Thirty cases with MRSA in the sputum (carrier state) were studied in relation to fecal MRSA detection. The back ground of the cases (disease, nasogastric tube, tracheostomy, antibiotics, H₂-blocker) and typing of MRSA (coagulase type, Pulse Field Gel Electropheresis (PFGE) type), and gastric pH were studied. Almost all of the patients were given antibiotics of the cephem series of the third generation. None of the cases had abdominal operations. Fecal MRSA was positive in 14 cases (47%). H₂-receptor antagonists (H₂-blocker) was administered to 6 cases, and all cases (100%) had positive fecal MRSA. Eighteen cases had a history of H₂-blocker administration and 5 cases had positive fecal MRSA. Duration after stopping the H₂-blocker in the 5 cases was shorter than the other 13 cases. (4.5 to 20.8 months). Nasogatric tube had no significant effect in detection of fecal MRSA. And gastric pH was of no significant difference between MRSA positive cases and negative cases. These results suggest that in patient with MRSA in the sputum receiving a H₂-blocker may produce MRSA enteritis because of MRSA passage to the stomach.

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Naturally-occurring toxoplasma infection has been observed for years in various kinds of wild animals. However, the infection situation has not been well characterized due to a lack of research. In present study, latex fixation tests were conducted for 109 main-land raccoon dogs (67 males and 42 females) all of which were kept in Kanazawa Zoo in Yokohama City, Kanagawa Prefecture between 1991-1994 to measure levels of toxoplasma antibodies. The test results indicated 20 positive samples out of the total 109, an 18.3% positive rate. This demonstrates that toxoplasma infection exists in the raccoon dog population in Kanagawa Prefecture, and that the raccoon dog could be a source of spread of toxoplasma infection. We believe there is significant reason to continue the investigation as a part of a prophylaxis for zoonotic diseases.

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Mutants of hepatitis B virus (HBV) in the pre-core/core gene exist in patients chronically infected with HBV. The core gene of HBV DNA is preceded by the pre-core region which takes a role of synthesis and secretion of HBe antigen (HBeAg). Previous studies have suggested that products of the core gene could be immunological targests of cytoxic T lymphocytes as well as those of variant pre-core genes and subsequently, that the clinical courses of HBV carriers might be influenced due to infected HBV variants. In this study, we therefore examined mutations in the core gene of HBV DNA on strains with or without a translational stop codon at the 28th codon of the pre-core region, using allele-specific oligonucleotide (ASO) probes and PCR-direct sequencing. The analysis of nucleotide sequences (codon 27-100) of HBV DNA in anti-HBe positive sera showed that there were two hypervariable segments of codon 31-49 and codon 87-97, where amino acid substitutions of L31I, S49T, S87G/N, K96N and I87F/1 frequently occurred regardless of the presence or absence of the mutation in the pre-core region. Meanwhile, less mutations were detected in the core gene of HBV DNA in HBeAg positive sera. Furthermore, we could identify the mutations at codon 87, 96 and 97 by using nonradioactive probes in a good coincidence with results by PCR-direct sequencing. The ASO probe method is useful for detection of mutations in the core gene in many specimens.

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Fever is a common and important clinical symptom observed among hospitalized geriatric patients.To investigate the frequency and duration of fever episodes, we surveyed fever episodes in a hospital where the frequency of patients over 60 years of age exceeds 90 per cent of the patients. Fever episodes with body temperature of over 37.5deg;C were registered from May in 1991 to December in 1994, and 6809 episodes were subjected to anlaysis. The average incidences per month were 157.1, 165.3, 158.0, and 139.3 in 1991, 1992, 1993, and 1994, respectively. The numbers of episodes per month did not show any significant correlation with temperature or humidity. Average duration of the episodes were 8.0, 6.5, 7.6, and 6.7 days for 1991, 1992, 1993, and 1994, respectively. Episodes of one day duration were the most frequent in all months, and the frequencies of that ranged from 37.1% to 58.6% with a mean of 47.8%. The average duration of episodes and the frequency of one day episodes did not change significantly irrespective of a notable decrease in the total incidence. The high frequency of one day episodes and their consistency through the observed period suggest that fevers with one day duration are one of the characteristic features of the febrile symptoms in geriatric patients. Causality and prevention methods for these one day fever episoders should be investigated.

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Vivax malaria is the most frequent among imported malaria in Japan, comprising about 60% of the total cases. Usually, after the acute phase therapy, e.g. with chloroquine, patients with vivax malaria are treated with the standard course of primaquine, i.e. 15 mg base/day for 14 days, as curative therapy. Recently, however, cases of relapse of vivax malaria after this standard primaquine therapy were reported from various countries and were also encountered in Japan. This report showed that the relapse after the standard primaquine therapy occurred most frequently in the cases acquired in Papua New Guinea, followed by Indonesia and Thailand. In contrast, the relapse rate of the cases acquired in India was low.
Most of the relapsed cases were successfully treated with either of the regimens 1) 30 mg/day for 7 days, 2) 2 courses of the standard primaquine therapy given 1 month apart or 3) 15 mg/day for 21 days, without noticeable side effects.
It is imperative to establish the most appropriate regimen with primaquine for the curative treatment of vivax malaria contracted in the areas mentioned above.

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Rotavirus (44.7%), adenovirus (5.6%), small round structured viruses such as astrovirus (9.8%) and Norwalk like virus (6.9%) were detected by latex agglutination and reverse transcription polymerase chain reaction amplification from 378 stool samples in an outpatient clinic of Pediatrics in Maizuru area from 1991 to 1994. 70.0% were found from 6 months to 2 years old and 91.0% were detected from January to April. Serotype 1 astrovirus and group 2 Norwalk like virus were mainly found in all serotypes in each virus.
Diarrhea, vomiting, nausea, fever, cough and rhinorrhea, and severity of diseases were examined in each case. Fever is significantly found in patients with rotavirus. Sporadic cases with small round structured viruses were recognized in the outpatient clinic of pediatrics.

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In 1995 an investigation was made for VP4 resions of coxsackie virus A16 (CA16) RNA sequence from hand-foot-mouth disease patients in eastern district of Shizuoka Prefecture.
Subjects were seven patients who were diagnosed as hand-foot-mouth disease due to CA16 at the Ohashi Pediatric Clinic in Susono City. Throat swabs of patients were extracted to RNA. Extracted RNA were assayed by reverse transcription polymerase chain reaction that primers corresponded to VP4 resion of enteroviruses. PCR products were marked by dye-deoxy terminator methods and assayed by direct sequence methods.
RNA sequences were classified into two types. Type 1 were three cases, and type 2 were four. The homology was 90.8% between type 1 and type 2. All cases of sixty-nine amino acids were the same as prottype strain.
We concluded that the two type strains of CA16 were prevalented in eastern district of Shizuoka Prefecture in 1995. It was at the same time and was widely nated in the eastern district.

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A newly devised 7H12 cultivation method combined with nested PCR assay using Mycobacterium tuberculosis-specific primers was evaluated for its usefulness to detect and identify tubercle bacilli in 38 sputum samples. This method yielded detection and identification of M. tuberculosis in sputum specimens with excellent sensitivity, specificity, and rapidity, when compared to the cultivation method using Ogawa egg medium or the 7H12 cultivation method in which bacterial growth is monitored by microscopy (71112-microscopy method) with the same sensitivity as that of the BACTEC^® 460 TB system.

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A case of septicemia due to Aeromonas hydrophila (A. hydrophila) in a 54-year-old male suffering from progressive severe jaundice and fatigue is reported. The patient developed multiple organ failure despite aggressive therapy including plasma exchange and glucose-insulin therapy. Upon admission to our hospital, therapy was started with ampicillin (ABPC) 4 g/day, gentamicin (GM) 120 mg/day, hemodialysis, continuous hemofiltration, catecholamines and a respirator, but he expired on the 2nd hospital day. Blood culture and histology revealed A. hydrophila. Postomortern examination showed alcoholic liver fibrosis which was most likely liver cirrhosis. In the literature, patients with septicemia due to Aeromonas had underlying hepatic cirrhosis more often than did those with septicemia due to other gram-negative bacilli. Therefore, it is important to consider the possibility of liver cirrhosis in patients with A. hydrophila septicemia.

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A 34-years male was admitted to our hospital with a hypochondria pain and low grade fever. Abdominal CT revealed an encapsulated 8×3 cm low density lesion on the surface of the liver (S5, S8) and multiple low density lesions of the spleen. The patient had already been treated with anti-tuberculous drugs for the past 7 months after being diagnosed as tuberculous pleuritis. Although echo-guided percutaneous needle biopsy was tried for the hepatic lesion, no special finding was obtained. Therefore a diagnostic laporatomy was performed and the hepatic lesion was resected. Abscess formation of the resected lesion was noted. Histopathology of the lesion reveaeld epitheloid granuloma, but microscopy, culture and PCR for tuberuculosis reveaeld negative results. Abdominal CT, 3 weeks after surgery, revealed enlargement of the splenic lesion. Splenectomy was carried out to avoid splenic rapture. Multiple abcesses of the resected spleen was noted. Pathological finding, Ziehl-Neelsen stain and PCR for tuberculosis confirmed the diagnosis of tubercular splenic and liver abscess. Although tubercolar liver and splenic abscess are very rare recently, it should be included in the differential diagnosis of unknown hepatic and splenic lesions.

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