We determined the characteristics of group. streptococci isolated from 29 sporadic cases with non-suppurative complication or severe infection during. 15-year period from 1977 to 1991. The clinical diagnoses of children included. patients with rheumatic fever, 2 with reactive arthritis, 2 with central nervous system complication, 5 with glomerulonephritis, 11 with Honoch-SchOnlein purpura, 4 with sepsis and. with empyema. Twenty-four strains were isolated from throat swabs, 4 from blood specimens and one from pleural fluid. M/T-serotypes and the number of isolates were as follows; 1/1: 10, 3/3: 1, 3·3R/3: 3, 4/4: 7, 5/NT: 1, 12/12: 3, 18/18: 2, 62/12: 1, NT/13: 1. All 29 isolates had productivity for at least one of streptococcal pyrogenic exotoxins (SPEs) A, B and C. Two strains were positive for A, 2 for. and B, 3 for A, B and C, 9 for. and 13 for. and C. Of 11 isolates from patients with Henoch-SchOnlein purpura, 7 and. strains were serotyped in M1 and M4, respectively, but none was in M12. Ten of 11 isolates were positive for SPE. or SPEs. and C.
Nontypable Haemophilus influenzae is one of the most important pathogenic bacteria inrespiratory tract infections. H. influenzae is most frequently associated with recurrent infections inchronic respiratory tract infections (CRTIs). It is known that H. influenzae often reemerges after theantibiotic treatment has been stopped. We analyzed serotype, biotype, and the OMP patterns of H.influenzae isolates from sputum of CRTIs patients to determine whether an exacerbation is caused byan identical H. influenzae strain, or by a new H. influenzae strain. One hundred eighty nine strains ofH. influenzae were obtained from 124 exacerbation from 24 patients. The first and second isolates wereidentical in 23 out of 33 exacerbations (≤15-days interval between each exacerbation) and also in 22 outof 34 exacerbations (15<days but≤30-days interval between each exacerbation). This is called earlyrecurrence. In contrast, the first and second isolates were different in 28 out of 34 exacerbations (>30-days interval between each exacerbation). This is called late recurrence. These results suggestthat early recurrence and late recurrence of recurrent H. influenzae infections occur in a differentmechanism.
The Working Party for Legionellosis headed by the Japanese Ministry of Health and Welfare processed to standardize the diagnostic procedures for Leginella pneumonia, as the first step to clarify the actual occurrence of patients with this respiratory disease. All the clinical data were collected and analysed on the 28 culture-confirmed patients in Japan during the past 11 years. from 1980 through 1990. The 28 patients were distributed throughout Japan, from Hokkaido to Kyushu. Out of 28 patients, 18 were community-acquired and 10 were nosocomially infected. In. of 18 community-acquired patients, any significant underlying disease was not observed. Though it was dominant in the age group in their 60s & 70s, victims were distributed in adults over 20 years of age and even in. new born baby. Only. out of 28 patients recovered successfully. From the autopsy findings, in. out of the remaining 23 expired patients, Legionella pneumonia seemed to be successfully treated. but other disease or other bacterial pneumonia put an end to the patients. The results of clinical laboratory tests and the efficacy of antibiotics to Legionella pneumonia were essentially the same as those reported in the literature.
Western blotting using antisera against each of reference ten serogroups was evaluated as a typing system for Clostridium difficle. A total of 164 isolates of C. difficile (114 epidemiologically unrelated and 50 isolates from a hospital outbreak in New York) were tested. Blotting patterns for the ten reference strains showed serogroup-specific bands located in the 30-60 kDa when each homologous antiserum was used. At greater than 60 kDa, variations in each serogroups were observed; these variations were used for subserogrouping the isolates. Serogroup A, G, H, and K were most frequently recovered in the group of epidemiologically unrelated isolates. Subserogroup G-1 strains of serogroup G was isolated from 28 of 36 patients (78%) of the hospital outbreak. The result suggested that the subserogroup G-1 strain was the major cause of infection in the hospital outbreak. A total of 46 of the 114 unrelated isolates (40.4%) and 9 of 50 outbreak isolates (18%) did not react with any of reference antisera and classified as nontypable. The western blotting was found to be useful not only as an epidemiologoical tool but as a typing system for C. difficile.
A study was made on the relation between in vitro bactericidal activity against Staphylococcus epidermidis which is the main bacterial flora of skin and the disinfecting activity of hand-washing with povidone-iodine, sodium hydrochloride, chloramin-T, chlorhexidine gluconate and benzalkoniumchloride. Although the bactericidal activity of povidone-iodine and sodium hydrochloride was significantly high as compared with those of the other three disinfectants, both povidone-iodine and sodium hydrochloride showed no or a little hand-washing effects. In vitro the bactericidal activity of both povidone-iodine and sodium chloride were significantly retarded by the addition of peptone in the reaction mixture. On the other hand, chloramin-T, chlorhexidine gluconate and benzalkonium chloride showed a high disinfecting activity in hand washing in spite of low in vitro bactericidal activity.Moreover, the bactericidal activity of these three disinfectants were not suppressed by the addition of peptone in the reaction mixture.These results strongly suggested that hand-washing effect of disinfectant is affected by the protein on the hand and that hand-washing activity of disinfectant should be determined by in vitro bactericidal activity in the presence of peptone.
The incidence of enteroadherent Escheridhia coli exhibiting localized adherence to HeLa cells was investigated using the EAF probe (Nataro et al., J. Infect. Dis., 152: 560-563, 1985) among 126 infants below 3 years of age along with 126 age-matched healthy controls in Brazil. The EAF probe proved to be sensitive and specific in detection of enteroadherent E. coli. EAF-probe positive E. coli was isolated from 23.0% of the infants with acute diarrhoea while the corresponding rate of isolation from healthy controls was 11.9%. EAF-probe positive E. coli strains belonging to the classical enteropathogenic E. coli (EPEC) serogrpoups were more often associated with diarrheal cases (18.3%) than with strains isolated from control healthy infants (5.6%). The predominant EAF-probe positive E. coli serotypes were 055: H-, O111: H2 and O119: 116. These serotypes, especially O111: 112, were mainly isolated from cases with diarrhoea suggesting a strong causal association. Among the EAF positive non-EPEC serotypes, the most prevalent serotype was 088: 125 and this represents a, hitherto, unrecognized diarrheagenic E. coli serotype.
Coagulase typing, staphylococcus enterotoxins (SE) A to E or toxic shock syndrome toxin-1 (TSST=1) production, and susceptibility to Oxacillin (MPIPC) were examined in 430 strains of S. aureus, which were isolated from clinical specimen of 43 Japanese National University or Medical College Hospitals during the one month period of August in 1990. Methicillin-resistant Staphylococcus aureus (MRSA): more than 4 mmg/ml of minimum inhibitory concentration for MPIPC in Mueller-Hinton broth containing 2% NaC1, occupied 58.6% of all the S. aureus, and more than 60% of the strains from admitted patients in all the areas of Japan except Hokkaidoh. Coagulase type II, SEC and TSST-1 producing strains were most frequently detected, 34.5% of all the MRSA. This kind of strain was distributed mainly in the eastern part of the Honshyu island, and showed high percentage especially in the Tohhoku and the Chyubu area. The second most frequent kind of MRSA was coagulase type II, no SE nor TSST-1 producing one, 15.4%, which was distributed mainly in the western part of Japan. Coagulase type IV, SEA producing MRSA strains and Coagulase type II, SEA, SEC and TSST-1 producing strains were detected in relatively high incidence, 10.3% and 8.7% respectively. Coagulase type III, no SE nor TSST-1 producing MRSAs demonstrated characteristic distribution, and were detected only in the western part of Japan, presenting the highest incidence in the Shikoku Island.
We attempted to detect cytomegalvorius DNA (CMV-DNA) and Pneumocystis carinii DNA (carinii-DNA) in urine, blood and sputum samples of 16 leukemia patients with pneumonia, using the polymerase chain reaction (PCR). Synthetic oligonucleotide primer pair were used to amplify DNA from the major immediateearly genes of CMV and genes for the large subunit of mitochondrial ribosomal RNA of P. carinii. Amplified products were detected by gel electrophoresis. In two cases, CMV-DNA was detected at about the time the pneumonia occurred, and in one of the two cases, CMV-DNA was detected in the sputum sample. This patient was treated immediately with ganciclovir. After ganciclovir treatment, clinical and biochemical signs of CMV pneumonia disappeared. In three cases, carinii-DNA was detected in their sputum samples. In their blood and urine samples, carinii-DNA were not detected. This three cases were treated with sulfamethoxazoletrimethoprim and successfully treated episodes of P. carinii pneumonia. We conclude that PCR amplification may be. valuable tool for rapid diagnosing CMV pneumonia and P. carinii pneumonia.
Polymerase Chain Reaction (PCR) was used to detect and to identify Mycobacterium species. In this study, 13 out of 14 Mycobacterium species were detected by using six pairs ofoligonucleotide primers. The PCR product was detected by non-isotopic southern blot hybridization even when as little as10 fg of purified M. tuberculosis DNA was used. And 8 mycobacterial species were identified by PCR-Restriction Fragment Length Polymorphism (RFLP) using two kinds of endonuclease.
Mycoplasma pneumoniae (M. pneumoniae) infection in infants had been considered to be very rare, but recently some clinical cases have been reported. We experienced an epidemic of M. pneumoniaeinfection in a nursery school, and compared M. pneumoniae infection in infants with that in preschooland school children to investigate the features of infantile M. pneumoniae infection. We obtained the following clinical findings in 15 infantile patients with M. pneumoniae infection: The maximum body temperature scarcely increased to 38.5°C or more and the period of hightemperature and cough was shorter in infant patients than in preschool and school aged patients.Stridor occurred in 4 patients but skin disorder was not observed. In the laboratory findings, the whiteblood cell count tended to increase with no changes in neutrophile/lymphocyte ratio and CRPincreased slightly. M. pneumoniae antibody was negative in all the patients except 3 and oldhemaggulination tests were positive in only 4 patients. The chest X-ray examinations showed a mildincrease in the hiliar shadow. However, the sequentially located homogeneous shadow which iscommonly seen in preschool and school aged patients was not detected. M. pneumoniae antibodyscarcely increased in infantile patients but M. pneumoniae was isolated by throat culture from 14 ofthe 15 patients who were diagnosed as having M. pneumoniae infection.
Forty-two isolates of P. aeruginosa from various infections were each incubated in Mueller-Hinton broth including piperacillin, cefsulodin, ceftazidime, imipenem, gentamicin or norfloxacin (1MIC-4MIC) at 35°C for 18 hours, and serotyped using monoclonal antibodies. Serotypes of 4 (9.5%)-8 (19.0%) of the 42 isolates each changed to different groups after incubation. No relationship was found between serotypes of the formed variants and anti-pseudomonal drugs used. When P. aeruginosa TA-2 was exposed to cefsulodin at different concentrations (1MIC and 2MIC) under the above conditions, the distinct variants different in serotypes were formed according to the drug concentrations. Furthermore, P. aeruginosa TA-2 and TA-13 were incubated in Mueller-Hinton broth including cefsulodin (1/2 or 2MIC) and gentamicin (1/2MIC), respectively, and the growth curves of parent and variant cells were determined. In the experiments, the variants appeared 6 hours after onset of the incubation and grew with the parents. The present results may explain our findings previously reported; coexistence of colonies different in serotype of P. aeruginosa isolated from some individual patients. The results indicate the possibility that alteration in bacterial surfaces in association with changes in serotypes might occur in vivo in these patients infected with P. aeruginosa and treated with anti-pseudomonal drugs.
We analyzed the initial and follow-up chest radiographs of 28 patients with culture-positive Legionella pneumonia, and developed a scoring system to quantitate the severity of radiological findings for pneumonia. Intrapulmonary shadows were observed on the initial chest radiograph in 26 patients, but pleural effusion was noted in only one. In one patient the initial chest radiograph had probably been obtained too early to reveal any pulmonary change. Alveolar shadows were noted on the initial radiograph in21 (81%) patients, and interstitial shadows in 5 (19%). In ten (38%) patients shadows were present in both lung fields. Shadows were prominent in the middle and lower lung fields. A cavity was noted in only one patient, and pleural effusion was also noted at some time during the clinical course in 19 (70%). A large amount of pleural effusion was observed in four patients. The average pneumonia severity score was 3.3 in the 9 patients who survived, and 5.1 in the 17 who died (p>0.05). The mortality rate was 53% in the 17 patients with pneumonia severity score of 5 or less and 89% in the 9 patients with a score of 6 or more (p>0.05). Twelve patients died within one week after the initial chest radiograph was obtained. There were no differences among patients with communityacquired infection with or without underlying disease and those with nosocomial infection in characteristic and extension of shadow, presence of pleural effusion, or pneumonia score. The chest radiograph of Legionella pneumonia include bilateral shadow findings characteristic, pleural effusion and rapid progression of shadow, and are clinically useful for diagnosis.
A child born from a mother with HIV infection was reported. We have followed the patient from 3 month old of age. Her HIV antibody disapeared at 7 month by ETA, and at 10 monthby WR. But we confirmed her HIV infection by PCR and HIV culture, repeatedly at those times. PCR and HIV culture are thought to be necessary for sero-neagative infants born from mothers positive for HIV antibody.
Immunocompromised hosts usually develop invasive mycotic disease. Among many pathogenic fungi. Aspergillus spp, is the most common pathogen of respiratory infection. Early diagnosis of invasive type pulmonary aspergillosis is still difficult, and the treatment is usually difficult. Many investigations have recently suggested that detection of Aspergillus antigen from sera of the patients is useful for early diagnosis to save their lives. We have experienced a case diagnosed by the detection of circulating Aspergillus antigen by Pastorex®Aspergillus, who was a 64-year-old female with the blastic crisis chronic myelogenous leukemia. After anti-leukemic chemotherapy, she suffered from pneumoniae with pleural effusions and sever hypoxia, which did not respond to antibioties. At this point, her serum sample showed positive Aspergillus antigen by Pastorex®Aspergilius. She was treated by intensive antifungal chemotherapy, and thereafter improved quickly. Titers of Pastorex®Aspergillus were well correlated with her clinical course. The sensitivity of the test requires further improvement, but the specificity of the test is considered to be high enough for clinical use.