We measured serum IgG antibody titers for C. trachomatis with enzyme-linked immunosorbent assay (ELISA) in patients of various urological infections, in normal male group, in normal female group, and in prostitutes.
1) Serum IgG class antibody titers to C. trachomatis had a good correlation with micro-IF titers. ELISA was considered a valuable melthod for measurement of serous IgG antibody titers for C. trachomatis.
2) In male patients with gonococcal urethritis (GU) and non-gonococcal urethritis (NGU), positive rate of ELISA absorbance value was 68% and 64% respectively. The value was not shown apparent difference in GU or NGU, and not done in positive or negative of C. trachomatis isolation.
3) Positive rate of ELISA absorvance value was 23% in normal male group. In male persons with frepquent sexual intercourse to prostitutes but without episodes of definite urethritis, the value was apparently higher than that in normal male group. Those in all male children without UTI were negative.
4) In prostitutes, positive rate of ELISA absorbance calue was 90%. and 52% of positive case shoed strong positive.
We considered the infection of C. trachomatis were caused in a wide range, and prostitutes played the most important role of infectous source.

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An epidemiologic study on rats associated with outbreak of hemorrhagic fever with renal syndrome (HFRS) in our college from 1976 to 1978 was performed to measure the antibody titer by using indirect fluorescent antibody (IFA) technique to Hantaan virus 76-118 strain, prototype of HFRS virus, and newly isolated from malignant histiocytoma of antigen positive rat.
1) On relationship between antibody titers of rats and patients; when rats' antibody titers rose markedly, we had HFRS patients within one or two months.
2) Rats' antibody titers of both 76-118 strain and WKM strain rose similarly in the course; they indicated to rise after one or two months when rats were supplied newly, and reached to the peak after 6-8 months, holding them for almost 24 months, and thereafter they were reduced.
3) There were yearly changes in rats' antibody titers of both virus strain; in 1976 antibody titers of 76-118 strain were higher than those of WKM strain, and in 1977 antibody titers of both strains were nearly equal, whereas in 1978 antibody titers of WKM strain were higher than those of 76-118 strain respectively.
4) In their growth in Vero E6 cells, WKM strain propagated more rapidly than 76-118 strain, and infectious virions were released into the culture fluid one after another, and the highest peaks were on the 8th and 13th day post infection respectively.
5) On the staining pattern in IFA test, there were a few differences between Vero E6 cells infected with 76-118 strain and with WKM strain; Vero E6 cells infected with 76-118 strain showed large granular dots in the cytoplasm, but on the other hand Vero E6 cells infected with WKM strain showed mixed pattern of small granular dots in the cytoplasma and cell surface staining. But there was a cross-reaction between 76-118 strain and WKM strain.
These results suggested that antigenic changes had occurred during the repeated infection among the feeding rats according as HFRS virus extended and adapted from apodemus to rat.

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After six years of HFRS outbreak an epidemiologic study was performed to measure the antibody titers by using indirect fluorescent antibody (IFA) technique to both Hantaan virus 76-118 strain (apodemus type) and WKM strain (rat type). And antibody titers of rats recently supplied from breeders to our animal quarter were also measured.
1) The tested rats were newly supplied from breeders after HFRS outbreak from 1982 to 1984, they showed that antibody positive rates of 76-118 strain were 2-9% and their antibody titers were relatively low.
2) We found many HFRS antibody positive members except previous patients with specific symptoms and relatively high antibodies, but no one showed a typical clinical course of HFRS or other related symptoms.
3) Rates of antibody positives of both two virus strains were nearly equal; compared with the rate differences in positive group of both two virus strains advanced to limit to their variable serum dilution of each sera such as 16, 32 or 64 fold, they indicated 11.6% to 76-118 strain and 12.1% to WKM strain at the fixed limit of 16, 5.3% and 6.2% were at the 32 and 2.3% and 2.5% were at the 64 respectively.
4) When we set the limit at the 64 fold dilution of serum, even some of previous typical symptomatic patients were considered to be negative, and one case of them showed antibody positive only to 76-118 strain.
5) In the most of antibody positive population, s antibody titers to WKM strain were generally higher than those to 76-118 strain. When increased the limit to 16, 32 and 64 fold dilution of serum, the rate for WKM strain was dominant against 76-118 strain and they indicated 45%, 55% and 61%respectively.
These results showed well cross-reactivity to both 76-118 strain and WKM strain, but the antibody titers to both strains were clearly different and as we previously reported, yearly changes of serum titers against to both strains in rats associated with outbreak of HFRS were clearly reflected to the antibody titers in our members.

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We reported fourteen cases of Tsutsugamushi disease which occured in Nagasaki prefecture from August 1983 to December 1984.
All cases occurred during the period from August to December and the endemic area was Nisisonogi peninsula and Isahaya district. Patients were suspected to be bitten at orange field, farm or camping site.
All patients were suffered from high fever. Thirteen patients showed skin rash and nine patients showed lymphnode swelling. Laboratory findings regarding to inflammatory reaction such as CRP, ESR and LDH were positive in most cases. Helper T lymphocyts in peripheral blood decreased in all three cases examined.
Eleven cases were diagnosed serologically by indirect immunofluorescence technique, but remaining 3 cases were clinically diagnosed. All cases were treated with doxycycline or minocycline and cured completely.

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The enzyme-linked immunosorbent assay (ELISA) has been applied to the detection of antibodies agaisnt Legionella pneumophila.
Outer menbrane protein, called “crude” antigen, was made from L. pneumophila serogroup 1-6 and “selected” OMP antigen, molecular weight 40, 000-90, 000, was purified using sephacryl S 200.
Immunized rabbit anti-L. pneumophila antisera except anti-serogroup 3 antisera reacted more specific to “selected” antigen than to “crude” OMP.
But antisera from the patient infected with L. pneumophila serogroup 3 showed no crossreaction to other serogroups in the both antigens.

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An enzyme-linked immunosorbent assay was examined for its usefulness in detecting BCG antigens in pleural fluids from patients with and without tuberculosis. Adenosine deaminase (ADA) activity in pleural fluids was also measured. Concentrations of BCG antigens in pleural fluids from 34 patients without tuberculosis and 2 patients with the presumptive diagnosis of tuberculous pleuritis was 6ng/ml or less. On the other band, pleural fluids from 3 patients were positive for Mycobacterium tuberculosis and their concentrations of BCG antigens was 18ng/ml or greater.
ADA activity of pleural fluid was found significantly high (p<0.01) in 5 patients with the presumptive and the definitive diagnosis of tuberculous pleural effusion (84.4±35.4 IU/l) comparing with the 34 with non-tuberculous effusion (19.1±10.6 IU/l). Comparing with the results of detecting BCG antigens, the estimation of ADA activity in pleural fluids proved more sensitive, simple, and rapid for diagnosing tuberculous pleuritis.

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Campylobacter pyloridis strains were isolated from biopsy specimens referred for three loci (antrum, lower body of lesser curvature, and/or upper body of greater curvature) in the stomach, and/or from the gastric juice of 46 out of various specimens of 91 patients withgastric complaints. This organism was found in gastric mucosa of 3 out of 7 cases and gastric juice of 2 outof 20 cases. Out of gastric mucosa and juice of 47 cases, the organism was isolated from gastric mucosa of 28cases and from both specimens of 11 cases. Furthermore, C. pyloridis was positive for gastricmucosa of one case out of gastric mucosa, gastric juice and saliva of 3 cases, and for it out ofgastric mucosa, gastric juice and bile of one case. But no C. pyloridis strain was found in gastric juice and duodenal fluid of2 cases, duodenal and jejunal fluid of one case, bile of one case, jejunal fluid of3cases, intestinal mucosa of 4 cases, gingival mucosa of one case and saliva of one case. Positive rates of C. pyloridis from gastric mucosa and gastric juice were 44/58 cases (108/153 biopsy specimens) and 13/73 cases, respectively. It is noteworthy that the organism could be very frequently cultivated from the gastric juice whosepH was 2 or 3. Susceptibility of the isolates of C. pyloridis from46 positive cases against 18 antibiotics was studied. All isolates were sensitiveagainst Penicillins, Cephalosporins, Aminoglycosides, Tetracycline and Chloramphenicol and resistant against Nalidixic acid, Colistin and Bacitracin. But the strains were clearly divided into two groups, the sensitive (44 strains) and the resistant (2 strains) to Macrolides.

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A study was performed to evaluate the leukocyte esterase test and the test for urinary nitrite as screening tests for bacteriuria. A total of 518 clinical urine specimens were tested with both tests and compared with a semiquantitative plate culture method. The leukocyte esterase-nitrite combination had a sensitivity of 91.3%, a specificity of 67.4% and a negative predictive value of a negative test of 95.6% for specimens with one or two potential pathogens with colony counts of more than 105 CFU/ml.Th e performance of leukocyte esterase test in tandem with the nitrite test resulted in a screening test combination that was significantly better than either test alone.

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Clinical studies of norfloxacin (NFLX) on biliary tract infections were performed and obtained the following results.
1) The concentrations of NFLX in the serum, gallbladder tissue and bile were measured in 14 patients who received consecutively NFLX for 3 to 6 days at a dose of 200mg, three times daily and compared with those after a single administration of 100 or 200mg. The serum level was 0.61±0.09 μg/ml after 4 hours of consecutive administration, as compared to 0.80, μg/ml after a single administration. The tissue concentration of NFLX in the gallbladder was 1.24±0.24μg/g in Ine average and 1.72±0.54, μg/g after 5 to 6 days. The concentrations of NFLX in the gallbladder bile was 15.8±7.6μg/ml (max. 32.2μg/ml) after 4 days, and 11.6±3.3, μg/ml in the average.
2) The biliary concentration of NFLX in the bile duct was measured in 9 patients received single administration of NFLX at 200mg. In 8 of 9 cases, the biliary excretion of NFLX was improved by concomitant administration ursodeoxycholic acid (UDCA) at 300 mg; Increase of the maximum biliary concentrations for example, 2.6→9.1, 6.7→15.1, 10.8→48.4μg/ml.
3) 20 patients with biliary tract infections consisting 16 with cholecystitis and 4 with cholangitis were treated for 3 to 7 days with NFLX at 200 mg, three times daily, and the clinical effects were evaluated based on ultrasonic observations, clinical and bacteriological improvement. NFLX showed excellent results with an effective rate 87.5% in evaluated 16 cases.
In conclusions, NFLX was demonstrated good biliary excretion and high concentrations in the gallbladder tissue, which are higher than the expected MIC for almost all pathogenic bacteria. The results suggest that NFLX is a useful drug for biliary tract infections.

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We presented two cases of primary pulmonary cryptococcosis in this report.
First case was a 63-year old woman complaining productive cough and right shoulder pain. Her chest roentgenogram showed multiple nodules in the right upper lobe, and one of them demonstrated a central cavity. The bronchoscopic biopsy specimen revelaed granulomatous lesion caused by C. neoformans.
Second case was a 73-year old woman complaining right shoulder pain. Her chest roentgenogram showed a solitary nodule 6×11 mm in diameter with a strand-like margin in the right middle lobe. In this case, the transbronchial biopsy did not give any histological diagnosis, but the nodule increased in size. Then lung cancer was suspected and lobectomy was carried out. The histological examination revelaed pulmonary cryptococcosis.

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A 61 years old man was admitted to our hospital complaining of fever, diarrhea and convulsion. Culture of blood, cerebrospinal fluid and stool revealed type 4b Listeria monocytogenes. Despite agressive chemotherapy by minocycline, piperacillin and cefotaxime, he died on the 12th day after admission.
At autopsy, arachinoid was turbid, thickened and adhered to brain. Microscopically, inflammatory cell infiltration was recognized there.
The minimal inhibiry concentration (μg/ml) of antibiotics against the isolated L. monocytegenes was as follows, ampicillin 0.39, piperacillin 1.56, cefazolin 1.56, cefmenoxime 12.5, erythromycin 0.2, minocycline<0.05, rifampicin<0.05.

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This is the first reported case of septicemia due to Capnocytophaga sputigena in Japan, which is the second in the world to our knowledge.
A 15-year-old cyanotic boy with truncus arteriosus was hospitalized for nephrotic syndrome. Edema and proteinuria disappeared after two weeks' treatment with 60 mg/day prednisolone. Four weeks later, while he was on 40 mg/day prednisolone, he developed suddenly fever, anisocoria and paralysis of left leg. A lumbar tapand brain CT scan revelaed no abnormal findings. These symptoms were gradually improved. Nine weeks after admission, he again developed fever and left hemiparalysis, with a WBC count of 13, 000/mm³ with 86% neutrophils. Fosfomycin and latamoxef were given, but neither of them was apparently effective, and he died four days later.
After a week of his death, Capnocytophaga sputigena was isolated from the blood obtained two days prior to his death. The isolate was sensitive to penicillin G, ampicillin, clindamycin and minocycline, but resistant to fosfomycin and gentamicin.
Among 43 cases of Capnocytophaga septicemia reported in the literature, there is only one report of septicemia due to capnocytophaga sputigena. Nine of 43 strains were C. ochracea, and the remains were unspecified. The patients with Capnocytophaga septicemia were apt to have underlying diseases such as leukemia, malignant lymphoma or other malignancies, and were generally leukopenic.
Members of the genus Capnocytophaga are not only associated with juvenile periodontitis, but also important as a pathogene in immunocompromized hosts having poor oralhygiene.

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