We have investigated the efficacy of anti-HBs human immunoglobulin (HBIG) in accidental exposures to HBV, and 3 cases that developed HBV infection in spite of passive immunization by HBIG were compared with 12 patients with acute hepatitis type B without HBIG immunization in their clinical features.
Anti-HBs were detected by radioimmunoassay in all samples obtained within 16 weeks and became undetectable by 24 weeks after passive immunization. The incidence of the development to acute hepatitis type B in spite of HBIG immunization was 0.8%(only one of 128) in our hospital.
All of the three cases that developed acute hepatitis type B despite immunization were infected by HBe antigen positive blood in accidental needle stick and they presented less severe clinical features than those without HBIG. Overt jaundice was acknowledged in only one patient, the peak value of serum total bilirubin was significanity lower and the mean period of incubation time was significantly prolonged.
These observation suggests the efficacy of HBIG and the necessity of longer follow-up more than 6 months after immunization in accidental exposures to HBV.

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Susceptibilities of 50 strains of M. pneumoniae which were isolated from acute respiratory infectious diseases, to several macrolide antibiotics were investigated by two methods. One is the agar dilution method, the other is M. pneumoniae L cell infection system.
The minimum inhibitory concentrations (MICs) of erythromycin (EM) and new macrolide, rokitamycin (RKM), which inhibit the growth of 75% strains of the microorganisms tested were 0.007μg/ml. The MICs of josamycin (JM) and kitasamycin (leucomycin, LM) were 0.015μg/ml and 0.03μg/ml respectively.
The minimum concentrations of EM which eliminate the microorganisms from L cells were not proportional to the MICs obtaind by the agar dilution method. The doses of EM for eliminations of several strains of microorganisms were more than ten times high in comparing with their MICs. In contrast, the doses of RKM, JM and LM for the elimination coinside essentially with their MICs. Also we confirmed by DNA staining method that the particles of M. pneumoniae which adhered on the surface of L cells could be eliminated after treatment of RKM.

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Recently, the isolation rate of methicillin-resistant Staphylococcus aureus (MRSA) from clinical specimens are increasing.
Such tendency was also observed with the organisms isolated from blood cultures in our hospital.
Increase of S. aureus in isolation rate and multiple antibiotic resistance seemed to be related to increased usage of antibiotics which were effective to gram-positive cocci.
In 1985, 96 percent of S. aureus isolated from blood cultures in our hospital were β-lactamase producers or MRSA (MRSA were seen at 78 percent).
Results obtained from measurement of MIC of various antibiotics nd several antibiotic combinations against MRSA, indicated that minocyclin, netilmicin, combination of fosfomycin and methicillin, or combination of fosfomycin and cephems are effective against septicemia caused by MRSA.

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Borth cultures (1-3×10⁷cfu/ml) of Candida albicans and C. tropicalis showed mannan concentrations ranging from 4.8 to 23 ng/ml, whereas broth cultures of Candida species excluding C. albicans and C. tropicalis showed mannan concentrations of 0.1ng/ml or less. In addition, sonicated and lyophilized Candida antigens of C. albicans and C. tropicalis had mannan concentrations ranging from 50 to 150ng/μg, whereas antigens of Candida species excluding C. albicans and C. tropicalis had mannan concentrations of 10 ng/μg or less.
Of 202 cancer patients, 107 died during hospital stay. Autopsy was performed in 55 patients, and invasive fungal infections were found in 25 patients. Mannan antigenemia (>1ng/ml) was detected in all patients with systemic candidiasis (8 cases), and in 3 patients with invasive gastrointestinal candidiasis (6 cases). Of 8 patients with probable invasive candidiasis, 7 patients had mannan antigenemia. Blood cultures were positive for Candida species in 7 patients, and antigenemia antedated the positive blood cultures by 5 to 19 days in 3 patients. On the other hand, 2 of 180 patients without candidiasis were positive for serum mannan. In 48 healthy adults, none of the sera had mannan concentrations of 0.5 ng/ml or greater.
Clinical evaluation of the detection of mannan (>1ng/ml) for 22 patients with invasive and probable invasive candidiasis was made, and the sensitivity and specificity of serum mannan were 82% and 99%, respectively. Thus, monitoring of high risk patients for serum mannan is useful to diagnose invasive candidiasis early in its course.

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The glycolipid (Rt. GM-2) containing mycolic acid as hydrophobic component was isolated from Rhodococcus terrae, which is a none pathogenic strain and is closely related taxonomically to Mycobacterium, and was examined the potency of increasing resistance to influenza virus infection in mice.
Water-in-oil-in-water emulsion containing 10μg of glycolipids were injected into the tail vein of ICR mice on two days after or before influenza virus A/Osaka/5/70 (H3N2) was infected. In both experiment, the significant protective effects were observed.
The protective effect of Rt. GM-2 against influenza virus infection was stronger than the protective effect of BCG cord factor.

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In order to evaluate the sensitivity of the enzyme immunoassay (EIA) which uses monoclonal antibody and is currently available as a screening test for the detection of hepatitis B surface antigen (HBsAg), we compared the performance of two commercial kits (EIA-I, EIA-II) in 756 persons against the conventional highly sensitive radioimmunoassay.
Incubation time was three hours in EIA-I, two hours in EIA-II, and 12-20 hours in RIA.
Rates of seropositivity in RIA and EIA-I were equal, 48.8% and-EIA-II was 47.6%. Nine sera were found to be positive for HBsAg by RIA and EIA-I but negative by EIA-II. When these sera were again tested by EIA-II using overnight incubation method, eight of nine sera were judged to be positive. The remaining one could not be tested because of the small amount of serum.
These data suggest that sensitivity of EIA using monoclonal antibody may be equal or a little less than that of RIA for detection of HBsAg.

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Among various third-generation cephem antibiotics, Cefoperazone (CPZ), a choleretic antibiotic, was given to children with various infectious diseases ranging in age from 3 months to 17 years, and its effects on the intestinal bacterial flora and the incidence of diarrhea were determined.
Diarrhea occurred in 15 (25.8%) of 58 patients. All episodes occurred before 4 years of age. The incidence was particularly high among infants younger than 2 years, with 11 cases (40.7%) out of 27 patients. Among diarrheic patients, the total number of microorganisms in the feces was markedly decreased, with a decrease in almost all organisms other than Candida and Enterococci. This was similar to the results with other third-generation cephem antibiotics. On the other hand, patients with no diarrhea showed a tendency toward an increase in Enterococci. Taking these findings into account, the effects of multi-drug-resistant St. faecalis preparation (BF-R) combined with CPZ were then investigated. Among 2-year-old or younger subjects, diarrhea occurred in 2 (8.0%) of 25 given the BF-R combined therapy, the rate being significantly lower than that for those not given combined therapy (p<0.01).
CPZ therapy requires full attention to the changes in the intestinal bacterial flora and the complication of diarrhea, and its combination with BF-R is useful for preventing diarrhea during administration of CPZ.

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Antigenic analysis of nine newly isolates of Rickettsia tsutsugamushi was carried out using indirect immunofluorescence technique with monoclonal antibodies against Gilliam, Karp, and Kato strains. Eight strains, Nishi, Maruyama, Watari, Ide, Hirano, Yamamura, Nagase, and Iwamoto, were isolated from patients with tsutsugamushi disease in Miyazaki Prefecture between 1980 and 1984, and one strain, shimokoshi, was isolated from a patient with tsutsugamushi disease in Niigata Prefecture in 1980. The hybrid cells were produced by fusing P3X63Ag8. 653 mouse myeloma cell line with spleen cells from BALB/c mice immunized with the rickettsial strains.
According to the immunofluorescence test against the 26 monoclonal antibodies, the nine strains are classified serologically as follows:
1. Eight strains isolated in Miyazaki Prefecture.
1) Nishi and Maruyama strains were identified as Gilliam type.
2) Watari and Ide strains were identified as Gilliam-Kato type.
3) Hirano, Yamamura, Nagase, and Iwamoto strains were identified as Kato type.
2. Shimokoshi strain isolated in Niigata Prefecture, was identified as Kato type.
The serological reactivity of these strains against the 26 monoclonal antibodies was not identical even in the same serotype. Although epitopes of the strain specific antigens are on 60 kD protein and those of the common antigens are on 44 kD or 61 kD protein using immunoblot technique, the present results suggest that many different epitopes exist on the same antigen molecules.
We expect that these monoclonal antibodies will serve in the identification and antigenic analysis of Rickettsia tsutsugamushi.

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To evaluate the vaccine efficacy of FHA predominant acellular pertussis vaccine, which has been in clinical use since 1981 in Japan, the author recently made a retrospective study by the questionnaire from of secondary pertussis attacks throughfamily contact in 96 children with pertussis diagnosed in the periodfrom January 1981 through August 1986.
Number of the answere to the questinnaire were 75 patients.
Secondary pertussis attacks throughfamily contact were found in 19 (65.5%) of 29 siblings not immuniz with pertussis vaccine.
On the other hand of the siblings immunized with FHA predominant acellular vaccine (Takeda), 13 were exposed to pertussis throughfamily contact and secondary attack was seen in only one of them.
The present survey revealed anefficacy rate of 88.3%for FHA predominant acellular pertussis Takeda's vaccine. A simultanous survey of whole cell pertussis vaccine reveald 79.3%.

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An investigation was performed on 56 cases with sepsis in infants and children during the last ten years in our institution.
We attempted to evaluate the relations between several factors and prognosis of sepsis.
The results were as follows:
1. Twenty nine cases occured in infants (52%). Anong these, newborn infants were eleven (38%). Underlying diseases were found in 44 cases (79%), including fourteen with malignancy and six with aplastic anemia.
2. Gram-negative pathogens were dominant in causative organisms (63%). Major four organisms were S. aureus (23%), Pseudomonas sp. (21%), E. coil (16%), and Klebsiella sp. (14%). The total of these was 75%.
3.Pseudomonas sp. and Klebsiella sp. identified by blood culture were also frequently found by stool culture examined at the same time.
4. Almost all organisms were progressively resistant to Ampicillin, whereas these were sensitive to Aminoglycosides.
5. The factors that deteriorated the prognosis of sepsis were caused by S. aureus (p<0.1), sepsis with neuroblastoma (p<0.05), sign of consciousness disturbance (p<0.02), abdominal distension (p<0.01), edema (p<0.05), petchiae (p<0.05), and complication of pneumonia (p<0.01), DIC (p<0.02), Shock (p<0.01), hypoproteinemia (<5 g/dl, p<0.01), severe thrombocytopenia (50000/mm³, p<0.01), and leukocytopenia (<40000/mm³, p<0.05).

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Bacterial endocarditis due to Kingella kingae is rare. As far as we learned, there are only 19 cases of IE due to this organism reported in the literature, and no case reported in Japan. We describe here a patient with endocarditis caused by K. kingae.
A 33 years house-wife, previously diagnosed as SLE, was presented with spiking fever and polyarthralgia. On examination, she was feverish but well-oriented. The body temperature was 40.0°C. The butterfly-like erythema was noticed on her face. The mitral regurgitant murmur was audible. The white blood cell count was 3400 with 6% band form, 52% segmented neutrophiles, 4% eosinophiles, and 28% lymphocytes. LE cells were positive. ANA was positive at a titer of 1: 320, with hypocomplementemia. She was given high dose of steroid, under the diagnosis of acute exacerbation of SLE, followed by partial resolution of high fever. On 6th hospital day, gram-negative coccoid bacilli were grown in a blood culture obtained on the 3rd day. Echocardiogram revealed large, mobile vegetation attached on posterior leaflet of the mitral valve. Same GNR was grown three times consecutively. A diagnosis of IE due to unspecified GNR was done.
She was started on ceftizoxime 1g d. i. v. every 6h, with peak serum bacteriocidal titer of 1: 128, and trough SBT of 1: 32. On 20th day, cefotetan 2g d.i. v. every 12h was substituted for CZX, with same peak and trough SBT as CZX, because of difficult maintenance of blood access. Her clinical course was complicated with major emboli to the right popliteal artery on 22nd hospital day, and renal infarction on 25th day. Echocardiogram taken after the events revealed no vegetation of the mitral valve. Medical treatment was completed after 35 days of antibiotics. No relapse was observed during one year followup period.
K. kingae, considered as human oral commensal, is oxidase positive, catalase negative and nonmotile gram negative coccoid bacillus. Differentiation from other fastidious GNR was made by the characteristic beta-like homolysis on sheep blood agar. Rapid NH system (Innovative Diagnostic System Inc, USA) was also useful for the rapid identification of K. kingae.

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