We treated three patients of chlamydial pneumonia with OFLX, two patients were diagnosed as psittacosis and one as pneumonia associated with TWAR strain by serologic test. Three hundred mg of OFLX was orally administered three times per day and the duration of treatment was from seven to fourteen days, and we compared the clinical effectiveness of OFLX in three cases (mild: 1, moderate: 2) with that of MINO in eleven cases (mild: 3, moderate: 8), who were administered two hundred mg of MINO two times per day orally or intravenously. We isolated C. psittaci from three pet birds including case 2 and the in vitro activity of OFLX and MINO against three strains of C. psittaci was determind. Clinical effectiveness were observed and obtained results were as follows. 1) In OFLX group, three patients judged as “Good”, and in MINO, one patient as “Excellent”, ten as “Good”. 2) The duration of pneumonic shadow was 9.33±3.21 in OFLX group, 10.3±3.50 in MINO group, and there was no significant difference between both groups. 3) The in vitro activity of OFLX and MINO against 3 strains was 0.78-1.56 μg/ml and 0.025μg/ml, respectively. From these results, it was concluded that OFLX was counsidered to be a useful antichiamydial agent in the treatment of mild or moderate cases of chlamydial pneumonia.
The immune response in human tsutsugamushi disease (scrub typhus) was studied. Antirickettsial activity of sera, peripheral mononuclear cells and their culture supernatants from patients on in vitro growth of Rickettsia tsutsugamushi proliferating in normal human peripheral macrophages was examined. The results obtained were as follows. 1) Sera from patients at the early convalescent stage, which exhibited high antibody titers against R. tsutsugamushi, effectively inhibited their growth in macrophages. 2) Sera from patients after a long period from the onset showed low antibody titers and did not inhibit rickettsial growth. 3) Mononuclear cells and T cell enriched fractions suppressed rickettsial growth when they were obtained from the patients at the early convalescant stage and even after as long as 3.5 years from the onset. 4) The culture supernatants of the T cell-enriched fractions which were collected from the patients mentioned above, exhibited a similar antirickettsial activity. These findings indicate that sensitized T lymphocytes and macrophages might play a fundamental role in immunological defense mechanism in tsutsugamushi disease. And the results obtained in our experiments are compatible with those previously reported in experimental scrub typhus in laboratory animals such as mice and monkeys.
In Japan, a fatal case due to Legionella micdadei was first recognized in our laboratory in 1986. On the epidemiological study just after the case, no Legionella was detected from the environmental samples of the patient's residence, such as shower water, tank water and so on. In the course of prospective investigations, no Legionella was isolated, but many organisms were grown on BCYEa and MWY agar plates. In the retrospective study, one of these organisms was found to support satellite growth of Legionella on BCYEagar without L-cysteine. This was the isolate from the shower hose and identified as Pseudomonas vesicularis with the biochemical and DNA-DNA hybridization test. And P. vesicularis type strain ATCC11426 also supported satellite growth of Legionella. Especially in the water supply system, the existence of P. vesicularis seemed to be effective on the growth of Legionella. It must be taken into consideration that efforts made to isolate the nutrient produced organisms as well as Legionella are needed.
Effects of oral aztreonam on fecal flora were studied in 6 comporomised children. Their ages ranged from 4 to 14 years. Daily doses of aztreonam were 10 to 30 mg/kg. The stool specimens were obtained before the treatment, on day 5 to 7 of aztreonam use and 2 to 5 days after the cessation of treatment. The counts of enterobacteria decreased from 107.7 to 104.4 per gram of wet feces (p<0.01), and bifidobacteria also decreased from 1010.2 to 108.4 per gram of wet feces (p<0.01) during aztreonam administration. Those of streptococci increased from 102.9 to 109.4 per gram of wet feces (p<0.001). The other anaerobic organisms showed no marked change. Based upon the above results, we conclude that oral administration of aztreonam may be useful for selective decontamination of intestinal flora in compromised hosts.
A clinicopathological study was carried out in 200 autopsied cases experienced in our department from 1981 to 1988. Cytomegalovirus infection was detected in 18 cases (9.0%). Eleven patients were male and 7 were female, and their ages ranged from 21 to 72 with a mean of 58.1 years. Primary diseases were mainly Non-Hodgkin's lymphoma (7 cases) and Adult T-cell leukemia (4 cases), and corticosteroid had been administered to all of them. The most commonly invoived organ was lung (77.8%), followed by adrenal (55.6%), esophagus, pancreas, ovary (22.2%), stomach, small intestine, thyroid (16.7%), liver, kidney, tongue (11.1%), and so on. Concomitant infections were frequently complicated, which were bacterial pneumonia (5 cases), fungal pneumonia (3 cases), disseminated varicella-zoster infection (2 cases) and herpes simpix virus esophagitis or stomatits (5 cases), while, ten patients died of cytomegalovirus pneumonia. Cytomegalovirus infection was one of the fatal opportunistic infections in immunocompromised, especially cell-mediated immunity impaired, hosts such as the patients with lymphocytic malignancies.
Bacteriostatic and bactericidal effect of Menfegol, which has been used as a spermicide, on Neisseria gonorrhoeae was investigated in vitro. The distribution of the MICs of N. gonorrhoeae to Menfegol consisted of 2 groups. Resistant strains showed the MICs of more than 3200 & mu;g/ml while the MICs of sensitive strains were less than or equal to 200 & mu;g/ml. When the resistant strains were suspended in several concentrations of Menfegol and were incubated at 35 & deg;C, no concentrations inactivated gonococci completely. However, the number of organisms was remarkably decreased within 30 minutes.
To evaluate the effectiveness of the immunoglobulin (IG) treatment for the prevention of cytomegalovirus (CMV) pneumonia in the cases with allogenic bone marrow transplantation (BMT), we examined the neutralizing activity of the IG preparation against both the free CMV particles and the cells infected with CMV in vitro. The results were as follows: 1) IG neutralized the free CMV particles but not the cells infected with CMV. 2) There was no difference in the number and size of plaques between the two overlay media with and without IG. These findings suggest that IG can not obstruct the cell to cell infection with CMV. Accordingly, it is concluded that if the effect of IG treatment in BMT cases is criginated from the neutralizing antibody, it may be explained by neutralizing of the free viruses but not by obstructing the cell to cell infection with CMV.
An outbreak of acute enteritis in children aged one to thirty-three months occurred from June 10th to 23rd, 1986, at a private orphanage in Matsuyama City. Twenty-two out of 23 children suffered from diarrhea. Nine of the 22 children excreted bloody stool. Fever and vomiting were observed with a few patients. One of them, a 33-month-old girl, developed hemolytic uremic syndrome, and died twelve days after the admission. Escherichia coli O111: H- was isolated from fecal specimens of 7 out of 15 patients. The culture filtrate of the isolate caused fluid accumulation in ligated ileal loops in a rabbit, and was lethal to mice. It wa found that all isolates produced two kinds of Vero toxins (VT1 and VT2, or shiga-like toxin I and II). The amount of VT2 produced in vitro was about 10 times more than that of VT1.
We examined the cross reaction of Chlamydia trachomatis (C. trachomatis) by antigen detection method using EIA against the aerobic bacteria which colonize in the respiratory tract of children. Chlamydiazyme showed a cross reaction among 5 out of 7 species of Gram negative bacteria (=71.4%) and Neisseria and Branhamella catarrhalis showed a cross reaction even in low concentrations of 1×103-4 CFU/ml. There were no Gram positive bactria which showed cross reaction. IDEIA Mark III did not react to Gram negative bacteria even in high concentratins of 1×107-10CFU/ml. One strain of coagulase positive staphylococcus (CPS) showed positive at a concentration of 1×108: however, other Gram positive bacteria including two other strains of CPS exhibited no cross reaction. The detectable concentration of C. trachomatis (D/UW 3 strain) using IDEIA Mark III was 1×103 IFU/ml. Low cross reaction rate and sensitivity suggest IDEIA Mark III is preferable for iagnosis of respiratory infection of C. trachomatis though further clinical studies are necessary.
A 62 year-old man had suffered from gout and mild renal insufficiency since he was 40 years old. He was admitted to our hospital complicated by a productive cough, high fever anda right swollen knee joint. The chest radiographs demonstrated a left upper lobe infiltration shadow. Streptococci pne-umoniae were found in the sputum, arterial blood and synovial fluid of the right knee joint, suggesting a severe pneumonia followed by pneumococcal septicemia which led to purulent arthritis. He was treated with cefamandole (CMD) and penicillin G (PC-G) for one week, but the chest X-ray findings were not improved. After treatment with cefbuperazone (CBPZ) and latamoxef (LMOX), his fever and other symptoms gradually resolved. Streptococcus pneumoniae is an uncommon organism of septic arthritis.Pneumococcal arthritis in a patient without immunodeficiency such as this case isvery rare, and has not been reported in Japan.
Capsule-deficient Cryptococcus naoformans (CN-CD) infection is very rare. The authors recently experienced the case of CN-CD infection with the complication of the syndrome of inapropreate antidiuretic hormone secretion (SIADH) in a 83 year old woman. She was admitted to our hospital with the complaints of fever and general fatigue on June 10, 1987. At the time of admission, there were no abnormal findings except a mildly lowered conciousness level on physical examination, there were no abnormal neurlogical finding nor menigeal signs. Labolatory data revealed a mild leukocytosis and hyponatremia. Chest X-P showed a few small nodular shadows scattered in both lungs. Antibiotics therapy was of no help and hyponatremia became worse. Then with the suspicion of SIADH, Demeclocycline was administered and limitation of water intable was decreased and hyponatremia improvement was used. Yeast-like fungi was detected in the venous blood culture and in the cerebrospinal fluid (cell count: 252/3) CN-CD by India-ink preparation and bacteriological nature were determined. We made a diagnosis of sepsis and meningitis by CN-CD accompanied with SIADH. In spite of Miconazole administration intravenously and intrathecally, she died 2 months after admission. The minimal inhibitory concentration (μg/ml) of antibiotics against the isolated CN-CD was as follows: Amphotericin B: 0.78, 5-PC: 1.56, Miconazole≤0.05, Nystatin: 25, Ketoconazole: 0.78.