The distribution of serotypes of Chlamydia trachomatis in urogenital infection in Sapporo was studied by typing 30 isolates with Monoclonal antibodies and by testing patient sera from 134 individuals with the micro-immunofluorescence test.
1. Among 30 isolates, the majority of strains were identified to be types D and E (23%), followed by G (13%), F (10%), H (10%), I (7%), J (7%) and K (7%) in this order.
2. In 134 patients sera, the most frequent antibody types were B/ED (64.8%), followed by C/J (13.3%), G/F (7.8%), H/I/J (7.1%) and K (2.3%). Thus, serovar D and E were the same predominant type of Chlamydia trachomatis in urogenital infection in Sapporo, as in the USA and Europe.

View full abstract

Comparatively little is known about the immunoprotective mechanisms against K. pneumoniae pneumonia. Whether the antibody against K. pneumoniae protects against K. pneumoniae pneumonia is not fully known. This study was designed to investigate some of the murine host factors responsible for immunization with K. pneumoniae DT-S to infection by aerosol inhalation with K. pneumoniae DT-S: in particular, the role of the antibody and the immunoprotective antibody which was the antibody against which component of K. pneumoniae was investigated. Mice preimmunized by aerosol inhalation with live or formalin-killed DT-S and mice preimmunized intravenously with live DT-S did not protect against infection by aerosol inhalation with DT-S. Mice preimmunized intravenously with formalin-killed DT-S were shown to protect significantly against fatal experimental K. pneumoniae pneumonia (p<0.01). This immunoprotection against fatal experimental pneumonia was related to titers of anti-ultrasonicates of DT-S antibody detected by an Enzyme-linked immunosorbent assay (ELISA). That this immunoprotection is dependent on the antibody against which component of DT-S was investigated by ELISA. An ELISA was performed to detected antibody against purified capsular poylsaccharide (CPS), lipopolysaccharide (LPS) and outer membrane proteins (OMP). Mice preimmunized intravenously with formalin-killed DT-S were detected to have antibodies against LPS, but not to CPS and OMP. Then the immunoprotection against fatal experimental pneumonia was related to titers of anti-LPS antibody. These findings indicate that anti-LPS antibody may play a major role in the protection against fatal experimental K. pneumoniae pneumonia.

View full abstract

We compared hospital acquired pneumonia (HAP) with nursing home acquired pneumonia in the elderly.
There were no differences in the underlying diseases, clinical signs and symptoms between HAP and nursing home acquired pneumonia, but activities of daily living were poor in HAP than nursing home acquired pneumonia.
By the bacterial studies from Transtracheal aspiration (TTA), S. aureus, K. pneumoniae, P. aeruginosa and anaerobes were more isolated in HAP. On the other hand, S. pneumoniae and H. influenzae were isolated more in the nursing home acquired pneumonia.
In the laboratory data, no difference was detected in inflammatory reaction between both groups, but in immunological data, especially complement C₃ and tuberculin skin test were markedly reduced in HAP.
The prognosis were significantly poor in HAP because the fatal rate was higher in HAP than nursing home acquired pneumonia.
With regard to HAP in the elderly, severe underlying disease, poor whole body state, aspiration, bacterial resistence to drugs, superinfection and polymicrobial infection were the factors predisposing difficulty in treatment of pneumonia in the elderly.
From the above results, prevention is the most necessary in HAP

View full abstract

Bactericidal activity in compromised host's serum i.e. patients with cancer, the elderly, diabetes, was stronger than that in normal serum against Proteus mirabilis (P. mirabilis) but was weaker against Klebsiella pneumoniae (K. pneumoniae) . Against Escherichia coli (E. coli) , bactericidal activity on serum of patients with cancer was weaker in the following order, that in elderly serum, that in diabetic serum. Against Proteus vulgaris (P. vulgaris) , bactericidal activity in elderly serum was similar to that in normal serum but was stronger than that in serum of patients with cancer. Against Pseudomonas aeruginosa (P. aeruginosa) and Staphylococcusa ureus (S. aureus) , bactericidal activity in elderly serum and diabetic serum was similar to that in normal serum but was weaker than that in serum of patients with cancer.
Piperacillin showed bactericidal activity in nutrient broth, normal serum and compromised host's serum at a concentration of 1/4 MIC against E. coli, P. mirabilis and P. aeruginosa. Aspoxicillin showed bactericidal activity in nutrient broth, and bactericidal or bacteriostatic activity in normal serum and serum of patients with cancer against E. coli and P. aeruginosa. While cefazolin and cefmetazole slightly inhibited the growth of bacteria in nutrient broth, they showed hardly any bactericidal activity in normal serum and compromised host's serum.

View full abstract

JC virus (JCV) and BK virus (BKV) are known as small DNA type tumor virues belonging to the human polyoma virus. The infectious state of these viruses has not yet been examined extensively in the aged persons; therefore, antibody measurements were made in 349 healthy volunteers from 20 to 90 years old and 383 cases of in-patients from 60 to 100 years old. As controls, measurements were made on the antibody titers to the herpes-type viruses which are known to be reactivated as the immunologic state of hosts decrease.
The results obtained were as follows;
1) In the aged cases over 60 years old, the average HI antibody titers for JCV were significantly higher than that for BKV.
2) In the aged persons of the prevalance rate the high antibody titer (1024<) for JCV was also higher than that for BKV.
3) In the results with EIA (EIA test human polyoma viruses common antigen), the significant increase in the antiboty titer was observed in the aged older than 70.
4) The average antibody titers of HSV and CMV, tended to increase as the age advanced until 60 and to decrease with age over 70. These results indicate that JCV is reactivated in a high rate in the aged (70<) persons.

View full abstract

Isolates from various clinical materials in 13 hospitals in Akita prefecture and their drug susceptibility were investigated by the Chemotherapy Research Commitee of Akita Prefecture during the period from Dec., 1987 to Feb., 1988. The results were as follows:
1. The total number of isolates was 8, 387, including Staphylococcus aureus (18.9%), Pseudomonas aeruginosa (10.9%), S taphylococcuse pidermidis (7.3%) and Enterococcusf aecalis (6.6%).S. aureus and P. aeruginosa were detected more frequently in the larger hospitals.
2. The detection frequency of S. aureus from the sputum, throat swab and pus exudate was also very high. There was a diversity in isolates from the urine and the frequency of Escherichia coli was low. More than half of the isolates from the blood were S. epidermidis and S. aureus. Many kinds of bacteria were detected from pleural fluid and ascites, but the isolate showed no particular tendency
3. The susceptibility of S. aureus to oxacillin were variable in hospitals, and the susceptibility to cefazolin were even lower. Low susceptibility were also seen with norfloxacin. S. aureus showed the highest susceptibility to minocycline. The susceptibility was lower for inpatients than for outpatients. P. aeruginosa showed low susceptibility to cefsulodin. The number of ampicillin-resistant Haemophilus influenzae isolates tended to decrease. Enterobacter cloacae showed a low susceptibility for cephems. Serratia marcescens showed low susceptibility to many drugs.
Based on the above results, we concluded that attention should be paid to S. aureus, P. aeruginosa and Enterobacter in clinical practice.

View full abstract

The serum diphtheria antitoxin levels in Japanese adults were investigated and the persistence of diphtheria toxoid effect was evaluated. The subjects consisted of 56 volunteers (20-31 years of age) who had received regular inoculations of diphtheria and pertussis vaccine (I and II or III phases). They had been immunized according to the Vaccination Law (old version) revised in 1958. The length of time after the last inoculation of diphtheria toxoid was speculated to range from 10 to 20 years. Serum diphtheria antitoxin was determined by passive hemagglutination method. Antitoxin level was 0.025 HAU/ml in 1 subject (1.8%), 0.05 in 2 (3.6%), 0.1 in 2 (3.6%), 0.2 in 8 (14.3%), 0.4 in 7 (12.5%), 0.8 in 12 (21.4%), 1.6 in 7 (12.5%) and more than 1.6 in 17 (30.4%). Results indicated that 55 of 56 (98.2%) possessed a higher level than the prophylaxis standard (0.05 HAU/ml). Since the current Vaccination Law prescribes a lower amount and fewer inoculations than the old law, the number of adults possessing prophylactic antitoxin level may decrease in the future. Further investigation of antitoxin level in adults needs to be continued.

View full abstract

Tonsillitis is the most common disease in the otorhinolaryngeal location. For most patients, tonsillitis is attributed to a group A streptoccal infection if the throat culture is positive for that organism or to a viral infection if the throat culture is negative. However, recent studies have shown that Chlamydia trachomatis can produce tonsillar infection. In this study, we evaluated the efficacy of Rokitamycin, a 16-membered ring macrolide antibiotic agent, in the treatment of tonsillitis associated with C. trachomatis. In 26 of 28 (92.9%) patients from whom C. trachomatis was isolated, the organism was eradicated by antimicrobial treatment with Rokitamycin of five days to three weeks' duration. In 25 of the 26 patients, they were totally free of tonsillar symptoms.

View full abstract

Adherence ability to catheter materials for intravenous use of coagulase-negative staphylococci (CNS) which is frequently isolated from prosthetic implants and medical devices inserted into the body was studied, and the mechanism of catheter-associated infections and the prevention against that were discussed. Difference of the adherence ability of CNS to various kinds of catheter materials was found, and adherence ability to the catheter materials was correlated with that of human epithelial cells in culture. CNS isolated from intravenous catheters had higher adherence ability to the human epithelial cell cultures than isolates from other clinical sources. Among 4 kinds of catheter materials, including ethylene vinyl acetate (EVA), polyvinyl chloride (PVC), silicone (Sil) and polyurethane (PUR), the adherence ability of CNS on the EVA containing barium was highest, and Sil treated with tungsten showed the lowest. The physicochemical properties of both the bacteria and the catheter materials, hydrophobicity of the bacterial cultures and the catheter materials, negative charges on surface of the bacteria, surface structure of the catheter materials, additives to the catheter materials, and coating the catheter surface gave great effects on the adherence of CNS to the catheter materials. In addition, as biofactors, fibronectin and PROTEAMIN-HICALIQ solutions enhanced the adherence of CNS. These results suggested that catheter materials having a smooth surface and higher hydrophobicity, treated with tungusten and coated with urokinase were effective on the suppression of the adherence to catheter materials. In addition to the improvement of catheter materials, aseptic procedures in catheterization were thought to be critical for the prevention of catheter-associated infections. In view of these results, it should be emphasized that coagulase-negative staphylococci is a major opportunistic pathogen in hospital-acquired infections.

View full abstract

Since it is very rare that cardiac tamponade due to myocardial rupture caused by infective endocarditis, occurs we are reporting this case.
A 62 year old man, who had underlying diseases of pneumoconiosis and hypertensive heart disease, visited Chikuho Rosai Hospital complaining of chest oppression and general fatigue on Feb. 7, 1987. He was diagnosed as having ischemic heart disease by electrocardiogram. Two days later, he suddenly had chills and a fever, and the laboratory data showed leukocytosis and a positive C-reactive protein (CRP). The echo cardiogram showed mitral regurgitation (MR) and aortic reguritation (AR), but neither vegitation nor pericardial effusion was observed. On Feb. 16, he was addmitted with shock, and he died the next day. The blood cultures grew gram-positive cocci, respectively. From the clinical symptoms, chest roentgenogram and electrocardiogram, we suspected a cardiac tamponade.
On autopsy findings, though coronary arteries were intact, the aortic valves had severe valvular adhesions, calcifications and hypertrophies. The rupture hole was observed in the left ventricles, which was just under the aortic valve through the percardiac space. It seemed that he died of a cardiac tamponade due to the outflow of blood from this hole.
On histopathologic findings of the cardiac wall, gram-positive cocci and many of neutrophils were observed.

View full abstract

A 6-year-old girl with acute suppurative thyroiditis is reported. She suffered from suppurative thyroiditis twice, and E. corrodens and α-streptococcus were grown from the abscess each time. They were sensitive to antibiotics used, but surgical drainage was necessary to cease to inflammation each time.
E. corrodens seemed to be a causative organism with or without another organism in compromised patients and/or patients with anatomical abnormalities. The presented patient was supposed to have some anatomical abnormality such as an internal fisutula from the piriform sinus connecting the perithyroidal space, however, no abnormalities were detected during these episodes.

View full abstract

Although bacteremia caused by non-typhoidal salmonella is frequently observed in immunocompromised hosts, it is rare to find this condition in healthy subjects. In this report, we present a case of bacteremia due to Salmonella enteritidis detected in a healthy man.
A 59-year-old man was admitted to our hospital with a fifty-day history of fever on May 18, 1985. On admission, he showed no symptoms except high body temperature (38.8°C). In the laboratory date C-reactive protein was 3+, white-cell count was 9600, and erythrocyte sedimentation rate was 12 mm/h. Culture in blood and stool yielded Salmonella enteritidis. However, no abnormal findings were found in UGIS, barium enema, OC + DIC, abdominal CT and echography. As soon as Ampicillin was administered, the fever was gone and the blood culture yielded nothing. After six months, the stoll culture was negative for pathological intestinal bacterial flora and he was in good physical condition.
Generally, bacteremia develops mainly in the immunocompromised hosts, such as patients with neoplastic disease, AIDS, leukemia or collagen disease. The literature provides so far twenty three adult cases of bacteremia due to non-typhoidal salmonella in Japan. Only two of them had no systemic disease as well as our case. Although it is unknown why bacteremia developed in this healthy man, we reported that bacteremia developed rarely in subjects with healthy condition.

View full abstract

A 37-year-old man who had had no allergic history was admitted to our hospital complaining of high fever, a dry hacking cough and dyspnea. Mycoplasma and Chlamydia mixed infection was diagnosed because of incresed antibody titers to simultaneous Mycoplasma pneumoniae and Chlamydia psittaci, however only the Mycoplasma pneumoniae antibody titer was not decreased during the over six months.
One month after the onset, bronchial asthma was diagnosed subsequently from for the clinical symptoms of wheeze and cough. Clinical studies of the dual infection and the possiblity of Mycoplasma pneumoniae as the probable antigen of bronchial asthma were discussed.

View full abstract

A 47-year-old male was admitted because of persistent jaundice. Akiyami C disease was diagnosed by serological tests using the microscopic agglutination tests. The source was considered to be a water contaminated with leptospiras which he had drunk while working at a civil engineering job. The reported cases of Akiyami C disease have recently decreaed and this is the 6th case reported in the last 15 years.

View full abstract