The organic symptoms and results of coagulation tests of disseminated intravascular coagulopathy (DIC) in 17 patients with infection were compared with those in 12 patients with malignancy. The infectious diseases were mainly sepsis and pneumonia, and the malignancy was mainly lung cancer. The mean antithrombin III (AT III) before treatment was 54% in infection and 68% in malignancy, and the AT III values improved after administration of 1500 U of AT III concentrates per day. The mean thrombin-antithrombin complex level decreased from 22 ng/ml to 9 ng/ml after the treatment in infection, but it increased in malignancy. There were no differences in DIC scores between infection and malignancy before treatment; however, the scores were significantly more improved in infection than in malignancy after treatment (p<0.05). The fibrin/fibrinogen degradation product level, platelet count, and fibronectin level were also significantly more improved in infection than in malignancy. This better response to treatment in infection than in malignancy is probably due to eradication of the causative organisms by antibiotics in infection. These data suggest that therapy against both DIC and the underlying disease is crucial for successful treatment.
In order to evaluate the feasibility for the detection of antibody to hepatitis C (anti-HCV), the first generation assay (c100-3 Ab) and two second generation assays (2nd EIA and 2nd PHA) were used to test 477 individuals who visited the medical hospital or clinics in Iki Island, Nagasaki Prefecture. HCV RNA, antibody titer by 2nd PHA and four kinds of antibody to epitope of HCV by RIBA II were also surveyed to determine their association with these three assays. Prevalence of and-HCV was 26.6% by c100-3, 38.8% by 2nd PHA and 39.6% by 2nd EIA, indications that the 2nd generation assays are much more sensitive than c100-3. Prevalence of HCV RNA was 82.1% among 190, and-HCV positive individuals; 100% among 52 individuals with liver disease, but only 75.4% in those without liver disease. HCV antibody titer, over 211 was higher among those who were positive for HCV RNA than those negative for HCV RNA. Four antibodies by RIBA II were all positive and reacted strongly when they were positive for HCV RNA, but only antibody to core antigen was observed among those negative for HCV RNA, suggesting that only antibody to core antigen remains in those with past HCV infection.
We investigated the current occurrence and the infection control of MRSA enteritis in the surgical facilities in Japan from July 1990 to June 1992. In this two years, MRSA enteritis was encountered in 831 cases in 144 of 279 facilities (51.6%) which had replied to our survey. Frequency of onset of MRSA enteritis in the surgical speciality was 95% in abdominal surgery and general surgery. Nosocomial infection controls for MRSA infection were done in 92.1% of 261 facilities who replied to our questionnaire. Preventive control in the preoperative and postoperative periods were performed in 23.8%. Various controls for MRSA enteritis were recognized and enforced in 56.7% with restriction of postoperative antibiotics, 65.5% with enviromental controls, 70.5% with preventive control for the medical staff and 42.9% with the control for the expansion of nosocomial MRSA infections.
An insertion sequence repeated multiple times in the chromosome of Mycobacterium tuberculosis was used as a target for amplification using the polymerase chain reaction (PCR) assay for detecting Mycobacterium tuberculosis in chinical specimens. The sequences of primers were 5'-CCTGCGAGCGTAGGCGTCGG-3'(primer 1) and 5'-CTCGTCCAGCGCCGCTTCGG-3'(primer 2). One cycle of amplification consisted of denaturing at 94°C for 2 min, primer annealing at 68°C for 2 min, and extension at 72°C for 2 min. DNA (5 fg) extracted from M. tuberculosis was detected by gel electrophoresis and Southern blot hybridization after 40 cycles of amplification. The amplification products were not obtained by DNA extracted from M. kansasii, M. intracellulare, M. avium, M. fortuitum, Escherichia coli, Klebsiella Pneumoniae, Pseudomonas aeruginosa, Legionella pneumophila and Staphylococcus aureus; only from the M. tuberculosis complex. PCR results were compared with conventional cultural, pathological and microscopic findings in the detection of M. tuberculosis in 112 clinical specimens. There were 25 specimens that were positive for M. tuberculosis by cultural or pathological examination, of which 20 (80%) were positive by PCR. PCR detected the organism in 5 (83%) of 6 smear-positive specimens and 15 (79%) of 19 smear-negative specimens in which culture or pathology revealed M. tuberculosis. In addition, 2 smear-negative specimens and 8 smear-negative and culture-negative specimens were positive by PCR. These 10 samples were collected from the patients suspected as having tuberculosis by the clinical diagnosis based on the clinical history, characteristic radiographs, a positive PPD skin test and the effectiveness of anti-tuberculous drugs. There were no false positive samples according to the PCR. PCR assay may be used to detect M. tuberculosis in clinical specimens and has significant potential as a rapid, sensitive and specific assay for diagnosis of infection caused by M. tuberculosis.
A total of 38 strains of Shigella flexneri 4, 14 of which were subserotype 4abut 24 of which were of an undecided subserotype, isolated in recent years, were studied for their biochemical and serological characteristics, and drug susceptibility. Among the biochemical characteristics examined, 21 of the 38 strains (55.3%) were mannitol negative biotype and utilized sodium acetate, meanwhile, 17 of the mannitol positive strains did not utilize sodium acetate. The results of serological tests showed that 22 of the 24 strains, were of anundecided subserotype, basically subserotype 4a. Drug susceptibility was tested for nine drugs (CP, TC, SM, KM, ABPC, ST, NA, FOM and NFLX). Fifteen of the 17 mannitol positive strains (88.2%) and 12 of the 21 mannitol negative ones (57.1%), were found to be resistant to the 5 drugs, such as CP, TC, SM, ABPC or ST. None of the strains were resistant to KM, NA, FOM or NFLX.
In pediatric patients with community-acquired pneumonia, most of the patients have received antibiotics before admission. In this study, we tried to determine whether we could identify the etiology of pneumonia by clinical and laboratory findings on admission. The etiology of acute pneumonia was studied in 596 pediatric inpatients. A pathogen was identified in 384 (64.4%) episodes of pneumonia. These 384 episodes were divided into six groups as follows; I: pneumonia with blood culture positive or pneumonia with bacterial antigen positive in urine, II: pneumonia with dominant bacterial pathogens in washed sputum. III: Mycoplasma pneumonia, IV: viral pneumonia, V: bacterial (I, II) + viral pneumonia, VI: bacterial (I, II) + Mycoplasma pneumonia. These groups were analyzed by clinical symptoms, physical examination and simple laboratory findings on admission. Patients with Mycoplasma pneumonia have increased blood sedimentation rate, high value of positive C-reactive protein and normal white blood cell count. It was difficult to distinguish bacterial pneumonia from viral pneumonia only based upon clinical symptoms, physical examination and simple laboratory findings.
Salmonella Enteritidis infections were a local epidemic in the nothern area of Nagasaki, Japan, during August to September in1992. Out patients (142) visited our hospital because of diarrehea and-or abdominal pain and 96 patients had stool cultures and 51 patients were diagnosed as Salmonella infection. Of the 51 patients it was found that the Salmonella serogroups were 09, 07, 08 and the number of patients were 42, 8, 1, respectively. Phage type 1 was identified in all of the S. Enteritidis infected 38 patients who were examined. About 90% of the patients were under 10 years old. Namely, this Salmonella Enteritidis epidemic in childhood. The peak epidemic period was consistent with the local summer festival and the etiology of infection was thought to be caused by polluted handmade ice cream. S. enteritidis was identified from the ice cream which was also phage type 1. The latent period was 87 hrs.
A new immunochromatography assay (Dainascreen Ausab Dainabot) has been recently introduced for the detection of the presence of antibody to HBsAg. To evaluate the feasibility of using the Dainascreen Ausab, we carried out comparison tests with this method and PHA. In the test of 439 sera from HB vaccinees, inhabitins in Iki Island, Nagasaki Pref., patients with autoimmune diseases and with acute hepatitis B, 154 (31.2%) were positive by Dainascreen Ausab, 145 (29.4%) were positive by PHA and 145 (29.4%) were positive by both Dainascreen Ausab and PHA. Nine (1.8%) were positive by only Dainascreen and there were none positive by only PHA. A good correlation was observed between the titer of the antibody by this method and IMx. The and-HBs assay by this method was able to be completed within 15 minutes and the procedure was very simple. The results indicate that the sensitivity of Dainascreen is superior to PHA and that it is easy to use.
To study the clinical significance of conducting Gen-Probe Mycobacterium tuberculosis Direct Test (MTD) during the course of the disease, sputum specimens from 19 pulmonary tuberculosis patients were smeared, cultured, and tested by MTD, once a month for five months from the initiation of chemotherapy. 1) MTD-positive rates declined in parallel with decreased pulmonary tuberculosis activity, and the MTD findings of 16 patients who presented mild to moderate pulmonary tuberculosis at admission became negative by four months after the beginning of treatment.Three patients (15.8%) who were consistently positive for MTD during five months after the beginning of treatment were serious pulmonary tuberculosis patients, excreting a large number of organisms at admission. 2) During the course, a total of 43 MTD negative findings were observed, of which one (2.3%) was positive for Ogawa medium culture and the other 42 (92.7%) were negative.MTD was useful in briefly determining the absence of infection, provided that a negative culture on Ogawa medium means no infection. 3) Eleven of the 12 specimens (91.7%) showing positive smears and negative cultures on Ogawa medium were positive for MTD.Since MTD shows negative results for atypical mycobacteria, this is a very useful test in identifying acid fast bacilli which shows a positive smear and a negative culture.
The pathogenicity of Streptococcus constellatus in pulmonary infections was investigated in mice in correlation with the phagocytic killing of the microorganisms by human polymorphonuclear neutrophils (PMNs).The histological inflammation score of the lungs in mice inoculated intratracheally with 108 cfu/mouse of the virulent strain S.constellatus RZYK001 obtained from bronchoalveolar fluid of a patient with pneumonia, was significantly higher than in mice inoculated with the avirulent strains S.constellatus RT4303 and RT6002 obtained from saliva of healthy adults (p<0.001).The bactericidal activity of human PMNs against Staphylococcus aureus ATCC 25923 was not inhibited at all by the culture filtrate of the virulent strain, but the killing index against RZYK001 was 36.4% after 90-min incubation whereas that against RT4303 and RT6002 was 94.7% and 99.4%, respectively (p<0.001).Theref ore, these results suggest a possible pathogenic mechanism of S. constellatus apparently mediated by a structural component of the organisms so that a virulent strain is less likely to be killed than an avirulent one, predisposing it to survive in the infection sites.
We report here a case of a 5-month-old infant with thrombocytopenic purpura associated with serologically confirmed primary human herpesvirus-6 (HHV-6) infection. His platelet count decreased to 17, 000/mm3 on the 3rd day from the onset. Bone marrow aspiration showed that the megakaryocyte count was 129/mm3 and almost all of the them were of the non-platelet forming type. The IgG antibody to HHV-6 by indirect immunofluorescent assay in the sera in acute and convalescent phases were <10× and 160×, respectively. IgM antibody to HHV-6 in the acute phase was positive. Platelet-associated IgG was also positive. We diagnosed this case as having thrombocytopenic purpura associated with primary HHV-6 infection. Steroid therapy was started for his thrombocytopenic purpura from the 4th day after the alleviation of his fever. His platelet count increased without side effects and became within the normal range without relapse despite discontinuation of steroid therapy. Thrombocytopenic purpura might be one of the complications of primary HHV-6 infection.
Recently, Chlamydia trachomatis infection in sexually active women has increased. C. trachomatis cause pelvic inflammation. A few of these patients develop Fitz-Hugh-Curtis syndrome (FHCS). Clinical symptoms of FHCS include pain of sudden onset in the right upper quadrant mimicking acute biliary disease. Diagnosis of FHCS has been weighed upon laparoscopic findings. Since FHCS is a benign disorder which responds to appropriate antibiotics, non-invasive diagnostic method would be expected. We report here two cases of FHCS, diagnosed by a high serum antibody titer against C. trachomatis and clinical manifestations. Both cases showed small effusion in the pelvic cavity detected by ultrasonography, one of them was associated with small effusion in the right perirenal space suggesting perinephritis. Detection of small effusion intra abdominal cavity or pelvic space could be useful for non-invasive diagnosis of FHCS.
The hemolysin produced by group C streptococci (GCH) has an isoelectric point (pI) of 5.6 and a molecular weight of 32, 000 and shows hemolytic activity in the absence of 2-mercaptoethanol (2-ME). The hemolytic activity of GCH was compared to that of streptolysin S (SLS). These hemolysins did not differ with respect to the binding and release of hemoglobin (Hb). GCH was bound to phospholipids on the membranes of target erythrocytes, followed by the rapid released of K+ and slow Hb release after a relatively long lag time. GCH showed a lower hemolytic efficiency than SLS, reflecting the fact that these hemolysins destroy erythrocytes by slightly different mechanisms.