Isolation frequency of multiple-antibiotic resistant Pseudomonas aeruginosa(MARPA) was 11.9%(fifty six strains) of a total of four-hundred seventy-one strains of P. aeruginosa isolated from clinical specimens at the Kyorin University Hospital from October 1994 to December 1996. Eighteen strains of MARPA and thirteen strains of antibiotic sensitive P. aeruginosa(ASPA) isolated from clinical specimens in internal medicine ward A were determined O serotype, and characterized with production of pyocyanin, pyoverdin, hemolysin, elastase, and caseinase. Sixteen strains (88.9%) of MARPA were identified as serotype C. The ability to produce pyocyanin, hemolysin, elastase, and caseinase was not detected in all MARPA. One side, thirteen strains of ASPA showed various serotypes, i.e., B: 5 strains (38.4%), G: 4 strains (30.8%), C: 2 strains (15.4%), E: 1 strain (7.7%) and unknown type: 1 strain (7.7%), and the production of both hemolysin and pyoverdin was observed in 13 strains (100%), pyocyanin in 8 strains (61.5%), elastase and caseinase in 9 strains (69.2%) of ASPAs, which suggests that ASPAs do maintain the synthetic ability of pathogenic factors and pigments, but MARPAs do not. These results indicate that from epidemiological points of view the current strains of MARPA spread from one clone within the internal medicine ward A with nosocomial outbreak by serotype C.

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Extracellular products of group A streptococci isolated from patients with streptococcal toxic shock syndrome (STSS) were examined. The outline of the discussion of the 3 products are as follows; streptolysin O (SLO), proteinase and erythrogenic toxin. SLO and proteinase showed a relatively large amount of products more than erythrogenic toxin. SLO produced by group A streptococci isolated from the patient with STSS had an isoelectric point (pI) of 6.0 and a molecular weight of 64, 000 and showed hemolytic activity in the presence of 2-mercaptoethanol (2-ME). Furthermore, the hemolytic activities of all components were inhibited by γ-globulin and cholesterol. Proteinase had pIs of 8.7 and 8.9, and a molecular weight of 21, 000. These data suggest that STSS clinical criteria probably reflects a characteristic of a large amount of products of individual S. pyogenes isolates.

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We report 34 cases of tsutsugamushi disease seen from 1989 to 1993 at Yagi Clinic, northern Osumi, Kagoshima Prefecture. Nineteen patients (55.9%) showed the highest antibody titers against the Kawasaki strain Orientia tsutsugamushi (Ot) and 13 (38.2%) against the Kuroki strain Ot. It is suggested that two antigenic types (Kawasaki and Kuroki) of Ot were distributed in Kagoshima Prefecture, and the Kawasaki type Ot more or less dominates Kuroki type Ot. There was no difference in clinical features between the two groups of patients.

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The aim of this clinical study was to investigate the changes in the epidemiological pattern and clinical characteristics of Mycoplasma pneumoniae pneumonia (MP). 244 patients with MP admitted to Kamo Hospital from 1979 to 1996 were reviewed.
In the first half (1979-1987) there was a sharp increases once every 4-5 years in 1979-1978, 1984-1985, and 1988, but in the latter half (1988-1996) there were not sharp increases and decreases. The latest MP incidence in winter (Dec. to Feb.) was 24% in the latter half (1988-1996) significantly (p<0.05) higher than 13% in the first half (1988-1996).
In recent years in the management of pneumonia we should take MP into consideration every year and every season.

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In 1996, we examined five domestic and eight imported cases of sporadic diarrhea caused by Vibrio cholerae non-01 in Tokyo. The domestic cases occurred during the summer, from June to September, while the imported cases were seen throughout the year.
The major clinical symptoms of the patients were watery diarrhea (100%) with an average frequency of 5.5 times/day, abdominal pain (77%), vomiting (31%) and fever (15%).
A total of 13 strains isolated from these 13 cases had the typical biochemical characteristics of Vibrio cholerae, and were classified into 11 kinds of serovars (O2, O5, O8, O9, O12, O14, O27, O51, O88, O97, and O161).
All strains produced hemolysin, and two strains produced NAG-ST, while no strain produced cholera toxin.

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The Measurement of serum (1rarr;3)-β-D-glucan (β-glucan) has been considered to be useful in the early diagnosis of deep mycosis. In this study, we investigated the clinical significance of β-glucan in pleural effusion or liquor from patients with various conditions.β-glucan was measured in 29 samples of pleural effusion from 27 patients (male: 17, female: 10 median age: 62.1).Two patients undergoing hemodialysis treatment were excluded from the study of normal range of β-glucan in these samples.
β-glucan was also measured in 39 samples of liquor from 23 inpatients (male: 15, female: 8 median age: 48.4) with certain neurological disorders.
In these cases, only two patients had deep mycosis.β-glucan in the pleural effusion from a patient with Aspergillus pyothorax showed an extremely high value of more than 1100 pg/ml. Slight elevation of β-glucan was obserbed in the spinal fluid from a patient with cryptococal, meningitis. In the other cases with no mycotic infection or any factor influencing the value of β-glucan, β-glucan in pleural effusion and spinal fluid were generaly lower than the normal range of serum samples. However, there is false positive elevation ofβ-glucan in pleural effusion.
The above results indicated that meausrement of β-glucan in pleural effusion or spinal fluid may be useful for the diagnosis of mycotic infection as the cause of pleuritis or meningitis.

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It is well known that Helicobactre pylori produced a large amount of urease which plays an important role in the maintenance of infection and adhesion. Two thousand three hundred and thirty-one specimens of the gastrointestinal mucosa were obtained from patients with peptic ulcer to isolate H. pylori strains.
Of these specimens, 1602 strains of H. pylori were isolated and 7 urease-negative H. pyloristrains were found.
Biological characteristics (except urease production) of urease-negative H. pylori were in accord with urease-positive reference strains (ATCC strains). Furthermore, these urease-negative strains were confirmed to be H. pylori strains by PCR. These results suggest that the emergence of urease-negative strains pose a new problem for H. pylori infection in patients with peptic ulcer.

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One hundred and twenty-five strains of Vibrio parahaemolyticus carrying both the tdh and trh genes were selected from the strains isolated from the travelers with diarrhea by an hybridization test using polynucleotide probes. The levels of TDH produced by these strains and the association between the TDH levels and related chracteristics in these strains were analyzed. The TDH level varied greatly from strain to strain, but none of the levels was as high as that of the typical Kanagawa phenomenon-positive strains. The strains were classified into “TDH producer”(18 strains), “Low-level TDH producer”(85 strains), and “No TDH producer”(22 strains) based on the results of a modified Elek test and the hemolysis assay on Wagatsuma agar. The highest TDH level achieved by the “TDH produce”was twofold lower than that of the Kanagawa phenomenon-positive strains as assayed by the RPLA method.
All strains possessed the toxR gene. The trhl and trh2 genes were detected in, respectively, 105 and 20 strains, and no correlation existed between the type of the trh gene and the levels of TDH produced. Considerable restriction fragment length polymorphism was observed with the tdh gene-bearing HindlIl DNA fragment in different strains, but it was not related with the TDH level.

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Although studies of bacteriology of closed oral abscesses have been extensively done, there are few studies on microorganisms involving open oral abscesses. We examined bacteriologically three open abscesses with precaution against bacterial contamination with oral normal flora and saliva, when sampling. The specimens were subjected to aerobic and anaerobic cultures within 2 hours after sampling. All three cases were infected with 5 to 14 species of aerobic and anaerobic bacteria; Streptococcus spp., Prevotella internedia and other Prevotella spp. were predominant in all three cases. All six Prevotella spp. isolated were β-lactamase producers, being resistant to β-lactam antibiotics. These results emphasize the importance of prompt anaerobic culture for the bacteriological study of open oral abscess and the significance of nitrocefin test to detect β-lactamase produced by oral isolates, especially Prevotella spp.

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Genotypes of 38 isolates of enterohemorrhagic Escherichia coli (EHEC) O157: H7 isolated from 11 sporadic cases and one outbreak in Iwate Prefecture from 1996 to February 1997 were studied by pulsed-field gel electrophoresis (PFGE), in comparison with a strain of EHEC O157: H7 isolated in 1992 in Ohazama-Cho, Iwate Prefecture, and two isolates of EHEC O157: NM. In order to substantiate the genotypes classified by PFGE, Southern blotting was performed to investigate integration sites of the Shiga toxin genes (stx) in the XbaI-digested genome DNA fragments. The stx₁ gene existed on an approximately 130 kb fragment in all isolates except two ones. On the other hand, the stx2 gene was observed on 11 DNA fragments in different length from 600 kb to 155 kb, indicating that the stx₂ gene integrates into more heterogeneous sites of genome DNA than stx₁ does. From these analyses, EHEC O157: H7 isolates examined were classified into 7 genotypes. Since half of the isolates were the same genotype as that of the isolate in 1992, it is suggested that this type of EHEC O157: H7 strain is expanding from Ohazama-Cho and Morioka City in Iwate Prefecture.

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We experienced Hepatitis A, B, C and fulminant hepatitis due to Herpes simplex virus type 1 (HSV-1) in our hospital for the severely multi-disabled (SMD) who had both severe motor and intellectual disabilities, and some of whom might be further complicated by blindess and/or deafness. In this hospital, 100 SMDs are hospitalized.
Case 1: The disabled, 25 year old male, was transmitted Hepatitis A from a nurse.
Case 2: The disabled, 60 year old female carrier of Hepatitis B virus (HBV) who has been cared for more than 10 years.
Case 3: The disabled, 46 year old male carrier of Hepatitis C virus (HCV) (RNA type 3), has been cared for more than 4 years.
Case 4: The disabled, 39 year old male, had a fever of 39°C for 9 days and suddenly died. He was diagnosed as fulminant hepatitis due to HSV-1 by necropsy.
The hospitals for SMD are characteristic in prevention of nosocomial infections; 1) The disabled infected is not aware of the fact that he or she is the source of infection and that the other disabled living with him or her are in risk of infection, because of their severe mental condition. 2) All of the disabled need complete or incomplete helps for activities of daily life (ADL), so that the disabled who is the carrier of some pathogen constantly gives risk of infection to staffs, including medical staffs (doctor, nurse and therapist), psychologist and helpers by bloody secretion from wounds, saliva, urine, feces as well as menstrual blood. 3) If a carrier of some pathogen is hospitalized, the staffs should serve under risk of infection involving bloodmediated infectious disease for many years, because SMDs are permitted lifelong stay in the hospitals for SMD, which also play a role of care house or institution, by public expense in Japan.
In case of an outbreak of Hepatitis A, nosocomial infection ended in the original case (a nurse), another nurse and a case of the disabled by general treatment and care against communicable diseases of the digestive organs.
In care of HBV and HCV carriers, an ordinary program to prevent nosocomial infection has been practiced in our hospital more strictly than in conventional hospital. HBV vaccine is injected to staffs caring the HB carriers who are negative on HBs antibody. Thus, during more than 10 years of care of HBV carrier and more than 4 years of care of HCV carrier, nonosocomial infection has never been experienced clinically as well as serologically in our hospital. However, we have often been faced by difficulty to guarantee QOL (quality of life) of the carriers, because carrier states of HBV or HCV have been long-lasting and they have been occasionally and inevitably separated physically and/or psychologically in order to prevent nosocomial infection.
In case 4, it was suspected that previously latently infected HSV-1 would be activated by another viral infection which had elicited fever for 9 days before death. The patient had neither history nor sign or symptom of immunodeficiency and had never been given drugs known as to be immunosupressive as side effect.

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We evaluated the clinical efficacy of LCR MTB, a reagent developed by Abbott in the USA, in the full automatic ligase chain reaction (LCR) for detection of DNA of M. tuberculosis complex using a thermostable ligase.
Using 458 samples isolated from patients with tuberculosis, LCR was compared with a smear method and with a culture method, and was also compared with two other methods of gene amplification, MTD and Amplicor, using 340 and 200 of the 458 samples, respectively.
The LCR method detected M. tuberculosis in 49.8%(228/458) of the samples, and was superior to the smear method (31.9%, 146/458) and the culture method (39.1%, 179/458) in sensitivity. The LCR method was also superior to the MTD and Amplicor methods; sensitivity were 37.9%(129/340) for MTD vs. 47.6%(162/340) for LCR, and 56.5%(113/200) for Amplicor vs. 59.5%(119/200) for LCR. These favorable results and the convenience of the LCR method, which enables rapid detection of target genes with a high degree of sensitivity, strongly suggest that LCR MTB is useful as a reagent for detection of M. tuberculosis using nucleic acid amplification.

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[in Japanese]

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Active cytomegalovirus (CMV) infection was treated successfully by only CMV antibodyenriched immunoglobulin (CMV-IG) in a renal transplant recipient. CMV-IG was injected at 86 mg/kg iv twice a day for a total of 16 days (4 plus 12 days, interrupted by a pause of 4 days), followed by weekly iv injection of 86 mg/kg (7 weeks). Active CMV infection was diagnosed on the basis of DNAemia in plasma, by a newly developed CMV polymerase chain reaction (PCR) test (AMPLICOR ^® CMV). The disappearance of CMV from plasma was confirmed by this PCR test. It seems that single CMV-IG therapy is worth consideration for the treatment of CMV infection

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