An outbreak of food-poisoning caused by Escherichia coli O159: H20 occured in Kamiyamada town, Nagano Prefecture during October 5th and 12th, 1984.
Positive rate of isolation of Escherichia coli 0159: H20 from the feces of patients in acute stage was 50.0%.The symptoms common to the 132 patients were diarrhea (97.3%), abdominal pain (56.8%), languor (18.9%), headache (10.6%), nausea (8.3%), mild fever (7.6%) and vomiting (3.8%).
In the outbreak, Escherichia coli O159: H20 was the only suspected etiological agent isolated from both patients and well water.The Escherichia coli O159: H20 organisms produced heat-stable enterotoxin but not heat-labile enterotoxin.

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The survey on sepsis in infancy and childhood was made by sending questionnaire to 48 pediatric institutions in university hospitals and their associated hospitals in Japan from January, 1980 to June, 1984.The analyses were performed with 761 cases who were proved to be bacteremia among 805 inpatients of sepsis.
The 761 cases correspond to 0.57% of total in-patients and the incidence had slightly increased year by year.The ratio of boys and girls was 1.5: 1 and boys always outnumbered girls.As to the incidence by age, 67.4% was for infants under 2 year old, among which 34.3% was for newborns and 12.2% was for those within three day old.
As to the detected organisms by year, gram-positive bacteria, especially S.aureus showed a tendency of slight increase year by year.Although gram-positive bacteria had prevailed over gram-negative ones in and after 1983, in contrast with prevalence of gram-negative bacteria in the preceding years, the mean ratio of gram-positive bacteria and gram-negative ones was 46.9 to 53.1 through the five years on survey and gram-negative rods which occupied almost all of the latter were prevalent.
As to the detected organisms by age, incidence was in descending order of E.coli, S.aureus, GBS, S. epidermidis, Klebsiella spp.and Pseudomonas spp.in infants under three month old.Enterococcus, anaerobes and GAS followed them with lower incidence.On the other hand, E.coli and GBS were obviously decreased in infants over three month old.Proteus spp., Staphylococcus spp.and Enterococcus spp. were mainly detected in infantile group and also detected in elder group.Enterobacter spp., Serratia spp., Klebsiella spp.and fungi were similarly detected in both age groups.S.viridans, S.pneumoniae, H. influenzae and Salmonella spp.were mainly detected in elder group.Listeria monocytogenes and anaerobes were detected mainly in infants under three month old.

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To elucidate whether the gram-negative anaerobes in stool make a major contribution to the generation of ammonia in hepatic encephalopathy, vancomycin hydrochloride, which is effective against anaerobic but ineffective against aerobic gram negative rods, was administered to five patients with chronic hepatic encephalopathy, and the changes in clinical symptoms, blood ammonia, electroencephalogram (EEG) and in faecal flora were studied.With the administration of vancomycin hydrochloride clinical symptoms of encephalopathy were improved, blood ammonia was decreased, and EEG was improved.These improvements were accompanied by a decrease in the number of anaerobic gram-negative rods, especially Bacteroides.In addition, major change was not observed in the number of aerobic gram negative rods.Changes in blood ammonia level corresponded very well with changes in the number of anaerobic Bacteroides.In conclusion, Bacteroides species may make a major contribution to ammonia production in hepatic encephalopathy.

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The induction kinetics, substrate specificities and inhibition of β-lactamases produced by Legionella pneumophila were studied. The induction study of β-lactamase produced by L. pneumophila serogroup 1 (ATCC 33152) was performed by using 3 kinds of antibiotics, cefazolin, cefmetazole and cefuroxime, with various concentrations.β-Lactamase of L. pneumophila serogroup 1 was induced by the addition of each of the antibiotics as compared with the control which had no induction. The induction activity depended on the concentrations of antibiotics added to the culture with the highest activity at a concentration of 1 MIC. The same results were also obtained in L. pneumophila serogroup 2 through 8 by the addition of cefuroxime at concentration of 1 MIC.
These induced β-lactamases showed characteristic broad substrate profiles and hydrolyzed most of penicillins and of cephalosporins including oxyimino-cephalosporins. It was observed that cefazolin and ceftizoxime were remarkably hydrolyzed at the highest rate among the cephem antibiotics. Cefoperazone, cefotaxime and cefuroxime were apparently hydrolyzed even though the reaction rate was low.
On the other hand, more than 90% of these enzymatic activities of β-lactamases produced by all the bacterial strains studied were inhibited by the addition of clavulanic acid or sulbactam with the concentration of 10 μM.
From these results, it is concluded that β-lactamases produced by L. pneumophila are inducible enzymes and belong to the group of the cefuroxime-hydrolyzing β-lactamase (cefuroximase type I).

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For the purpose of confirming a useful therapy in chronic lower respiratory tract infections, we tried a long term (over 6 months) chemotherapy with amoxicillin (1 g/day) in 4 cases and erythromycin (600 mg-1200 mg/day) in another 4 cases.8 cases were sinobronchial syndrome (SBS) with a large amount of purulent sputum, dyspnea on effort and hypoxemia.The primcipal organisms from transtracheal aspiration (TTA) were Haemophilus influenzae in 5 cases, Streptococcus pneumoniae in 1 case, Branhamella catarrhalis in 1 case and Haemophilus parainfluenzae in 1 case.
The results of our therapy were as follows:
1.a) The duration of treatment with amoxicillin in 4 cases were 2 months, 9.5 months, 12 months and 13.5 months.The reasons for stopping the treatment were superinfection by Pseudomonas aeruginosa in 3 cases and by anaerobe in 1 case.
b) The duration of treatment with erythromycin in the 4 cases was more than 10 months and the treatment continued without superinfection by Pseudomonas aeruginosa in all 4 cases.
2.During the long term chemotherapy, amoxicillin was effective in 3 cases and erythromycin in all 4 cases.
3.There were no observable sideeffects in any of the 7cases.
From these results, we consider that the long term chemotherapy with erythromycin, as compared with amoxicillin, is useful for the treatment of lower respiratory tract infections.

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For the purpose of confirming a useful therapy in chronic lower respiratory tract infections, we tried a long term (Mean: 16.8 months) chemotherapy with erythromycin (600-1200 mg/day) in 10 cases which included 3 cases with Pseudomonas infection. The disease of 10 cases was sinobronchial syndrome (SBS) with a large amount of purulent sputum, dyspnea on effort and hypoxemia. The principal organisms from transtracheal aspiration (TTA) were Haemophilusinfluenzae in 4 cases, Haemophilus influenzae and Streptococcus pneumoniae in 1 case, Streptococcus pneumoniae in 1 case, Haemophilus parainfluenzae in 1 case, Pseudonomas aeruginosa in 2 cases and Pseudonomas maltophilia in 1 case.
The results of our therapy were as follows:
1. Erythromycin waseffective in 9 cases exceptfor the 1 case with Haemophilus influenzae infection.
2. The organisms from TTA or sputum were not eradicated in 9 cases except for the 1 case with Streptococcus pneumoniae infection.
3. There were no observable side effects in any of the 10 cases.
From these results, we consider that the long term chemotherapy with erythromycin is useful therapy in chronic lower respiratory tract infections including Pseudomonas aeruginosa infection.

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Influenza HA vaccine was inoculated to patients with chronic renal failure [hemodialysis (HD) group 49, peritoneal dialysis (PD) group 17, under conservative treatment (conservative) group 22] and the healthy subjects (control) group 29, and the following results were obtained:
1) Degrees of increase in the geometric mean hemagglutinin inhibition (HI) titer, increase in numbers of cases who had HI titer of 64X or more, and 4X or more increase in the HI titer to the antigens contained in the vaccine, A/Kumamoto/37/79 (H1N1), A/Ishikawa/7/82 (H3N2) and B/Singapore/222/79 were comparably well in the HD, PD and conservative and the control groups.Comparing the various antigens contained in the vaccine, increase in the HI titer was better with A/Kumamoto/37/79 (H1N1), A/Ishikawa/7/82 (H3N2) than with B/Singapore/222/79 in the control, HD, PD and conservative groups.
2) Among drifted antigens of A (H3N2), increase in the HI titer responded to A/Kyoto/C-1/81 was significantly less in the HD, PD and conservative groups than in the control group, and increase in the HI titer responded to A/Niigata/102/81 was significantly less in the HD group than in the control group. Therefore, it may be said that the HI titer to some drifted antigens was not increased in the patients with chronic renal failure in the HD, PD and conservative groups, while the healthy subjects showed significant increase of the HI titer.
3) No specific adverse reaction, local or systemic, due to the vaccination was observed both in the patients and the healthy subjects.
4) General conditions of the patients under treatments for chronic renal failure were not aggravated by the vaccination.
It may be conclusively considered from the above results that when adequate strains are selected as vaccine strains, desirable HI titer increase may be expected after the vaccination in the patients with chronic renal failure as in the healthy subjects.
The results may suggest that safe vaccination will be given to the patients with chronic renal failure considered as high risk group to influenza infection, and such safe vaccination should be performed more positively in order to protect the patients from infection to influenza.

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One hundred and three cases of peculiar eruptive disease initiated by pyrexia were encountered during 2 months from the beginning of June, 1984.It showed marked epidemicity and intrafamilial contagiosity.It occured almost in children below 9 years of age, however its infection extended even to their parents.Echovirus type 16 was identified in 90% of patients from whom the sample could be collected, and the disease was thus diagnosed as Boston exanthem.
Peculiar eruptions developed a few days after elevation of the body temperature and usually disappeared about a week after the onset.The symptoms were relatively mild and there were no remarkable complication.Differentiation from similar eruptive diseases seemed to be relatively easy.
Isolation of echovirus 16 has been reported to be very rare.Explication of the causes for the observed high prevalence is awaited.

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The superoxide productive activity of peripheral phagocytic cells (granulocytes and monocytes) in 20 patients with liver cirrhosis was measured by the method of zymosan-induced-luminol-amplifiedchemiluminescence (CL) and compared with that in 20 healthy controls.
In patients the number of peripheral phagocytic cells was significantly less than that in the controls (p<0.001).
Both whole blood CL and mononuclear cells CL in patients were significantly lower than those in the controls (p<0.01, p<0.05).
On the other hand, the serum opsonic activity in patients was lower than that in the controls.
The present results suggest that the impaired peripheral phagocytic cells function might be one of the factors accounting for the increased susceptibility to infection in the patients with liver cirrhosis.
Moreover, the changes of CL activity at various states;diabetes mellitus, hepatocellular carcinoma, splenectomy and infections which often associated with liver cirrhosis were investigated.

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It is well known that human listeriosis leads to meningitis, bacteremia and granulomatosis infantiseptica in neonates and infants.In adults, it develops as an opportunistic infection in immunocompromised hosts.Naturally, its prognosis is said to be worse in adults than in children.
Recently we encountered a patient with lung cancer, in whom Listeria monocytogenes bacteremia recovered spontaneously without antimicrobial chemotherapy.The patient was a 55-year-old man who was under anticancer chemotherapy combined with irradiation for adenocarcinoma of the lung.He developed bacteremia due to Listeria monocytogenes 4b accompanied by pyrexia and general fatigueduring leucocytopenia.The febrile condition, however, soon disappeared and bacteremia resolved spontaneously with the negative result of the next blood culture.He died of the underlying disease, lung cancer, three months later.Post mortem examination disclosed no purulent lesions.
Indeed, in a very few patients with malignancy, Listeria monocytogenes bacteremia seemed to resolve spontaneously.

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