Nothing that coagulase-negative staphylococci (CNS) producing aminoglycosides 4′, 4′′-adenylyltransferease (4′, 4′′-AAD) began to be detected in Japan, the author investigated the state of theisolation of 4′, 4′′-AAD producing CNS within and outside hospitals in a certain limited period immediatelyfollowing their first reported appearance, and studied their significance as hospital strains.
1. From CNS strains collected during from January 1983 to July 1983, 299 strains (156 strainsoriginating in inpatients, 143 strains originating in outpatients) were extracted at randam and studied .The majority of inpatient strains were isolated from urine (28.2%), sputum (28.8%) and stool (25.6%).The outpatient strains were largely isolated from, in order of frequency, urine (46.2%), stool (22.4%) andotorrhea (16.1%).
2. In the disc sensitivity test, 96 strains (61.5%) from inpatients and 40 strains (28.0%) from outpatientswere resistant to kanamycin, gentamicin or amikacin.
3. Strains considered to produce 4′, 4′′-AAD accounted for 17 strains (10.9%) from inpatients and 9strains (6.3%) from outpatients. The species of these organisms were S. epidermidis in all but one straineach of inpatient and outpatient groups.
4. In the sensitivities of the above stains to AGs, MICs of tobramycin and KM were high and thoseof AMK were almost distributed betweem 6.25μg/ml and 25μg/ml. Furthermore, MICs of dibekacinwere distributed between 1.56μg/ml and 3.13μg/ml, but the MICs of GM were smaller than above.
5. Among AGs-resistant strains, those producing 2′-phosphotransferase and 6′-acetyltransferaseoccur predominantly in inpatient strains, which indicates that these can be regarded as so-called hospitalstrains. Isolation of the strains producing 4′, 4′′-AAD do not necessarily prevail among inpatient strains, with no significant difference in their isolation frequencies between inpatient and outpatient strains.From this fact, it was suggested that these strains have already spread widely both within and outsidehospitals. There is a possibility that they may yet thrive as hospital strains depending upon the usage ofantibiotics.

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Antigens of the two low virulent strains of Rickettsia tsutsugamushi isolated in Miyazaki district (Irieand Hirano) were used in the immunofluorescent antibody test of patient's sera.
The following results were obtained.
Titers of sera obtained in the acute phase of illness were higher to either Irie or Hirano antigen thanthose to Gilliam or Karp antigen respectively. The antibody to the former group seemed to be detectedearlier than the latter, and it is suggested to be useful for early diagnosis. The serological type of theinfected rickettsia was clearly determined by comparing titers to Irie and to Hirano. The type specificantibody did not related to Ig class.
Sera obtained 0.5 to 3.5 years after tsutsugamushi disease also showed higher titers to Irie or Hiranoantigen, and it is suggested to be useful in follow-up study for a long period of time after the disease.

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Bacteriocin typing based on the method of Traub, W.H., et al (J. Clin. Microbiol., 10: 885-889, 1982) was carried out on the clinical isolates of Enterobacter cloacae obtained from the in-patients, excludingre-isolates from the same patient, at Medical College Hospital of Oita during the period from March 1982 to July 1983, and the results obtained were discussed in regard to the application of thismethod for tracing the source of nosocomial infections.
A total of 150 clinical E. cloacae isolates were classified into 10 different bacteriocin types, mainlytype 7 (15.3%), followed by types 5 (10%), 13 (9.3%), 3 (8.7%) and so on in order; 19.3% were nontypableand 21.3% were unclassifiable by this typing method. The isolates were more devided in details bybacteriocin typing than by biotyping based on Minitek numerical identification system (BBL). Reproducibility of the bacteriocin types was often lack in some strains, but it was suggested that thistyping method would be useful and conventional for surveillance of nosocomial infections caused by E.cloacae if it was performed under controlled experimental conditions.
E. cloacae strains were confirmed as a nosocomial pathogen such as Serratia marcescens because thedistribution of bacteriocin types of these organisms showed a unique pattern in each year, ward andclinical source respectively.

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The incidences of parasitosis in Fukui Prefecture during about past ten years were surveyed justafter this Department started on April 1982, in consideration of the recent tendency of parasitic in -fections and a role of a newly established Medical School in this district.
Questionnaires on the incidence of parasitosis were sent to Fukui Prefectural Medical Association. The replying rate was rather low (16%) in total, and the clinicians interested inparasitosis was estimatedat 72% of all. The internal medicine was superior in the numbers of clinicians concerning withparasitosis by specialities, and also dermatologists were adequately interested in.
In addition to the replies of clinicians which have had experience in parasitosis, further references onthe cases of parasitosis found in Fukui Prefecture during the past several years indicate that the opportunisticinfections with protozoa, and parasitic zoonoses, especially food-borne larva migrans haverather increased in contrast to decrease of the endemic parasitosis. Particularlyanisakiasis anddiphyllobothriasis are abundant in Hokuriku District including Fukui Prefecture. Various troubles witharthropoda were common in the field of dermatology, but tsutsugamushi disease wasnot yet noticeable.
A result in inspections of the parasitic materials inquired during the period of a year and a half justafter this Department started represented a tendency similar to in survey throughthe questionnaires.
A parasitological survey, furthermore, on general inhabitants of a foothilly areaneighboring to thisSchool suggests that some protozoan infections have been still preserved becausedof the massexamination impracticable for detection of those species, while the soil-transmitted helminthiasis havedeclined except for the hyperendemic areas sporadically in the country.

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For the purpose of the ecological study on the respiratory pathogenic bacteria in pre-clinical stage ofchronic lower respiratory tract infections, the medical examination of respiratory diseases were carriedout in Aino town, Nagasaki prefecture. Six hundred eighty five persons (about 53%) of 1300 inhabitantmore than 40 years-old underwent our examination. Sputum specimens collected from 200 applicants (male 103, female 97) were examined by our quantitative sputim culture method, and 113 strains ofpotential pathogenic bacteria were isolated. Haemophilus influenzae (34 isolates), Streptococcuspneumoniae (28 isolates) and Staphylococcus aureus (22 isolates) formed 74% of the potential pathogens.From 48 persons, potential pathogenic bacteria were isolated more than 10⁷/ml. 38 (79%) of the 48sputum specimens contained single pathogenic bacteria, such as Haemophilus influenzae (15 specimens), Streptococcus pneumoniae (11 specimens), Staphylococcus aureus (3 specimens), Streptococcus pyogenes (3specimens), and so on. From 10 sputum specimens, two species of potential pathogenic bacteria wereisolated, and the combination of Haemophilus influenzae and Streptococcus pneumoniae formed 70% ofthem. Gram negative rods except Haemophilus influenzae were isolated from only two sputumspecimens. Except for the low frequency of gram negative rods, the results of this bacteriologicalexamination were very similar to the results of bacteriological examination of the patients with chroniclower respiratory tract infections.
Eight persons of 48 applicants who showed potential pathogenic bacteria more than 107/ml in theirsputum were diagnosed as the early stage of chronic bronchitis, but the other 40 persons revealed noclinical evidence of chronic lower respiratory tract infections.
These results support our inference on the correlations between the clinical stage and the maincausative pathogens of chronic lower respiratory tract infections, that is, Haemophilus influenzae and Streptococcus pneumoniae are mainly concerned with these diseases at early stage, and other gramnegative rods appear in late clinical stage.

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Campylobacters were examined in 7246 patients with sporadic diarrhea who were treated in the Department of Internal Medicine, Pediatrics or Infectious Diseases, for a period of four years and nine months between April 1979 and December 1983 (December 1981 in the Department of Infectious Diseases), and the following results were obtained.
Campylobacter jejuni, C. coli and C. fetus subsp. fetus were detected in 5.2%, 0.1% and 0.04%, respectively, in the Department of Internal Medicine, C. jejuni and C. coli in 14.5% and 0.2% in the Department of Pediatrics and C. jejuni in 11.2% in the Department of Infectious Diseases.
An epidemiological study was carried out on 201 of these patients. The results showed that the age of patients ranged from six months to 82 years and 61%(123) were young patients aged 10 or less. Thus, campylobacters were frequently detected especially in infants and children. Regarding the rate of detection classified by sex, the bacteria were found in 119 males and 82 females. The ratio of males to females aged 15 or less was 3 to 2, indicating that the detection rate was predominant in males.
With regard to clinical symptoms, diarrhea was observed in 100% of the patients and abdominal pain in about 50%. Especially in children, fever was present in 73.6% and bloody stools in 39.3%. Polymicrobial infection was noticed in 21 patients (10.4%). In these patients, Salmonella was most frequently identified; that is, in 15 of 21. Fourty-four (88%) of 50 patients excreted 10⁵ CFU or mor of C. jejuni per gram up to three days after onset of this disease and the number of bacteria excreted had a tendency to decrease in proportion to the increase in the days of illness.
The antibacterial action of 37 drugs against C. jejuni was determined and the following results were obtained. The antibacterial action of five drugs of the macrolide group, five of the aminoglycosid group, two of the tetracycline group, chloramphenicol and five of the pyridonecarboxylic acid group was found to be strong. Also, ampicillin was found to have a strong antibacterial action. However, the action of three drugs of the penicillin group, 10 of the cephalosporin group, novobiocin, colistin, polymyxin B and bacitracin was found to be weak. There was one strain of Campylobacter (0.7%) that showed a high MIC value of 25 μ/ml against erythromycin.

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In order to determine utility of oxaprozin (OXP, 400mg once daily) in the treatment of acute upper respiratory tract inflammations, a comparative double blind study was carried out using ibuprofen (IBP, 600mg/day in 3 divided doses) as the active control drug.
The following results were obtained.
1. As to global improvement rate, cases evaluated as slightly improved or more accounted for 93.6% and 86.2% of the cases of OXP group and IBP group, respectively, with no significant differencesb etween the two groups.
2. The improvement rate stratified by the symptom revealed no significant intergroup differences for any of the items. However, a tendency of higher improvement rate was observed for OXP group as compared to IBP group in terms of sore throat at the 2nd day of treatment. In both groups especially high degree of improvement was obtained for fever feeling, sore throat, myalgia, arthralgia and pharyngeal and tonsillar redness and swelling.
In both OXP group and IBP group good antipyretic effect was obtained with significant intergroup differences.
3. According to patient's impression, in 91.5% of the cases in OXP group and 79.3% in IBP group the clinical results were evaluated as slightly improved or more, with no significant differences between the two groups.
4. Side effects developed in 5 (6.5%) out of 80 cases in OXP group and 3 (3.9%) out of 77 cases in IBP group, with no significant intergroup differences. As to overall safety rate, 77 (96.3%) out of 80 cases in OXP group and 74 (96.1%) out of 77 cases in IBP group were evaluated as “No adverse reactions”. There were no significant intergroup differences.
5. In terms of utility rate, 87.2% of the cases in OXP group and 82.8% in IBP group obtained the evaluation of slightly useful or more, the intergroup differences being not statistically significant.
From these results it was considered that sufficient utility in the treatment of acute upper respiratory tract inflammations can be expected of OXP with 400 mg single dose per day.

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To study the mechanisms of immune protection against rickettsial infection, the course of infection, the effect of antibiotic treatment, the production of serum antibody and the protective effect of immune serum or splenic T cell transfer in nude mice, which lack the thymus congenitally, were examined using Rickettsia tsutsugamushi, high virulent Gilliam strain and low virulent Irie strain.
Nude mice exhibited high susceptibility not only to high virulent strain but also to low virulent strain, and did not convalesce inspite of tetracycline treatment.
In nude mice infected with high virulent strain, neither 7S antibody nor IgM antibody was detected. Immune serum transfer to nude mice infected with the rickettsia scarcely revealed protective effect, but that was different in the case of normal mice. The transfer of immune splenicT cells to nude or normal mice showed effective protection, but somewhat lesser efficacy in nude mice. This protective ability of T cells was recognized weakly at 10 days after donor immunization, became firm after a month and lasted as longer as 12 months without decay. By treatment of immune splenic T cells with anti-Thy-1.2 or anti-Lyt-1.2 alloserum, the protective ability was lost entirely and considerably diminished by treatment with anti-Lyt-2.2 alloserum.
To nude mice infected with low virulent strain, non-immune splenic T cell transfer showed enough protective effect as well as immune splenic T cell transfer. The transfer of splenic T cells immunized with low virulent strain did not show protective effect in nude and normal mice infected with high virulent strain.
From the results of these experiments, it may be concluded that immune protection against tsutsugamushi disease in mice is mainly depend on cellular immunity and serum antibody production, both 7S and IgM, is T cell dependent.

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For objective evaluation of the efficacy and safety of ceftazidime (CAZ), a new cephem antibiotic, in respiratory tract infections, a double blind comparative study was carried out against cefotiam (CTM). Either of the drugs was administered by intravenous drip infusion in the unit dose of 1 g (potency) twice daily for 14 days, and the following results were obtained.
1. In the assessment by the efficacy Assessment Committee, the overall clinical efficacy rate was 73.2%(90/123) in the CAZ group and 72.0%(90/125) in the CTM group, with no statistically significant difference between the two treatments. When reviewed for each diagnosis, the efficacy rate was slightly lower in the CAZ group than that in the CTM group 60.6%(40/66) and 74.2%(49/66), respectively, in bacterial pneumonia and lung abscess, although there was no significant difference between the two treatments. Whereas in chronic RTI the efficacy rate was higher in the CAZ group (86.0%, 43/50) than that in the CTM group (66.7%, 36/54) with significant difference (χ²-test, <0.05).
2. In the assessment by the physicians in charge, the overall clinical efficacy rate for all cases was 70.7%(104/147) in the CAZ group and 63.7%(101/147) in the CTM group, with no significant difference between the two treatments. When reviewed for each diagnosis, efficacy rate was 70.1%(68/97) in the CAZ group and 71.7%(66/92) in the CTM group in the treatment of bacterial pneumonia and lung abscess, and there was statistically no significant difference between the two treatments. In chronic RTI, the efficacy rate in the CAZ group (79.5%, 35/44) tended to be higher than that in the CTM group (66.7%, 34/51) (U-test, p<0.10).
3. In the 112 cases (55 cases in the CAZ group, 57 cases in the CTM group) in which the bacteriological response could be assessed, elimination of bacteria was achieved in more cases in the CAZ group than in the CTM group, with significant difference (U-test, χ2-test, p<0.01). As to the eradication rate including “replaced”, there was no statistically significant difference between the two treatments.
4. As far as the incidence of side effects and abnormal laboratory findings were concerned, there was no significant difference between the two treatments.
5. The Committee assessed the overall utility (efficacy + safety) as 84.0%(42/50) in the CAZ groupand 66.7%(36/54) in the CTM group in chronic RTI, and the utility in the CAZ group tended to be higher than that in the CTM group (χ²-test, p<0.10). In other diagnoses and also in all cases, there was no significant difference between the two treatments. In the assessment by the physicians in charge, there was no significant difference between the two drugs in the utility.
From the above results, CAZ was considered to be as useful as CTM, based on the efficacy and safety in respiratory tract infections.

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Pasterurella multocida (P. multocida) is well recognized as the causative agent of hemorrhagic septicemia and respiratory infections in animals. Recently, various infections due to P. multocida in human have been noted. Among them respiratory infections are unsual, and empyema is very rare. We report here the first case of P. multocida empyema in Japan, which is considered to be the 16th case in the English literatures.
A 78 year-old male farmer, suffered with high fever, productive cough and left chest pain, was admitted to our hospital 5 days after onset. Left pleural effusion and acute inflammatory reactions were shown. P. multocida was isolated alone from the bloody pleural fluid on the first hospital day. The administration of sulbenicillin, following cephaloridine, resulted in clinical improvement. Then cyclophosphamide therapy was started on the 4th hospital week, because the patient had been diagnosed as IgGκ type of multiple myeloma. But soon later the patient died suddenly of unkown cause.
On autopsy, invasions of atypical plasma cell were found in the bone marrow and the spleen, but little in the other organs. In the lungs, chronic bronchitis was revealed, but the empyema was cured following fibrosis of the pleura.
It was considered that latent respiratory truct infection due to P. multocida brought the patient with multiple myeloma and chronic bronchitis to the empyema.

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