In order to reveal some important factors that deteriorated the outcome of septicemia including infective endocarditis during the past 16 years at the department of internal medicine of Yamaguchi Prefectural Central Hospital was done.
Among 153 strains isolated from these patients, sixty seven percent were Gram negative rods (39%, fermentatives, 28%, non-fermentatives), and 22%, Gram positive cocci, 11%, anaerobes, respectively. E. coli was the most frequent etiologic agent followed in frequency by P. aerginosa, a-hemolytic streptococci, S. aureus, K. pneumoniae and B. fragilis. These six organisms holded the seventy percent of all isolates.
E. coli was frequently isolated from the out- and inpatients with mild underlying diseases resulting good prognosis. On the other hand, P. aerginosa was mainly isolated, as hospital acquired infection, from the patients with severe underlying diseases, especially with hematological diseases having miserable outcome. S. aureus was usually isolated from outpatients with cutaneoarthral infections. K. pneumoniaewas often isolated from the patients with ultimately-fatal and non-fatal diseases. B. fragilis was mainly isolated from the inpatients with gastrointestinal malignancies. The prognosis of septicemia due to P. aerginosa or K. pneumoniae was poor and of that due to B. fragilis was the worst.
Among these organisms, K. pneumoniae and B. fragilis were apt to complicate with shock with or without DIC. Three quarters of the patients with septicemia complicated with shockdied.
The propriety of antibiotic therapy influenced directly upon the prognosis of patients with septicemia. Namely, such patients received inappropriate antibiotic therapy, as having hematological diseases, as complicating with shock, as with septicemia due to B. fragilis, were alldied of septicemia.
In conclusion, main factors which deteriorated the prognosis of septicemia were as follows; 1) severity of underlying diseases, 2) inappropriate antibiotic therapy, 3) complication with shock, 4) B. fragilis as causative organism.

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The four factors which deteriorated prognosis of septicemia, concluded in the former report, were analysed in detail.
1) Septicemia in patients with hematological diseases: Nineteen percent of all the patients with septicemia had hematological diseases. The mortality rate in this group was 71%, and 82% of patients with acute leukemia died septic death. P. aerginosa was the most commonly isollated organism in these patients. Twenty eight percent of this group were under inappropriate antibiotic therapy. Shock was complicated in 18% of these patients.
2) Inappropriate antibiotic therapy: Sixteen percent of the patients with septicemia received inappropriate antibiotic therapy. The mortality rate of this group was 87%. Antibiotic inappropriateness was most commonly occurred in the patients with hematological and gastrointestinal diseases. Half of this group developed shock. Ineffective antibiotics were administered in the greater part of these patients.
3) Complication of shock with or without DIC: Twenty one percent of the 147 patients with septicemia complicated shock with or without DIC. The mortality rate of these patients was 68%. Shock was most commonly developed in the patients with gastrointestinal and hematological diseases. The majority of these patients were community acquired. K. pneumoniae and B. fragilis were apt to complicate shock with or without DIC. All the patients under inappropriate antibiotic therapy died of septicemia.
4) Septicemia due to B. fragilis: This was only 7% of all the patients with septicemia. The mortality rate of this group was 80%. The majority of these patients had gastrointestinal malignancies. All the patients with inappropriate antibiotic therapy or with shock were fatal. Nevertheless, these factors were linked with each other, it became clear that the keystone which deteriorated the prognosis of septicemia was inappropriateness in antibiotic therapy. On the other hand, species of causative organism in septicemia was clossly related with underlying disease. To remedy septicemia, therefore, it was recommened appropriate usage of antibiotics on presumption of causative microorganism according to underlying disease.

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For the diagnosis of Chlamydia psittaci infection, complement fixation test (CF), indirect immunofluorescent antibody technique (IFA), indirect immunoperoxidase technique (IIP) and enzyme-linked immunosorbent assay (ELISA) were tested and their sensitivity was compared. On the other hand, experimental infection was made in the lungs of mice, and the change in antibody was followed and discussed in regard to the fate of bacilli and pathological findings. The results were as follows.
1. The ratio was r=0.91 between IFA and IIP, r=0.69 in human and r=0.95 in mouse between TIP and CF, and r=0.65 in human and r=0.96 in mouse between ELISA and CF. All results confirmed good correlations. Sensitivity of tests is good in the following order; ELISA, IIP, IFA, and CF methods.
2. Incidence of ELISA antibody titer over 128 times among healthy normal subjects was relatively high, 26.6 per cent. Immunity-positive patients of respiratory infection has increased markedly since 1981 according to the study in the past ten years, indicating infiltration of this type of infection. Higher antibody titer was found more among the owners of birds, showing ELISA antibody over 128 times in 50 per cent of them.
3. In the experimental mice of C. psittaci infection, rate of isolation in the lung was 100 per cent on the 3rd to 8th days, 71 per cent on the 10th day, 43 per cent on the 14th day, and then gradually decreased. In the early stage of infection, alveolar involvement was more marked than the interstitial pathology with predominant neutrophiles in the infiltrated cells, whereas histiocytes dominated on the 8th to 10th day, improving day after day. Serum antibody titer increased after the 6th day and maintained high value in the period between the 21st and 28th day.

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Enzyme-linked immunosorbent assay (ELISA) test has been employed to detect antibodies to Legionella pneumophila serogroup 1-6.
Antisera to Legionella pneumophila were produced in rabbits by the method of Centers for Disease Control (CDC, 1979). We used whole bacterial cells of Legionella pneumophila, killed by suspending in 1.0% formalin overnight, as a ELISA antigen.
Although ELISA was much sensitive than indirect fluorescent antibody (IFA), weak cross reactions with a few strains of Pseudomonas aeruginosa and Bacteroides fragilis were observed.
The advantage of a whole-bacterial cell ELISA (bact ELISA) were numerous. Coating with the whole cell was as simple and rapid as with soluble purified antigen. In addition, use of whole cells obviated the necessity of laborious or expensive antigen purification procedures.
Consequently, it was considered that the bact ELISA was useful in clinical studies, for serological diagnosis of Legionnaires' disease.

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Thirty-eight of 72 outbreaks of nonbacterial acute gastroenteritis associated with oyster consumption, which were reported to Bureau of Public Health, Tokyo Metropolitan Government in the winter seasons from January of 1983 through April of 1985, were investigated for the symptoms of patients and the existence of viruses in their fecal samples.
Major symptoms observed in 238 patients were nausea (80%), diarrhea (74%), abdominal pain (59%), and vomiting (56%). The geometrical mean of incubation period was 38 hours, and the duration of illness did not exceed 4 days.
Of 168 patients who were involved in 38 outbreaks, viruses were isolated by cultured-cell method only from 3 patients of 2 outbreaks, Echo-5 from 2 and Coxsackie B3 from 1, and rotavirus antigen was not detected by ELISA from any patients. Out of 168 patients in 38 outbreaks of which fecal specimens were examined for virus-like particles by electron microscopy, 50 patients (43%) in 25 outbreaks (66%) were positive for the particles. The negatively stained particles were spherical in shape with projection on their surface. The morphology of the particles observed in fecal samples, which were obtained from patients of different outbreaks, resembled each other. The particles were observed most frequently in stools obtained 2 days after onset of illness, and detection rate for the particle decreased rapidly with the days proceeded. By immune electron microscopy, increase in antibody titer against the particles was demonstrated in convalescent serum of 3 patients of different outbreaks.
These findings suggested the possibility that the particles observed were the etiological agents of gastroenteritis.
The posible relationship between the particles described in this report and Norwalk virus is discussed.

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Using strain Ac-0119 of Acinetobacter anitratus isolated from clinical specimens, relation of capsule and pili production, mouse virulence and growth type in soft-agar medium was investigated and following results were obtained.
The parent strain showed large round colonial morphology in a soft-agar medium and produced large mucoid colonies on BTB agar plate. The organisms possessed small capsule and no pili was observed either under electronmicroscope or haemagglutination reaction.
Varaiant-A exhibited feather like growth type in soft-agar medium and growned small mucoid colonies on BTB agar plate. This variant small colonies depending upon the organismus and no pili was demonstrated.
Variant-B exhibited streaming-type colonial morphology in a soft-agar and non-mucoid colonies were formed on BTB agar plate. With this variant, no capusule was observed, however, pili was shown by a negative staining method although the haemagglutination reaction was negative.
Variant-C showed compact type growth in a soft-agar medium and produced small non-mucoid colonies on BTB agar plate. With this variant, neither capsule nor pili were observed by et an electronmicroscope. Mouse virulence of the parent strain and its variants was higher in order of the parent strain and the variants, A, B and C and no mouse was killed even with 108 cells of the variant C.

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Serologic markers of hepatitis B virus infection in 703 students, 927 samples in total, aged 15 and 19 years, of a mercantile marine collage in Hiroshima Prefecture were determined during a period from 1978 to 1985.
The prevalence rates of HBsAg and anti-HBs in 703 subjects were 2.0% and 7.5%, respectively. The annual average of the former was varied from 1.0% to 3.0% but was in a state of equilibrium, while that of the latter varied in rate from 15.3% to 2.0%, showing decreasing tendency during the study period.
In 224 subjects tested with paired sera, 4 were confirmed to be HBeAg carriers, while 187 were absent of the markers. Consequently, no evidence of newly infection could be proved within the study group.

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Human psittacosis is zoonotic disease caused by avian strains of Chlamydia psittaci (C. psittaci). Birds infected with C.psittaci excrete large numbers of the organisms into their feces. Man acquires the infection by inhaling aerosoles of dried fecal materials containing infectious organisms. Therefore, their feces are very important as the sources in human infection.
The purpose of the present note is to investigate excretory ratio of feces containing C.psittaci. The authors attempted to isolate C.psittaci from 215 feces collected at two parks and two temples in Nagoya city between May 1984 and February 1985.
The isolation was carried out by the following procedures. 20% emulsions of feces were inoculated into intraperitoneal cavity of mice and then 10% spleen emulsions of sacrificed mice were successively inoculated into HeLa 229 cells treated with DEAE dextran. Finally the evidence of isolation was identified with appearance of inclusion bodies in HeLa 229 cells and the following results were obtained.
Organisms were isolated from 24 (23.8%) among 101 feces collected at A Park, 8 (14.8%) of 54 feces at B Park, 8 (26.7%) of 30 feces at C Temple, 1 (3.3%) of 30 feces at D Temple, total positive rate was 19.1%(41 of 215 feces). This organisms were concluded as C.psittaci originated from feral pigeons by Giemsa, iodine stainings and indirect immunofluorescence test.
The above results suggested that the feral pigeons were very important as the sources of human infection. It was considered that this method was highly sensitive and more simple and suitable for chlamydial isolation from highly bacterial contaminated samples.

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Enzyme-linked immunosorbent assay (ELISA) was evaluated for detection of immunoglobulin M (IgM) antibodies against human cytomegalovirus (CMV). Results obtained by ELISA and immunofluorescence (IF) test were compared each other. Consequently, ELISA for CMV may prove to be more reliable for the detection of IgM antibodies as compared with IF test.

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When Lipopolysaccharide (LPS), Muramyl dipeptide (MDP) were injected intraperitoneally in mice, the number of macrophages, neutrophils and lymphocytes in peritoneal cavity, blood and spleen reached a maximum until 10 days. While Soluble Protective Antigen (SPA) were injected intraperitoneally in mice, those reached a maximum at 14 days. This corresponded that the protective activity of SPA reached a maximum at 14 days. The phagocytic activity against Latex beads of macrophages treated with SPA was higher than that of LPS, MDP. And even 30 days after of SPA treatment, a significant increase of phagocytic activity was evident as compared to control. The production of lysozome enzyme (Cathepsin-D, Acid-phosphatase, β-N-Acetyl-D-glucosaminidase, Lysozyme) and NBT reduction activity in macrophages treated with SPA increased as compared to control.

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The clinical effects and safety of a new antibacterial agent, AM-715, was evaluated in patients with acute infectious enteritis (bacillary dysentery, enteropathogenic E. coli enteritis, Campylobacter enteritis, Salmonella enteritis and other bacterial enteritis) and the corresponding carriers (174 subjects in total).
AM-715 was orally administered to the subjects at the daily dosage of 600 mg for 5 days except patients with acute Salmonella enteritis and the corresponding carriers administered for 7 days. The efficacy was analyzed in 176 patients and carriers on these subjectes.
Against 184 clinical strains from the subjects, the in vitro activity of AM-715 was compared with that of nalidixic acid (NA), pipemidic acid (PPA), ofloxacin (OFLX), enoxacin (ENX), ciprofloxacin (CPFX), kanamycin (KM), and fosfomycin (FOM).
The results of this study are summarized as follows:
1. Efficacy rate of AM-715 on clinical symptoms
The efficacy rate was 99.1% in 119 enteritic patients
2. Bacteriological efficacy rate of AM-715.
Each eradication rate was 98.8% in Shigella spp., 100% in enteropathogenic E. coli., 80% in Campylobacter spp., 100% in V. parahaemolyticus, 73.3% in Salmonella spp. and 100% in other organisms.
3. Side effects of AM-715.
Five cases experienced side effects: soft stool in two cases, vomiting, diarrhoeaand skin rash in each one case as subjective symptoms. In clinical laboratory test, GPT elevated in seven cases, and GOT and GPT in four cases; and eosinocyte count increased in three case.
4. Antibacterial acivity of AM-715.
AM-715 showed stronger activity than NA, PPA, KM and FOM, and showed the same activity as that of PFLX, OFLX and ENX. AM-715 inhibited most of the strains at MICs of 0.05-0.1μg/ml against Shigella spp. and V. parahaemolyticus, at 0.1-0.2μg/ml against enteropathogenic E. coli and Salmonella spp. AM-715 inhibited all of the tested strains at 1.56μg/ml and 175 strains (95.1%) at as low as 0.39μg/ml.
Global efficacy was 95.5% in acute infectious enteritis. AM-715 was judged as a useful oral antibacterial for the treatment of these infections.

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The case is a 48 years old man, who has been suffering from chronic sinuitis since 16 years old, complained of slight sputum since 15 years old. He admitted to T hospital first because of fever and productive cough at 44 years old, when he was diagnosed as pneumonia due to Klebsiella pneumoniae by chest X-ray film and sputum examination. These clinical features were improved by treatments, but cough and sputum continued. He admitted again because of pneumonia due to Klebsiella pneumoniae. He complained of hemosputum from 46 years old and dyspnea on effort from 47 years old. He admitted again because of diffuse nodular shadows on chest X-ray film. He was referred to our hospital for further examination in March 5, 1985. During in this time, Klebsiella pneumoniae has been isolated from sputum frequently, and many antibiotics were given to the patient. After this admission, he was diagnosed as sino-broncho-bronchiolitis.
We guessed from his clinical course and results of transtracheal aspiration of our hospital that he had been infected with Klebsiella pneumoniae in his lower air way for 4 years since the first pneumonia.
Reports of persistent infection of Klebsiella pneumoniae could not be found in the literature.
This unusual case is noticeable and progressive form of this case is suggestive.

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