The examination of sera for HBs antigen and HBs antibody were carried out on 2343pregnant women in Chubu district, Okinawa during the period of the years 1982 and 1983. HBs antigen was found in 78 sera (3.3%) of examinees. Further serological studies for HBe antigen and HBe antibody were performed on 64 cases among HBs positive pregnant women. HBe antigen was positivein four cases (6.3%) out of them and HBe antibody positive in 52 (81.1%).
The serological investigations for HBs antigen and HBs antibody on 912 healthy young people in Okinawa showed that in the age group of 0 to 9 years old, the positive rate of HBs antigen was 1.4% and HBs antibody 0.8%, respectively. From the result it is presumed that recently vertical infection with HBV seems to be reducing and subsequently HBV carrier rate in the lower age groupis decreasing.
In the serological investigations for HBe antigen and HBe antibody on 265 asymptomatic HBs antigen carriers (including 64 pregnant women), HBe antigen was positive in 34 cases (13%) and HBe antibody in 207 cases (78%), respectively. In the comparison of positive rate by the age group as 0-9, 10-14, 15-19, 20-24, 25-29 and over than 30 years old, the positive rate of HBe antigen was 100% in youngest group and declined gradually as the age group become older, in the age group over than 30 years old only two positive cases were found among 127 HBs antigen carrriers.

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Four hundred eighty-two strains of group A hemolytic streptococci were isolated from the pharynx of children with acute inflammation in the upper airways treated at the Department of Pediatrics, Municipal Nemuro Hospital, during the approximately seven-year period between february 1978 and December 1984. On the other hand, 44 strains of group A hemolytic streptococci were isolated from the pharynx in healthy elementary school children in Nemuro in 1978 and 1985.
Typing of these isolated strains was carried out according to T agglutination in order to investigate the changes in the types of strains isolated during the above period. Of these strains, 368 were also examined for variations in sensitivity to drugs.
Among the various types, type 12 was most frequent, followed by type 4. The two types, type 12 was most frequent, followed by type 4. The two types were regularly present during the seven years, and their incidences alternately reported increase and decrease in a cycle of three or four years. Other relatively frequent types were types 6, 28 and B3264. These types repeated appearing and disappearing in their particular cycles.
These isolated group A hemolytic streptococci were examined for sensitivity to six antibiotics, i. e., PC-G, AB-PC, CET, MINO, EM and CP. The sensitivity to PC-G was highest, followed by those to ABPC and CET. With MINO and EM, a two-peak pattern was occasionally noted in the sensitivity distribution. The sensitivity to CP was relatively invariable. Among the antibiotics, resistance to EM alon was found in some strains; there was no multiple drug resistance in any strain.

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Histologically proven deep seated mycosis were found in 33 cases (2.05%) out of 1613 autopsied aged patients more than 60 years old at Tokyo Metropolitan Geriatric Hospital from 1977 through 1983. Seven patients were involved systemically and 26 patients were localized (the lung in 18 patients, the urinary tract in 3 patients, the gastrointestinal tract in 4 patients and the CNS in one patient). Identified organisms were Aspergillus in 15 patients, Cryptococcus in 8 patients, Candida in 7 patients and unidentified in 4. In one patient Aspergillus and Candida were identified concomitantly. Underlying diseases were solid tumor in 11, hematological diseases in six and corticosteroid therapy in one. The other 16 pateints had no definite immunosuppresive condition other than bed ridden state for more than three months. No significant difference was found in underlying diseases, duration of illness or laboratory data between the systemic and other localized types of deep seated mycosis.

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Studies were made on a method of suspending culture of ESK cells and the susceptibility of the cells of suspending culture to influenza virus.
The results obtained from them are as follows. 1) ESK cells were cultured in a spinner flask containning MEM Joklik suspending culture medium to which newborn calf serum, methylcellulose (30 mg/ml), and polypeptone (100 mg/ml) had been added to a concentration of 10%, 3%, and 5%, respectively.
They multiplied so well in the culture that it was possible to obtain a sufficient amount of singly isolated cells in a good condition. 2) ESK cells of suspending culture showed essentially the same susceptibility to the standard strain of influenza virus as ESK cells of monolayer culture and MDCK cells of monolayer culture. There was a tendency, however, for the development of HA production to be seen in ESK cells 1-2 days later than in MDCK cells. 3) An attempt was made to isolate virus from 331 patients seemingly affected with influenza. As a result, 216 strains of influenza virus were isolated with ESK cells of suspending culture, 208 strains with ESK cells of monolayer culture, and 205 strains with MDCK cells of monolayer culture. Therefore, ESK cells of suspending culture exhibited a higher rate of virus isolation than those of monolayer culture or MDCK cells of monolayer culture.

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This paper concerns the statistical analysis performed in 414 patients with staphylococcal infection admitted to Pediatric Department of the Jikei University Hospital between 1955 and 1984. The incidence of staphylococcal infection reached its peak in 1973 and 1974 and declined thereafter. In 1984, however, the incidence marked a new high record of 31 patients. When classified by types of infection, there were 129 cases of pneumonia (greatest in number), 108 cases of SSSS, 96 cases of empyema, and 46 cases of sepsis.
Regarding the patients' age distribution, infants aged three years or younger accounted for 88% of all patients, and, of these, 315 infants were below age one, accounting for 65% of all patients. With respect to changes in mortality rate in severe cases of staphylococcal infection, the mortality rate which had been 47% over the five years between 1955 and 1959 continued to drop thereafter down to 27% and 18%, marking the record low of around 10% during the 10-year-period after 1970. Over the last five years, however, the mortality rate increased markedly up to 30%, indicating increasing severity of this infection. In order to investigate the factors for this trend, 78 cases of severe staphylococcal infection seen over the last 15 years were studied for their clinical symptoms, causative organisms, and results of laboratory examinations. When seen by types of disease, symptoms were most severe in cases of sepsis, while, when seen by causative organisms, the mortality rates were high in cases of sepsis and meningitis due to Staphylococcus epidermidis. In cases where prognosis was poor, shock symptoms including hypothermia and cold sensation in the extremeties, abdominal distention, and bleeding tendency were noted. With respect to the results of laboratory examinations, prognosis was poor in cases complicated by DIC.

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To investigate the contributing factors for increasing severity of staphylococcal infections, clinicopathological studies were performed in five cases autopsied during the last five years. Autopsies revealed that three patients had been compromized with transient hypogammaglobulinemia of infancy insulin-dependent diabetes mellitus, and congenital heart disease. Their clinical courses were precipitous, and thrombocytopenia and hypoproteinemia were noted in all cases. We therefore studied serum total protein concentrations in 56 cases of severe staphylococcal infection treated in our department during the past 15 years.
Hypoproteinemia was present in 30 of these 56 cases. With respect to the prognosis and clinicalfeatures in 14 cases of marked hypoproteinemia where protein concentrations were 5 g/dl or less, five patients died, four patients had phlegmon, and, in eight patients who had marked abdominal distention, symptoms were particularly of a severe degree. Meanwhile, total protein levels were normal in the remaining 26 cases, and there was no death case in the latter group. Sepsis, pneumonia, empyema, and meningitis are some examples of severe staphylococcal infections. If marked hypoproteinemia is superimposed on these cases, the grave clinical features will result. In these cases, therefore, the institution of prompt and vigorous antibiotic therapy coupled with adjunctive treatment is necessitated.
Emergence of strains which highly develop multiple drug resistance is one of the contributing factors for increasing severity and intractability of staphylococcal infections. In four cases where the antibiotic sensitivity test could be performed, however, staphylococcus aureus were shown to be considerably susceptibel (+++) to cephems and aminoglycosides.
One patient died of multiorgan dysfunction caused by the staphylococcal exotoxin.
Pathological studies on these five autopsied cases revealed features of transtracheal lobular pneumonia in four cases and those of pneumonitis due to sepsis in one case. In all of these five cases, non-suppurative fibrin thrombosis was present in the lung, kidney, or spleen, suggesting that these patients had been complicated by DIC.
In the five autopsied cases in the present study, the exotoxin produced by staphylococcus and the onset of DIC were thought to be the contributing factors for increasing severity of staphylococcal infections. Further exploration of the staphylococcal strains which cause DIC will be necessitated.

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Efficacy of the liver attenuated varicella vaccine (OKA strain) was examined on 174 seronegative healthy children. Blood samples were taken before and 4 to 9 weeks after vaccination. Immunological responses were determined by complement-enhanced neutralizing test (CNT) and varicella skin test (ST). The seroconversion rate based on CNT (1: 8 or higher) was 78% and that judged by ST was 58% when the positive-reaction was defined as the erythema of 5×5 mm or larger, but was 82% when the redness of 3×3 mm or larger was regarded as positive. No significant correlation was found between virus inoculum and CNT-titer or cutaneous reaction (CR). Two of our vaccinees were contracted mild varicella after the contact with varicella patients although they were CNT-positive (1: 32); while other two vaccinees who were CNT-negative and showed CR of 4×4 mm and 4×3 mm erythemata, respectively, experienced very mild varicella. These facts indicate that it may be useful CR of 3 to 4 mm redness to be regarded as weak-positive reaction to varicella antigen, although it has been defined as negative.

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To guess recent prevalent condition of intestinal parasites of the inhabitants in and around Tokyo we totalize and analyze the data of parasitological examinations on 14956 specimens carried out at the laboratory of Mitsui Memorial Hospital during Jan. 1980 to Aug. 1985. Almost all specimens were examined by formalin-ether sedimentation technique (MGL method). Persons examined can be divided between foreigners chiefly people returned from China (200 specimens) and Japanese lived in and around Tokyo (14756 specimens). Japanese examined can also be divided into two groups, one is made up of persons consulted complete physical examination (5325 specimens), and the other is made up of ordinary patients (9431 specimens). The number of positive specimens in Japanese group is 378 out of 14756 and the positive rate is 2.56%. The number of positive cases is 250, which is excluded double counts in the same case. The dominant parasite is Metagonimus yokogawai, which was found in 145 out of 250 cases (58.0%), and the next one is Giardia lamblia, which was found in 49 out of 250 (19.6%). Trichuris trichiura, Entamoeba histolytica, Clonorchis sinensis, Endolimax nana, Entamoeba coli and Strongyloides stercoralis followed Giardia lamblia in this sequence, and the number of positive cases of each parasite is less than 10 (4.0%). It is interesting that the positive rate of Metagonimus yokogawai is more than three times higher in the complete physical examination group constituted by the rich than the ordinary patient group. The cause is that rich persons have many chances to take expensive raw freshwater fish like “ayu” fish that is the second intermediate host of M yokogawai. It is not too much to say that prevalent condition of intestinal parasites has greatly changed in the recent years.

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Bactericidal activity of chlorhexidine against Pseudomonas aeruginosa was examined by a method similar to that for determing the phenol index. The results may be summarized as follows:
1) At high concentration (10⁷ and 10⁸ cells/ml) P. aeruginosa was killed after exposure for 30 sec to chlorhexidine, whereas at low concentrations (10⁴ and 10⁵ cells/nil) it was not killed even after exposure for 2-5 min. The phenomenon was observed only with P. aeruginosa.
2) When P. aeruginosa was mixed with supernatant from a culture of P. aeruginosa and exposed to chlorhexidine, the cells killed for 30 sec at low concentrations (10⁴ and 10⁵ cells/ml).
3) The sensitivity of P. aeruginosa to chlorhexidine was decreased when treated with DNase, and was increased on the addition of the slime produced by P. aeruginosa and calf thymus DNA.
4) In electron microscopic examination of ultrathin sections of P. aeruginosa cells, the treatment of P. aeruginosa with 0.02% chlorhexidine caused cytological damage and leakage of cell constituents at high concentrations (10⁸ cells/ml) for 5 min. At low concentrations (10⁵ cells/ml), caused a change in the appearance of the cytoplasm without leakage of cell constituents. When treated with slime and chlorhexidine at low concentrations (10⁵ cells/ml), caused markedly damage on surface and in cytoplasm.
From these results it is concluded that DNA in the slime produced by P. aeruginosa at high concentration increases the sensitivity of the organism to chlorhexidine.

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Infectious complications in SLE were investigated in 147 well-documented SLE patients during a 12 years period (1972-1983). Ninty one moderate or severe infections were obserbed in 68 patients, and 4 of them died of infections; 2 of septicemia and 2 of pneumonia.
More than two thirds of total infections was due to intracellular micro-organismsand particularly high incidence of herpes zoster was seen up to 28% of the total infections.
In the study on factors affecting the incidence of infection in SLE, no relationship between dosage of corticosteroids or disease activity in SLE and the increased susceptibility to infections of SLE patients was revealed.
The CRP value may be elevated higher in bacterial infections than in SLE without infection. The serum levels of complement (CH₅₀) are usually stationary or elevated during infectious complications in SLE. These parameters are useful indeces to differentiate infections from exacerbation of SLE.

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Six to seven-week-old ICR mice were inoculated intranasally, intraperitoneally, and intravenously with C. psittaci Meningopneumonitis (MP) strain. In mice inoculated intranasally, histopathological studies of lung tissues obtained during the early phase and of extrapulmonary organs after intranasal inoculation were carried out by means of haematoxylin-eosin (H-E) and direct immunofluorescent antibody (DFA) staining methods. In the same way, histopathological changes in organs in mice inoculated intraperitonealy and intravenously were examined. Transmission electron microscopy was done for the mice lungs at 96 hr after intranasal inoculation. The serum antibody responses of the intranasally inoculated group against C. psittaci were measured for 8 months after inoculation using micro-plate immunofluorescence antibody (MFA) technique.
The first evident histopathological change which appeared the infiltration of inflammatory cells, was observed at 6 hr after intranasal inoculation. This change developed into pneumonitis at 18 hr in the interstitium where PMNs were predominant among inflammatory cells. At 72 hr, the PMNs were replaced by numerous mononuclear cells and the pneumonia appeared to change into parenchymal pneumonia. Transmission electron microscopy revealed the formation of typical large inclusions of C. psittaci in type-I alveolar epithelial cells, broncho-epithelial cells and alveolar macrophages.
The serum antibody titers of IgM reached the maximum level (1: 128) on the 14th day and then disappeared during the next 2 months. The titers of IgG reached the maximum level (1: 8192) 2 months after intranasal inoculation and then decreased gradually to 1: 1024 during the next 8 months.
All of the intranasally inoculated mice died on the 6th day. The intraperitoneally and intravenously inoculated mice, however, died from the 6th day after infection, though some survived. In extrapulmonary organs, inclusions were detected only in the liver and spleen tissues in three of ten mice infected intranasally. However in both dead and surviving mice infected intraperitoneally and intravenously, inclusions were observed not only in the lung, liver and spleen, but also in the kidney, heart, brain and adrenal gland. Consequently, though both the intraperitoneally and intravenously inoculated groups showed a lower mortality than that of the intranasally infected group, inclusions were frequently observed in many organs.

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Two cases of amoebiasis which were considered to have been precipitated and aggreviated by pregnancy, and the administration of anticancer drugs and corticosteroid, respectively, are reported.
Case I: In July 1984, a 30 year-old woman in her 15th week of pregnancy was diagnosed as a carrier of Entamoeba histolytica and was subsequently admitted to the Department of Infectious Diseases at the Tokyo Metropolitan Komagome Hospital. She had a history of travel to tropical and subtropical countries in the previous year, and suddenly experienced clinical symptoms of amoebic colitis including the passage of melena three times a day. The stool was positive for the trophozoite of E. histolytica and she was treated with 2 grams of oral metronidazole for 10 days with complete recovery.
Case II: A 67 year-old woman who was diagnosed with breast cancer complicated by a right-sided carcinomatous pleuritis, was admitted to the Department of Surgery, Tokyo Metropolitan Komagome Hospital on April 1981. The radioisotopic liver scan was normal. She was treated with oral cyclophosphamide and intrapleural and selective intraarterial administration of adriamycin, experienced marked improvement. One month after treatment was initiated she became pyrexic and continued fevers up to 39°C, and experienced anal pain, melena, right upper abdominal pain, enlargement of the liver. The serum alkaline phosphatase titer was elevated and a tentative diagnosis of liver metastasis was made. Prednisolone was given, however, her condition rapidly deteriorated and she died of bacteremic shock. Autopsy revealed multiple metastases of the breast cancer, an amoebic liver abscess and amoebic colitis which had perforated, thereby spilling fecal content into the peritoneal cavity.

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