1) Fifty-eight patients suffering from acute epididymitis were investigated to assess the etiologic role of Chlamydia trachomatis and Ureaplasma urealyticum.
Sixteen (42.1%) of the thirty-eight patients without underlying diseases yielded C. trachomatis from the urethral swabs, but no bacteriuria (≥10⁴CFU/ml) was recovered. C. trachomatis was isolated from epididymal aspirates in 4 out of 10 patients in whom C. trachomatis was isolated from the urethral swabs.
Of the twenty patients having underlying diseases, 11 men were associated with urinary tract infections, but C. trachomatis was not isolated from the urethral swabs from any of these patients.
2) The antibodies to C. trachomatis in 21 sera was determined by micro-immunofluorescence test. IgG antibodies to C. trachomatis were found in 88.9%(8/9) of the men with chlamydial infections and in 25%(3/12) of the men without chlamydial infections. IgM antibodies to C. trachomatis were not demonstrated in any case.
3) U. urealyticum was isolated from urethral swabs in 15 (25.9%) patients with acute epididymitis, but was not isolated from epididymal aspirates in any of the cases.
In conclusion, C. trachomatis was regarded as the major pathogen in acute epididymitis, especially in patients without underlying diseases. But, the significance of U. urealyticum in acute epididymitis was not certain.

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A sandwich enzyme-linked immunosorbent assay (ELISA) for detection of a 11 serotypes of P. aeruginosa has been developed by using polyclonal rabbit anti P. aeruginosa (NC-5 strain) antiserum. The following results were obtained:
1) Cultured broth of P. aeruginosa was detected most sensitively by this assay followed by sonicated soluble antigen, washed bacetrial fluid and heated soluble antigen of P. aeruginosa. The lower limit of detection was approximately 2.3 × 10⁴ cfu/ml of P. aeruginosa (NC-5 strain) (containing 22.2 ng/ml of protein) in cultured broth.
2) By this assay, all serotypes of P. aeruginosa and some strains of Family Pseudomonadaceae (RNA group I) were detected, but no cross reaction was noticed to other species of bacteria (24 species, 268 strains).
3) The serum antigen in the experimental sepsis of P. aeruginosa or murine experimental pneumonia was detected when at least approximately 10³ cfu/ml of P. aeruginosa was present in serum or BALF. But the antigen was detected from concentrated urine even under the concentration of 10² cfu/ml in sepsis.
4) P. aeruginosa antigens in sputum of patients with chronic respiratory tract infection was also detected. There was a significant difference between absorbance value of sputum in non-infected patients (group 1) and one in infected patients by P. aeruginosa (group 3) (p<0.01), and between one in infected patients by bacteria other than P. aeruginosa (Group 2) and one in Group 3 (p<0.01). And there was a strong correlation between absorbance value of sputum in Group 3 and number of P. aeruginosa.
In 22 of 33 sputa (66.7%) with P. aeruginosa infection as verified by conventional culture methods, the antigen was detected in sputum. In a patient of P. aeruginosa pneumonia with acute leukemia, the antigen was detectable from spurum and one of the series of concentrated urine. It is concluded that the detection of P. aeruginosa antigen in sputum and urine by ELISA is a helpful aid to diagnose P. aeruginosa infection.

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The clinical efficacy and safety of Cefodizime (CDZM), a new cephem antibiotic, was objectively compared with that of Cefotaxime (CTX) in patients with respiratory infections under a wellcontrolled comparative study.
Patients were administered CDZM or CTX by drip infusion b. i. d. for 14 days in principle at a daily dose of two grams.
The parameters assessed were clinical efficacy, icacy, safety and clinical usefulness.
The following results were obtained:
1. On the basis of committee judgement the clinical efficacy rate was 78.1%(125/160) for the CDZM group, 82.7%(124/150) for the CTX group, and no significant difference was observed between the two drug groups. On the other hand, on the basisofjudgement by physicians in charge, the clinical efficacy rate was 83.1%(133/160) for the CDZM group, 83.9%(125/149) for the CTX group, and no significant difference was observed between the two groups.
2. The corresponding figures for patients with pneumonia and pulmonary suppuration were 82.4%(70/85) for the CDZM group, 79.7%(59/74) for the CTX group and no significant difference was observed according to the committee judgement. The judgement by physicians in charge also revealed 83.5%(71/85) for the CDZM group and 82.2%(60/73) for the CTX group. No.significant difference was noted between the two groups. While, the committee judgement for the clinical efficacy in patients with chronic respiratory tract infections showed 73.3%(55/75) for the CDZM group, 85.5%(65/76) for the CTX group, and no significant difference was observed between the two drug groups. The corresponding figures were 82.7%(62/75) for the CDZM group, 85.5%(65/76) for the CTX group, and no significant difference was observed between the two drug groups on the judgement by physicians in charge.
Furthermore, the clinical efficacy of both drugs on chronic respiratory tract infections was assessed according to “Criteria for Evaluation of Clinical Efficacy of Chemotherapeutics on Chronic Respiratory Tract Infection”. It was 76.8%(53/69) for the CDZM group, 76.3%(58/76) for the CTX group, and no significant difference was observed between the two groups.
3. The bacteriological eradication rate of causative pathogens was 92.4% out of 66 patients treated with CDZM and 95.5% out of 67 patients treated with CTX in whom judgement was possible. No significant difference was observed between the two drug groups.
4. The adverse reactions occurred in 4 (2.2%) patients for the CDZM group and 8 (4.5%) patients for the CTX group respectively, with no significant inter-group difference in frequency of these reactions for all cases. But the adverse reactions classified by pneumonia and pulmonary suppuration occurred in no patients for the CDZM group and 4 (5.1%) for the CTX group, with significantly less incidence in the former than the latter (p<0.05). The abnormal changes in laboratory findings were observed in 26.6%(45/169) for the CDZM group and 24.1%(39/162) for the CTX group, with no significant difference between the two groups for all cases.
5. There was no significant difference in the utility between the two groups for all cases, pneumonia, pulmonary suppuration and chronic respiratory tract infection groups according to both the commitee judgement and physicians' one.
Thus, it was concluded that CDZM is a drug with clinically high usefulness by the overall assessment on the basis of clinical efficacy and safety.

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We examined 4, 739 isolates of Salmonella isolated from patients with gastroenteritis during the period of 1966-1986 in Tokyo for the incidences of serovars, antibiotic resistance and conjugative R plasmids. The period of study was divided into three: 1966-73 (early period), 1974-79 (middle period), and 1980-86 (late period). The predominant serovars were S. typhimurium (34.3%), Infantis (5.6%), Panama (4.9%) in the middle period, S. typhimurium (31.7%), Paratyphi B (9.4%), Litchfield (7.3%) in the late period. These results were consistent with serovars of isolates from healthy citizens. The frequency of resistant isolates was as high as 86.9% in the early period, mostly streptomycin (SM)-and tetracycline (TC)-resistant isolates, but decreased significantly in the middle and the late periods, to 53.3 and 39.4%, respectively. The percentages of ampicillin (ABPC)-, chloramphenicol (CP)-, and kanamycin (KM)-resistant isolates increased in the late period. Strains carrying conjugative R plasmids were isolated as frequently as 57.8% of the total isolates in 1973, but as less frequently as 6.7% in 1981 indicating that the rate was roughly proportional to the incidence of the drug resistant isolates. The rate, however, increased gradually after 1981. The predominant resistance pattern of the R plasmids was TC-resistance in the early period, gradually changed into multiple and finally to AP-, CP-, KM-, SM-, TC-and sulfonamides-resistance in the late period.

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To investigate the occurrence of Branhamella catarrhalis respiratory tract infections in 109 outpatients with pneumoconiosis, clinical and bacteriological studies were prformed during a 4-year period from April 1984 to March 1988. B. catarrhalis was isolated in 26 patients; only three of these recieved continuous corticosteriod treatment. The incidence of B. catarrhalis respiratory tract infections increased gradually during the years 1984-1986, but decreased for the first time in 1987 compared with the previous year. There was a seasonal variation in isolations with a peak incidence during the winter, a pattern in contrast to Haemophilus influenzae. Almost all isolates produced β-lactamse. B. catarrhalis found in mixed culture was usually in association with H. influenzae or Streptococcus pneumoniae.
The isolation rates for B. catarrhalis in sputum of patients with pneumoconiosis followed those of H. influenzae and S. pneumoniae, and almost all strains were positive forβ-lactamase, so B. catarrhalis should be admitted that it is a primary pathogen.

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We tested blood neutrophil functions in the patients with chronic respiratory tract diseases to study the mechanism of susceptibility to bacterial infections. Peripheral blood neutrophils were obtained from 15 healthy subjects and 14 patients including diffuse panbronchiolitis, bronchiectasis, chronic emphysema and chronic bronchitis. Seven patients suffered from the chronic. P. aeruginosa infection.
Firstly, neutrophil chemotaxis was determined by the method of Boyden Chamber assays using FMLP as a neutropil chemoattractant. The number of migrated neutrophils were 239.2 ± 65.6 cells/50 HPF in the patients group and 256.6 ± 49.0 cells/50 HPF in the control group.
Secondly, neutrophil phagocytosis against P. aeruginosa, E. coli and K. pneumoniae was determined by phagocytic activity (PA) and phagocytic index (PI).PA against each bacteria was 44.1 ± 13.2%(P. aeruginosa), 44.8 ± 12.3%(E. colt) and 35.8 ± 13.6%(K. pneumoniae) in the patients group and 42.3 ± 10.6%(P. aeruginosa), 43.0 ± 11.9%(E. coli) and 36.3 ± 16.0%(K. pneumoniae) in the control group. PI against each bacteria was 2.2 ± 0.6 (P. aeruginosa), 2.1 ± 0.3 (E. colt) and 2.6 ± 0.9 (K. pneumoniae) in the patients group and 2.2 ± 0.6 (P. aeruginosa), 2.2 ± 0.4 (E. colt) and 2.5 ± 0.6 (K. pneumoniae) in the control group.
Thirdly, neutrophil bacteriocidal activity was determined by superoxide production and intracellular kiling efficiency. Superoxide produced from OPZ-triggered neutrophils was 17.8 ± 6.5 nmol/3.5 × 10⁶ cells/20 min in the patients group and 20.2 ± 5.8 nmol/3.5 × 10⁶ cells/20 min in the control group, respectively. Intracellular killing against each bacteria was 89.1 ± 10.2%(P. aeruginosa), 57.9 ± 23.2%(E. coli) and-46.5 ± 93.1%(K. pneumoniae) in the patients group and 92.1 ± 12.3%(P. aeruginosa), 62.2± 21.6 (E. colt) and-44.7 ± 66.0%(K. pneumoniae) in the control group.
These results suggest that neutrophil functions determined by chemotaxis, phagocytosis and bacteriocidal activity were not inhibited in the patients with chronic respiratory tract diseases. Probably, the susceptibility to bacterial infections in these patients could be attributed to other factors enhancing bacterial adherence and growth in the respiratory tracts.

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We investigated the hospital acquired infection of P. aeruginosa in urological wards by determining the serotype and testing the sensitivity of this bacteria to antibiotics.
The results were as follows:
1. 92 strains of G-serotype (22.2%), 76 of A-serotype (18.3%) and 65 of B-serotype (15.7%) were predominantly found in the serotype distribution of 415 P. aeruginosa strains isolated from urine or feces.
2. Comparing the sensitivity of P. aeruginosa to various antibiotics determined by MIC₅₀ (the concentration to inhibit growth of 50% of the objective bacteria), Dibekacin showed MIC₅₀ of 0.78 μ g/ml, Ceftazidime 1.56 μg/ml, Cefsulodin 3.13 μg/ml, and Polymixin-B, Piperacillin, Aztreonam 6.25 μ g/ml.
The analysis of the relationship between serotype and sensitivity to antibiotics demonstrated that K-serotype of P. aeruginosa tended to be highly sensitive and M-serotype be less sensitive to only Dibekacin. There was no definite relation of serotype to sensitivity against any other antibiotics.
The comparison of sensitivity to antibiotics determined by MIC_{50, 80} between P. aeruginosa isolated from urine and that from feces revealed that the former was less sensitive by one to four grades than the latter.
The sensitivity of P. aeruginosa isolated from feces at admission was not different from that at discharge.
In the chronological changes in sensitivity of P. aeruginosa isolated from urine, the strains highly resistant to Cefsulodin, Ceftazidime, Aztreonam and Dibekacin had increased in 1984 and 1985.
3. These highly resistant strains tended to break out in the urological wards, which suggested the need for more intensive prophylactic measures against hospital acquired infection.

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Fifteen hybridomas were produced by fusing P3X63Ag8.653 mouse myeloma cells with spleen cells from BALB/c mice immunized with Japanese encephalitis (JE) virus Kamiyama strain. Antigenic analysis of twenty-five strains of JE virus was carried out by hemagglutination inhibition (HI) test with anti-Kamiyama monoclonal antibodies (KAMIMAs). Twenty-one JE virus strains were isolated from various parts of Japan, and four foreign countries. These strains had been isolated from different host between 1935 and 1979.
According to the HI test against the five species-specific monoclonal antibodies, the twenty-five JE virus strains were classified serologically as follows:
Group A: Kamiyama, Sekiya, Mochizuki, Nishizono, Sasazaki, Mie 44-1, Fukuoka 7101, Fukuoka 7202, Fukuoka 7309, Fukuoka 7311, Fukuoka 7452, Fukuka 7463, Fukuoka 7506, Kumamoto 80679, Chang Mai and JaGAr 02 strains.
Group B: Nakayama-RFVL and Nakayama-Yoken strains.
Group C: Nakayama-Yakken, Kalinina, G-1 late, JaGAr 01, Beijing 1 and 691004 strains.
Group D: Muar strain.
These results mostly corresponded with the serological classification by anti-Nakayama-RFVL monoclonal antibodies.
Analysis of the biological activities of KAMIMAs revealed that there were no correlations among HI titer, ELISA titer and neutralization titer. Neutralizing and some non-neutralizing monoclonal antibodies protected mice infected with lethal doses of JE virus Kamiyama strain.
SDS-PAGE and immunoblotting analysis revealed that three antibodies reacted with a 52.0 kD band under non-reducing conditions and with a 53.0 kD band under reducing conditions, five antibodies reacted with a 52.0 kD band only under non-reducing conditions, and that seven antibodies reacted with a 14.5 kD band under both non-reducing and reducing conditions.

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To investigate the clinical incidence of inducible β-lactamase, we measured the β-lactamase activity in the sputum of 5 patients with chronic respiratory tract infection due to P. aeruginosa, by using the spectrophotometric method. During the piperacillin (PIPC) therapy given twice a day with a single dose of 2-3 g, sputum samples were collected every 2 hours for 3 days, and on the second day, two grams of Cefmetazole (CMZ) was added to PIPC therapy. The antibiotics concentration of each collected sputum samples were also measured by HPLC.
In one out of 5 patients, no β-lactamase activity in sputum was detected throughout the 3 days. However in three out of 5 patients, after the addition of CMZ to PIPC, the β-lactamase activity significantly increased 2-3 times (max: 0.03 units/ml) that on PIPC alone, and gradually decreased on the 3rd day when PIPC was given alone. Then the peak concentration of PIPC with the addition of CMZ decreased to 38-73%, compared with that of PIPC alone. these findings were supported by the fact that CMZ showed a high in vitro inducer activity against the isolates from the sputum. In the remaining one patient, high β-lactamase activity (mean: 0.16 units/ml) and no antibiotics concentration was detected to be constant throughout the 3 days, and it was confirmed for the reason that one of the isolates constitutively produced large amounts of β-lactamase. These results suggest that inducible and costitutive β-lactamase would clinically cause undesirable effects in the treatment by some /-lactams and have a possibility of indirect pathogenesis.

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We had an outbreak of 14 cases of enterocolitis due to Clostridium perfringens (Cl. perfringens) in a hospital for the severe multiply-disabled, where the 100 disabled were admitted, in summer in 1985.
The signs and symptoms shown by this enterocolitis were primarily diarrhea without fever and loss of appetite.
The feces of 10 cases were examined bacteriologically. The test showed 10³ to 10⁶ cells of Cl. perfringens per one gram of their feces and all the strains isolated were untypable by the classification of Hobbs. Nine out of 10 cases were randomly selected and all of the 9 cases were proved to have enterotoxin producing strains.
All the strains were highly sensitive to many kinds of antibiotics except kanamycine and gentamicin.
Eleven out of the 14 cases were admitted in the same ward and the 7 out of the 11 cases were in the same room of this ward. Considering the spreading route of this infection, itis unlikely that this outbreak occurred due to food supplied from kitchen in this hospital, becauseall of the disabled, admitted in this hospital, had little chance by which some of the disabled only in a specific ward or room were supplied with bacteriologically contaminated meals from the point of view of cooking and supplying system of this hosptial. Adding to this fact, if this outbreak was due to food-born infection, the symptoms of most patients should occur within 1-2 days, because the incubation period of this disease is within a day, however, the patients increased day by day for more than a week. On the other hand, the 7 patients occurring in the same room were able to touch each otherby moving through walking, kneel walking and/or bottom shuffling. Furthermore, all of them inevitably wore diapers, some of them might touch and lick their own feces. Therefore there might be saveral chances by which the cells of Cl. perfringens in their feces were orally taken through their and/or care-takers' fingers, toys and clothes.
We discussed whether enterocolitis would be caused with such a small numbers of bacteria as these taken in this manner. It is said that cells of Cl. perfringens exist mainly as spores in feces and as cells during growth in foods propagated by the bacteria. Furthermore, the spores are known to resist against acid much more than the cells during growth. In order to ascertain whether the spores survived in gastric juice, we showed that most of the spores of Cl. perfringens from a case of this outbreak which had the ability to produce enterotoxin survived, when incubated in culture medium acidified (pH=1.6) with HC1 at 37°C for 30 minuites; on the other hand, it was shown that the cells during growth decreased in numbers to 1/10⁴ of the initial counts.
From these facts, we suggested that this outbreak must not have been food-born, but due to orally taken bacteria in feces.

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Progress in chemotherapy and cardiosurgery has remarkably decreased the mortality due to infective endocarditis (IE) in recent years. In chemotherapy for IE, parental administration of antibiotics has been used routinely, the patients suffer from the psycological and physiological burden due to frequent injections and long period of therapy, even though the therapy for IE is successful. In this report, we present a case of IE caused by S. mitis, which was remarkably improved by oral administration of AMPC.
A case, 69. y. o. female. she felt like a common cold and visited a G. P. Cardiomegaly was pointed out and positive inflammatory findings in serological examination were found. A low grade fever continued, and she was admitted to the hospital. Blood cultures were positive for S. mitis. For further examination, she was transferred to the university hospital. Based on the extensive blood cultures and cardioechogram, she was diagnosed IE caused by S. mitis. Because there were no symptoms of heart failure, we decided to try oral administration of AMPC, 4 g/day or 6 g/day at an interval of 6 hours. On the second day of therapy, the blood culture turned to be negative for pathogenes, and on the fourth day body temprature became normal. On about the 60th day, the CRP finding became negative. Concentrations in the serum of AMPC were more than 10 folds of AMPC-MIC (0.5, μg/ml) for S. mitis. The patient, however, suffer from complications of lung embolism and was operated for exchange of heart vulves. After surgery, she has been well without any symptoms from IE.

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