We studied the effect of a new oral cephem antibiotic cefixime (CFIX) on the intestinal bacterial flora in pediatric patients. The subjects in this study were 10 infants and children (5 boys and 5 girls) ranging in age from 7 months to 11 years and ranging in weight from 5.8 to 43.5 kg. CFIX was administered in granule form twice daily in doses of 3 mg/kg either for the treatment of infection or prophylaxis of infection in the patients with cardiac disease. Feces were collected before the treatment with CFIX began and on the 3rd to 7th days of treatment and on the 3rd to 7th days after ending the treatment. Bacteria in the feces was identified, and bacteria count per gram of feces and drug concentration in the feces were determined., β-Lactamase activity in the feces was also studied. Although the changes in the intestinal flora varied widely among the subjects, it was possible to roughly identify three groups: Group A, in which both aerobes and anaerobes were mainly unchanged, Group B, in which only Enterobacteriaceae such as E. coli and Klebsiella were reduced and Group C, in which both aerobes and anaerobes such as Enterobacteriaceae, Bifidobacterium, Eubacterium and Bacteroides were markedly reduced. Enterococcus was either unchanged or tended to increase in all 3 groups. CFIX was excreted at a high rate in the feces of the subjects with little or no, β-lactamase activity, and the bacterial flora showed great change in these subjects. Thus it is thought that differences in the sensitivity of the constituent intestinal bacteria to this drug as well as the level of β-lactamase activity in the feces are two highly significant clinical factors affecting the intestinal flora during the treatment with CFIX. There were 3 cases of diarrhea which could be attributed to the administration of CFIX, probably owing to the suppression of intestinal bacterial flora and also to the presence of C. difficile.
We studied the prevalence of complement fixing antiboty to Campylobacter jejuni in healthy peoples. 800 sera tested were corrected during 1982-1984. The frequency of antibody positive (antibody titer, ≥1: 10) in adults of Ibaraki, Tokyo and Osaka prefecture were 3.6%, 48.0% and 21.3% respectivery. The distribution of seropositivity among age groups at Tokyo prefecture were 22.2-24.5% in 0-10 age group, 35.5-42.0% in 11-20 age group, 54.0-59.4% in 21-40 age group and 32.0-55.6% in over 41 age group. Our data showed that Campylobacter jejuni may be spread widely in Japan.
A new mycoplasma species M. genitalium (G37), isolated from urethral specimens of patients with non-gonococcal urethritis, was studied. The serologic and bacteriologic characteristics, pathogenicity and possible role in human respiratory disease was discussed. The results were as follows: 1. Biological properties. M. genitalium grew slowly in classical Hayflick medium and SP-4 medium. Cholesterol was required for growth. Colonies on agarose were variable in size and adherent to glass and plastic surfaces. 2. Morphology and ultrastructure. Electron microscopy of M. genitalium cells was similar to that of M. pneumoniae, but flask-shaped cells with terminal rod-like structures were seen in some M. genitalium. 3. Biochemical properties. The results of various biochemical tests were as follows: fermentation of glucose-positive; hydrolysis of arginine-negative; hemadsorption to human type-0 erythrocytespositive. 4. Serological properties. Cross-reactivity between M. genitalium and M. pneumoniae was shown by complement fixation test, indirect hemagglutinin test, direct immunofluorescence and double immune diffusion methods. Cross-reactivity was not demonstrated by metabolic inhibition test and growth inhibition test. 5. In hymsters intratracheal infection with M. genitalium produced peribronchitis, pneumonia and perivasculitis. These pathological findings were very similar to those seen in M. pneumoniae infection. It was suggested that M. genitalium may be pathogenic in animal respiratory tracts. 6. M. genitalium inhibited ciliary activity of hamster tracheal rings. These observations indicate that the characteristics of M. genitalium are very similar to those of M. pneumoniae. M. genitalium may have a pathogenic role in human respiratory disease.
1294 cases of childhood bacterial meningitis through 1979 to 1984 from questionnaire were studied. The form of questionnaire was consisted of the number of total inpatients and bacterial meningitis in each year, and age, sex, causative organisms, chemotherapy and prognosis of each bacterial meningitis. A frequency and the causative organisms of bacterial meningitis are discussed in the paper. The frequency of bacterial meningitis in total inpatients was 0.37%. The sex ratio (M/F) was 1.63. Nearly 3/4 bacterial meningitis was occurred in infancy. The isolation ratio of the causative organisms was 78.5%. The 5 major causative organisms were Haemophilus influenzae (279 cases), Streptococcus pneumoniae (201 cases), Escherichia coli (114 cases), group B streptococcus (100 cases), and Staphylococcus aureus (29 cases). The former two was obviously dominant over 3 months of life, and the succeeding two was under 3 months of life. Staphylococcus aureus was noted in all age groups. 10 cases were infected with two different organisms. The causative organism was obscure in 279 cases.
The clinical records of 93 cases with Staphylococcus aureus (S. aureus) bacteremia of the aged at Tokyo Metropolitan Geriatric Hospital from 1973 through 1984 were reviewed. In this period, the incidence of S. aureus bacteremia was 11% of all bacteremia. Eight cases were monomicrobial and 13 cases were polymicrobial bacteremia. Patients with malignancy were observed 37.6% and cerebrovascular disease were observed 20.4% of all cases. The most common portal of entry were the urinary tract in 21 cases and indwelling intravenous catheter related in 17 cases. The mean days of the indwelling intravenous catheter at the inguinal region prior to the detection of S. aureus bacteremia was 6 days and were shorter than other sites. Twenty two out of 80 cases of monomicrobial bacteremia developed shock. Total mortality of the bacteremia which was defined as death within one month at the onset of the bacteremia was 47.3%. A high mortality, 60.0%, was observed in patients with respiratory tract as the portal of entry. The factors which contribute to poor prognosis were malignancy, DIC and shock. And thier mortality were 68.6%, 88.9% and 86.7%, respectively. While, the mortality of the patients without malignancy or DIC, shock were about 16%. There was no significant difference in the mortality between methicillin resistant S. aureus (MIC≥25μg/ml) and methicillin sensitive S. aureus bacteremia.
Klebsiella oxytoca was detected from all of the bloddy stool specimens collected froni 11 patients with antibiotic-associated colitis in acute phase and the mean log10 number was 7.1 per gram of feces. The organisms were detected from 5 of 7 formed stool in convalescence with the mean log10 number of 5.5 per gram of feces. Clostridium difficile was not detected from any of the specimens, while C. difficile enterotoxin was detected from 2 of 10 bloody stool in acute phase. These two cases were diagnosed as antibioticassociated hemorrhagic colitis from clinical features and laboratory findings. The intestinal microflora of the acute phase showed a striking decrease in the total count and a simplification of bacterial groups as compared to that in the convalescence. In particular, the vaiable counts of the obligate anaerobes showed remarkable decrease so that some members were undetectable.
We investigated the activity of Candida albicans polysaccharide on the cardiovascular system of rats, and following results were obtained. 1) The heart: On Langendoriff's preparation of non-immunized rats, Candida polysaccharide increased left intraventriclar pressure (LIVP) and coronary flow (CE), and raised the heart rate (HR) after a temporary decrease. The responses were dose-dependent. From these results, it is concluded that the Candida polysaccharide has cardiotonic and coronary vasodilatatory activities. In the case of the immunized rats, Candida polysaccharide decreased LIVP and CF after a temporary increase and increased HR after a temporary decrease at the first challenge, but these preparations showed similar reactions in the heart of non-immunized animals at the second challenge. This phenomen suggests that some chemical substance i.e. autacoids may be produced immunologically as seen in the Type I allergy by the IgE antibody. The aorta: On spiral preparation of descending thracic aorta of non-immunized rats, Candida polysaccharide slightly constricted the aorta in the resting state and relased the aorta which was constricted phenylephrine. The responses were dose-dependent. As for the aorta of immunized rats, Candida polysaccharide increased only the constriction of the aorta in the resting state at the first challenge, but these preparations showed similar reactions in the non-immunized aorta at the second challenge. From these results, it is concluded that Candida polysaccharide has the vasoconstrictive activity and neutralizes the activity of phenylephrine.
A 38-year-old man who received a living renal transplantation 12 years ago came to our hospital with terminal hematuria. Salmonella typhimurium was isolated from expressed prostatic secretion and seminal fluid. He was diagnosed as chronic bacterial prostatitis and administered nalidixic acid, 2 g by mouth four times daily for one month. But 3 days after the drug was stopped S. typhimurium was again isolated from seminal fluid, so it was necessary to continue the same treatment for 2 months.
Alcaligenes dentrificans subspecies xylosoxidans (A. xylosoxidans) is one of non-fermentative Gram negative rod, which described by Yabuuchi and Ohoyama in 1971. Nevertheless its pathogenesis have been evident, septicemia caused by A. xylosoxidans are seldom reported. We report here one case of septicemia caused by the organism. A 73 years old male, who had been suffered from hypertension and aortic vulvular regargitation since several years, developed orthopnea by heart failure and was admitted to our hospital. Fever and chill with severe inflammatory reactions developed 4 days after insertion of central venous catheter. A. xylosoxidans was purely isolated from the catheter and from blood. Several days later, acute renal failure and pseudomembranous colitis associated with piperacillin developed. Intravenous administration of minocycline 100 mg/day, peritoneal dialysis and oral administration of vancomycine 1.0 g/day were performed. Five weeks after admission the patient improved well and was discharged. It is concluded on summary of 14 cases reported in the literatures that A. xylosoxidans is resistant to various antibiotics or antiseptics in common use, and therefore that the organism may play an important role in hospital acquired infections especially among compromized hosts.