The survey of bacterial meningitis in infancy and childhood from January, 1979 to June, 1984, was made by sending questionnaire to 107 pediatric institutions in major hospitals throughout Japan.
1280 in-patients of bacterial meningitis were analyzed on prognosis. Prognosis of bacterial meningitis had been improved during these six years and case fatality rate decreased from the highest level of 15.1% to 8.2%, 12.4% in average.
Same trend was observed in respect to causal agents, either it is caused by gram positive and gram negative bacteria.
As to the prognosis by age, mortality of infants within three days old showed the highest level of 26.4%, and then decreased with growth of infants.
The prognosis was significantly worse for those younger than three days old when compared with those older than them.
No significant difference was observed between male and female in any aspects except incidense.
As to the mortality by causal organisms, that for Gram positive cocci was 18.0% and that for Gram negative rods was 10.9% showing significant difference because major part of the latter was H. influenzae having fairly good prognosis, however, when observed as Enterobacteriaceae in stead of Gram negative rods, then mortality rate rose up to 18.5%.
Concerning major bacterial species on which more than 100 cases were collected, the prognosis was proved to be worst for GBS showing mortality of 20.0%, followed in descending order by E. coli (15.0%), S. pneumoniae (13.0%) and H. influenzae (6.4%).
For those of less than 100 cases the highest was P. mirabilis (56.7%) then follwed M. tuberculosis (30.0%), Klebsiella sp. (30.0%), L. monocytogenes (29.8%) and Pseudomonas sp. (18.8%).
No death was observed in 21 cases due to N. meningtidis.
The mortality for ten cases of polymicrobiotic meningitis was 30% and 7 of them were neonates and infants with two cases of death.
As to cases from whom no causal agent was detected, mortality was as low as 6.5% showing significnat difference with those of distinct causal agents.
It was presumed that common trend of premedication of antibiotic by general practitioners in this country might be a reason that very sensitive pathogens disappear or become hardly isolate after admission to the hospital.

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An interaction between virus and bacteria as the most likely cause of an acute exacerbation of chronic respiratory disorders was the subject of this study. It incroporates an analytical procedure as abstracted in the following text.
1. Antibody titer of Rhinovirus 14 in 14 cases of common cold syndrome accompanying nasal discharge as major complaint was determined through ELISA-method. The result was that a significantly elevated antibody titer was identified in 8 cases; of these an acute exacerbation was observable in 6 cases; TTA disclosed invariably S. pneumoniae, H. influenzae, and the like in these 6 cases.
2. Antibody titer of Influenza in 5 cases of common cold syndrome accompanying fervescence as major complaint was determined CF-method. The result was that a significantlty elevated antibody titer was identified in all 5 cases; these 5 cases invariably showed an acute exacerbation; TTA disclosed B. catarrhalis, S. pneumoniae, and the like in 3 cases, except for remnant 2 cases, where no bacteria responsible for the exacerbation has been specifically identified.
With the above findings involving concomitant identification of both kinds of infections it has been convinctingly shown that secondary infection induced by bacteria in lower air way would be closely related with virus infection that occured in upper air way.

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Thirty five hemophiliacs treated with imported blood products were tested for HIV antibody by ELISA technique. Eighteen cases were antibody-positive (53%) and other two cases were in cut-off values. These 18 positive sera were confirmed by immunofluorecence and immunoblot testing. HIV was isolated in two cases of ARC by co-cultivating peripheral blood lymphocytes and HIV-sensitive cell lines such as H9 and MORT-4. After a few week of cultivation, cells were examined for an expression of HIV antigen. Virus particles were recognized by an electron microscopic technique.
Clinical symptoms and laboratory data were discussed. One hemophiliac with AIDS died of Pneumocystis carinii pneumonia. Other three cases with oral candidiasis were in a stage of AIDS-related complex.

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The source of neonatal infection was studied by investgating the bacterial flora of the vagina, perianal region, and urethral meatus in 394 pregnant women and also by cultivating the gastric aspirates of 124 neonates immediately after delivery.
Bacterial study of the vagina was positive in 75.6% of pregnant women, and in 66.2% of parturient women with normal repture of membrances. Bacterial cultivation of the gastric aspirate in neonates, immediately after delivary, was positive in 73.5%. Repeated bacterial study of the vaginal flora in the same subjects revealed a wide variation of the result. For example, group B Streptococcus was always observed in some cases, while in others it was only sporadically found. Similar results were observed in the study of detecting Bacteroids in the vatina and F. meningosepticum in the perianal region and in the urethral meatus. Simultaneous bacterial studies of the vagina, perianal region, and urethral meatus in the same subjects frequently revealed positive findings in the perianal region and urethral meatus, but with negative study in the vagina.
The bacterial isolated from the gastric aspirates of neonates with normal rupture of membranes showed a distribution of bacterial incidences, which was most similar to that of perianal flora in pregnant women.
Therefore, it seems to be mandatory to screen not only the vagina but also the perianal and urethral regions for prophylactic bacterial study against neonatal infection.
Also, more than one bacterial study should be repeated, because only one study might not reflect the bacterial flora sufficiently.

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Serologic diagnosis in pneumonia or pelvic inflammatory diseases by C. trachomatis was confirmed by demonstration of rising titer of specific serum IgM antibodies. The possiblity that the specific serum IgA antibodies might be a marker of active chlamydial infection had recently been suggested by Sarov. We discussed the usefulness of the serum specific IgA antibodies as a marker of active chlamydial infections.
In monkeys inoculated with L2 strain of C. trachomatis, it was recognized that the specific serum IgA antibodies rised in primary infection and reinfection but the IgM antibodies did not appeared in secondary infection.
Sera obtained from 17 men with C. trachomatis isolation-positive non-gonococcal urethritis (NGU) and 19 men with C. trachomatis isolation-negative NGU were studied for the presence of C. trachomatis specific IgG and IgA antibodies. The IgA positive-coincidence ratio was 94.1%(16/17) in isolation-positive NGU patients and the IgA negative-coincidence ratio was 78.9%(15/19) in the isolation-negative NGU patients.
The specific srum IgA antibodies had been detected in three of four C. trachomatis antigen detected pneumonia infants and these four mothers had high level specific serum IgA and IgG antibodies.
It is suggested from our studies that specific serum IgA antibodies may be used as a marker of active C. trachomatis infection.

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The newly introduced Terumo Lysis-Filtration method (L-F method) as a blood culture system was applied to 227 patients at the Department of Internal medicine. The usefulness of the method was evaluated as follows:
1) Thirty-nine (17.2%) of 227 cases were found positive by the test for the bacterial presence. Positive results were obtained in 28 cases (12.3%) with the culture bottle method (Rosch) and 34 cases (15.0%) with the L-F method. Thus, slightly better detection rates were obtained with the L-F method.
2) Bacterial growth was quicker after one or two days in incubation with L-F method than with the culture bottle method.
3) Forty-four strains from the 39 patients were isolated. E. coli, K. pneumoniae, P. aeruginosa and Bacteroides were isolated a little, more frequently by the culture bottle method and S. pneumoniae, A. calcoaceticus var. anitratus, Flavobacterium spp. and Candida spp. were isolated a little more frequently by the L-F method.
4) Bacterial counts per 1 ml blood in positive case by the L-F method, in cases of less than 10 counts per 1 ml blood, positive cases by the culture bottle method were decreased to half.
5) In cases under a drug therapy, the L-F method revealed a higher detection rate than that of the culture bottle method. However, no difference was noted in cases without any drug treatment.

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Macrophage activating factor (MAF) production-inducing effects of toxic-shock-syndrome toxin-1 (TSST-1) on mice spleen cells were investigated. TSST-1, an exotoxin produced by Staphylococcus aureus recovered from patients with toxic-shock-syndrome (TSS), is thought to be a causative agent of the syndrome. MAF with a molecular weight of about 20 K daltons was obtained by stimulating mice spleen cells with TSST-1. For substantial amounts of MAF to be produced, 10 or 100 ng of TSST-1 per ml and 48 hr or more of incubation were required. Removal of T cells abrogated MAF production by spleen cells. Spleen T cells produced MAF on TSST-1 stimulation in the presence of spleen macrophages, indicating that MAF production by TSST-i stimulated T cells is dependent on the presence of macrophages.

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A well-controlled comparative study was undertaken to assess the clinical efficacy and safety of BRL28500 (BRL), a formulation comprising one part of clavulanic acid and 15 parts of ticarcillin, using piperacillin (PIPC) as a reference drug in patients with respiratory tract infections (RTI).
Patients with apparent clinical signs and symptoms of chronic RTI (chronic bronchitis, diffuse panbronchiolitis, infected bronchiectasis, infected pulmonary emphysema, infected pulmonary fibrosis and infected bronchial asthma), acute exacerbation of chronic RTI, bacterial pneumonia and lung abscess were administered 1.6 g of BRL (1.5 g of ticarcillin plus 0.1 g of clavulanic acid) or 2.0 g of PIPC twice daily by intravenous drip infusion for 14 days in principle.
BRL-treated group and PIPC-treated group were compared in terms of clinical efficacy, improvement of clinical symptoms and signs, bacteriological response, incidence of side effects, abnormal changes in laboratory findings and utility. The following results were obtained:
1. BRL and TIPC were administered to a total of 314 patients (BRL to 161 and PIPC to 153). Clinical efficacy was judged in 269 patients (138 on BRL and 131 on PIPC) excluding 45 patients from total patients by the committee.
Incidence of side effects was evaluated in 293 patients (148 on BRL and 145 on PIPC) and abnormal changes in laboratory findings were asessed in 286 patients (141 on BRL and 145 on PIPC).
2. Clinical efficacy rate for the BRL group and PIPC group was 78.8% and 79.4% in total cases, 82.1% (79 patients) and 79.5% (73 patients) in pneumonia and lung abscess and 74.6% (59 patients) and 79.3% (58 patients) in chronic RTI respectively. There was no statistically significant difference between the two groups.
3. As to improvement of clinical symptoms and signs, improvement of ESR in the BRL group was better than that in the PIPC group on 14th day after administration in patients with pneumonia or lung abscess. On the contrary, improvement of rale, WBC and CRP in the BRL group was inferior to those in the PIPC group on 3rd day after administration in patients with chronic RTI. Significant differences were shown in these items between both groups.
4. Bacteriological response was evaluated in 125 patients (68 on BRL and 57 on PIPC) and eradication of causative organisms was 75.0% for the BRL group and 71.9% for the PIPC group, giving no statistical difference between both groups. However, there was a significant difference in preference for BRL to PIPC in terms of eradication of Klebsiella spp. (87.5% for BRL and 16.7% for PIPC).
When causative organisms were classified into two groups according to susceptibility to PIPC, eradication effect of PIPC (94.7%) was superior (p<0.10) to that of BRL (69.6%) in PIPC-sensitive organisms having 50μg/ml of MIC. On the other hand, in PICP-resistant organisms having 50μg/ml of MIC BRL exerted better eradication effect (66.7%) than PIPC (12.5%) and a significant difference was shown between the two groups.
5. In 293 patients assessed incidence of side effects, five patients treated with BRL and eleven patients treated with PIPC complained of side effects and there was no significant difference between both groups.
6. Abnormal changes in laboratory findings were evaluated in 286 patients. Numbers of patients with the abnormal changes were 45 (31.9%) out of 141 patients treated with BRL and 28 (19.3%) out of 145 patients treated with PIPC respectively and the difference was significant (p<0.05) between both groups. Itemized analysis showed that abnormal changes in GPT were found in 26 (18.6%) out to 140 patients treated with BRL and 14 (10.0%) out of 140 patients treated with PIPC and indicated that elevation of BUN were shown only in the PIPC group (4/127, 3.1%), giving tendency of significant difference (p<0.10) on the above items between the two groups.

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A well-controlled comparative study was undertaken to assess the clinical efficacy and safety of BRL28500 (BRL), a formulation comprising one part of clavulanic acid (CVA) and 15 parts of ticarcillin (TIPC), using TIPC as a reference drug in patients with respiratory tract infections (RTI).
Patients with apparent clinical signs and symptoms of chronic RTI (chronic bronchitis, diffuse panbronchiolitis, infected bronchiectasis, infected pulmonary emphysema, infected pulmonary fibrosis and infected bronchial asthma), acute exacerbation of chronic RTI, bacterial pneumonia and lung abscess were administered 1.6g of BRL (1.5g of TIPC plus 0.1g of CVA) or 1.5g of TIPC twice daily by intravenous drip infusion for 14 days in principle.
BRL-treated group and TIPC-treated group were compared in terms of clinical efficacy, improvement of clinical symptoms and signs, bacteriological response, incidence of side effects, abnormal changes in laboratory findings and utility. The following results were obtained:
1. BRL and TIPC were administered to a total of 312 patients (BRL to 161 and TIPC to 151). Clinical efficacy was judged in 272 patients (138 on BRL and 134 on TIPC) excluding 40 patients from total patients by the committee. Incidence of side effects was evaluated in 289 patients (148 on BRL and 141 on TIPC) and abnormal changes in laboratory findings were assessed in 278 patients (141 on BRL and 137 on TIPC).
2. The respective clinical efficacy rate for the BRL and the TIPC group was 78.8%, 75.0% in total patients and 74.6%, 79.1% in chronic RTI. No significant difference was observed between both treatment groups. However, the statistical analysis of patients with pneumonia or lung abscess showed that efficacy rate was 82.1% for the BRL group and 70.8% for the TIPC group respectively. BRL tended to be more effective than TIPC (p<0.10).
3. As to clinical improvement of clinical symptoms and signs, improvement of ESR in the BRL group was better (p<0.10) than that in the TIPC group on 14th day after administration in patients with pneumonia or lung abscess. On the contrary, improvement of WBC and ESR in the BRL group was inferior (p<0.10) to those in the TIPC group on 3rd and 14th day after administration respectively in patients with chronic RTI.
4. Bacteriological response was evaluated in 136 patients (68 each on BRL and TIPC) and eradication of causative organisms was 75.0% for the BRL group and 67.6% for the TIPC group, giving no statistical difference between both groups. However, there was a significant difference (p<0.05) in preference for BRL to TIPC in terms of eradication of H. influenzae (100% in BRL and 88.9% in TIPC) and all strains of Gram-negative bacilli (78.6% in BRL and 60.0% in TIPC).
5. In 289 patients assessed incidence of side effects, five patients treated with BRL and seven patients treated with TIPC complained of side effects and there was no significant difference between both groups.
6. Abnormal changes in laboratory findings were evaluated in 278 patients. Numbers of patients with the abnormal changes were 45 (31.9%) out of 141 patients treated with BRL and 32 (23.4%) out of 137 patients treated with TIPC respectively and the statistical difference was not significant between both groups.
7. As to clinical utility judged by the committee taking into account of clinical efficacy and safety, the useful rate including “very useful” plus “useful” was 76.3% for the BRL group, 72.4% for the TIPC group in overall patients, 70.0% for the BRL group and 77.6 for the TIPC group in patients with chronic RTI, giving no siginificant difference between both groups. However, in patients with pneumonia or lung abscess the utility rate was 81.0% in the BRL group and 67.2% in the TIPC group respectively. BRL was more useful (p<0.10) than TIPC in these diseases.

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