By using HeLa cells, we tried to detect enteroaggregative Escherichia coli from stock strainsderived from infants with or without diarrhea in Brazil and Myanmer, and from diarrheal patients in Osaka, Japan. Enteroaggregative E. coli was detected from 7.9% in diarrheal cases, 5.6% in controlcases in Brazil and from 5.4% in diarrheal cases, 3.4% in control cases in Myanmar. A total of 38 strainsthat showed aggregative adherence to HeLa cells was examined for colony hybridization with the ³²P-labeled EAgg EC probe. Thirty-four strains hybridized with the EAgg EC probe, while 4 strains didnot hybridize with the probe, suggesting an existence of another aggregative factor. Seventeen of the38 strains were 0-antigen serotypeable. Eight strains belonged to serogroups 044, 086, 0111, 0125and 0126, which have been considered to be enteropathogenic E. coli serogroups. Most of the 38strains were H-antigen serotypeable.

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The authors conducted a comparative study on the rapid diagnosis of cytomegalovirus (CMV) interstitial penumonitis by 4 different methods. Among them, the polymerase chain reaction (PCR) methodwas found to achieve the most rapid diagnosis of CMV infection. The clinical usefulness of making adiagnosis from the serum antibody titer and viral isolation was questionable as compared with the PCRmethod. Therefore, early diagnosis of CMV infection by PCR may be promising especially for thecompromised patients with hematological diseases.

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We aimed at developing a method for early detection of Chlamydia pneumoniae (C. pneumoniae) from clinical specimens. For this purpose, we amplified C. pneumoniae-specific DNA fragments by polymerase chain reaction. A pair of 24 mer of oligonucleotides which were complementary to the sequences within the region encoding the major outer membrane were synthesized and used as primers. As the results, all three standard strains of C. pneumoniae (AR-39, TW-183 and AR-388) were identified by the detection of the amplified products of 174 base pairs, while each strain of Chlamydia trachomatis and Chlamydia psittaci and a total of 11 strains of bacteria and a strain of Mycoplasma pneumoniae were not. Thus, the present method was found to provide a very high specificity and also a high sensitivity of a detectable level of 10 × 10^-9 inclusion-forming units.

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Nasopharyngeal specimens were taken from 29 children with acute otitis media, 14 children with chronic sinusitis at acute exacerbation and 2 children with streptococcal pharyngitis who had received cefaclor for 14 days. The study was designed to compare the microbiologic flora of the nasopharynx before the treatment of these diseases with that after the treatment. In this report the subjects were limited to the children who had not received autibiotics within 1 month. Pathogens detected on initial examination were 49 strains consisting of 40 strains of H. influenzae, 3 strains of S. aureus, 5 strains of S. pyogenes, and 1 strain of S. pneumoniae. Two strains were detected in 4 patients. Pathogens remained after treatment in 29 patient, with an unchanged number of pathogens in 12 patients, a decreased number in 14, and microbial substitution in 3. All of the remaining pathogens were H. influenzae, and minimum inhibitory concentration (MIC) changed in 5 of the 26 patients in whom H. influenzae was detected before and after treatment. In a patients with increased MIC, the strain changed from a sensitive strain with an MIC of lower than 3.13 μ g/ml to a highly resistant strain with an MIC of 25.0 μ g/ml or higher. By contrast, in 2 patients with decreased MIC, the strain changed from a highly resistant strain with an MIC of 12.5 μ g/ml or higher to a sensitive strain with an MIC of lower than 3.13 μ g/ml. In the other patient, MIC decreased to 3.13 μ g/ml after it had increased from 3.13 μ g/ml to 25.0 μ g/ml. Selection of resistant pathogens, decreased in the activity of resistant pathogens in order to proliferate, and the host defensive activity against infection were presumed to be involved in the mechanism of these changes in MIC.

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AZT sensitivity was investigated on 6 HIV-1 isolates by culture method. Three of the isolates derived from 2 patients treated with AZT and the others were isolated from patients not treated with AZT.
Cultures of 2 isolates (005 and 038) from a patient not treated with AZT did not show cytopathic effect (CPE) in the presence of 0.1 μ M or 1.0 μ M AZT.
Meanwhile, cultures of isolate (043) from a patient treated with AZT for 2 months showed CPE in the presence of 0.1 μ M AZT. Furthermore, cultures of isolates from patients treated with AZT for 6 months (043-2) and for 14 months (091) showed CPE in the presence of 1.0 μ M AZT.
HIV-1 p24 antigen was not detected by ELISA in the supernatants of cultures which did not show CPE. However, HIV-1 p24 antigen was detected in the culture supernatants which showed CPE.
These results demonstrated that isolates from patients treated with AZT contained AZTresistant variants which could replicate in the presence of 1.0 μ M AZT.

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We assessed the C. trachomatis antibody assay kit HITAZYME^® (Hitachi ChemicalCo., Ltd.) using clinical specimens. This kit is based on an enzyme immunoassay (EIA) which utilized purified Chlamydia trachomatis outer membrane antigen as the solid phase antigen.
Twenty-nine untreated male urethritis patients, 816 pregnant housewives, 188 cervicitis patients, and 76 pelvic inflammatory disease patients were tested. Agreement between the HITAZYME^® test and antigen detection in infected area was assessed, and a comparison was made with IPAzyme^® (acommercially available indirect immunoperoxidase assay kit).
1) Summary of HITAZYME^® and IPAzyme^®
IgA: Agreement between the two assays was relatively good, i.e., 82.6%(916/1109). However, 5.5%(61/1109) were HITAZYME^® (-), IPAzyme^® (+), and 11.9%(132/1109) wereHITAZYME^® (+), IPAzyme^® (-). Thus, in quite a few cases the results did not agree.
IgG: Agreement between the two assays was 73.7%(817/1109). Agreement was relatively low, 24.4%(271/1109) were HITAZYME^® (-), IPAzyme^® (+).
2) In the cases of disagreement, more specific Western blot analysis was performed to check the reactivity of the anti-C. trachomatis antibody. When IgA was used, agreement between HITAZYME^® and Western blot analysis was 69.6%(16/23), and agreement between IPAzyme^® and Western blot analysis was 30.4%(7/23), whereas when IgG was used, agreement between HITAZYME^® and Western blot analysis was 80.0%(12/15), and agreement between IPAzyme^® and Western blot analysis was 20.0%(3/15). There was significantly greater agreement with HITAZYME^® than with IPAzyme^®. In other words, HITAZYME^® had greater specificity when reacted with C. trachomatis antigen than IPAzyme^®.
3) The IgA antibody-positive rate in antigen (+) cases (male urethritis: 72.7%, pregnant housewives: 65.7%, cervicitis: 70.3%, pelvic inflammatory disease: 70.0%) was significantly (p < 0.01) higher than in antigen (-) cases (male urethritis: 16.7%, pregnant housewives: 13.6%, cervicitis: 22.6%, pelvic inflammatory disease: 30.4%). Therefore, IgA antibody can serve as a suitable indicator for active infection.
4) The IgG antibody-positive rate in antigen (-) female cases was 15.5% using HITAZYME^® and significantly (p < 0.01) lower than with IPAzyme^®. HITAZYME^® had greater specificity than IPAzyme^®.
In conclusion, HITAZYME^® has relatively good sensitivity and specificity. Moreover, since it is an EIA assay, it allows objective evaluation of results. It permits processing of a large number of specimens because it is easy to perform. Thus, HITAZYME ^® is a superior antibody assay for C. trachomatis. It can be used when antigen tests are difficult to perform. It is strongly anticipated that HITAZYME^® will be able to be used clinically as a screening test.

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The ability of 15 Pseudomonas pseudomallei strains of different origin to survive at 5 ° C was tested, in comparison with the type strains of Pseudomonas aeruginosa and Pseudomonas cepacia. Viable cells of each strain were suspended in tryptic soy broth (diluted 1: 10) at a concentration of about 10⁶ CFU/ml. The suspensions were kept at 5 ° C, and the number of viable cells was determined by counting colonies every 10 days. Four strains of P. pseudomallei, including the type strain for the species, died within 90-100 days at 5 ° C. Ten other P. pseudomallei strains together with the type strain of P. cepacia survived 160 days or more, although viable counts of these strains decreased to 10^1-2 CFU/ml. The Oklahoma strain of P. pseudomallei and the type strain of P. aeruginosa maintained 10⁵ CFU/ml after 170-190 days. It was concluded that resistance of P. pseudomallei to low temperature differs from strain to strain. From the results of our experiments and those reported in the literature of nation-wide soil contamination by P. pseudomallei in France, prejudice regarding the organism as a tropical inhabitant must be corrected.

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This clinical study involved 35 cases, anaerobic bacteria were detected by TTA (transtracheal aspiration) or percutaneous lung aspiration, or pleural puncture. These cases were treated over the last 8 years in our department. There were 9 empyema, 9 pneumonitis, 5 lung abscess, 1 necrotizing pneumonia and 11 chronic lower airway infection. In 13 cases (37%), anaerobic bacteria alone were detected, whereas both anaerobic and aerobic bacteria were observed in the other 22 cases (63%). Of all bacteria detected. Bacteroids and Peptstreptococcus were the most common. With respect to host factors involved in the pathogenesis of pleural and parenchymal infection, aspiration was though to be a major trigger in only 11 out of the 24 cases (46%). The other 13 cases (54%) showed no evidence of aspiration, indicating that some other triggers was responsible. In further study, these 13 cases were found either to be heavy smokers with Brinkman index of more than 600, or to show sign of chronic lower airway infection. Both conditions were characterized by an inhibition of the mucocillalytransport in the lower airway. Therefore, this study suggested that in the case without apparent aspiration the failure of local defense mechanisms in the airway, as a result of heavy smoking and/or chronic lower airway infection are involved in the pathogenesis of anaerobic respiratory infection.

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The purpose of this study is to elucidate morphological changes in septicemic mice induced by an injection of E. coli into the abdominal cavity and to discuss the relationship between the clinical findings and morphological ones.
The liver of septicemic mice was morphologically demonstrated, a) Kupffercells entrapped bacterias and erythrocytes, and large lysosomes were found in Kupffer cells, b) hepatocytes with low dense cytosol increased, and in the hepatocytes, many conglomerations of lysosome and cytolysome, and degeneration of rER, sER and mitochondria were identified, c) intercellular bile canaliculus became narrow.
The conclusion is as follows: 1) the increase of the serum level of T. Bili is caused by the increase of the phagocyte of erythrocytes by Kupffer cells and by the dysfunction of bile transformation and transportation in hepatocytes, 2) the increase of the serum level of GOT, GPT and LDH is caused by the degeneration of mitochondria in hepatocytes, 3) the decrease of the capacity to synthesize protein and lipid is due to the degeneration of cell organelles in hepatocytes.

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A 62-year-old woman, who had been diagnosed as having rheumatoid arthritis (RA) with systemic amyloidosis and diabetes mellitus, was admitted to our hospital because of polyarthralgia on October 1, 1987. She had some subcutaneous nodules and rheumatic pleural effusion. Therefore she was treated with 20 milligrams of prednisolone (PSL) daily. On the ninth day after the beginning of steroid therapy, she complained of severe pain and a new swelling in her right knee joint. The knee joint aspirate on arthrocentesis yielded a pure growth of group B Streptococcus (GBS). Blood culture was also positive for GBS. Her suppurative arthritis gradually improved by treatment with penicillin G. However, after the discontinuance of PSL, her pleural effusion deteriorated and she died on January 10, 1988.
To our knowledge, there have been no prior reports of group B streptococcal suppurative arthritis complicating RA in Japan.

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A 38-year-old male with Kartagener's syndrome (KS) was admitted to our department for evaluation of recurrent pneumonia. Before admission the patient was diagnosed as having pneumonia in another hospital and received ofloxacin (300mg/day). Fever and production of purulent sputum decreased initially but again increased in the middle of April. On admission the films of both X-ray and CT scan of the chest revealed several air-fluid levels and infiltrative shadows on the left lower lung field. The patient was diagnosed as lung abscess using bronchofiberscopy. Gram staining of the intrabronchial specimens revealed many Gram-positive cocci and neutrophils including phagocytosed bacteria. A new carbapenem (L-627, 600mg/day), was started intravenously. After the therapy Streptococcus pneumoniae were eradicated soon from the sputum. At the same time the above symptoms including dyspnea on exertion subsided, and the findings of the chest X-ray and CT scan were also improved. Regarding KS the electron micrograph of the cilia showed the absence of the outer-dynein arms. While by both the saccharin test and the suptum cytology impaired mucociliary clearance was found. Lung abscess infrequently acompany KS.
There are reports of respiratory infections in KS, but to our knowledge no report of lung abscess was found in KS. We present this case report describing lung abscess in KS.

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A five-year old girl, diagnosed with fever of unknown origin (FUO), was transferred to our hospital due to a deterioration in her general condition. Pseudomonas cepacia (P. cepacia) was detected in her blood culture and she soon recovered after imipenem cilastatin (IPM/CS) administration. When the former hospital was informed of the results of her blood cultures, we learned that five other cases of FUO had occurred there within the previous two weeks in noncompromised children. Except for one case, Pseudomonas species was detected in their blood cultures. P. cepacia was found in one case, Pseudomonas aeruginosa (P. aeruginosa) was detected in two other cases, and both P. cepacia and P. aeruginosa were demonstrated in the other patient. Although the origin of the bacteria is unknown, it may have spread to the children through a contaminated liquid reservoir or medical devices.

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Solitary splenic abscess is a rare disease and usually treated with splenectomy. A 78-year-old female with diabetes mellitus and liver cirrhosis was admitted to our hospital in a state of fever and left hypochondralgia. The abdominal ultrasonogram and CT scan showed the splenomegaly and one abnormal mass in the spleen. Drainage under sonographic guidance was attempted to the splenic mass but only a little amount of aspiration fluid was obtained, from which Salmonella Enteritidis was detected. No other abscess in the other organs was detected, resulting in the diagnosis as solitary splenic abscess caused by S. Enteritidis. Antibiotic therapy was carried out and the abscess disappeared judging from the ultrasonogram, CT scan, and laboratory data.
The present case suggests that the fully application of ultrasonogram, CT scan, and drainage for the diagnosis leads to the healing of solitary splenic abscess without operation. This is the first case of S. Enteritidis infection in the spleen reported in Japan.

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A 22-year-old male student, who had been to Indonesia, was admitted to our hospital because of a high grade fever on October 12, 1990. On admission, vivax malaria parasites were detected in his blood smears and the antibody titers against Plasmodium vivax and P. falciparum antigen were respectively 1: 1024 and 1: 64 by the indirect fluorescent antibody test. Therefore, he was diagnosed as having vivax malaria and was treated with sulfadoxine/pyrimethamine (Fansidar), followed by primaquine at 15mg/day for 14 days. However, relapse occurred twice after treatment with the above-mentioned standard dose of primaquine. After his second relapse, he was treated with primaquine at 22.5mg/day for 14 days and remission was finally achieved without any adverse reactions. The antibody titer against P. vivax did not re-increase during the first and second relapses.

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