A total of 1, 404 strains of Vibrio cholerae 0-1 and non 0-1, V. fluvialis and V. parahaemolyticus isolated from humna sources in various countries from 1979 to 1984 were studied for their resistance to 6 different antimicrobial agents, i.e. ampicillin, chloramphenicol, kanamycin, streptomycin, sulfamethoxazole-trimethoprim and tetracycline, as well as for the presence of conjugative R plasmids.
Among vibrio strains studied, 19 strains (4.3%) of 438 V. cholerae 0-1, 13 (10.2%) of 127 V. cholerae non 0-1, 3 (2.3%) of 133 V. fluvialis and 20 (2.8%) of 706 V. parahaemolyticus were found to be resistant to some of the antimicrobials tested.
By transfer experiments, 13 of V. cholerae 0-1 and one of V. cholerae non 0-1 strains with multiple resistance were demonstrated to have conjugative R plasmids, but no strains of V. fluvialis and V. parahaemolyticus had plasmids. The R plasmids isolated from these resistant V. cholerae belonged to incompatibility group C. The molecular weight of these plasmids was estimated to be about 100 to 120 megadaltons by agarose gel electrophoresis.

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In two patients (one case of non-Hodgkin, mixed-type malignant lymphoma and one case of acute lymphatic leukemia) treated with co-trimoxazole for suspected Pneumocystis carinii pneumonia, cysts were demonstrated in the sputum after one day of treatment, and the patients died no longer viable four days of therapy. The morphology of cysts found in the pulmonary alveoli were examined by electron microscopy, and the treatment method was evaluated.
In patients with P. carinii pneumonia, the sputum is often non-productive, but examination for cysts should be performed adequately even after initiation of treatment, since expectoration of sputum becomes easier once treatment has been started.
In P. carinii found in pulmonary alveoli, fissuring of cell membranes were confirmed together with changes in the cytoplasm including the presence of intracystic bodies even after 4 days of treatment. Moreover, since lamellar-body-like structures such as are seen in pulmonary alveolar proteinosis were found in our cases, we surmised that active use of bronchoalveolar lavage to remove the material filling the alveoli is valuable not only for diagnostic purposes but also therapy of P. carinii pneumonia in which initiation of treatment has been delayed.

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Epidemiological studies on type C influenza virus (influenza C) infection of children lived in Yokosuka city were carried out.
During five years from 1980 to 1985, 4 strains of influenza C were recovered from 2670 patients of influenza-like illness. Serologica analyses of these 4 strains on 64 sera of children using HI tests sugges that antigenic variation does exist among the isolates.
Seven of 735 paired serum samples tested which were collected from patients of various diseases showed a fourfold or greater HI titer rise to influenza C, and six of these cases were respiratory diseases.
The age-related incidence of positive HI antibody in 351 sera collected in 1985 was determined. The antibody which was considered to be passively transmitted from the mother disappeared during the first 8-9 months after birth, subsequently the number of antibody-positive sera began to increase from about 10 month of age, then increased rapidly and reached 90% by the age of 6 years. The seropositivity rate of children was depended on their surroundings.
Ten of 405 paired serum samples tested which were collected from healthy children at intervals of 2-3 months for 3 years showed a fourfold or greater HI titer rise. The seasonal distribution of these 10 cases did not lean to the winter season. Dates of occurrence of 11 cases of the infections detected in this study (4 of virus isolated case, 7 of serologically diagnosed positive case) distributed in overall season.
These findings suggest that influenza C are spread in human being throughout the year.

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A serological survey was carried out on 54 SLE patients with or without past histories of herpes zoster, and the results obtained are as follows.
1) Forty of 42 SLE patients with past history of zoster showed positive complement-fixing (CF) test at titers of 1: 4 to 1: 512 at the point in time of this survey. No CF antibody was detectable in sera from 12 SLE patients without history of zoster and also in sera from 44 healthy adults.
2) Positive CF antibody titers were detected for longer period in some cases of SLE with zoster; CF antibody was detectable even 2 to 24 months after the episode of zoster in some cases.
In seven cases of SLE patients, zoster developed at the time of CF antibody positive.
3) Usual CF antibody response was seen in SLE patients.
4) It was recomfirmed that recurrences of herpes zoster occured more commonly in patients with SLE.

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Two hundred fifty one strains of coagulase-negative staphylococci were isolated from clinical specimens and environmental materials and were subjected to the tests for the identification of species, capsular typing and phage typing and following results were obtained.
The strains were classified as follows, 172 strains of S. epidermidis, 19 strains of S. simulans, 14 strains of S. capitis, 12 strains of S. cohnii, 10 strains of S. xylosus, 9 strains of S. haemolyticu, 8 strains of S. hominis, 3 strains of S. saprophyticus, 3 strains of S. warneri and one strain of S. sciuri. Among them, 23, 128, 11, 67 and 22 strains were capsular type I, II, III, polyvalent and nontypeable, respectively, indicating 91.2% of the typeability and capsular type II strain was detected as the highest population. With phage typing, 18, 116, 1 and 116 strains were phage type I, II, III and nontypeable, respectively. However, no relation was observed between capsular type and phage type in these strains.

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The level of serum IgM has been found to be increased in covalescent stage of M. pneumpniae infection. Thirty-two children with pneumonia due to M. pneumoniae were evaluated for serum IgM level and the contribution of M. pneumoniae antibodies and cold agglutinins to the raised IgM level was assessed. All of the 32 had elevated serum IgM levels (>140mg/dl) in convalescent stage.
The serum IgM level was significantly correlated with M. pneumoniae titer (r=0.54) and also with cold agglutinin titer (r=0.59). IgM secreting cells in patients' peripheral blood had no correlation with serum IgM levels. The high IgM convalescent sera absorbed with protein A revealed high M. pneumniae titer.
The sera absorbed with M. pneumoniae antigen revealed no antibodies to M. pneumoniae or cold agglutinins, but still showed high IgM levels. Immunoelectrophoresis demonstrated polyclonal IgM increase. These data suggest that serum. IgM increase in M. pneumoniae infection is of polyclonal response. A large part of the IgM increase would seem to be attributable to non -specific immunoglobulin production.

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The complication of infectious diseases is one of the important problems on the treatment of hematological disorders such as leukemia. Although fever related with or without infection is frequently seen in patients with these diseases it is difficult to clarify the cause of fever.
In this report, the causes of fever in 68 patients with leukemia, malignant lymphoma, and aplastic anemia who were admitted to the First Department of Internal Medicine of Ehime University Hospital between 1976 and 1983 were analyzed.
The frequency of days with fever more than 38°C in admission was 25% in blastic crisis of chronic myeloblastic leukemia (CMLbc), 16% in both aplastic anemia (AA) and malignant lymphoma (ML) and 13% in acute leukemia (AL). In AL and AA, more than 50% of febrile episodes were due to infections and occurred during neutropenia and other causes of fever except infections were due to blood transfusion and drugs on the treatment. In CMLbc and ML, fever was more often seen by non-infectious causes, especially their hematologic disorders itself than infections.
Respiratory tract was the most common site of infection. There were some correlations between the degree of neurtopenia and the manifestation of sepsis and fatal infection. The fatal infections were mainly pulmonary infections, sepsis, and liver abscess. Seventy-nine percent of 14 cases with sepsis and 86% of 14 cases with fatal infection were seen during severe neutropenia less than 500/μl. Sixty-sic percent of the causative organisms in all the infections were gram negative rods such as Pseudomonas aeruginosa, E. Coli, Klebsiella, and 20% of them were gram positive cocci such as Staphylococcus aureus, Enterococcus faecalis. Furthermore, mycobacteria and fungi were also found to be the causes of fatal pulmonary infections.

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Since an incidence of parasitic diseases is low in Japan, few kinds of anthelmintic drugs have been registered yet, therefore it has been a great trouble to get these drugs which are frequently administered in abroad. To improve the trouble, the Study Group on Pharmacotherapy for Imported Tropical Diseases has been organized by the Ministry of Health and Welfare (Japan) in 1980. For these six years, 172 cases have been treated with mebendazole and in these clinical trials, 99 cases of trichuriasis were included (9 cases were foreigners). It was found by stool examinations that only one patient was heavily infected (more than 5, 000 EPG) and the others were in low grade infection except one case of middle grade infection. As a regimen to trichuriasis, mebendazole (Vermox^®, Janssen Pharma.) was administered per os 100mg, twice a day for three days. As a result, laboratory data of stool examinations show that the EPGs in all of the examined 43 patients were decreased in number after the drug administration, however, small number of eggs was still detectable in five cases. Adverse reactions were observed in two cases, abdominal pain and skin eruption, but these symptoms were slight and transient. These adverse reactions have not been reported yet, thus little relationship may be suspected between the drug administration and the above symptoms.
From these data, it can be concluded that mebendazole is an effective and safe drug for the treatment of trichuriasis.

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We examined 234 isolates of Salmonella spp. (31 serovars) isolated from patients with gastroenteritis for the presence of plasmids and antimicrobial resistance. Eighty percent or more of S. typhimurium, S. enteritidis and S. braenderup strains carried plasmids. Some of the plasmids were unique to each serovar and their molecular sizes were 90, 54, and 110 kilobase pairs (kb) for S. typhimurium, S. enteritidis, and S. braenderup, respectively. Out of 55 S. typhimurium isolates, 17 (31%) harbored 90-kb plasmid, while all the 16 multiresistant isolates carried 110-to 150-kb R plasmids. Eight out of 14 (57%) ampicillinresistant (ABPC^r) S. typhimurium strains carried ABPC^r-miniplasmid of 10.4 kb or 7.5 kb in size. The plasmid profiles of S. typhimurium strains were different among isolates derived from several outbreaks, indicating that the plasmid profile can be a useful epidemiological marker for S. typhimurium. All of the 16 S. enteritidis isolates carried 54-kb plasmids which had the same Pst1-restriction pattern as the 54-kb virulence plasmid in S. enteritidis isolated from a cow by Nakamura et al. Futhermore, the 54-kb plasmids were shown to be similar to the 90-kb plasmid of S. typhimurium by restriction analysis of DNAs, suggesting a close relatedeness of these plasmids. Plasmids of 110-kb were detected in 36 isolates of S. braenderup (95%).

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Infective endocarditis (IE) caused by Staphylococcus aureus is one of intractable infections with high mortality even in these days of progressed chemotherapy. The authors recently experienced the case of IE caused by methicillin-resistant Staphylococcus aureus (MRSA) in a 4 year old boy who did not respond well to medical treatment. The patient suffered from IE caused by Streptococcus viridans group 6 month before admission to this hospital, and chemotherapy had been used with success at another hospital. However, vegetation of the mitral valve and mitral insufficiency remained without improvement. Afterwards, the patient made favorable progress, but was admitted to the Ashikaga Red Cross Hospital with the chief complaints of fever and convulsions, on September 16, 1984. At the time of admission, echocardiography revealed vegetation at the anterior leaflet of the mitral valve, and Staphylococcus aureus resistant to oxacillin and gentamicin was isolated from the blood. Although chemotherapy was started immediately using cefazolin, amikacin and fosfomycin mainly, only transient defervescent effect was observed but the causative organism was not eradicated. In addition, brain abscess developed on the 10th day of hospitalization. Afterwards, additional treatment with chloramphenicol etc. was ineffective and the tendency was observed that isolated organisms became resistant to antibiotics used, especially to β-lactam antibiotics. The patient underwent mitral valve replacement on the 23rd hospital day. The postoperative course was satisfactory and the patient experienced much relief while receiving 8 weeks of chemotherapy mainly by minocycline.
The number of the viable organisms in vegetation was 2.7-6.1×10⁶ CFU/g. The strains showed a wide distribution of sensitivity from being sensitive to being highly resistant to methicillin and cephem antibiotics. The resistant strains among them changed to be sensitive after 2-5 subcultures when they were subcultured in a medium without antibiotics. Additionally, the production of PBP-2', one of the penicillin-binding protein (PBP) which is characteristic to MRSA, was induced when the initial strain isolated at the time of admission was cultured at 32°C in the presence of 10 μg/ml of ceftizoxime. Both the coagulase type and the phage type of isolated strains coincided with the type II and 83A (group III), respectively. And those strains also had same plasmid DNA patterns.
From above-mentioned observation, it is assumed that the mechanism of resistance of the isolated strains in this case was induced resistance caused by the induction of PBP-2' in the living body which was ascribed to the cephem antibiotics used.

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Incidence of isolation from clinical material of Enterococcus sp. has been recently increased, and among them Enterococcus faecium is recieved much attention because of its resistance to various antibiotics. Enterococcus faecium septicemia are occasionaly observed in newborns and premature infants, infected during vaginal delivery or as nosocomial infection. However septicemia due to the organism in infants were rarely reported. We report a case of septicemia due to E. faecium in a infant. A 7-month-old boy, without any underlying disease, was referred to our hospital because of continuous high fever and of general marasmus. On admission, he was drowsy and could not eat anything. The skin was dry and poor. turgor. The erythrocyte sedimentation rate was 70mm/hr, the WBC count was 20, 000/cmm, CRP reaction was +6, and level of α₂-globurin was elevated. CSF and urine were normal. Although the patient was treated with ABPC initially, high fever was continued and his general condition was not ameliorated. On the 3rd hospital day, Enterococcus faecium was isolated from blood on admission. The isolate was resistant penicillins and cephems, while sensitive to chloramphenicol alone. Then treatment with CP was started, the temperature returened normal two days later and clinical improvement was noted.

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A case of acute thrombocytopenic purpura due to mycoplasma pneumoniae (M. P.) infection is described. The patient, a 12 year-old girl, was admitted to our hospital because of a sudden onset of epistaxis and purpuric rash. She had been suffering from cough, rhinorrhea and fever of 10 days duration. On admission, there was a evidence of mucocutaneus purpura on the oralmucosa, lips, upper limbs and neck. Also, macrohematuria was detected. No jaundice, anemia nor lymphadenopathy were present. Platelt count on admission was remarkably decreased. Examination of chest X-ray on two occasion was normal. Direct and indirect Coombs test, Ham test, immune complex and platlet associated (P. A.) IgG were all positive. The cold hemoagglutinin test was positive. Elevated M. P. complement fixation titer and indirect hemoagglutinin titer were detected. The ELISA IgM antibody to M. P. was elevated and return to within normal limits 21 days lator. These findings seems to be compatible to the antibody production mechanism in M. P. infection.

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