The role of IL-10 (Interleukin 10) in the patients with SIRS was demonstrated in relation to the TNF (Tumor Necrosis Factor).
1. Clinical observations Thirty three materials of IL-10 and 43 materials of TNF were taken from a total of 46 patients with SIRS. And their concentration of serum were compared with those of healthy volunteers (TNF: n=12, IL-10: n=9). The value of IL-10 and TNF in SIRS patients was significantly higher than those of healthy volunteers (p>0.05 in IL-10, p<0.01 in TNF). Also, the values of both IL-10 and TNF in the patients with MOF (n=22) were higher than those of the patients without MOF (n=24) (p< 0.05 in IL-10, p<0.01 in TNF).
Both the serum values of IL-10 and TNF in 7 patients with SIRS, whose materials were obtained at two points of their clinical course, were decreased in accordance with the favorable prognosis. In these patients, the changes in IL-10 and TNF were observed in parallel.
2. Experimental observations Five 4 week ICR mice were used in an experimental study. The serum concentration of TNF and IL-10 increased to the maximum at 2 hours after 4 mg/kg of LPS injection. TNF level disappeared at 6 hours, but IL-10 level still remained at this point.
Both the serum and BALF levels of TNF increased by LPS injection which was inhibited by the intraabdominal pretreatment of 200μg of IL-10 (in serum: p<0.1, in BALF: p<0.05). By preincubation of mice alveolar macrophages with IL-10, TNF production from the macrophage resulting from LPS loading also was significantly inhibited (p<0.01).
3. From the above, it may be concluded that IL-10 inhibits TNF secretion from monocyte and protects against the pathogenic activity of TNF in the SIRS patient.

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Infant rabbits were used as a model to study the diarrhogenicity of verocytotoxin^-producing Escherichia coli (VTEC) isolated from bovine. Infant rabbits aged 6 days were inoculated intragastrically with 10⁹ viable bacteria of four VTEC or three non^-VTEC strains. Of these strains, three strains (VT⁺, eaeA⁺), one strain (VT⁺, eaeA^-) and one strain (VT^-, eaeA⁺) caused diarrhea in rabbits 48 to 60 hr after inoculation. None of the two strains (VT^-, eaeA^-) caused symptoms.
Based on these results, it is suggested that the 6-day-old infant rabbit is a suitable animal for studying diarrhea caused by VTEC or eaeA-positive E. coli strains of bovine origin.

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On July 1994, a 62-year-old female, having a history of mitral regurgitation, was admitted because of high fever, hematuria and conjunctival petechiae. She was diagnosed as having infective endocarditis with mitral valve vegetation proved by ultrasonic cardiography. The gram negative rods were isolated from blood cultures performed five times, performed prior to the administration of antibiotics. The isolates were identified as strains of H. aphrophilus. After two days of treatment with PCG (12 million units/day), the organism became undetectable from the blood. Since the minimal inhibitory concentrations (MICs) of PCG and ABPC were ranged between 0.06-2.0μg/ml and 0.06-0.5μg/ml, respectively, ABPC was selected as a first choice antibiotic instead of PCG. ABPC was given 12 g/day for the first 3 days, then6 g/day for 28 days, followed by 3 g/day for 7 days. The patient recovered and was discharged after the 55 hospital days.
H. aphrophilus grew on BTB lactose agar, chocolate agar and sheep blood agar, but failed to grow on MacConkey agar. H. aphrophilus produced smooth transparent nonhaemolytic micro colonies after 48 hours on sheep blood agar and chocolate agar plates. Atmosphere with 5% CO₂ failed to enhance their growth. All the five strains of H. aphrophilus isolated, required neither factors V nor X. Positive synthesis of porphyrin from s-aminolevlinic acid confirmed their ability to grow without X factor. For the correct identification of H. aphrophilus strains, fermentation test of glucose, lactose, maltose and sucrose in either phenol red broth or CTA medium are necessary. Miniaturized identification kits, such as ID test HN 20 rapid and the Vitek NHI card could not identify any of our isolates.

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Type-specificity of serum antibodies from genital herpes patients was determined by an enzyme-linked immunosorbent assay (ELISA) using antigens extracted from herpes simplex virus (HSV) type 1-and 2-infected cells. Sixty-three of HSV type-known panel sera, which had been typed by HSV glycoprotein G-specific immunodot analysis, consisted of 3 groups; group I (25 sera; gG-1 antibody-and HSV-1 isolation-positive), group II (19 sera; gG-2 antibody-and HSV-2 isolation-positive) and group III (19 sera; gG-1 and gG-2 antibodies-and HSV-2 isolationpositive), were assayed for IgM, IgA, IgGi and IgG3 antibody activities (optical densities) against HSV-1-as well as HSV-2-infected cell antigens. IgG antibodies of these 3 groups showed 2 different patterns of reactivities. The group II sera reacted with the two antigens to the same extent and could be differentiated from other 2 groups. The latter 2 groups were difficult to differentiate because of similar reaction patterns showing higher reactivities to HSV-1 antigen. In contrast, type-specificity was not observed in IgM antibody activities. The higher reactivities of IgG antibody to HSV-1 antigen than to HSV-2 antigen in the group III sera indicate the “original antigenic sin” phenomenon, i. e.; memory B cells produced in prior infection with HSV-1 were activated by cross-reactive antigens of HSV-2 which infected secondarily. To presume the type of infected HSV from serum antibody reactivites was difficult as long as HSV-infected cells were used as antigens in ELISA.

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A nation-wide surveillance of causative organisms was conducted on 1, 699 elderly patients with UTIs aged more than 65 in 190 private clinics and 73 hospitals in August and September, 1993, in order to investigate the distribution of causative bacteria and the relationship between isolates and the background of those patients.
From 1, 233 of the 1699 patients, 1, 636 strains were isolated. E. coli was isolated most frequently (30%). In male and older patients, less E. coli were isolated, while more attenuated Gramnegative rods such as NFGNR including P. aeruginosa were found. A similar trend was observed in uncomplicated UTIs isolates in this study. More E. coli were isolated from patients with stronger subjective symptoms while more bacteria other than E. coli were isolated in those with weaker subjective symptoms.
From the above findings, it was confirmed that a high recovery rate of opportunitsic pathogen which is less susceptible to various antibacterials is one the refractroy factors in elderly patients with UTIs. Therefore, it is necessary to select a suitable antibacterial that can be used for complicated UTIs in elderly patients even when diagnosed as uncomplicated UTIs. Regardless of the size of the clinic or hospital, when treating elderly patients, with unsatisfactory results in initial treatment and with less subjective symptoms the physician must bear this in mind.

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A nation-wide surveillance of sensitivities of bacteria, which were isolated from elderly patients with UTIs aged more than 65 in 190 private clinics and 73 hospitals, for oral antibacter ials, CPFX, OFLX, NFLX, CPDX and CCL, was conducted in August and September in 1993.
Antibacterial activities of 5 agents against all 1, 511 strains were intensified in CPFX, OFLX, NFLX, CPDX and CCL in that order. Major pathogens such as Enterobacteriaceae, E. faecalis, Staphylococcus spp. and P. aeruginosa were more susceptible to fluoroquinolones than cephems.The rate of resistant strains to antibacterials was higher in isolates from older patients, patients with complicated UTIs and with indwelling catheter. The representative of resistant strains was P. aeruginosa, and about 50% of the strains of P. aeruginosa were resistant to even CPFX which had the most superior antibacterial activity among the 5 agents. About 40% of the S. aureus were MRSA, which were almost resistant to the 5 agents.
From the above findings, it was confirmed that a high recovery rate of strains which is less susceptible to various antibacterials is one of the refractroy factors in elderly patients with UTIs, particularly in complicated UTIs and with indwelling catheter. Regardless of the size of the clinic or hospital, Fluoroquinolones are more suitable for the treatment of elderly patients with UTIs than cephems.

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Lipopolysacchride (LPS) compositions of P. aeruginosa isolated from different clinical sources such as blood, urine, pus, sputum, and feces were analyzed by sodium dodecyl sulfatepolyacrylamide gel electrophoresis (SDS-PAGE), and aminoglycoside-susceptibility and serotype of these isolates were investigated in this study.
Fifty-nine isolates tested were divided into three groups according to the difference in their LPS compositions; 35 strains with the long-LPS chain (B-band LPS), 14 strains with the short chain (A-band LPS) and 10 LPS-deficient strains.
The relationship between the LPS compositions and their sources of 59 strains were investigated. The majority of clinical isolates (12 of the 13 strains) from the blood samples possessed the long-LPS chain (B-band LPS) and the remaining possessed the short-LPS chain (A-band LPS). About 67% each of the isolates from urine and feces possessed the long-LPS chain, and the minor part of both groups possessed the short-LPS chain. In isolates from both sputum and pus samples, the long-and chort-LPS chains were found at almost the same rate, and the LPS-deficient isolates were found in the sputum samples at a considerably high rate of 42%.
The 19 of the 35 isolates with the long-LPS chain were susceptible to gentamicin (54%) and 12 isolates were resistant (34%). On the other hand, the 14 isolates with the short chain were divided roughly into three groups, gentamicin-resistant, and-susceptible groups and intermediate groups. It was also notable that 7 of the 10 LPS-deficinet isolates were resistant to gentamicin.
Serotypes of 35 isolates with the long-LPS chain were classified into A, B, C, E, G and H types, but not into M type or non-typable groups, respectively. However, 12 and 2 of the 14 isolates with the short-LPS chain were classified into M type and non-typable groups, respectively, and also 8 and 2 of the 10 LPS-deficient isolates were classified into non-typable and M type groups, respectively.
These results indicate that the frequency of P. aeruginosa isolates with the long-and short-LPS and without LPS differed among the clinical sources used for the bacterial isolation. It was also clarified that heterogeneity of the LPS-chain size of P. aeruginosa isolates affected the differences in their susceptibility to gentamicin and serotype.

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Sparfloxacin seems to be a good candidate for antimycobacterial treatment. However, there have been no clinical studies. We experienced 2 SPFX-treated cases, who could not use other antimycobacterial agents because of side effect, we tried SPFX-treatment on these cases. Good results were obtained, however, for long time use to prevent side effects, we tried SPFX every second day and monitored the serum levels of SPFX. SPFX-every second day treatment gave good clinical results and adequate serum levels of SPFX were observed.

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The inhibitory effect of metallic EDTA compounds on growth of Vibrio cholerae and Escherichia coli was studied. Only Fe-EDTA among the compounds tested showed pH-dependent growth inhibition on E. coli at pH 9.0, but no inhibition of V. cholerae at the same pH. By addition of Fe-EDTA as a selective inhibitor, a novel enrichment broth (tentatively designated as VCF broth) for the selective isolation and cultivation of V. cholerae from other Gram-negative bacilli has been developed, and the selective enrichment capacity of VCF broth for V. cholerae and selective inhibiting activity against E. coli were significantly higher than those of alkaline peptone water. A simple procedure for rapid detection of V. cholerae by selective enrichment for 6 hr with VCF broth and then amplification of the cholera toxin target DNA fragment by the polymerase chain reaction was presented. VCF broth may be a useful tool for the selective enrichment of V. cholerae in bacterial examinations.

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A case of myelodysplastic syndrome (MDS) complicated by septic pulmonary embolism is reported. A 61-year-old female who had been followed for refractory anemia with excess of blasts suddenly died of acute respiratory failure. An autopsy revealed massive pulmonary emboli with gram-positive cocci gathered in the emboli and alveolar spaces. Stsaphylococcus aureus was also detected through a blood culture from the right atrium.
We speculate that pulmonary embolism was the result of septicemia induced by the immunosuppressive condition associated with MDS.

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We report a case of tsutsugamushi disease found in south western Shikoku. A 64-year-old male who lived in Towa Village in Kochi, developed a fever and headache on April 6, 1994, and was admitted to Uwajima City Hospital on April 15, with a ten-day history of illness. He had an eschar on the right anterior side of the breast and an enlargement of the right axillar lymph node, without a rash. Laboratory data showed mild liver injury and atypical lymphocytes with 6% in peripheral blood. After his blood was drawn for rickettsial isolation, the minocycline was administered. His symptoms improved rapidly and was discharged in good condition.
We successfully isolated the causative agent, Rickettsia tsutsugamushi, and designated it as the Shiba strain. High antibody titer against the Kato, Karp and Gilliam strains was detected in serum on admission and increased during the course of the disease.
In Shikoku, tsutsugamushi disease is rare and only 13 cases were reported during last ten years. Especially in south western district of Shikoku, there have been no case reported since 1960. This case is important epidemiologically and suggests that we should pay attention to this disease.

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