Clinical efficacy of fluconazole on fungal infections was evaluated. Fluconazole was administrated orally or intravenously to 16 cases with fungal infections (chronic renal failure 4, congestive heart failure 2, cerebral infarction 2, etc).
All cases were suspected of mycosis. The details of those administrated were 16 cases of pneumonia 3 cases, fungemia 9 cases (suspected 7 cases) and urinary tract infection 3 cases.
Clinical efficacy rate was 71.4%.
Side-effects were observed in only 1 case, and this consisted of transient increase of leukocytes and thrombocytes.
Fluconazole is considered to be a potent, safe antifungal agent for the treatment of suspected fungal infection during intravenous hyperalimentation.

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From April 1990 to February 1992 two hundred and ten strains of Streptococcus pneumoniae were isolated in the laboratory of Nara Medical University Hospital.
Frequency of erythromycin resistant Streptococcus pneumoniae, prescription mode of macrolide antibiotics and biological properties were investigated.
1. Erythromycin resistant Streptococcus pneumoniae was predominantly isolated from the wards of the respiratory unit of Inter-nal Medicine and Pediatrics.
2. Patients with erythromycin resistant Streptococcis pneumoniae were treated with macrolide antibiotics frequently in the respiratory unit of Internal Medicine and Pediatrics.
3. MIC 90 of EM, CLDM, MINO and ABPC for Streptococcus pnuemoniae was 8.0, 8.0, 8.0 and 1.0μg/ml, respectively, indicating moderate resistance to penicillin derivatives and high resistance to macrolides, particularly EM; some strains showed high levels of MIC over 400μg/ml.
4. Investigations on biological properties using VITEK GPI cards revealed that some erythromycin resistant strains showed less responsiveness to DEX, LAC, PUL and MEL.
5. The survival rate of mice infected with erythromycin resistant strains was longer than that with erythromycin sensitive strains. These findings suggested that the prolonged administration of erythromycin causes a virulence reduction of the organism.

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In the nursing home belonging to our hospital, an outbreak of influenza A (H3N2) occurred in January 1995, and we studied 23 elderly residents with influenza A infection. Twenty three residents with influenza A (8 males and 15 females) ranged in age from 67 to 95 years (average 83.1 years), 91.3% of them were bedridden. And all had underlying medical conditions with neurologic, cardiac, orthopedic, being the most frequent. The most common complaints were fever (100%), followed by cough (95.7%), sputum (60.9%), but sore throat was significantly less frequent.
Influenza A virus was isolated from throat swab specimens from 6 of 18 ill patients. Fourteen persons were hospitalized and 2 of them had pneumonia, but nobody died. The levels of CRP, WBC were significantly high in the influenza group, as compared to the non influenza group. So this result suggested that influenza A infection among elderly subjects was apt to cause bacterial infection such as bronchitis and pneumonia. This outbreak was caused by contact from the staff to residents, so we think the health care of the staffs and prevention of influenza should be a high priority in nursing homes.

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Infections and fever are frequent in patients with liver cirrhosis. Study on bacteremia in cirrhotic patients has not been reported in Japan. In a 16 year period from 1979 to 1994, we collected 39 cases with 40 episodes and 44 microorganisms of bacteremia for this study. The incidence of bacteremia in cirrhotic hospital admissions was 4.8%(39/808). Gram negative bacteria were the predominant microorganisms of bacteremia (66%, 29/44). Among them, Escherichia coli, Klebsiella pneumoniae, Vibrio sp. were the three most commonly detected microorganisms. Pseudornonas aeruginosa bacteremia has not been detected. Laboratory data of cirrhotic patients showed that positive blood culture patients had significantly lower serum albumin, prothrombin time and hepaplastin test than negative patients. Focal infection could be diagnosed in only 45%(20/44). The mortality rate was 28%(11/39), but the bacteremia related death (by septic shock) were only 2 cases. The other causes of death were hepatic failure in 9 cases. In conclusion, bacteremia is a important complication of liver cirrhosis. Blood culture is necessary in cirrhotic patients with fever.

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Effects of. glucose and amino acid mixture prescribed for parenteral alimentation on atni-Candida activity of neutrophils were examined. Neutrophils obtained from peripheral blood of healthy humans inhibited the growth of Candida albicans in vitro. More than 1.0% of glucose inhibited the anti-Candida activity of the neutrophils in. dose-dependent manner. This glucose effect was reduced by the addition of an amino acid mixture clinically prescribed with. carbohydrate solution (PN-twin) in Japan. The amino acid mixture neutralized the suppression of anti-Candida activity of neutrophils by dexamethasone. These results suggest that an amino acid mixture prescribed in an alimentation solution may play. role as. neutralizer of the suppressive action of glucose for anti-Candida activity of neutrophils in. limitted area near the top of. catheter in. blood vessel.

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The etiology of acute lower respiratory tract infections (ALRI) was studied in pediatric inpatients under 2 years of age admitted to Chiba Municipal Hospital between June 1994 and March 1995.
Eighty-seven patients, 99 episodes were investigated for bacterial infection with the use of blood culture and washed sputum culture, for viral infection with the use of viru sisolation, antigen detection and antibody assays, for Mycoplasma pneumoniae infection with the use of antibody assay and fo Chlamydia infection with the use of antigen detection.
Pathogens were identified in 71 (71%) of the 99 episodes. Evidence of bacterial infection was detected in 43 episodes (43%), viral infection in 37 episodes (37%), Mycoplasma pneumoniae infection in 4 episodes (4%) and Chlamydia infection 3 episodes (3%).
The major bacterial pathogens were H. influenzae, M. (B) catarrhalis and S. pneumoniae. RS virus and influenza virus epidemics occurred during the winter. A mixed bacterial and viral infection was documented in 13 episodes (13%). RS virus infection was common in infants up to 6 months old. Mixed bacterial and influenza virus infections were common in 1 or more year old children.
Virus isolation was useful for the grasp of the viral epidemic. Bacterial associated infections were common in children under 2 years of age with ALRI. Washed sputum culture and sputum gram stains' were useful for the treatment of infant ALRI.

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A novel method for the extraction of HCV-RNA by using DNA probe coated-latex microparticle (AmpliTex) was developed. This high density particle, with a large surface area, could be dispersed uniformly in a guanidium lysate of the serum. The DNA probe on the particles could hybridize with a few copies of HCV-RNA in the lysate. The RNA thus extracted on the particle can be subjected to the reverse-transcription and PCR reaction. Analytical sensitivity to detect HCV in serum was approximately 20 copies per ml. AmpliTex and the conventional organic extraction gave the same sensitivity and specificity (both 100%) to detect the HCV-RNA from fifty clinical specimens. It was also possible to extract the HCV-RNA from heparinated plasma.

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Techniques for detecting hepatitis E virus nucleic acid by RT-PCR and digoxin probe spot hybridization tests were developed. The examination by RT-PCR test of 250 stored stool specimens from patients with acute hepatitis E gave a positive rate of 40.9% and was positive in one stool specimen collected 28 days after the patient had contracted the illness. Serologic examination yielded a positive rate of 66.7%, and also utilizing the DIG probe labelled with PCR product it was 66.6%. RT-PCR with the digoxin probe proved to be suitable for clinical diagnosis and basic research on hepatitis E.

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Against gram-positive sepsis, vancomycin (VCM) was administered in combination with imipenem or cilastatin (IPM/CS). Its excellent efficacy was confirmed in 2 cases, one affected with methicillin resistant Staphylococcus aureus and another with Gemella morbillorum. By calculating the FIC index according to a checkerboard technique, the in vitro synergistic effect was also demonstrated. At the present state multi-drug resistant gram-positive infections prevailed, the combination of VCM with IPM/CS can be expected as an effective measure for treating these diseases.

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A 22-year-old female was admitted to our hospital because of general fatigue and continuous high fever. Salmonella Typhi was detected from her blood.
Her mother, 44-year-old female was admitted to our hospital a few days later because of high fever. She had nursed to her daughter and inserted suppositories to her daughter several times. S. Typhi was also detected from her blood. No other member of her family was infected with S. Typhi.
From the study of the route of the infection, we are confident that S. Typhi was delivered from daughter to mother by insertion of suppositories.

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We have encountered a 12-year-old girl with acute respiratory disease including pneumonia caused by adenovirus type 7. While being followed-up for bronchial asthma, she developed this disease with dyspnea accompanied by high fever, pharyngalgia and a dry cough subsequent to a slight fever. Adenovirus type 7 was separated and identified from the pharyngeal smear. Additionally, perfusion scintigraphy of the lungs presented evidence of interstitital pneumonia. with these findings and the clinical course put together, this case was diagnosed as having acute respiratory disease with pneumonia caused by adenovirus type 7. Thereafter, perfusion scintigraphy of the lungs continued showing interstitial shadows, which suggested the presence of severe sequlae of the lung. Formerly the separation rate of adenovirus type 7 was low in Japan, but the rate has tended to increase in cities in recent years. Cases presenting such acute, severe respiratory symptoms are expected to increase in the future, and clinically we consider to be our case important enough to be reported.

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An 83-year-old male was admitted to our hospital because of pancytopenia and low grade fever on April 19, 1993. On admission, hematological data were as follows: WBC 1, 000/jul with 19% neutrophils, RBC 367×10⁴/μl, Hb 9.5g/dl and platelets 6.7×10⁴/μl. Bone marrow examination revealed 6.6% myeloblasts and 33.5% erythroblasts. Morphological abnormalities included hypersegmentation, degranulation and pseudo-Pelger's nuclear anomaly in neutrophils. Based on these findings the diagnosis of refractory anemia with excess of blasts (RAEB) of the myelodysplastic syndrome (MDS) was made and therapy with low dose Cytarabine (Ara-C) was initiated in April 1993. The patient had two episodes of severe pneumonia in June and July. Therefore, 75 μg/day of G-CSF was given in addition to antibiotic therapy for the second episode of infection in July. Thereafter the severe infection subsided, and G-CSF administration was switched to an intermittent schedule (75μg twice a week) since September. Cytarabine ocfosfate (100mg/day) was added for 10-14 days at interval 1-2 months from October, 1993. He has been well with no episode of infection for more than two year.
One major concern regarding the clinical application of G-CSF in MDS patients is related to the possible stimulation of leukemic cell proliferation. Frequent hematological monitoring is ecessary in patients with RAEB who are prone to develop acute myeloid leukemia. However, we administered G-CSF at a relatively low dose twice a week for over two year and could successfully prevent infections without inducing the leukemic changes.

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A case of the greater omentum abscess due to Peptostreptococcus ssp. is reported.
A 63-year-old male was admitted to Heisei Memorial Hospital with a complaint of abdominal pain. An intraperitoneal mass measuring 6 cm in diameter was detected by CT and ultrasonogram.
He was diagnosed as having an intraperitoneal abscess. After antibiotics therapy by cefotiam, laparotomy was performed and an abcess about 7 cm in diameter at the edge of the greater omentum was found. There was no evidence of perforation in the intestine wall. The abscess was removed and Peptostreptoccocus spp. was isolated from the dark red pus drained from the abscess.

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A 47-year-old male was infected with Tsutsugamushi disease showing typical findings after mountain climbing in the Republic of Korea (ROK). Immunoserological examinations suggested that he had been infected in ROK. In this case, detection of the characteristic sting was useful for early diagnosis and treatment. Until now, Tsusugamushi disease has not been reported in Hokkaido. It is the first case registered in Hokkaido. With extensive international intercourse these days, this case suggests that Tsutsugamushi disease can occur potentially all over Japan.

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