We observed the clinical and laboratory features in 4 patients with C. trachomatis and 4 patients with non C. trachomatis pneumonia in infants less than 3 months from December 1983 to April 1984 comparatively.
In each case, conjunctival and nasopharyngeal smear for C. trachomatis detection and serum specific antibody to C. trachomatis were examined. The diagnosis of C. trachomatis infection was made by either detection in the specimen or positive specific IgM antibody using indirect immunofluorescence technique.
Clinical characteristics in 4 infants with C. trachomatis pneumonia was of afebrile course, insidious onset and poor weight gain. Conjunctivitis or otitis media was developed in 3 out of 4 patients.
ESR and CRP were variable depending on the cases. Mild eosinophilia was observed in 2 of 4 cases. Immnoglobulin levels were elevated in all cases. Transient elevation of serum GOT and GPT was noted in 3 of 4 patients. Chest X-ray demonstrated bilateral symmetrical pneumonitis and hyperinflation for a long period in all 4 patients with C. trachomatis pneumonia.
Erythromycin was effective in the treatment of C. trachomatis pneumonia.

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Three strains of Legionella pneumophila serogroup 1 were isolated from cooling tower on October, 1984. This is the first report of the isolation from environmental samples in China. The cooling tower was used from air-conditioning of a hotel in Guanzhou City.
We used a modificated methods for detection of the organism reported by Morris, et al.and Saito, et al. The cooling tower water in control room was collected aseptically in a sterile receptable (500ml) at three different days. The each sample was centrifuged at 4500 rpm for 30 min and its supernatant was discarded with remainning the sediment in volume of 10ml. The sediment was devided to each 3ml (total 9ml for intraperitoneal inoculation to three guinea pigs and 1.0ml for low pH treatment reported by Bopp, et al. (1981)). After the guinea pigs were sacrificed at 4 days later, their peritoneal swab and spleen homogenate (0.1ml, each) were inoculated on B-CYE agar. The sample of low pH treatment for 10ml was inoculated on B-CYE with antibiotics (Vancomycin 0.5μg/ml, Polymixin B 40units/ml and Aminomycin 80μg/ml), and these were incubated at 35°C for 7days.
All three isolates from each one of the peritoneal swab among each three guinea pigs had typical appearance on B-CYE agar, failed to grow on blood agar and yielded typical patterns of biochemical properties except oxidase reaction. These strains were sent to 2nd Department of Internal Medicine, Nagasaki University School of Medicine, in Japan and finally identified as L. pneumophila serogroup 1. As no strain was isolated from spleen homogenates or low pH treatment samples, it would be the best way for isolation of L. pneumophila from cooling tower water to be used intraperitoneal swab of guinea pigs.

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For the purpose to determine initial focus of streptococcal invasion an experiment was studied by aerosol infection of group A stretococci type 12 in rabbits.
In this study suspension of living streptococci and fluorescein isothiocyanate (FITC) labeled streptococci were used at the nebulizer concentration of 10⁹ colony forming unit/ml. These suspensions were exposed 20 ml per rabbit for 120 min.and infected rabbit were sacrificed at 2 hours to 14 days after the exposure.
Streptococci were recovered in the throats or lungs of rabbits within 3 days after the exposure on blood agar plates. In the heart and liver of one rabbit streptococci were cultured but not in the blood and other organs of other rabbits.
Histologically adherence and presence of bacteria were proved on the pharyngeal mucosa of rabbits within 3 days after the exposure by light microscopy and were proved on the tonsillar surface, tracheal mucosa and lungs of rabbits within 24 hours after the exposure by fluorescent microscopy.
By scanning electron microscopy adherence phenomenon of streptococci was showed on the pharyngeal mucosa but not on the laryngeal and tracheal mucosa.Cilia of the tracheal mucosa of the rabbit after 2 hours of exposure were disarranged and decreased.
By a direct immunofluorescent technique, staining with FITC labeled rabbit y-globulin anti whole group A streptococcal antigen, fluorescent particles or deposits were observed on the pharyngeal mucosal surfaces of the rabbit sacrificed at 2 hours after the exposure and phagocytic cells with diffuse fluorescent cytoplasm or fluorescent particles were showed in the lungs of all experimental rabbits.
From these results of the experiment, it became clear that rabbits inhaled streptococci to the lungs in these aerosol methods, because bacteria were recovered in the throats and lungs within 24 hours after the exposure. But as there was no bacterial multiplication or suppurative inflammation in these organs, it was thought that streptococci were treated with some defence mechanisms in each mucosa.
Histologically the phenomena of the adherence of streptococci were found in the throats and tonsils, and mucociliary clearance in the larynx and trachea and also the phagocytosis in the bronchi and the lungs were found.
It was supposed that there are differences of tissue tropinisms and defence mechanisms against streptococci among each mucosa.

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Hemophilus influenzae type b (H. infl) is the most frequent cause of bacterial meningitis. Since the last ten years, there have been many reports of meningitis in children caused by ampicillin-resistant H. infl.
In the recent three years, three cases had been admitted by suffering the ampicillin-resistant H. infl meningitis in Tokyo Women's Medical College Daini Hospital.
These three cases were treated with Ceftizoxime (CZX) and determined the CSF levels of CZX. Because the meningitis was injected by every 6 hours, CSF levels of CZX were determined on 4 to 5 hours after injected whether antibiotic levels exceeded the minimal inhibitory concentration (MIC) or not.
CSF levels of CZX were 5 to 7μg/ml on 4 hours after CZX 200mg/kg/day injected. For the CZX, MIC of isolated organism was 0.025μg/ml or less. CSF levels of CZX exceeded the MIC of isolated organisms.
Clinical improvement was excellent and did not found the any side effect of CZX.
Throat swab culture of family of three cases isolated the ampicillin-resistant H. infl in two families.It was suggested the intra-familial infection on these cases.

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In order to investigate the initial focus of streptococcal invasion, an experiment was carried out with aerosol infection of group A type 12 streptococci in rabbits, and the fine structures of buccal and pharyngeal mucous membranes, palatine tonsils and tracheas were observed with scanning electron microscopy.
Streptococci were adjusted to a concentration of 10⁹ colonyformingunit/ml in saline. A rabbit was exposed to 20ml of the aerosolized suspension for about 120 minutes, and sacrified at 2 hours to 14 days after exposure.
In the experiment, interesting findings were observed in palatine tonsils. That is, micropores of crypts in rabbit tonsils were similar in structure to those in human tonsils, and invading streptcocci and cell débris-like masses were observed in the micropore of a crypt. On the other hand, adherence of streptococci were observed in buccal and pharyngeal mucous membranes, but invading lesions were not. And disarrangement of cilia and decrease in number of cilia were observed in tracheas, but invading lesions were not, as well.
These data suggest that the micropores of the tonsillar crypts play an important role in the initial focus of invasion of group A streptococci.

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A rapid and simple identification method was evaluated as a means of classifiing 153 isolates of group D streptococci from clinical specimens in to different species.
All of these cultures were obtained from 141 patients in our hospital. The present method utilizes the system to determine six different biological properties simultaneously. These include:(i) hydrolysis of L-pyrrolidonyl-β-naphthylamide and arginine and (ii) acid production from mannitol, sorbitol, aabinose and raffinose. (iii) the results were interpreted after incubation at 35°C for 4h under aerobic condition:
A total of species differentiated by the present method gave positive growth in 6.5% NaCl and reaction of Phadebact D serogrouping. The results obtained using the present method were in good agreement with those of API 20S system identification. Therefore, the usefulness of this method was suggested emphatically.
Of 153 clinical isolates, 134 isolates (87.6%) were speciated as S. faecalis, 16 (10.6%) as S. faecium, 2 (1.3%) as S. avium, 1 (0.6%) as S. durans.
Susceptibility test of these cultures to 7 antimicrobial agents was carried out. The results revealed that S. faecalis was resistant to TC with relatively high frequency but was sensitive to other agents. Conversely, S. faecium showed high frequent resistance to all agents except to CP. S. avium was resistant only 2 agents, TC and SBPC.
The numbers of multiple drug-resistant strains among major species were as follows: 7 of 134 S. faecalis (5.7%), 16 of 16 S. faecium (100%), 2 of 2 S. avium (100%). All of S. faecium strains showed resistance to 6 agents or more than 4 agents, although other strains were resistant mostly to 2 agents.
65 strains of S. faecalis including 7 resistant strains, 16 of S. faecium and 2 of S. avium were measured for MIC of Vancomycin. A total of these strains had a maximal peak at 1.56μg/ml of MIC which ranged between 0.39μg/ml and 6.25μg/ml. Of these strains, S. faecium had a maximal peak at 0.78μg/ml of MIC which were lower than that of S. faecalis (1.56μg/ml).

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During the period from 1978 to 1984, parasitological examinations on 458 specimens were carried out at the Department of Parasitology, Gifu University School of Medicine. The specimen species were 222 for stool, 74 for serum, 65 for thick and thin blood films, 38 for parasites, 20 for adhesive cellophane tapes for the detection of pinworm infections, 11 for blood, 7 for bile, 7 for tissue sections, 6 for sputum, 3 for thoracic fluid, 3 for aspirated materials from renal and liver abscesses, and 2 for urine, respectively. Helminth eggs (Trichuris trichiura, Metagonimus yokogawai/Heterophyes heterophyes, Diphyllobothrium latum, Clonorchis sinensis, Enterobius vermicularis, Echinostoma sp., Trichostrongylus orientalis, Ascaris lumbricoides and Necator americanus) and worms (E. vermicularis and Strongyloides stercoralis larvae) were found by the stool examinations. E. vermicularis eggs were also detected by the adhesive cellophane tape examinations. Plasmodium vivax, P. falciparum, P. malariae and Dipetalonema perstans were detected by the blood film examinations. Parasites identified were helminths (D. latum, Anisakis lavrvae, E. vermicularis, A. lumbricoides, Taenia saginata, Mesocestoides lineastus, S. stercoralis, T. trichiura and Sparganum mansoni) crab louse and ticks. Giardia lamblia was detected by the bile examinations, Pneumocystis carinii, Entamoeba histolytica and Anisakis spp. by the tissue section examinations. Paragonimiasis, sparganosis, gnathostomiasis, fascioliasis and loiasis were serologically diagnosed. It is suggested that parasitic infections through fishes (diphyllobothriasis, metagonimiasis/heterophyiasis, anisakiasis, etc.) and imported infections (especially malaria) are increasing. Trichuriasis appeared to be still prevalent in some rural areas.

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The clinical effect of minocycline on genital infections by C. trachomatis was investigated. Fifty cases of male C. trachomatis urethritis, five cases of C. trachomatis epididymitis and five cases of C. trachomatis cervicitis were subjected to the study. Minocycline was given orally with the dose of 200 or 300mg daily for 7 to 14 days. Direct demonstration of C. trachomatis using fluorescein-conjugated anti C. trachomatis species-specific monoclonal antibody (CTFA) was performed both prior to and after the treatment with minocycline. C. trachomatis was identified in all cases during pre-treatment period, but was negative without exception in all cases after treatment regardless of dose and duration. Subjective symptoms were variable from patient to patient, might disappear after administration of antiinflammatory agent, were lacking in some patients with urethritis and in all patients with cervicitis and therefore were found to be an unreliable index for asessment of the treatment of C. trachomatis genital infections. Dizzyness were noted among the patients treated with the daily dose of 300 mg, but these side effects were not severe enough to discontinue the treatment. From above results it is concluded that minocycline is effective in the treatment of C. trachomatis genital infections.

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Minocycline was used for the treatment of non-gonorrheal urethritis caused by chlamydia trachomatis. To 22 male patients minocycline was administered at a dose of 100 mg, orally, twice daily, for 10 to 36 days. Of the 22 patients, 21 showed improvement of subjective and objective symptoms and signs. The effective rate was 95.5%. In no case adverse reaction was noted. Minocycline was proved to be useful in the treatment of chlamydia trachomatis infections.

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Case 1: A 62-year-old male, with a past history of acute amoebic dysentery in 1943 in Burma, developed loose to formed stools, mixed with mucus and blood, 2 to 3 times a day, accompanied by tenesmus in the year of 1955, which persisted during the subsequent years. As these symptoms became aggrevated from 1980 onwards, he visited the Tokyo Metropolitan Komagome Hospital and was diagnosed as having intestinal amoebiasis on the basis of endoscopic, pathohistologic and serologic studies. He was treated with metronidazole 2.0 grams daily for 10 days. A dramatic improvement was obtained within a few days after the start of this antiamoebic compound. A follow-up study yielded no evidence of relapse of amoebiasis after 5 months of this therapy.
Case 2: A 66-year-old male, with a past history of acute amoebic dysentery in 1943 in China, developed mucous and bloody stools, and general itching without a skin rash in the year of 1945, which then persisted until he was admitted to the Shizuoka Rosai Hospital in January 1983 because of the abrupt onset of upper abdominal pain, shivering chills and fevers up to 40°C. This patient was diagnosed as having amoebic dysentery associated with a liver abscess, based on serologic and roentgenologic studies. Treatment with piperacillin and cefoperazone, followed by oral metronidazole 1.2 grams was given daily for 62 days, and a favourable outcome was obtained. No relapse was seen during the 23-month follow-up perieod.

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