Conventional chromogenic limulus test (toxicolor test) reacts with glucan of bakers yeast as well as endotoxin, because toxicolor test contains factor G which is sensitive to glucan and polysaccharide of fungus. A new endotoxin specific limulus test (endospecy test) was developed to improve reaction which responed only to endotoxin.
The toxicolor test showed the positive reaction to the culture media of candida albicans 7N strain in RPMI 1640 mediun, but the endospecy test did not. D-arabinitol, measured by fluometric enzymatic method, also was positive to culture media.
These results suggested that a combination of the toxicolor and the endospecy test and enzymatic measurement of D-arabinitol could be applied to rapid diagnositic methods of fungal infection.

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We encountered two cases of legionella pneumonia which ran a dramatic course and isolated Legionella dumoffii from one patient and Legionella pneumophila serogroup 5 from the other patient. The patient from whom L. dumoffii was isolated was a 59-year-old male with no basic disease. He presented chill, fever, coughing and other symptoms, starting on July 3, 1986, and his disease was diagnosed as pneumonia at the clinic of his company. The patient was then introduced and admitted to our hospital. On admission chest radiography disclosed zonal pneumonia with an uncler border in the right superior lobe of the lung; as β-lactum preparation was administered, but no effect was obtained and the lung lesion showed a rapid advance. From this condition, we suspected legionella pneumonia and changed the therapy to treatment with erythromcin and rifanpicillin. Despite this, no improvemtn occurred and the patient died on the 26th hospital day. Colonies like Legionella colonies were separated from a total of seven specimens of biopsically aspirated matter from the airway and autopsically collected lung abscess and tracheal secreta, and the bacterium was identified as L. dumoffii based on the biochemical and serological properties. In addition, the patient's serum was found to have an increased antibody titer against L. dumoffii. Based on these findings, the patient's disease was diagnosed as pneumonia as caused by L. dumoffii, a relatively rare bacterium as a member of the genus Legionella.
The patient from whom Legionella pneumophila serogroup 5 was isolated was an 81-year-old man with basic diseases such as heart failure, anemia and hypothyroidism. He presented fever, general fatigue, anorexia and other symptoms, starting around June 2, 1987; pneumonia was suspected and the patient was uregently admitted to our hospital. The patient died of pneumonia of unknown cause on the second hospital day. To clarify the cause, autopsy was conducted; a large number of colonies like Legionella colonies were noted in the lung tissue. Identification test was then conducted and the bactrium was identified as L. pneumophila; we concluded that the patient's pneumonia had been caused by the identified bacterium L. pneumophila. The isolate was further subjected to slide agglutination test and identified as L. pneumophila serogroup 5.

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We measured NK activity before and after administration of erythromycin in 7 cases of chronic respiratory infection, and investigated the relationship between NK activity and improvement of the clinical syndrome.
1) We saw a significant rise in NK activity after treatment of erythromycin. Values before and after ranged from 40.0±21/2% to 62.0±32.7%.
2) There was no correlation between treatment period of erythromycin and the rate of rise in NK activity in the various cases such as rapidly rising cases or slowly rising cases, etc.
3) We saw a rise in NK activity before improvement of the clinical syndrome. Therefore it is suggested that treatment of erythromycin affects a rise in NK activity.

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The existance of virus in facal specimens was investigated by electron microscopy in five outbreaks of nonbacterial acute gastroenteritis. Small round viruses (SRV) were found in all outbreaks. The negatively stained particles were about 30-35 nm in diameter and with ragged edges. Morphological characteristics resembled each other. Immune electron microscopical examination revealed large aggregates of SRV particles and antibody in convalescent sera from patients of all outbreaks. Furthermore, the second outbreak caused by oysters contaminated with SRV seemed to be associated with the Hawaii agent.

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We previously reported that a variant of herpes simplex virus type 1 (HSV-1) designated variant type A was isolated at a much higher frequency in Western Japan than in Eastern Japan. We examined the localization of two other variant types designated B and C. The proportion of the type B and type C variants among 553 fresh HSV-1 isolates from 10 areas in Japan were 5.4% and 1.3%, respectively. The isolation frequency of type B variant in Eastern Japan was 8.3%. It was as high as 20.5% in Iwate area. The frequency in Western Japan was only 3.0%. Type C variant showed no specific geographic localization. These results were discussed in terms of characteristic mode of HSV infection and the history of the Japanese nation.

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It has been recognized by clinical data that most of sepsis occurring in the immunocompromised host are endogenous infection. In recent years, we have investigated the mechanism of these bacteremia and sepsis by experimental studies using neutropenic mice treated with cyclophosphamide. And we evidenced that most pathogens causing bacteremia originated in the intestinal flora of the host. It has been shown that bacteria causing bacteremia were divided into two main groups, causing systemic bacteremia and causing portal bacteremia. Pseudomonas aeruginosa and Morganella morganii belonged to the former, on the other hand, Escherichia coli, Enterobacter cloacae and some other bacteria belonged to the latter.
In this study, we studied the role of the reticuloendothelial system (RES) in the etiology of bacteremia or sepsis, using various kinds of bacteria isolated from bacteremic mice. As a result, the following facts were revealed.
1. It was suggested that the low blood clearance rate of the bacteria was one of the great risk factor of systemic bacteremia, since the blood clearance rate of bacteria causing systemic bacteremia was significantly lower than those of bacteria causing portal bacteremia.
2. Bacteria in the blood were eliminated by the RES, mainly by the liver, and the level of bacterial clearance by the liver was relative to the type of bacteremia which was systemic or portal.
3. It was suggested that the bacterial clearnace by the liver mainly reflected the phagocytosis by Kupffer cells, and especially the adherence of these cells to bacteria as the first step of phagocytosis.

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We examined the immune response against Chlamydia trachomatis (serovar L2) inoculation in mice by measuring the serum interferon (IFN) level, 2'-5'A synthetase (2-5A (S)) activity, antibody titers (IgM, IgG) and the spleen weight as parameters of infection. The interferon activity was detected 6 hrs (400 U/ml) and the activity peaked 12 hrs (450 U/ml) after inoculation, and then gradaully decreased thereafter (24 hrs: 12 U/ml, 36 hrs: undetectable). It was found that Chlamydia trachomatis induces IFN as well as bacteria. To monitor the behavior of IFN action after serum IFN was cleared, 2-5A (S) activity in the spleen cell extract was measured. It was found that the activity reached its peak 1 to 2 days after inoculation and then decreased as well as in infectivity of Chlamydia trachomatis. The activity however was almost not detected in sera of mice after inoculation of heat-inactivated Chlamydial organism (56°C, 10 min). This may indicate that intact Chlamydial organisms were required for induction of IFN. IFN induced in mice was stable in pH 2.0 treatment and IFN induced by Newcastle disease virus inhibited growth of Chlamydia trachomatis in L929 cell cultures in a dosedependent manner. The weight of the spleen gradually increased and reached its peak (2-to 3-fold of the control) in 3 to 5 days after inoculation, and then gradually decreased to the control level. IgM and IgG antibodies to Chlamydia trachomatis were detected by immunofluorescence method and enzyme-linked immunosorbent assay, respectively. The antibody IgM was detected as early as 2 days and reached its peak 3 to 4 days after inoculation. The antibody IgG was detected 7 days after inoculation and gradually increased thereafter.
The change of these parameters show host immune responses against Chlamydia trachomatis. We believe that these findings are useful for understanding the defence mechanism in Chlamydial infection.

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Clinical and bacteriological data of 145 inpatients with septicemia, treated at the hospital of Chiba University School of Medicine from 1972 to 1987, were reviewed by dividing them into three stages. (stages I: 1972-76, stage II: 1978-82, stage III: 1983-87)
Patients with underlying diseases have been increasing: 91.8% of the total patients in stage III. Among the patients with underlying diseases, malignant and hematological diseases occupied about 60%, and in the other diseases, congenital heart diseases have been increasing in number.
As to the organisms isolated, gram positive bacteria have increased, while gram negative bacteria have decreased. In stage III, the rate of gram positive organisms and gram negative ones accounted for 43.1% and 41.2% of all the isolates from the septic patients with malignant & hematological diseases, respectively. In patients with malignant & hematological diseases, α-streptococcus, coagulase-negative staphylococcus, and Fusobacterium sp. have been increasing, whereas, Escherichia coli, Enterobacter sp., Klebsiella sp., and Pseudomonas aeruginosa decreasing. In patients with other underlying diseases, S. aureus, CNS, and non Fermenters have been increasing. Among the patients without underlying diseases, gram positive bacteria accounted for the major part. The decrease of gram negative organisms in patients with malignant and hematological diseases may partially depend on the introduction of polymixin B as the drug of gut decontamination.
The outcome of septicemia in the patients with malignant & hematological diseases has been markedly improving through all the three stages. During stage III, episode mortality and case mortality rate proved to be 23% and 31%, respectively. The introduction of the third generation cephems has decreased the mortality rate for gram negative organisms and contributed to the improvement of the total prognosis.
The prognosis was worst in the case of P. aeruginosa, showing a mortality rate of 50% during stage III. Coincidence rate of blood and other cultures have been largest in the case of P. aeruginosa, so, the drug sensitivity of the strain cultured from other sites is sometimes usefull in the choice of antibiotics.

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A pathological study was carried out in 200 autopsied cases experienced in our department from 1981 to 1988. Eight patients (4.0%) had herpes simplex virus (HSV) infections in their visceral organs. Another one patient was diagnosed as HSV hepatitis through necropsy of liver.
The nine patients (five of them were male) ranged in age from 34 to 70 years (mean, 58). Four patients had non-Hodgkin's lymphoma, and the other included one with adult T-cell leukemia, one with multiple myeloma, one with idiopathic interstitial pneumonia and one with bronchial asthma, however, one did not have any underlying disease. Two patients died of HSV fluminant hepatitis and one died of HSV diffuse interstitial pneumonia.
The most commonly involved organ was esophagus (7/8), followed by tongue (5/8), liver (3/9), spleen, pancreas, lymphnode (2/8), and lung, adrenal, tonsil (1/8). Typical herpetic changes such as ballooning degeneration of cells, multinucleated giant cells, ground-glass nuclei and Cowdry type A intranuclear inclusions were observed at the margin of the ulcer or coagulation necrosis. Indirect immunoperoxidase stain revealed HSV-1 antigen in all of the 9 cases, HSV particles were demonstrated in 2.
Seven patients had concomitant infections with one or more pathogens in addition to HSV, which included cytomegalovirus in 5, aspergillus in 4, candida in 3 and bacteria in 3.

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We experienced 57 episodes of Pseudomonas aeruginosa bacteremia in 55 patients with hematologic disorders in a 16-year period. Ninety-five percent of the patients had hematologic malignancies such as acute leukemia. All but one patient received cytotoxic or immunosuppressive therapy at or prior to the onset of bacteremia.Seventy-seven percent of the episodes occurred during profound granulocytopenia of below 100/mm³.All the patients acquired their infection in the hospital, and 96% had received antibiotic therapy during the preceding two weeks. Periodontal, anorectal, lower respiratory tract, and urogenital infections were the sources of bacteremia in about three-quarters of the episodes.
Periodontal infection tended to progress to cellulitis of the face or the floor of the mouth, often resulting in bacteremia of the unimicrobial type, while anorectal infection predisposed to abscess formation, frequently leading to bacteremia of the polymicrobial type.
Cellulitis at onset was seen in 35% of the episodes. Most sites of infection didnot become apparent until one to three days after the onset of fever, probably because of depressed inflammatory response associated with severe granulocytopenia.The majority of patients complained of gastrointestinal symptoms such as nausea and vomiting, abdominal pain, diarrhea, and abdominal fullness at the onset of bacteremia.
Major complications included bacteremic shock (63%), impaired consciousness (25%), ecthyma gangrenosum or hemorrhagic gangrenous cellulitis (18%), and jaundice (12%). Furthermore, there were one case each of endocarditis and disseminated intravascular coagulation. It wasthus suggested that the clinical picture of P.aeruginosa bacteremia complicating hematologic disorders is influenced by the predisposing conditions associated with the underlying diseases and their treatment.

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We experienced 57 episodes of Pseudomonas aeruginosa bacteremia in 55 patients with hematologic disorders such as acute leukemia over a 16-year period. All the patientswere treated on the same hospital ward. A total of 57 blood culture isolates of P. aeruginosa were divided into nine serogroups. Seventy-four percent of the isolates belonged to four serogroups, which became preponderant one after the other. Surveillance throat and/or stool cultures grew the organisms identical to the isolates from the blood at or prior to the onset of bacteremia in 75% of the episodes. Only 11% of the patients had had P. aeruginosa cultured at admission. The acquisition of the organism was closely associated with antibiotic therapy for other presumed or proved infection. On the other hand, 60% of the episodes occurred during the administration of at least one in vitro effective antibiotic. In five episodes, thepatients had received an antipseudomonal penicillin and an aminoglycoside in combination, both of which proved effective in vitro against the infecting organism, when bacteremia occurred. In managing P. aeruginosa bacteremia complicating hematologic disorders, it was thus suggested that surveillance cultures should be regularly carried out, and that attention should be drawn to the occurrence of “breakthrough” bacteremia.

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We reviewed 57 episodes of Pseudomonas aeruginosa bacteremia in 55 patients with hematologic disorders such as acute leukemia during a 16-year period, focusing especially on the prognosis. Survival at one week after onset was observed in only 39% of the episodes. Prognosis was significantly better in patients with unimicrobial bacteremia than in those with polymicrobial bacteremia (21/42 vs 1/15, p<0.01), in patients without shock than in those with shock (13/21 vs 9/36, p<0.02), in patients with granulocyte count at onset of at least 100/mm³ than in those with more marked granulocytopenia (10/13 vs 12/44, p<0.01), in patients with an increase in granulocyte count by at least 100/mm³ during their infection than in those without any subsequent increase (18/18 vs 4/13, p<0.001), and in patients with total serum protein level at onset of at least 6.0 g/dl than in those with hypoproteinemia (18/32 vs 4/25, p<0.01).
Patients with bacteremia secondary to urogenital infection tended to have a higher one-week survival rate than those with pneumonia followed by bacteremia (4/8, 50% vs 2/9, 22%). With regard to the antibiotic treatment of unimicrobial bacteremia, 14 (70%) of 20 patients receiving therapy with one or two anti-pseudomonal β-lactam antibiotics and an aminoglycoside in combination that were effective in vitro against the infecting organism survived, and so did only seven (32%) of 22 patients receiving therapy with either one in vitro effective β-lactam or aminoglycoside or inadequate drugs (p<0.05). It was thus suggested that P. aeruginosa bacteremia complicating hematologic disorders may improve in prognosis if only efforts are made to augment host resistance, in addition to early diagnosis and effective antibiotic treatment.

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