From January 1983 to December 1991, 94 cases of Staphylococcus aureus septicemia were identified at Matsue Red Cross Hospital and were evaluated. Methicillin-resistant Staphylococci aureus counted 49%. Seventy two percent of the patients were 60 years or over in age. Intravascular catheters were the most common foci (33%), respiratory infections in 25% and so on. Administration of antibiotics before isolation of Staphylococcus aureus were thought to be the most significant factor in producing the methicillin-resistant septicemia, used in 41% of MSSA and 91.3% of MRSA cases. Especially, the trend of unproper usage of the 3rd generation cephems deravative antibiotics had a major role in producing multi-drug resistant bacteria. No significance was seen in the clinical background, underlying diseases, primary site of infection in between the two groups of methicillin resistant and sensitive cases. Mortality due to septicemia was 47.9% in the MSSA group of patients, while it was much higher in cases of MRSA (73.9%).
In conclusion, as the administration of antibiotics even in non-infectious episodes is common in daily clinical activities in some out-patient clinics, the indications should be restricted, in order to prevent the further MRSA infections.

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To determine the extent of contamination by bacteria of hair-washing shampoo and rinse used professionally at barber shops and hair-dressing saloons, quantitative isolation of bacteria were performed by using a total of 39 samples of shampoo and rinse fluid obtained from 17 facilities. It was found that a maximal number of ×10⁷/ml colony forming units/ml of bacteria were isolated from 60.7%(17 out of 28 samples) of the shampoo and 45.5%(5 out of 11) of the rinse. Gram-negative bacilli were the predominant strains (87.9%) involved in bacterial contamination and the major isolates were Serratia marcescens (43.3%, most frequently isolated), Pseudomonas cepacia, P. fluorescens, P. aeruginosa and Klebsiella pneumoniae, all which are widely recognized as nosocomial-infection causing pathogens. These results indicate hair-washing liquids for professional use are contaminated with a great number of gram-negative bacteria, being possible causes of nosocomial infections, and much attention should be paid to the sanitation and cleanliness of the shampoo and rinse for hair-washing.

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The serotype variants were formed in some isolates of Pseudomonas aeruginosa in the presence of anti-pseudomonal drugs in vitro. Pyocin type, various biochemical properties and drug susceptibility of these variants were compared with those of the parent cells. Furthermore, the patterns of outer membrane proteins were also examined for some respective parent and variant cells by the SDS-PAGE and compared with their drug susceptibilities.
In P. aeruginosa No.1-S (serotype E) and No.1-R (serotype C), simultaneously isolated from the identical specimen of the infectious patient, the serotype variants were formed by anti-pseudomonal drugs and accompanied by changes in pyocin types, some biochemical properties and susceptibilities to various kinds of anti-pseudomonal drugs.
When the profiles of outer membrane proteins of P. aeruginosa No.1-R parent and two variant cells were evaluated by the SDS-PAGE, the quantitative differences of the porin proteins between the parent and variant cells were well related to their drug susceptibiloities.
Although eight variant cells with other serotype were formed from the parent cells (serotype A) of P. aeruginosa No.13, four variants with serotype M and one non-typable variant showed changes in drug susceptibility such as resistance to imipenem only and no changes in biochemical properties.
On the other hand, three other variants showed marked changes in two kinds of biochemical properties and in susceptibilities to various kinds of anti-pseudomonal drugs. From the results of SDS-PAGE, it was found that the porin protein profiles of outer membranes of these parent and variant cells except a few cells which corresponded to their drug susceptibility.

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The purpose of this report is to examine the effect of Macrolides (Erythromycin and Roxythromycin) on swarming ability and antistaphylococcal activity of Pseudomonas aeruginosa. The standard strain (ATCC27854) and clinically isolated P. aeruginosa were used as test strains. The influence of Macrolides on antistaphylococcal activity and swarming ability were determined by the agar plate dilution method.
The antistaphylococcal activity of P. aeruginosa was not affected at the concentration of 1.56μg/ml of both Erythromycin and Roxythromycin. But the antistaphylococcal activity was not observed at the concentration over 100 pg/ml. The swarming ability was not affected at the concentration up to 12.μg/ml.
It has been proved that Macrolides reveal inhibition of virulent factors of P. aeruginosa such as protease, elastase, piocianin and so on. Furthermore our data revealed that Macrolides inhibited swarming ability of P. aeruginosa, and did not affect the antistaphylococcal activity of P. aeruginosa under 1.56μg/ml concentration.
Concequently, these results suggest that Macrolides have exhibited a previously unknown phrmacological effect, and may be of interest in that there may be bacterial interaction between MRSA and P. aeruginosa.

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Virological examinations were performed on stools obtained from 1, 264 overseas travellers with diarrhea at Nagoya International Airport between 1986 and 1991. Group A rotavirus was detected in 11 samples (0.87%) by latex aggulutination method, but other viral agents such as atypical rotaviruses and small round structured viruses were not observed by electron microscopic analysis. Rotaviruses were detected in various age groups, but the positive rate of rotavirus in females (6/398) was higher than that in males (5/866). Seasonal variation in the detection of rotavirus was observed. Entero 71 was isolated from one of 11 rotavirus-positive cases, but the other 10 cases were not associated with enteroviruses. All rotavirus-positive cases were negative for isolation of enteropathogenic bacteria.

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The efficacies of macrolide antibiotics, rokitamycin, leukomycin, josamycin and erythromycin were investigated against 63 strains of M. pneumoniae included FH strain which were isolated from clinical specimens obtained in 1986-1987, 1991, 1992-1993. Values of MICs and MBCs of these antibiotics were evaluated by two methods, broth dilution method and M. pneumoniae L cell infection system. In broth dilution method, MIC₅₀and MBC₅₀of rokitamycin were 0.0063-0.025μg/ml and 0.025-0.2 μg/ml respectively. The ratios of MBC₅₀/MIC₅₀ were 1-32. MIC₅₀ of leukomycin, josamycin and erythromycin were 0.0063-0.05μg/ml, 0.0025-0.05, ug/ml, and 0.0125-0.05μg/ml respectively. MBC₅₀ of these drugs were 0.0125-50μg/ml, 25-50μg/ml, and 25-50μg/ml respectively. The ratios of MIC5O/MBC₅₀ were 2-800, 500-2000, 500-4000. MIC₅₀ of rokitamycin and leukomycin to the isolates during period from 1992-1993 were higher as compare to those of isolates during 1986 to 1991.
On the other hand, rokitamycin markedly reduced the numbers of CFU in the growth phase when added at the concentrations of 16 and 4 times the MIC, but the other macrolides were reduced slightly CFU at the concentrations of 4 times the MIC. In L cell infectious system, MIC₅₀ and MBC₅₀ of rokitamycin were 0.005-0.0125μg/ml and 0.05-0.1μg/ml respectively. The ratios of MBC₅₀/MIC₅₀ were 1-2 Ratios of leukomycin, josamycin, and erythromycin were 0.05-0.1μg/ml, 0.05-0.2μg/m1 and 0.050-0.1μg/ml respectively. The MBC₅₀ of these drugs were 0.2-0.4μg/ml, 0.8-1.6μg/ml, 0.8-1.6 pg/ml. Ratios of MBCv/MIC₅₀ were 2-8, 4-32, 8-32.
These accumulated results suggest that rokitamycin possesses potent antimycoplasmal activity except macrolide resistant mutants of M. pneumoniae, and rokitamycin could be a promising antimycoplasmal drug for the treatment of mycoplasmal infections.

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Recently, “low-dose and long-term” erythromycin (EM) has been reported to be effective in treatment of diffuse panbronchiolitis (DPB), but its mechanism is still obscure. We studied the effect of EM on cytokine mRNA expression by using LPS-stimulated human whole blood as an experimental vivo model.
IL-8 mRNA was expressed in biphasic fashion with peak expression at 6 hours and 20 hours from the start of LPS stimulation. When whole blood was pretreated with EM (2μg/ml) for 1 hours. IL-8 mRNA expression was depressed at 20 hours (p<0.025) from the start of LPS (1μg/ml) stimulation.H owever, when pretreated for 12 hours, it was not depressed.
EM (2μg/ml) also depressed IL-1β(p<0.025) and TNFα(p<0.05) mRNA expressions at 6 hours from the start of LPS stimulation.
From the above results, it was suggested that the direct inhibition of IL-113 and TNFα production by EM resulted in subsequent depression of production of IL-8 that is a potent chemotactic factor for neutrophil, and consequently, EM acts to protect the bronchiole tissues of DPB patients from destruction by proteolytic enzymes released from neutrophils.
This assumption seems to be supported by our previous observation that when patients with DPB were treated with EM a marked decrease in number of neutrophil in bronchoalveolar lavage fluid (BALF) was accompanied by clinical and radiographic improvement.

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We experienced 12 patients who were suffering from bacteremia or sepsis and pneumonia or lung abscess coincidently caused by the same bacterum, during the 8 years from 1985 to 1992 a Hokusyo Central Hospital.
All of them has some underlying diseases, and the average age was 73.6 years old. In ten out of 12 patients bacteremia or sepsis preceded the respiratory tract infection, and in 7 cases indwelling intravenous catheter was thought to be the port of entry of the bacteria. Respiratory tract infections were composed of pneumonia in 8 cases and lung abscess in 4 cases. Methicillin resistant Staphylococcus aureus (MRSA) was detected in 4 cases, Methicillin sensitive Staphylococcus aureus (MRSA), Klebsiella pneumoniae and Pseudomonas aeruginosa were in 2 cases respectively, Citrobacter freundii and Methicillin resistant Staphylococus spp. were in one cases respectively. Eight out of 12 cases died in spite of current antibiotics therapy, suggesting poor prognosis.

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We studied 37 cases of respiratory syncytial virus infection hospitalized during the period January 1, 1989 and March 31, 1993. 37 patients were 0-4 years old on admission. Fever, positive CRP and elevation of BSG were frequent in patients aged 8 months-4 years old. Patient more than 8 months of age didn't need supplementation of oxygen.
Of the 37 patients, we had one case who had hyponatremia and six cases who were admitted with severe apneic attacks required incubation. Of the six cases, one patient had delayed neurological deterioration after anoxia due to apneic attacks. He, followed up for 4 years, have serious residual deficits including spastic quadripletia, delayed development and epilepsy. Variety of factors, including premature birth, young postnatal age and milk feeding appered to be significant risk factors for severinfections of RSV.
In RSV infection, apneic attacks can cause near-miss SIDS. So, we stress the importance of careful and rapid diagnosis for all infants less than 8 months of age.

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The efficacy and safety of aciclovir granules (containing 40% w/w aciclovir) were evaluated in the treatment of chickenpox in otherwise healthy children.
Patients presenting with chickenpox received aciclovir granules at a dose of 20 mg/kg four times daily for five to seven days. Overall 51 children received treatment with aciclovir. A further 53 patients receiving conventional symptomatic therapy acted as a control.
In the aciclovir group the overall efficacy rate was 92.2%. There were reductions in the numbers of lesions, fever, itching and the duration of symptoms. No adverse experiences were reported. Overall this formulation of aciclovir appears to be a safe and effective treatment for chickenpox in this patient population. However the need for anti-viral therapy in otherwise healthy children is still the subject of debate and it might be appropriate to identify sub-groups for whom such therapy is justified.

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Pasteurella multocida (P. multocida) is well recognized as “normal flora” in the upper respiratory tract of cats, dogs and other animals. Recently, various infections due to P. multocida in human have been noted as pulmonary infections in the patients with chronic pulmonary diseases as well as skin abscesses or septicemia after an animal bite or scratch.
We report here three cases of respiratory tract infections caused by P. multocida. The first two patients had acute exacerbation of bronchiectasis caused by P. multocida and the other patients with pulmonary emphysema developed pneumonia. These three patients improved by antibiotic therapy.
In Japan, P. multocida respiratory tract infection is rare, but it may become more common in the future. Therefore, it seems to be important to take this pathogen into consideration in the management of chronic lung disease.

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We encountered two relatively rare cases of sepsis due to Campylobacter fetus subsp. fetus (C. fetus).
Case 1. A 54-year-old female with abdominal polysurgery developed a slight fever and vomiting in August 1984. Despite the administration of some digestive drugs by her family doctor, these symptoms continued. In mid-October, she was hospitalized with high fever with chill and rigor on the skin. On the third hospital day, C. fetus was detected in the blood culture. After combination chemotherapy of intravenous drip infusion of latamoxef (LMOX) (2 g/day) and oral administration of erythromycin (EM) (800 mg/day), her symptoms improved.
Case 2. A 57-year-old male with diabetic retinopathy and nephropathy was hospitalized because of slight fever, general edema and pleural effusion. On the 6th hospital day, C. fetus was detected in the blood culture and he was diagnosed with sepsis. Under treatment with the intravenous drip of LMOX (2 g/day) and oral administration of EM (1200 mg/day), his condition improved.
Both cases had common underlying diseases such as hypoproteinemia with edema and problems in the lower intestinal tract; the former had polysurgery and malabsorption syndrome, the latter had diffuse ulceration of the colon. Such underlying conditions may have permitted the invasion of C. fetus into the blood.

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Enterococcal infections involving the central nervous system are uncommon clinical entities. A 74-year-old male was admitted to our hospital on November 3, 1991 for high fever. Nuchal rigidity was observed at neurological examination. All four blood cultures yielded E. faecalis. The MIC value of ABPC against the isolated E. faecalis was 0.25μg/ml. Vegetation on the mitral valve and mitral regurgitation were revealed by an echocardiogram. Enhanced CT scan showed low density area with ring enhancement in the right basal ganglia and a CSF examination suggested bacterial meningitis. He became better after ABPC 8 g/day was intravenously administered. Then the vegetation on the mitral valve and the brain abscess disappeared. He was discharged with no complications. We reported a rare case of brain abscess associated with enterococcal endocarditis.

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A 66-day-old female with infant botulism is reported. She was admitted to our hospital with respiratory failure. Laboratory examinations detected botulinal toxin type A in her feces. This was the first case with no history of honey ingestion among the 13 cases of infant botulism reported in Japan.
It is possible that other cases, in which honey had not been consumed, remain undiagnosed. Further studies may be needed to clarify the factors necessary to cause infant botulism.

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A 36-year-old male was admitted because of swelling and pain in the lower left limb. He had been diagnosed as having non-insulin dependent diabetes mellitus 4 years previously and had been treated unsuccessfully with insulin. Since gas formation was radiographically demonstrated in the soft tissue of the left foot, we treated him with antibiotics and hyperbaric oxygen under the diagnosis of gas gangrene. Despite this therapy, the gangrenous lesions progressed. Amputation of the left foot was necessary. Peptstreptococcus was isolated from the gangrenous area and identified as such on the seven hospital day.
Nine cases of diabetic patients with non-clostridial gas gangrene who were treated with hyperbaric oxygen therapy have been reported in Japan. The results indicated that hyperbaric oxygen therapy is ineffective in the treatment of non-clostridial gas gangrene in diabetic patients.

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