Kansenshogaku Zasshi
Online ISSN : 1884-569X
Print ISSN : 0387-5911
ISSN-L : 0387-5911
Volume 66 , Issue 10
Showing 1-18 articles out of 18 articles from the selected issue
  • Naohide TAKAYAMA, Michiko TAKAYAMA, Masayoshi NEGISHI
    1992 Volume 66 Issue 10 Pages 1373-1377
    Published: October 20, 1992
    Released: September 07, 2011
    We observed two mild varicella cases of an advanced-age man and woman, although varicella in the adult generally presents a more severe course than in the child. The cases had been exposed to his great-grandchild and her grandchild with varicella in their home. They did not experience neuralgia as is typical from herpes zoster. Serological examinations revealed that they had high IgG-antibodies (Ab) against varicella-zoster virus (VZV), but low anti-VZV IgM-Ab. They were also found to have a high level of Ab against VZV soluble antigens (Ag) which are generally low in primary VZV infection. Immunoblotting analysis of anti-VZV IgG-Abs using sera from case 1 or 2 showed that their reaction patterns resembled those of sera children who contracted mild varicella after immunization with varicella vaccine and a herpes zoster-patient rather than those of sera from an immunocompetent adult with varicella. These results of serological examinations and their clinical course indicated that the cases had contracted varicella in the past and were again exposed to VZV resulting in clinically overt but mild varicella.
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  • Osamu ZAHA, Seisho NIIMURA, Nagisa KINJO, Minoru IKEMA, Hiroshi NAKAMU ...
    1992 Volume 66 Issue 10 Pages 1378-1382
    Published: October 20, 1992
    Released: September 07, 2011
    We treated strongyloidiasis patients and obtained the following results:
    Of the 299 patients (184 males and 115 females), 81 patients (27.1%) had no complaints before treatment, 218 patients complaints of some symptoms, including arthralgia and/or lumbago (28.4%), abdominal pain and/or borborygmus (19.3%), numbness of extremities (18.1%), constipation (16.3%) and itching (15.7).
    We treated 219 patients with mebendazole and symptoms improved after treatment described below:
    Thirty-seven of the 63 patients (58.7%) with arthralgia and/or lumbago improved. Twenty-seven of the 36 patients (75.0%) with numbness of extremities improved. Thirty-one of the 32 patients (96.9%) with heartburn improved.
    We treated 26 patients with mebendazole plus thiabendazole and twelve of 14 patients (85.7%) with abdominal pain and/or borborygmus were improved after treatment.
    We treated 54 patients with ivermectin and five of 18 patients (27.8%) with arthralgia and/or lumbago were improved after treatment.
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  • Hiroshi TADA, Sachiko ITAMI, Yasuo YAMAMOTO, Kazuhiro KOBAYASHI, Masum ...
    1992 Volume 66 Issue 10 Pages 1383-1389
    Published: October 20, 1992
    Released: September 07, 2011
    The vero cytotoxin (VT) is responsible for hemorrhagic colitis and hemolytic uremic syndrome. Polymerase chain reaction (PCR) was used to detect VT-producing coliform bacteria from dairy cattle. It was found that 39 (33.3%) of the 117 fecal samples examined were recognized with VT genes in BGLB enrichment broth by the PCR method (named BGLB-PCR). Of the VT-positive samples, 31 samples (26.5%) were found to have VT-producing Escherichia coli. Frequencies of isolation in younger cattles (under 5 months) were 31.3-32.9%. On the other hand, the PCR method using the bacterial suspension of some colonies from DHL selective isolation medium (named DHL-PCR), was used for 105 samples. The DHL-PCR was validated according to the number of colonies tested for detecting VTEC. When using E. coli strains which have been stored after isolation by the conventional culture method, the VT-producing strains found were 7 (10.3%) of the 68 isolates tested. The 101 out of the 108 VTEC strains from cattle were classified into 14 0 groups. 4 0 serogroups (026, 0111, 0145, 0157) from 60% of VTEC positive cattle, were also the most common in humans with diarrhea. All E. coli O157: H7 isolates failed to ferment after 48 hrs and to hydorolyze 4-methyl-umbelliferyl-beta;-D-glucuronide (MUG). These results suggests that cattle may play an important role in human VTEC infections. The BGL B-PCR technique is usefull in ecological studies for VT-producing pathogens.
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  • The 5th Report on Long-Term Cases Followed Over 7 Years
    Keiichi MIKASA, Masayoshi SAWAKI, Eiji KITA, Mitsuru KONISHI, Koichi M ...
    1992 Volume 66 Issue 10 Pages 1390-1395
    Published: October 20, 1992
    Released: September 07, 2011
    Clinical studies were made over 7 years on 9 cases to whom long-term chemotherapy with EM was administered for chronic airway infection.
    1) Clinical effectivenes: Highly effective in 8 cases; Improvement in QOL was observed in 8 cases. Bacteriological effect: In 7 cases, pathogenic bacteria disappeared.
    2) No side effects were observed.
    3) Changes in Pa02 levels with the passage of time: In most cases, Pa02 reached a plateau within 1 year. Although in some cases, there was subsequent elevation.
    4) The frequency of catching cold over the 7 years period was low with an average of 1.2 times/year per subject. In only 2 cases were subjects hospitalized due to acute exacerbation triggered by a cold.
    5) Mucociliary transport improved in 7 out of 8 cases examined. However, only 4 of these recovered normal transport. The effect of EM in the other cases in which clinical improvement was not demonstrated was deemed slightly effective.
    On the basis of the above findings, it was suggested that long-term chemotherapy using EM was clinically efficacious. This is based on the fact that its efficacy, including amelioration of QOL appeared within one year of the initiation of therapy, and continued without decline for over 7 years.
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  • Akemi OMORI, Atsushi TAKAHASHI, Kiwao WATANABE, Keizo MATSUMOTO, Hidea ...
    1992 Volume 66 Issue 10 Pages 1396-1403
    Published: October 20, 1992
    Released: September 07, 2011
    The state of MRSA contamination of inpatients, hospital staff, and the hospital environment was evaluated. Nasal, pharyngeal, and digital samples from 182 patients admitted in September and October, 1990, and 288 hospital staff members and sputum, urine, and feces of the inpatients were cultured. Environmental contamination was examined in samples collected from the air by air sampling and from the floor by the wiping method. The MIC and the coagulase type of the MRSA obtained were determined, and their relationships were evaluated. MRSA was detected in 9.5% of nasal samples, 7% of pharyngeal samples, 10% of sputum samples, 0% of urine samples, and 2.6% of fecal samples from the 182 inpatients. It was detected in 4% of nasal samples, 0.7% of pharyngeal samples, and 1% of digital samples from the 288 hospital staff members. From the environment, MRSA was detected from hospital rooms of the surgery and neurosurgery wards, the nursing room and corridors of the obstetrics and gynecology ward, and the recovery room of the urology ward. The coagulase type of the MRSA obtained was the primarily type II regardless or whether the samples were obtained from the subjects or the environment. Concerning the drug sensitivity, many MRSA strains were highly resistant to DMPPC and FOM, but the sensitivity to RFP was 0.1g/μml or less in all strains except for one highly resistant strain (200μg/ml or above). MRSA was sufficiently sensitive to RFP, MINO, Teicoplanin, VCM, ABK with the sensitivity to MINO being 0.78μg/ml or less in all strains, those to Teicoplanin and VCM being 3.13μg/ml or less in all strains, and that to ABK being 6.25μg/ml in 4 strains and less than 6.25μg/mi in the remaining strains. The number of patients infected by MRSA and the number of MRSA strains separated were the greatest in the neurosurgery and surgery wards. MRSA appeared to circulate in the hospital centerring on these wards, and prompt measures against hospital infection are needed.
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  • Yoshihiro IMAMURA, Nobuyuki HAMADA, Takayuki NAGAI, Masahisa SHINGU
    1992 Volume 66 Issue 10 Pages 1404-1410
    Published: October 20, 1992
    Released: September 07, 2011
    Fecal samples from sporadic acute gastroenteritic patients who visited at a pediatrician during five consecutive winter seasons in Kurume City located at north part of Kyushu district. Fecal samples were subjected to detection of rotavirus and other viruses and study of yearly changes in serotype of rotavirus. The rate of group A rotavirus positives in third winter and other consecutive winters were 12.5%, 40 to 65%, respectively. 60% specimens were successfully serotyped: 58% was serotype 1, 22% was serotype 3, 6% was serotype 2, and 14% was serotype 4. The dominant serotype in first, fourth and fifth winter was type 1. However in second winter each serotype of rotavirus was almost equally detected. During five consecutive winters six patients visited at the same pediatrician twice more than two months interval. They all had acute gastrointestinal symptoms. In six patients rotavirus was detective just once.
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  • Norimasa OKABE, Ryuichi KATAYAMA, Kazuhiko YOSHIDA, Yhu NISHIDA, Naoko ...
    1992 Volume 66 Issue 10 Pages 1411-1415
    Published: October 20, 1992
    Released: September 07, 2011
    The current alteration of the detection rate of Helicobacter pylori (H. pylori) on mucous membranes of the stomach has been surveyed and reviewed for 49 cases of gastro-duodenal diseases. The surveyhas been conducted for 3 years and an endoscopic examinations have been performed 2-8 times. On the first visit, the diagnosis can be made endoscopically, and H2 blockers and another agents were used as therapeutic drugs.
    The detection rate was 67.3%(33 cases) for positive cases and positive reaction cases, while the rate was 32.6%(16 cases) in negative cases and negative reaction cases. Among them, the most commonly observed disease was atrophic gastritis, followed by duodenal ulcer, and acute gastric mucous lesions (AGML). Peptic ulcer was not seen.
    After administration of H2 blockers and anti-ulcer agents, the H. pylori-detection rate was found to fluctuate according to the diseases and alterations in the morbidity period. Some cases indicated the disappearance of H. pylori in accordance with the improvement of the lesion site.
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  • Hirofumi MIYAZAWA, Tomoyo WAKAI, Takeshi TOSHIDA, Yumiko YAMAMOTO, Mic ...
    1992 Volume 66 Issue 10 Pages 1416-1421
    Published: October 20, 1992
    Released: September 07, 2011
    The pneumonia, sepsis and meningitis are common diseases of GBS infection in infants. There are early-onset and late-onset types in this disease, the result of the infection is unknown. M. Sugiyama reported that M9 is a new type of GBS in Japan in 1989. Analysis of GBS typing and serum specific antibody concentrations of the type are simple with new technics.
    By studying the infants' contamination we discovered that GBS appeared to originate from mother-infant sources. The infants were followed for a year. 52% of the infants had GBScontamination in their throat or stool. The most common type was Ia, followed by III, JM9 and NT6. Those types without III type had been present for more than 9 months in the infant.
    The contamination term of Ia or III type in infants correlated with the blood specific antibody concentration of the type.
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  • 4) Isolation of Enteropathogenic Bacteria from Patients with Traveller's Diarrhoea at Osaka Airport Quarantine Station during 1984-1991
    Akio YOSHIDA, Koji NODA, Kanzo OMURA, Kazufumi MIYAGI, Hideto MORI, No ...
    1992 Volume 66 Issue 10 Pages 1422-1435
    Published: October 20, 1992
    Released: September 07, 2011
    During the last 8 years (1984 to 1991), 16, 639, 233 overseas travellers were quarantined at Osaka Airport Quarantine Station and 38, 326 travellers reported that they were (or had been) suffering from diarrhoea. Bacteriological examination of stools from 12, 573 persons revealed the following results.
    1) Various enteropathogenic bacteria were isolated from 3, 669 cases (29.2%) examined. The predominant species of bacteria isolated were as follows: Salmonella, 1049 cases; Plesiomonas shigelloides, 1030 cases; Vibvrio parahaemolyticus, 789 cases; Shigella, 607 cases; enterotoxigenic Escherichia coli, 422 cases; Vibrio cholerae non-O1, 212 cases.
    2) There were no apparent seasonal variations in the isolation rate of these pathogens
    3) The suspected regions for infection with these pathogens were as follows:
    a) Salmonella, Enterotoxigenic E. coli and Plesiomonas, mainly South-East and South-West Asia.
    b) Shigella, South-West Asia, especially India (59.8%).
    c) V. parahaemolyticus and V. fluvialis, mainly South-East and East Asia.
    d) V. cholerae non-O1, V. mimicus, almost restricted to Asia, mainly South-East Asia.
    4) 22 strains of V. cholerae O1 were isolated and 19 were Ogawa, E1 Tor. Of these strains, 13 were cholera toxin-producing strains and 9 were non-toxigenic strains.
    5) Several pathogens (mixed infection) were isolated simultaneously from 670 cases.
    6) The 1247 Salmonella strains were identified into 98 serovars.
    7) Of 624 Shigella strains isolated, 57.9% were S. sonnei, 29.2% were S. flexneri, 8.6% were S. boydii, 4.3% were S. dysenteriae.
    8) The most predominant serovar of V. parahaemolyticus was O4: K8. of 1, 247 strains isolated, 9.8% were not producing thermostable direct hemolysin (TDH).
    9) 570 (91.3%) of 624 Shigella strains and 409 (32.8%) of 1, 247 Salmonella strains isolated were resistant to any one of the drugs tested (SM. CP. TC. KM. ABPC. NA. OFLX). The resistance rate and the number of multiple drug-resistance strains increased year by year.
    10) Enterotoxigenic E. coli was isolated from 422 cases (10.7%) of 3, 939 cases. Cases with enterotoxigenic E. coli strains producing ST (heat-stable), LT (heat-labile) or both ST and LT were 53.8%, 24.2% and 14.2% respectively. The others were cases with mixed types of enterotixin production.
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  • Hisashi FUNADA, Hiroshi YONEYAMA, Toshihiko MACHI, Tamotsu MATSUDA
    1992 Volume 66 Issue 10 Pages 1436-1443
    Published: October 20, 1992
    Released: September 07, 2011
    During the 20-year period, 1972-1991, 27 episodes of Staphylococcus aureus bacteremia, including 10 with methicillin-resistant strains (MRSA), were documented in 26 patients with hematologic disorders, mainly acute leukemia and malignant lymphoma, representing 6% of all 433 episodes of bacteremia in a hematology unit. MRSA replaced methicillin-sensitive strains (MSSA) in the last four years. The skin and upper respiratory tract were the two most common primary foci. Most episodes occurred during neutropenia. Pharyngeal colonization often preceded the development of bacteremia. Antibiotic therapy predisposed to MRSA acquisition during hospitalization, whereas MSSA was mostly detected in admission cultures. Among 22 patients with monomicrobial bacteremia, 19 (86%) survived longer than one week, including all four with MRSA bacteremia who received vancomycin. The survival rate did not differ materially between MRSA and MSSA bacteremias. Secondary foci, chiefly located in the lung, were found in 30% of all patients with S. aureus bacteremia. Prolonged antibiotic therapy, therefore, seems warranted in patients with evident metastatic lesions, although abbreviated therapy is proposed in neutropenic cancer patients.
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  • Yukiyoshi MORIUCHI, Yasuaki YAMADA, Masao TOMONAGA
    1992 Volume 66 Issue 10 Pages 1444-1448
    Published: October 20, 1992
    Released: September 07, 2011
    Between January, 1982, and January, 1992, a total of 112 patients with adult T-cell leukemia (ATL) and 109 patients with non-Hodgkin's lymphoma (NHL) were admitted to our hospital. They were studied for their infectious complications.
    Infectious complications were seen in 90 patients (80.4%) with ATL, and 51 patients (46.8%) with NHL (p<0.001).
    Documented infections were seen in 70 patients (62.5%) with ATL, and 30 patients (27.5%) with NHL (p<0.001).
    Pneumonia (p<0.005), skin infections (p<0.05), Pneumocystis carinii pneumonia (p<0.05), fungal infections (p<0.05), cytomegalovirus infections (p<0.05) and herpes simplex virus infections (p<0.01) were identified infections at high risk for patients with ATL.
    Tuberculosis, listeriosis and salmonella infections were seen only in patients with ATL.
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  • Kimi ASANO, Eiichi IWASHITA, Ryuji ASANO, Shigeo HOKARI, Yasutomo ARAS ...
    1992 Volume 66 Issue 10 Pages 1449-1453
    Published: October 20, 1992
    Released: September 07, 2011
    To clarify whether sanitary and hygienic conditions surrounding humans and pet animals have improved or not, we examined feces from dogs for intestinal parasites in Tochigi in 1979 and 1991.
    Intestinal parasites were detected from 109 of the 262 dogs (41.9%) in 1979 and 86 of the 260 dogs (32.8%) in 1991. Among the parasites. Ancylostoma caninum, Tirchuris vulpis and Toxocara canis were most commonly detected, and their detection rates were higher in 1979. Onthe contrary, Dipylidium caninum, Strongyloides stercoralis, Isospora spp., which are important causes of human diseases, were detected at higher rates in 1991. In the dogs of outdoor feeding, the detection rates of parasites were markedly decreased, but slightly increased in the dogs of indoor feeding in 1991.
    These results suggest that sanitary conditions surrounding pet animals have not been sufficiently improved, in spite of the fact that humans are in more contact with theirpet animals.
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  • The Influence of Clarithromycin to Biofilm with P.aeruginosa
    Hiroaki TAKEDA, Noritaka OOGAKI, Naomi KIKUCHI, Hiroyuki KOBAYASHI, To ...
    1992 Volume 66 Issue 10 Pages 1454-1461
    Published: October 20, 1992
    Released: September 07, 2011
    Clarithromycin (CAM) was administered long-term to patients with diffuse panbronchiolitis (DPB) to clarify the mechanism of the usefulness of the macrolides (MLs).
    1. A tendency for clinical improvement was observed in 17 patients with DPB. Bacteria were eradicated in 7 of 9 patients with P. aeruginosa found in sputum.
    2. A biofilm experimental model with P. aeruginosa was found to be destructed through constant contact with CAM and formed into a single cell with a smooth surface.
    3. It was believed that the new lesionforming capability of P. aeruginosa that had been in contact with CAM was reduced due to a significant decrease in adherence to tissue. P. aeruginosa was principally eradicated by the host factors.
    These results suggested that the improvement in the prognosis of DPB with P. aeruginosa in the sputum after adding MLs was closely related to the destructive effect of the MLs on the biofilm.
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  • Takaoki HIROSE, Yoshiaki KUMAMOTO, Akibumi YOKOO, Tsugio UMEHARA, Masa ...
    1992 Volume 66 Issue 10 Pages 1462-1472
    Published: October 20, 1992
    Released: September 07, 2011
    Sparfloxacin (SPFX) is a new quinolone compound with a long half-life of 16 hours and a potent antibacterial activity (MIC90:≤0.025μg/ml against Escherichia colt), suggesting that the agent can be effectively used in single-dose therapy for acute uncomplicated cystitis in female patients. To find the optimum dose, the present dose-finding study was conducted. A dose of either 100 mg or 200mg of SPFX was selected by the double-blind method, and was administered only once (single dose therapy).
    Theclinicalefficacywasjudged on day 3, 7 and 14 after administration. On day 3, of the 49 pts. in the 100 mg-group, the efficacy icacy rate was 95.9%(excellent rate: 79.6%), and of the 42 pts. in the 200 mg-group, it was 100%(excellent rate: 88.1%). On day 7, of 38 pts. in the 100 mg-group, it was 94.7%(excellent rate: 78.9%), and of 28 pts. in the 200 mg-group, it was 100%(excellent rate: 92.9%). On day 14, of 27 pts. in the 100 mg-group, it was 92.6%(excellent rate: 66.7%), and of 26 in the 200 mg-group, it was 96.2%(excellent rate: 84.6%). Recurrence was observed in 4.8%(1/21) in the 200 mg-group.
    Therefore, there was no significant difference in the efficacy rate between the two groups, but the rate of excellent responses was higher in the 200 mg-group.
    Otherwise, the efficacy was estimated to be insufficient in 3 pts. and recurrent in 1 pt. they were examined the findings of detailed urological intractableness. Among 2 pts. in whom the external genitalia and urethra were closely examined, a urethral caruncle was noted in 1 pt.
    The results of our study indicate that 200 mg of SPFX is recommended as a single dose therapy for acute uncomplicated cystitis in females.
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  • Hisao KOMEDA, Takashi DEGUCHI, Kouji TADA, Hiroyuki YAMAMOTO, Emiko KA ...
    1992 Volume 66 Issue 10 Pages 1473-1478
    Published: October 20, 1992
    Released: September 07, 2011
    We have reported a method for detection of Chlamydia trachomatis by polymerase chain reaction (PCR) with two oligonucleotides based on sequences within the major outer membrane protein gene from C. trachomatis serovar L2. In the previous report, in addition to treatment of the mixture of first-voided urine (FVU) sediment and 1ml of urine with proteinase K. DNA purification by phenol extraction was necessary for preparation of template DNA for PCR. In this study, FVU sediment was suspended in 1ml of Chlamydiazyme dilution buffer and a part of the suspension was treated with proteinase K for DNA extraction. The DNA extraction solution could be used as template for PCR without purification of DNA by phenol extraction.
    One hundred FVU specimes obtained from male urethritis patients were examined with the two methods (PCR and IDEIA) for detection of C. trachomatis. In 33 of 100 specimens, the DNA fragments of C. trachomatis was amplified by the PCR and in 32 of 100, the chlamydial antigen was detected by IDEIA. The positive and negative coincidence rate of the PCR to IDEIA were 93.8%(30.32) and 95.6%(65/68) respectively, resulting in a high overall coincidence rate at 95%. Thus, the improved method with PCR using FVU as a specimen is proved to be a useful, non-invasive diagnostic tool for diagnosis of chlamydial urethritis.
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  • Hideji HAYAKAWA, Mitsuo NARITA, Toshiyuki KATOH, Chie NAKAMURA, Masayu ...
    1992 Volume 66 Issue 10 Pages 1479-1482
    Published: October 20, 1992
    Released: September 07, 2011
    We presented a case of tuberculous meningitis in which a nested polymerase chain reaction was useful for its rapid diagnosis and follow-up.
    A 5-month-old girl was hospitalized for gastrointestinal complaints of 4 days' duration. She initially had no meningeal signs, but showed a bulging of the anterior fontanel on the 10th day of her illness. Cerebrospinal fluid examination revealed a cell count of 886/3μl (80% lymphocytes), protein of 20mg/dl, and glucose of 27mg/dl. Tuberculous meningitis was suspected clinically and an anti-tuberculous therapy was commenced on the 13th day. Although repeated attempts to culture Mycobacterium tuberculosis were negative, the DNA of the organism was detected sequentially from the cerebrospinal fluid of the 13th and 16th day by the method of a nested polymerase chain reaction. The final diagnosis of tuberculous meningitis was established on the basis of the positive results of the nested polymerase chain reaction, a positive tuberculin test, and typical cerebrospinal fluid findings. She recovered rapidly in response to the therapy and was discharged from the hospital without any neurological sequelae on the 89th day. The follow-up samples of the nested polymerase chain reaction resulted as negative after the 26th day of the illness.
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  • Hiromi TOMIOKA, Bun-ichi UMEDA, Hitoshi NAKAI
    1992 Volume 66 Issue 10 Pages 1483-1487
    Published: October 20, 1992
    Released: September 07, 2011
    We described a case of adult respiratory distress syndrome (ARDS) likely due to measles and Mycoplasma pneumoniae. A 24-year-old, previously healthy man was referred to our hospital because of respiratory arrest. He was unconscious and cyanotic. He had erythematous and polymorphic eruptions on his extremities and trunk, but his face was spared. His chest roentogenogram showed consolidation with air bronchograms affecting the whole bilateral lungs. After mechanical ventilation with positive end-expiratory pressure and administration of intravenous hydrocortisone and protease inhibitor “urinastatin” and so on, the patient recovered from his critical condition. No attributable organisms were isolated from the specimens investigated in his acute phase. Serological examinations of the specific IgM antibody to measles during the course indicated a recent measles infection. Mycoplasma pneumoniae indirect hemagglutination test rose from a titre of less than 1/40 to 1/60. ARDS is a rare complication of measles or Mycoplasma pneumoniae infection. Moreover he received measles vaccine before 1970 in Japan, so this case was suspected to be atypical measles.
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  • Kazuo KITAGAWA, Takayoshi TASHIRO, Hideaki SHIGENO, Toshiyuki NAKAYAMA ...
    1992 Volume 66 Issue 10 Pages 1488-1491
    Published: October 20, 1992
    Released: September 07, 2011
    A 60-year-old male with adult T-cell leukemia (ATL) complained of fever, cough and dyspnea, after anti-leukemic chemotherapy. Chest X-ray film showed a diffuse interstitial shadow, and cytomegalic inclusions and cytomegalovirus (CMV) antigen were detected in the bronchoalveolar lavage specimen and sputum. The diagnosis of CMV pneumonia was made, then ganciclovir and intravenous CMVhyperimmune globlin was administered. Although CMV pneumonia was improved with the treatment, the patient died of ATL. There was no cytomegalic inclusions in the lung but in the adrenal at autopsy. The combination therapy of ganciclovir and intravenous CMV-hyperimmune globulin is considered to be effective ective f or CMV pneumonia.
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