We examined lymphocyte subpopulations in the peripheral blood and serum concentrations of immunoglobulin (Ig) in 8 patients with tsutsugamushi disease. In 7 of the 8 cases, there was a 4-fold or greater increase in IgG and IgM antibody titers between the initial and convalescent serum specimens. In one case, there was no increase, but IgM antibodies were detected with diagnostically significant antibody titers. The percentages of CD8-and CD2-positive lymphocytes measured before treatment were found to be significantly higher than during the recovery stage of patients with tsutsugamushi disease. The CD4/CD8 ratio in the peripheral blood calculated before treatment was significantly lower than that during the recovery stage. Serum concentrations of IgG and IgM in patients during the recovery stage were significantly higher than pretreatment levels, respectively.
Minimum bactericidal concentrations (MBC) of penicillin-G were determined for 94 isolates of 0-hemolytic streptococci: 37 group A; 40 group B; 6 group C; and 11 group G. Our experiments focused on the influence of technical variable factors on the outcome of the MBC test such as inoculum preparation, manner of inoculation, technique of sampling for survivors, growth phase of inoculum, final concentration of inoculum, and time of incubation. The results were summarized as follows: 1. The mean MBC, ranged from 0.0145μg/ml (group A) to 0.084μg/ml (group B). The MBC/MIC ratio ranged from 1-to 4-fold (3 strains: 2 group A, 1 group C), showing no penicillin-G tolerance. 2. Logarithmic-phase inocula used were prepared by incubating 10 ml Mueller-Hinton broth (MHB) in water bath at 37°C for 4 to 5 h after adding 0.01 ml of 24 h-incubated cultures. 3. 0.1 ml of logarithmic-phase inocula were released on the surface of penicillin-containing MHB (1 ml) without shaking or splashing. 4. It was important to resuspend the organisms by vortexing 4 h before tubes were sampled so that any organisms contaminating glassware above the meniscus were exposed to antibiotic. 5. No carry-over effect was observed with 0.01 ml samples. 6. Effect of bacterial growth phase on outcome of MBC test was not confirmed. 7. All tests used final volumes of 1.1 ml of MHB containing 105 cells/ml and 24-hincubation time.
The peritoneal macrophages from mice treated with soluble protective antigen (SPA) or lipopolysaccharide (LPS) showed an increase in chemotactic activity, but muramyl dipeptide (MDP)-induced macrophages did not show any enhancing effect. Conversely, the chemotactic activity of mice peritoneal neutrophils was enhanced by SPA, LPS or MDP treatment. The superoxide anion (O2)-generating activity of SPA-induced macrophages was higher than LPS or MDP. And even 30 days after SPA treatment, a significant increase of O2-generating activity was evident as compared to the control. SPA-induced macrophages showed a higher degree of intracellular killing of Listeria monocytogenes, in vitro, as compared to macrophages obtained from normal mice. In the studies of in vivo protection, the number of bacteria in the liver after challenging with L. monocytogenes was smaller in SPA-treated mice than in untreated mice. Also, SPA-treated mice showed an increased resistance to L. monocytogenes infection
To establish a rapid method for detection of Haemophilus influenzae, an antiserum against H. influenzae (Anti-HibOMP) was prepared by immunization of rabbits with crude outer membrane proteins (OMP) of H. influenzae type b. Various isolates of H. influenzae including typable and nontypable strains and other species were tested by ELISA and Western blot assay with Anti-HibOMP. The results are as follows: 1. Anti-HibOMP reacted to all of the OMPs from 18 H. influenzae isolates which contained typable and nontypable strains by Western blot assay. Molecular weights of these OMPs were about 24, 27, 31, 34, 39 and 45 kilo-dalton. This result suggests that all H. influenzae isolates have identical antigenic proteins on their outer membranes.= 2. It was found that 172 out of 179 (96%) culture suspensions of H. influenzae isolates including 66 typable and 113 nontypable showed positive result by ELISA with Anti-HibOMP. 3. To define the cross-reactivity of Anti-HibOMP, 20 species (111 isolates) other than H.influenzae were tested by the ELISA. All isolates were negative with exception of a portion of H.parainfluenzae and Staphylococcus aureus producing Protein A. The cross-reactions to H. parainfluenzae and S. aureus were removed by absorpation of Anti-HibOMP with formalinized cells of H. parainfluenzae and reduction of the antibody to F (ab) 2 with pepsine digestion respectively. These results suggest that Anti-HibOMP contains various antibodies against common antigens on the outer membrane of H. influenzae which includes typable and nontypable strains, and furthermore, the ELISA with Anti-HibOMP will be useful as a rapid and sensitive method for direct detection of H. influenzae in specimens such as sputum, blood or urine.
Nosocomial infections due to aerobic gram-negative bacilli are life-threatening problems for immunocompromised patients. Most of these infections might arise from the patient's own flora, especially from their faecal flora. The purpose of this study was to investigate the bacterial portal of entry in experimental mice with bacteremia which were treated by cyclophosphamide (CY). It was clarified that almost all of the isolates from blood of CY and atibiotics treated mice were identical with their own faecal flora, and that organisms were isolated in some cases only from the portal vein but not from heart blood. From these results it was concluded that some of the bacteria entered from the intestinal tract through the portal vein to the systemic circulation in the immunosuppressed state. The time course of bacterial translocation were examined with SPF mice which were given Pseudomonas aeruginosa orally prior to CY treatment. Twelve strains of Escherichia coli were isolated, 10 of which were isolated only from mesenteric lymph nodes (MLN). Though six strains of P. aeruginosa were isolated from the heart blood, 4 were not isolated from MLN. It was suggested that translocations of E. coli and P. aerugionsa occured by lymphogenous and hematogenous routes respectively. And translocation of viable E. coli was observed only after ABPC treatment but before CY inoculation, on the other hand translocation of viable P. aeruginosa was observed after CY inoculation. So only disruption of the normal flora ecology was necessary for translocation of E. coli, but immunosuppression was additionaly necessary for translocation of P. aeruginosa.
A 51-year-old male, who had a history of excessive drinking and chronic hepatitis, was admitted to our hospital because of high fever and shock. Physical examinations, chest X-ray films and hemodynamic data revealed that he had progressed to septic shock due to pneumonia. Combination chemotherapy of latamoxef plus piperacillin was immediately started. After Klebsiella pneumoniae was isolated from bronchoalveolar lavage fluid, the antibiotics were changed to ceftizoxime plus amikacin. Furthermore human gamma globulin preparations and frozen fractional plasma were administered because of granulocytopenia and a decrease in complement. Gabexate mesylate, methylpredonisolone (MP) and branched chain amino acids were given to prevent disseminated intravascular coagulation and/or multiple organ failure. With this intensive care, he recovered from shock and pneumonia. The effects of MP on the whole blood chemiluminescence (CL) were examined. Incubation of whole blood with 25, 50 or 100μg/ml of MP for 10 to 60 minutes had no effects on the CL response. This indicates that MP does not affect the production of reactive oxygen species from phagocytic cells at concentrations comparable to those used in drug therapy.
We studied on the prognosis-related factors on 17 cases of Japanese encephalitis experienced during the last ten years and compared the clinical features with those in previous reports, especially when the disease was prevalent. The patients, ranging from 33 to 91 years old, consisted of 7 men and 10 women. All of them showed an encephalitis type. 47.1% of the patients were completely cured, 35.3% cured with sequelae and 17.6% died. The mortality rate was decreased compared to that of previous reports. All of the death cases were women. There was no relationship between the mortality rate and the patients' age. As previously reported, the more severe the disturbance of conciousness, the higher the mortality was. However the rate of death was lower than that of previous reports. We conclude from this study that clinical features of the disease have changed when compared with that of the older days.
The clinical efficacy and safety of Roxithromycin (RU) were compared with those of Midecamycin acetate (MOM) in patients with pneumonia in a double blind study. RU and MOM were administered orally for 14 days with daily doses of 300 mg (150 mg b.i.d.) and 600 mg (200 mg t.i.d.), respectively. The following results were obtained. 1. RU and MOM were administered to a total of 204 patients (RU: 101, MOM: 103). The clinical efficacy was judged in 150 patients (RU: 70, MOM: 80), with 54 of the patients excluded from the total by the committee. 2. The clinical efficacy rates were 81.4% for RU and 70.0% for MOM on the basis of the committee's judgement. There was no significant difference between the two groups. In the evaluation of the clinical efficacy by the doctors in charge, the efficacy rates were 81.4% for RU and 67.5% for MOM, which constitutes a significant difference between the two groups (p<0.05). 3. No significant difference was found between the two drugs in bacteriological efficacy. 4. No significant differences were observed in either the incidence of side effects between RU (4.3%) and MOM (4.0%) or in abnormal changes in the laboratory findings. 5. Regarding the clinical usefulness judged by the committee, RU showed a significantly higher rate than MOM (79.2% vs. 67.9%). There was no significant difference in the judgement by the doctors in charge. From the above results, it was concluded that a daily dosage of 300 mg of RU was equal in usefulness to 600 mg daily of MOM in the treatment of mild to moderate pneumonia.
A 18-year-old man was admitted with fever, dry cough, erythema, conjunctivitis, and dyspnea. The case was diagnosed as measles because of the typical clinical course and the increase of measles viral antibody titre. Electrocardiogram showed transient ST-T abnormalities and the laboratory data showed transient increase of CPK. Therefore myocarditis was considered. However chest rentogenogram showed no abnormal findings. Arterial oxygen was low. The Gascintigram revealed diffused uptake in both lungs. Microscopic examination of the transbronchial lung biopsy revealed alveolitis. In view of he above, measles pneumonia was daignosed in this case.
We have reported on the clinical courses of 4 cases of adult Listeria monocytogenes (Lm) infection, and the autopsy findings of 2 cases, those we have observed over the past 5 years. They were 2 cases of meningitis, 1 case of meningitis and sepsis and 1 case of sepsis. These 4 cases had CML, neoplastic angioendotheliosis, SLE and post-renal transplant condition, as their underlying diseases, and all were receiving immunosuppressive therapy. One meningitis patient who recovered showed mild liver dysfunction during her clinical course. The other 3 patients who died had jaundice at the time of onset and severe liver dysfunction. The 2 cases those were autopsied were the sepsis cases. The one with an acute course and hepatic failure showed multiple miliary necrotic foci in the liver, where the presence of Lm in the cells could be verified. The other autopsy case, which had received adequate antibiotic therapy and the Lm infection had been cured, showed no necrotic foci in the liver. The case that had necrotic foci in the liver was the first such adult case in Japan. We have discussed the hepatic Lm infection in adult compromized hosts, which conventionally has not been considered a serious problem.
Septicemia encounterd at Kawasaki Municipal Hospital between 1985 and 1986 were studied clinically. Forty six patients had monomicrobial and 5 has polymicrobial infections, respectively. Out of these 46 patients with septicemia, 17 were due to Escherichia coli, 7 were due to Klebsiella pneumoniae and 4 were due to Staphylococcus aureus. Ten patients had hepatobiliary, 7 had hematological, 7 had malignant diseases as underlying diseases, respectively. Out of 10 patients complicated with septic shock, 7 died. Twenty three patients were community acquired infections. The age of most of the patients were over 50. The motality rate of more than 6 5-year-old patients were higher than that of other patients. Our of 5 patients with septicemia due to polymicrobials, only 1 patient with erythroleukemia died. Fifty patients were treated mainly with β-lactam antibiotics such as piperacilin or cefmetazole alone or in combination with aminoglycosides and so on Three patients with infective endocarditis were encountered during this period. Two were due to a-streptococcus and 1 was due to Enterococcus. A 41-year-old patient with mitral valve insufficiency and metastatic gastric carcinoma to the bone marrow were complicated with disseminated intravascular coagulation. This patient, however, was successfully treated with a daily dose of 24 mega units of benzylpenicillin, and was given gabexate mesilate, concomitantly.
We cultured the cervical lymphonodal lymphocytes of a patient suffering from cutaneous T-cell lymphoma. His anti-ATLV antibody was positive by indirect immunofluorescent method (IF). ATLV was detected on these cultured cells by IF. Type C particles were observed in the cultured cells by electron microscopy. These particles were measured to be 60 to 120nm in diameter with electron dence core, and were considered as ATLV. This case showed a possibility of detecting ATLV by culture of lymphonodal lymphocytes from such a patient.