An epidemiological investigation for Methicillin-resistant Staphylococus aureus (MRSA) was performed at 21 medical institutes in Kinki area by the questionnaire from Kinki Infection Working Group in 1995.
The most frequent specimen for MRSA was pus (25.3%) from out-patients and sputum (34.4%) from in-patients, respectively. As compared to the investigation of the MRSA Forum in 1992 and 1993, MRSA increased over 20%, and furthermore 57.8% was MRSA out of S. aureus under this study. It demonstrated that drug-resistance was accelerated for a few years. Polymicrobial infection, especially with more than 3 pathogens, increased significantly compared with the results of the MRSA Forum (p < 0.01). It was suggested that compromized host increased and therapy turned to be more difficult. Simultaneous pathogens detected with MRSA were Candida species, Pseudomonas aeruginosa and Enterococcus faecalis.
In terms of chemosusceptibility, VCM (99.9%), ST (99.4%) and ABK (99.3%) were still determined to be higlhy sensitivity against MRSA.

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An epidemiological investigation for penicillin-resistant Streptococcus pneumonia (PRSP) was performed at 18 medical institutes in Kinki area by the questionnaire from Kinki Infection Working Group 1995. This investigation was the first report that was performed for a long term (one year) and a large area.
The most frequent specimen was sputum from out-patients (50.3%) and inpatients (48.8%), and especially from spinal fluid of 3 cases were detected. Polymicrobial infection with more than 3 pathogens was 15.7%, and it was more frequent than MRSA previously investigated. Simultaneous pathogens detected with PRSP were Candida species, Haemophilus influenzae and Staphylococcus aureus.
In terms of chemosusceptibility, VCM (100%), FMOX (97.9%), IPM/CS (85.9%), CEZ (93.4%) and CDTR-PI were determined to be high by sensitive. However, the sensitivity of CCL, which was one of the most common antibiotics, was only 37.7%.

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Adenovirus type 7 (Ad7) was rarely isolated in Japan till 1994, but during April 1995 to August 1996, isolations of Ad7 were reported 230 cases. We isolated Ad7 in January and July 1996 in Fukuoka prefecture. We analyzed its genome type by using 14 restriction endonuclease and studied seroepidemiology of Ad7 infection in Fukuoka prefecture.
Isolated Ad7 strains were identical by 14 restriction endonuclease. Between new Ad7 isolates and prototype (Gomen; Ad7p), 4 restriction endonuclease patterns were identical but 10 restriction endonuclease patterns were different. From the result of restriction endonuclease pattern analysis, genome type of Ad7 isolated in Fukuoka may be the same to Ad7c reported by Noda et al.(1996). The alterations in the cleavage sites of 10 restriction endonucleases between new Ad7 isolates and Ad7p were revealed at least 12 sites.
Ad7 antibody positive rates in serum specimens collected in Fukuoka Prefecture were 3.6% in 1994 and 9.7% in 1996.

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We evaluated the relation with nutritional state and methicillin-resistant Staphylococcus aureus(MRSA) infection of 20 patients who isolated Candida of 31 patients who were suspected as candidiasis. All of the patients who were hospitalized in internal medicine wards in our hospital between February 1993 and January 1994. All patients with hematological disease were excluded. MRSA is now gotten much attention as pathogen of hospital infection, but each MRSA is detected not only alone but also concomitant with other bacterium. In our hospital MRSA was detected alone 36.8%(39/106), Candida 9.4%(10/106) was frequent as mixed infectious pathogen concomitant with MRSA following Pseudomonas aeruginosa 19.8%(21/106) and Enterococcus faecalis 12.3%(13/106).
Intension of host-immunity is a important factor as prevention of both infection. We evaluated the nutritional state of patients with 7 cases of infection group and 13 cases of colonization group. There was no significance between two groups as for serum total protein (mean) were 5.97 g/dl in infection group and 5.96% g/dl in colonization group. Furthermore there were significance (p<0.01) for mean serum albumin (mean) were 3.11 g/dl v.s. 3.27 g/dl.
But both serum total protein and serum albumin of these evaluated patients who isolated Candida were less than normal limit. Therefore we considered nutritional disturbance was important addition to over-use of antibiotics and severe underlying diseases as risk factor of candidiasis, and revealed the importance of improvement of nutritional state at the prevention and therapy.

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Trypanosoma cruzi is the causative parasite of Chagas' disease, while the closely related T. rangeli is non-pathogenic in humans. Restriction fragment length polymorphisms (RFLPs) of a portion of the cysteine proteinase gene were used to distinguish T. cruzi from T. rangeli. This procedure was very sensitive, with a single cell of either species being sufficient for the PCR. The sensitivity and clear ability to distinguish between T. cruzi and T. rangeli suggest that this procedure may be easily applied in the field.

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In murine infections due to Mycobacterium avium complex (MAC), bacterial regrowth of the pathogens is frequently encountered in the relatively late phase of infection even in mice receiving daily treatments with antimicrobial agents including rifamycins and macrolides. In this case, the bacterial regrowth is usually accompanied by concomitant increase in the tissue levels of IL-10 and transforming growth factor-β(TGF-β), well known immunosuppressive cytokines. In this context, it is of interest to note recent findings that steroidal anti-inflammatory drugs up-regulate TGF-β production from T lymphocytes, thereby suggesting participation of immunosuppressive cytokines in the expression of their anti-inflammatory activity. In this study, we examined the effects of various anti-inflammatory drugs including glucocorticoids and nonsteroidal anti-inflammatory drugs (NSAID) on in-vitro IL-10 production of murine peritoneal macrophages (Mφs) infected with MAC organisms. When the IL-10 production by MAC-infected Mφs was measured in terms of protein and mRNA expression of the cytokine using ELISA and RT-PCR assays. the following results were obtained. First, the IL-10 production into Mφ culture fluids was temporarily increased around days 1 to 3, thereafter gradually declined, and returned to normal by day 14. Secondly, IL-10 mRNA expression of Mφs was rapidly induced after MAC-infection and the maximum level of the mRNA expression was achieved at 2 hr. Thereafter, IL-10 mRNA expression ceased rapidly and returned to normal by 24hr. Thirdly, the majority of test anti-inflammatory drugs, not only glucocorticoids but also NSAID, were found to up-regulate the IL-10 production of MAC-infected Mφs, suggesting some possible roles of IL-10 in the expression of the anti-inflammatory activities of these agents.

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We analyzed the clade distribution of B and E in HIV-1 isolates in Japan by a nested PCR method using 5'-CCCACAAGATTTAAATATG-3' of the gag gene as clade B primer and 5'-CCCACAAGATTTAAACTCC-3' of the gag gene as clade E primer. Seventy-two anti-HIV-1 confirmatory positive serum samples were collected during a period of 1991-1996 in two hospitals in Yokohama City. Peripheral blood mononuclear cells were obtained from the buffy coat of these samples and extracted DNA were used for nested PCR. The 72 cases comprised of 11 Japanese hemophiliacs, 14 Japanese male homosexuals, 19 Japanse male heterosexuals, 5 Japanese female heterosexuals and 23 Thai female heterosexuals. Of these 36 were clade B and 35 were clade E and one case showed positive PCR results for both B and E primers.
Almost all male Japanese hemophiliacs and homosexuals in our sample have clade B, while the female Thai heterosexuals have clade E, irrespective of the year of isolation. As for Japanese male heterosexuals, through 1993, clade B was predominant but since 1994, the predominate clade switched to clade E. Although the number of Japanse female heterosexuals in our sample is small, clade B was isolated in 2 cases even after 1994.

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We evaluated the usefulness of bacterial agglutination antibodies for serodiagnosis of verotoxin-producing Escherichia coli (enterohemorrhagic E. coli) O157 infections. We examined 50 serum samples from 50 control children (whiout diarrhea 31, with diarrhea 19), 24 samples from 8 diarrhea cases due to O157: H7, 37 samples from 14 cases of hemolytic uremic syndrome (HUS) for antibodies to heat-killed E. coli E32511 (O157: H-) strain using the bacterial agglutination technique. Of the control sera all but one (×80) showed 20≥ in the antibody. All the diarrhea patients due to O157: H7 showed a significant rise (×160-×5120) of the titers in the sera at 5-7 days on illness, after that the titers fell rapidly. Significant antibody rise (×160-×5120) was detected in twelve out of 14 HUS patients at the early stage of the illness which fell in the convalescent phase. The assay appeared to be a useful serodiagnostic technique because of its easiness and simplicity as well as because of its high sensitivity and specificity.

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Strains of Vibrio cholerae O140, which were isolated from river (Hikichi River) water in Kanagawa, Japan, were studied for their biochemical characteristics and toxin genes, and analyzed by an amplified polymorphic DNA method in comparison with both clinical and environmental isolates of V. cholerae O140.
Biochemical characteristics of 4 river isolates studied were found to be unanimous by conventional tests and a commercially available identification kit (Api 50 CH). The strains were also found to react positively with both cholera Inaba factor (C) and V. cholerae 0140 specific factor (F).
A total of 34 V. cholerae O140 strains including the 4 stains, a reference strains (487-95), 25 strains isolated from samples of river or sea water in Japan, 4 strains isolated from a patient and imported foods, was investigated by the PCR method for presence of ctx, zot, hlyA, and NAG-ST genes. It was found that all strains carried the hlyA gene but none of them carried either ctx, zot, or NAG-ST genes. V. cholerae O140 shared a common antigenic structure with pathogenic V. cholerae strains but its pathogenicity seems to be comparable to that of V. cholerae non-O1 non-O139.
Subsequent RAPD analysis indicated that the strains can be divided into 9 groups. Four strains from the Hikichi River showed the same RAPD pattern. The results suggest that the analysis can be a useful epidemiological tool for V. cholerae O140, and that V. cholerae O140 persists in the Hikichi River throughout years.

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We reported a case of a 3-year-old girl with hemolytic uremic syndrome (HUS), which showed hemolytic anemia (Hemogulobin 8.2 g/dl, lactate dehydrogenase 1277 IU/1 and total bilirubin 0.6 mg/dl), small purpura on the skin (platelet 7.3×10⁴/μ1) and slightly decreased output of urine (creatinin 0.4 mg/dl and blood urea nitrogen 27.2 mg/dl). Verotoxin producing Escherichia coli (E. coli) O157 was not isolated, but Salmonella agona and E. coli O125, which is one of the enteropthogenic E. coli, were detected from her stool culture. However, the IgM antibody against verotoxin producing E. coli (VTEC) 0157 lipopolysaccharide was detected in both serum of the acute and convalescent phase by immunoblot assay. In addition verotoxin DNA was demonstrated in the stool by PCR method.
Therefore, we think this HUS might be due to VTEC 0157, which must have been co-infected with Salmonella agona and E. coli O125. There have been four cases including the present case of co-infection with VTEC 0157 so far, and the other three cases were of the Salmonella species. Although the reason of co-infection was unknown, we may infer that food might be contaminated with some pathogens including Salmonella species or that these patients might be already infected with Salmonella species prior to VTEC infection. Even when some other pathogens were detected by a stool culture from a patient with HUS, we should pay attention to demonstrate associated of VTEC and HUS by the specific antibodies and PCR for verotoxin DNA.

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A 67-year-old male was admitted to our hospital because of lung cancer and interstitial pneumonia. Cisplatin, vindesie and mitomycin C were administered for treatment of lung cancer. The leucocyte-counts declined to 1700/μl on the eighth day after the chemotherapy. Though granulocyte colony-stimulating factor was administered, pain in the right thigh and high grade fever developed. Because Staphylococcus aureus was isolated from the blood specimen, piperacillin was administered. But the high grade fever continued and the pain was expanded to the right hip, left hip, thigh and leg. Because a computed tomograph of the lower limbs showed low density areas in bilateral gluteus maximus muscle right adductor magnus muscle, left biceps femoris muscle and left soleus muscle and the culture of an aspirate from abscess of right leg detected S. aureus, multiple muscular abscesses of the lower limbs was confirmed. We changed the antibiotics from PIPC to imipenem/cilastatin and minocycline on nineteenth day after the chemotherapy. His symptoms improved after the change of antibacterial agents. But he died of acute exacerbation of interstitial pneumonia, after about two months of the chemotherapy. Muscular abscesses of the limbs are very rare in Japan. Only four cases with muscular abscess of the limbs were reported in Japan, since 1988. This case suggests that a muscular abscess must be considered in the differential diagnosis of fever in patients with neutropenia.

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We report a case of progressive dementia and prolonged gait disturbance correlated with influenza A/H3N2 infection in 91-year-old female patient, admitted because of in ability to take care of herself due to aging and cerebral infarction. At admission, conversation and comprehension were not significantly impaired, and she was able to walk by herself. Flu symptoms such as high grade fever, chills, arthralgia, and cough appeared after a short stay at home. Influenza A/H3N2 was confirmed serologically. Delirium occurred on the sixth day after influenza onset, persisted for three weeks, followed by recovery. Dementia symptoms such as memory defects and disorientation continued and did not improve. Due to this febrile episode, she was unable to walk unassisted. The results of computed tomography performed before and after the influenza episode were unremarkable for additional cellebro-vascular events during the observed period. Influenza infection may be an important risk factor for reducing the quality of life in the elderly. In geriatric cases, influenza should not be treated as a mere transient illness, but rather one which has important consequences for the elderly population, including the possibility of life threatening complications.

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A previously healthy 28 year old Japanese man came to us with a genital ulcer which appeared 13 days before admission to our hospital. He had subsequently fever (40°C), arthralgia, sore throat and oral aphtha 6 days before admission. He had a history of sexual contact with female commercial sex worker one week before his illness.
On the day of admission, he had shallow ulcers on the lip, tongue and penis. Initial laboratory test included leukopenia and thrombocytopenia. His fever abated 3 days after admission. His condition and bicytopenia recovered completely after 12 days of admission. Although, his serum HIV-1 antibody was negative when he was admitted, 3 months later the antibody was seroconverted. And p24 antigen and HIV-1 RNA of stocked serum were positive. Diagnosis of primary HIV-1 infection was made. Recently, HIV-1 infection has been increasing in Japan. Consideration ofthis disease in differential diagnosis of acute febrile illness is necessary.

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