Misaka strain was isolated as the causative agent from a patient with spotted fever group rickettsiosis in Japan by using nude mice on Awaji Island, Hyogo in September 1988. The nude mice infected with the isolate showed weakness and splenomegaly and died in two or three weeks after the infection. The cyclophosphamide-treated mice infected with the isolate died between four and seven days after the infection. The infected normal mice recovered and acquired immunity. The infected adult male guinea pigs were feverish and showed swelling and redness of the scrotum between two and eight daysafter the infection, and recovered. The Misaka strain was propagated well in Vero cells in tissue culture. The rickettsial particles were seen as diplobacillary and diplococcal forms growing predominantly in the cytoplasm and occasionally in the nucleus of infected cells.
The serological characteristics of the Misaka strain were analyzed by the cross-immunofluorescent antibody method. The Misaka strain, the Katayama strain first isolated in Tokushima in 1987, and the representative strains of spotted fever group rickettsiae in the world; R. rickettsii Smith, R. sibirica 246, R. conorii Moroccan, R. akari MK (Kaplan), R. australis Phillips, R. montana Tick and Thai TT-118 strains were used as antigens. And immune mouse serum samples against the Misaka, Katayama, 246, Phillips and TT-118 strains were used as antisera. The result revealed that these strains showed cross-reaction and share a common antigen of spotted fever group rickettsiae. Furthermore, it became obvious that the Misaka strain and the Katayama strain have the same serotype-specific antigen different from the strains of other spotted fever group rickettsiae using Anti-Katayama monoclonal antibodies.

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Sera from 69 adult prostitutes, 139 juveniles in the reformatory for boys, and 63juveniles in the reformatory for girls, were collected between 1986 and 1987 in Fukuoka City. These samples were tested for the presence of antibody to human T-cell leukemia virus type-I (anti-HTLV-I), for hepatitis B surface antigen (HBsAg), and for antibody to hepatitis B core antigen (anti-HBc).The juveniles in the reformatory for girls were surveyed for the incidence of venereal diseases (VD) and for a history of intravenous drug use.
Anti-HTLV-I was detected in 5.8% of the prostitutes, 0.7% of the boys, and 1.6% ofthe girls. Prevalence of anti-HTLV-I among the prostitues was higher than that among the controls, but no significant difference was recognized.
HBsAg was detected in 7.2% of the prostitutes, but was absent in the boys and girls. Prevalence of HBsAg among the prostitutes was higher than that among the controls, but no significant difference was recognized.
Anti-HBs was detected in 39.1% of the prostitutes, 10.1% of the juvenile boys, and 17.5% of the juvenile girls. In each group prevalence of and-HBc was higher than that in the controls.Especially between the prostitutes and the controls a significant difference was recognized (p<0.005).
In the reformatory for girls anti-HBc was detected in 40.0% of 11 girls who wereexposed to VD and in 7.0% of 43 girls who were not exposed to VD.Prevalence of and-HBc among the exposed group was significantly higher than that among the non-exposed group (p<0.005). Prevalenceof and-HBc among the intravenous drug users (20.0% of 25) was higher than that among the non-intravenous drug users (15.8% of 38), but no significant difference was recognized.
In the groups studied, no evidence of significant increase of HTLV-I transmission was shown, but HBV transmission increased significantly among the prostitutes. This may be due to sexual transmission of HBV, and exposure to VD may be a risk factor for HBV infection.

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It is well known that recombinant human granulocyte increases dramatically the number of granulocytes in peripheral blood. It is interesting to see if G-C SF enhances the functions of neutrophil since the neutrophil is one of the most important factors of host defence mechanism against infections. In this study, we have demonstrated that G-CSF induced the polarization of neutrophil while it could not be chemoattractant for the cell.
Polarization is considered to be the initial reaction of chemotaxis. Therefore, G-CSF might enhance the defence effect of the neurophil to infections in this point.

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In present study, we have investigated superoxide (O^-₂) production from human neutrophils by recombinant human granulocyte colony-stimulating factor (G-CSF) using the microtiter plate for the purpose of being close to the inflammatory site. G-CSF by itself did not induce the release of O^-₂ in human neutrophil on either Fetal Bovine Serum (FBS)-coated plate or plate uncoated with FBS, even if neutrophils were exposed for maximum 3 hr. However, the optimal concentration of G-CSF (50ng/ml) was able to prime human neutrophils with enhance of O^-₂ release stimulated by the chemotactic peptide, N-formyl-methionyl-leucyl-phenylalanine (FMLP) from 10^-6 to 10^-8 M, but not by the non chemoattractant such as phorbol myristate acetate (PMA), concanavalin A, and ionomycin. These findings indicate that G-CSF might enhance bactericidal activity of neutrophils by priming them penetrating into the inflammatory site.

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The conjugative transfer by using a filter mating method in 109 cases of combinations between 20 strains of β-hemolytic Enterococcus faecalis and 28 strains of a-hemolytic Enterococcus faecium was tried. A stable transconjugation was observed in two cases: from E. faecalis No.170 to E. faecium No.49 and from E. faecalis No.500 to E. faecium No.48. From the results, it was proved that the β-hemolysin plasmid of E. faecalis is tranferred by conjugation to E. faecium.
The virulence (LD₅₀) of E. faecium No.17049, No.50048 (heterogeneous transconjugant) and E.faecalis No.17067, No.50067 (homologous transconjugant) in mice was compared with their parent strains. The virulence of E. facecalis transconjugants was more marked than that of the recipients. However, the virulence of E. faecium transconjugants was not enhanced. This fact suggests that, only in E. faecalis, does β-hemolysin play a role in its pathogenicity in mice.β-Hemolysin in E. faecium transconjugants does not participate in pathogenicity in mice. It may be due to the fact that it takes more time to cause β-hemolysis on blood agar plate or β-hemolysin production in B-YEG broth by E. faecium transconjugants than by E. faecalis transconjugants.

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Seventy-one strains of Streptococcus milleri were isolated from 68 patients admitted to Tamana Central Hospital. (1985·2-1989·1) S. milleri was isolated from the following specimens: sputum (15strains), urine (10), ascites (9), postoperative wound (9), pleural effusate (6), bile (5), genital discharge (3), aspirated fluid from lung abscess (2) and others (12). In 12 patients (18%), S. milleri was isolated in pure culture and in 56 patients (82%) as part of a mixed flora. Other bacteria isolated in associaion with S. milleri were obligate anaerobes (41%), Gram-negative rods (40%), Gram-positive cocci (16%) and others (3%). In 71 strains of S. milleri, 9 strains (13%) were β-haemolytic, 62 (87%) were a-haemolytic (week) or non-haemolytic. In 68 patients, type specific male-female ratio was 15: 9 for S. milleri I, 20: 15 for II and 1: 8 for III respectively. The patient's age ranged from 7 to 86 years and 75% of patients were more than 50 years old. In respiratory infection, 10 cases (pyothorax, 6; pneumonia, 3; lung abscess, 1) were related to S. milleri infection and considered clinically significant. 8 cases had underlying disease, however, 2 cases (pyothorax, lung abscess) had no underlying disease. In these 2 cases, S. milleri was isolated in pure culture. Succesful treatment of these ten cases usually required either antibiotic therapy or drainage of the lesion.
S. milleri was isolated from various clinical specimens and some cases were associated with serious infections. S. milleri was more commonly associated with suppurative infections than other viridans group streptococci. S. milleri may therefore have different characteristics which other streptococcal species of normal flora have not.

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In this study, transmission electron microscopy was employed to observe the morphological changes in Pneumocystis carinii (P. carinii) in the alveolar space of patients and experimental rats treated with co-trimoxazole.
Experimentally, P. carinii pneumonia was induced in Wistar rats by peritoneal injection of prednisolone and then treated with co-trimoxazole. The animals were divided into an untreated group and groups treated with co-trimoxazole for 3-9 days.
In the untreated group, various forms of P. carinii were seen to be filling up the alveolar space. There were few morphological changes (shape, size and intracellular substances) in the P. carinii in the alveolar space of the animals in the 3-day and 5-day treated groups. However, in the 7-day treated group, important intracellular components such as mitochondria were not seen, and after 7 or more days of treatment there were no crescent-shaped P. carinii, which are characteristically observed in the proliferative stage. In the 9-day treated group, the cell membranes of thick-walled cysts were ruptured, and there was intracellular vacuolization.
In addition, untreated patients complicated with P. carinii pneumonia (2 cases), patients treated for 3-5 days (4 cases) and a patients treated for 1 month (1 case) were studied. The morphology of P. carinii in the alveoli of those clinical cases was similar to that seen in the rats, and the changes in shape, intracellular components and cell membranes after treatment were the same except in case 5. In case 5, lamellar-body-like substances such as seen in alveolar proteinosis filled up the alveoli, and the cell membranes of P. carinii were ruptured.
Electron microscopic studies revealed no changes in the cell membranes during the early period of treatment. We surmise that co-trimoxazole is taken into P. carinii cells and then interferes with the cellular metabolism.
On the basis of the results of this study, the critical period determining whether a patients with P. carinii pneumonia can be cured or not is around the 9th day of treatment with co-trimoxazole.
Therefore, it is necessary to make an early diagnosis, begin treatment with co-trimoxazole as soon as possible and continue the treatment for 9 or more days.

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During the period from June 1981 through Dec. 1985, isolation of group A streptococci was attempted from throat swabs of pharyngitis patients of all ages, who visited a clinic in the central area of Yokohama-city. The data were analysed clinically and epidemiologically. The results were 1) Group A streptococci were isolated from 85 (30.5%) out of 279 patients with pharyngitis. This is almost within the range of other reports.
2) During one year in the study period, no isolates of group A streptococci were obtained from throat swabs of 32 controls (healthy persons working in the clinic or patients without pharyngitis).
3) The isolation rate correlated with the presence of pharyngeal purulent exudate and also with high maximum body temperature after onset of the illness. The isolation rate was significantly higher in patients with these two signs than those without them. Therefore, these two signs are useful to predict group A streptococcal pharyngitis prior to laboratory examinations.
4) The isolation rate was high in the age groups under 10 and from 30 to 39.
5) The isolation rate was high in winter and low in summer.
6) The typing test revealed T types 13, 28 and 4 to be relatively frequent isolates.

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In this study, we measured D-arabinitol, candida antigen and β-glucan in the rabbit model of systemic candidiasis.
It was recently reported that the factor G, one of the coagulation enzymes from the horseshoe crad amebocyte lysate, reacts with β-glucan or polysaccharide from fungus, and not with endotoxin.
The newly developed endotoxin specific chromogenic Limulus assay (endospecy test^®), which isd evoid of factor G, did not react with any rabbit serum. But the β-glucan measured by the conventional Limulus assay (toxicolor test^®), which contains the factor G, was elevated (from 10 βg/ml to 100 pg/ml) in all cases of rabbit model of system candidiasis.
Serum D-arabinitol, measured by Sone's enzymatic fluorometric method, increased in all cases, but Cand-Tec^® (candida detection system by latex agglutination) showed only one positive case in five innoculated rabbits.

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In January 1983, a number of premature infants under management in the premature infants' unit of our hospital were found to have bacteremia due to Staphylococcus aureus. By the end of February of the same year, 4 of these infants, who had been treated in the same unit, developed impetigo. The S. aureus responsible for this condition was classified as type IV by a coagulase typing. In a subsequent antimicrobial susceptibility test using the disk diffusion method, this microorganism was found to be resistant to methicillin, erythromycin and lincomycin, and to be susceptible to tetracycline, chloramphenicol and cefmetazole, indicating that it was a methicillin resistant S. aureus (MRSA). Because the result from the coagulase typing agreed with the antimicrobial susceptibility pattern in all cases, we concluded that these cases represented nosocomial infection with MRSA. The source and route of the infection were investigated, and measures taken to prevent bacterial spread from carriers and to keep instruments and environments clean. Although the source of infection was not identified. Then, we tried wiping the body surface of the premature infants with an Isodine^® solution (10% PVP-I, 1: 100 dilution) in order to prevent colonization of the microorganism on the body surface. With this precation, MRSA was no longer detected from the body surface of the premature infants, and no additional MRSA infection occurred in the premature infants' unit. Data collected for premature infants' managed at our hospital in the subsequent 6 years allows us to conclude that MRSA infection can be almost completely controlled by frequent surveys of carriers and appropriate body surface wiping with Isodine ^® solution. None of the premature infants wiped with Isodine^® solution showed any objective abnormalities, although laboratory testing disclosed an elevated blood iodine level and a transient mild reduction of T4 in some infants.

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It was found that the human normal immunoglobulin G product, prepared from pooled plasma of at least 1, 000 normal human donors, contained some specific IgG antibodies to Mycoplasma pneumoniae by Western blotting. M. pneumoniae-ELISA OD values increaed linearly from 25 to 800 μg/ml in the concentration of the product, there were no differences in the M. pneumoniae-ELISA OD value of the products among lots. Then we used this product as control serum for measurement of IgG antibodies to M. pneumoniae in human sera by ELISA and compared the results with those obtained by complement fixation (CF) and indirect hemadosorption (IHA) tests. ELISA titers determined by this method had a mutual relation with CF and IHA titers.

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A 70-year-old male was admitted to our hospital because of fever and dyspnea. The patient was seropositive for HTLV-I and ATL cells were seen in the peripheral blood in the percentage of 2-5. The proviral DNA was positive and the diagnosis of smoldering ATL was made. His chest X-ray film showed diffuse reticulo-nodular infiltrates in both lung fields. The lung tissue obtained by transbronchial lung biopsy showed the lymphocytic infiltrations in the alveolar septums and the submucosa of the bronchioles. Bronchoalveolar lavage (BAL) fluid showed an increased proportion of lymphocytes that consisted mainly of CD3⁺ DR⁺ cells and the CD4⁺/CD8⁺ ratio was 2.1 during exacerbation and 0.8 after steroid therapy. Anti-HTLV-I IgG and IgA antibodies were positive in both serum and BAL fluid b Western blotting method.
It is suggested that T-lymphocyte alveolitis may occur in patients who are seropositive for HTLV-I and the immunological mechanism seems to be responsible.

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Clinical features of 36 cases of psittacosis experienced from 1980 to 1988 were analyzed. The following results were obtained.
1) Sixteen patients were male; twenty were female. The thirty-six patients ranged in age from 29 to 76 years.
2) Fifteen patients had been exposed to Parakeets prior to the onset of illness.
3) High fever (94.1%) and cough (94.4%) were prominent clinival symptoms.
4) The number of pneumonic foci per lung field by chest X-ray, showed the right inferior lobe was most frequently involved (45.2%). According to the nature of roentgenologicalshadows, the ground-glass-like shadow was most frequent (70.6%).
5) Leucocytosis was present in only three patients. The erythrocyte sedimentationrate and C-reactive protein were high in many patients. Half of the patients had elevated serum glutamate oxaloacetate transaminase and glutamate pyruvate transaminase.
6) All cases were treated with antibiotics and cured.
The Incidence of psittacosis may be increasing. Therefore, it is useful for clinicians to know the clinical features of this disease. These results may be useful in early diagnosis.

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Three cases of spotted fever group rickettsiosis occurring on Awaji Island, Hyogo Prefecture, the first reported in the Kinki District, are described. The illness appeared from August to September in 1988. High-grade fever and papular erythema were observed in all cases. Eschar, lymphadenopathy and hepatomegaly were observed in two-thirds of the cases, respectively. The antibody titers for Proteus OX-2 by the Weil-Felix reaction were elevated, and immunofluorescence test with R. rickettsii of the spotted fever group demonstrated a significant rise in specific antibody titer. Tetracycline was effective in all cases. Every patient was thought to have been infected with rickettsiae in the Yuzuruha mountain range in the southern part of Awaji Island. On the other hand, tsutsugamushi disease occurs in autumn and winter in the northern part of Awaji Island. It would be of considerable interest from an epidemiological viewpoint to study the vector of these spotted fever group rickettsiae.

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A case of pneumonia caused by C. pneumoniae, strain TWAR is described in this paper. A 65 year-old male with a persistent dry cough was admitted to our division for left lower lobe infiltrates of the chest X-ray. The serum antibody titers against mycoplasma and some viruses were not elevated, but the serum antibody titers against TWAR reached the maximum level (IgG×1024, IgA×256) using microplate immunofluorscence antibody technique (MFA). Isolation of TWAR was tried by BAL and nasophalingial swabs, but were not successful. TBLB from Lt. S¹⁰ revealed TWAR inclusion bodies within alveolar epithelial cells using TWAR specific monoclonal antibody (Washington Research Foundation).

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