The former is characteristic of JEV species-specificity and the latter of Nakayama strain-specificity.
Experiments were performed in mice to support the clinical efficacy of a gamma-globulin preparation. Intraperitoneal administration of the pepsin-treated gamma-globulin preparation resulted in highest concentration in the blood 30 min. later followed by rapid excretion. The concomitant use of this preparation with an antibiotic active against Pseudomanas aeruginosa produced a greater antibacterial effect in mice with septic infection with the organism than did the antibiotic alone. Moreover, the addition of the gamma-globulin preparation enhanced phagocytosis of peritoneal neutrophils of mice intraperitoneally inoculated with Pseudomonas aeruginosa.
Three cases of herpes simplex virus (HSV) encephalitis are reported. Adenine arabinoside (Ara-A) was administered to one of the cases, and was very effective. To establish early diagnosis of HSVencephalitis, brain biopsy has been claimed almost imperative and serological examination has not been appreciated. Retrospective examination of HSV antibody titer in serum as well as in cerebrospinal fluid (CSF) of the three cases by complement fixation technique showed that theserological method can also be used for this purpose. In addition, we have presented data which show that titer of anti-HSV antibody in CSF rarely exceeds 4-fold in subjects whose serum anti-HSV is positive except for cases of HSV-meningitis, HSVencephalitis, and bacterial meningitis. This result suggests that it might be possible to find out probable cases of HSV-encephalitis much earlier by simply examining HSV-antibody in CSF.
A 71-year-old man became febrile with transient pain of left upper quadrant for one or two days and admitted to prior hospital. He was treated with various antibiotics during about two months in prior hospital, but his fever continued and small amount of left pleural effusions were occasionally observed at his chest X-ray film. He was removed to Suibarago Hospital on July 17, 1980 introduced by prior hospital. On admission his temperature was 38.7°C, abdominal pain and jaundice were not present, liver, spleen and kidneys were not palpable. The WBC count was 19800/mm3 with 76% neutrophils and CRP reaction was 6+. No abnormality was found in his hepatic- and renal-function. Blood cultures were negative. A computed tomography (CT) of upper abdominal region showed irregular shaped multiple (maximum size: 2.5×3.5 cm in diameter) low density areas in enlarged spleen at the left upper side of left kindney. The diagnosis of multiple spleenic abscess was made and chemotherapy was instituted with clindamycin, dibekacin and cefotetan. Clinical symptomes were not changed and CT findings after three weeks were stationary. Splenectomy was performed on August 21. The spleen was covered with adherent surroundings organs namely stomach, diaphragm, colon and omentum. Abscesses were present in various sized yellowish granulomatous lesions. Aerobic and anaerobic culture of purulent materials yielded no growth. The patient recovered and discharged on November 9. CT is a non-invasive and valuable technique in diagnosis of spletiic abscess.