Two groups of cases of deep mycoses in Japan were summed up from questionnaires and literatures, the one of which consisting of 918 cases until 1966 and the other consisting of 1985 cases from 1971 through August 1981.In comparing with the two groups, the following trends were noted.
1.The total cases were larger in number in the latter than the former.As to the relative frequency of each mycosis, a significant decrease occurred in aspergillosis and a significant increase in cryptococcosis and nocardiosis.
2.The male/female ratio diminished significantly in aspergillosis and cryptococcosis.
3.The decades when mycoses occurred more frequently became higher in aspergillosis, candidiasis, cryptococcosis, mucormycosis and double or triple fungus infection.
4.The mean age of the patients became significantly higher in aspergillosis, candidiasis, cryptococcosis and double or triple fungus infection.
5.The number of secondary aspergillosis cases decreased significantly and that of secondary candidiasis cases increased significantly.
6.Cases of aspergillosis, candidiasis, cryptococcosis, mucormycosis and double or triple mycosis secondary to infectious diseases decreased in frequency.
7.The frequency of administration of steroids and cytotoxic drugs in secondary mycoses increased in aspergillosis, candidiasis, cryptococcosis, mucormycosis and double or triple infection.The frequency of administration of antimicrobial drugs in secondary mycoses decreased significantly in aspergillosis, candidiasis, cryptococcosis and mucorymycosis.
8.The incidence of premortal diagnosis by histopathological examination of surgical or biopsy specimen increased significantly in aspergillosis, candidiasis and cryptococcosis.
9.The fatality rate in primary mycoses declined in aspergillosis, candidiasis, cryptococcosis and mucormycosis.

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An experimental aerosol infection which resembles that of Legionnaires'disease was studied in several animal models.The Philadelphia 1 and the L44 strains were used.The L-14 strain had been isolated from a cooling tower on the roof of A hospital in Okayama, and was identified as belonging to L. pneumophila serogroup 1.The effect of this strain on guinea pigs exposed to nitrogen dioxide (NO₂) was studied.The effect of the host defense mechanism on the L-14 strain infection in guinea pigs immunized with the Philadelphia 1 strain was also studied.Serum antibodies and skin reactions were measured after the immunization at stated intervals.
In aerosol infection with the L-14 strain, a fatal widespread bronchopneumonia similar to human Legionnaires'pneumonia was produced in guinea pigs with 100% mortality. ICR mice, deer mice, and nude mice, however, all animals survived with chinese hamsters, there was 40% mortality.In the infection with Philadelphia 1 strain, no fatal bronchopneumonia was produced even in guimea pigs.In the guinea pigs exposed to NO₂, the mortality rate was not significantly different from controls with a high dose infection of the L-14 strain.NO₂-exposed guinea pigs were more sensitive to L.pneumophila at a low dose infection. Of the aerosol infection-immunized guinea pigs, more than 70% survived. Induced antibody responses appeared after one week and positive skin reactions were induced after five weeks.
From these results, it was recognized that sensitivities differed with animal species, and it was suggested that there was the virulent strain in environmental samples.NO₂-exposed guinea pigs were easy infected by a low dose infection.In immunized guinea pigs, it was considered that cell-mediated immunity played an important role, but also that humoral immunity played a role in the host defense against L.pneumophila.

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The epidemic of influenza in 1983-1984 was mainly caused by Russian A type virus.In it, a peak of occurrence of patients throughout the country was noticed over a period from the end of January to the beginning of February, 1984.Such peak of occurrence of patients, however, was found in Tokyo area in the 50th week of 1983, or over a period from 11 to 17, December.Therefore, there is a large difference in the time of appearance of a peak of epidemic between this area and the whole country.
To interpret the chronological difference in the appearance of such peak, the authors carried out meteorological studies on the epidemic of influenza with the Fukuoka area as a control. The following results were obtained from these studies.
1) Judging from the average atmospheric temperature in the passed years, it was unusually low in both Tokyo and Fukuoka areas in the present epidemic period.There was no significant difference in the average temperature in this period between the two areas.
2) A comparison was made on the number of days (in November and December, 1983) when the average relative humidity was less than 50% between the two areas.As a result, the number was significantly larger in the Tokyo area in these months than in the same area in both months of any other year free from an epidemic of influenza or in the Fukuoka area in the winter of 1983.
3) The number of days in January, February, and March when the average relative humidity exceeded 60% was significantly larger in Tokyo area in the 1983-1984 epidemic period than in any ordinary year.
In conclusion, it was indicated that there was a remarkable relationship between the number of days in November and December, 1983, when the average relative humidity was less than 50% and the chronological difference in the appearance of a peak of prevalence of unfluenza in the 1983-1984 epidemic period between Tokyo area and the whole country.

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Efficacy and safety of a hepatitis B vaccine (H-B-VAX, Marck) were studied in 70 healthy medical personnels of Tokai University Hospital.The subjects received primary dosis of 20 micrograms of the vaccine with one or two boosters one and six months later.
Systemic and local reactions following vaccination were monitored.Serological responses were studied measuring anti-HBs titers by a radioimmunoassay.Antibody titers were measured at 1, 3, 6 and 9 months after the primary vaccination.
Seroconversion rates were 45.7% after one month, 88.6% after 3 months, 90.5% after 6 months and 95.5% after 9 months respectively.
The incidence of systemic reactions such as chill, headache, fatigue, malaise and myalgia/arthralgia ranged from 1.8% to 17.8%.Temperature elevation above 37.5°C was not observed. Local reactions such as heat, induration, swelling and pruritus were observed in 1.2% to 21.9% of the vaccinees.
Cellular immunity of the vaccinees before and after vaccinations were also evaluated.Lymphocyte subpopulations (T, B), T-cell subsets (OKT 3, 4, 8 and 4/8 ratio), and mitogenic responses (PHA ConA) showed no significant changes.
Consequently, this H-B-VAX may be considered to be effcient and safe as already observed in the United States.

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An indirect fluorescent antibody test was used to determine the prevalence of serum antibodies to Legionella pneumophila serogroups I-IV from prospectively collected srum specimens of 432 apparently healthy adult Okayama residents, and from 160 stored serum specimens of patients hospitalized in the Division of Respiratory Diseases of our hospital.
No serum sample collected from healthy adults had titer levels greater than 256, three had titer levels of 128 (0.7%) and 11 had titer levels of 64 (2.5%).The remainder of the samples all had titer levels of less than or equal to 32 (96.8%).There was no significant difference detected in age and sex distribution between the subjects with high titer level values and those with lower titer level values.
In contrast to the findings in the healthy adults, hospitalized patients had higher titer levels. Eighteen of the these patients, all of whom had infectious diseases, had serum titer level values of greater than or equal to 64 (11.3%), as opposed to 3.2% prevalence in the healthy population (p<0.0001).
Of those 18 patients, five had serum antibody level values in the range of 256 to 1024.The diseases that these eighteen patients had were pneumonia in 10, exacerbation of lower respiratory tract infection in 6, and fever of unknown origin in 2.Nine of these patients had underlying chronic obstructive lung diseases or bronchiectasis. No patients without respiratory infection had a serum titer level value greater than 32.
These results suggest, but by no means prove, that the etiology of some pulmonary infectious diseases in Okayama prefecture is due to Legionella pneumophila.This queation needs to be addressed further by a prospective study of the cause of pneumonia in our prefecture.

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In order to grasp the actual state of transmission of HBV in healthy persons, the virus related antigens and antibodies were investigated on 1939 samples in total, of 941 students aging 18 to 24, of a nursing school in Hiroshima Prefecture during a period from 1976 to 1983.
The positive rate of HBs antigen of a total 1939 samples was 1.7%, and that of and HBs antibody was 14.7%. The three years moving average of the former was 1.4% to 2.1% and was in a state of equilibrium, while that of the latter was 18.7% to 10.4%, showing 1% to 2% decrease every year.The positive rate of and HBs antibody in the students of clinical nursing II course (night class) was 19.2% and was significantly higher than 11.0% in those of clinical nursing course (x² test, p<0.01).
The anti HBs antibody positive rate of the first-year students decreased from 16.3% of the first half period (1976-1979) of the study to 9.3% of the latter half one (1980-1983).This trend was especially remarkable in the students of clincal nursing II cours (x² test, p<0.05).
Only six students were confirmed to be HBe antigen carriers. Three students were proved to be newly infected with the virus during the study period. However, no evidence could be obtained through the serological and enrollment investigations that they were horizontally infected within the study group.

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We studied the organisms in the aspirates obtained by transtracheal aspiration in 7 cases with chronic lower airway infection. All of the cases were examined repeatedly (more than twice) for one year or more and then we had 42 aspirates in this series.
1) In 40 of 42 aspirates, organisms were isolated and in the other two aspirates obtained after chemotherapy, no organisms were isolated.
2) The aspirates were obtained most frequently in september and December, next in August and a few in the other months.
3) In 6 of 7 cases, the same kinds of organism were isolated from the specimens, and the organisms are H.influenzae in 2 cases, H.influenzae + a-streptococcus + Neisseria in 1 case, S.pneumoniae in 1 case, B.catarrhalis in 1 case and P.aeruginosa in 1 case.
From these results, we consider that these cases have persistent-bacterial-infection in lower airway and have their own special flora in lower airway.

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A long-term observation on HI antibody against Japanese encephalitis virus (JEV) was performed in a group of healthy adults extending from 1966 to 1982.
The results obtained are as follows:
1. In June 1967, 224 HI antibody negative persons were vaccinnated twice by subcutaneous injection of 1.0 ml of JEV vaccine, and 178 persons (79.5%) changed to seropositive a month after the first inoculation. Titers of HI antibody of 138 persons (77.5%) ranged from 1: 10 to 1: 40. The levels of the serum HI antibody acquired after vaccination were not maintained for long term for the most cases; 80% of them returned to seronegative one year after. In a few cases, they returned to seronegative from as high titer as 1: 160.
2. In 1971, 106 persons showed the positive HI test at the titer of 1: 10, and they received a single dose of vaccine in 1972. In 1975, 65 persons (61.3%) were seronegative, among which 52 persons received one or two doses of vaccine, and 50 of them (96.2%) acquired the detectable HI antibody again at titers of 1: 10 to 1: 80.
3. Although 220 persons who showed the HI titer of 1: 20 or higher in 1971 did not received the booster vaccination for the following six years, 193 of them (87.7%) were still seropositive in 1975. All of the persons who showed the positive HI test at titers of 1: 80 or higher in 1971 maintained detectable HI antibody for a period of six years. At least, none of 51 persons were vaccinated since 1966, and all of them maintained HI antibody at titers of 1: 10 to 1: 320 for sixteen years. It seems that these persons probably acquired the antibody after the subclinical infectioin with JEV and HI antibody was maintained for a long term in these cases.
4. After fifteen years of the systematic vaccination against JEV as mentioned above, positive rate of HI antibody in the group increased from 43.4% in 1966 to 67.5% in 1971 and 73.2% in 1982, respectively. In a period of the observation, outbreaks of Japanese encephalitis were endemic in Japan, and it seems that the upturn of the rates of the seropositives is due to the effect of vaccination and not to the immunization by natural infection of JEV.
5. One hundred and one persons who showed negative HI test in 1966 were frequently inoculated with JEV vaccine thereafter, but 38 out of 101 were still seronegative and 33 showed low HI antibody titer (1: 10) in 1982. The rate of such low responders was estimated at about 14% of all of the members in this series. No linkage was observed between the low responsiveness to JEV by HI test and the certain types of HLA-A, B, and C antigens. Most of these HI antibody negative cases showed positive neutralizing antibody. It is suggested that the discrepancy between HI test and neutralization test is not due to the difference of sensitivity of these tests, but may be due to the constitution of individuals.

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A female patient aged of 51 y.o. had been administrated by corticosteroid for treatment of systemic lupus erythematodes and autoimmune hemolytic anemia. She was suffered by cryptococcal meningitis during the steroid therapy. Though the symptoms of meningitis slightly reduced by a therapy with miconazole and flucytosin, the symptoms were found again after 3 months. Then she was treated with 1200 mg/day of ketoconazole. This therapy resulted in abatement of subjected symptoms and sterilization of cerebral spinal fluid. Transient elevation of GOT, GPT, ALP and γ-GPT were observed after 2 months from begining of admisnistration.
This case suggestes that therapy with ketoconazole is useful for patients with cryptococcal meningitis who can't be recieved standard therapy with amphotericin B or the combination of amphotericin B plus flucytosine.

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We encountered a diabetic with solitary pyogenic liver abscess containing a large amount of gas. Gas gangrene due to Clostridium species has been considered a representative gas-forming infection. It has been pointed out, however, that the incidence of non-clostridial gas gangrene is on the increase in recent years, and some cases of emphysematous pyelonephritis and emphysematous cholecystitis were reported as gas-forming infection other than gas gangrene. However, gas-containing liver abscess is a rare condition.
The patient was a 62-year-old woman, who was admitted for fever of unknown etiology. On admission, she had marked leucocytosis and GOP, GPT, ALP and LAP levels were elevated. Plain X-ray examination of the abdomen demonstrated a gaseous area under the right hemidiaphragm. Ultrasonographic examination of the same region visualized a mass composed of both hyperechoic and hypoechoic areas in the right heaptic lobe. Computed tomography showed a low density area accompanied by images suggestive of a large amount of gas with air-fluid level. Based on these findings, she was diagnosed as gas-containing liver abscess. The patient was immediately laparotomised to perform tubed drainage, and concurrently systemic and local chemotherapies were carried out. Soon, the liver abscess healed up and the patient was discharged. Smell of gas and pus was not foul, and Klebsiella pneumoniae was isolated from the pus and blood.

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