We studied the efficacy of NY-198 (Lomefloxacin), a new quinolon derivatives, in the 46 cases of nongonorrhoeae urethritis. NY-198 was mainly administered in doses of 600 mg three time a day for 7-14 days. The clinical and bacteriological effects of N. gonorrhoeae and C. trachomatiswere already reported from many other authors, so we mainly summaized the cases of U. urealyticum. The 21 cases of isolated U. urealyticum, 19 cases of C. trachomatis and 2 cases of N. gonorrhoeae were all eradicated after this treatment. We concluded that NY-198 was a very useful drug for sexually transmitted disease.
Patients with HTLV-I-associated myelopathy (HAM) show subclinical pulmonary involvement. Bronchoalveolar lavage (BAL) studies of HAM patients have shown that there is T-lymphocytosis in association with increased soluble IL-2 receptor levels in BAL fluid. Furthermore, BAL lymphocytes as well as peripheral blood lymphocytes obtained from HAM patients proliferated spontaneously when cultured in vitro. The lymphocytes proliferating were T-lymphocytes (both CD4+cells and CD8+ cells) and released soluble IL-2 receptors in supernatant fluid. These results indicated that T-lymphocytes were activated in HAM patients. In conclusion, activated T-lymphocytes may play an important role in the development of the spinal cord and pulmonary lesions in HAM patients.
A novel human native immunoglobulin liquid preparation for intravenous injection, C-425, was used in combination with antibiotics to study its efficacy, safety, and usefulness in 262 patients with severe infections which had not responded to antibiotic therapy of 3-day or more duration. As a result of the Committee judgment, 12 of the 262 patients were excluded from this study; 87 were included only in safety analysis; 163 (62.2%) were included in efficacy, safety, and usefulness analyses (complete inclusion). The complete analysis of 163 patients consisted of 93 patients (57.1%) with suspected septicemia, 33 (20.2%) with pneumonia, and 18 (11.0%) with septicemia. Eighty percent or more of the patients had severe underlying diseases such as leukemia and malignant lymphoma. Clinical efficacy of C-425 was judged by the doctors in charge to be “excellent” or “good” in 49.1% of the total cases. The rate of effectiveness was calculated at 74.8% when “excellent”, “good” and “fair” cases were all included. Similarly, the rate of effectiveness calculated from the results of Committee judgment was 53.4% when “excellent” and “good” cases were included, and 68.7% when “excellent”, “good” and “fair” cases were included. Microbiological assessment was conducted in 19 patients. Causative organisms were eliminated in 11 patients, decreased in number in 1, persisted in 5, and replaced in 2. The rate of elimination was 57.9%. Side effects appeared in 6 of 250 patients (2.4%). It was judged that 3 patients (1.2%) of the 6 were affected by the drug or suspected to be affected, but they were not considered clinically important. Hepatic disfunction was found in 4 patients (1.6%) of the 250; but it was not clarified whether this was related to the drug. From these results, C-425 was considered to be an effective and very safe drug for treating severe internal infections.
A newly developed human immunoglobulin liquid preparation for intravenous injection was studied for efficacy, safety, and usefulness in treating severe and/or refractory infections in children receiving antibiotic treatment. It is suggested that C-425 is a useful intravenous preparation of human immunoglobulin for the treatment of severe and/or refractory infections in pediatrics. C-425 was administered to 87 inpatients with severe and/or refractory infections at 23 institutions nationwide. The Committee selected 61 cases for the present analysis. Physicians in charge judged clinical efficacy of C-425 to be “excellent” in 23 cases (40.4%), “good” in 24 (42.1%), “fair” in 7 (12.3%), “poor” in 3 (5.3%), and “unknown” in 4. The efficacy rate was calculated at 82.5% when the “excellent” and “good” cases were combined, and 94.7% when the “fair” cases were also included. According to the Committee's judgement, the efficacy of C-425 was “excellent” in 27 cases (44.3%), “good” in 18 (29.5%), “fair” in 7 (11.5%), and “poor” in 9 (14.8%). The efficacy rate was 73.8% when the “excellent” and “good” cases were combined. The rate increased to 85.2% when the “fair” cases were added. Organisms were identified in 31 cases, and the time course was followed in 19 instances. Organisms were eliminated in 12 cases (63.2%), decreased in number in 2 (10.5%), and persisted in 5 (26.3%). Eradication rate was 63.2%. One of the 87 patients died of fulminant hepatitis 2 days after the end of the treatment. The remaining 86 cases were analyzed for the safety of C-425. A skin rash was observed in one case. Laboratory examination revealed increase in transaminase levels in a total of 8 cases; both in GOT and GPT in 5, in GOT alone in 2, and in GPT alone in 1. These findings were not clinically important.
In a nationwide study conducted in 11 surgical institutions of C-425, a newly developed human native immunoglobulin liquid preparation for intravenous injection, was combinedwith conventional antibiotic treatment to investigate the efficacy and safety. A total of 47 patients with severe infections which had not symptomatically responded to 3-day or longer treatment with any antibiotics was included. Doctors in charge judged the efficacy of C-425 to be “excellent” in 3 patients, “good” in 13, “fair” in 15, and “poor” in 4. Thus, a total of 16 patients (45.7%) was judged to have responded to C-425 when the “excellent” and “good” responses were combined. The number responding was 31 (88.6%) when the “fair” cases were also included. Excluding 31 patients who did not meet the Committee's criteria, the Committee judged the efficacy of C-425 in a total of 16 patients; the efficacy was “excellent” in 2 patients, “good” in 4, “fair” in 9, and “poor” in 1.The number of responding patients was 6 (37.5%) of the 16 when the “excellent” and “good” cases were combined, and 15 (93.8%) when the “fair” cases were added. Bacteriological assessment was conducted in a total of 9 patients. Causative bacteria were eradicated in 3 patients, decreased in number in 1, replaced in 2, and persisted in 3. Thus, bacteriological efficacy was observed in 6 of the 9 patients (66.7%). Neither adverse reactions nor drug-related laboratory abnormalities were observed in the 47 patients.
The bacteriology of the isolates from the sputum or the throat swab of patients with respiratory infections visiting a doctor in private practice in Sendai city during the period from March in 1988 to February in 1989 was documented, and their sensitivity to 45 anitimicrobial agents was determined. Of the 568 patients, 514 cases had acute pharyngitis, 8 cases each had acute tonsillitis and acute bronchitis, 7 cases were acute pneumonia, 6 cases had herpangina, 18 cases had hand-foot-mouth disease with the signs of respiratory infections, 5 cases had variacella with the signs of respiratory infectins and 2 cases were mumps with the signs of respiratory infections. Three hundred strains of potential (≥107 CFU/ml) pathogens were recovered from 293 of the 568 cases, which consisted of 124 strains of Haemophilus influenzae, 58 strains of Streptococcus pneumoniae, 45 strains of Straphylococcus aureus, 26 strains of Branhamella catarrhalis, 25 strains of Streptococcus pyogenes, 9 strains of Klebsiella pneumoniae and 13 strains of other species, not including non-fermentile gram-negative bacteria such as Pseudomonas aeruginosa and Acinetobacter calcoaceticus. Staphylococcus aureus and other strains were documented simultaneously in 6 out of 7 cases in which multi-organisms were recovered. Many strains of Staphylococcus aureus were isolated from young patients throughout the year. On the other hand many strains of Branhamella catarrhalis were isolated from elederly patients in winter. The sensitivity of 45 antimicrobial agents of 231 of 300 strains was determined by sensitivity disks (EIKEN, Japan). No strain of the Haemophilus influenzae in this study was resistant to ampicllin. None of the Streptococcus pneumoniae and Streptococcus pyogenes was resistant to ampicillin or cefazolin. None of the Staphylococcus aureus was resistant to cloxacillin, cefazolin, gentamicin or ofloxacin. We conclude from the above results that antibiotic-resistant strains are found presumably only in a very few cases in primary care clinic.
The correlation of pathogenic and immunologic characteristics of Rickettsia tsutsugamushi to clinical findings of patients with tsutsugamushi disease in Miyazaki was investigated. In two immunological types, Hirano type strains seemed to have higher virulence to mice than Irie from the findings during the course of infection and on autopsy. A strain of Hirano type was so virulent as to succumb to the infection. As to clinical findings, incidence of hepatomegaly was slightly higher in Hirano type patients than Irie, which is one of the signs in severe type tsutsugamushi disease. This was supported by the higher mean value and frequent appearence of abnormality in liver function test, sGOT, sGPT and LDH, in this type of patients.
We continued the epidemiological survey on sexually transmitted disease due to Chlamydia trachomatis in Okayama Prefecture. The results obtained from October 1984 to October 1988 are briefly summarized in this paper. 1) Sera from outpatients with suspected chlamydial infections were tested for IgG antibodies to Chlamydia trachomatis by the microplate immunoluorescence antibody technique (MFA). Fifty five percent of the male and 61% of the female patients were positive for anti C. trachomatis IgG. 2) Clinical swabs obtained from 735 males and 251 females were examined for Chlamydia trachomatis antigens by the isolation method and direct immunofluorescence tests (DFA) were carried out simultaneously. C. trachomatis was recovered from 34% of the male and 22% of the female patients. 3) The age structure of the female patients was younger than the male patients. Female patients under 29 years of age were 57% of all female antigen-positive cases.
In order to establish a stable and uniform cultural method in a cell line HaLa 229, we studied the effect of DEAE-dextran, centrifugation, cycloheximide and their combination on infectivity and progeny yields of Chlamydia psittaci isolated mainly from birds. Of 11 strains (10 avian and one human origin Ito strain), 9 showed maximal inclusion formation when host cells were treated with a combination of dextran and cycloheximide. Of the other two strains, one showed maximum inclusion formation with dextran alone and any treatments did not enhance the inclusion formation in another strain. Maximal yields of progeny at 48 hours after infection was observed in 5 (4 avian and Ito) strains when host cells were treated with a combination of dextran and cycloheximide. One avian strain showed maximal yields with a triple treatment; dextran and cycloheximide combined with centrifugation. At 72 hours after infection, three avian and Ito strains showed maximal yields with a double treatment (dextran and cycloheximide) and other two avian strains showed that with a triple treatment (double treatment added with centrifugation). The results suggest that in a cell culture HeLa 229, the treatment with dextran and cycloheximide may provide an efficient isolation and growth pattern for most strains originated from birds.
In 1987 and 1988, in 9 elementray schools, the percentage of children who received two sessions of vaccination and the overall rate of absenteeism resulting from influenza were determined for each class, and their relationship was investigated. The following results were obtained. 1) The mean vaccination rate was 58.6% among 157 classes in 1987, whereas it was 29.9% among 151 classes in 1988, the rate being significantly higher in 1987. 2) The mean overall rate of absenteeism was 1.524% in 1987, which was significantly lower than the corresponding rate, 2.802%, in 1988. 3) There was a significant negative correlation between the vaccination rate and the overall rate of absenteeism in 7 of the 9 schools in 1987; the overall rate of absenteeism became significantly low with an increase in the vaccination rate. 4) No such trend, however, was noted in any of the schools in 1988. 5) The difference between the results in 1987 and those in 1988 seems to be attributable to the facts that variability of the prevailing strains of influenza was low (Vo, 82%) in 1987, in addition to the high vaccination rate in that year, and that influenza virus type B having a high variability (V3, or more, 78%) prevailed in 1988, when the vaccination rate was low.
In this paper, the patients were from in-patient in epidemic area. The diagnosis was made by exeluding other type of virus hepatitis, and has been proved that it is Epidemic non-A and non-B Hepatitis (ENANB · H) and it was spreaded by gastrointestinal tract. The mode of transmission was similar to hepatitis A. The clinical manifestations and abnormality liver functions were mild than hepatitis A or B. Most of them were young and middle-aged people. The pregant women were nore susceotible to this type of hepatitis and the mortatity was higher. The hemorrhage may be primary factor of the death of ENANB · H. The histological findings were inflammation in the portal area, Cholestasis and Sportt-patchy necrosis. On transmission electron microscope (TEM), the virus particle, 26-30 nm, presented in cytoplasm. The patients wer followed up during the convalescence, which tend to chronization. It is reported that ENANB · H has been epidemic in neibouing countries-India, Burma, Nepal, Soviet and Parkistan etc for ten years. Since 1980, the spordic epidemic has presented in south Xinjiang. The outbreak epidemic was presented from Sep. 1986 to May 1988, in this paper the clinical manifestations were reported.
In a seroepidemiological study of hepatitis B virus (HBV) over 7 years from 1982 to 1988, in a fixed population of 633 healthy students (15-20 years old), it was found that one HBV carrier who had adw subtype of HBV had also become sero-positive to r subtype, suggesting the superinfection with r subtype of HBV to the carrier. Then, some serological markers of HBV were further examind in the other 10 HBsAg positive carriers in the same population, and discussed the possibility of horizontal transmisison of r subtype of HBV in the pupulation. Of the 10 HBsAg positive carriers, 5 possessed adr subtype, 2 adwr, 2 adw, respectively, and the remaining one was not tested. Four of seven r subtype of HBsAg positive carriers exhibited pre-S2Ag and HBeAg activities which were considered as infectious markers. Epidemiological survey was carried on the four carriers with special refference to the possibility of the superinfection. As a result, it is still unclear the source of the superinfection, but at least, iatrogenically accidental transmission at the time of vaccination and contact infection in everyday life in school may be unlikely to attribute to the horizontal transmission.
A study was made on the passive protection against rotavirus-induced diarrhea. Chickens were immunized with bovine rotavirus (serotype 1) and the egg yolk immunoglobulins containing a high titer anti-rotavirus neutralizing antibody (CEYI) was obtained. The CEYI was then orally administered to specific-pathogen-free cats, and the cats were infected with human rotavirus. The cats treated with the CEYI remained clinically healthy after challenge, whereas diarrhea occurred in the pracebo-fed cats as control. Virus antigens were detected in feces in all the diarrheal cases in the placebo-fed cats but were only sporadically detected in the CEYI-fed cats. However, the cats were only protected against rotavirus infection by the presence in the gut at the time of inection of the antibody. These results suggested that continuous administration of the CEYI is capable of preventing children from diarrhea induced by human rotavirus infection and viral shedding.
Six to seven-week-old ICR mice were inoculated intranasally with C. pneumoniae TW-183 strain and observed for sickness and death. The inoculated mice showed weakness within the 1st day and decrease in weight were observed, however, mice were cured within 7 days after inoculation. No death was observed. Histopathological studies of the mice lungs clearly revealed interstitial pneumonitis ont he 3rd day and parenchymal pneumoniae on the 5th day after inuculation. Pathological changes were, however, improved in 10 to 14 days after inoculation. Inclusions were detected from the 1st to 10th day in broncho-epithelial cells and alveolar epithelial cells by DFA stain and TWAR specific monoclonal antibody. Serum antibodeies, IgG and IgM, were assayed by microplate immunofluorescence antibody technique (MFA). From 7 to 14 days after inoculation, the titer of IgG rapidly increased and reached 1: 4096 and then this titer level was maintained for 3 weeks and more. On the other hand, IgM was detected on 7th day and increased up to 1: 16 on 14th day. However, t he IgM titer declined within 1 month. To examine the specificity of the antibody titration, IgG in sera prepared against C. pneumoniae TW-183, C. psittaci Cal 10 and C. trachomatis L2 strains were assayed by MFA using in situ inclusions of each strain and compared. The results indicated that IgG titer in homologous combination between antigen and antiserum was alwasys 2 times higher than that of heterologous combination, suggesting strongly that the chlamydial species responsible for the infection could be differentiated by the comparison of IgG titers obtained in the MFA titration.
An epidemic disease with maculopapular exanthem, especially on the face and the extremities was observed form June to July of 1988 in Kitakyushu-shi. The clinical findings of 15 patients (male 12, female 3) with exanthem were described. Symptoms included fever (10 patients), diarrhea (5), cough and nasal discharge (2), headache and vomiting (1), and hyperreflexia (1). Echovirus type 18 was isolated from throat swabs and stool samples of 9 patients.
Rickettsial infections of a spotted fever group have recently been experienced in Japan. Although there have been 50 cases reported by this time, they were exclusively distributed in the areas along the Pacific coast. We report in this paper the first case of spotted fever group rickettsiosis in Shimane prefecture, an area faced to the Japan Sea. A 57 year-old man with high fever, general fatigue and rash was admitted to the hospital of Shimane Medical University at the end of September 1987, who had been treated with cefaclor for a few days without effect before his visit to the University Hosptial. Physical examination revealed erythematous eruption, eschar on the left side of the abdomen, and generalized lymphadenopathy. Hepatosplenomegaly was not detected. Laboratory studies showed normal leukocyte counts with relative lymphopenia, high ESR and increased CRP. Transaminase levels were slightly elevated. Paul-Bunnel and Weil-Felix tests resulted in negative. Specific immunofluorescence tests demonstrated that IgG and IgM antibodies of acute-phase serum to Rickettsia japonica, a spotted fever group rickettsia isolated from patients in Japan, were not detected, while both IgG and IgM antibody titers of convalescent-phase serum increased to 1: 320. Convalescent-phase serum reacted at significantly lowr titers with R. typhi as well as other pathogenic spotted fever group rickettsiae. The patient was treated with ofloxacin for six days and then with combination of ofloxacin and minocycline. It should be noted that clinical symptoms such as high fever and general fatigue disappeared during a single therapy with ofloxacin. The present report describes that, in addition to the first case of a spotted fever group rickettsiosis in the area of the Japan Sea, this case was the first disease with systemic lymphadenopathy in Japan. It was also suggested that ofloxacin is a useful treatment for the spotted fever group rickettsiosis.