Hepatitis B virus DNA (HBV DNA) was determined in the sera of 141 HBV carriers by spothybridization test with cloned HBV DNA probe.The following results were obtained.1) Spotting 10μl of serum directly onto nitrocellulose filter gave higher sensitivity than spotting nucleic acid extracted from 300μl of serum.
2) Prevalence of serum HBV DNA of HBV carriers before and after seroconversion from HBeAg to anti-HBe was studied.Serum HBV DNA was detected in 84.4%(27/32) of HBeAg positive phase sera, 5.0%(1/20) of samples negative for both HBeAg and anti-HBe and 12.5%(3/24) of anti-HBe positive phase sera.
3) Of anti-HBe positive HBV carriers, serum HBV DNA was detected in 11.6%(5/43) of group consists of normal transaminase level, and 25.0%(11/44) of abnormal transaminase level.There was no significant difference in the rate of detection of serum HBV DNA between normal and abnormal carriers by the chi-square test.
4) Serum HBV DNA was detected in only one case out of 22 HBV carriers who cleared HBsAg during the follow-up period.In this case HBeAg was detected even after the appearance of anti-HBs.

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Theoretical analysis of seroepidemiological survey data was made in an attempt to establish a procedure for forecasting epidemics of Japanese encephalitis (JE) among herds of swine.
On the hypothesis that general features of infection and epidemic of JE can be expressed theoretically with three factors, i.e.
1) Percentage of swine which would serve as a potential source of infection (Y_i-1),
2) Percentage of uninfected swine [100-(Y₀+Y₁+---+Y_i-1)], and
3) JE virus transmission coefficient (K), the estimated percentage of swine that will newly contract infection (Y_i) may be calculated by the equation: Y_i=Y_i-1×[100-(Y₀+Y_i+---+Y_i-1)]×K.
Inserting into this equation measured HI antibody positivity rates at consecutive units of time in the course of epidemic, the transmission coefficient (K) was determined according to the least squares method of estimation. The incidence of swine that may newly contract JE infection and the infection rate were estimated thereby using the K-value and percentage of animals serving as the potential source of infection at onset of an epidemic (Y₀).
Infection rates calculated by the equation using measured HI antibody positivity rates during incipient stage of a swine JE epidemic showed a remarkably close approximation to those estimated by the same equation but using measured HI antibody positivity rate for the entire course of the JE epidemic. The results indicate that it is practicable to predict with considerable accuracy the magnitude of swine JE epidemic during any given year by inductive theoretical analysis of data obtained for HI antibody positivity rates during very early stage of the epidemic of that year, using equation proposed herein.

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We examined the chlamydial antibodies and antigens in a population of mothers, who had infants with C.trachomatis infection.Chlamydial IgG antibody was demonstrated in 9 of 10 mothers .In addition, C.trachomatis was detected in cervical swab specimens from all 4 mothers examined.
It seemed that maternal and infantile infection played an important role in infantile chlamydial infection. Chlamydial IgG antibody of mothers, measured by indirect immunofluorescence test, had no influence on the development of chlamydia trachomatis pneumonia.

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For the purpose of evaluating the efficacy, safety and usefulness of ceftriaxone (CTRX), a cephem antibiotic, in respiratory tract infections, a well-controlled comparative study was carried out with cefotaxime (CTX) for a reference.
One (1) gm of either CTRX or CTX was administered by drip infusion twice a day for 7 to 14 days in principle into patients with chronic bronchitis and diffuse panbronchiolitis aggravated with infections, chronic respiratory diseases accompanied with infections in the lower respiratory tract like bronchiectasis, bronchial asthma, pulmonary emphysema, pulmonary fibrosis, obsolete pulmonary tuberculosis, lung cancer, etc. and bacterial pneumonia.
Results were as follows:
1) Clinical efficacy: The efficacy rate was 81%(100/124) with CTRX and 74%(94/127) with CTX, with no statistically significant difference between the two drugs. The efficacy rate in the moderately infected patients was 81%(54/67) with CTRX and 62%(37/60) with CTX, CTRX being significantly superior to CTX.If cases infected with P. aerugirrosa were excluded, CTRX was higher in efficacy than CTX.
2) Bacteriological effects: The bacterial eradication occurred in 35 patients out of 44 (80%) with CTRX and in 42 out of 54 (78%) with CTX, with no statistically significant difference. There was no significant difference in efficacy between the two, whether according to strains of isolates or types of infections (single or mixed).
3) Adverse reactions: The incidence of adverse reactions was 10.5%(14/133) to CTRX and 6.3%(9/143) to CTX, no statistically significant difference being noticed. The incidence of skin rash was significantly higher with CTRX. In the clinical laboratory test, abnormal signs were observed in 37 out of 130 (28.5%) with CTRX and in 36 out of 137 (26.3%) with CTX, no significant difference being detected.
4) Usefulness: CTRX was evaluated to be very useful in 3 out of 133, useful in 94, slightly useful in 13 and useless in 20. There were 3 unevaluable cases.CTX was very useful in 2 out of 143, useful in 90, slightly useful in 14 and useless in 28. Evaluation was impossible in 9 cases.There was no significant difference in usefulness between CTRX and CTX.
5) Conclusion: From the above, CTRX was considered to be clinically very useful for the treatment of infections of the lower respiratory tract like chronic respiratory tract infections and pneumonia.

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Factors contributing to the prognosis of tetanus were investigated by analysing the case records of 593 tetanus patients collected from various sources throughout Japan during 1940-1982.
1) The onset time was a reliable and simple indicator of prognosis.The case fatalities of tetanus patients with the onset time of less than 48 hours and more than 48 hours were 60 and 18%, respectively (p<0.01).
2) Those patients whose tetanus followed bone fracture (s) or heat injury were usually associated with a short onset time of less than 48 hours.The case fatality was significantly high in the patients who developed tetanus following bone fracture (s).
3) The onset time of tetanus patients following multiple injuries, Caesarean section, artificial abortion and neonates was usually short and these patients were associated with high case fatality.
4) Many severe cases of tetanus died within 10 days of admission before 1960 when artificial respiration was not employed properly for the treatment of tetanus.The case fatality was low in the patients who were admitted for more than 3 weeks, but it rose again due to complications when the duration of admission exceeded 70 days.
5) Eleven percent of our patients were associated with undetectable injury and their case fatality was 41.7%.

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Using the TST-RPLA reagent (Denka Seiken Co.) which was originally developed by H.Igarashi, we examined the production of Toxic Shock Syndrome Toxin (TSST) in 91 Staphylococcus aureus strains which were isolated from clinical specimens of 74 patients at our hospital during the year of 1984.
We studied enterotoxin production, coagulase types and antibiotic susceptibility patterns with respect to the production of TSST in S.aureus strains.
Among 91 strains, 28 (30.8%) strains produced TSST.Simultaneously, they produced enterotoxin C.
All of TSST-producing strains belonged to coagulase type II and were recovered only from inpatients.
91 encountered strains were tested for β-lactamase production which was performed by using Cefinase (BBL).49 (53.8%) strains were totally positive.Only 5 (17.9%) of 28 TSST-producing strains were positive, whereas 44 (69.8%) of 63 non-producing strains were positive.
Antibiotic susceptibility patterns of TSST-producing strains against 18 drugs, which were tested by the tri-disk diffusion method, showed more multiple resistance to penicillins, cephems, aminoglycosides, FOM and EM than non-producing strains except to CP, TC, MINO and AMK.Susceptibility patterns of MCIPC, ABPC, CET, CEZ, CMZ an GM were measured with MIC and the results showed the same obtained with the tri-disk method.
Since all of TSST-producing strains were recovered only from inpatients, we analyzed distribution and frequency of isolation among the five different wards.Most strains were distributed mainly in one of the wards.These strains distributed in this ward possesed the identical characteristics in production of enterotoxin, haemolysin, fibrinolysin and β-lactamase as well as antibiotic susceptibility patterns.Thus, it was suggested that a hospital acquired infection with particular strains occured in the ward.
It is found that the TST-RPLA test is recomended for both the determination of TSST and as a tool of epidemiological investigation.

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In July and October of 1984, three patients with fever and rash were treated at the Muroto Clinic in Muroto-city, Kochi Prefecture.The sera collected from patients were subjected to the Weil-Felix test using the antigens standardized against the appropriate convalescent serum.A significantly high level of OX2 agglutinin and a more than fourfold rise in OX19 agglutinin titer were observed.Levels of complement fixing antibodies reactive to R. akari and R. rickettsii were found to be significant.In addition, the sera from three individuals were tested, who had been ill with similar symptoms and signs in October of 1983.Although the sera were collected later than one year after onset, two out of three samples showed positive reactions to the antigen of R.akari in complement fixation test.The serologic examinations proved that the disease was a spotted fever group rickettsiosis.

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It's known that typhoid fever and paratyphoid fever often cause changes indicative of hepatic involvement and even jaundice.
This study was conducted on 36 patients 27 cases with typhoid fever (TY) and 9 cases with paratyphoid fever caused by Salmonella paratyphi A (PA) who were admitted to Tokyo Metropolitan Toshima General Hospital from 1979 through 1983 and were all bacteriologically confirmed for the purpose of investigating the liver injury in these diseases.
Liver function tests were analysed in all cases and liver biopsies were parformed in 3 cases with TY and 2 cases with PA.The serum bilirubin level was greater than 2 mg/dl in only 2 cases but one patient with jaundice had value over 10 mg/dl.Abnormal elevation of the GOT level occurrd in 19 cases (70.4%) with TY and 7 cases (77.8%) with PA. The averages of elevated GOT values were 242.9 IU/1 in TY and 119.3 IU/1 in PA.The difference of GOT level between TY and PA was significant (p<0.05).The GPT level was elevated abnormally in 16 cases (59.3%) with TY and in 7 cases (77.8%) with PA.The averages of elevated GPT values were 212.6 IU/1 in TY and 111.3 IU/1 in PA.The maximum values of GOT and GPT were 780 and 660 IU/1 in a case of TY.These elevations of GOT and GPT level began around the 14th day of illness and improved to normal level around the 30th day of illness.The LDH level was abnormally high in 92.6% of TY and in 100% of PA.The ALP level was elevated in 63.9% of 36 cases with TY or PA. The γ-GTP level was elevated in 41.1% of these 36 cases.
The following changes were flequently observed in the liver: The focal necrosis of liver cells, the mobilization of Kupffer cells and the slight enlargement of portal areas.The regeneration of liver cells including two-cell-thick plate and double nuclears of liver cells were shown in all specimens. The typhoid nodule was found in only one case with TY.There were no histological differences between TY and PA. Above-mentioned histological findings were those of so called “non specific reactive hepatits”.

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Two hundred and the strains of Acinetobacter anitratus freshly isolated from clinical specimens were subjected to the examination by the soft-agar technique.Their growth types in the medium were differentiated as large round, diffuse and compact.When encapsulated organisms exhibited more than twice or less than twice of the organisms in size, these capsules were designated as large and small, respectively, determined under light microscope using india ink method.Also strains exhibited positive for haemagglutination against guinea pig red cell were regarded as pili possessing organisms.
With those procedures, strains showing large round and diffuse type growthes were observed at 4.0 and 96.0 percent, respectively, and no strain exhibited compact type in the strains showing single growth types.In large round type strains, large and small capsule were observed at 50 percent, respectively, and no strain possessed pili.In diffuse type strains, small capsule was shown at 4.1 percent and pili was semonstrated at 13.3 percent of the strains.With these pili possessing strains mannose resistant strain was observed at 60 percent.In these strains, highest mouse virulence was shown in the strains exhibited large round type and large encapsulated, and second highest was large round type and small encapsulated.Strains of diffuse and compact type were significantly lower in their mouse virulence comparing to large round type strains.

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The topological analysis of the antigenic determinants on Japanese encephalitis (JE) virus was performed by the enzyme-linked immunosorbent assays (ELISA) using monoclonal antibodies (NARMA) with hemagglutination inhibition (HI) reactivities against Nakayama-RFVL strain.Of the 26 HI antibodies, all except NARMA 5 showed neutralization (Nt) reactivities against the homologous strain.The HI and Nt titers of these antibodies were not parallel.In addition, the ELISA and HI titers of these antibodies were not parallel.
All 26 antibodies reacted to the glycoprotein V₃-Furthermore, the competitive binding assays (CBA) were performed to analyze the distribution of the antigenic determinants on envelope glycoprotein V₃ of JE virus.The results suggested the existence of at least five different HI sites.All 10 JE species-specific HI antibodies competed completely or partially with 3 JE species-specific HI antibodies.This finding suggests the presence of a JE species-specific HI site.Furthermore, an absence of competitive binding was observed in all reciprocal CBA between the 10 JE species-specific antibodies and the 3 genusspecific antibodies.This indicates that the JE species-specific HI site and the flavivirus genus-specific HI site were topologically distinct.

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The survey on sepsis in infancy and chilhood was made by sending questionnaire to 48 pediatric institutions in major hospitals throughout the country of Japan from January, 1980 to June, 1984.761 cases which were proved to be bacteremia among 805 in-patients of sepsis were analysed on prognosis, underlying diseases and complications.
Prognosis of sepsis had been improved in comparison with the survey for the preceding five years (p<0.005) and mortality decreased from the highest level of 27.1% to 19.4%.As to the prognosis by age, mortality of infants within three days old showed high level of 26.4%, and then decreased with growth of infants.But, it turned to increase again in school children up to the mean mortality of 33.8% and the prognosis became worse.The mean mortality was 22.5% through the whole childhood.
As to the mortality by causal organisms, that for gram-positive cocci was 18.2% and that for gramnegative rods was 25.8%, showing statistical significance (p<0.025).Prognosis for the cases with detected fungi or polymicrobic were significantly worse than those of the respective control groups (p<0.005).The prognosis was worst in the cases with fungi, showing mortality of 73.3%, followed in descending order by P.aeruginosa, Enterobacteriaceae and S.aureus.Whereas the cases with H. influenzae, S.pneumoniae and Salmonella spp.showed better prognosis.
For the cases with any underlying diseases, mortality was 35.4%, whereas 9.3% for the cases with no such diseases and the former was significantly worse (p<0.005).Mortality of the premature infants with body weight under 1500 g was 50.0% and mortality of those over 1500 g was 20.4%, and the former was significantly worse (p<0.005).As to the cases with other underlying diseases such as Down syndrom, congenital heart anomalies, leukemia, other hemodyscrasia and malignant tumor, prognosis was generally bad.As to the complications, the cases with purulent meningitis showed the highest incidence of 18.5% followed by pneumonia of 6.7%.In the cases with DIC, mortality was 41.2%.

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Seventy-two patients with empyema were admitted to Pediatric ward, Kagoshima University Hospital, between April, 1974 and March, 1984.In order to investigate the risk factors in these patients, statistical analysis was carried out with Fisher's exact probability test.
Patients ranged in age from 12 days to 10 years, and 43 patients (59.7%) of them were less than 6 months.The affected side of the lung was seen more often in the right (61.1%).Positive cultures from pleural fluids were obtained in 53 cases (73.6%), and S.aureus grew in 47 cases (65.3%).Many strains of S.aureus showed the resistance to ABPC, EM, and TC.A few strains had acquired the resistance to aminoglycosides as GM, DKB, and TOB.
Nine patients with empyma died and the mortality rate was 12.5%. The risk factors of these patients were studied statistically, and were as follows: 1) infants less than 5 months (8 cases died in 39 cases, p=0.026), 2) infants affected in bilateral lungs (3 died in 5, p=0.012), 3) white blood cell count on admission under 10, 000/cmm (5 died in 12, p=0.0049), 4) complications as paralytic ileus or DIC (6 died in 9, p=0.0027).Forty-five cases had one risk factor and more, and in those 9 cases died (p=0.01).Further, 7 cases died in 9 cases with 2 risk factors and more (p=0.000059).
These data suggest that the risk factors are useful for inferring the prognosis of the patients with empyema even on admission, and if a patient has a risk factor, both adequate antibiotic therapy and systemic assistant therapy are to be done rapidly.

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A 65 years of previously healthy male patient became severely ill developing toxic shock syndrome associated with bacteremia of Staphylococcus aureus and disseminated intravascular coagulopathy which were caused from periurethral abscess.
The patient underwent transurethral resection of the prostate for the treatment of longstanding atonic bladder dysfunction caused by neurosyphilis (Tabes dorsalis). Previous to the surgery he had been treated with a cephem antibiotics to eradicate Escherichia coli colonized in the urine by repeated cathetrization done by himself. The antibiotics was discontinued because severe diarrhea developed suggesting of pseudomembraneous colitis.S.aureus colonized in the urethra after transurethral surgery and periurethral abscess developed within a few days.Then he became severely ill with generalized erythroderma hypotension and bleeding from the resected area suggesting of disseminated intravascular coagulopathy.He was treated with hydrocortisone, large (24 g/day) of pentocillin, heparin and copious fluid administration.However, adult respiratory distress syndrome, acute pancreatitis, liver and renal dysfunction (disclosed by laboratory investigations as elevated blood urea, creatinine, GOT, creatine phosphokinase etc.which are typical of multiorgan failure and elevated amylase due to infection of pancreas) developed very soon.Respiratory assist was needed through a tracheostomy for a month. Temporaly myelosuppression due to administration of ceftazidime for two days and generalized cramp possibly due to brain atrophy of syphilis complicated during the later period. Fortunately, S.aureus infection responded favorably to pentocillin and the patient recovered from severe illness promptly after removal of resiratory assist. Moreover, occasional agonizing pain from which the patient had suffered for more than 10 years very much diminished associated with recovery of sensation of urination and lowered titre of serology for syphilis, which revealed satisfactory response of neurosyphilis of long duration to administration of large dosage of pentocillin.
Staphylococcus aureus strain isolated from the perineal wound and blood was analysed, and found to belong type 4 by coagulase production and produce TS-toxin (enterotoxin F).
This is the first report of toxic shock syndrome from which S. aureus producing TS-toxin was isolated in Japan.

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A 22 year-old male baker was admitted on the 28th October 1982, complaining of headache, high fever and diplopia. Physical examination revealed neck stiffness and left-abducens nerve paralysis. The CSF findings were as follows: initial pressure was 510mm H₂O, turbirity was slightly positive, cell count, 629/3, protein level; 91 mg/dl, glouse level; 5 mg/dl, and also numerous cryptococci were observed in the Indian-ink stain and culutre. Chest X-ray films showed infiltrative shadows in the right upper lung and a few small round cavities with thick walls in the lower left lung.A CT scan of the brain was normal. He was diagnosed as having lung cryptococcosis and cryptococcal meningitis. So, for the first 54 days, Ketoconazole (KCZ) was orally administered (800 mg/day; in all, 43.2 g). After a brief interval, 5-Fluocytosine (5-FC) subsequently was orally administered for the next 78 days (at a dose of 10g/day).In addition, from the time of diagnosis, Amphotericin B (AMPH-B) was concomitantly administered both intravenously and intrathecally for a period of five months (total I. V. dose, 2200 mg; total intrathecal dose, 6.5 mg).
CSF and serum levels of KCZ (400 mg orally administered) were measured; serum peak level was 8.88μg/m1 at 2 hours and CSF peak level was 0.24μg/ml at 4 hours. MIC of KCZ, AMPH and 5-FC against the cryptococcus neoformans found in this patient were 0.31, 0.2 and 0.39μg/ml respectively.
He responded to the treatment. Headache, neck stiffness, and fever disappeared within 2 weeks and CSF culture became negative in a month, at the end of KCZ administeration, both slight heaptic dysfunction (GPT 121 I. U./L) and gynecomastia appeared, but the hepatic dysfunction returned to the normal level 7 weeks after ceasing KCZ administeration.However, gynecomastia persistid until he was discharged. These two effects were considered to be the side effects of KCZ.Despite the side effects AMPH (hypokalemia and renal tubular asidosis), controlled doses of AMPH combined with KCZ and 5-FC, resulted in CSF glucose level, cell counts and pressure returning to normal values within one month, and 4 months later he was discharged.
In the eighteen months since his discharge, he has not had a recurrence, and has been in good health. Therefore, KCZ and AMPH combination therapy is considered to be effective in the treatment of cryptococcal meningitis.

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