To evaluate the efficacy of large dose of orally administered Amphotericin-B to prevent the fungal infection, clinical studies were performed to nine patients with hematological malignancies.
Serum level of Amphotericin-B ranged from 0.1μg/ml to 0.2g/mi in 7 patients and from 0.5 to 1.0 in two.
Decrease of fungus unmber detected with Sabouraud's medium was observed in 5 patients. No fungus infection developed in the patients during the study and no side effects were observed.
It will be necessary to perform such a study using more cases with larger amount of Amphotericin-B to confirm the preventive effect of the drug by oral administration.

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In vitro antibacterial activity of new derivatives of pyridonecarboxylic acid, norfloxacin (NFLX), ofloxacin (OFLX), enoxacin (ENX) and ciprofloxacin (CPFX), against Vibrio cholerae O-1 was investigated. A total of 253 V. cholerae O-1 strains of different geographical origin, including 177 sensitive strains and 76 resistant strains to CP, TC, SM, KM, AP or ST, were submitted to the test for their minimum inhibitory concentrations (MICs) by standard agar dilution method.
Growth of all the strains tested was inhibited by NFLX, OFLX, ENX and CPFX at the concentration of 0.2μg/ml or below. The MICs of these antibiotic agents were considerably lower than those of nalidixic acid, chloramphenicol, tetracycline, streptomycin, kanamycin, ampicillin and trimethoprimsulfamethoxazole, and distributed between 0.1 and ≤0.013μg/ml for NFLX and OFLX, 0.2 and 0.025μg/ml for ENX, and 0.025 and ≤0.013μg/ml for CPFX, regardless of serotype, source, year of isolation, or sensitivity to the other antibacterial drugs than these pyridonecarboxylic acid derivatives of test strains.

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We clinically examined 48 cases with tsutsugamushi disease occurred in Miyazaki district during 1984.
In clinical sign, eschar was detected in all cases. Systemic lymphadenopathy and hepatomegaly were observed in the cases after 7 days from onset. Laboratory examination revealed leukopenia and minimal or moderate liver dysfunction. Of the serotypes of infected Rickettsia tsutsugamushi which were defined in 31 cases by antibody analysis, 26 were Irie and 5 were Hirano type. There was no difference in clinical feature between two groups of patients. Comparing our cases with the cases in Miyazaki during 1957-1964 and the cases reported from other district in Japan, we concluded that there was significantly no difference in clinical findings except bleeding tendency among them.

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Thirteen patients with infective endocarditis were admitted to Pediatric ward, Kagoshima University Hospital, from January, 1970 to June, 1985. In order to investigate the predisposing factors of these patients, clinical studies were carried out.
All patients had underlying diseases. Twelve patients had heart diseases such as congenital heart diseases, and one had hydrocephalus followed by ventriculoatrial shunt.
Predisopsing factors were found in three patients (four episodes), and in other two cases, respiratory tract infection seemed to be the factor. On the other hand, diarrhea followed remittent fever in two patients, and causative organisms of these two patients were E. feacalis and Serratia species respectively.
Relationships between septicemia and diarrhea or intestinal flora in compromised host had been reported in recent years, and it seems necessary to pay attention to diarrhea as a predisposing factor of infective endocarditis.

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The sites of Streptococcus pneumoniae and Haemophilus influenzae infection differ in patients with respiratory infection. We investigated the in vivo mechanism of respiratory infection due to these organisms in mice, using an intranasal infection model.
Growth factors such as hemin and NAD in the tracheal tissues and a growth inhibitor in the lung tissues were clearly involved in the development of H. influenzae infection. Chronic bronchial infection was caused by imparied mechanical clearance as well as by changes in the quantitative and qualitative function of neutrophilis. In S. pneumoniae infection, the decrease in the functional level of neutrophils was one of the factors in causing respiratory infection.

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Relationship between pathogenecity in systemic mouse infection and hemolytic activity, protease activity, superoxide dismutase activity and catalase activity of E. faecalis isolated from urinary tract infection and septicemia was studied.
In these activities, hemolytic activity was related to the virulence, β-hemolytic E. faecalis killed the mice at relative small challenge dose comparing with non-hemolytic E. faecalis. Virulence of mutant strain deleting the hemolytic activity was more weak than that of parent hemolytic strain. The results indicate that β-hemolytic activity of E. faecalis is undoubtedly an important determinant for its virulence. The difference of the infectibility of non-hemolytic E. faecalis between normal mice and leukopenic mice was larger than that of β-hemolytic strain. Culture filtrate of β-hemolytic strain inhibited the bactericidal effect of mouse PMN, and the number of neutrophil in blood was decreased by mixed incubation of the filtrate.
As these results, the high virulence of hemolytic E. faecalis in normal mice was due to a substance in the culture filtrate inhibiting the bactericidal activity of mouse neutrophil.

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It is difficult to make newly a laminar air flow room or to reconstruct a room for bone marrow transplantation. We placed a bed isolator in a room of pediatric ward and carried out bone marrow transplantation in 3 patients with acute leukemia. Intestinal and oropharyngeal decontamination was done using 3 drugs of vancomcin, tobramycin, amphotericin B, and strict bed isolator protection was carried out.
Gut was decontaminated for aerobic as well as anaerobic bacteria, whereas candida albicans were difficult to eliminate in 1 case.
In two patients, who had a difficulty to take oral medication and to carried out oropharyngeal nebulizer, suppression of oral microbial flora were not sufficient.
During bed isolator protection, there were no febrile episode in 2 cases. In one patient, stomatitis and febrile episodes likely caused by oropharyngeal bacteria occurred, and these were well managed by using single antibiotics.
It was suggested that bed isolator protection had a protective efficacy to prevent bacterial and fungal infection in bone marrow transplantation.

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For an objective evaluation of the clinical efficacy and safety of carumonam (CRMN) in chronic respiratory infections due to gram-negative rod bacteria, a double-blind study was conducted using cefoperazone (CPZ) as a positive control. Either 1 g of CRMN or CPZ per dose was administered by the intravenous drip infusion twice a day and, as a rule, for 14 consecutive days. The results were as follows:
1) Homogeneity testing of background factors showed that P. aeruginosa as the causative organism was more frequently detected in the CRMN group with a significant difference (p<0.05) but no bias was found in any other background factor.
2) The clinical efficacy rate (excellent and good ratings combined) was: in the committee evaluation, 51.6%(32/62) for CRMA versus 58.2%(39/67) for CPZ, and in the presiding doctor evaluation, 65.1%(41/63) for CRMN versus 66.7%(44/66) for CPZ. Thus, both evaluations generated similar results.
As P. aeruginosa was detected more frequently in the CRMN group, the bias was corrected by the direct standardization method. The corrected efficacy rate was: in the committee evaluation, 55.0% for CRMN versus 54.2% for CPZ and in the presiding doctor evaluation, 66.9% for CRMN versus 62.8% for CPZ.
3) There was no intergroup difference in improvement rates for symptoms and laboratory findings. However, when the population for analysis was limited to cases with P. aeruginosa as a causative organism, the improvement rate for sputum property in the CRMN group was significantly higher than in the CPZ group (p<0.05).
4) As to bacteriological effect, the eradication rate was 56.5%(35/62) for CRMN versus 53.8%(35/65) for CPZ. In regard to P. aeruginosa which was most frequently isolated, the eradication rate was 51.4%(18/35) for CRMN versus 31.8%(7/22) for CPZ, thus being in favor of CRMN. A more remarkable difference was found when “decreased” ratings were included; thus 71.4% for CRMN versus 45.5% for CPZ (p<0.1).
5) The safety evaluation showed that the two drugs were almost equivalent in regard to the incidence of side effects and abnormal laboratory findings; 23.5%(23/98) for CRMN versus 24.4%(22/90) for CPZ.
With both drugs, allergic symptoms such as fever and eruption and gastrointestinal symptoms such as diarrhea were found as accompanying symptoms. Most of the abnormal laboratory findings were changes in liver function and hematology parameters for both drugs. No side effects were found with CRMN that are particularly different from those reported with the cephem drugs.
6) The clinical usefulness rate covering “useful” and higher ratings was: in the committee evaluation, 48.4%(31/64) for CRMN versus 54.5%(36/66) for CPZ and in the doctor evaluation, 61.9%(39/63) for CRMN versus 62.5%(40/64) for CPZ. Thus, the two drugs generated similar usefulness rates. However, the clinical usefulness rate after correction of the bias in the frequency of P. aeruginosa according to the same procedure as 2) was: in the committee evaluation, 51.9% for CRMN versus 51.0% for CPZ and in the presiding doctor evaluation, 64.2% for CRMN versus 58.7% for CPZ.
In efficacy and safety, CRMN was found to be equivalent to CPZ. In consideration of the fact that P. aeruginosa is frequently isolated in chronic respiratory infections, it is concluded that CRMN is an extremely useful drug in the treatment of these infections.

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Chronic mucocutaneous candidiasis (CMCC) is an uncommon disease mainly associated with incurable superficial candidiasis since childhood and partial incompetence of cellular immunity is assumed to be the cause.
We now report one rare case treated for repeated respiratory infections due to CMCC.
A woman aged 34 years has suffered from candidiasis on nails of feet and hands since childhood. She was very susceptible to colds from her childhood and contacted pneumonia at age of ten.
On July 1980, she has suffered from left pulmonary suppuration and liver abscess and received cefalothin for relief. On December 1984, she was affected with similar pulmonary disease again, being diagnosed sepsis and meningitis. She was then treated with a large amount of PIPC, hydrocortisone and y-globurin to give relief and now is out-patient to follow up.
CMCC is immunologically characterized by lack of a delayed skin reaction and a decrease of lymphoblastic reaction for a candial antigen. These two findings were also found in this case.
Prognosis after CMCC is generally said to be good. However patients with repeated respiratory infections such as in this case do not convalescence satisfactorily and careful follow-up examinations are necessary.

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A 36 year-old man who had been followed up at out-patient clinic was admitted for an chemotherapy of the disease. After hospitarization, many anti-cancer agent were admininistrated. But lymphoblast in peripheral blood was gradually increased. Then finally high dose Ara-c was given so that agranulocytosis developed. As the result high fever and pulmonary consolidation also developed. Finally he died because of respiratory failure. Trichosporon cutaneum was isolated from venous blood when he was still alive and from lung after death. A microscopic examination of lung, liver and spleen showed multiple tissue invasion of T. cutaneum mycelium. Therefore systemic Trichosporosis was diagnosised. Serum antibody to T. cutaneum was not detected even by indirect fluoscent antibody method.

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We reported a case of meningoencephalitis due to group F Streptococcus anginosus. The patient was a 15-year-old boy. He had had fever, headache and vomiting since Jan. 10. In Jan. 15, he admitted to our hospital because of dysarthria and consciousness disturbance. On physical examination, cerebellar ataxia and right facial nerve palsy were then noticed. From clinical manifestations and results of CSF examination, meningoencephalitis was suspected. ABPC (8g/day) and CTX (6g/day) were used to him in combination with glycerol and γ-globulin. Microaerophilic streptococcus was isolated from a blood sample at admission. MIC of ABPC and CTX for the potent pathogen was both 0.1μg/ml. Despite of intensive therapy, he died in Jan. 25. At autopsy, subarachinoidal abscess was present on left parietal portion. Microaerophilic streptococcus was isolated from the abscess as well as the blood sample at admission. Microscopic findings and further bacteriological examination revealed that he was a case of meningoencephalitis due to group F Streptococcus anginousus.

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