From September 1986 to December 1993 31059 anti-HIV antibody tests were performed on the samples from our clinic, from 29 health centers and their branches of Osaka Prefecture, from a hospital and from high risk groups. Enzyme immune assay (EIA) was used up to 1988 and from 1989 particle agglutination (PA) has been employed. The indeterminates of Western blot (WB) were seen in 5 EIA positives and in 2 PA positives. False positive rate of EIA was 0.235%(11/467) and that of PA was 0.011%(2/17922). Two false negative cases of anti-HIV-1 antibody test due to window period were documented and the importance of co-use of antigen test at the time of confirmative antibody tests was discussed.
The MBCs of Ac against P. aeruginosa (7 strains) isolated from infected skin lesions of patients were more than 6400 μg/ml, and those of Gv were more than 1600 μg/ml. When either Ac or Gv was used independently, these dyes did not have the bactericidal effect of P. aeruginosa. When Gv was used in combination with Ac, predominantly synergism on the bactericidal effect of Ac and Gv against P. aeruginosa was obseved. The MBCs of an Ac-Gv cocktail were between 100 μg/ml and 225 μg/ml. We have previously reported that Gv possessed significantly a bactericidal effect to MRSA isolated from clinical specimens. Therefore, these results suggestedthat a combination treatment by an Ac-Gv cocktail may be one of the useful drugs for the MRSA and P. aeruginosa mixed infection on the skin lesions which is frequently observed clinically.
During the period from January 1984 to December 1991, 118 strains of Yersinia enterocolitica were isolated from the specimens which were requested for bacterial examination from various medical practitioners. The results of bacteriological examination of these isolates showed that 11 of Y. enterocolitica serotype 0: 8 sporadic infections were confirmed at Hirosaki district in Aomori Prefecture. Of the eleven isolated strains, nine were from feces, two were from contents of extracted appendix. These strains were biovar (Wauters) 1, harboring 42 megadalton virulence plasmid, positive for autoagglutination and calcium dependency. Patients were under fifteen years old except one case of a 45 year old. Seven patients were living in the inter-mountain area, three in the urban area and one in the plain area. The infectious source was not found.
A clinical study was conducted to clarify the clinical state of pneumonia in elderly patients using transtracheal aspiration (TTA). Without prior administration of antibiotics, S. pneumoniae was the most clinicallysignificant in both elderly and non-elderly groups whether the onset of pneumonia was hospital acquired pneumonia or community acquired pneumonia. Compared to the non-elderly group, multiple pathogens were isolated more frequently in the elderly group. Analysis about host factors showed that the number of underlying diseases per patient was more along those with poorer general conditions in the elderly group. The Brinkmann Index was also signficantly higher in the elderly group. Clinical examinations before onset of pneumonia indicated that serum total protein, albumin and DNCB skin reaction were signficantly lowered in the elderly group. Over the clinical course, the prognosis was poorer and the incidence of adverse reactions of antibiotics tended to be more in the elderly group. These results suggest that a complex clinical background exists for pneumonia of elderly people, related to poorer prognosis. Therefore, more cautious and meticulous care should be provided to elderly patients with pneumonia.
Two Shigella strains (85-634 and 94-30) isolated from two sporadic travellers with diarrhea who returning to Tokyo from abroad, did not react to any antisera to Shigella prepared commercially. These strains had the typical biochemical characteristics of S. boydii and were biochemically identical, and were positive in the Serény test and other tests for invasiveness; these indicate that they can cause shigellosis in humans. The results of serological analyses using the antisera to 6 kinds of provisional Shigella serovars, showed that both strains had provisional S. boydii serovar E16553. Although the serovar has been reported by Gross et al in the United Kingdom, this may be the first report in Japan.
Penicillin (PC) resistance of Streptococcus pneumoniae was tested by oxacillin disk method (Bauer-Kirby method) of the strains collected at the primary pediatric office. The rate of oxacillin resistance of S. pneumoniae was 36.4% in 1990, 41.4% in 1991, and 51.9% in 1992, respectively. The efficacy of oral antibiotics in the treatment of PC-insensitive S. pneumoniae infections was also studied retrospectively in 234 cases. Treatment failure rate was 17.7% in the amoxicillin group, 8.7% in the cefpodoxime proxetil group, while it was 42.9% in the cefixime group. These differences were statistically significant. From these data prevalence of PC-insensitive S. pneumoniae is very high in Japanese children, and amoxicillin and cefpodoxime proxetil can be used for the treatment of outpatients with PC-insensitive S. pneumoniae infections.
A 22-year-old male was admitted to our hospital because of progressive weakness of bilateral lower limbs on October 29, 1992. He also complained of cough, sputum and back pain for 6 months. He had no history of underlying disease. His family history disclosed that his elder brother had tuberculous peritonitis. Chest radiogram on admission showed an abnormal shadow around the right first arch. Computerized tomogram revealed osteolytic lesions of the verbebral corpus and posterior elements at the level of C3, Th5, and Th11. Metastatic bone tumor was strongly suspected and surgical decompression was done on Nobember 12. Histologic findings of the bone showed caseation and Langhans's giant cells, and acid fast bacilli were isolated. He was treated with anti-tubercular chemotherapy and showed remarkable reflief of his symptoms over a period of 6 months therapy. This was a case of atypical tuberculous spondylitis. The main locus existed at the posterior elements of the vertebra and the distribution of vertebral lesions was multiple including cervical spine.
A 78-year-old woman was admitted to our hospital because of disturbance of consciousness. She had been diagnosed as uterus carcinoma and had undergone radiotherapy one year before admission. On admission, her body temperature was 35.5°C and systolic blood pressure was 50 mmHg. Ascites and semicomatose consciousness were detected. Laboratory evaluation demonstrated the following values: leukocyte count 38800/μl, blood sugar 3 mg/1 and arterial blood pH 6.9. Therapy with catecholamine and antibiotics was started, but she expired 10 hours after admission. Bacteroides ovatus was detected from her blood. Autopsy findings disclosed abscess and perforation of the uterus, and liver cirrhosis. Hypoglycemia has rarely been described as a clinical manifestation of sepsis and this case is, to our knowledge, is the first report of sepsis complicated with hypoglycemia in Japan.
We encountered five members of the same family infected with parvovirus B19. The latency period in these patients was 17 to 20 days, which matched that observed by Anderson et al. after inoculating humans with the virus. The latency period in 24 cases of familial infection observed in 17 families at the same time showed peaks at both 10 days and 20 days. Thus, it is still necessary to determine the actual latent period of erythema infectiosum infection.