In early 1980's methicillin-resistant Staphylococcus aureus (MRSA) was reported as a major pathogenic organism of geriatric hospital infection in Japan. At the same time in the geriatric hospital MRSA infection was prevalent. To decrease nosocomial infections some active preven tive measures against hospital infection were taken since Oct. 1991.
After introduction of preventive measures of hospital infection in the geriatric ward (190 beds) nosocomial bacteremia and pneumonia were markedly decreased in comp arison of episodenumber before introduction of prevention.
However several patients with MRSA colonization were observed every month. The aim of this clinical study was to clear how frequent MRSA was isolated from ski n.
Consequently 3 strains (3.4%) of MRSA were observed in 86 cultured skin.
In conclusion we considered frequency of MRSA colonization frequency of MRSA col onizationon skin was not so high but rather very low under the preventive measure s.

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To determine the prevalence of hepatitis C virus (HCV) infection in health care personnel in an HCV endemic area, we conducted a seroprevalence study of 1638 Kurume University Hospital physicians, nurses, laboratory staff, and clerical staff (560 men, 1078 women). Antibody to HCV (anti-HCV) was found in 2.8%(46) of subjects and hepatitis B surface antigen was found in 1.1%(18). The anti-HCV positive rate in health care personnel was no higher than reported in the general population of Fukuoka prefecture in Kyushu, Japan. There were no significant differences in anti-HCV positive rate by occupation. However, the prevalence of anti-HCV positive individuals increased significantly as age and length of time in an occupation increased. Anti-HCV positive rate in health care personnel was probably not related to length of time in an occupation. The data suggest that HCV infection is not easily transmitted to health care personnel in an HCV endemic area.

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Although the risk of occupationally acquired infection is a matter of considerable concern for health care workers, the problem of needlestick injuries has yet to be fully understood in Japan.
We investigated 257 cases of needlestick injuries in five Nagoya Municipal Hospitals from 1989 to 1994 using the Japan EP Inet. The number of needlestick injuries increased each year of the study. In one of these hospitals, the Higashi Municipal Hospital, a specialist committee began activities in April, 1993, and protective equipment and devices were also introduced during 1994.
HCV contamination injuries accounted for 70%-80% of the total number of injuries reported during the 1991-1994 period at the four hospitals and during 1991-1992 period at the Higashi Municipal Hospital. At the Higashi Municipal Hospital, HCV contamination injuries decreased from 22 cases (48%) in 1993, to 15 cases (25%) in 1994. The use of the Japanese EPINet for analytical purposes enabled us to clearly identify the causes and status of needlestick injuries, resulting in the establishment of an effective prevention program.

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In order to promote the serological diagnosis of legionellosis in the clinical laboratory, the cutoff values of serum anti-Legionella antibody titers for microplate agglutination (MPAT) test were determined. Antibody levels were tested for 178 serum specimens including 98 healthy persons, 22 ordinally workers having either metabolic or renal failure, definitely diagnosed patients of 17 mycoplasmal and 9 chlamydial pneumonia, 32 patients of other bacterial pneumo-nia. Heat killed unstained cell suspension of each strain of Legionella pneumophila serogroup (SG) la, lb, SGs 2 to 6, L. bozemanii, L. dumoffii, L. gormanii, and L. micdadei were used as antigens. Strains of L. pneumophila SG lb were mainly isolated from environmental specimens. However, in some Legionella pneumonia cases, etiologic agents were determined as L. pneumophila SG 1 b. Thus the representative strain of SG lb was used as an antigen for the determination of thepatient's antibody titer. Quantitative agglutination was performed by using a 96-well U-bottom microplate for each antigen. Test sera were diluted from 1: 16 to 1: 256. Results were read after 20 h at 25°C. Cutoff values for 11 antigens were determined, at this moment, as 4-fold or greater increase in level to ≥1: 128 in paired sera, and ≥1: 256 in single serum. However, final diagnosis should be given by over-all coordination of serological results and clinical symptoms together with other laboratory findings. Two culture-positive Legionella pneumonia cases due to either SG3 or 6 in which significant rise of serum antibody titers against organisms of corresponding SG estimated by MPAT method were discussed.

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A portion of the neuS gene concerning Escherichia coli Kl, was amplified by the PCR to detect the K1 antigen among extraintestinal infection with E. coli. The correlation between K1 antigen and O: H serotype was investigated. The predominant serotypes were O7: H-, O16: H6, O18ac: H7 from cerebrospinal fluid with meningitis, O16: H6 from blood with septicemia, O1: H7, O7: H-, O16: H6, O18ac. H7, O75: H-from urine with cystitis. The same O: H serotypes tended to be found frequently irrespective of source. K1 antigen was found O1: H7, O7: H-, O16: H6, O18ac: H7, and almost all the strains possessed to H6 or 1-17.

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We tested antimicrobial activities of ten oral antibiotics; ampicillin (ABPC), cefdinir (CFDN), cefaclor (CCL), fosfomycin (FOM), norfloxacin (NFLX), nalidixic acid (NA), kanamycin (KM), minocycline (MINO), doxycycline (DOXY), and tetracycline (TC) against eleven enterohemorrhagic Esherichia coli (EHEC) O157 clinical strains. Two strains were resistant to ABPC and TC. Other strains were sensitive to all the ten antibiotics. To investigate the effect of antibiotics on extracellular release of verotoxin (VT), strain EHEC TT10 was grown in 10 ml of LB containing various concentrations of the antibiotics for 2 h. Number of viable cells were counted and the amounts of VT1 and VT2 released in the supernatants were measured with reverse passive latex agglutination (RPLA) using serially diluted sterilized culture supernatants. The amount of VT1 and VT2 was evidently increased with ABPC, CFDN, CCL, and FOM, the inhibitors of cell wall biosynthesis. In the case of quinolons, VT2 was markedly increased, but VT1 was not released to the supernatant. KM killed the bacteria efficiently, but no release of VT1 or VT2 was observed in the supernatant. Tetracyclines (MINO, DOXY, and TC) did not make the bacteria release either VT1 or VT2, but could not kill the bacteria appreciably. These results indicated that the inhibitors of protein synthesis (KM, MINO, DOXY, TC) are the safe antibiotics not causing the release of verotoxin from the cells and thus preventing development of hemolytic uremic syndrome (HUS) or thrombotic thrombocytopenic purpra (TTP), the important sequelae of the enteritis.

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Vertical transmission of HTLV-1 (human T-cell leukemia virus type 1) from HTLV-1 carrier mothers to their newborns has been reported with transmission rates, ranging from 6% to 78% This study was undertaken to identify the high risk group of vertical transmission by detecti ng viral antigen in cultured lymphocytes and provirus obtained from carrier mothers.
Subjects of this study were 70 HTLV-1 carrier mothers who attended the department of obstetrics and gynecology of hospital located in the Kanto area (ATL non endemic area).
HTLV-1 antigen was detected in 40 out of 55 (72.7%) in peripheral blood lymphocytes of carrier mothers. HTLV-1 antigen was detected in 2 out of 40 (5.0%) in cord blood lymphocytes of infants born of carrier mothers. These two infants were born from carrier mothers with positive antigen detection study. It seems that carrier mothers whose peripheral lymphocytes are positive for antigen expression by culture are a high risk group for vertical transmission.

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We have studied the clinical effect of lomefloxacin (LFLX) for the documented infections in the patients with hematological disorders, and also analyzed the prophylactic usefulness of LFLX for the prevention of succeeding infection after the chemotherapy. Fifty five patients were entered in the trial, and 51 patients were eligible. Among 51 eligible patients, 40 patients were suffered from accompanied infections, and 11 patients were registered for the prophylaxis of the infection. In the group of documented infection, the ratio of out-patients was 62.5%, and 63.0% in prophylactic usage.
In the treatment of the documented infection, LFLX was effective in 20 patients; the efficacy rate was 50.0%. In the prophylactic administration, LFLX was effective in 9 patients, yielded the efficacy rate of 81.8%. LFLX was effective for all 5 patients with urinary tract infection, in 10 out of 18 patients with respiratory tract infection (efficacy rate; 55.6%), in 5 out of 12 patients with fever from undetermined origin (41.7%), showed no effect for cholecystitis, colitis, and phlegmon. Bacteriological examinations revealed that all of the bacteria detected as pathogens were eradicated. The efficacy rate in the group of the malignant disorders such as leukemia/ lymphoma was smaller than that of non-tumorigenic diseases as aplastic anenia.
As myelodysplastic syndrome (MDS), four infection-bearing patients and five patients with prophylactic usage were analyzed. The efficacy rate of LFLX was 50.0 and 80.0%, respectively, and the overall efficacy rate was 66.7%. All MDS patients without prophylactic administration failed to have infections. Thus, LFLX was thought to be useful in the prevention of successding infections after the chemotherapy. No clinical and laboratory adverse reactions were reported.

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We conducted a field trial to evaluate the efficacy of nasal influenza vaccine combined with Escherichia coli heat-labile enterotoxin B subunit (LTB) containing a trace amount of the holotoxin (LT) in preventing or attenuating influenza among volunteers during the winter season of 1994-1995. A trivalent inactivated influenza vaccine, composed of A/Yamagata/32/89 (H1N1), A/Kitakyusyu/159/93 (H2N2) and B/Mie/1/93 influenza virus strains, was administered intranasally together with recombinant LTB containing 1% recombinant LT (LTB*). Vaccination was done twice 4 weeks apart. Salivary secretory IgA and serum HI antibodies were measured before and 8 weeks after the primary vaccination.
Thirty-two volunteers were enrolled in this study; 18 volunteers (mean age 37.7 ± 11.3) were given LTB*-combined vaccine and 14 volunteers (mean age 44.1 ± 11.3) given placebo.
Outbreaks of H3N2 subtype and B type virus were observed during this study period. Six (42.9%) of the 14 volunteers in the placebo group and 3 (16.7%) of the 18 receiving the LTB*-combined vaccine contracted influenza. There was no statistically significant difference between the two groups, because the number of subjects was small.
Higher percentage of positive IgA and HI antibody responses among vacciness given vaccine with LTB* were observed as compared with those in the placebo group. Positive IgA antibody response to all vaccine strains were observed in 46.7%(7/15) of the vaccine group. On the other hand, none of the placebo group showed positive IgA antibody response to all vaccine strains. These results suggest that nasal influenza vaccine with LTB* appears to be effective in preventing influenza.

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Attempts to isolate Verotoxin-producing Escherichia coli (VTEC) from 53 dead baby cattle were made during a period from January 1989 to July 1991.
From 6 cattle of 5 farms, VTECs were isolated. Further examination of cattle from 2 farms with dead baby cattle and from 1 farm with an outbreak of diarrhea among baby cattle, from 8 of 26 cattle with diarrhea and from 9 of 58 healthy cattle, VTECs were isolated. Several serotypes which caused food poisoning in Japan as well as in the US and Europe were included in the isolated strains. VTECs were also isolated from several cattle imported from the US suggesting that these VTECs were from outside the country together with the imported cattle.

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A 57-year-old male was admitted to our hospital because of high fever, productive cough and dyspnea. Six days prior to admission he had an episode of drowning in a public bath. On admission chest X-ray showed wide-spread pneumonia causing severe respiratory distress for which mechanical ventilatory support was started. Despite chemotherapy including erythromycin and rifampicin his condition continued to deteriorate. Chemistry showed marked elevation of CPK and findings of acute renal failure. He eventually passed away with septic shock. During the course Legionellae remained negative with culture of broncho-alveolar lavage fluid. L. pneumophila serogroup 1 (SG1) antigen in the urine was not detected, and no elevation of serum antibody titer was noted. Culture of the material obtained from the lung abscess at autopsy revealed L. pneumophila SG6 and serum antibody titer against SG6 also was found to be extre mely high. With this evidence we concluded that this case of pneumonia was caused by L. pneumophila SG6. We believe this is the first reported case of the SG6 pneumonia in Japan.
Another remarkable feature of this case was massive rhabdomyolysis pathol ogically confirmed after autopsy. Although the pathogenesis of this process has not been clarified, there are several case reports of rhabdomyolysis complicated with Legionnair's disease in the past. Therefore, we should bear in mind and pay careful attention while coping with this disease.

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Psoas abscess is relatively rare and often difficult to make early diagnosis. We treated a patient suffering from hepatocellular carcinoma due to hepatitis C virus infection who was admitted to our hospital complaining of right inguinodynia and a high fever. Positive CRP test were seen. Staphylococcus aureus was detected from blood culture and he was treated for sepsis with antibiotic therapy. After starting treatment, his inguinodynia continued and abscesses were demonstrated in the right psoas muscle by pelvic computed tomography (CT). The abscesses were drained and a specimen yielded S. aureus on culture. After drainage, the symptoms improved and the abscesses disappeared on pelvic CT. Pelvic CT can be successfully used to diagnose psoas abscess and to monitor the efficiency of the treatment.

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