During the period from October 1981 to March 1982, 24 water samples collected from coolingtowers and 32 environmental samples from Okayama prefecture, were cultured for isolation for Legionella spp. Environmental samples included 3 groups;(1) Seven samples of tap water, nebulizers, portable shower and baths, in Kawasaki Medical Hospital. (2) Nine samples of tap water, circulatingwater of air-conditioning systems and well water, from three private houses. (3) Seventeen variedsamples of pond soil mud and creek water, around Kawasaki Medical Hospital in autumn and winter.
The isolation was carried out by guinea pig inoculation and direct plating on E-F agar after Low-p Htreatment of samples. Isolated strains were identfied as Legionella sp. by 19 ordinary biochemical tests, gaschromatography and direct fluorescent antibody techniques (DFA) useing FITC labeled antiserumwhich were prepared by injection of L. pneumophila serogroup 1, 2, 3 and 4 into rabbits. Theseserogroups were also used in biochemical tests and gaschromatography as controls.
Sixteen strains (66.7%) of L. pneumophila were isolated from 24 water samples collected fromcooling towers, 4 strains of L. pneumophila and one strain of Legionella Like Organisms (L.L.O.) wereisolated from 6 samples of group 3 collected in autumn, while no Legionella sp. was isolated from othersamples in group 1, 2, and 3 collected in winter. From these result, it was very likely that amount of L.pneumophila decreased in winter season, and these organisms could not grow up in circulating water at ahigh temperature (50-75°) in air-conditioning systems set up in the private houses.
Of 20 strains of L. pneumophila, only 10 stratins showed positive reaction in the Kovac oxidase test.However, several of these strains were negative when they were re-examined by the same test. Itseemed, therefore, that L. pneumophila was unstable in oxidase activity. In other biochemical tests, isolates showed identical results with those of standard strains. All isolates of L. pneumophila grew wellon B-CYE agar at 25 and 41°, indicating that B-CYE agar was more appropriate for the L. pneumophilacultivation than other media reported previously.
The analysis of cellular fatty acid composition clearly demonstrated that differances existed between L. pneumophila and L.L.O., showing the usefulness of gaschromatography for classification ofthese organisms.DFA demonstrated that 18 isolates were identified as serogroup 1, one isolate serogroup 4, and theother one was seemed to be serogroup 5, 6 or nontypable.
It is emphasized, that L. pneumophila is widely distributed in water in cooling towers and environmentsin Okayama prefecture.

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Fifty university students regarded as seronegative by haemagglutination inhibition (HI) test werevaccinated against rubella. Time lapse results of antiboddy titer, specific rubella immunoglobulin (Ig M) and side effects were determined.
Some observations and outcomes are as follows.
1. HI test to rubella was performed on 168 students before the vaccination. HI positive (titers of 1: 8or more) rates in 117 female and in 51 male were 59.0% and 76.3%, respectively.
2. Observation made on the 3 weeks after vaccination revealed rise in HI and neutralized antibody (NT). However on the 5 weeks all were positive (100%).
3. Mean antibody value on the 5 weeks was 68.6 (times dilution) for HI and 42.4 for NT. Goodcorrelation of r=0.95 was revealed between HI and NT values.
4. By sucrose density gradient centrifugation, 2-mercaptoethanol (2-ME) sensitive antibody (Ig M) was detected in a some case of sera between 3 and 6 weeks.
5. Among the 50 volunteers vaccinated, side effects were observed in 6 cases (12%), of these arthraligiawas detected in 3 cases, swelling in two and one case each of exanthema and fever.

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The efficacy of a gamma-globulin preparation given as a supportive therapy was examined inrefractory chronic respiratory tract infection (RTI) causing expectoration oflarge amounts of purulentsputa and repeating acute aggravations.
In human i.v. doses of the pepsin-treated gamma-globulin preparation gave considerably fluctuatingconcentrations in the blood and sputum, but those concentrations reached their peaks at 3-5 hours. Witha dose of 5g, peak sputum levels ranged from 10 to 80mg/dl, showing good penetration of contained gamma-globulins into the sputum.
Reactions of contained gamma-globulins with bacteria were confirmed in vitro by the latexagglutination method and the immunofluorescence method. The immunofluorescence method alsodemonstrated that bacteria coated with gamma-globulins underwent phagocytosisof human neutrophils. In addition, immunofluorescent examinations of sputa from patinets with chronic RTI demonstrated thatnegative cases turned positive soon after gamma-globulin treatment, revealingthat the gamma-globulinstransferred into the sputum promptly reacted with bacteria existing there.
On the basis of the above results, we examined the efficacy of the gamma-globulin preparationadministered at 1-2 weeks' intervals over a long period in refractory, chronic RTI causing expectorationlarge amounts of purulent sputa and repeating acute aggravations. The efficacy of the gamma-globulinpreparation was excellent or good in 3 of 6 patients.

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We had already reported that the direct detection of enterotoxin in the feces of patient would behelpful for a rapid laboratory diagnosis of the food poisoning due to C. perfringens. In the present paper, three sporadic diarrhea cases due to C. perfringens were proved through the study of detection of enterotoxinin fecal specimens. Symptoms of three cases were observed typical diarrhea and abdominalpain.
A total of 88 patients presenting acute diarrhea in and out patiens at the hospital were cultured for C. perfringens and detection of C. perfringens enterotoxin from fecal specimens. The enterotoxin wasdetected from three cases by passive hemagglutination technique (RPHA) in the feces. The RPHA titerof the enterotoxin from in those two feces were 1:640, another 1:5, 120. Large number of C. perfringens were also isolated from feces in those three cases and serological characteristicus of the strains weretyped TW serotype by our own system 47, 23, and 57 respectively. Two organisms in those cases wereproduced enterotoxin in both DS medium and Tortora medium. However, the another strain was notproduced the enterotoxin in those media.

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Distribution of Legionella species over Japan was investigated.
Five hundred ml of various environmental sources (343 samples of cooling tower water, 25 samples of water of puddy field. 29 samples of river, 3 samples of lake, 1 sample of fountain, 2 samples of puddle, 4 samples of well water, 6 samples of hemodialysate, 5 samples of antiseptic solution for washing hands at operating room) were cultured for isolation of Legionella spp.
Isolations of the organism were applied to intraperitoneal injection to guinea pigs and direct inoculation to semiselective medium (B-CYE agar with antibiotics) after low pH treatment.
One hundred sixty-six strains of Legionella spp. were isolated from 126 (36.7%) out of 343 cooling tower water samples.
The origin of positive samples ranged from Hokkaido (Northern Japan) to Okinawa (Southern Japan).
L. pneumophila, serogroup 1 was the most frequent isolates (66.3%); next in frequency of occurrence were Legionella-like organisms (16.3%), L. pneumophila serogroup 4 (7.2%), L. bozemanii (7.2%), L. pneumophila serogroup 6 (1.8%) and serogroup 3 (1.2%).
L. pneumophila serogroup 2, serogroup 5, L. micdadei, L. dumoffii, L. gormanii, L. longbeachae and L. jordanis were not isolated from cooling tower water samples in this study.
Five out of 28 soil samples were positive culture of Legionella spp. with L. pneumophila serogroup 1 (5 strains), serogroup 4 (2 strains) and serogroup 5 (1 strain).
One strain of L. pneumophila serogroup 1 was isolated from one of 2 samples of puddle in construction sites. No positive culture was obtained from remaining materials.
These results indicated that many types of Legionella species were widespread in all over the country.
Environmental isolates possessed to have almost same endotoxin-like activity as clinical isolates by limulus test. However, there was some variations in virulence to mice among environmental isolates.

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The clinical efficacy and safety of cefpiramide (SM-1652, CPM) were compared with those of cefmetazole (CMZ) in patients with complicated urinary tract infections by double-blind method.
Either of CPM or CMZ was assigned to each patient at random. Administration was performed by intravenous drip infusion for a fixed period of 5 days and daily dosage was fixed at each 2 g for CPM or CMZ.
Out of 249 patients, 211 patients (CPM; 110 cases, CMZ: 101 cases) were evaluated for clinical efficacy by the criteria proposed by UTI committee in Japan. It was indicated that there was no significant difference between the two groups (CPM group and CMZ group) regarding the all of background factors.
Overall clinical effectiveness; Response was excellent in 27.7%, moderate in 39.8% and poor in 32.5% of the CPM group, excellent in 17.3%, moderate in 33.3% and poor in 49.3% of the CMZ group. Response rate inclusive of excellent and moderate was significantly higher in the CPM group than in the CMZ (p<0.05).
Effect on pyuria; Rate of improvement (Cleared and Decreased) on pyuria was 44.6% in the CPM group and 36.0% in the CMZ group. There was no significant difference between the two groups.
Effect on bacteriuria; Rate of improvement (Eliminated and Decreased) on bacteriuria was 60.2% in the CPM group and 46.7% in the CMZ group. There was no significant difference between the two groups.
Bacteriological response; The eradication rate for all organisms isolated before treatment was 75.8% in the CPM group and 80.2% in the CMZ group. There was no significant difference between the two groups.
The incidence rate of side effects and abnormal laboratory findings were 2 cases (eruption 2) and 3 cases (elevation of transaminase), respectively in the CPM group and 1 case (itching and pericheiloparalysis) and 4 cases (elevation of transaminase or BUN), respectively in the CMZ group, with no significant differences between the two groups.
These results indicate that CPM is a useful drug for the treatment of complicated urinary tract infections.

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A newly developed human immunoglobulin preparation for intravenous use, GV-523, had been studied in the internal and the surgical clinics on the effects of 276 cases of the various severe infections in the combined use with the antibiotics. GV-523 was found to be highly safe and effectively useful drug.
1. Total number of the patients affected with various severe infections were 276 cases, 92.3% of which had been accompaining other underlying diseases as malignant tumore or leukemia (67.2%).
2. Among them 247 cases were chosen for the clinical evaluation by docters in charge. GV-523 effected excellently in 30 cases, good 88, fairly 61 and poorly 68. The efficacy rate was summerized as 47.8%. The effectivity on the bacterial infections (193 cases) was 46.6%, on the viral (14) 78.6, on the fungal (11) 36.4 and on F.U.O. (29) 44.8%, respectively.
3. Among the above cases 124 were accepted as the evaluable cases by the Committee. GV-523 effected excellently in 37 cases, good 41, fairly 8 and poorly 38. The effectivity was summerized as 62.9%. The effectivity on the bacterial infections (91 cases) was 61.5%, on the viral (11) 81.8%, on the fungal (6) 66.7% and on F.U.O. (16) 56.3%.
4. The dose and the effectiveness of GV-523 were analyzed to find relationships between underlying diseases, infectious diseases and causative organisms, without any significant tendency.
5. Adverse effects were observed in 6 cases among 276 treated cases. Three (1.1%) of them were suspected to be due to GV-523. However, their symptoms were not so severe. GV-523 was found to be practically safe drugs.

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A 53 year-old male caterer of raw sea foods, who had cirrhosis of the liver and diabetes mellitus since age of 38, was admitted to Tokyo Metropolitan Komagome Hospital with fever, chills and a painful swelling of the right ankle. The day prior to admission, he noticed the formation of small painless vesicles on his right leg. On the same day he experienced nausea, vomiting, several loose stools and an abrupt fever of more than 38.1°C associated with chills.
On admission this well-developed and well-nourished male was quite alert. His bodytemperature was 38.9°C. He was moderately anemic and icteric. The abdomen was not distended andthe liver was palpable 4 finger-breadths below the right costal margin with no tenderness on pressure. There was a painful phlegmonous swelling on the anterior surface of his right ankle, covered with vesicles, bullae, pustulae and erosion. Laboratory data included: WBC count 13, 200/cmm; hemoglobin 12.1g/dl; SGOT units; SGPT 49 units; serum creatinine 1.4 mg/dl; total protein 5.4g/dl; gamma globulin 34.6%; fasing blood sugar 395 mg/dl; prothrombin activity 46%. No significant bacteria were isolated from the throat, urine or fecal specimens. The organism isolated from the blood and the pustulae on the phlegmonous lesion was gram-negative, having curved and rod-shaped bacterium with a single flagellum and was identified as Vibrio vulnificus. A diagnosis of bacteremic phlegmon associated with cirrhosis of the liver diabetes mellitus was established and the patient was successfully treated with antibiotics (ampicillin, cephalothin, tobramycin and thiophenicol), insulin and surgical debridement of the necrotic tissues of the phlegmon. His body temperature became normal after five days on this treatment. Disseminated intravascular coagulation and significant hypotension did not occur in this patient during clinical course.

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