We attempted to find out whether there is a correlation between viral infection and secondary bacterial infection on the basis of the analysis of the results of the culture of virus and bacteria in the same specimen from the throat swabs of 95 patients who had an acute upper respiratory inflammation when they visited a doctor in private practice in Sendai city during the epidemic caused by influenza virus. Viral culture was performed by a microplate-method devised originally by Numazaki. The influenxa virus was recovered from 56 cases (59%) consisting of 43 cases of type A (Hong-Kong) and 13 cases of type B. From 73 cases, (77%), 79 strains of possibly pathogenic bacteria were recovered, consisting of 43 strains of H. influenzae, 18 strains of S. aureus, seven strains of S. pneumoniae, four strains each of C. freundii and S. liquefaciens and one strain each of 0-haemolytic Streptococcus and B. catarrhalis. The incidence of positive culture of both virus and possibly pathogenic bacteria was high already at the early stage (2-3 days) of the disease. We found no correlation between the type of virus and the species of the microbial isolates. There was no difference in the incidence of positive bacterial culture in relation to age group. We suggest that a secondary bacterial infection occurs already at the early stage of the disease after viral infection because the incidence of positive culture of possibly pathogenic bacteria was high at the above stage.

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To evaluate the vaccine efficacy of acellular pertussis vaccine which has been in clinical use in Japan since 1981, a retrospective study was made by a questionnaire from secondary pertussis attack through family contact in 149 children with pertussis diagnosed in the period form January 1981 through May 1988.
In this study, Takeda's acellular vaccine which contains a high level of FHA, low level of PT and a small amount of agglutinogen, was evaluated.
Secondary pertussis attacks through family contact were found in 17 of 29 siblings (58.6%) not immunized with pertussis vaccine.
On the other hand of the siblings immunized with Takeda's acellular vaccine 27 were exposed to pertussis through family contact and a secondary attack was seen in only one of them (3.4%).
The present study revealed an efficacy rate of 94.2% for the Takeda's acellular pertussis vaccine.

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The biological characteristic and activity of slime isolated from Staphylococcus aureus No.71 and Staphylococcus epidermidis No.2 was studied.
The slime isolated from both strains had high contents of protein, RNA (orcinol reaction-positive substances) and sugar. The slime showed low toxic effect when it was injected intravenously and intraperitoneally into mice. It, however, exhibited potent cytotoxic effect against mouse neutrophils in both ex vivo and in vivo experiments. The enhancement of virulence of Escherichia coli by slime isolated from staphylococci was due to neutrophil-impairing effect. It is suggested that the slime isolated from S. aureus and S. epidermidis may act as an virulence factor.

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In order to elucidate the vulnerability to infection in patients on chronic hemodialysis, as one of the host defense mechanisms, the production of oxygen free radicals by phagocytes was studied in patients by luminol-or lucigenine-enhanced chemiluminescence (CL). Whole blood CL of the patients, in both luminol-or lucigenine-enhanced was significantly higher than that in healthy adults after stimulation by zymosan, PMA, and Staphylococcus aureus (S. aureus) 209 P. However, the CL response of the patients' polymorphonuclear neutrophils (PMNs) with the same stimuli was slightly lower than that in healthy adults.
There were no differences in the levels of opsonins, such as complements and immunogloblins, between the patients and healthy adults.
It appears that any factor in the patients' serum enhances CL response, because of the PMN CL response after addition of patients' serum was higher than that after addition of healthy controls' serum, and the PMN CL response after the addition of patients' serum obtained after hemodialysis was higher than that before hemodialysis.
The addition of erythrocytes to PMNs from healthy adults caused a reduction in the PMN CL response, but the addition of urea and creatinine had no effect.
The CL response induced by microsphere-bound luminol (lumisphere), which makes possible the direct measurement of highly reactive oxygen within phagosomes, was studied in the patients and controls. The CL response in the patients was slightly lower than those in controls, but not significant. These results suggest that not only CL response of phagocytes but also other defense mechanisms should be studied further to make clear the vulnerability to infection in these patients.
In addition, the effect of three antibiotics, cefbuperazone, cefminox and latamoxef on luminolenhanced CL of whole blood was studied in healty adults and the patients. After 3-hour exposure to those drugs at subinhibitory concentration (1/4 MIC), Klebsiella pneumoniae (K pneumoniae) 163 treated by drugs induced higher CL response of whole blood than that by untreated bacteria in both healthy adults and the patients, and the peak time of the CL response induced by the drug-treated bacteria was shorter than that by untreated bacteria. This study suggests that the three drugs at sub-MIC work in partnership with host defense against infection due to K pneumoniae even in patients on chronic hemodialysis.

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Different types of coxsackieviruses group B were isolated from the sewage consecutively annually from January 1982 to March 1987: type 3 in 1982, type 4 in 1983, type 2, 4 and 5 in 1984, type 3 in 1985, and type 4 in 1986 were found. These viruses caused large epidemics among children aged 1 to 4 and proximities. Herald waves for the epidemics were observed six times during this period, and the viruses were detected in a brief period of isolation.
With respect to the periodicity of these viruses, the cycles for types 3 and 4 were 2 to 3 years, and longer cycles seemd to be exhibited by types 1, 2, and 5. The onset and termination of the epidemics will only be grasped by surveys throughout the year. HEp-2 cells exhibited the best sensitivity to the viruses.

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Antimicrobial agents susceptibility of 42, 940 strains of clinical isolates (from 1979 to 1986) were investigated and the data were analyzed on the basis of the sources of isolates; materials from in-and out-patients or from the different hospital units. Bacteria studied were limitedto the species of which isolates were 100 or more durig 1979 to 1986. The following results were obtained.
i) When the antibiotic susceptibility of the isolates from the out-patient-materials were compared with that from the in-patient-materials, the following 13 bacterial species isolated from the former source were found to be more susceptible to antibiotics than that of the latter. These were S. aureus, S. epidermidis, E. coli, Citrobacter sp., Klebsiella sp., Serratia sp., P. vulgalis, P. rettgeri, M. morganii, P. aeruginosa, P. putida, S. sonnei and Salmonella sp..
ii) The frequency of isolation and their antibiotic susceptibility of S. aureus, Enterobacter sp. and P. aeruginosa from both the in-and out-patients were comparable through 1979. However, S. aureus isolated from the in-patient-materials tended to show increased antibiotic resitance since 1983. This is probably due to the frequent use of the 3rd generation cephalosporins.
iii) Comparison of the antibiotic susceptibility of the isolates from the different hospital units showed that the resistant strains were more frequently isolated in the materialsfrom the urology unit and the susceptible strains were more frequently isolated in the materials from the infectious diseases unit.
iv) Antibiotic resistant S. aureus and P. aeruginosa increased abruptly since 1983 in the materials from the surgery and urology unit, respectively.
On the basis of these results, it can be stated that antibiotic resistant S. aureus and P. aeruginosa are increasing in sugical and urological materials, respectibly, and may also increase in the near future.

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Combination of aztreonam/amikacin/ticarcillin (AAT) and latamoxef/amikacin/ticarcillin (LAT) were compared in a prospective ramdomized trial of empiric therapy for febrile neutropenic patients with hematological malignancies. Low dose amphotericin B was also added to each regimen from the beginning.
Of 45 evaluable episodes, 23 were treated with AAT and 22 with LAT. The response rates were 61 percent for AAT and 50 percent for LAT, statistically not significant. There was one infection-related death among patients assigned to AAT therapy and also one among those assigned to LAT therapy. Dose escalation of amphotericin B seemed to be effective for those patients who did not improve with initial therapy.

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The effect of bacterial infection on immunologic parameters was investigated in the elderly, with special reference to natural killer (NK) cells. The parameters studied were percentage of lymphocyte subsets, interleukin-2 concentration and NK cytotoxicity. In the bacterial infection group (n=15), there were several changes in the immunological parameters when compared with the healthy aged control group (n=42): decreased in the lymphocyte number, decreased percentage of CD4⁺ cells resulting a lower CD4⁺/CD8+ ratio, diminished NK activity without a change in the percentage of NKH-1+ cells, and increased CD25+ cells which consisted mainly of CD25+ NKH-1+ cells. These changes recovered in all patients examined (n=7) following resolution of the infection. Decreased NK activity, although transient, may be related to be susceptible to infection or to be prolonged course of infectious diseases in the elderly.

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A 75 year old woman who was admitted to Higashisaga National Hospital due to chronic bronchitis showed a high fever (39.2°C) and marked lymphadenopathy of the bilateral inguinal lymphnodes. Chest X-ray showed diffuse infiltration. Cryptococcus was detected in biopsied lymphnodes. Although 5-fluorocytosine, miconazole, amphotericine-B were administered for six weeks, she died and an autopsy was performed. Disseminated cryptococcosis was observed in the lung, liver, spleen, kindey, bone marrow, and lymphnodes of the lung hilum, paratrachea, retroperitoneum, gall bladder and groin.
She was a human T cell leukemia type I (HTLV-I) carrier, and this could be related to disseminated cryptococcosis.

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A 60 year-old woman, who was pointed out as having hyperglycemia, was admitted to our hospital, with a two-week history of fever.
Blood sugar on admission was 424mg/dl and blood cultures yielded Streptococcus agalactiae. Systolic and diastolic heart murmurs were heard. Echocardiography showed aortic regurgitation and vegetation on the aortic valve. Penicillin-G (4 million units every 4 hr) iv and streptomycin (1 g every 12 hr) im were started. Chemotherapy was continued for 48 days. After chemotherapy, aortic valve replacement was done.
We reported a very rare infective endocarditis case due to Streptococcus agalactiae.

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The patient is a 39 year-old Japanese male who had traveled to Southeast Asia from March 14, 1987 and returned on April 2. On April 3 and 5, he had a high fever with chills and he was admitted to our hospital. Despite initial treatment with antibiotics, a high fever over 39°C appeared with a 48 hour periodicity.
On the 8th day after admission, malarial parasites were identified on the peripheral blood smear after repeated trials. Combined with a raised serum antibody titer, Plasmodium vivax malaria was diagnosed. He was successfully treated with the sulfadoxine 500 mg and pyrimethamine 25 mg (Fansidar^®) and body temperature was normalized after the 12th day.
More interestingly, the patient showed pancytopenia without splenomegaly. The bone marrow aspiration revealed hypoplasia of erythroblasts, granulocytes and megakaryocytes. Because of this pancytopenia in the peripheral blood and hypoplasia of the bone marrow which improved after recovery from malarial infection, it was indicated that they were caused by the malarial infection. Generally, it is considered that anemia in malarial patients is caused by destruction of the blood cells by parasites and/or hypersplenism and compensatory hyperplasia of the bone marrow is seen. On the contrary, this case showed pancytopenia accompanied with hypoplasia of the bone marrow probably due to the malarial infection suggesting a new aspect of pathogenesis in the hematological abnormality of the malarial infection.

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A 66-year-old woman was admitted to the Medical College Hospital of Oita on February 23, 1988, because of headache and fever. Chest X-P and chest CT findings showed a coin lesion in r-S⁴. Cryptococcus neoformans was isolated from the CSF. Abnormal lymphocytes with lobulated nuclei were found in 0-5% of peripheral leukocytes. The ATLA-antibody was positive and bone marrow smear showed normal myelogram. According to these data, we diagnosed the patient as smouldering adult T-cell leukemia accompanied with pulmonary cryptococcosis and cryptococcal meningitis. C. neoformans disappeared from the CSF and cryptococcal antigen was not detectable after Amphotericin B and Flucytosine treatment.
On April 1, the patient complained of a dry cough, high fever and dyspnea. A chest X-ray showed bilateral patchy infiltrations. By the methenamine silver staining, cysts of Pneumocystis carinii were found in the specimens of transbroncheal lung biopsy and bronchoalveolar lavage fluid. The abnormal shadow on chest X-ray disappeared after TMP-SMX and aerosolised pentamidine treatment.

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