The records of 46 enterococcal bacteremia at Tokyo Metropolitan Geriatric Hospital from 1972 through 1984 were reviewed. Sixteen out of 46 cases were monomicrobial bacteremia and 30 cases were polymicrobial bacteremia. Portal of entry were urinary tract in 15 cases, biliary tract in 10 cases, decbitus in 10 cases, and unknown source in 11 cases. Seven out of the 15 patients with enterococcal urosepsis were monomicrobial bacteremia. On the other hand, almost all patients with enterococcal bacteremia originated from biliary tract and decubitus were polymicrobial. Of the 48 strains indentified to species level, 34 were S. faecalis, 8 were S. faecium and 6 were S. avium. S. faecalis was isolated from 14 out of 15 patients with enterococcal urosepsis. In patients whose portal of entry was biliary tract or decubitus, 3 species were recovered in almost same proportions. Total mortality of the bacteremia was 41.3%. The factors which contributed to poor prognosis were DIC, shock, and antimicrobial treatment during 2 weeks prior to onset of the bacteremia. Portal of entry and polymicrobial bacteremia did not influence the mortality.
In 1980, Vibri cholerae O1, biotype El Tor, serotype Inaba, was isolated from the Aja river, Okinawa, The 12 strains examined belonged to classical Ubol type.The original focus of the organisms could not be determined in spite of intensive survey.The organisms was characterized by an unique biochemical behaviour, i.e., no fermentation of sucrose in aerobic condition within 24 hours.The phage typing by El Tor cholera phage revealed type 1 in 11 strains and type 6 in 1 strain.On the contrary, the other 32 Ubol type strains recently isolated in various countries in the world revealed type 4 or untypable. These facts suggested that the Vibrio cholerae O1 isolated in Okinawa was not recently imported, but has been living there for a long time as native organism.The pathogenicity of the organisms were examined with De-test, toxigenicity and adhesive property to the intestinal epithelium.And these organisms appeared non or less pathogenic.
Subjects for the study were untreated children with acute respiratory infection who had visited the pediatric outpatients' department of Mizonokuchi Hospital, Teikyo University Hospital and Azusawa Hospital between Octover 1980 and September 1981.Pharyngeal swabs were obtained from all patients, and examined for an epidemiological survey of pathogenic bacteria and the streptococcal flora to interfere with growth of the pathogen (interfering streptococci).The results obtained are as follows: 1. The presence or absence of interfering streptococci was examined by an agar overlay procedure with S.aureus, S.pyogenes, S.pneumoniae and E.coli as indicator strains.The rate of detection of interfering streptococci against the 4 indicator strains was 60-70% throughout the year, though statistically it was low in April and July. 2. The frequency with which S.pyogenes or S.aureus was isolated from a certain clinical material tended to be negatively correlated to the frequency with which interfering streptococci were isolated from the same material, but the correlation was statistically not significant. 3. The frequency of isolation of interfering streptococi was markedly low in the under-6 months age group, and remarkably elevated to 60-70% in the over-6 months age group.Difference in both age groups was statistically significant. 4. There was no correlation between the isolation of S.aureus S.pyogenes, S.agalactiae or S.pneumoniae from a certain clinical material and that of interfering streptococci from the same material. 5. The growth of S.aureus as indictor strain was mainly inhibited by S.sanguis and S.mitis, and that of streptococci such as S.pyogenes and S.pneumoniae by S.salivarius. 6. S.sanguis, S.mitis, and S.salivarius produced the same effect against clinically isolated S.aureus, S.pyogenes, and S.pneumoniae as against the indicator strains of the same bacteria in respect to the antibacterial spectrum and intensity of the inhibitory action.
The purpose of this investigation was to study the changes of isolated strains between monomicrobial and polymicrobial isolation from urinary tract in patients of Tsukuba University Hospital from 1980 to 1982. 1) In the monomicrobial isolation of the inpatient, E.coli was the most common isolate (583 strains, 18.3%).S.marcescens was the second (463 strains, 14.5%) and P. aeruginosa the third (403 strains, 12.6%). 2) In the polymicrobial isolation, Enterococcus group was the most common isolate (975 strains, 47.1%).P.aeruginosa was the second (458 strains, 28.7%) and E.coli the third (405 strains, 25.4%). Enterococcus group had a tendency to increase through three years. 3) E.coli was isolated more frequently in 20 to 40 years old age group and P.aeruginosa was isolated less in 10 to 40 years age group. 4) E.coli was isolated more frequently from the female than the male while S.marcescens was isolated more frequently from the male than the female in both monomicrobial and polymicrobial isolation. 5) The most frequent combination of bacteria in polymicrobial isolation was that of Enterococcus group and P.mirabilis.
The virulence of clinical isolates of Acinetobacter calcoaceticus, Pseudomonas cepacia, and Pseudomonas maltophilia in urinary tract in mice was studied.In general, the virulence of these organisms in urinary tract of normal mice was relatively mild.The effect of anti-inflammatory and immunosuppressive drugs on pathogenicity of these organisms was studied in mice.The mice previously treated with betamethasone or prednisolone as anti-inflammatory drug, and with cyclophosphamide or azathiopurine as immunosuppressive drug, were more susceptible to these bacterial infections than were the non-treated ones.As for the capacity of bacterial attachment to the epithelial cells of the bladder, these organisms were generally shown to have low adhesion.Furthermore, the hemagglutination patterns were mannose-sensitive in human and guinea pig erythrocytes.
Infection and immunity in 15 patients with severe burns were studied. The mortality rate from sepsis was approximately 63%.The predominant infection was due to gramnegative organisms such as pseudomonas, acinetobacter and enterobacter.Pseudomonas was most detected in burn eschar, blood and sputum.In contrast, serratia led to urinary tract infection.Although most aerobic organisms showed increasing resistance to antibiotics at the beginning of the early burn state, pseudomonas was susceptibile to AMK contineously and acinetobacter to MNC. Regarding cellular immunity, the total population of T cells including T4, T8 and T11 cells decreased.B cells increased compared to T cells.Con A stimulation index also decreased.Regarding humoral immunity, a marked decline of IgG and IgA occurred but IgM remained in normal range.Both cellular and humoral immunity were depressed more strongly in the died patients than in the survivals. In complements, there were remarkable decreases of C3 and CHSO and a slight decrease of C4. Thus, an evidence is mounting for the occurrence of remarkable interference with host defence mechanism in burn patients, and it is suggested that opportunistic infection may affect the development and outcome of gram-negative infection.
The roles of oxidative metabolism and lysosomal enzymes in the phagocytosis of activated macrophages against Pseudomonas aeruginosa, Staphylococcus aureus, and latex particles were studied. It can be said that enhancement of the host defence mechanism against p. aeruginosa infection was increased by activating the reticuloendothelial system by Propionibacterium acnes pretreatment. The oxidative metabolism as measured from cheniluminescence, and lysosomal enzymes against p. aeruginosa play an important role in the intracellular killing of bacteria, and these activities are enhanced by p.acnes treatment. Activated macrophages generated the highest chemiluminescence response when they ingested p.aeruginosa in combination with gentamicin and gamma-globulin. In contrast, such mechanisms show little participation against S. aureus and latex particles.
The clinical efficacy and safety of Lenamicillin (KBT-1585, LAPC) were compared with those of Bacampicillin (BAPC) as the control drug in patients with bacterial pneumonia by double blind study. Patients over 16 years old with apparent clinical signs and symptoms of pneumonia were administered LAPC (at a daily dose of 1 g) or BAPC (at a daily dose of 1 g) orally for 14 days in principle. Then the clinical and bacteriological efficacy, improvement in symptoms, side effects, abnormal changes in laboratory findings, and utility were assessed. After excluding the patients which did not fit the protocol from the total 209 patients admitted to the study, clinical efficacy, side effects and abnormal changes in laboratory findings were analyzed statistically in 187 patients, in 199 and in 193 patients respectively. Basides, clinical efficacy was analyzed in the patients with bacterial pneumonia which were completely adapted to the protocol and also in the total patients including those with non-bacterial pneumonia and other respiratory tract infections. 1) On the basis of committee judgement, the clinical efficacy rate in the patients with bacterial pneumonia was 86.9% for the LAPC group and 86.7% for the BAPC group, respectively. As for the total cases, the rate was 80.2% for the LAPC group and 85.4% for the BAPC group, respectively. In both analyses, no significant differences were found between the two groups. 2) According to the judgement by doctors in charge, the clinical efficacy rate in the patients with bacterial pneumonia was 90.0% for the LAPC group and 84.0% for the BAPC group, respectively. As for the total cases, the efficacy rate was 81.6% for the LAPC group and 81.7% for the BAPC group, respectively. In both analyses, there were no significant differences between the two groups. 3) As for the bacteriological efficacy, there was no significant difference between the two groups. 4) The incidence of side effects was 4.1% in the LAPC group and 7.8% in the BAPC group, respectively. The incidence of the abnormal changes in laboratory findigs was 19.4% for the LAPC group and 22.0% for the BAPC group, respectively. There was no significant difference between the two groups. 5) The utility rate in the patients with bacterial pneumonia judged by the committee was 86.9% for the LAPC group and 80.0% for the BAPC group, respectively. The rate in the total cases was 80.2% for the LAPC group and 79.2% for the BAPC group. No significant differences between the two groups were noted. In the utility rate judged by doctors in charge, no significant difference was found between the two groups, too. As described above, any significant differences were found between LAPC (at a daily dose of 1 g) and BAPC (at a daily dose of 1 g) neither in the efficacy rates nor in their safety. From these results, LAPC as well as BAPC are considered to be highly useful antibacterial agents for the treatment of respiratory tract infections.
I have made series of experiment using Shigella flexneri to clarify the defense mechanism against the enteric infection.I have already observed that the virulent strain caused inflammation in intestinal loop test in rabbits and guinea pigs. Intestinal loop test in various animals 18 hrs after operation was studied in this paper.Either S. flexneri 2b 17-A or Escherichia coli O-124 S caused inflammation of all intestinal loops in rabbits and guinea pigs, but neither S.flexneri 2b 17-N nor E.coli 0-124 R could cause inflammation.Using intestinal loops in non-treated mice, the virulent strains caused the inflammation of intestinal loops at the rate of about one third.The results were considered to be positive when the ratio of fluid to length of the looped intestine was 50 or more mg per cm.In case of mice treated withi.p.administration of carageenan (100 mg/kg) before 3 days as well as treated with washing of loop with PBS-, the positive rates were not different from those of non-treated mice.On the other hand, using intestinal loops in treated mice with peroral administration of chloramphenicol (1mg/ml) for 3 days ori.p.administration of cyclophosphamide (100mg/kg) before 3 days, the virulent strains caused the positive results at the rate of about two third. Thus, it was suggested that mice, after being treated with adequated chemicals, could be used for the intestinal loop test to prove the invasive ability of enteric bacteria.
The patient was a 13 year, 6 month old girl who was admitted in our hospital by lupoid hepatitis and improved soon after administration of glucocorticoid, though SLE-related laboratory tests, for example, LE cell test, anti-DNA antibody titer, hypergammaglobulinemia, etc, further continued positive. She was treated by daily oral administration of small dosis of aspirin and/or anti-inflammatory drugs after the glucocorticoid therapy. On June 25, 1983, her temperature elevated to 39.5°C and she complained general malaise and joint pains at bilateral elbows and knees. The next morning, the fever still continued and she showed hypotention with systolic pressure at 66 mmHg. Confusion, menigeal signs and abnormal findings of spinal fluid with increased leukocyte counts (1662/ 3/cumm with 92% of neutrophils), increased, protein content (200 mg/dl) and decreased sugar content (36 mg/dl) were also observed. White bloodcell counts were 21900/cumm in peripheral blood with 95% neutrophils with left shift. With intensive care, her blood pressure was stabilized in 48 hours after the onset of the illness. However she had hyperemia of her conjunctivae, lips, oral mucosa, pharynx and skin, especially at the cheeks and the palms. She also showed manifestations of multisystem involvement; diarrhea and vomiting, elevated values of GOT, GPT, LDH, CPK, BUN and creatinin in serum, prolonged P-Q interval in ECG, muscle pains, alteration of consciousness without any focal signs even after recovering from shock and hyperexia, etc. She was treated by peritoneal dialysis for 5 days from June 27 owing to acute renal failure. At 7th day of the illness, the spinal fluid was normalized and no pathogen was detected from central nervous system, suggesting that the abnormal findings of the spinal fluid had not been due to direct invasion of pathogen, but due to temporary reaction of central nervous system against exotoxin and/or some products of the pathogen. The patient was finally recovered without any sequelae. Staphylococcus aureus was isolated from throat and the lesions of angular stomatitis as well as pustle of chest wall at the onset of the illness; the isolate from throat was 52A/79/84/85 of phage type, those from angular stomatitis and pustule were 79/84. All the isolates produced enterotoxin A and coagulase type VII, though toxic shock toxin (TST) was not detected. Serum ASO titer was not significantly changed. Agglutinins against Yersinia, Leptospira and Proteus OX strains (Weil-Felix reaction) were not detected. Serum levels of complement C3, C4 and CH50 were decreased at the shock state. We reported a unique case of TSS with temporary manifestations of aseptic meningitis at the onset of the illness.