In the former report, the bacterial portal of entry in experimental mice with bacteremia were analysed in detail. And it was clarified that almost all of the isolates from blood of cyclophosphamide (CY) and antibiotics treated mice were entered by their own flora, especially by their faecal flora.
From this point of view, great care must be taken when using antibiotics for immunosuppressed patients, because it easily causes a super-infection, that is one of the most important factors of endogenous infections. In order to potentiate host immunity, we examined the preventative effect of biological response modifiers (BRM) to experimental endogenous septicemia. MDP-Lys (L18), rhGCSF, and rhIL-1 were effective on experimental Pseudomonas aeruginosa endogenous septicemia of mice. The effect did not depend on the increased number of total leukocytes and PMN. Further experiments using nude mice suggested that the host defence mechanism inhibiting Pseudomonas endogenous infection might not depend on T-cell mediated immunity.

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During the period from October 1982 to July 1984, a total of 1, 157 specimens that consisted of 132 river and lake water, 514 river and lake muds, and 511 fresh-water fish caught in both Tama River andSagami River were examined the presence of the organisms.
Of them, 132 (100%) river and lake waters, 304 (59.1%) river and lake muds, and 462 (90.4%) intestinal contents of fresh-water fish were found to have harbor a mean concentration of 1.3×10³/l, 1.6×10⁶/g, and 1.1×10⁶/g of motile-Aeromonas respectively. However, noseasonal variation was observed in the incidence of the organisms throughout the period of investigation.
When attempts were made to classify the isolates by the method described Popoff et al., 17 (14.2%) of 120 water-isolates were typed as A. hydrophila, 33 (27.5%) as A.sobria and 35 (29.2%) as A. caviae respectively. And the rest of the 35 (29.2%) remained untypable.
As for the 176 mud-isolates, 38 (21.6%) were typed as A. hydrophila 23 (13.1%) as A. sobria and 41 (23.3%) as A. caviae respectively. And the rest of 74 (42.0%) remained untypable.
Same efforts were made on the 1, 056 strains obtained from fresh-water fish, and 182 (17.2%) were typed as A. hydrophila, 332 (31.4%) as A. sobria and 206 (19.5%) as A. caviae respectively. And the rest of the 336 (31.8%) remained untypable.

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In 1974, Kelsey and Maurer proposed the improved Kelsey-Sykes test as an evaluation method for bactericidal effect of all kinds of disinfectant.
We examined the necessity of culturing test organism with the fixed special broth, preparing organism popuration and using the special container called the universal container proposed in this test.
We compared these test results with the phenol coefficient method used usually as an evaluation method for bactericidal effect of disinfectants, and investigated its availability and exerimental procedure: the results are as follows.
1) There was not difference between growth medium according to K-S test (Bacto Synthetic Broth A.O.A.C. Code No.0352) and our nutrient broth (Nissui Nutrient Broth Lot No.065210) in growth support for the test organisms.
2) There was not difference in test results of bactericidal effect between the standard hard water and whole broth culture used as test organisms suspension or organism suspension with the pellicle of P. aeruginosa and without one.
3) The result using the usual operating test tube was the same as when the universal container was used.
4) The procedure of K-S test was complex in comparision with the PC test method, but was able to presume the usual use-dilution. The K-S test had an advantage in this point.

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During the period from April to November in 1986, an epidemic of aseptic meningitis occurred in Gifu prefecture. Epidemiological, virological and serological investigations were performed.
Cases involved ranged from 0 to 30 years of age, and 84.2% of them were under 7 years of age. Seven types of enterviruses were isolated from 136 of 190 cases (71.6%), and echovirus type 7 was recovered from 121 cases (88.9%).
With the cross neutralizing test between the prototype and isolated strains in 1986 of echovirus type 7, a remarkable antigenic variation could not be found.
In the serological studies, the positive rates of neutralizing antibodies to echovirus type 7 in 1985, was lower than those in 1975. During the past 18 years before the 1986, echovirus type 7 was not isolated in Gifu prefecture, but in the serological studies, it was confirmed that the sporadic infeciton with echovirus type 7 had occurred in Gifu prefecture.

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For the purpose of evaluation of clinical efficacy, safety and usefulness on acute infectious enteritis (bacillary dysentery, and enteritis caued by Salmonella spp., Campylobacter spp., enteropathogenic E. coli, and so on), T-3262, a newly developed pyridone-carboxylic acid derivative, was administered to a total of 136 patients and carriers. In addition, in vitro antibacterial activity of T-3262 was determined against the clinical isolates, and compared with those of nalidixic acid (NA), pipemidic acid (PPA), enoxacin (ENX), norfloxacin (NFLX) and ofloxacin (OFLX).
The daily dose of 450 mg of T-3262 was administered orally three times after meals for 5 days, with the exception of 7 day administration against Salmonella enteritis.
A total of 89 cases were evaluated; 23 with Shigella spp., 30 with Salmonella spp., 15 with Campylobacter spp., 6 with enteropathogenic E. coli, and 15 cases with the other pathogens or pathogen-negative.
The efficacy on clinical symptoms judging from duration of fever, and duration of diarrhea and abnormal stool character was 100% in all the enteritis except enteropathogenic E. colii enteritis, in which it was 50%(n=2).
Concerning bacteriological response, elimination of the causative organisms from the feces was 100% in Shigella spp. (n=19), Salmonella spp. (n=30), and enteropathogenic E. colii (n=6), although64.3% in Campylobacter spp. (n=14).
As an adverse effect, epigastric discomfort was observed in one (0.8%) of 130 cases. Deteriorations in laboratory findings were seen in five (6.2%) of 81 cases, consisting of two with elevated GOT and GPT, two with elevated GPT, and one with increased eosinophils count, although they were all slighti n degree.
MICs of T-3262 which inhibited 90% of the isolates of Shigela spp, Salmonella spp., and Campylobacter spp., were 0.025, 0.05, and 0.78μg/ml, respectively. These values were lowest among the quinolone derivatives tested, except that the MIC₉₀ against Campylobacter spp. was the same as that of ofloxacin.

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The clinical efficacy, safety and usefulness of lomefloxacin (LFLX, NY-198), a new quinolone antimicrobial agent, were compared with those of pipemidic acid (PPA) in the treatment of infectious enteritis (bacillary dysentery, enteropathogenic Eschericia coli enteritis and Campylobacter enteritis) by a double blind method.
Daily dosage of LFLX and PPA was 600 mg and 2000 mg, respectively administered orally divided into 4 doses. The duration of the treatment was 5 days.
Of 290 cases studied, 100 cases were excluded and 21 cases were dropped from analysis of effectiveness and usefulness. The effectiveness and usefulness was evaluated in 169 cases (LFLX group: 83, PPA group: 86). There was no significance difference between the two groups in any background characteristics. The results obtained were as follows: 1. In 73 symptomatic patients (LFLX group: 35, PPA group: 38) on the day of the beginning of administration, the clinical effect was 91.4% in the LFLX group and 84.2% in the PPA group with no significant difference erence between the two groups. 2. In a total of 184 strains (LFLX group: 90, PPA group: 94), the bacteriological effects of LFLX (93.3%) was superior to that of PPA (80.9%) with a significant difference (p=0.0153). 3. In 169 evaluable patients, the global clinical effects of LFLX (92.8%) wassuperior to that of PPA (79.1%) with a significant difference (P=0.0144). 4. Side effects were observed in 1 (0.7%) of the 141 patients in the LFLX group and none of the 143 patients in the PPA group. Abnomal laboratory test values were noted in 10 (7.6%) of the 132 patients treated with FLLX and 7 (5.1%) of the 136 patients treated with PPA, but they as no significant difference between the two groups. 5. In 169 evaluable patients, the clinical usefulness of LFLX (91.6%) was superior to that of PPA (76.7%) with a significant difference (P=0.0111). From these results, LFLX is considered to be a clinically useful medicine in the treatment of infectious enteritis including bacillay dysenstery.

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Fundamental and clinical studies of OFLX were performed against the patients with typhoid fever and typhoid carriers.
1) Clinical and bacteriological effects: Eight patients with typhoid fever and 3 typhoid carriers were treated with OFLX. Daily doses of the agent were 900 mg in 5 dault patients, 600 mg in a child patient and 3 adult carriers. In one case of the remaining 2 adult patients, daily doses of the agent changed from 800 mg to 1200 mg and from 900 mg to 1200 mg in the other one. The duration of the treatment was 9, 14 or 21 days. Clinical efficacies of OFLX against the patients proved 4 cases were “excellent”, 3 cases were “good” and one case was “poor”. The eradication of Salmonella typhi recognized in all cases containing 3 carriers with the exception of the “poor” case. Adverse reactions were observed transiently in 3 patients, such a slight decrease of RBC count, decrease of granulocyte count and elevation of GPT value respectively.
2) Antimicrobial activity: MICs of OFLX against 40 strains of S. typhi were 0.05μg/ml and 0.1μg/ml. The MICs of NFLX, CPFX and T-3262 were almost the same as that of OFLX, and those of ENX, NY-198 and NA were higher than that of OFLX. The peaks of MIC of CP and ABPC, first choice drug against typhoid fever, were 1.56μg/ml and 0.38μg/ml respectively.
3) Serum concentration; Serum concentrations of OFLX were serialy measured on 5 patients through the day. The concentrations of the drug were distributed from 0.82μg/ml to 6.34μg/ml at 6.30 a.m. and from 2.52μg/ml to 11.2μg/ml at 9.00 p.m. Those of the day time showed considerable individual differences.

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A three-year epidemiological study (from January 1985 to December 1987) was carried out on sporadic cases of acute diarrhea.
A total of 2889 fecal specimens in Cary-Blair transport medium were examined for bacterial enteric pathogens, and 832 strains of fifteen species were isolated from 739 specimens, 73 patients having two or more pathogens. C. jejuni shared 51.7%, Salmonella spp. 18.3%, V. parahaemolyticus10.3%, and Aeromonas spp. 15.7% of total fecal specimens.
Isolation rates of C. jejuni and Salmonella spp. in children under the age of fifteen years (19.3%, 6.4%) were higher than those of older years (9.8%, 3.9%), respectively.
Isolation of C. jejuni decreased to 24%(12/50) during 2-4 days storage at room temperature in Cary-Blair transport medium, which showed the necessity of rapid plating for isolation of C. jejunifrom fecal specimens.
Incidence of A. caviae in children up to ten years of age was significantly higher as compared with those of other Aeromonas species.
Desoxycholate-hydrogen sulfide-xylose-agar (DHXA) was used for direct plating technique and for plating after enrichment with alkaline pepton water (without NaCl), which was found suitable as an enrichment medium for Aeromonas spp.
Enterohemorrhagic E.coli (EHEC) 0157: H7 was isolated from 3 patients by using desoxycholatehydrogen sulfide-sorbitol-agar (DHSA).

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Two admitted patients, a 5-year-old Filipino girl and a 29-year-old Indonesian man, who were diagnosed otherwise were concurrently found to harbour Trichuris trichiura eggs in stoll specimens containing 3, 300 and 30 eggs per gram feces (EPG), respectively. A satisfactory response was obtained with administration of mebendazole in the recommended dose of 100 mg twice daily for three consecutive days. Repeated post-treatment fecal examinations revealed 0 EPG. Adverse reaction, either physical or laboratory, due to the anthelmintic was negative. The study indicates that the effectiveness of mebendazole on mild infection with T. trichiura is excellent without any untoward effect.

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A 32-year-old man who had received a kidney transplant from a living related donor, contracted cytomegalvirus (CMV) pneumonitis in the 8th month. He was treated with human interferon-0 and cured of the pneumonitis. After that, his serum creatinine value increased gradually. Renal biopsy revealed the cells with intranuclear inclusion bodies in the renal tubulus and the cells were positive for CMV antigens by direct immunofluorescence test using FITC-labeled mouse monoclonal antibody against an early antigen. He was hospitalized with persistent CMV viruria and treated with ganciclovir. Ganciclovir was administered daily in doses of 3 mg per kg per day for 32 days by intravenous drip infusion and thereafter the same dose was given 3 times weekly for 8 weeks. His urine was positive for CMV before the ganciclovir treatment and became negative on the 31st day after the treatment. The and-CMV effect of ganciclovir was evidenced by gradual decrease in titer (PFU) of infectious CMV in the urine samples. His serum creatinine value decreased from 3.2 mg/dl to 2.8 mg/dl, and no adverse effect was noticed. Thus, ganciclovir is considered to be efficacious against CMV infections in kidney transplant recipients.

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Cryptococcal meningitis is the most frequent fungal infection of the central nervous system, known readily to complicate with immuno-compromised patients. There are only a few cases of primary infection in healthy non-immuno-compromised patietns. Amphotericin-B (AMPH-B) and 5-Fluorocytosine (5-FC) are effective agents against Cryptococcal meningitis, although, their toxicityand drug resistance are limiting factors. However, in recent years Micronazole has been widely used against fungal infections and it's effectiveness has been reported.
This is a 68 y. o. male who was admitted to Toyohashi Municipal Hospital on March 15, 1987 because of headache, vomiting, diplopia and gait disturbance. Continuous lumbar drainage was performed since lumbar puncture revealed surprisingly high cerebrospinal fluid (CSF) pressure and presence of many Cryptococcus neoformans, i. v. AMPH-B and p.o. 5-FC was also administrated. A 7 day course of i. v. AMPH-B and p.o. 5-FC showed no improvement with side effects of macroheaturia and anorexa. Then Miconazole was administrated i. v. and intrathecal (i. t.). The clinical signs and CSF laboratory data improved after a 90 day course of Miconazole therapy and the patient was discharged on August 24. But the patient was readmitted from March 10 to April 30, 1988, because of a slight increase of C. neoformans in CSF (17/mm³) and improved by i. v. and i. t. Micronazole. The total Miconazole dosage was 90.6g (i. t.: 505mg) at the first admission and 36 g (i. t.: 50mg) at the second admission, but no side effect was seen. The reduction of elevated CSF pressure with continuous CSF drainage was also important for the treatment of such cases with increased intracranial pressure.

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Recently cases of tsutsugamuchi disease have been reported in various areas in Japan. We met a case infected in a rural area, Sennan of Osaka prefecture. The patient suffered ered f rom high fever, left axillary lymphadenitis. At his left elbow an eschar was detected, so tsutsugamushi disease was suspected, despite no rash nor CRP elevation. By indirect immunofluoresecence (IF) method, the diagnosis was comfirmed. At an early stage (the fifth day after onset) he was followed by probable DIC, remitted successfully by administration of minocycline.
For 20 years tsutsugamushi disease has not been reported in Osaka prefecture. This case is the second one and the first child case in Wakayama prefecture. Epidemiologic assessments may need to be investigated in Osaka and Wakayama Prefecture.

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