Sera of 375 blood donors which were seropositive for syphilis were examined for antibodies against Entamoeba histolytica. Antibody prevalences against E. histolytica using complement fixation (CF) test were 12.0%, and enzyme-linked immunosorbent assay (ELISA) were 2.7%. The positive rates of antibodies in the CF test were significantly higher in sera showing positive by the Venereal Disease Research Laboratory (VDRL) test than in the VDRL-negative sera, and not related to the results of Treponema pallidum hemagglutination (TPHA) test. Only one sample in the VDRL-negative sera was positive by CF test. On the other hand, the positive rates or mean absorbance in ELISA were not correlated to the results of VDRL or TPHA test. The percent positivity in CF test became higher with the level of antibodies in VDRL test, but not that in ELISA. The level of antibodies in CF and VDRL test were weakly correlated. These results suggested that the results of CF test for E. histolytica antibodies were most likely false-positive in relation to the results of VDRL test.
10 (2.7%) of sera were positive by ELISA, but all ELISA-positive samples showed low ELISA titers and absorbance. 9 of the ELISA-positive samples showed indirect fluorescent antibody (IFA) titers of over 1: 50, and the level of antibodies in the IFA test correlated to that in ELISA, so ELISA-positive persons seemed to have been previous infected or were asymptomatic cyst carriers.

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Antibody titers of monomeric and polymeric types of serum specific IgA for Chlamydia trachomatis were measured by indirect immunoperoxidase assay (Savyon kit) in male and female cases with various chlamydial urogenital infections. From these results, the ratio of monomeric to polymeric IgA (m/p ratio) was determined. All cases were positive for specific IgA and IgG antibodies for C. trachomatis, and the antigen was also detected in all of cases except for those with prostatitis.
1. Study in males: The m/p ratio (mean± S. E.) was 2.6± 1.0 in acute chlamydial urethritis and 8.0± 2.2 in chronic non-bacterial prostatitis. The result indicated monomeric IgA-predominance in the chronic stage.
2. Study in females: The m/p ratio was 5.0± 1.9 in subacute chlamydial cervicitis, while it was 8.5± 2.9 in pregnant women considered to have chronic chlamydial infection. The rate was 31.5± 16.8 in prostitutes considered to have repeated chlamydial infections. The result suggested that monomeric IgA was predoninant in patients with chronic and repeated infections.
3. As for sequential changes of IgA antibody titer, polymeric IgA alone decreased after treatment of acute chlamydial urethritis. However monomeric IgA decreased in chronic infection such as prostatitis, and a similar change was shown in IgG antibody.
4. These results suggest that polymeric IgA is predominant in the acute stage of chlamydial infections, while monomeric IgA predominates in the chronic stage.

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Chlamydia pneumoniae (Strain TWAR), the new third species of genus Chlamydia, is emerging as an important human respiratory pathogen in Western countries. However, little is known about it in Japan. In this study, 1330 serum samples were tested for seroprevalence of three species of genus Chlamydia including C. pneumoniae in Hiroshima. Microimmunofluorescence test was used to measure serum IgG antibody, and formalinfixed elementary bodies of C. trachomatis, C. psittaci, and C. pneumoniae were used as antigen. Serum titer of 1: 32 or greater was considered positive. Seropositive rate of C. pneumoniae began to increase around the 6 month to 3 year old age group and reached 44% in the 8 to 11 year olds. A peak of seroprevalence according to age was around 20 year old, and about half of the adults were seropositive. Outpatients and healthy persons held almost the same seropositive rate. The positive rate in childhood was higher and the peak appeared earlier than some former studies in Western countries. The seropositive rate of C. trachomatis was noted 1-2% in the 6 month-7 year old age group, but no seropositive child was found in the 8-15 year olds. The rate was increased after adolescence and reached 10% in adults. The seroprevalence of C. psittaci was 1%. These data suggest C. pneumoniae is the most prevalent Chlamydia in Japan and as prevalent as in the Western countries.

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The seroepidemiological study of HBV infection has been done against 9044 inhabitants in order to define a predominant transmission mode and a target population of HBV infection in Kenya
Results are as follows:
1) A total of 379 HBV carriers were identified. The prevalence of HBV carrier ranged from 4 to 9% in adults and 1 to 2% in children under 5 years of age.
2) The prevalences of HBs antigen and anti-HBc antibody in family members of carriers were 2 or 3 times higher than the other population.
3) 60 to 90% of the carrier children under 10 years old was positive for anti-HBe and 10 to 15% of the adult carrier and the pregnant carrier were found to be positive for e antigen.
4) Yearly infection ratio by horizontal route of transmission in the carrier family (1.4%) was 4 times higher than the control groups (0.3%).
5) 49% of the 96 carrier children was born to the carrier mother and in 40% the parent was negative for HBs antigen.
6) E antigen positive carrier mothers were highly infectious against their children than anti-HBe positive carrier mothers and fathers.
These results suggest that HBV infection will happen more frequently within the family members of carriers either by horizontal and vertical infection. Marked reduction of carrier rate and infectivity observed in the children under 5 years of age infers that the improved way of mass immunization using disposable needles during infancy will deplete the incidence of horizontal mode of infection and that in the future mother to baby transmission appears to be the main route of HBV infection as in other developed countries.

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An outbreak of gastroenteritis involving a total of 256 patients (49.7%) among 515 persons occurred at a primary and secondary school in Agatsuma Town, Gunma Prefecture between the 23rd and 28th of June 1988. The majority of the cases occurred within the first 4 days. The main symptoms were abdominal pain (81.6%), diarrhea (57.0%) and headache (40.2%). In most cases, the stools were watery and occasionally mucous. Although food-borne infection was strongly suggested epidemiological evidence did not incriminate any foods as the cause of the outbreak.
In the bacteriological study on stool specimens from 25 patients, Escherichia coli 0167: H9 was isolated from 20 of these specimens, virtually in pure culture. The isolates of the E. coli serovar were negative for recognized diarrheagenic virulence properties: production of heat-labile and heat-stable enterotoxins, enteroinvasion, and production of Shiga-like toxin. When the HEp-2 cell-adherence test was used, however, they exhibited localized adherence. All the strains were demonstrated to carry 56 Md plasmids that presumably mediate the production of the adherence factor.

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Many infections are caused by the patient's own oro-intestinal microbial flora under a protected environment. Thirty-eight patients with acute leukemia and two patients with blast crisis of chronic myelocytic leukemia were treated under a protected environment with or without prophylactic antibiotics. Antibiotics used.for decontamination were vancomycin (V), polymyxin B (P) and nystatin (N). The number of patients in the VPN, PN and the no antibiotic group were 13, 13 and 14, respectively. While the intestinal microbial flora was almost completely eliminated in VPN group, the number of bacteria decreased slightly in PN group. The mean number of pharyngeal and anorectal bacterial species decreased most markedly in the VPN group, but there were no significant differences among the three groups. The number of febrile days was significantly lower in the VPN and PN group than the no antibiotics group with neutrophil counts of less than 100/μl. The average number of episodes of infection per patient was lowest in VPN group and highest in the no antibiotic group. These data indicate that VPN administration is effective for eliminating intestinal bacterial flora and resultantly protecting endogenous infections.

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These studies were carried out to investigate the background factors in the outbreak of acute infection of odontogenic origin.
In the clinical study, fifty patients who suffered from acute odontogenic infection were compared with fifty symptom free controls with chronic odontogenic inflammation. The subjects were asked whether they had basal disease or not, and were given a series of questionnaries about the episodes of recent life changes (f.e. busy, decrease of sleeping time, travel etc) to measure the incidence of these background factors.
In the experimental study, the effect of serum after 24 hours sleep deprivation on PMN chemotaxis in vitro was studied in six young voluunteers. Chemotactic assays were performed with the modified Boyden chamber method.
Results obtained were as follows:
1) The basal diseases were observed in 16 cases (32%) with acute odontogenic infection, and in 14 cases (28%) of controls. The incidence was not different statistically between both groups.
2) The incidence of background episodes in the patients were noted in 39 cases (78%) of patientsand 10 cases (20%) of the controls (p<0.01). The predominant factor in these episodes were busy (36%), and decrease of sleeping time (30%) in the patient group.
3) Serum of all 6 subjects obtained after sleep deprivation showed depressed effects on PMN chemotaxis to chemotactic factor. (p<0.05).
4) Pre-exposure levels were regained in five of the six subjects within seven days after terminating the visil.
These results suggest that fatigue plays a major role in the susceptibility to acute odontogenic infection by the alternation of PMN chemotaxis. Further studies would be necessary on chemotactic factors in the serum and other functions in order to appreciate the host-parasite interaction in acute odontogenic infections.

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Succeeding the previous report on antivirus activity of non immunized bovine colostrum immunoglobulin, we studied the bacteriostatic activity of the immunoglobulin, lactoferrin and lactoferrin Fe by using the automated antimicrobial susceptibility testing system. We have presented the representative positive and negative reactions. Then, we have reported that the immunoglobulin was effective in 10 of a total of 20 species which we exaimined. In some species, the lactoferrin was slightly more effective than the immunoglobulin was. These results indicated that the immunoglobulin, lactoferrin and lactoferrin Fe were useful for the bacteriostatic reaction.

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The experimental and clinical aspects such as difficulties in eradicating Salmonella, intracellular facultative bacteria, causing gastroenteritis were investigated.
1. In vitro study:
In the present study using human polymorphonuclear neutrophilic leucocytes (PMNs), the author evaluated the eradicating effects of various drugs on Salmonella which can not be killed usually within PMNs. The author inferred that the phagocytic action was enhanced by fosfomycin (FOM); the transport of FOM to PMNs contributes greatly to the enhancement of the eradicating effects of FOM on Salmonella. This finding has been further supported by the morphological changes in the Salmonella in PMNs which were examined by electron microscopy.
Further it was confirmed that various chemotherapeutic agents were affected by ii-lactamase in the feces.
2. Clinical study:
Some drugs were used for the treatment of Salmonella gastroenteritis to investigate the relationship between the drugs and eradication of the bacteria. The first was treated with FOM for 5 days after treatment with the other drugs for 5 days, the second was treated with FOM initially, and third was treated with the other drugs. The treatment in the first group was the most useful and the eradication rate of the bacteria was significantly high.

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During the 10-year period from 1980 through 1989 using gonococci isolated in Sapporo, we studied β-lactamase production capacity and the sensitivity of various antibacterial agents and obtained the following results.
1. The frequency of isolating β-lactamase producing gonococci (PPNG) displayed a gradual tendency to increase during the first half of the 80's and reached a peak in 1985 of 23.9%(61/255). However, thereafter it tended to decline and in 1989 it was 6.3%(2/32).
2. The sensitivity to penicillin-type antibacterial agents was higher against PPNG than non-PPNG against PCG, ABPC, and AMPC displaying about a 7 level MIC₉₀ so that it was quite sensitive. Against CVA/AMPC, SBTPC it showed a relatively favorable MIC₉₀. Also, the sensitivity of PPNG against AMPC with 1984 as the boundary, thereafter the MIC distribution was observed to decline somewhat.
3. Against the monobactam-type injectable drug, AZT, both non-PPNG and PPNG showed a low MIC distribution and against SPCM both showed a relatively high MIC distribution of 3.13-25 μg/ml.
4. In regard to the sensitivity to cephem-type antibacterial agents, against such 3rd generation injectables as CZX, CFTM-PI, etc. it displayed a particularly low MIC distribution.
5. Against tetracycline and macrolide antibacterial agents, it displayed a relatively high MIC distribution.
6. Against new quinolone type antibacterial agents, regardless of being non-PPNG or PPNG, it showed a low MIC.

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C. trachomatisantigen in first-voided urine sediments was detected by a new EIA kit using a monoclonal antibody, IDEIA CHLAMYDIA ^® (IDEIA, Novo Nordisk), in males with urethritis and females with cervicitis. The result was compared with that by Chlamydiazyme ^® (Abbott).
1.C. trachomatisantigen detection in male urethritis (285 cases) by the IDEIA test: The antigen detection rate was 37.9%(108/285) in urethral smears, and 33.7%(96/285) in first-voided urine sediments of the patients. The positive co-incidence rate between urethral smears and first-voided urine sediments was 82.4%(98/108). Thus, the detection of the antigen seems feasible in first-voided urine sediments.
2. Comparison ofC. trachomatisantigen detection by the IDEIA and Chlamydiazyme tests: In 78male cases with urethritis undergoing both tests, the rates of antigen detection from urethral smears and first-voided urine sediments were studied. The detection rate from urethral smears was 41.0%(32/78) for IDEIA, and 37.2%(29/78) for Chlamydiazyme. In first-voided urine sediments, the rate was 35.9%(28/78) for IDEIA and 24.4%(19/78) for Chlamydiazyme. In both specimens, the detection sensitivity was higher for IDEIA.
3.C. trachomatisantigen detection in chlamydial cervicitis (28 cases) by the IDEIA test: The antigen detection rate was 46.4%(13/28) in urethral smears and 60.7%(17/28) in first-voided urine sediments. The detection rate in first voided urine sediments was higher. Thus, in patients suspected of having chlamydial cervicitis, it seems necessary not only to search the antigen in cervical smears but also to study the first-voided urine sediments.
4. Detection of C. trachomatis antigen in first-voided urine sediments by IDEIA is considered to be useful for the diagnosis of male urethritis.
In female cervicitis, it is also considered possible to perform this test for the clinical diagnosis of the disease.

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In order to determine the optimal dose of cefpirome sulfate (HR810, CPR) against respiratory tract infections (RTI), an optimal dose-finding study was conducted on cases of chronic RTI, and the clinical properties of the drug were compared with those of ceftazidime (CAZ). Inpatients with chronic RTI were randomly assigned to 3 groups: an HR 0.5 g group, receiving 0.5g ×2/day of CPR an HR 1.0 g group, receiving 1.0×2/day of CPR and a CAZ group, receiving 1.0g×2/day of CAZ. As a rule, the drugs were administered by intravenous drip infusion for 14 days, after which period clinical efficacy, bacteriological response, safety, and utility were investigated. Of the total 121 cases, 106 were subject to analysis of clinical efficacy, including 38 cases in the HR 0.5 g group, 32 in the HR 1.0 g group, and 36 in the CAZ group. Efficacy rates in the assessment by the committee were 84.2% for the HR 0.5 g group, 75.0% for the HR 1.0 g group, and 86.1% for the CAZ group, without any significant difference between the 3 groups. The bacterial elimination rates were 73.9%, 75.0%m and 88.5%, respectively, without any significant difference between the 3 groups. Associated reactions were noted in 2 of 36 cases in the HR 1.0 g group (eruption and diarrhea), but not in the other 2 groups. The incidence of abnormal clinical laboratory findings was 23.1% in the HR 0.5 g group, 22.2% in the HR 1.0 g group, and 22.5% in the CAZ group, without any significant difference between the 3 groups. Utility rates were 84.2% for the HR 0.5 g group, 74.2% for the HR 1.0 g group, and 86.1% for the CAZ group, without any significant difference between the 3 groups. The HR 0.5 g and LO groups showed no difference in clinical efficacy, bacteriological response, safety, and utility against RTI, and the results of both groups were about equal to those of the CAZ group.

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The effects of commercially available HA influenza vaccines, produced in 1988, was investigated in pupils in elementary schools located in six cities in Saitama Prefecture during the prevalence of influenza from 1988 to 1989. The state of absence in the children as a whole and in those with a history of disease was examined statistically, by dividing them into three groups in terms of the number of vaccinations given. The following results were obtained
1) The proportion of children who had received no vaccination (71.2%) was significantly higher than that of children who had received one (9.6%) or two (19.3%) vaccinations
2) A history of disease was found in 1, 048 (3.3%) of the 31, 941 children. The percentage of children having such a history was 3.6%, 2.7% and 2.5% among those who had received 0, 1 and 2 vaccinations, respectively; those who had no such history accounted for more than 96.0% in each group of children.
3) There were no differences between the three groups of children with regard to the proportion of those who had a history of respiratory or circulatory symptoms
4) The rate of absenteeism and the overall rate of absenteeism were found to be significantly higher in children without any vaccination than those with two vaccinations, regardless of whether all subjects were considered or only those who had a history of disease were considered.
5) Both among all subjects and among those who had a history of disease, the mean number of days of absence was significantly high in children without any vaccination than those with 2 vaccinations.
6) Absence from school for 2 days or less was more frequent in children with 2 vaccinations than in those without any vaccination. In contrast, the frequency of absence for 3 days or more was lowest in children with 2 vaccinations and highest in children without vaccination, being medium in those with 1 vaccination.
Thus, vaccination was useful for decreasing absentees among children with a history of disease as well as those without such a history. Even when vaccinated children were infected with influenza virus, showing manifestation of symptoms, these symptoms were only slight and resulted in a short period of absence from school. On the other hand, when unvaccinated children were infected, the period of absence tended to be prolonged because of persistent fever
The results of the present study strongly suggest that commercially available HA influenza vaccines produced in 1988 were effective.

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A 58-year-old female was introduced to our hospital for admission on April 22, 1988, because of high grade fever and agranulocytosis. She had eschers on her left zygomatic region and medial region of the right thigh. The latter lesion was accompanied by cellulitis. Laboratory tests showed her WBC was 600/mm3 and T-Bil was 6.51 mg/dl. By using minocyclin, piperacillin and other drugs, her general condition and laboratory data became better in a few days.
Although her skin lesions resembled “Tsutsugamushi disease”, serological tests showed no evidence for Rickettia infection. So we could not rule out that another kind of insect bite may also develop such a severe clinical course. Furthermore, Staphylococcus aureus or Clostridium spp., which were detected in her pus, might have the toxic effects of inducing agranulocytosis, which might mainly be the result from the local WBC emigration, and jaundice, just like the effects of the endotoxin of Gram negative bacteria.

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The patient was diagnosed as having Kawasaki's disease. Streptococci were isolated from cultures of all blood samples collected during the acute stage (the third, fifth and seventh day of the disease). The streptococci were subsequently identified as Streptococcus sanguis (MCLS-1) and Streptococcus pyogenes. This finding may suggest induction of Kawasaki's disease by S. sanguis MCLS-1, and in this case, the complication of septicemia by S. pyogenes.

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