This is the first case with Legionella micdadei isolated from a patient of fatal pneumonia in Japan. The patient was 61 years old male, and had myeloma as the underlying disease. He admitted a clinic for high fever and headache on September 11, 1986. After 8 days, he admitted Kobe Central Municipal Hospital as an emergency case for respiratory distress, cyanosis and hypoxemia. Chest X-ray showed homogenous shadow in all the lung fields without right middle and lower lobe. Despite of treatment with latamoxef, dibekacin and erythromycin, he died with DIC and pulmonary bleeding on Sept. 25. Legionella colonies were observed in pure culture on BCYEα agar plate from both lungs taken out during the autopsy. Fatty acid profile, biochemical and serological characteristics of the organism isolated was all identical with L. micdadei.

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Epidemiological study for ATL was performed in Ehime Prefecture, Japan. In Nanyo district, Southwest Ehime Prefecture, 42 patients of ATL were identified during 1981 to 1985, showing an average incidence of 4.6 (the highest incidence: 16.8) per 100 thousand inhabitants. Although no seasonal periodicity of occurrence was observed, because 4-5 simultaneous occurrences were observed in the same month or same place, the occurrence of ATL showed space and time clustering. The age of onset was distributed between 32 to 84 years with the average 58.4. Themale-female ratio was 2.0. By applying Sartweel log-normal model for distribution of incubation period, it was presumed that exposure to HTLV-I occurred intrautero or very early in life and the incubationperiod was about 50 years.
Serological survey for anti-ATLA antibody was performed by the gelatin particle agglutination method. The rate of anti-ATLA antibody positive sera in Nanyo, Chuyo, Touyo were 7.4%, 2.4%, 1.6% respectively, among healthy inhabitants aged over 40. It was considered that Nanyo was an endemic area. As the population over the age of 40 in this district was 181, 502, the annualincidence of ATL was one per 1, 600 seropositive population inhabitants.

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Microscopic examination of gram-stainedsmear and antigen detection by coagglutination (COA) using sputum specimens obtained from patients with respiratory infection were carried out as a rapid diagnosis of pneumococcal infection. Of the 180 gram smear positive specimens, 84 were positive for COA.
When microscopically purulent sputum containing more than 25 leukocytes per low power field and less than 25 epithelial cells per low power field were cultured quantitatively, S. pneumoniae were recovered at a frequency of 88.1% from COA positive specimens in numbers of 105 cfu/ml or more.
In contrast the frequency was only 48% using the specimens heavily contaminated with oropharyngeal flora. Most COA positive reactions observed with such specimens seemed to be falsepositive due to contaminated a-hemolytic streptococcus other than S. pneumoniae.
Moreover, in purulent sputum, 65 out of 89 culture positive specimens (73%) were predictable by microscopic examination of sputum smears, while the predictability was 48.3% in contaminated samples.
These results clearly showed that Gram-smear and COA are reliable techniques for true purulent sputum in establishing a presumptive diagnosis of pneumococcal infection.

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A total of 308 raw meat samples from buchers in Tokyo were examined for the contamination of thermophilic campylobacters by CEM enrichement culture. Campylobacter jejuni was isolated from 123 (39.3%) meat samples and Campylobacter coli was also isolated from 19 (6.2%) of them. The contaminated rate of Campylobactrs among chicken meat were 77.7%, pork were 1.4% and beef were 5.1%. The viable cell number of C. jejunii raw chicken meat ranged under 10 to 10³ CFU per 100g.
The swabs of chopping board, kitchen knife and othe utensils of butchers were examined and 33 (5.0%) of 666 swabs of them were positive for Campylobacters. The chopping board, kitchen table, vessel kitchen knife, dusters, washing water at the different stage of slaughtering were examined at three poultry processing plants. Campylobacters were isolated from 52.8% of 36 samples of A, 76% of 25 samples of B and 45.5% of 22 samples of C poultry processing plant.
By our serotyping schem, 225 out of 320 C. jejuni isolates from meat could be typed. The common serogroups among those which were also isolated most frequently from human diarrheal cases were TCK 4, 7, 20, 24 and 26.

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Trehalose trimycolate derived from Gordona aurantiaca (Ga-GM) was examined on protection effect against Yersinia enterocolitica infection of mouse. Intravenous administration of Ga-GM with w/o/w emulsion 6 days before infection protected BALB/c mice against infection with Y. enterocolitica mouse than a LD₅₀. The protection of BALB/c mouse was observed only when Ga-GM was administered 6 days before infection, but not when administered 2 days before or simultaneously.

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The latex agglutination method (LA: Culturette Brand Ten-Minute Group A Strep ID, Marion Scientific) and enzyme immunoassay (EIA: Strep A Testpack, Abbott Laboratories), rapid diagnosis methods for detecting group A streptococci directly from throat swabs, were compared with the traditional culture technique. Samples were taken from the throats of 100 children with pharyngitis. Three swabs were obtained from each patient with Culturette at the same time and each was applied to culture, LA and EIA. Twenty-three of the cases were Group A streptococcus positive by bacterial culture. Seventeen cases were positive in both LA and EIA. Of the 23 culture positive cases, 7 were negative in EIA, and 9 were negative in LA. The test had an agreement of 88%, a sensitivity of 61% and a specificity of 96% with the results obtained by culture method. EIA showed an agreement of 92%, a sensitivity of 70% and a specificity of 99% respectively. Fourteen cases showed conflicting results between the three methods. The number of colonies was less than 30 in 4 cases. Drug had been administrated before the collection of samples in 5 cases. Inappropriate sample preservation was considered in 2 cases. In the remaining 5 cases we couldn't find the reason for the conflicting results. Anti-streptococcal antibody titer (ASO, ASK) was examined in 19 cases. In the cases of obvious antibody titer elevation, the results of the three methods were in better agreement than in other unelevated cases.
Culture and EIA were performed with one throat swab from the other 56 patients. Five of the 56 cases were group A streptococcus positive by culture and showed a complete agreement with the results of EIA.
Sensitivity of LA and EIA was compared by using the group A streptococcal strain isolated from the clinical specimen under the sequential dilution. No difference was found between the sensitivity of these two methods.
EIA and LA seem to be useful for rapid diagnosis of group A streptococci infection with the physician noting the possibility of conflicting results with culture under certain conditions.

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An investigation was made on the frequency of isolation and susceptibility to antibiotics and the effect of chemotherapy, with drug resistant Staphylococcus aureus which are derived from β-lactamase by plasmidal DNA and by the change of PBP regulated by chromosomal DNA, and the following results were obtained:
1) The mean isolated frequency of β-lactamase producing S. aureus from 1982 to 1985 was 63.6%, and that of methicillin resistant S. aureus (MRSA) was 14.1% respectively.
2) The isolated frequency of β-lactamase producing S. aureus was not so variable among clinical specimens, however, those of MRSA were high in blood, catheter tips, and pus.
3) The results of susceptibility of MRSA to antibiotics were excellent in MCIPC, OFLX, VCM, followed by MINO, GM, AMK, FOM, IPM/CS, FMOX. The effect of temperature on susceptibility was remarkable at 30°C which is the most satisfactory temperature for the appearance of PBP-2', and at that temperature the effect of β-lactamase to the susceptibility was almost not noted.
4) The excellent clinical effects of chemotherapy by viccillin-S (ABPC/MCIPC) in 2 cases of sepsis and MINO was effective in 1 case of pneumonia.
As a result of this study, the strict temperature of culture at 30°C is necessary for the detection of MRSA, and for clinical success of chemotherapy.

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The Mycotrim-GUTM (Hana Biologics, Berkeley, Calif.) biphasic culture system and a conventional system were compared for their ability to detect Ureaplasma urealyticum and Mycoplasma hominis in standard strains and 27 clinical specimens. The Mycotrim-GUTM system showed the same ability to detect U. urealyticum and M. hominis in the study with pure cultured standard strains. Both systems detected 4 M. hominis isolates in the study of clinical specimens. The conventional system detected all 18 U. urealyticum isolates recovered in the study of clinical specimens.
The Mycotrim-GUTM system detected 15 U. urealyticum isolates and could not detected the remained 3 isolates because of the growth of contaminated bacteria.
The Mycotrim-GU^TM system offers several advantages over the conventional system: it is commercially available, consists of a one-flask system which is ready to use, has a significantly longer shelf life. This study showed the Mycotrim-GU^TM system to be an useful one for detecting the urogenital mycoplasma in clinical examinations.

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Coagulase-negative staphylococci (CNS) were typed by monoclonal antibodies. Five different monoclonal antibodies used were derived from the fusion of mouse myeloma cells P3-NS1-1-Ag4-1 (NS-1) and spleen cells from BALB/C mice immunized with a strain of formalin killed S. epidermidis, N44-1. It was confirmed by immunoblotting that all five monoclonal antibodies recognized surface proteins of various species of CNS but not those of S. aureus strains.
Three hundred and forty-one strains of CNS isolated from clinical specimens, healthy volunteers and environmental materials were subjected to ELISA for serotyping by these monoclonal antibodies. All CNS strains tested reacted to at least more than one monoclonal antibodies and were classified into eight serotypes. The same strains were also subjected to phage typing for comparative study and some correlations among our serotypes and phage types were found, although there were many untypable strains by phage typing. Some typing phages are known to react to S. aureus strains, but none of our monoclonal antibodies reacted to S. aureus strains. These reuslts suggested that our serotyping was useful as a new typing method to simplify the classification of CNS species.

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Lymphocyte proliferative response to mitogens and skin testing for delayed hypersensitivity to tuberculin were diminished during acute phase of Mycoplasma pneumoniae pneumonia. We analyzed peripheral blood lymphocytes from patients in the acute phase of illness, convalescent phase of illness and after recovery using monoclonal antibodies Bl, OKT3, OKT11, OKT4, OKT8, OKIA1, Leu7 and Leull. In the acute phase of illness a peripheral lymphocytopenia was found. The percentage of OKT3 positive lymphocytes and the absolute number of Bl, OKT11, OKT3, OKT4 and OKT8 positive lymphocytes were decreased in the acute phase of illness. In the convalescent phase of illness, tuberculin test and the absolute number of lymphocytes, OKT11, OKT3 and OKT4 positive lymphocytes returned to normal. The absolute number of OKT8 positive lymphocytes were still decreased. As a result, helper-suppressor ratio (OKT4/OKT8) was increased during convalescence. After recovery, lymphocyte proliferative response to mitogens and lymphocyte subsets became normal. These results demonstrate that the transient immunosuppression in the acute phase of Mycoplasma pneumoniae pneumonia is probably caused by peripheral lymphocytopenia, T lymphocytopenia and reduction of helper/inducer lymphocytes.

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The pathogenetic factors of P. aeruginosa were studied in 196 strains of P. aeruginosa isolated from the patients with respiratory infection. In vitro and in vivo studies were performed to determine whether IgG protease was an important pathogen in elastase producing strain of P. aeruginosa.
The results obtained were as follows;
1. The relationship among the producing ability of many extracelluler enzymes, exotoxin A and haemolysin, clinical stage including serotypes and pathogenesis of respiratory infection was studied, however a definite relationship was not observed.
2. The survival rate in experimental murine pneumonia was studied in both 5 elastase producing strains and 5 non- producing ones. The survival rate of elastase producing strains was higher than that of the non-producing strains. However no statistical difference was observed between the two groups.
3. Four factors, such as elastase, protease, exotoxin A and haemolysin were evaluated to be pathogenic and the summation of the 4 factors and an intimate connection with the pathogenesis as lethal in experimental murine pneumonia and each factor played an important role as the pathogen of the pneumonia from the onset to terminal phase of the disease.
4. The pathogenesis of elastase as IgG protease was studied in vitro and in vivo. The elastase digest the mouse and human IgG and the activity of IgG protease was inhibited by α₂-macroglobulin with dose response.
5. The low positivity of antibody coated bacteria in the sputum of refractory chronic respiratory tract infection by P. aeruginosa could be due to the elastase producing ability of P. aeruginosa, but that was not proved experimentally.
The host defense mechanism against Pseudomonase infection seems to be carried out mainly by humoral immunity like the antibody and complement with neutrophil and macrophage. The elastase of P. aeruginosa could play an important role as IgG protease in clinical cases.

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We reported a case of Haemophilus parainfluenzae endocarditis. A 45-year old male patient, who suffered from fever elevation and was administered some cephems orally or intravenously with no clinical efficacy, visited our hospital. He admitted on 25th March 1986, after a week from the onset of the disease.
On admission his body temperature was 40.2°C and a grade of Levine II systolic murmur was audible at the mitral ostium, but no sign of the heart failure was recognized. H. parainfluenzae was isolated twicefromfour serial blood cultures.After the bacteriological examinations daily doses of 6.0 g of ampicillin (ABPC) with 600 mg of ofloxacin (OFLX), of 4.0 g of cefotaxime (CTX) and of 6.0 g of THR-221 were administered successively. However, the clinical effects were insufficient, so that the antimicrobial agents were changed on the 27th hospital day again up to daily doses of 9.0 g of ABPC and 600 mg of OFLX for 42 days, and then daily dosis of 2.0 g of amoxillin was prescribed in place of ABPC. The therapy was over on the 87th hospital day, resulting in good clinical course. Fainally, he discharged on the 102 nd hospital day.
MICs of CTX, THR-221, ABPC and OFLX against the isolated strain were 0.0125μg/ml, 0.0125μg/ml, 0.39μg/ml and O.05μg/ml respectively.

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