1. Introduction: Only about 10 years have passed since HIV was discovered but WHO presumes that there will be 30 to 40 million infected cases by the year 2, 000. This then possesses the possibility of more frequent contact with such persons and thus means we must look for how to protect ourselves. I would like to discuss the present state of AIDS, particularly in eastern European countries such as Bulgaria, Hungary, Romania and Russia, based on recent data I have compiled.
2. AIDS-related laws at present in various countries.
(1) Comparison of major laws (17 countries) including 1) patient (17 countries) and infected person (13 countries) notification, 2) protection of privacy (9 countries), 3) prohibiting infected person discrimination (3 countries) and 4) other matters including restraint on behavior to spread infeciton (6 countries).
(2) Entry laws from foreign country (10 countries) applicable to patient and infected person for 1) entry (3 countries) and 2) long period of stay (8 countries).
3. Present countermeasures to AIDS.
(1) Data for 8 countries including Japan, U. S. A. U. K., France, Germany and three eastern European countries with regard to 1) budgets, 2) examinations, 3) medical care, 4) consultation and guidance and 5) education. I shall also discuss the following 2 countermeasures in Japan. I have proposed to the Diet: 1) Examination to detect HIV-antibodies in donated blood. This measure is present in effect since Nov. 1st, 1986, as a result of my proposal made to the Diet on March 14th, 1986. 2) For person infected by transfusion of the blood products without heat treatment, I proposed that expenses should be defrayed according to the CD 4 level at either CD 4≤200 or CD 4 5≤500.
(2) Present situation in eastern European countries.
Common features are as follows: 1) Infected person and patient are quarantined if they request, since they know their condition which was disclosed based on data from past mass screening test under communism. 2) At present infected persons are few in number. 3) This number will radpidly increase with greater active interchange with western countries following elimination of the Berlin Wall. 4) AIDS countermeasures such as blood and blood products examinations are inadequate due to insufficient funds. In Bulgaria, the government has conducted AIDS tests on more than half the population and in Romania, there is the tragic situtation.
(3) Guidelines for WHO-ILO countermeasures to AIDS at work places.
4. Present situation in research.
The development of effective medicines and vaccines is the primary objective of AIDS research. Research programs may be enumerated as follows; 1) In the U. S. A., NIH and CDC are major organizations which lead research around the world. The major objective is synthetic medicine. 2) In U. K., the development of vaccines for monkey and cat is being sought. 3) In China, herb medicine is administrated to patients in Un-nan-sho where AIDS patients are quite numerous. 4) In Japan, a recombinant vaccine is being sought through use of BCG, vaccinia viruses and the like.
5. Topics related to AIDS include 1) informed consent to be treated by a AIDS-infected doctor, 2) suits against doctors who fail to make infected person known infection and 3) government control laws for AIDS in Russia.

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Bullous Impetigo caused mainly by S. aureus is seen in high incidence in children. Three decades ago CEMs were much more effective for bullous impetigo than today. Recently, the causative S. aureus obtained resistance against not only PCs but multiple antibacterial drugs except a few agents. Therefore the therapy for the disease has become difficult, especially the first choice effective antibacterial drugs for general use. Sensitivity of antibacterial drugs against S. auresu isolated from skin lesions, including some MRSA was studied in 113 patients with bullous impetigo. The agents with high sensitivity against all strains were VCM (100%), MINO (100%), CLDM (96.5%), FMOX (96.3%) and against 39 MRSA strains were VCM (100%), MINO (100%), OFLX (92.3%), CLDM (87.2%) and FOM (82.1%). Clinically available antibacterial drugs for children are MINO granules and FOM drysyrup. Phage group and coagulase type of the S. aureus were simultaneously examined to elucidate which strains were causative or secondary infectious agents of the bullous impetigo.

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Varicella has been thought to be one of the representative infectious disease in childhood, but recently we are under the impression that adults contracting varicella are increasing in number. On the other hand, they say that varicella generally causes a serious illness in adult patients. So we investigated signs and symptoms of varicella, source of infection, occupations of adult patients, except those who were immunologically compromised, by means of medical records, to know the characteristics of varicella in adulthood. According to the varicella severity score proposed by Nagai et al., varicella in the hospitalized adult patient was found to be much severer than that in children. The most remarkable symptoms, were high fever and sore throat, and these were the main reason of hospitalization in most of our patients. Although severity scores were very high in admitted adult patients with varicella, their clinical courses were not serious, and most of them recovered with only supportive therapy. These patients rarely suffered from complications, like pneumonia. If adult patients with varicella hospitalized in the early stage and received supportive care, they could recover without any complications. In most cases of adult varicella the source of infection was unknown. In the case of married persons, however, many of them were infected through their child. When adults contract varicella, not only the patients themselves suffer from high fever and sore throat, but also they act as the source of infection, if they are medical care workers. Furthermore, in public, the contraction of varicella results a socioeconomic loss from suspension of business caused by the illness. Prophylaxis with varicella vaccine, therefore, should be considered, when there are people who have never contracted varicella, whether or not they are medical staff.

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We evaluated two kits which detect either Verotoxin (Novapath EHEC) or EHEC O157 (Novapath O157) directly from stool specimens and compared with the result of PCR. The tests can be completed in 3 hrs. All fecal specimens from 18 healthy volunteers showed negative results with both kits and PCR. Specimens from patients of EHEC O157 outbreak in Okayama Prefecture and asymptomatic families of patients of outbreak in Sakai City of Japan were also analyzed. Fecal specimens from which EHEC O157 was isolated showed positive results with both kits and PCR. Some specimens which were culture negative showed positive results with either Novapath EHEC or Novapath O157 or both. The sensitivity of Novapath O157 was lower than PCR to detect O157 organisms but took shorter time to get result. Novapath EHEC showed very high sensitivity in detecting Vero toxin. These results suggest that Novapath EHEC especially can be used clinically for rapid diagnosis.

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The rapid detection method of Escherichia coli O157 in feces by using the latex agglutination test kit (Prolex ^®; Pro Lab Diagnostics) and the immunochromatic assay kit (NOW ^® EH. E. coli;Binax) was studied. 176 fecal samples obtained from 154 healthy men and 22 patients who had diarrhea by E. coli O157 were examined. Tellurite cefixim sorbitol MacConkey (TC-SMAC), Prolex ^® and NOW ^® were used for studies and also these were done after the enriched culture by tellurite cefixime vancomycin toriptic soy broth (TCV-TSB). In the direct inoculation, 5 (23%) of 22 samples, 7 (32%) and 9 (41%), and after the enriched culture, 7 (32%), 10 (46%) and 11 (50%) were positive by culture, Prolex ^® and NOW ^®, respectively. On the other hand, 154 samples from healthy men were all negative in the direct inoculation, but in the enriched culture, 7 of 40 (18%) were positive by NOW ^®. These samples were negative by boiled (100°C, 15 minutes).
Our results indicated that Prolex ^® and NOW ^® were useful for accurate and rapid diagnosis of E. coli O157 enteritis, and more sensitivity results were obtained with the enrichement broth.

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The outbreak of enterohaemorrhagic Escherichia coli (EHEC) O157: H7 infection in Obihiro City, Japan, occurred in late October 1996. The infection affected a total of 169 kindergarten pupils and school staff members in a private kindergarten. Twenty-one children (12.4%) progressed into hemolytic uremic syndrome (HUS). Moreover, the person-to-person infections in 9 families and the duration of excretion of EHEC in 13 patients were observed. The contaminated food was identified as the potato-salad served at lunch. Analysis of biological characteistics, the ability of toxin production, and the DNA analysis by PCR-based fingerprinting, the RAPD tests, among all clinical isolates, clarified a homologous origin of contamination.

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A rapid detection for Shiga-like toxin in feces was developed with the nucleic acid extraction method by silicondioxide-guanidine thiothianate and rapid-cycle polymerase chain reaction by RapidCycler ^® (model 1002; Idaho Technology, RC-PCR here after). Twenty-two fecal samples that were collected from patients with diarrhoea caused by E. coil 0157: H7 and frozen for 6 months were examined directly by RC-PCR, conventional PCR assay using by ThermalCycler ^® 9600-R (Roche, TC-PCR here after) and by the culture method using tellurite-cefixime sorbitol MacConkey (direct method). These examinations were done also after being injected into TCV-TSB and incutated at 35°C overnight (indirect method).
The sensitivity of RC-PCR and TC-PCR using a diluted suspenison of broth enriched at 35°C overnight were 4.1 pg and 410 fg, respectively. Positive results in the direct method wereobtained in 7 for RC-PCR, 10 for TC-PCR and 5 for culture. Positive results on indirect assay were obtained in 9 for RC-PCR, 9 for TC-PCR and 7 for culture.
It was demonstrated that the RC-PCR assay was able to detect Shiga-like toxin gene in feces in less than 90 minutes after being recieved at the laboratory.

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Many outbreaks of EHEC 0157 were occurred in Japan in 1996. There was the biggest outbreak involving approximately 6000 victims in area of Sakai City. We conducted a questionnaire survey on the EHEC infection to the physicians who treated these patients and the microbiologists. For physicians we asked mainly clinical manifestation of patients they observed and treatment they did and their outcome (Answer A). Microbiologists were also required to answer the opinion about treatment (Answer B). Eighty-five of physicians replied about their 222 patients and 209 of microbiologists answered their opinions. In this report we summarized the data and obtained following results:
1) We observed higher frequency of HUS/TTA complication in female than male.
2) Higher HUS/TTP complication was accompanied with patients complained symptoms of fever, bloody diarrhea, and general fatigue.
3) The most patients (96%) were received antimicrobial agents, especially fosfomycin (84%), followed by new quinolon (17.8%) and Cefems (12.2%). Later starting of treatment with antimicrobial agents than 7 days from onset of symptoms increased HUS/TTP complication.
4) Anti-diarrhoeal agents seems to be one of risk factors for HUS/TTP complications.

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We investigated the effect of erythromycin (EM) in patients with diffuse panbronchiolitis (DPB) who were divided into 2 groups, the short term group with 8 patients who were treated for at least 2 years and the long term group with 7 patients who were treated for more than 3 years. Each mean value of %VC, FEV_1.0, FEV_1.0% and PaO₂ two years after administration to these patients was improved than before administration of EM, with the exception of PaO₂ in the long term group. There was no change in %VC, FEV_1.0, FEV_1.0% or PaO₂ in each group between one year after the therapy and thereafter, with the exception of the fact that FEV_1.0% in the short term group, except patients restarting EM therapy, 2 years after the therapy was significantly higher than in the long term group. One patient was readministered EM because of recurrence of DPB after cessation of EM therapy, whose %VC, FEV_1.0 and Pa0₂, but not FEV_1.0%, one year after the therapy were increased in those before the therapy. The Neutrophil proportion in the bronchoalveolar lavage (BAL) fluid in this patient was still high after the therapy (94.5%), while that in the patients with cessation of the therapy was improved to the level of less than 8%. Neutrophil proportion in BAL fluids in the patients with continuation of the therapy revealed a high or low level after the therapy.
These results suggest that the patients, whose %VC, FEV_1.0% and PaO₂ were improved and whose proportion of neutrophils in BAL fluid reduced to a normal level compared with those before EM therapy, can be allowed to cease therapy after 2 years or more of EM therapy.

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There is no consensus about the optimal treatment for fascioliasis. Here we report 5 cases of fascioliasis and 12 cases of fascioliasis reviewed from the literature, and discuss the clinical characteristics and treatment of this parasitic disease. The diagnosis was made in 88% of all patients by the serological test and eggs in the feces were negative in all patients. The characteristic CT findings of all patients in our series were cluster of multiple abscess-like lesions in the liver. Eosinophilia was present in all patients. Bithionol was effective in all of the 13 patients and praziquantel was effective in 4 of 8 patients. Three of 4 patients, in whom praziquantel was not effective, were treated with bithionol successfully. No severe side effects were noticed in all patients. Bithionol seems to be more effective against fasciola sp. than praziquantel. Bithionol is proposed as the drug of choice for the treatment of human fascioliasis.

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Detection of Helicobactger pylori was studied on the feces and biopsy specimens of 91 patients with gastric ulcer by using cultured and polymerase chain reaction methods. Number of samples from feces and biopsy specimens were 1 (1.1%) and 56 (61.5%) by culture method, on the other hands 49 (53.8%) and 70 (76.9%) in polymerase chain reaction method, respectively. Sensitivity of polymerase chain reaction applied to feces and biopsy specimens were 68.1 and 97.2, respectively. Noninvasive diagnosis such as detection of organisms from feces is effective for patients who have difficulty in collecting the gastric biopsy specimens. Infection route was not clarified, however, fecal-to-oral transmission was strongly suggested by the fact that the organisms were detected from feces samples in this study.

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On the basis of DNA hybridization data and phenotypes, most pathogenic strains of Aerornonas hydrophila are grouped into hybridization group 1 (HG1). These pathogenic strains secret the theromostable lipase, and it's gene (lipAH) has been cloned and sequenced. The present study was performed to identify the pathogenic strains of A. hydrophila by the polymerase chain reaction (PCR) technique to detect the lipAH. Synthetic oligonucleotide primers (lipAH-ns-1 and-na-1) were used in the PCR. The PCR identified 80% of lipAH-positive strains, consisting of seven of the 11 011 strains (64%), 13 of the 15 016 strains (87%) and 25 of the 30 034 strains (83%) in clinical isolates of A. hydrophila used in this study.

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