We previously reported the efficacy of ivermectin (IVM) for the treatment of 23 strongyloidiasis patients. We now reported the efficacy and safety of IVM therapy on 54 patients.
Fifty-four patients, 28 males and 26 females, received a single oral dose of IVM one hour before breakfast and this treatment was repeated 2 weeks later.
The following results were obtained:
1) The cure rate at 2 weeks after the initial treatment was 92.5%(49 of 53 patients) and 2 weeks after the second course was 96.0%(48 of 50 patients).
2) Four patients (7.4%) complained of diarrhea (n=2 patients), constipation (n=1), borborygmus (n=1), dizziness (n=1), diplopia (n=1) and peri-anal itching (n=1) after the first treatment. Three patients (5.6%) complained of borborygmus (n=1), itching (n=1) and exanthema (n=1) after the second treatment. But all symptoms were mild and required no treatment and sudsided in a few days.
3) Positive rate of HTLV-1 antibody was 25.9% in the patients. As described above, although side effects occurred in some cases, they were mild and transient.
From these results, we concluded that IVM is an effective drug for strongyloidiasis.

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The new serological tests for candidemia were evaluated. In nine cases of candidemia, fungal index (Endotoxin D-Endospecy) was 146.8 ± 116.8 μ g/ml and D-arabinitol/creatinine 1.10 ± 1.0 4 μ mol/mg. Fungal index was significantly (p<0.01) higher in candidemia than suspected infections. All candidemia were positive for Cand-Tec latex agglutination, but twelve of the sixteen cases of suspected infections were also positive. Mannan latex agglutination was very specific for candidemia. Four cases of candidemia was positive for Mannan latex agglutination and only one case was positive in suspected infections. Fungal index and D-arabinitol/creatinine was decreased after treatment of antifungal agents. In poor clinical efficacy case, these titer remained high even after treatment. These data suggested the usefulness of these serological tests for candidemia.

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Specific immunological responses (varicella-specific Ig and Ig) and various parameters (interferon, C3, C4, platelet count, erythrocyte count, erythrocyte CR1) in varicella infection were determined over the course of the disease (days) and their relationships to severity and immunological significance evaluated. Defining the day varicella appeared as disease day 0, Ig appeared on the disease day 4 and Ig on day 5. The preceding disease days were dominated by non-specific immunological mechanisms. Interferon appearance preceded that of these antibodies but did not correlate with severity. In serious cases, C3 and C4 increased in the acute stage while platelet count declined. Erythrocyte count decreased in severe cases after disease day 5. Three patients with lower erythrocyte CR1 activity values remained critical. These findings suggested that determining platelet count is expedient in determining severity in the early stage and that the complement pathway is a major component of early immunological response.

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Between December 9 1988 and January 28 1989, there were four outbreaks of acute gastroenteritis in Saitama prefecture. Eighty-two of 123 persons (67%) attending four banquets in restaurants became ill: 44 cases attending three banquets were related to eating raw oysters, and 38 attending one banquet to eating sashimi. The most common symptoms were nausea, diarrhea, abdominal cramps, and vomiting. Average incubation periods were 29 to 32 hours long.
Bacteriologic analysis of stool specimens did not reveal causative agents. Small round structured viruses were detected in fecal specimens from 19 of 39 ill persons (49%) by electron microscopy. In one of four outbreaks, the formation of antibody to small round structured virus in paired serum samples was detected by western blot test. Small round structured viruses were eimplicated as the etiologic agents in four outbreaks of acute gastroenteritis.

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Enterococci are important causative organisms of nosocomial infections as well as methicillin resistant Staphylococcus aureusand Pseudomonas aeruginosa. Enterococcal bacteremia has been increased in Nagoya University Hospital from April 1983 to March 1990. We analized the clinical backgrounds, portal of entry and mortality for the patients with Enterococcal septicemia.
Thirty-four cases with enterococcal septicemia (24 Enterococcus faecalis, 10 Enterococcus faecium) were subjected in this study. Twenty-seven cases were monomicrobial septicemia and 7 cases were polymicrobial septicemia. As to the portal of entry, intra-abdominal infections in 21 cases, urinary tract infections in 4 cases, respiratory tract infections or chest tubes in 2 cases, decbitus infection in 1 case, intravascular catheter in 1 case, and unknown sources in 5 cases. Total mortality of the septicemia was 44.1%.
E. faecium and Enterococcus avium were much more resistant to antimicrobial agents than E. faecalis. Enterococci with high-level resistance to gentamicin (minimal inhibitory concentration, 2000 μg/ml) accounted for 35% of the 26 clinical isolates of enterococci.

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Penicillinase I-, II-and III-producing R-plasmid of Escherichia coli were transferred to Escherichia coli 177, KC-14, and 444. These strains are highly virulent in mice. This study was conducted to investigate the influence of conjugative R-plasmid on the virulence of its host strains.Escherichia coli 177 after penicillinase I-or III-producing R-plasmids transfer retained parental levels of virulence. On the other hand, penicillinase II-producing transconjugants showed reduced virulence in mice. The virulence of its revertants, in which R-plasmid was eliminated by heat, were equivalent to that of the host strain. It is suggested that the decrease in the virulence of transconjugants was not due to transferred R-plasmid. The reduced virulence of the these transconjugants may be due to alterations in their components such as the lipopolysaccharides in the cell envelope.

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Nosocomial infection due to MRSA at the Kagoshima University Hospital and their coaglase typing were examined using S. aureus (349 strains) clinically isolated in 1989. The results were as follows:
1) S. aureus consisted of 43.6% of MRSA and 56.7% of Methicillin-sensitive S. aureus (MSSA).
2) MRSAs were recovered most frequently from the specimens from the respiratory tract (47.8%).
3) The isolation of MRSA gradually increased in frequency from January to August; however, that of MSSA did not show a similar tendency.
4) The isolation of MRSA was higher in frequency in the surgical wards, the ICU and the pediatric ward.
5) When classified into 8 coagulase types, MRSAs (133 strains) consisted of only 3 types (54.1% of type II, 32.3% of type VII, and 12.0% of type IV), whereas MSSAs contained all coagulase types. As compared with the results of coagulase typing at other insititutions, the incidence of type VII was much more frequent at our hospital.
6) A few coagulase types of MRSA appeared in each ward. Also, type II MRSA strains increased in June and July, and type VII MRSA increased in August. However, MSSA strains did not show any similar tendency.

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Susceptibility to antibiotics of 123 MRSA strains isolated at the Kagoshima University Hospital in 1989 was examined. The results were as follows:
1) Susceptibility of MRSA strains was excellent to VCM, MINO, and RFP, followed by IMP, CLDM, and CPFX. However, most strains were resistant to PCG, MPIPC, ABPC, CET, CMZ, CZON, GM, and AMK.
2) Five strains highly resistant to RFP were isolated. Three of these strains were isolated on the ward for tuberculosis. This suggests easy development of resistance to RFP by MRSA.
3) Differences in susceptibility to antibiotics between coagulase type II and type VII strains were examined. The cumulative percentage of type II strains susceptible to CLDM (MICs<0.5μg/ml) was 15.3%, and that of type VII was 45.2%. Strains resistant to CLDM were more frequently isolated among type II than among type VII strains (p<0.001). A similar relationship between strains and antibiotics was also found with EM and CPEX. On the other hand, the cumulative percentage of type II strains susceptible to AMK (MICs<25 μg/ml) was 89.7%, and that of type VII was 9.7%. Strains resistant to AMK were more frequently isolated among type VII than among type II strains (p<0.001).

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The effect of sparfioxacin (SPFX) on fecal microflora and its fecal concentrations were examined in four patients and one carrier with bacillary dysentery.
SPEX was administered to five cases with a daily dose of 200 mg, once a day, for five days after breakfast.
The results were as follows: Escherichia coli, a main bacterium in Enterobacteriaceae, was not detected during the drug administration, except one from whose feces mucoid type of E. coli was found all the time, and the colony forming units (CFUs) were not recovered to the initial level at the seventh day after the medication. Enterococcus, found in all of the cases before, was eliminated or decreased during and the CFUs showed slow recovery after the medication. Total CFUs of aerobes were decreased during and not returned to the initial level at the seventh day after the medication. Total CFUs of anaerobes were kept invariable, although variation of the CFUs with the species was seen.
The peak levels of the fecal concentrations of SPEX were 177 to 535 & g/g on the third to the fifth day of the medication. The fecal concentrations were 1.3 to 4.4 & g/g at the seventh day after the medication in all of the cases.
The clinical efficacy was excellent in three cases, poor in one evaluated for the other bacteria than Shigella, and unknown in one. No adverse reaction was observed

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Clinically, prophylactic effects of Granulocyte-colony stimulating factor (G-CSF) on granulocytopenia originating from the use of anticancer agents are thought possible, and clinical studies are being performed.
Recently the application of G-CSF against infectious deseases has been considered, and we reported the prophylactic effect of G-CSF against experimental urinary tract infection induced by Pseudomonas aeruginosa in diabetic mice treated Streptozotocin, acompromised host model.
In this report, we investigated the therapeutic effect of G-CSF alone and in combination with Amikacin (20 mg/kg) against experimental urinary tract infection induced by Pseudomonas aeruginosa in diabetic mice.
In diabetic mice, the therapeutic administration of G-CSF alone and Amikacin alone did not produce an increase of 7 day survival rate and decrease of incidence of infection. But, combinational administration of these increased the 7 day survival rate and yielded a lower incidence of infection.
Thus, the therapeutic efficacy of Amikacin was improved by a combinational use G-CSF. This result suggests that the synergy of bactericidal effect of neutrophils accelated by G-CSF with Amikacin, and suggests the meaning and the efficacy of G-SCF as an additional therapy with antibiotics for infectious deseases.

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Rokitamycin, a newly developed macrolide, was administered to a total of 107 cases, 16 years old or more, in order to evaluate its clinical efficacy, safety and usefulness on Campylobacter enteritis.
Daily dosage of 600 mg of rokitamycin was administered orally in three divided doses for 5 days. Bacteriological and clinical efficacies were judged by the attending doctors from the evaluation criteria made by the committee and from the days required for improvement of diarrhea, defervescence and so on, respectively. Antibacterial activities against the isolates were tested of rokitamycin (RKM), erythromycin (EM), josamycin (JM) and ofloxacin (OFLX).
The results were as follows; 41 symptomatic patients and 5 carriers were evaluated. Clinical efficacy (n=41) was 100%(excellent; 34.1%, good; 65.9%). Bacteriological efficacy (n=41) was 97.6%. Eight of the 9 cases with consecutive stool cultures were free of the bacteria on and after one day of the drug administration. Clinical usefulness (n=46) was 97.8%. Slight epigastric pain was seen in only one as a side effect. The items of abnormal laboratory findings were 4 elevated GPT and/or GOT and one increased number of WBC in 4 cases. MIC90 of RKM, EM, JM and OFLX against 41 clinical isolates of C. jejuni were 1.56, 3.13, 3.13 and 0.78 & mu;g/ml, respectively. Rokitamycin was considered clinically useful to treat Campylobacter enteritis.

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The clinical efficacy, safety and usefulness of Rokitamycin (RKM), a new macrolide antibiotic, were compared with those of Ofloxacin (OFLX) for the treatment of Campylobacter enteritis by a double blind method.
The daily dose level of RKM or OFLX was 600 mg. They were orally administered in three divided doses for 5 days.
Of 223 cases studied, 106 cases were diagnosed as Campylobacter enteritis. Ninety cases (RKM group: 50, OFLX group: 40) except for 16 excluded or drop-out cases were analysed. There was no significant difference between the two groups in any background factors. The effectiveness and usefulness was evaluated in 88 cases (RKM group: 48, OFLX group: 40).
The results obtained were as follows:
1. In a total of 82 strains of Campylobacter jejuni/coli (RKM group: 42, OFLX group: 40), the bacteriological efficacy rate of RKM (95.2%) was superior to that of OFLX (70.0%) with a significant difference (p=0.006).
2. In 76 symptomatic patients (RKM group: 42, OFLX group: 34) on the day of the beginning of drug administration, the clinical efficacy rate was 97.6% in the RKM group and 85.3% in the OFLX group with no significant difference between the two groups.
3. In 88 evaluable patients, the global clinical efficacy rate of RKM (95.8%) was superior to that of OFLX (67.5%) with a significant difference (p=0.001).
4. Side effect was observed in 1 (1.9%) of the 54 patients in the RKM group and none of the 44 patients in the OFLX group. Slightly abnormal laboratory findings were seen in 4 (10.8%) of the 37 patients treated with RKM and 3 (9.7%) of the 31 patients treated with OFLX, but there was no significant difference between the two groups.
5. In 88 evaluable patients, the clinical usefulness of RKM (91.7%) was superior to that of OFLX (67.5%) with a significant difference (p=0.01).
From these results, RKM is considered to be a very useful agent for the treatment of Campylobacter enteritis.

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A polymerase chain reaction (PCR) procedure was developed for detection of Chlamydia trachomatis. Two oligonucleotide primers based on sequences within the major outer membrane protein gene from C. trachomatis serovar L2 were used. A single DNA fragment was amplified, when C. trachomatis DNA was template for the PCR. No amplified product was detected in Chlamydia psittaci DNA, Chlamydia pneumoniae DNA or other bacterial DNAs. The amplified DNA fragment was detected, when DNA of≥102 C. trachomatis per reaction was used as template for the PCR. Thus, the PCR was shown to be specific for C. trachomatis and more sensitive than the enzyme immunoassays for detection of chlamydial antigen and the chlamydial rRNA:DNA probe hybridization method.

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We experienced siblings of hemolytic uremic syndrome which occurred following diarrhea and bloody stool. They were immediately treated with dipyridamole and aspirin, and recovered from hemolytic uremic syndrome in about two weeks. E. coli O157: H7 (verotoxin producing E. coli) which is recently thought to be related to the pathogenesis of hemolytic uremic syndrome was isolated in their stool cultures on admission. As far as we know, this is the first case in Japan from which stool E. coli 0157: H7 was detected. Moreover, we reported clinical effectiveness of genomic investigation utilizing polymerase chain reaction method for verotoxin coding region in a rapid diagnosis of this bacterial infection.

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Scabies was first found in a 71-year-old female who had been diagnosed as having leukemic transformation of primary myelofibrosis and had undergone treatment for the disease. She was admitted to the hospital in December 1986, because of abdominal fullness and a generalized subcutaneous tumor that proved to be myeloblastoma. For treatment of the underlying disease, the regimen of the combination of vindesine, cyclophosphamide, 6-mercaptopurine, and prednisolone was selected. She developed cardiac failure and fell into a coma one month after starting the anticancer therapy. She was put on artificial respiration and on additional steroid therapy as well. Dexamethasone was administrated at 16 mg/day. Since the myeloblastomas found on admission regressed, the steroid therapy was continued. She was in coma for a few days before her skin lesions turned red and formed a grayish crust in the lower abdominal region. Several days later, the doctor responsible for the treatment of this patient developed pruritus and exanthema on both arms, and soon many nurses in the same hospital-ward developed similar symptoms. At approximately the same time, the patient with myelofibrosis was diagnosed as having Norwegian scabies: the crusted skin lesions revealing manySarcoptes scabieimites. Two doctors (2/18), 17 nurses (17/19) and 3 other patients (3/51) were found to have contracted scabies, and we recognized the hospital spread of the infection. The first patient was isolated in a private room, and we avoided direct contact with her. The persons with scabies were treated with crotamiton liniment. The first scabies patient died of cardiac failure 1 month after falling into a coma. The nosocomial infection subsided about 4 weeks after the death of the first scabies case.
Scabies can be an opportunistic pathogen in an immunocompromised host. In our case, the hospital spread of the infection started with a immunocompromised patient with myelofibrosis.Scabies, not Norwegian scabies, has been described in healthy individuals, but the patients have skin lesions that are simple eruptions and differ greatly from the widespread hyperkeratotic lesions of Norwegian scabies. The host reaction of the skin against theS. scabieiis changed by immunosuppression. However, we do not know exactly when or how she was exposed toS. scabiei, and the pathogenic mechanism of the crusted type of scabies is unknown.

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Aspergillus infection is the most frequent fungal infection associated with chronic granulomatous disease (CGD), and often results in a life-threatening situation. This report describes the use of high-dose fluconazole, a new antifungal agent, for invasive Aspergillus infection in a patient with CGD. A 27-month-old boy was sent to our hospital because of unknown fever in October, 1988. He was then admitted for pneumonia and pleural effusion of the right lung in February, 1989. Treatment with antibiotics was ineffective, and cultures of throat and pleural fluid were negative. In May, 1989, Aspergillus fumigatus was cultured from a subcutaneous abcess at the point of pleural puncture. Therefore we speculated that Aspergillus might have been the cause of pneumonia. The patient was diagnosed as having CGD by NBT test. Treatment with miconazole, flucitocin and amphotericin-B syrup was ineffective. From July, 1989, he was given 100 mg/day fluconazole d. i. v., but the drug did not reach an effective serum concentration to combat Aspergillus. However, an effective concentration of fluconazole was reached at a dose of 250 mg/day, and the chest X-ray findings subsequently improved, despite occasional high fever and continued high CRP. In July, 1990, the route of fluconazole administration was changed from d. i. v. to p.o. at the same dose, resulting in a serum concentration of fluconazole higher than that achieved with d. i. v. treatment. Both the clinical and laboratory findings showed improvement thereafter. Therapy for Aspergillus infection associated with CGD was found to necessitate high doses of anti-fungal drugs over a long period, although treatment with previously employed anti-fungal drugs could not be cotinued due to their adverse side effects. Our present case showed that high-dose fluconazole could be given over a long period because of its mild side effects, and was therefore useful for Aspergillus infection associated with CGD.

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In Japan, we experienced the first case of Hafnia alvei septicemia with shock and disseminated intravascular coagulation (DIC) in an adult with postoperative lung cancer. A 63 year-old male, who had been followed up in our department since 1987, was admitted to our hospital with the complaints of fever, hemoptysis and dyspnea on June 25, 1989. After admission, he was treated with sulbactam/cefoperazone 4 g/day intravenously for suspicion of respiratory-tract infection. After antibiotic administration, the fever subsided and the general condition became almost good. The patient experienced fever again after the antibiotic was stopped. For this reason subsequent Clavulanic acid/Amoxicillin, Flomoxef, and Ceftazidime was administered, but was not effective. Therefore septicemia was suspected and blood culture was done. The bacteria isolated from blood culture was identified as Hafnia alvei. Hafnia alvei is a gram-negative organism belonging to the Enterobacteriaceae family and quite rare pathogen in human.

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