Neisseria gonorrhoeae was detected from first-voided urine sediments of male patients with urethritis by polymerase chain reaction (PCR). Urine and urinary sediment were treated with proteinase K, and DNA was further purified by phenol extraction. Two oligonucleotides based on sequences within a ribosomal RNA gene from N. gonorrhoeae were used as primers for the PCR. A DNA fragment of 206 bp specific for N. gonorrhoeae was amplified by PCR and detected by agarose gel electophoresis. In 19 specimens of urine sediments collected from 21 patients in whom N. gonorrhoeae was isolated from urethral swab by culture, 206 bp DNA fragment was amplified by PCR. In all specimens of urine sediments from 24 patients in whom cultures for N. gonorrhoeae were negative, no DNA was amplified by the PCR. The overall coincidence rate between the PCR for detecting N. gonorrhoeae in first-voided urine sediments and culture in urethral swab was 95.6%(43/45). PCR procedure for detection of pathogens from first-voided urine sediments would be noninvasive and would be applied for the diagnosis of gonococal urethritis and chlamydial urethritis.

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To assess the clinical significance of coagulase-negative staphylococci (CNS) in patients with urinary tract infection (UTI), the clinical characteristics of a total of 117 patients (106 complicated UTI patients, 11 uncomplicated UTI patients) from whom CNS were isolated at urinary colony counts of 10⁵ or more per ml were studied. Of the complicated UTI patients, 95 patients (89.6%) suffered from no symptoms while 11 (10.4%) had fever of 38 & deg;C or greater, which was strongly suspected to be due to genitourinary tract infections. Six of these patients were managed by indwelling urinary catheters. On the other hand, all of the patients with uncomplicated UTI were young women and had typical symptoms of acute cystitis. These results suggest that CNS, which hitherto have been considered mere contaminants or benign colonization rather than true pathogens, can also cause complicated UTI requiring chemotherapy under certain conditions such as indwelling urinary catheterization and acute cystitis in sexually active women.

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In the southeast coast of Shikoku, most of the Japanese spotted fever (JSF) patients were found to be infected with the rickettsial pathogen through bamboo plantation, and also the eschar was frequently noticed in skin inspection, so that it was clinically speculated to be caused by ticks. According to out field research, the tick fauna was very rich throughout that area, and it was permissible enough to determine ticks as the vectors, based on arising of and-SF group rickettsiae (SFGR) antibody in mice inoculated with some tick emulsions, findings of rickettsiae reactive to patient sera or a species-specific monoclonal antibody to JSFR in the hemolymph cells of some ticks, and electron microscopical observations of SFGR in various internal organs including the salivary gland of ticks. Also the transovarial and transstadial transmissions of SFGR in ticks were supposed. Our results suggest that common species (adult/nymph) of the genus Haemaphysalis may be the most related vectors to man, based on their dominances, SFGR-prevalences, behavior and incidences of infestation but also indicate that various genera and species should be kept as the potential vectors, in spite of JSFR isolation from a restricted species of ticks in the future.

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To investigate the prevalence and clinical features of hepatitis delta virus (HDV) superinfection in hepatitis B virus (HBV) carriers, antibody to hepatitis delta antigen (anti-HD) was determined in the sera of 328 HBV carriers in Japan.
1) Of the 328 HBV carriers, six (1.8%) were seropositive for and-HD by enzyme linked immunosorbent assay. IgM-antibody to hepatitis delta antigen was detected in 2/6 patients with a high anti-HDV titer. None of the patients was positive for hepatitis delta antigen.
2) HBV carriers with chronic liver disease had a greater frequency of seropositivity of and-HD than asymptomatic HBV carriers.
These data indicate that HDV superinfection may be an etiologic agent of chronic liver disease in HBV carriers.

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We reported the efficacy of albendazole (ABZ) for the treatment of 27 patients with strongyloidia-sis. Twenty-seven patients, 23 males and 4 females, received 200 mg of ABZ one hour before breakfast and supper for 3 days and this treatment was repeated 2 weeks later.
The following results were obtained:;1) The eradication rate at 2 weeks after the initial treatment was 70.4%(19 of 27 patients) and 2 weeks after the second course was 66.7%(16 of 24 patients).
2) One patients (3.7%) complained of abdominal pain after the first treatment. Four patients (14.8%) complained of headache (n=2), nausea (n=1) and exanthema (n=1) after the second treatment. But all symptoms were mild and required no treatment and subsided in a few days.
3) Positive rate of HTLV-1 antibody was 45.8% in the patients.
As described above, side effects occurred in some cases, although they were mild and transient.
From these results, it can be concluded that on increased dose of ABZ could be much more favorable for the treatment of strongyloidiasis.

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We examined the effect of azithromycin (AZM), a 15-membered azalide newly synthesized from erythromycin (EM), on serum sensititvity of 6 strains of Pseudomonas aeruginosa. Incubation for 48 h on agar with EM 12 μg/ml or AZM 1.6μg/ml induced increased serum sensitivity in 2 of 6 strains (S-6, PA-103), but there were no changes in any strains with josamycin (JM) 12 μg/ml. Although EM 12 μ g/ml induced increased serum sensitivity of S-6 after more than 36 h incubation, AZM 1.6 pg/ml induced increased serum sensitivity of this strain at 12 h incubation. AZM 0.8 μg/ml (1/62.5 MIC) showed more potent activity to enhance serum sensitivity of S-6 than that of EM 12 μg/ml (1/8 MIC) after 48 h incubation. P. aeruginosa S-6 incubated with EM 12 μg/ml or AZM 1.6 μg/ml for 48 h was less hydrophobic than that of control bacteria, but there was little change in the hydrophobicity of the strain incubated with JM 12 μg/mi. These results show that AZM has more potent activity to enhance serum sensitivity of P. aeruginosa than that of EM. Since decrease of cell surface hydrophobicity of P. aeruginosa S-6 was correlated with increased serum sensitivity, EM and AZM may induce enhanced serum sensitivity by changing cell surface structure of P. aeruginosa.

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Actinobacillus pleuropneumoniae, isolated from the pneumonic lung tissue of pigs, was resistant to streptomycin, sulfadiazine and tetracycline. This isolate, TA5, possessed 2 plasmids (pTA51=3.7 Kb, pTA52=6.2 Kb); one of the plasmids (pTA52) was coded for resistance to SM and SA. Another isolate of A. pleuropneumoniae, TA8, also possessed 2 plasmids (pTA81=3.7 Kb, pTA82=4.4 Kb), with a plasmid (pTA82) coded for resistance to SM and SA.
All 4 plasmids were not transmissible and small.

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In order to clarify the epidemiological situation of whooping cough in Fukui prefecture, 478 nasopharyngeal swabs from patients with pertussis-like symptoms were submitted to bacterial isolation. Laboratory data of these patients with clinical informations at the departments of pediatrics of 6 hospitals in Fukui city from June 1986 to May 1991 were also examined in relation to the above bacterial isolation. The results observed in culture positive patients were as follows:
1) B. pertussis were isolated from 83 patients (41 men and 42 women). 2) Isolates were classified into 3 serotypes. Most dominant type was 1 · 3 · 6 (80 strains, 96.4%), and followed by 1 (2 strains) and 1 · 4 · 5 (1 strain). 3) Most of the patients were non-vaccinees less than 3 years of age (69 of 83 (83.1%). This evidence suggested strongly that pertussis vaccine was highly effective to prevent pertussis. 4) The patients under 3 years of age whose leucocyte counts were ≥15000/mm³ and lymphocyte rate to total leucocyte were ≥70% in their peripheral blood at the time of nasopharyngeal swabs sampling were only 49.3%(33 of 67). Therefore, diagnosis of pertussis by leucocyte findings alone were considered to be inadequate. 5) The area of the patient's residence covered 7 regions of 8 health center districts in Fukui prefecture. The areal distribution of the number of patients from June 1986 to May 1991 was relatively proportional to the population of each district. 6) The number of patients in these 5 years showed apparently yearly variations and the similar variations were observed in a rate of positive antibody to B. pertussis toxin (PT) and filamentous hemagglutinin (FHA) in the children from 1986 to 1990. It seemed to be important to examine the above yearly variations for pertussis epidemiology in the future. 7) Isolation rates of B. pertussis from nasopharyngeal swabs of patients were significantly higher on HG-SS media newly designed by us in comparison with those on Bordet-Gengeu medium and Cyclodextrin Solid Medium (CSM).

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A survey of intestinal parasites was conducted on 198 foreign workers aged 19-27 from Inodonesia and Philippines. They work for a private company in Ishikawa Prefecture as technical trainee. On the base of stool examination, 94 (71%) out of 133 Indonesians and 48 (74%) of 65 Filipinos had intestinal helminths and/or protozoan infections. The prevalence of Ascaris lumbricoides, Trichuris trichura and Hookworm was 4.5, 64.1, 10.6%, respectively. In addition, the positive rate of the cyst of Entamoeba coli, Endolimax nana, Blastocystis hominis and Giardia lumblia was 11.1, 5.6, 4.5 and 2.0%, respectively. No E. histolytica was found; however, counter current immunoelectrophoresis revealed that one out of 112 sera possessed the antibody against the antigen of HK-9 strain of E. histolytica. Sixty-three cases of trichuriasis were treated with mebendazole at a dose of 200 mg/day × 3 consecutive days. Re-examination revealed that 53 (85.5%) of them were cured.

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We characterized 8 monoclonal antibodies (MAbs) to Karp, Kato, and Gilliam strains of Rickettsia tsutsugamushi, and analysed 17 isolates from patients with Tsutsugamushi disease using these MAbs. These were divided into 3 strain-specific (Kp/D1 1, Kt/2D9, and Gi/E4) and 5 cross-reactive MAbs (Kp/1F11, Kp/1C10, Kp/C6, Kt/3B2, and Kt/3C2). All MAbs recognized characteristic protein antigens using the indirect fluorescent-antibody test (IFA) and proteinase K treatment. Analysis by polyacrylamide gel electrophoresis and immunoblotting techniques revealed that Kato-specific MAb Kt/2D9 recognized a polypeptide with a molecular mass of 54 kilodalton (kDa) of the homologous strain, and cross-reactive MAbs Kp/1F11, Kp/C6, and Kt/3B2 recognized those of 46-47 kDa, 46-47 KDa, and 60 kDa, respectively to the homologous and heterologous strains. MAbs Kp/1C10 which exhibited a high IFA titer against the Karp strain and only low titers against heterologous strains recognized only the 110 kDa polypeptide of the homologous strain. MAb Kt/3C2 which reacted with both Karp and Kato strains recognized a 54 to 56 kDa polypeptide band of the two prototype strains as well as several other polypeptides, however, each molecular mass was present in only one of two strains. Testing by the plaque reduction technique showed another characteristic of MAb Kt/3C2 to neutralize both Karp and Kato Strains. Fourteen isolated strains from patients in the south and west regions of Gifu Prefecture, the Shimokoshi stain isolated in Niigata Prefecture, and Kawasaki and Kuroki stains isolated in Miyazaki Prefecture were examined for reactivities to 8 MAbs by IFA to classify their antigenicities. No isolated strains reacted with Karp-specific Kp/D1 1, Kato-specific Kt/2D9, or Gilliam-specific Gi/E4. The fourteen isolates from Gifu Prefecture fell into four groups using the 5 cross-reactive MAbs. A GJ-1 strain group (4 strains) isolated in the north of the Mino region of Gifu Prefecture reacted with all these MAbs well. A KN-2 strain group (7 strains) isolated in the west and east of the Mino region did not react with the cross-reactive MAb Kt/3C2. A KN-1 strain group (2 strains) isolated in the east of the Mino region did not react with either MAbs Kp/1C10 or Kt/3C2. KN-3 isolated in Kani was the only lethal strain to mice and differed from the other isolates by having a low reactivity with MAbs Kp/1F11, Kp/C6, and Kt/3B2. Kawasaki and Kuroki strains were concluded to be identical with the KN-1 and GJ-1 strains, respectively, because of their reactivity with these 5 cross-reactive MAbs. The Shimokoshi strain was suggested to be an independent strain because of low or no reactivity against MAbs Kp/1C10, Kt/3C2, and Kt/3B2. These results suggested that the prevalent strains of R. tsutsugamushi in Japan had various antigenicities and were able to be identified by using these cross-reactive MAbs to prototype strains.

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A total of 282 strains of Staphylococcus were isolated from University Hospital ward environment from April 1991 to January 1992 and drug-susceptibility tests were performed. The main isolates were 84 strains of S. epidermidis (30%), 65 strains of S. aureus (23%), and 58 strains of S. haemolyticus (21%). One hundred and thirty-six strains of all staphylococci (48%) and 13 of 65 strains of S. aureus (20%) were methicillin (DMPPC)-resistant. The DMPPC-resistant strains of S. aureus were multiple drug-resistant to three to seven antibiotics; ampicillin. cephaloridine, cephametazole, tetracycline, erythromycin, gentamicin, and methicillin, while the DMPPC-susceptible strains were resistant to less than two drugs. These results indicate that this routine testing, along with testing of the anterior nares of the medical staff, is necessary to prevent nosocomial transmission.

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To investigate the relationship of efficacy of chemotherapy to host defense, we reviewed the clinical features, treatment and outcome in 648 patients with acute pneumonia (424 males and 224 females; mean age, 65 years) treated between 1984 and 1989. Pneumonia complicated pulmonary disease in 336 patients (52%) and complicated systemic disease in 258 (40%).
Pneumonia pathogens were diagnosed in 346 patients (53%); the five major pathogens were S. pneumoniae (19%), H. influenzae (16%), S. aureus (14%), K. pneumoniae (14%) and P. aeruginosa (11%). The incidence of K. pneumoniae infection were decreased from 18% to 3.5% and that of S. aureus increased from 10.9% to 26.3% during the study period. The incidence of S. aureus and of P. aeruginosa infection was much higher in patients with nosocomial pneumonia, systemic disease, or serum protein concentration under 6.5 g/dl.
β-lactamase antibiotics were administered to 70% of all patients, with an efficacy rate of 74.9% of after the first course of antibiotics therapy. The efficacy rate was decreased in patients with nosocomial pneumonia, systemic or pulmonary disease, or malnutrition.
The data presented in this study indicate that the risk of pneumonia must be taken into careful consideration in patients with compromising complications.

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Clinical usefullness of a newly developed assay kit for ACB (SD-8828) which detects urinary bacteria coating IgG was evaluated and compared to the enzyme antibody plate method.
A total of 48 patients including 20 patients with acute simple cystitis and 28 patients with acute or chronic pyelonephritis, who were shown to have pyuria of at least 5 cells/HPF, bacteriuria of at least 104 CFU/ml were enrolled in this study. By enzyme antibody method. ABC was positive in 92.9% of patients with upper urinary tract infection and negative in 100% of patients with lower UTI, this difference being statistically significant (p<0.02). By SD-8828, 85% of positive coincidence rate and 100% of negative coincidence rate, compared to the enzyme antibody technique, was obtained. The overall coincidence rate was high (91.7%).
This SD-8828, a new simple assay for ACB, which detects IgG alternating the plate method, may be used as a convenient method in clinical practice.

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A 79-year-old male was admitted to the Metropolitan Hiroo Hospital with chief complaints of icterus and fever. A few weeks prior to admission, he developed fever and swelling of right side of the neck and was seen at a local hospital where an anti-inflammatory agent was prescribed. The fever subsided in a few days, but recurred together with development of icterus a few weeks later, precipitating this hospitalization. After admission, hepatic failure progressed rapidly, indicating a fulminant hepatitis. Renal failure also developed and he died.
Autopsy revealed diffuse caseous necrosis with demonstration of acid-fast bacilli in the liver, as did in the spleen, kidney and bone marrow. This case epitomizes a subset of miliary tuberculosis in which the hepatic failure predominates the clinical presentation while lacking the ante-mortem chest X-ray features suggestive of pulmonary tuberculosis and post-mortem macroscopic changes indicative of tuberculosis.

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