We studied by transtracheal aspiration (TTA) the polymicrobial infection in chronic lower airway infections. Incidence of mixed isolation of organisms from TTA was 48.7%(57 times) of 117 times. The principal organisms from TTA were H. influenzae (N. 54), S. pneumoniae (N. 29), B. catarrhalis (N. 21), P. aeruginosa (N. 16), H. parainfluenzae (N. 12), α-Streptococcus (N. 19), and Neisseria (N. 16). Ratio of mixed isolation from TTA of each organism was as follows; 53.7%(H. influenzae), 69.0%(S. pneumoniae), 95.2%(B. catarrhalis), 31.3%(P. aeruginosa), 41.7%(H. parainfluenzae), 78.9%(α-streptococcus) and 100%(Neisseria). The principal combination of mixed infection were H. influenzae+S. pneumoniae (N. 9), S. pneumoniae+B. catarrhalis (N. 8), and H. influenzae+B. catarrhalis (N. 7). The growth of organisms in the same material were H. influenzae>S. pneumoniae ( “Unequal type”), S. pneumoniae=B. catarrhalis ( “Equal type”) and H. influenzaeB. catarrhalis. From the results we realize that the polymicrobial infection in chronic lower airway infections is mainly composed by normal upper airway flora with H. influenzae as the leader. By comparison of organisms from TTA, we attempt to classify the polymicrobial infection into “Equal type” and “Unequal type” as above.
We tried trastracheal aspiration for 60 patients (74 times) with bronchopulmonary infection. In 40 patients (54 times) organisms were positive and in 6 patients (8 times), Branhamella catarrhalis was isolated. Diagnosis of patients with B. catarrhalis were chronic bronchitis (N. 4), bronchiectasis (N. 1) and diffuse panbronchiolitis (N. 1). B. catarrhalis isolated as one of polyorganism in all 6 patients. Other organisms from TTA of 6 patients were K. pneumoniae (N. 2), S. marcescens (N. 2), H. influenzae (N. 1) S. pneumoniae (N. 1), H.influenzae+S. pneumoniae+non f. GNR (N. 1) and S. pneumoniae+γ-streptococcus (N. 1). B. catarrhalis isolated from sputum of only 3 patients of 6 patients with B. catarrhalis from transtracheal aspiration. From the results, we realize that the role of B. catarrhalis in chronic lower airway infection, especially in polymicrobial infection, is important.
A total of 196 cultures of Serratia marcescens were isolated as etiologic agent (105 coloney forming units/ml or greater) from specimens of urinary tract infections at Bactriological Laboratory in Kyorin University Hosptial, during a period from December 1980 through July 1982. These isolates were serotyped by O-agglutination. Number of isolates by serovar were 60 strains of 0-13 (30.6%), 56 of 0-2/3 (28.6%), 18 of 0-12/14 (9.2%), 10 of 0-14 (5.1%), 21 of others (10.7%), and 31 of not typable (15.7%), respectivery. The isolates of major serovars were subjected to sensitivity tests to 6 antibiotics by the agar plate dilution method. The results indicated that they were highly resistant to sulbenicillin and cefmetazol, moderately resistant to amikacin (AMK), and sensitive to micronomicin and astoromicin. However, sensitivity of these against gentamicin (GM) were different in grade. The prolonged outbreaks with three endemic strains of Serratia marcescens were found in the hospital. They were 0-12/14 (AMK-resistant), isolated from December 1980 through September 1981, 0-2/3 (GM and AMK-resistant) isolated from June 1981 through July 1982, and 0-13 (inceasing GM and AMK-resistant) isolated continuously.
Adult rabbits were immunized with ten Pseudomonas cepacia strains by intravenous injection of heatkilled organisms. Antisera thus obtained were reciprocally titrated with ten P. cepacia strains and ten sera were defined as serologicaly distinct. One hundred and five strains of P. cepacia were examined for serotyping by a microtiter agglutination test with the ten antisera and the strains were divided into ten serogroups. The distribution of the 105 strains among the serogroups was as follows: serogroup A, 6 strains; B, 2 strains; C, 22 strains; D, 19 strains; E, 11 strains; F, 11 strains; G, 6 strains; H, 5 strains; I, 5 strains; J, 5 strains. Three strains were not agglutinated with any of the antisera. Ten strains were polyagglutinable. The serotyping of P. cepacia may be useful for the analysis of nosocomial infections caused by these organisms.
Safety and antigenicity studies were conducted in 173 and 163 subjects with the 22-valent and 23-valent pneumococcal polysaccharide vaccines, respectively. Systemic and local reactions after vaccination were monitored and antibody titers (23-valent vaccine) were determined. The local reactions after the 22-valent and 23-valent vaccines were: pain was reported most frequently, that is in 60.7% of the 22-valent group and in 40.7% of the 23-valent group; this was followed by erythema, swelling, induration and local heat in 17.9 to 23.7%, and 4.3 to 12.3% of the 22-valent and 23-valent groups, respectively. Fever over 37.5° C was noted in 4.1% and 1.9% with the 22-valent and 23-valent vaccines, respectively. The incidence of systemic reactions, such as chills, headache, fatigue, malaise and myalgia/arthralgia, was reported in 1.7 to 18.5% and in 4.9 to 14.7% with the 22-valent and 23-valent vaccines, respectively. The severity of both systemic and local reactions was usually mild and the symptoms disappeared in a few days. Antibody titers were determined by a radioimmunoassay method in 30 subjects selected at random among the 23-valent vaccinees. The geometric mean antibody titers after vaccination were 2.3 to 6.8 fold greater than before vaccination. A 2-fold or greater increase in titer was found in 73 to 100% of the 30 subjects for each of the 23 types. These antibody responses were considered to be quite good.
The pathogenicity of 11 strains of Bacteroides fragilis and 11 of non-B. fragilis (eight of B. distasonis, two of B. thetaiotaomicron and one of B. uniformis) mainly isolated from clinical specimens was estimated by intracutaneous injection of bacterial suspensions into guinea-pig skin, and the result was compared with each other. The pathogenicity was expressed as the number of inoculated organisms required to induce a skin lesion of 10 mm in diameter; this value was calculated for living and dead suspensions of each strain. The lesion with living becteria showed generally bigger than that with dead; B. fragilis was, on average, about three times in living and about two times in dead as pathogenic as non-B. fragilis. On the assumption that the inflammatory change of the skin lesion produced by dead bacteria was due to their toxicity and by living was due to their multiplication, persistence or invasiveness, B. fragilis strains were persisted in the guimea-pig skin and more pathogenic than non B. fragilis ones significantly (p<0.1).
We evaluated the protective effects of the three types of pooled human gammaglobulin preparations (intact: GG, S-sulfonated: GGS, and pepsin-treated: GGP) for intravenous use against experimental aerosol infection of mice with B. pertussis. Gammaglobulin preparations, especially, GG and GGS showed significant protective activity but GGP did not at least as evaluated by survival numbers, body weight gains and repression of leukocytosis. Nutralizing activity for tetanus and diphtheria toxins did not vary among the three types of gammaglobulin preparations, whereas GG and GGS but not GGP possessed neutralizing activity against leukocytosis promoting activity of pertussis toxin. Evaluation of protective activities of GG, GGS, and GGP, prepared from rabbit gammaglobulin highly immunized with purified PT and not containing any and-F-HA and agglutinin antibodies, demonstrated that and-PT-GG and anti-PT-GGS but not anti-PT-GGP protected against experimental infection by B. pertussis. These results suggest that the protective activity was correlated with anti-PT titer but the Fc portion of the gammaglobulin molecule might be necessary for actual protection against whooping cough by B. pertussis.
The clinical effectiveness and side effects of DL-8280 in the treatment of lower respiratory tract infections including pneumonias were compared with those of amoxicillin (AMPC) by a double-dummy fashion. The following diseases were included in this study; infectious exacerbation of chronic bronchitis and diffuse panbronchiolitis, chronic respiratory tract diseases with infections (bronchiectasis, bronchial asthma, pulmonary emphysema, lung fibrosis, inactive pulmonary tuberculosis) and various kinds of bacterial pneumonias. Two hundred mg dose of DL-8280 was orally administered 3 times per day and 250 mg dose of AMPC was orally administered 4 times per day. Out of all 279 patients, DL-8280 was used in 139patients and AMPC was in 140 patients. Clinical effectiveness and side effects were observed and the obtained results were as follows. 1) One hundred and twenty-two patients of DL-8280 group and 115 patients of AMPC group were evaluated on clinical effectiveness. In DL-8280 group, 6 patients were judgedas “Excellent”, 89 as “Good”, 16 as “Fair”, 10 as “Poor” and its effectiveness rate was 78.5%. On the other hand, in AMPC group, 5 patients were judged as “Excellent”, 73 as “Good”, 14 as “Fair”, 22 as “Poor” and the effectiveness rate was 68.4%. However, one unevaluable patient was seen in each group. The clinical effectiveness of DL-8280 was superior to that of AMPC, especially, the effectiveness rate of DL-8280 group was significantly higher in chronic bronchitis. 2) Bacteriologically, the eradication rate of 88.6% was observed out of 79 clinical isolates in DL-8280 group and it was 61.1% in 72 clinical isolates in AMPC group. These results revealed the significant superiority of DL-8280 to AMPC. Particularly, the bacteriological response of DL-8280 against H. influenzae was significantly superior to that of AMPC. 3) Side effects were noted in 6.1% of 132 patients with DL-8280 and 7.7% of 130 patients with AMPC, and abnormal changes in laboratory findings were noted in 11.1% in DL-8280 group and 14.2% in AMPC group after administration. There was no significant difference between two groups. Neither progressive side effect nor remarkable change in laboratory findings was noted. 4) From these results, it was concluded that DL-8280 was more useful agent than AMPC in the treatment for lower respiratory tract infections, particularly chronic complicated cases.
Recently, we have experiented an unusual case of disseminated candidiasis (DC), producing numerous nodular lesions in the multiple organs involving liver and spleen at the terminal stage of acute leukemia. A 26 year-old house wife was diagnosed of acute lymphocytic leukemia and was tried serveral times of combined chemotherapy, but failed to achieve remission. During marked granulocytopenic period, she developed high fever, 39-40°C, and red papules of adzuki-bean size at the trunk and extremities. She has not complained of myalgia, but serum glutamic oxaloacetic transaminase (GOT) was raised to 3185IUIL alone. There were no growth of candida in cultures of blood, throatswab, or urine during life. In autopsy, numerous soy-bean sized nodules were recognized in the liver, and a few such lesions in the spleen, kidneys, stomach, small intestine and left lung. Pathologically, these nodules were composed of coagulation necrosis, and contained innumerable candidal pseudohyphae. In the lung lesion, it was associated with Aspergillus. Such cases were reported only few in Japan, but presumed to increase in the future. It is highly probable that the skin lesions and elevated GOT values in this case were signs of DC. It is recommended to try biopsies actively to establish early diagnosis of DC, when these lesions are noticed in a patient of compromised state.
A two-year old girl was admitted to our hospital complaining of fever and vomiting. Blood and cerebrospinal fluid (CSF) cultures disclosed Listeria monocytogenes. Intravenous ampicillin (AB-Pc) treatment was started and CSF findings improved, however fever and inflammatory reactions persisted. Antibiotic therapy was changes drom AB-Pc to chloramphenicol (CP). The patients was improved after CP therapy. AB-Pc concentration in CSF (5 hours after 75mg/kg/dose of AB-Pc) gradually decreased as the clinical course improved. CSF concentration of AB-Pc showed 0.9μg/ml in 6th day, 0.31μg/ml in 9th day and 0.12μg/ml in 18th day of illness. Minimum inhibitory concentration of Listeria monocytogenes was 0.2μg/ml for AB-Pc. These data may suggest that the CSF concentration of AB-Pc was dependent on the degree of meningeal inflammation. The prolonged course of this case was most likely caused by a low AB-Pc concentration in CSF when meningeal inflammation became less.