Pneumonia in the elderly often occurs repeatedly, and the mortality rate from pneumonia continues to remain high today despite the usual use of antibactrial chemotherapy. Therefore, we conducted immunotherapy using a polyvalent bacterial vaccine (broncasma Berna). We treated 54 elderly patients with Broncasma Berna, containing chief bacterial pathogens responsible for pneumonia in the elderly. Clinical results obtained during 2 years were compared with those of 18 subjects not treated with Broncasma Berna.
The survival rate was 64.8% for the group treated with Broncasma Berna and 50% for the group not treated. The frequency of contraction of pneumonia decreased significantly in the group treated. Clinical efficacy was obtained in 63% of the group treated to prevent pneumonia. The death rate from pneumonia was 17.6% for the group treated and 44.4% for the group not treated. Immunologically, reinforcement in humoral and cellular immunities was indicated by immunoglobulin avlues, positive tuberculin skin tests, and an increase in lymphocyte stimulation index values for Broncasma Berna. Significant pathogens in sputum disappeared or decreased in 6 (54.6%) out of 11 patients. Side effects such as pain or redness at the site of injection were observed in 6 patients.
From the above results, it may be concluded that Broncasma Berna can be considered to be effective as a long-term immunoprophylactic agent in the prevention of pneumonia in the elderly.

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Primary host defense mechanism of mice against intraperitoneal infection with herpes simplex virus type 1 (HSV-1) was studied using heat-killed Lactobacillus casei YIT 9018 (LC 9018), a bacterial immunostimulant, in combination with inactivated HSV-1 antigen. Peritoneal exudate cells (PECs) in the early period of mice pretreated intraperitoneally (ip) with LC 9018 showed the cytotoxic activity against BALB/3T3 cells infected with HSV-1, in vitro, whereas PECs induced by thioglycollate broth did not. The limitation of HSV-1 replication in monolayers of HSV-1-infected PECs induced by LC 9018 was greater than that in PECs induced by thioglycollate broth. Both activities of PECs induced by LC 9018 were markedly enhanced by the administration of inacivated HSV-1 antigen which showed an interferon-producing activity in the early period after the treatment. These results suggest that the host defense mechanism of mice against intraperitoneal infection with HSV-1 may be mainly related to peritoneal macrophages activated by and interferon produced by the administraton of LC 9018 and inactivate HSV-1 antigen.

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Five cases of penicillin insensitive or resistant pneumococcal infection in children were experienced during the period of 2 years since March, 1986. One isolate from middle ear showed the MIC of 4 μg/m1 against penicillin-G. One isolate of insensitive pneumococcus was isolated from C SF specimen. Between 1976 and 1987, 59 siolates from 88 stocked penumococcal clinical isolates were alive. These 59 strains were screened by oxacilin disc for insensitive and resistant pneumococcus. Five strains which were insensitive or resistrant strains had inhibitory zone under 20 mm. The prevalence rate of insensitive or resistant pneumococcus since 1986 was 18%.

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Investigation on the etiology of septicemia occurring among the immunocompromised patients was performed by using experimental model of the mouse with leukocytopenia. The ddY conventional mice of 4 weeks of age were inoculated with cyclophosphamide (CPM) intraperitoneally 3 to 5 times every other day with a dose of 3 mg/mouse once to make an agranulocytic status. Then, intraperitoneal administrations of various antibiotic regimens consisting of ampicillin (ABPC) alone, ABPC + ceftazidime (CAZ), ABPC + CAZ + cloxacillin (MCIPC), ABPC + CAZ + MCIPC +minocycline (MINO) and saline as a control to these immunosupressed mice were begun once every day for 10 days after the second inoculation of CPM.
The mortality rate of the mice given saline as a control was very high with a frequency of 43.3%and there were significant differences between the saline group and another antibiotic groups other than ABPC (p<0.01). On the other hand, the mortality rate of the group given APBC showed the highest rate of 70% and it was significantly higher than that of the saline control gorup (p<0.05). The main cause of most of the dead mice was septicemia due to P. aeruginosa and which were isolated from the feces of all these mice and serotype of the strains isolated from the heart blood and feces in the same host corresponded to each other. Moreover, intestinal bacterial flora in mice treated by saline and ABPC which highly showed Pseudomonas sepsis, was occupied dominantly by P. aeruginosa, although P. aeruginosa was not detectable from the experimental environments.
From these results, it was clarified that sepsis induced by administrations of CPM and antibiotics was the typical endogenous infection and dominant intestinal bacterial flora, especially P. aeruginosaas a result of superinfeciton takes an important role as the causative pathogen. This experimental mouse model will contribute not only to analyze further mechanisms of nosocomial sepsis obsrved among the immunosupressed patients but also to prevent these infections, since it seems that the etiology of sepsis in mice is very similar to those of the human being.

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The clinical efficacy and safety of Roxithromycin (RU 28965, RU), a new macrolide preparation, were compared with those of Josamycin (JM) in superficial suppurative skin infections.
The study was designed as double-blind controlled trial with daily dosages of 300 mg in RU group and 1200 mg in JM group.
A total of 209 cases (RU: 105, JM: 104) was analyzed and the final global improvement rating was 82.9% in the RU group and 80.8% in the JM group; there was no significant difference between the two groups.
Slight adverse reactions were observed in 3.6%(4 cases) of the RU group and in 4.6%(5 cases) of the JM group.
In conclusion, RU at daily doses of 300 mg is as effective as JM at daily doses of 1200 mg in superficial suppurative skin infections.

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Escherichia coli strains isolated in Tokyo from stool cultures of two sporadic diarrheal cases of travellers returning from South America and Thailand in 1985 and in 1987 respectively, were found to be enteroinvasive strains with rare serotype O29: H-.
These E. coli O29: H-strains showed typical biochemical reactions of enteroinvasive E. coli in that they were negative lysine decarboxylase and non-motile. They were positive for Sereny test with guinea pig eye, cell-invasion test with HeLa cells, 140 megadalton virulence plasmid, and the virulenceplasmid encoded outermembrane protein, indicating that these strains were pathogenic and may cause a Shigella-like disease.
Although the same serotype strains have been isolated in other countries, this may be the first report of isolation in Japan.

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Variants which lacked capsular envelopes on their cell surface were isolated from the culture of a highly virulent Yreka strain of Yersinia pestis grown in the presence of acridine orange, ethidium bromide or sodium dodecyl sulfate at incompletely growth-inhibitory concentrations. The variant could be divided into two types on the basis of the presence and the absence of intracellular envelope antigen. Both types of the variants lacked the 13 megadaltone (Md) plasmid. Thus, it may well be said that the 13 Md plasmid would play some decisive role in extracellular envelope formation and no concern with the synthesis of intracellular antigen. It was clarified that these characters were carried by each different gene. The intracellular envelope antigen synthesis could not be correlated with other plasmids isolated from Yreka strain, i.e., 7, 23, 44 and 59 Md plasmids. On the other hand, further treatment of the intracellular-positive variant with the above inhibitors resulted in the occurrence of the antigen-deficient type variant at a rate of 1-2%. The high frequency appearance of the variant by the plasmid-depleting agents might indicate possible presence of some yet unknown plasmidresponsive to the intracellular synthesis of envelope antigen.

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Fifteen cases of typhoid fever occurred in “HARADA” district Fuji City in Shizuoka Prefecture during the period of 1983 to 1985.
Epidemiological and bacteriological investigations were carried out on the samples from a small water supply system, and drains of apartment houses in 1985. Water from a small river in the neighboring water supply system, and faecal specimens from people living in close proximity were investigated.
The results obtained were as follows:
1) Salmonella typhi were isolated from 3/3 patients (1 pupil and 2 employees) in 1983, 3/5patients (3 employees) in 1984, and from 4/7 patients (1 kindergartener, 1 pupil and 2 junior high school boys) in 1985. Phage type of these isolates were the same type “Dl”.
2) In the bacteriological survey on environment, S. typhi (phage type D1) were isolated from water of the water source of “HARADA” water supply in Fuji City with membrane filter methods, and from the sand source “HARADA” water supply with enrichment culture methods.
Also, with an examination that tested 3, 670 inhabitants, it was found that a carrier (phage type D1) was living near the “HARADA” water supply.
3) In the three selective media for the isolation of S. typhi, Bismuth sulfite agar (Difco) was the most sensitive, and detected 13 samples (61.9%) out of 21, from water source and sewage.

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Secondary bacterial infection was studied on 231 children admitted with Respiratory Syncytial virus (RSV) infection in the 10 years since 1987. Of the 231 children, 56 (24.2%) had dual bacterial infection possibly due to secondary bacterial invasion. The diagnoses of bacterial disease were sepsis (2), pyothorax (2), pneumonias (41), otitis media (7), nasopharyngitis (2) and urinary tract infection (2). Dual bacterial infections were more frequent in infants and children over 6 months than in infants younger than 6 months. The main etiologic agents were Staphylococcus aureus and enteric gram-negatives in infants, and Haemophilus influenzae, Streptococcus pneumoniae, β streptococci and Branhamella catarrhalis in children over 1 year.
The incidence of secondary bacterial infection was compared according to the usage of antibiotics just before admission. Patients who had been administered with penicillins or macrolides before admission had a significantly higher percentage of secondary bacterial infection (21/56, 37.5%) than those of no previous antibiotic therapy (11/64, 17.2%, p<0.025). The results indicate that the RSV infection itself sometimes predisposes to secondary bacterial infections, but indiscriminate use of antibiotics further increases the risk of secondary bacterial infections.

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Patients with legal communicable diseases admitted to Kawasaki Municipal Hospital between 1981 and 1986 were studied. Ages of patients were over 15 year-old. During this period 115 patients were admitted. Out of these patients 84 had Shigellosis, and 9 had amebiasis. Out of 20 Salmonellosis, 18 were due to Salmonella typhi and 2 were due to Salmonella paratyphi-A, respectively. Two were admitted because of Cholera.
Out of the patients with Shigellosis, 27 were domestic and 57 were foreign infections, respectively. Most of patients were infected in Sough Asia or India and its neigbour countries. Shigella flexneri were mainly isolated from these patients. On the contrary, Shigella sonnei was the main causative organism of patients infected in Japan.
Three amebiasis patients had liver abscesses with peritonitis, and 1 patient was a bisexual person.
Out of Salmonellosis, 11 were patients with typhoid fever and 9 were carrier.
One Cholera patient with severe diarhea and acute renal failure was successfully treated and already reported elsewhere.

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The first case of tsutsugamushi disease in Ehime Prefecture was experienced in December 1987 with successful isolation of the causative agent. The patient was taken ill twelve days after infection. Immunofluorescent antibody tests using the isolate, Yamazaki strain, and Gilliam, Karp, Kato, Irie and Shimokoshi strains as antigens revealed that the specific antibodies against these antigens appeared and increased in the blood of the patient during the course of the disease. And the antibody titers to the Yamazaki antigen were the highest of these antigens. Agglutinin for Proteus OXK did not appear in the blood of the patient. The immunofluorescent antibody test using type-specific monoclonal antibodies to Gilliam, Karp, Kato, Irie and Shimokoshi strains and these five strains and the Yamazaki strain as antigens revealed that the Yamazaki strain was identified as Karp type of Rickettsia tsutsugamushi.

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The third case of infant botulism in Japan is reported.
A four-month-old baby boy suddenly had weakness of suckling force, constipation and generalized hypotonicity. He was the product of normal gestation, labor and delivery. Growth and development were normal unitil he was nineteen weeks old. He received fruit-juice and honey daily. By bacteriological examination, Clostridium botulism type A was isolated from his feces and the honey which he had received. Type A toxin was detected from his feces but not from his serum.

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