Patients with diabetes mellitus (DM) often suffer from various and severe infection. Patients with pancreatic DM have malnutrition due to chronic pancreatitis. Therefore it is believed that patients with pancreatic DM have a lower ability of host defence to infectious diseases than normal subjects. We examined the primpheral lymphocyte subsets (T cell, B cell, NK cell, CD3+56+T) of eighteen patients (males, age = 52.8±12.7 years old, mean±SD) with pancreatic DM by two color flow-cytometry to evaluate the lymphocyte function. Ratios of T cell (T%, 66.9±9.3%±SD). B cell (B%, 13.1±5.8%) and NK cell (Nk%, 19.3±8.7%) to total peripheral lymphocytes of patients with pancreatic DM were not significantly different from those (T% =66.4±7.8%, B% =13.5±6.7%, NK% =19.9±9.1%) of thirteen nomal subjects (males, age = 51.2±13.1). CD3+56+ T cell %(4.1±1.9%) of patients with pancreatic DM was lower than that (6.0±3.0%) of normal subjectes (p<0.05). CD3+56+ T cells have cytotoxic activity and it is likely that this activity is similar to that of NK cells. These results suggested that a decrease in peripheral CD3+56+ T cell % is a factor showing a weak host defense mechanism to infectious diseases in patients with pancreatic DM.

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One hundred isolates of methicillin-resistant Staphylococcus aureus (MRSA) collected from hospitals located in different geographical areas of Japan were used in the present study. The susceptibilities of the strains to gentamicin (GM), erythromycin (EM), tetracycline (TC) and ofloxacin (OFLX) were determined and classified into twelve groups according to their differences in the patterns of the resistance to the four drugs. Of the 100 strains tested, 75 belonging to the main four groups were investigated for the relationships between their patterns of the drug-resistance and biological properties such as coagulase, enterotoxin and phage types, TSST-1 and β-lactamase producibilities, and percentages of the strains carrying plasmids of large size (≥20, 000 bp).
The main four patterns of drug resistance of the 75 strains were as follows: the first group (33 strains resistant to GM, EM, TC and OFLX), the second group (15 strains resistant to EM, TC and OFLX), the third group (11 strains resistant to GM, EM and OFLX) and the fourth group (16 strains resistant to EM and OFLX) and the remaining 25 strains were divided into further groups.
A considerable number of the strains in the third group differed markedly in some biological properties from those in the other groups; coagulase typing (III type-50%: the other groups-II type), enterotoxin typing (64%-non-production: the other groups-C type), TSST-1 producibility (36%-production: the other groups-76 to 88%-production) and phage typing (55%-non-typable: the other groups-80 to 97%-non-typable). In β-lactamase and plasmids of large size, the first group consisted of the strains with β-lactamase producibility at the ratio of 50: 50, but the other groups consisted of most of the strains with the β-lactamase producibility. Most of the strains belonging to the second and fourth groups carried large size of plasmids, but 36 and 46% of those belonging to the first and third groups did not carry them.
On the other hand, our results of the susceptibility test for the 100 strains showed that a considerable number of strains were susceptible to GM (35%) and TC (42%) at therapeutically significant concentrations.

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We followed 54 HIV-1 carriers (44 asymptomatic carriers and 10 AIDS patients) by virus isolation and immunological examination and evaluated their usefulness for prognostication of the onset of symptoms. From 37 carriers (27 asymptomatic carriers and 10 symptomatic), 132 HIV-1 strains were isolated; the virus isolation rate was 60% in the asymptomatic carriers (AC) but 100% in the symptomatic. In the AC, the isolation rate was 54.5% in the group showing stable in the CD4+level but 95.5% in the group showing a decrease in the CD4 + level. With progressionof the disease, the culture time required for virus isolation was shortened, and the percentage of isolates showing infectivity to the T-cell line (MT-4 cells) increased. These findings suggest that the virus in the body is changed with progression of the disease to that showing rapid replication, T-cell tropic, and high pathogenicity. Indeed, progession of the disease was observed in all carriers in whom a highly pathogenic virus was detected; some developed the disease within 1 year, some showed temporary recovery in the CD4+level after AZT administration followed by progression to ARC, and others showed a rapid decrease in the CD4+level. In contrast, in carriers with only slightly pathogenic virus, the CD4+level was maintained for a long period. These results suggest that the detection of a highly pathogenic virus is one of the most reliable marker for the prognostication of the onset of the disease. The detection of HIV-1 antigen in the plasma and a decrease in the gag antibody were also associated with the progression of the disease. However, the reliability of these markers seems to be lower than that of virus isolation.

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We have reported on the investigation of 54 HIV-1 patients concerning the isolation and clinical marker in the preceding paper. We have attempted the analysis of the V3 and RT genes. HIV-1 from a patient who had rapidly taken a turn for the worse had basic amino acid at position 11 (Arg) and lost an acidic amino acid at position 25 (Gin) of V3. This sequence pattern was a distinguished feature of a virus with a rapid-high, syncytium inducing (SI) and T-cell-line tropic phenotype. In contrast, patients with no or mild clinical symptoms had sequences characterized as slow-low, non-synsytium inducing (NSI) and macrophage tropic. We then investigated the appearance of resistant to AZT and ddl. It was shown that the virulent virus obtained drug resistant variants faster than the wild type by analysis of the RT gene.
We consider that these data concerning virus isolation and gene analysis are useful for prognosis and strategy for clinical therapy.

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We respectively evaluated the nutritional state of 31 patietns who isolated Methicillinresistant Staphylococcus aureus (MRSA) was isolated from January to November in 1993. Because 4 of 31 isolates were not considered to be a causative bacteria, we evaluated the rest 27 cases. Fifteen of 27 cases were diagnosed as MRSA infection and 12 (44%) MRSA colonization. We evaluated the nutritional state of patients with infection and colonization. There was significance (p<0.01) between two groups as for serum total protein were 5.52g/dl in infection group and 6.65 g/dl in colonization group. Furthermore there were significance (p<0.05) for mean serum albumin were 3.04 g/dl v.s. 3.58g/dl and total cholesterol were 122.3 mg/dl v.s. 162.5 mg/dl. Thus, MRSA was colonized in respiratory patients who were in better nutritional state, suggesting that importance of nutritional improvement for prevention and therapy against MRSA infection. We obtained similar results on Methicillin-sensitive Staphylococcus aureus (MRSA).

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A comparison of the rate of recovery and time for detection of mycobacteria from clinical specimens of the newly developed Mycobacteria Growth Indicator Tube (MGIT), the biphasic Septi-Chek, and the egg-based Ogawa medium was made. From the 305 sputum specimens processed, a total of 83 mycobacterial isolates were detected. From these 80 (84.3%) isolates were detected with both the MGIT and Septi-Chek systems, respectively, and 50 (60.2%) were detected by the Ogawa egg method. The difference in the percentages of positive cultures between the two systems based on liquid media and the Ogawa egg method was significant (p<0.001). The mean time for the detection of the Mycobacterium tuberculosis complex were 16.3 days with the MGIT system, 25.6 days with the Septi-Chek, and 21.5 days with Ogawa egg method. These results indicate that the MGIT system is efficient for the recovery of mycobacteria.

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A 44-year-old female admitted to our hospital because of fever, purpura and macroscopic hematuria. She had been diagnosed as having ventricular septal defect (VSD). She noticed purpura with pain on bilateral legs and macroscopic hematuria since September 18, 1994. Three weeks later she also manifested a fever. Physical examination of admission revealed numerous purpura and leg edema. Laboratory data showed macroscopic hematuria, marked anemia (Hb 3.3 g/dl), leukocytosis, azotemia (Cr 2.7 mg/dl) and positive acute phase reactants. Increased serum immune complex level and hypocomplementemia were also found. The diagnosis of allergic purpura was made initially, but positive blood culture of Streptococcus mitis and the detection of vegetation attached to the right ventricular wall near the ostium of the VSD made the difinite diagnosis of infective endocarditis (IE). Chemotherapy with PCG was started for two weeks but with no effect. The chemotherapy was altered to panipenem/betamipron with a daily dose of 3 g, Then, her fever fell and purpura, macroscopic hematuria and renal failure gradually disappered. In this case, the cause of renal manifestations was considered to be immune complex glomerulonephritis. This is the first report of IE with macroscopic hematuria due to immune complex glomerulonephritis.

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A case of psoas abscess associated with diabetes mellitus in the elderly is reported. A 81-year-old male who had been followed for cerebral thrombosis, diabetes mellitus and basal cell carcinoma was admitted to our hospital because of high fever. Leukocytosis, a positive CRP test and pyuria were seen. Proteus mirabilis and Escherichia coli were detected by urine and blood culture, respectively. He was treated with antibiotic therapy for urinary tract infection and sepsis. After starting treatment, a low grade fever continued. On the twenty first hospital day he developed pyrexia again, and a large abscess was demonstrated in the right psoas muscle by pelvic couputed tomography. The abscess was drained and a specimen from it yielded E. coli on culture. Treatment with antibiotics and drainage resulted in symptomatic improvement.
In Japan, 82 cases of psoas abscess have been reported from 1990 to 1994. Four cases of these reports were above eighty years old. The experience with this case indicates the necessity of adequate care in cases of elderly diabetes complicated by psoas abscess.

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A family outbreak (3 cases) of Chlamydia psittaci infection was reported. The first case, a 56-year-old man was adimitted with fever and general fatigue.
Chest X-ray film revealed a consolidation in the right lower lung. One month beforeadmission he had purchased 2 parakeets (chick) and one parakeet died. On learning of his history of contact with the chick, psittacosis was suspected. After administration of fixation (CF) antibody titer against chlamydia rose to 1: 128 and IgA titer against Chlamydia psittaci by microimmunofluorescence antibody technique (MAF) rose to 1: 128 in 21 days after admission.
The second case, the wife of the first, a 53-year-old woman had a fever and a cough about two weeks before the admission of the first case. At the time of her husband was admitted, she attended the outpatient department. The chest CT X-ray film showed a ground glass appearance in both lower lung fields.
The third case, the daughter of the first, didn't have any signs. Chest X-ray film was normal. But IgM titer against Chlamydia psittaci by MAF rose to 1: 16 and IgA titer against Chlamydia psittaci by MAF rose to 1: 128. This case was considered as inapparent infection.

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A 69-year-old male was admitted to our hospital on Jan. 10, 1995 complaining of bloody sputum, left back pain and fever of 39°C. He had a history of pulmonary tuberculosis 45 years ago. His chest X-ray and CT showed the presence of air-fluid level in the left pleural cavity with thickening and calcification of the pleura. Salmonella Enteritidis was isolated from the sputum, bronchoalveolar lavage fluid and stool. He was diagnosed as suffering from Salmonella-empyema with an internal fistula. Based on the in vitro sensitivity test, sulfamethoxazole/trimethoprim was started. However, the efficacy of the antimicrobia was not sufficient. He then underwent left pleuropneumonectomy. Salmonella was cultured also from the specimen obtained at the operation. His course after operation was uneventful.
Thus, although Salmonella Enteritidis is known as a common pathogen of food poisoning, it can cause empyema, especially in a case with an impaired host defence system.

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