To investigate the significance of oropharyngeal flora and gastric flora in elderly patients receiving nasogastric tube feeding, throat secretions and gastric aspirates were cultured and the pH of the latter was measured. Of 116 bacterial isolates from throat secretions of 27 elderly patients, 30 were βstreptococci and 28 were Pseudomonas aeruginosa. Bacteria isolated from gastric aspirates numbered 86 and 24 (27.9%) of them were the same species as those found in the throat secretions. Patients with gastric pH were below 3.5 had significantly lower concentrations of gram-negative bacilli in gastric aspirates.
We also studied oropharyngeal flora in 33 elderly patients who were admitted to NagoyashiKoseiin Geriatric Hospital. The major bacterial isolates from throat swabs of bedridden patients were gram-negative bacilli and βstreptococci, especially group B streptococci (GBS). We measured the level of antibody to GBS in these patients. Those from whom GBS were isolated had high titers.
These results suggest that in elderly patients receiving enteral (nasogastric) tube feeding, large numbers of bacteria colonize the oral cavity and stomach. The measurement of typespecific antibody to GBS may be useful in managing such patients.

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To investigate correlations between the interval between blood transfusion and the start of IFN therapy, and IFN efficacy, we studied chronic hepatitis C patients with a history of blood transfusion.
The subjects were 122 patients with chronic hepatitis C and a history of blood transfusion at 64 institutions. The patients were treated with high or low-dose IFN. High-dose therapy consisted of intramuscular injection of human lymphoblastoid interferon (HLBI), 6×10⁶ IU daily for 2 weeks, 3 times a week for 22 weeks, and low-dose interferon therapy of intramuscular injection of HLBI, 6×10⁶ IU daily for 2 weeks, then 3×10⁶ IU 3 times a week for 22 weeks. Normal serum levels for 6 months or more after completing IFN (complete response) were found in 44/122 (36.2%) patients and HCV RNA was no longer detectable after completing IFN therapy in 19/68 (27.9%). Patients in whom the interval between blood transfusion and the start of IFN therapy was than 20 years had significantly higher rates of HCV RNA-negative complete response than those whom the interval was 20 years or more (p<0.039).
When chronic HCV infection is caused by blood transfusion, the efficacy of IFN depends on the duration of chronic HCV infection. Since the duration of HCV infection is a factor in predicting efficacy, early IFN therapy may be more effective.

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Two Shigella strains (93-119 and 95-619) isolated from stool cultures of imported diarrheal cases in Japan, did not react to any antisera of the established Shigella serovars.
These strains had the typical biochemical characteristics of Shigella dysenteriae, and were biochemically identical to each other. Both strains were positive in the Sereny test and other tests for invasiveness; these indicate that they can cause shigellosis in humans.
The results of antigenic analyses showed that they did not belong to any of the recognized or provisional serovars, and were serologically indistinguishable.
Strain 93-119 is designated as the test strain for this new serovar.

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A total of 1, 319 strains of Vibrio parahaemolyticus isolated from traveller's diarrhea were analysed for Kanagawa phenomenon (KP) with the Wagatsuma blood agar test and the results were also compared with those of analyses of tdh and trh genes which encode thermostable direct hemolysin (tdh) and TDH-related hemolysin (trh). The majority of the strains (1, 152 strains) counting 87.3% had positive KP, among which 1, 049 and 103 strains were only tdh and both tdh and trh-positive ones, respectively. However, 167 strains counting 12.7%, which is quite high compared to the previous report, were found to have negative KP, among which 94 and 24 strains were only trh and both tdh and trh-positive ones, respectively.

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Eleven hundreds and seventy-six strains of Streptococcus pneumoniae were isolated from pediatric clinics of Chiba Children's Hospital during 1990 through 1995. Annual penicillinresistant rates of these strains were as follows; 24.0%(1990), 29.0%(1991), 36.2%(1992), 55.8%(1993), 58.6%(1994), and 59.3%(1995). Overall penicillin-resistance during these 6 years was 45.8%. Nine out of 11 cases of systemic pneumococcal infections were due to penicillin-resistant S. pneumoniae (PRSP) during the same period. Of PRSP strains, their PCG-MIC levels had become higher and their spectra of resistance had expanded not only to β-lactam but also to non-β-lactam antimicrobials. Although panipenem was the most efficacious antibiotics in this study and was recommended currently to use in the case of pneumococcal meningitis, it should be noted that a strain with high-level MIC (2μg/ml) had emerged in 1995. Close surveillance of pneumococcal antimicrobial susceptibility including panipenem is necessary.

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In the present study, we assessed the serum level of IL-6 and TNF-α by ELISA in patients with chronic lower respiratory tract infection.
The serum levels of IL-6 and TNF-α of patients in acute exacerbation phase are higher than that of in stable phase.
We also classified patients in acute exacerbation phase into two groups according to the microrganism of persistant infection. The serum level of IL-6 and TNF-α in the patients with persistant infection with Pseudomonas aeruginosa were higher than that with Haemophilusinfluenzae.
Moreover, the serum level of IL-6 and TNF-α were found to be related with malnutrition which assessed by clinical indices such as the serum level of albumin and cholinesterase.
The present result suggests that IL-6 and TNF-αmay have relationship with not only inflammation in airway but also indices of nutrition in patients with chronic lower respiratory tract infection.

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Effects of low concentration of clarithromycin (CAM) on the production of Verotoxin (VT) by Escherichia coli O157 was investigated in vitro. The production of VT1 was suppressed up to 10 hours when bacteria was incubated with 0.64μg/ml (equivalent to the 1/100th of MIC) or higher concentrations. However, the production of VT1 reached to the control level after 22 hours even with 6.4μg/ml of CAM. On the other hand, production of VT2 by 22 hours was partially suppressed with 0.64μg/ml of CAM and completely with 6.4μg/ml of CAM. When the eight clinical isolates were incubated with 0.64 or 6.4μg/ml of CAM, VT1 and VT2 were suppressed in two and eight strains, respectively. In these strains, similar but less effiicinet suppression of the toxin production was also observed with erythromycin. In contrast to the macrorides, ampicilin did not inhibit or rather stimulated the production of VT1 and VT2 in some strains.

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Bacteriostatic and bactericidal activities of vingar products against food-borne pathogenic bacteria including enterohemorrhagic Escherichia coli(EHEC) O157: H7, and other bacteria were examined.
By the presence of spirit vinegar at 0.1% acidity, the growth of 34 strains of bacteria was completely inhibited. Grain and rice vinegars also inhibited the growth of bacteria at the same acidity. These results suggest that vinegars have strong bacteriostatic activity.
Bactericidal activity of vinegar products was measured. The order of their activities against E. coli O157: H7 strains was spirit vinegar >grain vinegar >rice vinegar.
Susceptibility of 7 EHEC strains (6 E. coli O157117 isolated from 3 outbreaks and 1 E. coli O26: H11 from a sporadic case) to spirit vinegar was similar to each other, and much lower than that of an enteropathogenic E. coli 0111: K58: H^- strain. It indicates that these EHEC strains are rather acid-tolerant. The bactericidal activities of vinegars were independent of bacterial inoculum sizes, but were dependent of growth phase. Bacteria of logarithmic growth phase were more sensitive than those of stationary phase. Bactericidal activity of spirit vinegar profoundly depended on the reaction temperature. At higher temperatures, spirt vinegar killed bacteria much more rapidly. In 2.5% acidity vinegar, the times for the log3 reduction of cells were 4, 516 min at 10°C, 739 min at 20°C, 137 min at 30°C, 14.4 min at 40°C, and 0.84 min at 50°C, respectively. These results suggest that treatment with vinegar solution at handy temperatures ranged 40-50°C may be one of the useful methods to prevent bacerial food poisoning.

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Bactericidal effects of various kinds of AWASEZU (processed vinegar, 2.5% acidity) on food-borne pathogenic bacteria including Escherichia coli O157: H7 and other bacteria were examined. The order of bactericidal activities was NIHAIZU (3.5% N_aC1 was added)> SANBAIZU (3.5% NaCl and 10% sucrose were added)>plain vinegar (spirit vinegar)>AMAZU (10% sucrose was added). This indicates that their activities were enhanced by the addition of sodium chloride and suppressed by the addition of sugar. On the other hand, when soy sauce was used instead of sodium chloride, the order of bactericidal activities was plain vinegar > AMAZU> NIHAIZU> SANBAIZU. This is mainly because their activities were suppressed by the increase in the pH value.
The effect of sodium chloride (0.01-15%) and temperature (10-50°C) on bactericidal activities against E. coli O157: H7 in spirit vinegar (0.5-2.5% acidity) was further examined. When vinegar was used in combination with sodium chloride, predominant synergism on the bactericidal activity was observed. Their activities were markedly enhanced by the addition of sodium chloride in proportion to the concentration. In addition to this, at higher temperatures spirit vinegar killed bacteria much more rapidly. It should be noted that the bactericidal activity of spirit vinegar was extremely enhanced by the combined use of the addition of sodium chloride and the rise of temperature. For example, in 2.5% acidity vinegar, the time required for 3 log decrease in viable cell numbers at 20°C was shortened to 1/140-fold by the addition of 5% sodium chloride, shortened to 1/51-fold by the rise of the reaction temperature at 40°C, and shortened to 1/830-fold; 0.89 minutes by both the addition of 5% sodium chloride and the rise of temperature at 40°C.
In order to propose the methods to prevent food poisoning by bacterial infection, bactericidal activities of vinegar solution containing sodium chloride on cooking tools and raw vegatables were examined. Vinegar solution (1-2% acidity, 3-7% NaCl) produced more than 3 log decrease in viable cell numbers of E. coli O157: H7 on the surface of cutting board, and cabbage and cucumber at 20-50°C. These results suggested that the treatment with vinergar solution containing sodium chloride may be one of the useful methods to prevent food poisoning.

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A 54-aged woman consulted with right buccal phlegmon caused by lower apical periodontitis. The primary chemotherapy using flomoxef induced allergic skin eruption.
A decision was made for using clindamycin, levofloxacin and fosfomycin as chemotherapic agents. Cultured organismus from the abscess revealed the mixed infection with Streptococcus sanguis, Veillonella sp., Prevotella loescheii, Wolinella spp. On 12th hospital day, her serum CRP turned to negative. This case carried numerous implications for the use of antibiotics as chemotherapy agents.

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Tsutsugamushi disease is widely spread throughout Japan. A case of tsutsugamushi disease was seen in October, 1996. A 64-year-old male developed typical symptons of tsutsugamushi disease with Rickettsia tsutsugamushi, after he returned to Japan from Cheju Island, Korea. Not only in Japan but also in other Asian countries including Korea, China, Taiwan, and Thailand, tsutsugamushi disease is one of the most important rickettsial diseases carried by ticks or mites.
If a traveller returning from an Asian country has symptons such as high fever, skin eruption, and lymphadenitis, we should susupect that he is suffering from tsutsugamushi disease and should search if he has an eschar on any area of his body. We should not forget that tsutsugamushi disease is an imported disease. Patients of tsutsugamushi disease often have hematological disorders. They are sometimes referred to the hematological section of the hospital. Hematologists should be familiar with this disease.

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We encountered a case of a girl where Human Parvovirus B19 infection was considered to have been concerned with the development of systemic type juvenile rheumatoid arthritis (JRA). While the affected child did not show any evident infectious erythema-like findings, changes in the serum antibody titer by the EIA method presented the pattern of first infection. During the clinical course the condition of the disease as JRA was serious and hemophagocytic syndrome developed concurrently. Furthermore, the resistance to the treatment was also noted. So the patient was treated with prednisolone combined with low dose weekly MTX therapy. The possibility of Human parvovirus B19 being concerned with the development of rheumatoid arthritis in one form or another has been suggested in recent years. In the disease type with systemic angititis as main pathophysiology, which is called systemic JRA we encounted this time, it is not clear how Human Parvovirus B19 was concerned with the development of this disease, but it appeared to hold a key position in studying pathophysiology of the development.

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