Kansenshogaku Zasshi
Online ISSN : 1884-569X
Print ISSN : 0387-5911
ISSN-L : 0387-5911
Volume 64, Issue 6
Displaying 1-16 of 16 articles from this issue
  • Clinical Analysis of Septic Patients Admitted to the Second Department of Miyazaki Medical College Hospital for the Past Ten Years
    Tsutomu YOKOTA, Eiichi SHISHIME, Akihiko OKAYAMA, Junzo ISHIZAKI, Koic ...
    1990 Volume 64 Issue 6 Pages 653-660
    Published: June 20, 1990
    Released on J-STAGE: September 07, 2011
    JOURNAL FREE ACCESS
    Two hundred and sixty-two patints (actual number 162) of hemalotogical malignancies were admitted to our department from November 1977 to December 1986. Fourty-three of them (16.4%) were demonstrated to be accompanied with sepsis by blood culture. In acute non-lymphocytic leukemias (AML, APL, AMoL) the rate of sepsis was 33.8%(27 patients), while in lymphocytic malignancies (ML, HD, ATL) it was 11.7%(16 patients), particularly being 3.0% in ATL.
    Among the detected pathogenic microorganisms, gram-negative bacilli were 86.2% in the former and 50.0% in the latter. Especially, Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli occupied 58.6% of the total in the former.
    Laboratory examination, when sepsis occured, revealed peripheral neutropenia in acute nonlymphocytic leukemias (mean 831/cmm) but not in lymphocytic malignancie (mean 4, 420/cmm). And 20 of the 27 cases showed remarkable neutropenia of below 500/cmm in the former. On the other hand in the latter, out of 16 only one with ATL was the case.
    Hypogammaglobulinemia was one of the characteristic features in lymphocytic malignancies but not in acute non-lymphocytic leukemias. Hypogammaglobulinemia in lymphocyic malignancies might be affected by long-term immunodepressant therapy.
    Immunologic skin rection was demonstrated to be decreased in lymphocytic maliganacies on admission.
    From the findings mentioned above, affecting factors to infections may be mainly neutropenia in acute non-lymphocytic leukemias and immunodeficiency in lymphocytic malignancies. And sepsis can occur frequently under neutropenic condition. In ATL both of humoral-and cellular-immunologic disturbance were detected before therapy. But peripheral neutrophil count was maintained to be normal and this could be the reason for the low septic incidence in ATL despite of total immunodepression.
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  • Shuji TOKUNAGA, Mitsuo OHKAWA, Mitsuhiro TAKASHIMA, Haruo HISAZUMI
    1990 Volume 64 Issue 6 Pages 661-667
    Published: June 20, 1990
    Released on J-STAGE: September 07, 2011
    JOURNAL FREE ACCESS
    We investigated 32 patients with bacteremia that occurred in the Department of Urology, School of Medicine, Kanazawa University between April, 1983 and March, 1989. This incidence represented 1.9% of the total number of inpatients. The study group comprised 29 males and 3 females, and their age varied from 25 to 82 years with a mean age of 61.7 years. Twenty-two (75%) of the 32 patients had urologic malignancies. The majority of patients were compromised hosts who had one or more (average, 3.8) factors that promoted bacteremia. Urinary tract infections existed in 26 (86.0%) patients before the bacteremic episode and urine cultures revealed a species identical to that simultaneously isolated from the blood in 19 (73.1%) of the 26 patients. Out of the 26 patients, there were 22 (84.6%) with complicated pyelonephritis and 22 (84.6%) with an indwelling urinary tract catheter. In blood cultures, the most common isolate was Staphylococcus epidermidis and gram-positive cocci were cultured at a rate of 43.9% which was higher than that (39.0%) of gram-negative rods. In contrast, in urine cultures, gram-negative rods were isolated predominantly. S. epidermidis and Corynebacterium spp. isolated less frequently in blood than in urine, indicated contaminants. However, Enterococcus spp. and Candida albicans were recognized as causative organisms of bacteremia via the urinary tract, because the urine culture demonstrated a species identical to that obtained from blood in these bacteremic patients. Antibiotic sensitivity tests demonstrated that isolates from blood tended to show tolerance to β-lactam antibiotics, but had good sensitivity to aminoglycosides.
    Seven (22.5%) of the 16 patients who developed clinical septicemia died within a week after the bacteremic episode and 4 died before identification of the organism from blood. Out of the 4 patients, 3 were given inappropriate antibiotics and 2 showed serious drug-induced leukopenia. To improve the therapeutic results of septicemia in leukopenic patients, treatment with agents which raise the peripheral white blood cell count seems to be necessary in addition to the selection of appropriate antimicrobial chemotherapy.
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  • Kiyokatsu TANABE, Kaoru SHIMADA
    1990 Volume 64 Issue 6 Pages 668-673
    Published: June 20, 1990
    Released on J-STAGE: September 07, 2011
    JOURNAL FREE ACCESS
    We have analyzed the clinical data of 189 patients with malaria to establish antimalarial regimens in Japan. The causative parasite species were Plasmodium falciparum in 56 cases (30%), P. vivax in 132 (70%) and P. malariae in 1 (1%). The outocmes of malaria cases are as follows: Cure rats in falciparum and vivax malaria are 86% and 91%, respectively. Two patients died of falciparum malaria and recurrence occurred in 6 cases (11%) of falciparum malaria. Relape was seen in 12 (9%) of vivax malaria. Chloroquine was most frequently used among antimalarial agents (in 123 cases, 65% of the total) for suppressing acute attacks. The efficacy of chloroquine was evaluated by classifying each case into three groups; chloroquine alone in group one, chloroquine in combination with other an timalarials in group two and other antimalarials except chloroquine in group three. The cure rate among each group is about 80% and there is no difference among them. However, it is noticable that recurrence occurred when patients were treated with a combination of chloroquine and quinine. We have found a similar result as this in another old report in Japan.
    Primaquine is effective for eliminating hepatic tissue schizonts but in this study, relapse occurred in 12 cases of vivax, although primaquine had been used in 10 out of 12 cases. In primaquine group, relapse occurred at a similar rate between chlorquine and Fansidar cases. Further studies are needed to decide whether a larger dose of primaquine is appropriate for treatment of vivax malaria.
    Recovery periods from fever and parasitemia were comparied between chloroquine and Fansidar cases. Chloroquine was superior in eliminating the fever attack by one day earlier than Fansidar was. But the period of schizont elimination was similar among these two groups.
    Concerning the current status of malaria in Japan, the first problem is that the registration of chloroquine has been revoked and so it is not marketed any more in our country. This is because the Government and the drug companies felt responsible for the side effect, chloroquine retinopathy. But physicians can obtain this drug from the Study Group for Tropical Diseases which has been organized since 1981. Chloroquine, quinine, Fansidar and primaquine are available for only treatment not for chemoprophylaxis of malaria.
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  • Shigeru OZAWA, Kamesaburo YOSHINO, Shizuko HARADA, Hiroaki ISHIKO, Kaz ...
    1990 Volume 64 Issue 6 Pages 674-680
    Published: June 20, 1990
    Released on J-STAGE: September 07, 2011
    JOURNAL FREE ACCESS
    We analyzed herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2) infections in 6 families, to see whether or not a single strain had infected members of each family, analyzing DNA's of viral isolates with restriction endonucleases. We also analyzed 29 isolates from 13 patients to examine if herpetic lesions on different sites of each patient's body had been caused by a single strain. In 4 cases of family infection and 10 cases of individual infection with multiple site manifestations, electrophoretic profiles of digested DNAs of the epidemiologically closely related HSV-1 or HSV-2 isolates were exactly the same. In the other 2 family infections and the other 3 individual infections, there were some differences in size of certain DNA fragments among the isolates which were epidemiologically related to one another. But, these differences did not necessarily indicate that they were distinct strains. Thus, it has been suggested that a single strain spreads among members of a family, and herpetic lesions on different sites of an individual body are caused by the same viral strain in most cases of HSV-1 or HSV-2 infections.
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  • Yoshiki OBANA, Takeshi NISHINO
    1990 Volume 64 Issue 6 Pages 681-686
    Published: June 20, 1990
    Released on J-STAGE: September 07, 2011
    JOURNAL FREE ACCESS
    The virulence of Enterococcus faecalis in the urinary tract in mice was studied. Pyelonephritis was distinctly caused by E. faecalis which have a high affinity to mouse kidneys. This infection was continous, but did not turn into sepsis. The relationship between the production of hemolysin or protease and the virulence in the urinary tract was investigated without finding any distinct association.
    It is concluded that E. faecalis is a pathogenic organism in the urinary tract and presumably induces a severe infection in the compromised host.
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  • Hisaichi BANNAI, Akihiro MIYANO, Hiroshi MIYAZAWA, Yoshimori ASHIHARA
    1990 Volume 64 Issue 6 Pages 687-692
    Published: June 20, 1990
    Released on J-STAGE: September 07, 2011
    JOURNAL FREE ACCESS
    Evaluation of the in vitro activity of rokitamycin (RKM) against Chlamydia trachomatis in cycloheximide treated HeLa 229 cells and McCoy cells by comparing with five drugs including doxycycline (DOXY), minocycline (MINO), ofloxacin (OFLX), ampicillin (ABPC) and erythromycin (EM) with regard to assaying minimal inhibitory concentrations (MICs), minimal lethal concentrations (MLCs), and by yield reduction assays:
    1) direct treatment of Chlamydial organisms with various concentrations of antibiotics before inoculation, 2) pre-treatment of host cell (HeLa 229) with the antibiotics before they are infected and 3) treatment of already infected cultures (48 hrs after infection) with antibiotics. The yield of Chlamydia was determined by both assaying the infectivity of Chlamydia and/or Chlamydiazyme® value (from Abott Co Ltd USA).
    It was found that similar MIC was obtained among the drugs tested (except EM) in both HeLa 229 cell and McCoy cell assay system. The MLC of RKM (0. 3μg/ml) was the same as that of OFLX and was significantly lower than that of other drugs tested.
    When Chlamydial organisms and the host cells were treated with various concentrations (25-0.1μg/ml) of the drug, the infectivity and the growth of Chlamydia was noteworthily decreased with RKM treatment. Infectivity of Chlamydia in an already infected cultures also decreased with RKM treatment within 24 hours when comparing the value of the control. In other drugs treatment, 96 hours or more hours were required for obtaining the same infectivity as RKM. Although the Chlamydiazyme® value of the control culture (no drug) gradaully increased, the values of drug-treated samples (infected cell+fluid) did not changed within the time tested: just before and 24, 48, 72 an 96 hours after treatment with drugs. This suggests that RKM permiates both host and Chlamydial cells and results in strong bactericidal activity. These in vitro results make us expect that RKM will be an excellent antimicrobial agent for therapy of the patients with Chlamydial infection.
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  • Noboru YAMAURA, Kouichi MURAMATSU, Tsutomu YASHIMA, Tetsunori MUTO, Ka ...
    1990 Volume 64 Issue 6 Pages 693-698
    Published: June 20, 1990
    Released on J-STAGE: September 07, 2011
    JOURNAL FREE ACCESS
    S. typhimurium (STM) were isolated from outbreaks of Salmonella enteritis and wre studied for their reactivity to monoclonal antibody TMY1 specific for Salmonella O5-antigen with the following results;
    By using the bacterial agglutionation test with TMY1, STM were classified into O5-antigenic molecule positive and negative (copenhagen type) strains, suggesting the usefulness of TMY1 as an exquisite epidemiologic tool for Salmonella enteritis.
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  • 1. Application of Amoebic Antigen for CF Test to ELISA
    Isao NAGANO, Hiroshi OHTOMO, Gohta MASUDA, Mitsuo TOKORO, Nobuji NODA, ...
    1990 Volume 64 Issue 6 Pages 699-703
    Published: June 20, 1990
    Released on J-STAGE: September 07, 2011
    JOURNAL FREE ACCESS
    We studied the establishment of enzyme-linked immunosorbent assay (ELISA) using amoebic antigen for complement fixation (CF) test. Optimal dilution for ELISA of sera from patients was 1: 100, and that of CF-antigen was 1: 400. The upper limit of the 99% critical range of the reaction of negative sera was 0.068 (cut-off level). Absorbance of sera from patients diluted 1: 100 to antigen and antibody titers of ELISA were strongly correlated, so it was possible to estimate antibody titers from absorbance of serum diluted 1: 100.
    ELISA and CF test were done to compare sensitivity of the tests using 63 sera from patients with invasive amoebic disease. The sensitivity of ELISA compared well with CF test (62 sera were positive by ELISA and 61 by CF test). Only one sample was both positive by ELISA and negative by CF test. This sample had low ELISA titers, so this discrepancy was mainly due to the sensitivity of CF test in detecting lower levels of antibody.
    These results suggested that the amoebic antigen for CF test can be applicable to ELISA, and this method was so sensitive and specific.
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  • Akira TAMURA, Norio OHASHI, Hideyuki SAKURAI, Hiroshi URAKAMI, Seigo Y ...
    1990 Volume 64 Issue 6 Pages 704-714
    Published: June 20, 1990
    Released on J-STAGE: September 07, 2011
    JOURNAL FREE ACCESS
    Microimmunofluorescence (IF) and immunoperoxidase tests are generally used for the serodiagnosis of scrub typhus. While these tests give satisfactory results in the hands of experienced personnel, they can be troublesome for inexperienced technicians. To develop a simpler diagnostic method, dot-blot assay was examined in this study. Six antigenically distinctive strains of Gilliam, Karp, Kato, Shimokoshi, Kawasaki and Kuroki of Rickettsia tsutsugamushi and a strain of Rickettsia sibirica were dotted on a nitrocellulose sheet by a dot-blot instrument. The sheets were treated with patient sera, followed by peroxidase-conjugated anti-human immunoglobulin-antibody and then with the substrate of the enzyme, and the color development on the dots was compared by naked eye observation. By this procedure, anti-rickettsial antibody-positive patient sera showed clear color development on at least one, usually several dots, while the very faint color was observed by the treatment with antibody-negative sera. On the other hand, it was ascertained that the antigens on nitrocellulose sheets were stable for at least 4 months at room temperature. Therefore the diagnostic kits were prepared, and the practical application of this procedure for diagnosis of scrub typhus were tested in Shizuoka and Miyazaki Prefectural Pabulic Health Laboratories. The results indicated a very good comparability between the dot-blot assay and IF-tests, and this dot-blot method was ascertained as a simple and useful method for the scrub typhus serodiagnosis.
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  • Koji MORITA, Noboru WATANABE, Masato KANAMORI
    1990 Volume 64 Issue 6 Pages 715-724
    Published: June 20, 1990
    Released on J-STAGE: September 07, 2011
    JOURNAL FREE ACCESS
    A total of 174 Aeromonas isolates consisting of 100 strains from patients with diarrhea being mainly overseas tavellers and healthy subjects, and 74 strains from environmemtal sources including foods, fish, fresh water, sea water and river soil collected in the area of Tokyo Metropolis and Kanagawa Prefecture was examined for the antimicrobial resistance, presence of plasmids and hemolytic activity.
    Almost all the isolates (99.4%) were resistant to aminobenzyl penicillin. The isolation frequency of chloramphenicol-or tetracyline-resistant strain was low. Most environmental isolates of A. hydrophila were resistant to multiple antimicrobial agents. Thirty-seven percent of environmental isolates and 39% of human fecal ones carried plasmids. In environmental isolates, seven A. hydrophila and three A. sobria strains carried 63-to 150-kilobase pair (kb) conjugative R plasmids. Two A. hydrophila strains from both the healthy subject and domestic case with diarrhea carried 58-to 90-kb conjugative R plasmids, respectively. None of the isolates from the feces of overseas traveller's diarrhea carried the plasmid. Irrespective of the sources, A. hydrophila showed the highest hemolytic activity among three Aeromonas species. Eighty percent or more of A. hydrophila isolates were of hemolysin positive. The hemolytic titer of A. hydrophila strains from human feces was higher than that of the strains from environmental sources.
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  • Kyoko HIMI, Shigeki MIYAMOTO, Hiroko OHSHIMA, Haruo KUROKI, Nobuyasu I ...
    1990 Volume 64 Issue 6 Pages 725-733
    Published: June 20, 1990
    Released on J-STAGE: September 07, 2011
    JOURNAL FREE ACCESS
    Recently, isolation of penicilin-resistant S. peumoniae has been increasing. The first Japanese case of penicillin-reistant peumococcal meningitis was reported in 1988.
    We experienced a case of a one-year-old boy with penicillin-resistant pneumococcal meningitis who dead on arrival on his third day of illness. Minimal inhibitory concentration (MIC) of penicilin G of S. pneumoniae isolated from cerebrosinal fluid and blood was 0.6 μg/ml.
    We evaluated the antibiotic suscetibility of 163 strains of S. penumoniae isolated from children from 1985 to 1988. Penicillin G (PCG), ampicillin (ABPC), cefotaxime (CTX), imipenem (IPM), and vancomycin (VCM) had good susceptibilities to S. pneumoniae.
    Twelve of the 163 isolates (7.3%) were penicillin-resistant strains whose MIC of PCG were more than 0.1 μg/ml, and all of them were intermediately resistant. The annual penicillin-resistant rates were 12.5% in 1985, 1.3% in 1986, 0% in 1986, and 19.0% in 1988. We also evaluated the MIC distribution and MIC90 of antibiotics available for meningitis against penicillin-sensitive and-resistant S. pneumoniea. MIC90 of PCG and ABPC against penicillin-resistant strains was 1.56 μg/ml, and it might be dangerous to use PCG or ABPC for central nervous system pneumococcal infections. MIC90 of IPM against penicillin-resistant strains was 0.1μg/ml, and that of VCM was 0.4μg/ml. There was little fall of susceptibilities of resistant strains in IPM and VCM.
    We evaluated the MIC distribution and MIC70 of antibiotics for oral usage against penicillinsensitive and-resistant S. pneumoniae. Although there were falls of susceptibilities of resistant strains in PCG and ABPC, these two antibiotics had the best susceptibilities among the oral antibiotics.
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  • Shigeru MATSUSHITA, Sumio YAMADA, Yasuo KUDOH, Makoto OHASHI
    1990 Volume 64 Issue 6 Pages 734-740
    Published: June 20, 1990
    Released on J-STAGE: September 07, 2011
    JOURNAL FREE ACCESS
    A total of 70 strains of enteroinvasive Escherichia coli (EIEC) belonging to 8 different O serogroups including O28ac, O29, O121, O124, O136, O143, O144, and O164, was studied for their biochemical characteristics, growth on selective isolation agar, antimicrobial susceptibility, and diarrheagenic toxin production.
    Among the biochemical characteristics examined, all EIEC strains gave negative lysine decarboxylation and all but one belonging to O124 serogroup, were non-motile, regardless of their O serogroups. The one motile O124 strain had a H30 antigen. Some close correlations were also observed between their O serogroups and biochemicals such as utilization of sodium acetate and mucate, ornithine decarboxylation, arginine dihydrolation, gas production from glucose, and lactose fermentation.
    Among the selective isolation agars, MacConkey and Deoxycholate-hydrogen sulfide-lactose (DHL), and modified Shigella-Salmonella (SS) agars supported growth of the EIEC strains well, whereas SS agar was remarkably inhibitory for strains of some O serogroups.
    Antimicrobial susceptibility was tested for nine drugs including chloramphenicol (CP), tetracycline (TC), streptomycin (SM), kanamycin (KM), amplicillin (ABPC), sulfamethoxazole-trimethoprim (ST), nalidixic acid (NA), fosfomycin (FOM) and norfloxacin (NFLX). Forty-one of the 70 strains (58.6%) were found to be resistant to the 6 drugs, such as CP, TC, SM, KM, ABPC or ST. None of the strains were resistant to NA, FOM or NFLX. Among the resistant strains recognized, the strains which showed the resistant patterns of CP · TC · SM · ABPC, CP · TC · SM, TC · SM · ST, TC · SM, and SM appeared to be prevalent.
    None of the strains gave positive reactions for the production of diarrheagenic toxins of heat-labile enterotoxin, heat-stable enterotoxin, and verocytotoxins 1 and 2.
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  • Masahide KAWAHIRA
    1990 Volume 64 Issue 6 Pages 741-751
    Published: June 20, 1990
    Released on J-STAGE: September 07, 2011
    JOURNAL FREE ACCESS
    The pathophysiologic significance of vitronectin in bacterial pneumonia was studied. The following conclusions were obtained.
    1) Plasma vitronectin in healthy persons was 252.3 ± 65.2 μg/ml. The level was markedly decreased to 167.0 ± 42.7 μg/ml in patients with bacterial pneumonia. However, it was gradually increased to the normal levels as recovering with pneumoic lesions. It was also found the negative correlation between plasma vitronectin and CRP (r=-0.7) and plasma fibrinogen (r=-0.6) in the course of pneumonia.
    2) Vitronectin was localized on elastic fibers of the basement membrane of bronchial epithelium, the alveolar interstitium and the blood vessels in normal lung tissue by immunohistochemical method. On the other hand, vitronectin was significantly localized on inflammatory sites, in particular, fibrin matrix and fibrous sites in pneumonic lesions. These findings were more dominant in severe pneumonia. The results are suggested that reducing in plasma vitronectin appers to be depended on the vitronectin consumption in pneumonic site.
    3) In in vitro experiments, activating PMNs, alveolar macrophages and pulmonary fibroblasts were easy to adhered to vitronectin. This adhesiveness to vitronectin was also observed in the strains of S. pneumoniae, S. aureus, and P. aeruginosa, but not in K. pneumoniae and E. coli.
    These results suggest that vitronectin plays an important role for host defense mechanism by mediating to cell-bacteria interaction and it promotes the recover of injurd tissue by induction with pulmonary fibroblasts.
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  • Osamu KURIMURA, Hiroshi ICHIMURA, Tetsuzo KODA, Shigenori HONDA, Ikuo ...
    1990 Volume 64 Issue 6 Pages 752-757
    Published: June 20, 1990
    Released on J-STAGE: September 07, 2011
    JOURNAL FREE ACCESS
    Recently we experienced two male typhoid patients who required additional treatment with CP sodium succinate (CP succinate) to OFLX therapy. Although both of the cases were administered 900 mg/day of OFLX orally for three and four days, respectively, the clinical efficacies were not sufficient. We added 2.0 g/day of CP succinate intravenously for six days, although a lasting high fever returned to normal level in a few days. The administration of OFLX was continued up to 14 days. The daily doses of OFLX during the co-medication with CP succinate were 600 mg in one case and 900 mg in the other case. In both cases no recurrence was observed clinically and bacteriologically for six months after their discharge.
    No adverse reaction was observed throughout the therapy.
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  • Mitsuo OBANA, Yasuo MATSUOKA, Shoichiro IRIMAJIRI
    1990 Volume 64 Issue 6 Pages 758-762
    Published: June 20, 1990
    Released on J-STAGE: September 07, 2011
    JOURNAL FREE ACCESS
    A 43-year-old man was admitted to our hospital because of bloody diarrhea and abdominal pain on January 10, 1989. On laboratory examination S. dysenteriae 1 was isolated from his stool, therefore he was diagnosed as shigellosis. After the administration of ofloxacin was started, S. dysenteriae 1 was immediately eradicated. But his diarrhea persisted until the 19th day from the onset of the illness and his abdominal pain persisted until the 21st day. He had never been overseas and he had never eaten any imported uncooked food recently.
    Only 14 cases of shigellosis due to S. dysenteriae 1 were found in the last ten years in Japan. All of them were overseas travellers. Although we were not able to determine the source of infection in our case, we inferred that he was primarily infected with S. dysenteriae 1 in Japan.
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  • 1990 Volume 64 Issue 6 Pages 763
    Published: 1990
    Released on J-STAGE: September 07, 2011
    JOURNAL FREE ACCESS
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