Causal organisms and their changes were evaluated in 158 cases of septicaemia admitted to Jikei University Hospital from 1975 to 1994. Eighty patients (50.6%) were aged less than 1 year, and 37 patients (23.4%) were newborns. The average mortality rate was 18.4%. The mortality rate between 1975 and 1984 was 26.8%, and that of the past 10 years (from 1985 to 1994) decreased to 13.7%. Staphylococcus aureus (29 cases, 19.4%) was the most common pathogens isolated, followed by Pseudomonas sp. (24 cases, 15.2%), Escherichia coli (19 cases, 12.0%), and Haemophilus influenzae (18 cases, 11.4%). H. influenzae, Acinetobacter sp., Streptococcus pneumoniae and Group B streptococcus (GBS) increased in the past 10 years (from 1985 to 1994), compared with the preceding 10 years (from 1975 to 1984). The mortality rate of Klebsiella sp. septicaemia (28.6%) was highest, followed by Pseudomonas sp. (25.0%), S. aureus (24.1%), S. pneumoniae (22.2%). H. influenzae and Acinetobacter sp. septicaemia were not fatal. E. coli and GBS were common among neonates and patients aged less than 1 year. H. influenzae septicaemia occurred mainly in patients with meningitis, in those younger than school age. Acinetobacter sp. was common among neonates and children with leukaemia. Pseudomonas sp., Klebsiella sp., and Acinetobacter sp. were mainly detected in patients with underlying diseases. E. coli, H. influenzae, S. pneumoniae and GBS were mainly detected in patients without underlying diseases.

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Underlying diseases, complications, clinical findings, and laboratory findings were evaluated in 158 cases of septicaemia admitted to Jikei University Hospital from 1975 to 1994, in order to conjectured factors that prescribe for the prognosis. 50% of the patients had underlying diseases. Malignancy including leukaemia (31 cases, 39.2%) was the most common underlying disease, followed by low birth weight infant (17 cases, 21.5%), aplastic anemia (9 cases, 11.4%), and congenital heart disease (7 cases, 8.9%). The death rate for patients with underlying disease (27.8%) was significantly greater than the mortality for normal patients with septicaemia (8.9%) (p <0.05). Meningitis (24.7%) was the most common complication, followed by DIC (19.6%), shock (15.2%), and pneumonia (10.8%). The mortality rate of septicaemia complicated by shock was 66.7%(p < 0.01), and that complicated by DIC was 45.2%(p < 0.01). The mortality rate for patients with the clinical findings of respiratory distress, cough, abdominal distention, cyanosis, splenomegaly, or peripheral coldness was more than 40% and significantly greater (p <0.01).Mortality rate in patients with granulocyte counts of <4.000/mm³, platelet counts of <5×104/mm³, total protein of <5.0 g/dl, or ESR of <20 mm/hr were significantly greater (p<0.01) than those in patients with normal laboratory findings. Coincidence rate of blood and stool cultures was 57.9% for E. coli, and 28.6% for Klebsiella sp., and that of blood and throat cultures was more than 30% for Pseudomonas sp., Haemophilus influenzae, and Staphylococcus aureus. In the study of antimicrobial susceptibility for microorganisms isolated, the number of drug resistant S. aureus had increased in the last 10 years.

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A total of 603 strains of Salmonella serovar Enteritidis (SE) isolated from patients with sporadic diarrhea during the period from April 1985 to December 1995 in Yamanashi Prefecture, were examined for their yearly and monthly frequency of SE isolates, drug susceptibility, phage typing and plasmid profile.
The results can be summerized as follows:
1) The rate of sporadic diarrhea due to SE to all the Salmonella isolates were 4.4% during the period from 1985 to 1988. However it suddenly increased to 47.1% in 1989. After that, the rates decreased to half every year as compared to 1989. And yet, in the last 3 years it became as high as 69.2%, 68.9% and 73.5% in 1993, 1994, and 1995, respectively.
2) Monthly frequency of isolates was 20.1% in September, 19.4% in August, 15.3% in October, 10.9% in July.
3) The predominant ages of isolates were 2 years of age (7.3%), 1 year of age (6.1%), 4 years of age (5.8%), 3 years of age (5.6%).
4) The rates of isolates from males was higher than females (Male: 59.5%, Female: 40.5%).
5) The rate of resistant isolates was 85.4% in the period. The predominant resistance pattern was SM single (417 strains: 69.2%), SA·SM·TC resistance (76 strains: 12.7%).
6) The phage type (PT) of isolates were classified into 15 different patterns. After 1990, the most prevalent PT was PT4. And recently, new types of PT appeared in isolation of PT22 in 1994, PT5 in 1995.
7) The predominant plasmid profile (PP) of SE isolates was 60 kb plasmid. Almost all SE strains of PT4 carried 60 kb plasmid. SE strains of PT1 possessed 2 patterns of PP. One pattern showed that SM single resistance strains carried only 60 kb plasmid, on the other hand SA·SM·TC resistance strains carried 60, 50, 7.5 kb plasmids.

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An outbreak of influenza A (H3N2) in a hospital where almost 90% of the inpatients are aged over 70 years is described. An increase of febrile episodes was seen during the period from January 29th to March 17th, 1992 in two of six wards. paired sera, at the onset of fever and more than two weeks later, were obtained from patients in sixty-five episodes. Serum antibody titer to influenza A (H3N2) elevated over four times in 39 (60%) of 65. Influenza A (H3N2) virus was also isolated from seven patients. These results indicated an outbreak of influenza A (H3N2) in this population. Maximum body temperature was over39°C in 18 patients (46.2%) with influenza, and were significantly higher than that of the non-influenza patiens. The duration of fever in 12 patients of 39 was longer than 8 days in 12 patients, and significantly longer than that of non-influenza cases. Bronchopneumonia was found in ten patients (25.6%). These results suggest that the influenza infection causes a high grade fever in geriatric patients and lasts longer than is commonly seen in patients with fever not associated with influenza. Influenza infection also frequently induces bronchopneumonia and may contribute to increase mortality in the elderly, especially in patients over 70 years old.

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We performed a clinical study of 26 cases (27 episodes) of acute respiratory infection with H. influenzae by trans tracheal aspiration (TTA) from May 1987 to April 1995.
15 episodes (14 cases) were bronchitis and 12 episodes (12 cases) were pneumonia. 8 episodes were monomicrobial infection and 19 episodes were polymicrobial infection. Compared to the group of patients of monomicrobial infection, the number of elderly patients and the levels of WBC and CRP were higher in the group of patients of monomicroibal infection.
In bronchitis cases, monomicrobial infections of H. influenzae were 7 episodes and polymicrobial infection containing H. influenzae were 8 episodes. In the latter group, Pa02 level was lower and CRP was higher on average. All patients recovered, but the period for treatment was longer in the latter group.
In the pneumonia group, only one episode was monomicrobal infection and 11 episodes were polymicrobial infection. Inspite of treatment, one patient died.
It was considered that polymicrobial infection was an important factor of acute respiratory infection with H. influenzae.

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A total of 478 Vibrio parahaemolyticus strains isolated from overseas travellers' diarrhea during the last 7 years of 1989 to 1995 were examined for the production of Kanagawa hemolysin by reversed passive latex agglutination (RPLA) test. Three hundred-seventy (77.4%) out of 478 strains were positive for Kanagawa hemolysin, whereas 108 strains were weakly positive or negative.
For those Kanagawa hemolysin-weakly positive or nagative strains, the tdh and trh genes associated with the production of TDH (thermostable direct hemolysin) and TRH (TDH-related hemolysin), respectively, were studied by the polymerase chain reaction method. The trh gene was detected in 98 (90.7%) out of 108 strains. In 35 strains belonging to 13 serotypes such as 03: K6, O1: K33, O3: K59, the trh gene alone was detected. On the other hand, both trh and tdh genes were detected in 63 strains of 17 serotypes including O1: K69, O3: K72, O6: K46. Among the strains of 4 serotypes including O1: K56, O1: KUT, O3: KUT and O5: KUT, two types of the trh positive alone and the trh and tdh positive were observed.
Of interest, all of the 98 trh-positive strains were positive for the urease hydrolysis, whereas all Kanagawa hemolysin-positive strains were not. Furthermore, the strains of serotype O6: K18 (4 strains) were positive for the fermentation of dulcitol, and the strains of serotype O1: K1 (5 strains) were indole negative. These characteristics of the strains were completely different from those of typical V. parahaemolyticus strains.

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Studies were conducted with the goal of developing a kit for assaying anti-Chlamydia pneurnoniae antibodies in human serum which would enable judging positive cases with high specificity by means of an objective numerical index. Thus, an enzyme-linked immunosorbent assay (ELISA) method employing a C. pneurnoniae outer membrane complex protein was established.
Elementary bodies (EB) were purified from the YK-41 strain of C. pneurnoniae, and subsequent treatment with Sarkosyl, DNase and RNase yielded chlamydial outer membrane complex (COMC). COMC was employed as the antigen and immobilized on 96-well microplates for ELISA method.This ELISA method was used to test 51 serum specimens from patients who had been demonstrated to be positive for C. pneumoniae antigen (throat swab: PCR positive), and the levels of IgG, IgA and IgM antibodies were assayed. For each specimen, comparison was made with the antibody titers determined by the micro immunofluorescence test (Micro-IF method). The results showed good correlation coefficients of 0.950 for IgG, 0.852 for IgA and 0.866 for IgM. In addition, the two assay methods showed the following high agreement rates: 90.2% for IgG, 84.3% for IgA and 82.4% for IgM. Specimens which did not yield the same results with the ELISA method and Micro-IF method were subjected to analysis by Western blot method, and the rates of agreement with the ELISA results were 80% for IgG, 87.5% for IgA and 88.9% for IgM. These data indicate the efficacy of this new ELISA method.
Moreover, COMC was reacted with mouse antisera to three Chlamydia species, and the mouse IgG antibody was assayed. Anti-C. pneumoniae antiserum showed the strongest reactivity, whereas weaker reactivity was shown by anti-C. trachomatis antiserum (1/32nd of the reactivity of the anti-C. pneurnoniae antiserum) and anti-C. psittaci antiserum (1/4th). In addition, sera from patients infected with C. trachomatis or C. psittaci (Psittacosis) were subjected to the ELISA method using COMC from C. pneurnoniae. It was found that the correlation between the ELISA and Micro-IF methods was higher in relation to the anti-C. pneumoniae antibody titer than either the anti-C. trachomatis antibody titer or anti-C. psittaci antibody titer. These findings indicate this new assay kit based on the ELISA method has high specificity for C. pneumoniae.

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We measured anti-Chlamydia pneumoniae (C. pneumoniae) specific antibody titers by means of a newly-developed enzyme-linked immunosorbent assay (ELISA) method using an anti-C. pneumoniae specific antibody detection reagent. The clinical usefulness of this method was hereby evaluated.
The IgG, IgA and IgM titers in 418 serum specimens obtained from patients with respiratory tract infections were measured by this new ELISA method, and the results were compared with the titers determined for the same specimens with the micro immunofluorescence (Micro-IF) method. The results showed good correlation coefficients for IgG, IgA and IgM. The two assay methods showed high agreement rates for positivity and for negativity. Specimens which did not yield the same results with the ELISA method and the Micro-IF method were subjected to analysis by the Western blot method, and the rates of agreement with the ELISA results were high.
In addition, the child (0-15 yrs old; n=122) and adult (16-90 yrs old; n=133) cases were classified on the basis of being antigen-positive or antigen-negative at the initial examination, and their antibody-positive rates were determined. The adults showed no statistically significant differences in the antibody-positive rates for either IgG or IgA antibodies as a function of the pretreatment antigen status. However, the children showed statistically significant (p <0.001) differences in the antibody-positive rates for both IgG and IgA antibodies as a function of the antigen status in the antigen-positive group compared with the rates in the antigen-negative group. Furthermore, the IgM-positive rates for the children were high in the antigen-positive group compared with the rates in the antigen-negative group, and the difference was statistically significant (p <0.001). The IgM-positive rates in the adults were also significantly (p <0.05) different between the antigen-positive group and the antigen-negative group.The Micro-IF method was applied to 34 specimens from antigen-positive patients, and 22 specimens were found to show an IgG titer of _> 512 or an IgM titer of16. The diagnoses of these patients were acute respiratory disease in sixteen, pneumonia in four. Application of the ELISA method to those 22 specimens showed all of them to exhibit IgG absorbance of > 0.6 and IgA absorbance of 0.2.
The results described above indicate the clinical usefulness of our new ELISA method for the detection of antibodies specific for C. pneumoniae. The significance of this ELISA method for serological diagnosis of C. pneumoniae infections and the criteria for diagnosis of acute infections were also discussed.

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