With the addition of Smith surface antigen (SSA), extracted from the Smith strain of Staphylococcus aureus, to human pooled sera antigen antibody complex was obtained. Propionic acid (pH 3.0) containing 5% sucrose was added to this complex and an eluate was dialyzed against phosphate buffered saline containing 5% sucrose. Bacterial agglutination titers of the eluates by using the Smith strain differed depending upon the amounts of SSA used. The eluate exhibited the highest titer in bacterial agglutination was the highest protein content and total amount of IgG, IgA and IgM in the eluate was 97% of the protein. With intraperitoneal injection of 50 pg protein of this eluate in mice, they were protected against lethal infection with Smith strain. The eluate was further subjected to sucrose density gradient ultracentrifugation. Then, 23.5μg and 230μg protein amounts of IgM and IgG rich fractions, respectively, were capable to protect against similar infection.
Hemorrhagic fever with renal syndrome (HFRS) was first found in Japan in about 120 residents of Osaka City during the decade of 1960. As 22 cases of them were admitted to Osaka University Hospital between 1961 and 1970, we studied and summarized the clinical manifestations of these cases as group A. The HFRS developed again in the staffs of animal laboratories in Osaka University Medical School between 1980 and 1982, and we also studied the clinical features of 5 of these cases as group B. The HFRS in group A was mediated by wild urban rats, but one in group B was considered to be mediated by experimental animals. High fever of 39-41°C for 3-7 days and proteinuria were always observed in patients of both groups. Anorexia, lassitude, emesis, myalgia, abdominal pain and headache were main complaints in the majority of patients. Injection of the oral and conjunctival mucosa, coating of the tongue, tenderness in the abdomen, petechiae on the palate and hepatomegaly were common manifestations observed in most cases. Development of microscopic hematuria, various casts and polynuclear giant cells in the urinary sediment, leukopenia with a marked neutrophilia and shift to the left and extremely low sedimentation rate during the initial stage, leukocytosis with an increase of lymphocytes, development of atypical lymphocytes, thrombocytopenia, polycythemia and increases in serum enzymes such as GOT, GPT, LDH and CPK were common abnormalities in the laboratory data. Moreover, transient glycosuria, glucose intolerance or low serum cholesterol levels, which have not been reported previously, were also frequently observed. However, azotemia (BUN>23 mg/dl) was seen only in 30% of all cases. In group A, some severe cases manifested petechiae on the body (7/22), epistaxis (5/22) and/or hypotension (6/22), and two cases were fatal, but none in group B showed such serious symptoms. Marked proteinuria over 3 g/day was observed in 10 cases (45%) of group A, but urinary protein was slight and very transient in most cases of group B. On the contrary, serum GOT and GPT levels were generally higher in group B than in group A. It is, therefore, suggested that the HFRS which develops in the animal laboratories in Japan may cause more severe damages in the liver than in the kidney. When the clinical manifestations of our cases (including both group A and B) are compared with those reported from other Eastern Asian countries, they are generally mild and their course cannot be distingwished so clearly as reported by Sheedy, et al. (1954). The clinical feature, which shows relatively serious hepatic complications with high serum enzyme levels and rather mild renal syndrome with a slight azotemia, seems to be something different from those in other countries and be characteristic ofthe HFRS in Japan. The course of illness and the clinical features of HFRS in Japan, which generally consists of mild cases, are almost clarified in this study by summarization and analysis of the patients experienced in Osaka University Hospital in the 1960's and the 1980's.
Annual cases of S. aureus bacteremia in Tokyo Metropolitan Geriatric Hospital were two to nine up to 1979, and eleven to twenty after 1980. Susceptibilities of S. aureus strains isolated from blood cultures were determined to methicillin and cefazolin. All strains isolated before 1977 were sensitive to both antibiotics, and 39 out of 63 strains isolated after 1980 were resistant to these two antibiotics. Hypoproteinemia was more frequent in methicillin-cephem resistant bacteremia but not statistically significant. β-Lactamantibiotictreatmentwithintwoweekspriortoonsetofbacteremiawassignificantly frequentinpatientswithmethicillin-cephemresistantS.aureusbacteremiathaninthosewith methicillin-cephemsensitiveA.aureusbacteremia (p<0.01).
The purpose of this study was to characterize the role of a cytotoxic principle in diarrhea due to cholera-like-enterotoxin-negative non-O1 V. cholerae. The highest cytotoxic activity was observed when non-O1 Virbrio cholerae strains were grown in Brain Heart Infusion Broth (Difco) without shaking and Vero cells were used as target cells. This cytotoxic principle was different from that found in a fluid accumulating factor (FAF) of non-O1 V. cholerae, strain 79-9-2, for its instability to heat, for its hemolytic activity and for the toxicity to Vero cells, and designated as cytotoxin V. A fraction of cytotoxin V obtained from culture filtrate of Strain 6-17-80 by ammonium sulfate precipitation, followed by gel filtration with Sephadex G-200 and Hydroxyapatite column chromatography, was hemolytic, lethal to mice and positive in ligated rabbit ileal loop test (RIL). Antiserum against this fraction neutralized cytotoxicity and hemolytic activity in culture supernatants of many other non-O1 V. cholerae strains irrespective of their biological characteristics, as well as those from V. mimicus and O1 V. cholerae strains. There seemed to be a close correlation between the level of cytotoxin V and that of hemolysin or lethal toxin in each individual strain of non-O1 V. cholerae, but not between the level of cytotoxin V or hemolysin and fluid accumulation in the RIL with whole culture. Concentrated culture filtrates containing high levels of cytotoxin V or hemolysin was shown to cause fluid accumulation in the RIL. These results indicate that the cytotoxin V of non-O1 V. cholerae is an entity closely correlated with hemolysin, and that it could possibly cause diarrhea, if a large amount would be accumulated in the intestine. Cytotoxin V alone, however, does not seem to explain the major enteropathogenic mechanism of non-O1 V. cholerae strains which do not produce cholera-like enterotoxin.
We isolated Rickettsia tsutsugamushi from wild rodents (Apodemus speciosus) at the new area in Gifu Prefecture, Japan. The isolated R. tsutsugamushi was demonstrated to have natures of Karp strain in antibody analysis of Apodemus and ddY mice inoculated with spleen of wild rodents. Gahrliepia saduski, Leptotrombidium fuji, L. palpale and L. kitasatoi were collected from wild rodents. Survery of antibody to R. tsutsugamushi in healthy people in different areas in Gifu Prefecture was performed. The positive rates were 30.2% to 4.0%. A tendency that the positive rates of antibody were high in endemic area was observed.
The smear specimens from male urethritis and female cervicitis were examined for C. trachomatis using reagents of fluorescence-labeled monoclonal antibodies specified to C. trachomatis (direct specimen test). The positive rate of C. trachomatis in direct specimen test was compared to results in culture method using McCoy cell which was done in same cases. As clinical studies, the efficacy of doxycycline treatment on those cases of male urethritis was investigated. 1) Positive rate of C. trachomatics by direct specimen test was 21.3%(13/61) in male gonococcal urethritis (G. U.) and 40.0%(24/60) in male non-gonococcal urethritis (N. G. U.). 2) Positive rate of C. trachomatis by culture method was 21.7%(5/23) in male G.U. and 38.1% 8/21) in male N. G. U. 3) Positive coincident rate in both direct specimen test and culture method was 81.8%, and negative coincident rate was 89.3%. 4) Positive rate of C. trachomatis in direct specimen test was 25%(2/8) in female gonococcal cervicitis, and 22.7%(10/44) in female non-gonococcal cervicitis. 5) All cases (12/12) of male C. trachomatis positive N. G. U. were cured with doxycycline treatment, but only half cases (3/6) of male C. trachomatis negative N. G. U.were cured by same treatment.
The in vitro activities of eight chemotherapeutic agents against two clinical and three laboratory strains of Rickettsia tsutsugamushi were determined by a cell culture method. Tetracycline, rifamycin, chloramphenicol and erythromycin were generally effective (MIC, 0.15-0. 31, 1.25-2.5, and 2.5-10.0μg/ml, respectively), whereas aminobenzylpenicillin, kanamycin, lincomycin, and nalidixic acidwere not effective below 100μg/ml. There was no significant difference of MICs between recentlyisolated strains and old ones.
Three cases with glucose non-fermentative gram-negative rods septicemia were reported. In case M. F., 70 years old man witn T-cell chronic lymphocytic leukemia, was associated with a septicemia of Flavobacterium meningosepticum, and died after the combination chemotherapy of cefoxitin (CFX) and ceftizoxime. In case M. Y., 36 years old man, had been in good health until June 1983 when fever and generalized eruptions developed. Pseudomonas cepacia was isolated from his blood. The patient was cured by the treatment with succesive combined antibiotics of CFX and minocycline. In case H.I., 72 years old man with pyothorax, was suffered from sudden onset of a high fever. Blood culture revealed gram-negative rods identitied as Alcaligenes faecalis. The patient was recovered from the septicemia by the administration of piperacillin and cefsulodin.
The first case of tsutsugamushi desease in Fukui Prefecture which was validly diagnosed was reported with a special notice to the isolation of Rickettsia from its blood donated for a blood donor center. The patient, a 50-year-old male in Takahama, Fukui Pref., began to have chill and fever with a eschar on his left arm on May 28, 1984. He was admitted to the Department of Dermatology of Maizuru Kyosai Hospital, Kyoto Pref. on June 4. Because the extensive roseolar and the eschar suggested tsutsugamushi disease, he was initially treated with Minocycline 200 mg/day for 14 days, and was discharged as recovered clinically on June 18. The elevated titers of serum antibody to rickettsial antigens were observed in Indirect Immunofluorescent and Peroxidase-Labeled Antibody tests during the course. His donated blood was locked up just after the tentative diagnosis, and then a strain of Rickettsia was isolated from the material at the first passage using ddY mouse. The strain was mildly pathogenic, but not yet clarified about the characteristics.
This report relates to a case of Pneumocystis carinii pneumonia successfuly treated with a combination of co-trimoxazole for intravenous injection (i. v.) and pentamidine isethionate. A 13 years old boy was admitted with a malignant lymphoma to Juntendo University Hospital. He had a local radiological therapy at his cervical lymphnodes and a systemic VEMP therapy. His condition was improved. On the day of his discharge, a marked leucopenia was found and he had to be readmitted on the following day. He started an antibiotic therapy, but his pharyngalgia was aggravated and his body temperature tended to rise up, and so the antibiotic was changed to other one. In spite of the treatment, his condition was not improved. Chest x-ray examination on the 10th hospital day showed diffuse shadows in the bilateral lung fields and a marked hypoxemia developed. A presumptive diagnosis of Pneumocystis carinii pneumonia was made and he was given intravenously co-trimoxazole for 4 days. A smear test of sputum disclosed a cyst of P. carinii. So a combination of co-trimoxazole and pentamidine for i.v. was given for 8 days. His high fever tended to fall down and hypoxemia was disappeared 9 days after the initiation of the therapy. The combination therapy with both drugs for i.v. was stopped and an oral administration of cotrimoxazole only was continued during 120 days. There was no sign of reccurrence thereafter. The patient recovered from Pneumocystis carinii pneumonia by combined remedy with cotrimoxazole for i. v. and pentamidine for i. v. Considering his clinical course, he was expected his noticeable effect even if co-trimoxazole for i.v. alone was given from the beginning of his illness. Co-trimoxazole for i. v. has not been available yet in Japan. This patient may be the first case treated with co-trimoxazole for i.v. in Japan.