From March 1990 to January 1991, a total of 46 outpatients with acute upper respiratory infections (URTI) were studied to determine the etiological role of Chlamydia pneumoniae. Sera from 40 patients were tested by micro-IF method for evidence of recent or past infections of this organism, and swab specimens from tonsilar crypt from 26 were cultured. Sera from 20 patients without any evidence of acute infectious disease were selected as controls.
The seroprevalence of antibodies to C. pneumoniae was 52.5% in patients group and 30.0% in the control group. No statistical difference was found in seroprevalence between patients and controls.
Serological evidence of acute infections with C. pneumoniae was found in 7 (17.5%) patients with acute URTI, but was not found in any of the control group. Of 26 patients, three (11.5%) had C. pneumoniae isolated from a tonsilar crypt swab specimen. Therefore ten of the 46 patients with acute URTI were associated with C. pneumoniae.
It is suggested that C. pneumoniae is a common pathogen in acute upper respiratory infections without any evidence of lower respiratory tract symptoms.

View full abstract

Protective ability against the challenge of different strains by immunization with culture filtrate (CF) obtained from Salmonella enteritidis was investigated. It was shown that the different strains of S. enteritidis can be separated into two distinct groups of protective (2547, 116M, 116-54, SR-98G, and 3775) and nonprotective strains (2822, 3975, and IID-604). Using a cell-free microbicidal system, the susceptibilities of these strains to active oxygen species was evaluated. S. enteritidis was found to be susceptible to these active oxygen species, however no differences between the protective and nonprotective strains were observed. Both catalase(H₂O₂ scavenger) and histidine (¹O₂ scavenger) inhibited the bactericidal activity of the xanthine-xanthine oxidase system. Therefore, among the various oxygen intermediates, H₂O₂and ¹O₂ appears to be necessary for killing of S. enteritidis. In tests for the ability to trigger an oxidative burst in murine peritoneal macrophages, strain 2547 triggered O^-₂ generation at levels as high as those observed with strain 2822. These studies indicate that the difference between the protective and nonprotective strains is not attributed to susceptibility against active oxygen species nor to the ability to trigger an oxidative burst. From these observations, it is suggested that the difference is not due to differences in resistance to the killing of different strains within macrophages.

View full abstract

We investigated the incidence of herpes zoster (HZ) and the immunological state toHZ in patients with rheumatoid arthritis (RA) and mixed connective tissue disease (MCTD) in comparison with systemic lupus erythematosus (SLE). HZ occurred in 6 (25%) out of 24 patients with RA and 4 (22%) out of 18 patients with MCTD. One patient had had HZ before the diagnosis of RA. On the other hand, all 4 patients with MCTD had had HZ before the diagnosis of MCTD.
The patients with RA and MCTD showed normal or higher antibody titers to varicella zoster virus (VZV) than normal subjects as assayed by both complement fixation technique and neutralization test. However, the antibody levels were not very high compared to those in patients with SLE. On the other hand, only 7 (50%) of 14 patients with RA and 4 (40%) of 10 patients with MCTD showed positive skin reactions to VZV antigen, whereas all 15 normal subjects had positive reactions. Thus, cellular immunity to VZV was thought to be impaired in these diseases. In the patients who were receiving less than 10 mg/day of prednisolone, 7 (64%) of 11 had positive skin reactions in RA patients and 3 (60%) out of 5 patients with MCTD, whereas none (0%) out of 3 patients with RA and 1 (20%) out of 5 patients with MCTD who were receiving 10 mg/day or more prednisolone showed positive skin reactions.
These results suggest that the high incidence of HZ in patients with RA and MCTD is probably due to an impaired cellular immunity as in the case of SLE.

View full abstract

Clinical and pathological findings of 34 patients with isolation of methicillin-resistant Staphylococcus aureus (MRSA) from stools during the past one and half a year were studied.
Twenty-three patients (68%) had internal diseases and the remaining were postoperative patients (32%).
Thirty-three patients (97%) had diarrhea, and properties of the stools were watery in twenty-four and mushy in nine. The degrees of fever, leukocytosis and increase of serum C-reactive protein as inflammatory signs were various, and these had no relation with severity of diarrhea. Diarrhea preceded MRSA infection of organs except for the digestive tract in 7 patients (21%) and appeared alone in 14 patients (41%). These results indicate that closed observation of the stool was very important for early diagnosis of MRSA enterocolitis.
C. difficile were isolated in 17 patients (50%) and there were many patients in whom C. difficile took part in diarrhea. We should take notice of this organisim on stool culture and therapy of diarrhea.
Twenty-seven patients (79%) improved and 7 patients (21%) died. Three natients who did had MRSA enterocolitis as one of the cause of death. This shows that early diagnosis and therapy are important and fundamental therapy are the attempt of improvement of the general condition and appropriate use of antibiotics.
Pathologically most the common finding was edema of the colon, which was found in 4 of five autopsied patients, and specific findings were not observed. As other findings, edema and bleeding of ileum and multiple erosion of the colon were found in one, bleeding of the colon in one, and neutrophili nfiltration and pseudomenbarane of the colon in one with isolation of C. difficile.

View full abstract

Characteristic features of children subjected to vaccination against influenza were analyzed in view of the state of their absence from school during a non-prevalence period of this disease.
A total of 31, 902 children were divided broadly into those with a history of asthma, allergy or cardiac disease [disease history group, 1, 048 (3.3%) children] and those without such a history [nondisease history group, 30, 854 (96.7%) children]. Each group was further divided into three subgroups according to the number of inoculations (0, 1, 2 inoculations) given during the period between October and November 1988. The three subgroups in each group were compared statistically with regard to the state of absence from school during the non-prevalence period of influenza between April and July 1988, and the following results were obtained.
1. Disease history groups.
There was no significant difference among the three subgroups with regard to the rate of absenteeism or mean number of days of absence. Also, no significant difference among them was found in the overall or segmental distribution of days of absence. These findings indicate that the three subgroups of children with a history of disease were almost hemogenous.
However, the overall rate of absenteeism was significantly high among children who recived one inoculation (p<0.001). In this subgroup, the number of children who were absent from school for21-30 days was greater than that of children who were absent for fewer days. This contributed to the highest overall rate of absenteeism in this subgroup. This finding by itself does not serve as evidence for the heteogeneity of the three subgroups of children having a history of disease.
2. Non-disease history group
There was no significant difference in the rate of absenteeism or mean number of days of absence among the three subgroups of children who had no history of disease. Thus, these three subgroups were also hemogeneous.
Taking into consideration the overall rate of absenteeism and the distribution of days of absence, it is possible that children given two inoculations might include a greater proportion of physically weak children, but this appears impractical. The most important finding of this study is that children without a history of disease who received no inoculation included no particularly high proportion of physically weak children.

View full abstract

“Streptococcus milleri group” are the part of the indigenous oral flora, and they are proposed to contain three distinct species: Streptococcus anginosus, Streptococcus constellatus, and Streptococcus intermedius. Though not included in the approved lists of bacterial names, “S. milleri group” are regarded as the causative organisms of suppurative infections, such as oral abscess, brain abscess, lung abscess and empyema. I have studied the clinical significance of the “S. milleri group” in respiratory infections.
An investigation was performed to confirm the incidence of “S. milleri group” colonization in healthy 120 volunteers'(20 y/o-80y/o) throats, and it was found that 11.7%(14/120) were positive. On the other hand, attention should be paid to the fact that the “S. milleri group” was highly isolated, 24 (24.7%) in 97 purulent respiratory specimens (94 sputa and 3 throat swabs) from which no other significant microorganism was recovered.
I have measured the serum antibody titers of the “S. milleri group”, employing the IFA technique, in 10 patients from whose specimens “S. milleri group” was predominantly isolated, and compared with those of 18 healthy volunteers. Whereas all of the titers of healthy volunteers reveal less than 1: 256, those of the patients reveal more than 1: 512. And antibody titers to “S. milleri group” showed the highest in two weeks after “S. milleri group” isolation, and came down to healthy adult levels in six weeks or more.
Thus far, about half of the causative organisms of acute pneumonia have been reported unknown. In this study I have suggested that the “S. milleri group” plays an important role as the causative organism in respiratory infections including pneumonia

View full abstract

IgA antibody titers to C. trachomatis in local secretions were measured by immunoperoxidase assay (Savyon kit) in male and female cases with various urogenital infections, and the clinical significance of IgA antibody in the local secretion was discussed. In addition, the antigen specificity of the IgA for C. trachomatis in the local secretions was analyzed by immunoblotting assay.
1) In female cases with cervicitis and male cases with urethritis, the positive rate of IgA antibody in their secretions was higher in cases with C. trachomatis antigen than in those without it. In addition, the IgA antibody titers in their secretions tended to be higher than in serum, suggesting that the result reflected a local immune response at the site of infection.
2) In cases with chronic prostatitis, a condition in which detection of antigen at the site of infection was difficult, the positive rate of IgA antibody in prostatic secretion was 23.6%. We confirmed that most of the IgA antibodies in prostatic secretions were of the secretory type.
3) IgA antibodies in secretions reacted to the major outer membrane protein (MOMP) and 60-Kd polypeptides of the outer membrane of C. trachomatis by immunoblotting assay, proving that they were the secretory IgA antibodies specific for C. trachomatis.
These results described above confirmed that measurement of IgA antibody titers in local secretions by immunoperoxidase assay and immunoblotting assay was useful for the diagnosis of chlamydial urogenital infections such as chronic prostatitis, which the antigen detection was usually difficult.
Examination of IgA antibody in local secretions was considered to be useful for making a correct diagnosis even in cases who were suspected to have C. trachomatis infection but showed negativeantigen.

View full abstract

Minimum inhibitory concentration (MIC) of Macrolide anibiotic (ML) against C. trachomatis was found to greatly vary with the cell culture system used for the assay. We then investigated the ability of various cell cultures to uptake MLs in the relation to MIC determination. Penetration of the¹⁴C-labeled MLs, Erythromycin, Jasamycin and Rokitamycin into cells was quantitatively studied bymeasuring the radioactivity incorporated into McCoy, HeLa229W and HeLa229F cells. It was found that HeLa229W cell showed the lowest MIC for the drugs followed by HeLa229F cell and then by McCoy cell.
Reversely, McCoy cell showed the lowest intracellular concentration of an ML followed by HeLa229F cell and then by HeLa229W cell.
These results indicate that MIC of an ML significantly varies depending on the ability of the test cell to uptake the drug.

View full abstract

The new Micro Particle Enzyme Immunoassy technique (MEIA, IMx HBc, Abbott) has been recently introduced for the detection of the antibody to hepatitis B core antigen (anti-HBc).
To evaluate the feasibility of using the IMx-HBc, we carried out comparison tests with this method and RIA using various sera.
Results obtained were as follows:
In the test of 813 sera, 427 (52.3%) were positive by both IMx and RIA, two (0.2%) were positive by RIA only, and the remaining 384 (47.3%) were negative by both methods. A good correlation between IMx and RIA was observed with a concidence rate of 99.8% and a correlation coefficient of 0.969.
Examination of diluted sera using IMx revealed that IMx can be used as efficientlywas RIA: high anti-HBc titer was found among HBsAg carriers, but not among non HBsAg carriers.
Anti-HBc was assayed within 45 minutes by IMx, and the procedure was simple because of the auto analyser used in this method.
These results indicate that the sensitivity of IMx is equivalent to that of RIA, and that it is easier to use than RIA.

View full abstract

A 45-year-old woman was admitted to our hospital with complaints of fever and lumbago. She was treated for adult T-cell leukemia and thrombocytopenia with 20 mg/day of predonisolone. CT scan showed multiple abscesses in right peri-kidney, right iliopsoas muscle, left subcutaneous region in the abdominal wall and the brain. (BE) Left subcutaneous abscess was drainaged. Gram-positive organisms consisting of filaments were found, and Nocardia farcinica was grown in cultures. After two months of chemotherapy (FMOX, MINO and AMK), all abscesses except one in the brain disappeared. Cerebral abscess was cured fifty days after the start of the treatment with oral administration of Sulfamethoxaxole-trimethoprim (SMX/TMP).
The mortality of Nocardial cerebral abscess is high. This patient is a very rare case in which multiple Nocardial abscesses including brain abscess was cured by chemotherapy.

View full abstract

We described a eight-year-old girl with encephalopathy due to cat scratch disease. Cat scratch disease is a common cause of benign, self-limited, regional adenopathy seen among young people. Encephalopathy is uncommon but is a serious complication of cat scratch disease. Cat scratch disease with associated encephalopathy was described by Stevens in 1952. Since then there have been reports of only 39 cases in the English literature. As far as we know, this case is the first case in Japan. In cases of a rapidly progressive encephalopathy, the diagnosis of cat scratch disease should be considered.

View full abstract

We have experienced 99 medical employees who had stuck themseleves by the needles used bypatients in the past 5 years. Sixteen of the 99 cases (16.2%) were of the patients who had hepatitis CVirus (HCV) antibodies. We followed up these 16 medical employees during 24.8±12.0 months. Wecould not find any case among them who had seroconverted HCV antibody positive in their serums.
We concluded that the risk of HCV infection by the needlestick accident is not so high.

View full abstract

We report a case of diarrhea associated with Giardia lambria and Salmonella. A 28-year-old male who had no chance to go abroard visited our hospital with complaints of abdominal pain, watery diarrhea and fever, but his symptoms persisted in spite of medication. He was admitted to our hospital on the next day for definite diagnosis and treatment. Many trophozoites of Giardia lambria were recognized in the feces. The symptoms were improved using metronidazole, so he was discharged on the 8-th day. The cause of this double infection was not determined. The domestic infection like this case is rare in Japan.

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

A 46-year-old man was admitted to Oita Medical College Hospital on October 16, 1987, because of cough and sputum. Chest X-ray and chest CT films showed diffuse reticulonodular shadow. The specimens obtained by transbronchial lung biopsy revealed cysts of pneumocystis carinii. Abnormal lymphocytes with lobulated neuclei were found 2-7% of peripheral leucocytes. The anti HTLV-I antibody was positive. According to these data, we diagnosed the patient as smoldering adult T cell leukemia with pneumocystis carinii pneumonia. The abnormal shadow on chest X-ray disapeared after SMX-TMP and pentamidine treatment.
After about 1 year, he was again admitted for high fever. Chest X-ray showed infiltration with cavity in right upper lobe. Streptococcus pneumoniae was isolated from the sputum. The infiltration shadow on chest X-ray disappeared after antibiotics treatment. However, multiple nodular shadowappeared on the chest X-ray and ATL cell infiltration was found in the specimens of transbronchial lung biopsy. ATL cells in peripheral blood also increased and serum LDH and Calcium levels were markedly high. According to these data, we diagnosed the patient as having a ATL crisis. Although chemotherapy for ATL was started, the ATL, cell infiltration shadow on the chest X-ray enlarged, and bilateral diffuse pacthy shadows was appeared on the chest X-ray. He died of respiratory failure on April 26, 1989. Cytomegalovirus pneumonia and ATL cell infiltration were revealed by necrops

View full abstract