Investigations of trombiculid mites and Rickettsia tsutsugamushi in wild rodents were made in Ena (Nov. 1988) and Takayama (May 1989) City. In the former area where no patient has been reported so far, Leptotrombidium pallidum (63.9%) was most predominant and no L. scutellare was found. A Karp-related rickettsia (11.1%) was isolated from wild rodents and 30% of them had antibody to R. tsutsugamushi (anti-Karp was prominent). The latter area where patients were reported in spring as well as in autumn, L. pallidum (22.4%) was one of the dominant species in spring. Karp-related strains were isolated from 37.5% of wild rodents. And the antibody possession rate was 50.0%. These data reconfirmed our hypothesis that the majority of patients in autumn were infected by L. scutellare and a part by L. pallidum. In spring in Takayama area, the vector was L. pallidum which possessed Karprelated strain (s).

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To obtain the basic data on the route of Giardia infection as zoonosis, we examined feces from 354 dogs and 34 cats for Giardia cysts and trophozoites and evaluated the detection rates. In addition, the feces of owners of the dogs infected with Giardia were examined.
Giardia cysts and trophozoites were detected in 58 of the 354 dogs (16.4%) and 3 of the 34 cats (8.8%). Of the 61 animals from which cysts and trophozoites were isolated, 59 were purchased from the breeders and the other two animals had been kept for examinations in the research institute. None of the owners of the dogs had this infection.
This result suggests that the possibility of human infection from contact with infected dogs or cats seems to be very low. However, attention should be paid to the possibility of cross-infection between men and animals, because it is not yet clear whether Giardia is strictly host-specific or not.

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HTLV-I seroprevalence in the southern part of Miyazaki prefecture was reported to be high in many seroepidemical surveys. In order to determine the distribution of antibody to Human T-cell lymphotropicvirus type I (anti-HTLV-I) in the Kushima district of Miyazaki prefecture and evaluate the relation between the HLTV-I carrier and disease, determination of anti-HTLV-I status of patients in a hospital in Kushima City, Miyazaki prefecture was carried out from March to July, 1985. Sera from 542 patients was tested for presence of anti-HTLV-I by particle agglutination (PA) and indirect immunofluorescence (IF).
Results obtained are as follows
1) Overall prevalence of anti-HTLV-I was 31.2 per cent (169 of 542 individuals). It increased gradually with age and elevated remarkably in the 60-69 age group, showing the highest rate of 39.6 per cent.
2) Prevalence of anti-HTLV-I was 28.6 per cent (65 of 227) in males and 33.0 per cent (104 of 315) in females. A significant difference by sex was not recognized.
3) No significant difference was found in the geographical distribution of anti-HTLV-I, but prevalence in the Toi area was relatively low.
4) Anti-HTLV-I was prevalent in the patients with tuberculosis (46.2 per cent), most of whom had a history of blood transfusion. In this study, the relation between HTLV-I carriers and diseases was not analysed.
5) Seroprevalence of anti-HTLV-I in the patients who had had blood transfusions was significantly higher than that of those who had not had blood transfusions (p<0.01).

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We analized the changes of frequency of bacterial positive cases on the basis of blood cultures, clinical background and administrated antibiotics for the patients with bacteremia in Nagoya University Hospital from January 1978 to December 1987.
During the ten years, the number of samples increased from 330 in 1978 to 1231 in 1987. Moreover, bacterial positive cases increased from 27 (8.2%) in 1978 to 152 (12.3%) in 1987. Organisms isolated consisted of 138 strains of coagulase negative Staphylococci (CNS), 81 Staphylococcus aureus, 60 Candida sp., 58 Escherichia coli, 47 Pseudomonas aeruginosa, and other species.
During the period of 1986-1987, of the 92 patients with bacteremia, 85 patients (92.4%) had underlying diseases including leukemia, solid tumor, cardiovascular disease, diabetes mellitus or other diseases. In addition, 67 patients (73.9%) underwent intravascular catheters, urethral catheters, postoperative drainages or other prosthetic insertions. Fourteen patients died of septicemia within a week after recovery of the organism in the blood culture.
The recovery rate for gram positive cocci in blood culture increased in the 1980's. It may partly be due to the prevalent use of these prosthetic insertions, and the preferable use of second and third generation cepholosporin antibiotics.

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One hundred and four samples of various imported meats obtained from the stores and supermarkets in Matsuyama-city and Iyo-city from November, 1987 to October, 1988 were examined and two strains of Vero toxin-producing Escherichia coli were isolated: one was from beef from Australia and the other was from pork from Canada. By bead-ELISA, it was confirmed that the strain from beef produced Vero Toxin 1 (VT1) and Vero toxin 2 variant (VT2vh) and the strain from pork produced VT2vh. These results suggest that imported meats may be contaminated with VTEC and thus are possible sources of human VTEC infection, such as hemorrhagic colitis and hemolytic uremic syndrome.

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A bacterial strain was isolated that possessed the biochemical characteristics of Shigella dysenteriae but did not belong to any of the established S. dysenteriae serovars, from the feces of a diarrheal case who had travelled to Turkey, Pakistan, India and Thailand for about a month. This strain was invasive to tissue culture cells and gave a positive Sérny test. Preparing antiserum against this strain and examining the antigenic relationship with the established O antigens of Shigella and Escherichia coli O1-O170, we found that the strain had O antigen identical to that of the E. coli O serogroups 150. The results indicated that this strain could be a provisional serovar of S. dysenteriae. Although our strain could probably be the same serotype as that of the strains reported in Israel, this may be the first report of isolation in Japan.

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The new Micro Particle Enzyme Immunoassay technique (MEIA, IMx HBsAg, Abbott) has been recently introduced for the detection of the presence of hepatitis B surface antigen (HBsAg).
The present trial was carried out to determine the feasibility of using the IMx HBsAg with sera and plasma, and for comparison with RIA (Ausria II, Abbott) and RPHA (Reversecell, Megroken).
Results obtained were as follows:
In the test of 622 sera from inhabitants in Okinawa, 455 (73.1%) using IMx were positive for HBsAg, 454 (73.0%) with RIA, and 330 (53.0%) with RPHA.
Five of the 179 tests using plasma from hemodialysis patients were positive for HBsAg with both IMx and RIA. One of these 5 was negative for HBsAg with RPHA.
The difference of HBsAg positive rates between IMx and both RIA and RPHA increased with advancing age.
Twenty four individuals were followed up from three to ten years and had had it confirmed that HBsAg had become negative in their sera, HBsAg was still positive from one to four years in both IMx and RIA after HBsAg became negative in RPHA. It was noted that HBsAg was assayed within one hour by IMx, and that the procedure was simple because of the autoanalyser equipped for this method.
The results indicate that the sensitivity of IMx might be equal to that of RIA more than that of RPHA, and easier to measure than either of the others.

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The present paper describes the relationship between the contamination with non-O1 Vibrio cholerae and Vibrio mimicus of marine fish, with special reference to the seasonal variation and the concentration of contamination, and the actual cases of domestic food poisoning by these organisms.
A 10 year survey revealed that non-O1 Vibrio cholerae (non-O1 V. cholerae)strains were frequently isolated from fish during the summer season with some variations from one year to another, and isolates from fish showed similar biological properties to those of isolates from diarrhea cases of over-sea travellers. Experimentally enteropathogenic strains were included among these isolates.Vibrio mimicus (V. mimicus) strains were also isolated from fish, the frequency being not so high as in strains were also isolated from fish, the frequency being not so high as in V. choleraeStrains of serovar o-41 which was most predominant among strains from diarrhea cases were also detected among the isolates from fish. The viable cell counts, however, were very small with regard to both non-O1 V. cholerae and V. mimicus From these observations, factors causing food poisoning by non-O1 V. cholerae or V. mimicus seemed to be essentially similar to those by Vibrio parahaemolyticus (V. parahaemolyticus) ;that is, the food poisoning by non-O1 V. cholerae or V. mimicusis apt to occur in the summer season and is caused by the consumption of raw fish, although the frequency might be significantly low in comparison to that of V. parahaemolyticus.The actual cases of the domestic food poisoning by non-O1 V. cholerae or V. mimicus were retrospectively surveyed by the literature. At least 10 cases have been disclosed, among which 4 were caused by non-O1 V. cholerae and 6 by V. mimicus. Nine out of 10 cases occurred during the period from the end of July to the end of September. In most cases in which the causative foods were known, the consumption of raw fish seemed to be related. Although the serovars were different, all of the non-O1 V. cholerae strains from food poisoning cases showed similar biological properties to those from fish, being capable of growing on TCBS agar plate in which colistin was added at the final concentration of 1 pg/ml and unable to or lately ferment cellobiose. Five out of 6 cases by V. mimicus mimicus seemed to reflect the ecology of these organisms in fish.

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Clinical and pathological analysis were performed on 127 cases of deep mycoses diagnosed by autopsy during the 24 years between 1964 and 1987 in Juntendo University Hospital. The following findings were obtained.
1) There has been a tendency for the number of mycoses to increase each year, especially notable for candidiasis and aspergillosis.
2) Underlying diseases were, in order of incidence, various hematologic diseases, solid tumors, inflammatory diseases and collagen diseases; the most common were various types of leukemia.
3) Candidiasis was often observed in patients with gastrointestinal tract cancers. Aspergillosis was often observed in patients with collagen diseases.
4) Regarding the visceral distribution of mycoses, aspergillosis was observed in the lung, candidiasis was observed in the lung, kidney and intestinal tract in decreasing order, and cryptococcosis was also observed in the lung and central nervous system.
5) There was a probability of fungal infections occurring in cases of lymphopenia.
6) A fever was present at the time of hospitalization in many cases of aspergillosis, and the presence of an indwelling catheter was a common feature in cases of candidiasis.
7) Fungemia was frequently observed in candidiasis, but very rarely in cases of aspergillosis.
8) The large amounts of corticosteroid hormones and blood transfusions were suspected as causative factors of fungal infections.

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This survey of occupationally acquired infections in clinical laboratory workers was made by questionnaires to 306 hospitals in which 698 doctors and 8654 technicians worked. There were 177 probable infections during the previous decade (1979-88). In both doctors and technicians annual incidence rate of infection was 0.2% on an average. These included 77 cases of tuberculosis, 59 cases of HBV hepatitis, 24 cases of non-A, non-B hepatitis, 6 cases of rubella, 5 cases of HAV hepatitis, 2 cases of mycoplasmal pneumonia, one case of campylobacter enteritis, one case of paratyphus, one case of salmonellosis and one case of chicken pox. There were no fatal cases.
In the recent two years the occurrence of HBV hepatitis among the clinical laboratory workers apparently has decreased, but tuberculosis and non-A, non-B hepatitis occurred unchangedly. Tuberculosis occurred frequently among the staff of the pathology laboratory (40 cases) and in bacteriology (25 cases), but rarely in biochemistry (3 cases) and in hematology (one case). On the other hand, HBV hepatitis occurred frequently among the staff of the biochemistry laboratory (33 cases) and in hematology (11 cases), but rarely in bacteriology (one case). These differences showed the existence of occupational exposure, but only 20% of these cases were due to recognized accidents.
According to these results infection control practices for deminishing laboratory-associated infection must be performed.

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The optimal dosing regimens and combination effects of gentamicin (GM), or astromicin (ASTM) and piperacillin (PIPC) against P. aeruginosa in a mouse thigh infection model were studied.
Therapeutic efficacy of the single regimen and duration of a postantibiotic effect (PAE) of GM and ASTM were dose dependent, but those of PIPC were dose independent. The optimal dosing of GM or ASTM with the same total daily dose was less frequent, but that of PIPC was frequent. Initial killing (the Δlog bacteria changed at 2 hour after starting of the therapy) was the main significant pharmacokinetic and pharmacodynamic parameter determining efficacy for GM, whereas the time that serum levels exceeded the minimum inhibitory concentration (T>MIC) was the major parameter for PIPC.
The optimal synergistic combinations of GM or ASTM plus PIPC in various dosing intervals with the same total daily dose were observed in the less frequent regimens of GM or ASTM and the frequent regimen of PIPC.
The differences of therapeutic efficacy were observed in twice a day regimens of GM or ASTM plus PIPC in three dosing schedules (GM or ASTM before PIPC, with PIPC simultaneously, after PIPC). The effect of GM or ASTM after PIPC exposure was inferior to that of the other dosing regimens.
These findings suggest that it may be possible to use the optimal regimens of aminoglycosides and β-lactams against clinical P. aeruginosa infections in humans. Further careful, controlled clinical trials are needed.

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1) We report 5 cases of aseptic meningitis following vaccination against mumps. Of the 5 cases, 4 cases were diagnosed as mumps meningitis. 2 cases recieved monovalent mumps vaccine and the other 2 MMR vaccine. They consisted of 2 boys and 2 girls, aged 2 years and 2 months to 4 years and 5months. The period between vaccination and symptoms ranged from 15 days to 20 days (mean 18 days). Cerebrospinal fluid of the cases contained 507 to 2688 cells/mm³. Eruption was observed in the 2 cases who recieved MMR vaccine, while parotid swelling was not seen in any case.
2) In all 4 cases, IgM antibody to mumps virus in the cerebrospinal fluid was detected by the ELISA or EIA methods. Causative organism of the fifth case was obscure.
3) PCR (Polymerase Chain Reaction) tests revealed that mumps virus isolated from 2 cases were of vaccine strain origin.
4) To evaluate the frequency of mumps meningitis following vaccination, it seems important to investigate carefully the number of children who recieved the vaccine and to exclude the cases of aseptic meningitis caused by other agents. On the other hand, cases of young infants tend to be overlooked because of atypical signs.

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We report a case of recurrent tonsillitis and otitis media with effusion (OME) from which Chlamydia trachomatis was isolated. Chlamydia pneumoniae, a newly recognized species of Chlamydia, was also recovered from the tonsillar and bronchial swabs.
A 8-year-old girl was seen on February 23, 1988, because of a running nose, a productive cough and bilateral hearing difficulty. She had a history of recurrent tonsillitis. The diagnosis was acute sinusitis with tubal obstruction, then cefixime was prescribed. Her symptoms were once resolved, for the time being but she came back to the hospital a week later with a bilateral ear-ache. The tympanic membranes were injected and characteristically retracted. Her left ear showed type B tympanogram (effusion). Tympanocentesis was performed to remove middle-ear effusion, from which C. trachomatis but no ordinary bacterium was isolated. Therefore rokitamycin 300mg/day was administered for a week. Her condition improved, however, a rhinorrhea, a plugged ear sensation and a hacking cough returned in a month. She was admitted to the hospital on May 10, for tympanostomy and grommet insertion, but from the day before admission, she had a sore throat with fever (39.2°C). The surgery was withheld until May 26. When adenotonsillectomy and grommets insertion were undertaken, C. trachomatis had disappered from the middle-ear effusion, but C. pneumoniae was recovered from both tonsillar and bronchial swabs. Readministration of rokitamycin was performed and to date (June, 1990) she remains well.

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[in Japanese]

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A 58-year-old woman was admitted to our hospital with complaints of general fatigue, thirst and lumbago. A diagnosis of Cushing's syndrome was made on the basis of elevated serum levels of cortisol and adrenocorticotropic hormone (ACTH). Although Cushing's disease was most suspected, no evident image of pituitary adenoma could be found on brain CT scan and MRI. Therefore, treatment with oral Trilostane was started. Three months after admission, left hemiplegia was noticed and cerebral abscess in the right frontal lobe was demonstrated by brain CT scan. In spite of surgical removement of the abscess by total resection, she had a relapse in the same site and also developed a new lesion in the left lateral lobe.
Surgical drainage was performed and Nocardia asteroides was isolated from the drained pus.
An intensive chemotherapy with aminobenzylpenicillin (ABPC) and latamoxef (LMOX) in combination resulted in marked decrease in size of the lesion in the brain and subsequent improvement of left hemiplegia was achieved. Since approximately one month before when a diagnosis of cerebral abscess was made, there had been demonstrated a coin lesion in the right middle field on chest X-ray films. This lesion in the right lung disappeared concomitantly with the improvement of the lesions in the brain.
This fact strongly suggests that the lesion in both brain and lung were of the same nature.
Nocardia is known to make a primary lesion in the lung after being inhaled and then through hematogenous dissemination to make distant lesions in various sites, especially in the brain. Therefore, it is conceivable that the lesion in the lung observed in this patient was a primary lesion and that in the brain were developed secondarily.
The suppressed humoral and cellular immunities in this patient were evident from the results of the tests, namely, lowered serum levels of IgA and IgG, a low OKT4/OKT8 ratio, attenuated blastogenesis reactions to PHA and ConA, and weakened tuberculin skin reaction.
It is well known that immunity is suppressed in the majority of the patients with Cushing's syndrome, as observed in this case. And in this patient an underlying disease, i.e. Cushing's syndrome per se, might play a crucial role in development of pulmonary and cerebral abscess due to Nocardia.
There has been no report, to our knowledge, dealing with Cushing's syndrome associated with cerebral abscess due to Nocardia. The present particular case strongly suggests that we should bear in mind the possibility of infection due to Nocardia in addition to the other opportunistic pathogens.

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