The importance of Mycoplasma pneumoniae as a pathogen of human infectious diseases, particularly of respiratory infections, has been well recognized.
However, the details of the mechanism through which lung tissue damages are produced inmycoplasmal infection has not been fully understood.
It has been pointed out that beside the direct invasive process certain immunological responses to the deposited microbes are crucial in development of mycoplasmal pneumonia.
In the present study, we aimed at elucidating the role of neutrophils in producing pneumonia due to Mycoplasma pneumoniae in hamsters.
For this purpose, hamsters were divided into two groups; the one not pretreated and infected with Mycoplasma pneumoniae and the other immunosuppressed by ⁶⁰Co irradiation and infected.
A serial determination of the numbers of mycoplasmal cells recovered from the treacheal tissue and bronchoalveolar lavage fluid (BALF) and analysis of cellular components in BALFs were carried out. The severity and the nature of pathological changes produced in the lungs were evaluated and scored on the basis of microscopic findings.
As a result, it was found that the numbers of mycoplasmal cells recovered from both tracheal tissues and BALFs reached maximum on the seventh day of infection in both groups and decreased rapidly.
There no apparent difference was found between the two groups in number of cells recovered.
In the not-irradiated control groups, the percentage of polymorphonuclear leukocytes (PMNs) in BALF was very high on the seventh day and then they were replaced by lymphocytes by the 21st day of infection. The observed predominance of neutrophils in BALF in the control group on the seventh day was accompanied with a variety of such marked and characteristic pathological changes in the lungs as broncho-bronchiolitis, perivasculitis, and alveolitis with infiltration of a large number of neutrophils and monocytes.
Whereas, the numbers of PMNs in BALFs and in the lung lesions in groups of ⁶⁰Co-irradiatedhamsters were very small even on the seventh day of infection and the morphological changes in the lung tissues were far mild as compared with those in control group.
The results mentioned above indicate that immuno-inflammatory reactions play an important part in development of pneumonia caused by Mycoplasma pneumoniae and the role of neutrophils is considered to be crucial at the earlier stage of the sequencial host reactions.

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Among patients examined at the Central Laboratory of Yokohama City University Hspital over the 25 years from 1965 to 1989, those whose clinical samples showed Cryptococcus were studied in greater detail. The following findings were obtained.
Of 16 patients who were found to have cryptococcosis, 14 (87.5%) were treated at the department of internal medicine, and one each at the departments of neurosurgery and dermatology. A study of these patients in terms of clinical type revealed 10 patients (62.5%) with meningitis, two with pneumonia and one with sepsis. The remaining three patients had complicated diseases: meningitis with sepsis, pneumonia with cutaneous cryptococcosis, or pleuritis with sepsis. Underlying disease, including liver cirrhosis, leukemia, multiple myeloma, malignant lymphoma and collagen disease, was found in 6 patients (37.5%), who were all from the department of internal medicine. All patients but onewere given antimycotic agents. They were treated by a combination therapy except for three patients who received single amphotericine B (AMPH) therapy. The mos frequent combination was AMPH +5-flucytosine (5-FC), which was found in 7 cases. Seven patients (43.4%) died, three males and four females. Analysis of these cases in terms of clinical type revealed meningitis in four, and pneumonia, sepsis, or pleuritis complicated with sepsis in the remaining three patients. Four patients (57.1%) had underlying diseases. In addition, eleven strains isolated from the specimens were examined for serotypes and minimum inhibitory concentration (MIC) using three types of antimycotic agents.Serotypes of Cryptococcus neoformans were all A and the MIC was 0.1-0.39 μg/ml for AMPH, 0.05-0.2μg/ml for 5-FC and 0.2-0.78μg/ml for miconazole (MCZ).

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A double blind study was conducted to objectively evaluate the usefulness of Cefuzonam (CZON) in the treatment of bacterial pneumonia and lung abscess.
Cefotiam (CTM) was used as a control drug. Each drug was administered by intravenous dripinfusion at 1 g at a time, twice aily, for 14 days as a rule.
The results are as follows:
1. Enrolled in this study were 145 cases in total, comprising 72 of CZON group and 73 of CTM group. Of the total cases, 109 (53 of CZON group and 56 CTM group) were evaluated for clinicalefficacy by the evaluation committee. Exclusion rate and background of patients were not significantly different between the two groups.
2. Clinical effectiveness assessed by the committee showed the efficacy rates of 84.9%(45 cases out of 53) for the CZON group and 83.3%(47 cases out of 56) for the CTM group, with no significant difference between the two groups.
3. The bacteriological eradication rates were 89.5%(17 strains out of 19) for the CZON group and 78.3%(18 strains out of 23) for the CTM group, with no significant difference between the two groups.
5. Usefulness rates caluculated by the commitee were 79.2%(42 cases out of 53) for the CZON group and 76.8%(43 cases out of 56) for the CTM group. There was no significant difference between the two groups.
These results show that CZON is a useful drug in the treatment of bacterial pneumonia and lung abscess.

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Efficacy and safety of a new injectable cephem antibiotic, cefpirome sulfate (hereafter, CPR), against respiratory tract infections were examined and compared with those of a control drug, ceftazidime (hereafter, CAZ). As a rule, CPR 0.5 g twice a day, 1.0 g twice a day, or CAZ 1.0 g twice a day (hereafter CPR 0.5 g group, CPR 1.0 g group, and CAZ group) was administered for 14 days and the following results were obtained.
1. The total number of cases was 470 (155 cases in the CPR 0.5 g group, 160 cases in the CPR 1.0 g group, and 155 cases in the CAZ group). Among them 390 cases were subjected to analyses of clinical efficacy by the efficacy evaluation committee (131 cases in the CPR 0.5 g group, 131 cases in the CPR 1.0 g group and 128 cases in the CAZ group).
2. Efficacy rates determined by the efficacy evaluation committee were 82.4%(108/131) for the CPR 0.5 g group, 81.7%(107/131) for the CPR 1.0 g group, and 83.6%(107/128) for the CAZ group. Efficacy rates determined by the physician in charge were 82.0% (105/128) for the CPR 0.5 g group, 80.5%(99/123) for the CPR 1.0 g group, and 88.5%(108/122) for the CAZ group. No statistically significant difference was observed among the 3 groups. In evaluation of equivalency, clinical efficacy for the CPR 0.5 g group and the CPR 1.0 g group determined by the clinical efficacy evaluation committee was proved to be statistically equivalent to that for the CAZ group.
3. In patients with pneumonia, efficacy rates determined by the efficacy evaluation committee were 87.1%(61/70) for the CPR 0.5 g group, 80.7%(71/88) for the CPR 1.0 g group, and 78.9%(56/71) for the CAZ group. Efficacy rates determined by the physician in charge were 85.3%(58/68) for the CPR 0.5 g group, 80.7%(67/83) for the CPR 1.0 g group, and 86.2%(56/65) for the CAZ group and no statistically significant difference was observed among the 3 groups. In patients with chronic respiratory tract infection, efficacy rates determined by the efficacy evaluation committee were 77.0%(47/61) for the CPR 0.5 g group, 83.7%(36/43) for the CPR 1.0 g group, and 89.5% (51/57) for the CAZ group. Efficacy rates determined by the physician in charge were 78.3%(47/60) for the CPR 0.5 g group, 80.0%(32/40) for the CPR 1.0 g group, and 91.2%(52/57) for the CAZ group. No statistically significant difference was observed among the 3 groups.
4. Bacteriological efficacy was judged by bacterial eradication rates, which were 86.6%(58 strains out of 67 strains) for the CPR 0.5 g group, 87.9% (58 strains out of 66 strains) for the CPR 1.0 g group, and 93.0% (66 strains out of 71 strains) for the CAZ group. No statistically significant difference was observed among the 3 groups.
5. Adverse events occurred in 3 (2.1%) of the CPR 0.5 g group patients, 8 (5.6%) of the CPR 1.0 g group patients, and 9 (6.4%) of the CAZ group patients. No statistically significant difference was observed among the 3 groups. The incidences of abnormal laboratory findings were 21.3%(29/136) for the CPR 0.5 g group, 35.7%(46/129) for the CPR 1.0 g group and 24.8%(32/129) for the CAZ group and there was significant difference among the incidences of the 3 groups. Multiple comparison demonstrated that neither the CPR 0.5 g group nor the CPR 1.0 group was significantly different from the CAZ group in the incidence but the CPR 1.0 g group showed a significantly higher incidence of abnormal laboratory findings than the CPR 0.5 g group (p<0.05).
6. Utility rates determined by the efficacy evaluation committee were 81.1%(107/132) for the CPR 0.5 g group, 79.5%(105/132) for the CPR 1.0 g group, and 79.2%(103/130) for the CAZ group. No statistically significant difference was observed among the 3 groups. Utility rates for pneumonia and chronic respiratory tract infection were not significantly different among the 3 groups.

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virological surveillance of acute respiratory tract illnesses (RTI) of children in Morioka, Japan, was mainteined from September 1973 to December 1983. Nasal and throat swabs were collected from 4, 334 children with RTI. These patients consisted of 3, 500 children (80.8%) with upper RTI (URTI) and 834 children (16.2%) with lower RTI. When these patients with URTI were classified by maximum temperature recorded into 4 groups (≥37.0°C-37.1-37.9°C, 38.0-38.4°C, and≥38.5°C), the number of patients in each group was 1, 909 (44.0% of all patients), 702 (16.2%), 378 (8.7%), and 512 (11.8%), respectively.
The viruses were recovered from 932 patients (21.5%). The most frequently recovered virus was rhinovirus (HRV; 31.7% of positive patients). The other common viruses were respiratory syncytial virus (RSV; 15.3% of positives), enteroviruses (13.9%), adenoviruses (13.6%), and influenza viruses (11.1%). Coronaviruses (HCV) were isolated from 2 patients and dual infections were detected in 20 patients (2.1% of positives).
HRVs were isolated from 8.9% of afebrile URTI, in addition to 7.4% of bronchitis and 12.8% of asthmatic bronchitis. RSVs were mainly isolated in the winter, but some of them were isolated in the summer of 1974 and 1975. HCVs were isolated from 2 patients with afebrile URTI in the spring of 1979.
Consistent patterns have been observed in clinical manifestation, seasonal occurrence, and age distribution of infections; we indicated that HRV was not only most important pathogen of URTI, but also it was important in bronchitis and asthmatic bronchitis of children.

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We previously reported the short period cure rate of mebendazole (MBZ) treatment to strongyloidiasis. We are now reporting the long period cure rate of the treatment.
The results were as follows:
1) The cure rate was 73.9%(17/23) in single use of MBZ (100 mg twice daily for 28 days).
2) The cure rate was 100.0%(22/22) in combination therapy (thiabendazole 500 mg three times a day for 5 days and after that, MBZ 100 mg twice daily for 9 days).
Before we obtained the cure rate of 6 months after the treatment described above, we concluded that MBZ could be used for the treatment of stronglyoides infection because of the lack of severe side effects and suitable intervals between courses would prevent liver injury. Thus, in this study, 47 patients were treated with 100 mg of MBZ twice a day for 5 days and this treatment was repeated 1, 3 and 4 weeks later on the same schedules (group 1). But because of liver injury, 13 patients were interrupted and moved to the 4th course (group 2).
The following results were obtained:
1) Out of a total of 60 patients, the cure rate was 88.1%(52/59) after 2 courses, 92.3%(12/13) after 3 courses and 100.0%(46/46) after the 4 courses were finished.
2) Diarrhea (10.6%), arthralgia and lumbago (8.5%) were observed in group 1. No side effects were observed in group 2.
3) The incidence of liver injury occured 48.9%(23/47) in group 1 and 30.8%(4/13) in group 2.
4) Positive rate of HTLV-I antibody was 40.0%(24/60).
As described above, the cure rate after 4 courses was 100%, although there were intractable cases after 2 courses and 3 courses. Although abnormal liver function developed, the incidence was lower than the previous study because of decreased use of the dosage per course and long intervals between each treatment.
From these results, it can be concluded that treatment periods of each course to be decreased from 5 days to 4 days and the treatment to be given in 4 courses could be much more favorable for the treatment of strongyloidiasis.

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The infectivity of Enterococcus faecalis was compared with that of Escherichia coli in the urinary tract in mice. The infectivity of E. faecalis in normal mice was found to be equal to that of E. coli. The mice previously treated with cyclophosphamide, carrageenin or alloxan as the immunosuppressive drug, and restricted water supply, were more susceptible to enterococcal infection than non-treated ones. These data were confirmed with histological examinations. E. faecalis is a pathogenic organism in the urinary tract and therefore cautions should be given to the treatment in clinical practice

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To study the serovar distribution of C. trachomatis in Japan, a total of 85 genital C. trachomatisisolates from male and female patients attending the clinics were examined by the microimmunofluorescence test using immune sera of the isolates produced in mice. Of these isolates, 34 (40.0%) were typed D or E, and 19 (22.4%) were typed G or F. The serovars of the remaining 32 isolates were B, H, I, J, and K, and the proportions of these serovars were from 8.2 to 3.5%. Thus, two thirds of C. trachomatis isolates in this country were found to fall into only four serovars, namely, D, E, G, and F, and, therefore, the epidemiology of C. trachomatis infection in Japan seems to be similar to that of other countries in North America and Europe.
The relative distribution of serovars of C. trachomatis isolates from male patients and female patients somewhat differed. Serovars D, E, and G, F were isolated in the same ratio from male patients, while the isolation ratio of the former serovars was three times or more higher than the latter serovars in female patients. No isolate typed serovar K was found in male patients, while 15% of isolates from female patients were typed this serovar.

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At present Non-A and Non-B hepatitis disseminated from the intestine in the world is believed to have a better prognosis and has no chronicity. From 1980-1986, this hepatitis has occured in the south of Xinjiang. It was sporadic (1980-1985) and there was an outbreak (1986). Our study indicated that the results from 500 cases followed up for two years were different from the literature reported.
1. Patients with hepatomegaly were 11.2% at 7th months, 12.8% at 19th months and 45.3% at 28th months. At the same time there were 3 cases of splenomegaly and spider in each of the 19th month and 28th month.
2. Liver function test showed that γ-GTP, BSP and γ-globulins rose in different degrees among the 3-7 month cases. Reexamined at 19th months, 3.6% cases of both ZTT and SGPT were high. General proteins of 8% patients dropped. In 42% of the patients the globulins rose and the album in dropped.
3. Biopsy of the liver after 28th months demonstrated that it was in agreement with the pathologic changes found in chronic lobule hepatitis of CPH under the light microscope and electron microscope.

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We evaluated the clinical usefulness of a new EIA kit using a monoclonal antibody, IDEIA CHLAMYDIA ^® (IDEIA, Novo Nordisk), for detection of C.tnchomnatis antigen from the genital tracts of male and female cases. The results were compared with those by Chlamydiazyme^® (Abbott).
1. C. trachomatis antigen detection by the IDEIA and Chlamydiazyme tests before treatment;
IDEIA has a significantly higher detection rate (38.0%, 105/276) than Chlamydiazyme (29.8%, 80/276), for C. trachomatis antigen from urethral smears of 276 male patients with urethritis. In 646 female cases, including cervicitis and so on, IDEIA detected C. trachomatis antigen from cervical smears in 14.5%(94/648) of the total, while Chlamydiazyme did so in 11.9%(77/648).
When considering the different results using IDEIA and Chlamydiazyme, approximately 20% of the IDEIA-positive cases were Chlamydiazyme-negative. However, when IDEIA was negative, less than 1% showed Chlamydia-positive.
2. C. trachomatis antigen detection during and after treatment;
We studied the clinical courses of 14 male urethritis and 8 female cervicitis cases who had had positive results with both IDEIA and Chlamydiazyme before treatment. Two of the 14 urethritis cases showed positive results with IDEIA, but not with Chlamydiazyme after either 7 or 14 days treatment by an antimicrobial agent. These two also had symptoms indicating persistent urethritis.
One of the 8 female cervicitis cases showed a positive result with IDEIA but not with Chlamydiazyme after 7 days treatment by an antimicrobial agent, and this case also had symptoms indicating persistant cervicitis. Thus, these clinical findings suggest that IDEIA can detect even a small quantity of antigen soon after treatment, but Chlamydiazyme can not.
In conclusion, IDEIA has a higher sensitivity than Chlamydiazyme, in the detection of C. trachomatis antigen, suggesting that IDEIA is more useful.

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Though incident due to Serratia spp. has decreased with the use of third generation cephems, S. marcescens with multiple drug resistance are still clinically occasionally isolated. S. marcescens strains 218, 219 and 220 we isolated clinically, were found to possess aminoglycoside inactivating enzyme activities which had not been expected to exist in Serratia spp. These isolates inactivated aminoglycoside antibiotics except strains 218 and 219 were sensitive to isepamicin whereas strain 220 was sensitive to isepamicin and gentamicin. It was found that strains 218 and 219 possessed aminoglycoside inactivating enzyme AAC (2), and strain 220 AAC (6'). The genes coding for these inactivating enzymes were found to be on R-plasmid and transferred between bacterial cells. Frequencies of transfer of the R-plasmid from Serratia to Escherichia coli x-1037 were be low, but the transfer definitely occurred as frequencies of 4.3 × 10^-7 from strain 218, 5.2×10^-7 from strain 219, and 8.3 ×10^-7 from 220 were determined.
To prevent nosocomial infections, the eradication of multi-resistant Serratia strains is strongly recommended when they are isolated even apparent symptoms of infections are not observed.

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An adult case of Virus-associated hemophagocytic syndrome (VAHS) was reported and a review of this syndrome in adults in Japan was also made.
A 79 year-old woman was referred to our hospital for detailed examination for sustained generalized fatigue lasting for about two weeks. Other clinical manifestations of this patient included fever, generalized lymphadenopathy, hepatosplenomegaly, anemia and mild liver dysfunction
The biopsy of the lymph node revealed hyperplasia of histiocyte with hemophagocytosis. There was also an elevation of Ig G antibody against EB virus and the patient was therefore diagnosed to have VAHS. The predonisolone therapy was then initiated and the patient responded to this treatment very well.
By the review of the Japanese literatures, seven adult cases of VAHS were found. Based on the descriptions on these cases, the prognosis of this syndrome appeared to be extremely poor which is totally different from VAHS in children.
Our case showed a very favourable clinical course following steroid therapy and this suggested that steroid therapy should be considered even at the early stage of this syndrome in adults.

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[in Japanese]

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A 19-year-old boy, who complained of fever and fatigue was hospitalized in November 1986. On physical examination, he had a temperature of 37°C, cervical lymphadenopathy and hepatosplenomegaly. Serum transaminase was elevated moderately, while serum alkaline-phosphatase was elevated severely.
Extremely elevated antibody titers to the EBV capsid antigen (IgG: 2560x, IgA: 160x), early antigen (IgG: 1280x, IgA: 160x) and nuclear antigen (160x) were noted. PPD and DNCB skin test were negative.
Severe mobilization of Kupfer cells and mild proliferation of pseudoductule were seen in liver biopsied specimen. Cervical lymphnode biopsy showed necrotizing lymphadenitis associated with proliferation of histiocyte.
In February 1987 his temperature was elevated to 40°C and he had arthralgia and exanthema. Intravenous Acyclovir (500 mg every 8 hours) and Interferon α(6 million u/day) were administered together for 1 month. After that he improved for about a week.
In March 1987 he had dyspnea. Arterial blood gas analysis in room air showed a PO₂ of 51.8 mmHg, a PCO₂ of 28.9 mmHg. A chest radiograph showed thickening of bilateral bronchial walls and obscurity of pulmonary vascular shadows. The effects of transfer factor and Interleukin-2 were unremarkable. High antibody titers to EBV, liver dysfunction and hypo-oxygenemia continued. He died of respiratory and heart failure on 24 October 1987.
The most interesting finding of autopsied specimens was stenosis of pulmonary artery associated with interstitial pneumonitis. Hemophagocytosis was seen in liver, spleen and bone marrow.

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We reported a rare case of Plasmodium vivax malaria who showed findings of disseminated intravascular coagulation (DIC).
A 50-year-old Japanese male was sent to our hospital with the diagnosis of Plamsodium vivax malaria on the 26th of April, 1990. He had stayed in the Solomon Islands from Oct. 1987 to Dec. 1989, and had febrile episodes during his stay in the island. On April 18, 1990, he complained of a high fever with chills, and showed the same episodes on the 20th, 22th and was diagnosised as malaria. He was treated successfully with the sulfadoxine 500 mg and pyrimethamine 25 mg (Fansidar^®), following the normal temperature on 4th day and disapperance of malarial parasites in the peripheral blood smear on the 6th day.
Interestingly, he had thrombocytopenia and a high titer serum level of fibrin degradation product (FDP) supporting the questionable diagnosis of DIC. Even on the 12th day after improved thrombocytopenia by treatment with Gabexate (FOY) ^®, the serum level of FDP, D-dimer and thrombin-nati-thrombin (TAT) III complex still remained at high titer levels. One month later he was readmitted for a relapse of Plasmodium vivax malaria, when he showed thrombocytopenia but the serum level of FDP, D-dimer, TAT III complex and PM·_α2 PI complex were normal levels. We concluded that the thrombocytopenia and the high titer of FDP at his first admission was a manifestation of DIC.

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