Clinical usefulness of C-425, a native human immunoglobulin liquid preparation for intravenous injection, was studied in combination with antibiotics in severe bacterial infections in a double blind group comparison using an alkylated human immunoglobulin liquid preparation (Polyglobin^®, A·γG) as a reference drug.
The following results were obtained:
1. C-425 or A·γG was administered to a total of 117 patients, of whom 89 patients, 45 in C-425 group and 44 in A·γG group, were included in the present analysis of efficacy and usefulness. Analysis of safety of the drugs included a total of 113 patients, 58 in C-425 group and 55 in A·γG group.
2. Efficacy and usefulness were graded according to a visual analog scale (VAS).
3. Mean efficacy values with standard deviations of VAS value were calculated at 52.0±34.9 for the C-425 group, and 47.2±34.8 for the A·γG group. The respective medians were 59.0 and 61.0. The Mann-Whitney U-test revealed no significant differences between the two groups. When those with VAS values of 50 or above were regarded as cases of effective treatment, the efficacy rates of the two groups were also practically comparable.
4. Side effects were not observed in either drug group.
5. Mean usefulness values with standard deviations were 52.3±34.9 for the C-425 group, and 47.9±35.0 for the A·γG group. The respective medians were 60.0 and 61.0. The Mann-Whitney U-test revealed no significant differences between the two groups. When the cases with VAS values of 50 or above were regarded as cases of useful treatment, there were no significant differences in the utility rates between the two groups.
From these results, C-425 was considered to be useful for treating severe bacterial infections when used combinedly with antibiotics.

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To increase understanding of immune response of host against G. hispidum, antigenic recognition of rodent gnathostomiasis were identified by the immunoblot method after PAGE of the advanced third stage larvae of G. hispidum and G. doloresi. The molecular weight of the major antigenic bands of G. hispidum extracts were 35 kDa and 16 kDa, and of G. doloresi were 48 kDa, 37 kDa and 35 kDa. Of these bands, the 35 kDa antigen of G. hispidum and G. doloresi was recognized with the sera of rats infected with G. hispidum 5 weeks after inoculation. Lecting staining with endoglycosidase-H or hydrolytic degradation on nitrocellulose strips revealed that the 35 kDa band of G. hispidum possessed the mannose-rich oligosaccharides. On the other hand, the band of G. doloresi had the hybrid-type glycopeptides. The larval extracts and excretory-secretory materials of G. hispidum were not antigenitically identical.

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Results of semiquantitative culture of the gastric mucosa for Campylobacter pylori (C. pylori) are reported. The samples were obtained by biopsy at the pyloric antrum along the lesser curvature from 197 patients with various gastric or duodenal disorders.
1) C. pylori was found in most cases with duodenal ulcer (100%), gastric ulcer (87.7%) and acute gastric mucosal lesion (AGML) (87.5%). Relatively heavy infestation was usual in these diseases, while relatively small amounts of the organism were found in various frequencies in other gatroduodenal disorders.
2) Samples from gasric ulcer cases under H₂-blocker treatment had reduced amount of C. pylori as compared with those from untreated cases (p<0.01). C. pylori decreased in quantity in each case of AGML after successful treatment with a H₂-blocker but not in a case without favorable respone.
3) C. pylori distributed evenly among the gastric mucosa sampled at the margin of the ulcer and that at a relatively healthy portion in the pyloric antrum of the same stomach.
4) There was a modest, positive correlation between the amount of C. pylori and that of inflammatory cells, especially of neutrophilic granulocyte, in the gastric mucosa (r=0.679), while there was a weak, negative correlation between the former and the extent of intestinal metaplasia of the epithelial cells (r=-0.479).
5) Quantitative rather than qualitative observation of C. pylori seems mandatory for considering the releavance of the bacterium to gastric and duodenal disorders. Although C. pylori can be found in the mucoa of the stomach with any type of disorder, its quantity tends to parallel with the activity of duodenal as well as gastric ulcer.

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TESTPACK ROTAVIRUS^®, a simple 10 min enzyme immunoassay, was compared with reversed passive hemagglutination assay (RPHA) and polyacrylamide gel electrophoresis of virus RNA (RNA-PAGE) for the detection of rotaviral antigens in feces from 104 diarrheal children. The reults of TESTPACK ROTAVIRUS^® were identical with those of RNA-PAGE. Discordant results of RPHA were further examined by latex agglutination and electron microscopy, and were finally decided to be negative. Pararotaviruses, adenoviruses and small round viruses were negative in the TESTPACK ROTAVIRUS^®.

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We surveyed Chlamydial infection with Chlamydiazyme^TM for 3010 pregnant housewives in Hokkaido. Four hundred and fourty six out of the 3010 pregnant housewives were also be retrospectively investigated for the influence of C. trachomatis on outcome of pregnancy and on their newborns.
The results were as follows.
1) Of the 3010 pregnant houswives, 217 (7.2%) were C. trachomatis-antigen positive, when their endocervical specimens were tested. There was no difference in the positive rate of C. trachomatis among the six cities where our investigation was performed.
2) A high C. trachomatis-positive rate (21.9%) was achieved in the pregnant teen-aged housewives with a significant decrease as age increased.
3) As for placenta previa, threatened abortion, preterm delivery and small for date infants, the incidence was higher in the untreated C. trachomatis positive group than in the C. trachomatis negative group.
4) The weeks of gestation and birth weight of newborns in the untreated C. trachomatis positive group were significantly lower than those of the C. trachomatis negative group.
5) No statistical significance was found in the incidence of premature rupture of membrane, fatal distress, spontaneous abortion nor postpartum fever between the C. trachomatis negative group and the untreated C. trachomatis positive group.
These results suggest that Chlamydial infection in pregnant housewives is widely spread in Hokkaido and gives some disadvantage to pregnancy outcome and newborns. Consequently, Chlamydial infection in pregnant women must be appropriately diagnosed and treated in the early stage of pregnancy.

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We investigated varicella cases developed in children who received varicella vaccine in the period from October 1984 to March 1987.In this period 463 children were vaccinated and 334 of the vaccinees were seronegative before injection. Seroconversion was observed in 276 seronegative vaccinees producing a seroconversion rate of 83.1%.Thirty-five children developed exanthem more than 4 weeks after the vaccination and were diagnosed as varicella.Among them one child was found to be antibodypositive in his preserum and five were seronegative in both their pre-and post-sera.Thus, among the children who were seroconverted by the vaccination only 30 had varicella (the attack rate=10.9%).No varicella cases were reported, however, among 27 children who first became seropoitive after revaccination.When these children were added to the seroconverted ones, the caserate amounted to 9.9%(30/303).
The general symptoms of varicella observed in the vaccinated children were mild or extremely mild, so varicella vaccine is reasonably indicated to be efficient and useful although it could no completely protect the vaccinees from natural varicella.

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Anti-varicella zoster virus (VZV) mouse monoclonal antibodies conjugated with fluorescein isothiocyanate were evaluated for their usefulness as a practical diagnostic tool in the clinical field by examining cells infected with isolated herpes viruses and 431 clinical samples. The kit stained clearly the cells infected with 14 isolated VZV strains without cross reaction to 15 isolated herpes simplex virus type-1 strains (HSV-1) and 14 type-2 (HSV-2) strains.
In clinical specimens, viral antigens of VZV were detected in 92/105 (87.6%) cases of varicella and in 176/190 (92.6%) cases of herpes zoster. Specific fluorescence of VZV was also observed in 5 out of 96 cases diagnosed as HSV infections, although these samples had no specific reaction to HSV when tested by the commercially available diagnostic kit. In 24 cases which could not be clinically diagnosed as herpes zoster or herpes simplex, the VZV antigen was demonstrated in 9 cases. All 109 VZV-positive cases in virus isolation by culture were also judged VZV-antigen positive by the kit, while all 69 HSV-positive cases in virus isolation were VZV-antigen negative. Furthermore, the VZV antigen was detected by the kit in 53/60 clinical diagnoses of varicella or herpes zoster without successful virus isolation.
These results clearly indicate the usefulness of the kit as a practical VZV diagnostic reagent, especially in terms of specific sensitivity and easy techical manipulation.

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Three-hundred and eighty-five strains of Pseudomonas aeruginosa were isolated from Gunma University Hospital from 1984 to 1987. Out of these strains, thirty strains (7.8%) were resistant to GM. We investigated antibiograms, serotyping, phage typing, and plasmid profiles of these strains.
The following results were obtained.
1) Only one kind of GM-resitant (GM^r) plasmid was obtained in 1984. Two kinds of GMr plasmids were found in 1985, and three kinds of GM^r plasmids in 1987, respectively. 2) A strain of I-serotype and Hh8-phagetype containing the plasmid I (GM-SM-SA-PIPC, Tra^-, 22.6Kb or 22.5 Kb) was suspected to cause the nosocomial infection mainlyin Departments of Internal Medicine, and a strain of non-serotypable and Hh8-phagetype containing the plasmid IV (GM-SM-SACP-Hg, Tra⁺, IncP-2) was suspected to cause the nosocomial infection mainly in Surgical Departments.
3) Plasmid profiles adding to serotyping and phagetyping contribute to the epidemiological analysis of Pseudomonas aeruginosa infection.

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This is a report on the clinical courses and pathological findings in two gay male patients with acquired immunodeficiency syndrome (AIDS) infected in Japan.
Case 1. A 39 year-old Japanese homosexual male was diagnosed as amebic dysentery complicated with liver abscess on admission. He was placed on Metronidazole with complete relief. Serological tests was positive for AIDS. On second admission, he was found to have pneumocystis carinii pneumonia (PCP) and cytomegalo-viral uveitis. Administration of Pentamidine was partially effective, however the therapy with Azidothimidine was discontinued by bone marrow suppression. On his third admission, he suffered from cryptococcal meningitis and therapy-resistant fungusemia. Finally he died of recurrent pneumonia regardless of appropriate therapies. Autopsy proved extended cryptococ cal infection in the brain, meninx, lungs, liver and kidney, and cytomegalo-infection in the lungs, liver and kidney. Furthermore, atypical mycobacteriosis was found in the lymphnodes. There was no active findings compatible with PCP.
Case 2. A 44 year-old Japanese homosexual male was admitted with oral candidiasis and diagnosed as AIDS related complex. He suffered from pneumonia with marked improvement on sulfamethoxazole-Trimethoprim. On his sceond admission, he developed diarrhea and was found to be infected with Giardia lamblia. In addition, cytomegalo-viral infection damaged his eye sight. He died of pneumonia and meningitis shortly there after. Autopsy proved a cytomegalo-viral infection in the lung and colon, old lesions possibly caused by PCP in the lungs, and suppurative meningitis in the meninx.
These experiences confirm that AIDS patients can be exposed to several opportunistic infections at the same time in the multiple organs. Furthermore, it is suggested that homosexual patients with AIDS may have unique opportunistic infections such as amebic dysentery or Giardia lamblia unlike other AIDS patients related to hemophilia.

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A case of vietnamese immigrant with tuberculous mediastinopericarditis was reported and the literature was reviewed. A 39 year-old man was admitted to our hospital with chief complaints of dyspnea and weakness. Blood chemistry suggested the existence of congestive liver dysfunction. Chest X-ray film revealed marked cardiomegaly and a abnormal mass in the anteriorlysuperior area which was confirmed as anterior mediastinum on CT scan. Echocardiogram disclosed a large. volume of pericardial effusion and thickened pericardium. Tuberculin test was positive.
Firstly, this mediastinal mass was believed to be malignant tumor and the pericardial effusion had originated from it. Finally, tuberculous mediastinopericarditis was diagnosed by detecting tuberculous mycobacterium from the cultured pericardial effusion and also thebiopsied lymphnode. Although occurrence of tuberculous mediastinopericarditis is rare at the present time in Japan, this disease has not been exterminated and should be kept in mind.

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A 48-year-old male with Adult T-cell leukemia (case 1) and a 57-year-old with acute lymphocytic leukemia (case 2) died of rapid progressive pneumonia and pleuritis Histopathological findings of the lungs were multifocal hemorrhagic coagulation necrosis, and typical Cowdry type A and full type intranuclear inclusion bodies were observed in alveolar cells, bronchial cells, fibroblast, endothelial cells of small vessels, bronchial gland cells and pleural cells. Antigen against varicella-zoster virus (VZV) was positive in these cells by immunostaining, and the antigen was also demonstrated in other organs such as liver, spleen, pancreas, kidney, adrenal gland, esophagus, stomach, intestine and so on. Furthermore, cytomegalovirus was simultaneously superinfected lungs of both cases, and concomitant candida gastritis (case 1), aspergillus lung abscess and candida liver abscess (case 2) were observed. In the immunocompromised host VZV may involve the visceral organs and death may result from VZV pneumonia.

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A 19-year-old young man was admitted to our hospital complaining of fever and general fatigue. There were infiltrative shadows and pleural effusions in the both lung fields. Mycoplasma pneumoniae infection was diagnosed because of the elevation of mycoplasma antibody titers in the serum and pleural fluid. There was no recovery in clinical symptomes in spite of the administration of the EM (1200 mg) and CLDM (1200 mg) combination chemotherapy.
Three week after admission, a cavity-like shadow appeared in the lt. middle lung field on the chest X-ray film, suprative arthritis and penicillin resistant S. aureus by blood culture test were found. Mycoplasma pneumoniae infection followed by S. aureus bacteremia was diagnosed. After the administration of antibiotics (CTT, FMOX) the clinical symptoms and laboratory findings improved 2 month after admission. Clinical and basic studies about the dual infection between M. pneumoniae and several bacterias were discussed.

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A 66-year-old male with chronic alcoholic liver injury was admitted on July 27, 1986 to our hopital with complaints of high fever, convulsion and skin erythema. He had consumed raw fish 3 days before, and had a scratch wound over the right arm and left leg because he had slipped in a small stream in the woods the day before admission.
He was already in shock state with sepsis of V. vulnificus and DIC on admission. Although the treatment with ABPC, CP, CAZ, MINO for sepsis, and Heparin & Antithrombin III for DIC was immediately begun, he died only 10 hours after admission.
On autopsy, the skin lesion revealed phlegmon with necrotizing angitis and the liver showed fatty changes with Mallory's body.
The causative organism was detected from the blood and on autopsy from the skin wound, bile juice, liver, spleen, kidney and bone marrow, and its type was determined as a V. vulnificus serovar 4.
It was suspected that the route of infection in this case was the raw fish rather than via the wound because the water in which he had been wounded was fresh water and the bacterium was not detected from the water, shells, nor moss existing there.

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Pulmonary nocardiosis is a rare disease. We reported a case of pulmonary nocardiosis associated with middle lobe atelectasis.A 66-year-old female was admitted to Saga Medical School Hospital with complaints of fever, productive cough and hemosputum. Nocardia asteroides was isolated from her sputum and bronchial lavage fluid. Administration of sulfamethoxazole-trimethoprim (ST) improved her symptoms and Nocardia asteroides were rapidly eliminated from her sputum. However, she had severe side effects of ST: toxic dermatitis, granulocytopenia and liver dysfunction, whereupon administration of ST was stopped. About two weeks later, Nocardia asteroides appeared again in her sputum. Either netilmicin (NTL) or minocycline (MINO) given consecutively could not eliminate Nocardia asteroides from her sputa. Subsequently a combination therapy of OFLX administration and gentamicin inhalation was tried. This treatment improved her symptoms and eradicated Nocardia asteroides from her sputa completely.
In vitro study, ST, MINO and aminoglycosides showed good susceptibility agaisnt Nocardia asteroides. In this case, it was revealed that GM inhalation therapy is also very useful for pulmonary Nocardiosis.

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Three infants having Listeria monocytogenes meningitis were admitted to our hospital in the last ten years. They were a nineteen-month-old boy, a two-year-old girl and a five-year-old girl. They were all healthy infants.
The two female patients survived, while the male patient died.
At autopsy, arachnoid turbid, swollen brain substance and slight bleeding under the cerebellar tent were observed.
Judging from the minimal inhibitory concentration of antibiotics against the isolated L. monocytogenes, antibacterial activity of penicillin G and ampicillin was good, whereas that of cefotaxime and latamoxef was poor.
In conclusion, for therapy of bacterial meningitis due to unknown origin, the combination of ampicillin and cephalosporins is necessary.

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