From May 1985 to October 1986, We made a bacteriologic study of almost all the central venous catheters used in our hospital. The results obtained are as follows;
1) We got the positive results of 137 cases with microorganisms out of 940 catheters, and its ratio was 14.9%. The microorganisms were mainly normal skin flora, such as Staphylococcus aureus, Candida, Bacillus and so on.
2) There were 16 blood cultures positive, of which 13 also had microorganisms in the catheters. In 9 out of these 13, the same microorganisms were found both in the blood cultures and the catheter tips.
3) In cases with fever and contamination at the site of catheter insertion, the positive ratio was meaningfully higher than the others.
4) As the time of catheterization got longer, the positive ratio got meaningfully higher.
5) As the condition of the patient got worse, the positive ratio became meaningfully higher.
6) On the matter of maintenance, we got the better results on adhesive wound dressing when we compare with other mediums.
7) Sex, age, the puncture site, antibiotics, the injection times, the changing of the delivery systems and filters, could not be correlated with incidence of catheter contamination.

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Clinical study on development of resistance and cross resistance of respiratory pathogens to ofloxacin (OFLX) and ciprofloxacin (CPFX) was carried out in 11 patients with cystic fibrosis, 1 patient with chronic respiratory tract infection having congenital hypogammaglobulinemia and 1 patient with bronchopneumonia secondary to controlled respiration because of spinal cord injury.
Causative organisms isolated from the expectorated sputum were 13 strains of mucoid Pseudomonas aeruginosa, 6 of rough P. aeruginosa and each one of P. maltophilia, Serratia liquefaciens and Klebsiella oxytoca.
Determination of minimum inhibitory concentrations (MICs) of OFLX and CPFX was performed by using agar plate method for 10 colonies of each isolate.
OFLX was administered to a total of 6 cases infected with P. aeruginosa. MICs of OFLX against P. aeruginosa increased 4 time or more in two cases in comparison with initial values and MICs of CPFX increased 4 times or more in same strains simultaneously.
In another case, MIC of OFLX was not changed, however MIC of COFX increased 4 times afterwards.
MICs of OFLX against S. liquefaciens and K. oxytoca in one case increased, MICs of CPFX against both strains also increased significantly. Two patients were treated with CPFX alone and 6 were treated with CPFX and other antibiotics in combination.
MIC of CPFX against mucoid P. aeruginosa in case No.6 increased and MIC of OFLX against same strain increased. In case No.14, both mucoid and rough P. aeruginosa became resistant to CPFX and OFLX after CPFX treatment.
It is considered that among new quinolones, cross resistance could be developed easily, however there is no strains which become highly resistant to both OFLX and CPFX.

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An animal model was used to study the persistence and pathogenisity of U. urealyticum in the prostate. Bacteriological and pathological deta were obtained from groups of rats which had been directly inoculated with U. urealyticum and the following results were obtained:
1) U. urealyticum was not recovered from the prostate, bladder or kidney.
2) No inflammatory changes were found but there were histological changes in a few rats.
3) U. urealyticum was recognized as being neither persistent nor virulent in the rat prostate. Nevertheless it is considered that further experiments are necessary under various host conditions.

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Existence of the plasmid (s) in strains of Serratia marcescens isolated from urinary andrespiratory tract were examined. Thirty four strains (69%) of 62 strains isolated from urinary tractwere proved to be the plasmid-bearing strains but 26 strains (35%) of 74 strains isolatedfrom reapiratory tract were the plasmid-bearing strains. The numbers of plasmids detected in one strain was distributedfrom one to six plasmids in a strain depending on strains used. Their approximate molecularweight were fallen in the range of 2.5 to more than 60 megadaltons. The examination of drug sensitivityof S. marcescens with Tridisk method revealed that most of strains isolated from urinary tract werefully resistant to antibiotics such as erythromycin, cephaloridine, ampicilin and sulfisoxasole and partially to knanamycin, tetracycline, gentamycin, cephoxytin and nalidixic acid. However the strains isolated from respiratory tract were sensitive to most of these drugs except erythromycin, cephaloridineand sulfisoxasole which showed full resistant to these strains.
By transformation method with isolated plasmid DNA from urinary tract isolates some of these characters of drug resistance were transfered to Escherichia coli. Although plasmid DNAs isolated from about 60% of urinary tract strains could transfered the ability of resistance toantibiotics, ampicilin, kanamycin and gentamycin, to E. coli, only one plasmid DNA isolatedfrom respiratory tract strains could transfered the ability of resistance to ampicilin to E. coli. These resultssuggested that there was remarkable difference on drug resistance between strains isolated from urinary and respiratory tract and in strains isolated from urinary tract some of this drugresistance dependedof the existence of plasmids.

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Two specific strains of Str. sanguis were isolated from tooth plaques in 61.7% of the patients with MCLS and their mothers, while the incidence among 744 controls was 1.9%. Serum indirect hemagglutination inhibition test, assayed by using sensitized sheep RBC with superficial antigen of the strains, showed a maximal increase in titers at 2 to 3 weeks of the disease course, followed by a gradual decrease. Injections of these strains, the filtrate and the purified component of the bacterial culture broth each caused various inflammatory changes compatible with MCLS in the experimental animals. No other strains of Str. sanguis produced the same changes. These findings suggest that some specific strains of Str. sanguis may be involved in the etiology of MCLS.

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The isolation of Trichomonas vaginalis has been declining steadily during the past decade. Particularly the recent five years have seen a statistically significant decrease as compared with more than a decade ago. The most important single factor in this decrease appears to be a declining frequency of Trichomonas vaginalis infections in the field of obstetrics and gynecology. Today, it appears that Trichomonas vaginalis is assuming less and less importance as a causative agent of nongonococcal urethritis.

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A 23 year-old female was admitted to St Marianna University Hospital with high fever since 5 days previously. She had a history of rheumatic fever at age 5 and mitral regurgitation since the age of 11 year-old.
Infective endocarditis was strongly suspected because of high fever, hepatosplenomegaly, Osler's nodes, Janeway's lesions and splinter hemorrhages.
Benzyl penicillin in combination with streptomycin therapy was commenced from the first day of admission.
On the third hospital day, blood culture revealed Staphylococcus aureus. Then benzyl penicillin was replased by cephalothin.
As drug eruption appeared from the 7th day, cephalothin adminjstration was holted and cloxacillin with adrenocorticosteroid hormone were given.
The drug eruption disappeared, her clinical symptoms improved and, she became afebrile on the 27th day.
Three years later, she is healthy except for mitral regurgetation.

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A case of congenital syphilis is reported. Antenatal serology test was initially negative in her father while positive in her mother at gestational age of 19 wks. The treatment during pregnancy given to her mother seemed to be not sufficient given erythromicin for syphilis.
Clinical signs of her such as failure to thrive, hepatosplenomegaly and symmetrical exanthema without rhnitis and osteochondritis are suggestive of congenital syphilis.
Confirmative diagnosis was established by the positive serological test and positive fluorescent antibody for Treponema pallidum in cereblospinal fluid.

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Two cases of spotted fever rickettsiosis were experienced in Miyazaki in August 1986, which seemed to be the first clinically observed and serologically confirmed case of the disease in the area other than southeast coast of Shikoku island.
Case 1 is 73 year old man, who suffered from high fever and generalized erythematous rash on August 9, 1986. He admitted the hospital on his 5th day of illness and was medicated for 3 days with oxytetracycline. After 2 days the rash disappeared, and fever declined after another 2 days. Laboratory examination gave positive CRP, abnormally high GOT and LDH value. Anti-Rickettsia sibirica antibody titer rose from 1: 40 in the acute phase to 1: 2, 560 in the convalescent phase.
Case 2 is 63 years old woman, wife of the case 1. On August 17 she visited the clinic becaese of high fevere for 3 days. On examination, erythematous rash on the whole body, two eschars on her right flank and lymphnode enlargement on the neck were observed CRP was 2+. The antibody titer to R. sibirica rose to 1: 160 in the convalescent stage.
Interestingly, their residential area has been highly endemic with R. tsutsugamushi since 1979, suggesting the neccessity of being aware of the possibility of prevalence of both diseases in future.

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We reported an infantile case of acute laryngobronchitis by Moraxella subgenus Branhamella catarrhalis (B. catarrhalis) . An eight month-old boy, otherwise healthy, was admitted because of cough, stridor and dyspnea. When he was brought, he was somnolence, showed irregular, shallow respirations and retraction of his suprasternal and subcostal portions and was cyanotic in both his hands and feet. Despite of oxygen supplement, he was still in severe respiratory distress. Then he was intubated. The vocal cord was coated with pseudomembrane and it showed slight swelling. After intubation, we got much purulent sputum from the tube and his respiratory distress gradually improved. Microscopical examination of his smear of pseudomembrane revealed many Gram negative diploccoci, some of which were phagocytised by neutrophils.
Roentgenogram of the chest disclosed slight increased pulmonary markings. The pseudomembrane culture yielded many colonies of B. catarrhalis. The physical findings and laboratory data were consistent with the dignostic criteria formulated by K. Matsumoto et al and a diagnosis of acute laryngobronchitis caused by B. catarrhalis was established. After administration, he was underwent drip infusion of cefotaxime which was replaced by latamoxef since after the bacteria was identified. His clinical course was favorable and he could be discharged on the twelfth hospital day.
It has recently been pointed out that B. catarrhalis plays an etiologic role as one of the bacterias which cause opportunistic or chronic respirarory infections in adults. In children, they know that it causes acute otitis meida, conjunctivitis, acute sinusitis and so force, however it seems very rare that it does acute laryngobronchitis.

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A case of Plasmodium falcipayum Malaria was reported.
This patient was a 33-year-old Japanese man who worked for the lumber section of a trading company. From October 29 to December 3, he stayed in Indonesia and frequently visited forests of west Irian.
On December 10, he developed a high fever and blood smear on December 17 disclosed Plasmodium falcipayum.
Physical examination on admission disclosed jaundice, hematemesis, bloody stool and distended abdomen. The patient was treated with Quinimax and blood transfusion. He died on the 4th day of his admission. The cause of death was pulmonary edema.

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