Between the end of November 1996 and the beginning of March 1997, there was an outbreak of Escherichia coli O26: H11 infection in Asahikawa. The strain produced only verotoxin type 1. The minimal inhibitory concentrations (μg/ml) of the strain under aerobic condition and those of anaerobic were as follows; chloramphenicol (1.56, 0.78), minocycline (12.5, 3.13), kanamycin (3.13, 25), ampicillin (>100, > 100), fosfomycin (12.5, 1.56), norfloxacin (0.1, 0.1), and cefaclor (6.25, 3.13). Forty-one episodes of antibiotic therapy to 32 children, who were treated in Asahikawa Kosei Hospital, Asahikawa Municipal Hospital, and Asahikawa Red Cross Hospital, were evaluated bacteriologically. In 26 episodes treated with fosfomycin, the pathogen from stools of 19 were eradicated, 4 were not eradicated, and 3 were isolated again within 2 weeks after the cessation of therapy. Eight episodes treated with norfloxacin and 5 episodes in kanamycin were all eradicated.
In East Asian countries, the prevalence of viral hepatitis has been reported to be high, but precise data for each country remained to be investigated. Here we report the prevalence of viral markers of hepatitis B and hepatitis C in outpatient volunteers visiting two general hospitals in Ulaanbaatar, Mongolia. One hundred fifty sera were tested for HBs antigen (HBsAg), anti-HBs, and anti-HCV by Counting Immunoassay. The backgrounds of groups of patients positive for HBsAg and negative for anti-HCV (group 1; n=18), negative for HBsAg and positive for anti-HCV (group 2: n=47), positive for both HBsAg and anti-HCV (group 3; n=25), and negative for both HBsAg and anti-HCV (group 4; n=60) were compared. The prevalence of HBsAg, anti-HBs, and anti-HCV in this study group was 28.7%, 39.3% and 48.0%, respectively. Sugjects of group 1 (mean±SD; 31.3±12.4 years old) were younger than those of group 4 (39.2±14.3; p <0.05), while patients of group 2 (48.7±15.5) were older than those of group 4 (p < 0.01). More group 2 subjects had histories of jaundice (23/47) than those of group 4 (15/60; p <0.05). Transaminase levels were higher in group 1 (median range) IU/ 1 of AST, ALT; 29 (13-95), 32 (9-144) and group 3 (25 (15-187), 22 (8-185)) than in group 4 (18 (9-13), 15 (6-133); p <0.05, p <0.005 vs. group 1, and p <0.005, p <0.001 vs. group 3, respec ively). In HBsAg-negative subjects, those with higher titers of anti-HCV (cut-off index > 15) were older, and had more histories of jaundice and higher levels of AST and ALT than anti-HCV negative subjects (50.3±14.8 vs. 39.1±14.3, p<0.01; 15/28 vs. 15/60, p<0.01; 22.5 (12-127) vs. 18 (9-93), p<0.05; 20.5 (7-362) vs. 15 (6-133), p <0.05; respectively). In conclusion, this preliminary surveillance for hepatitis B and C viral markers showed that both hepatitis viruses are prevalent and may cause liver diseases in Mongolia. A nation-wide survery for these viruses should be urged and preventive measures should be taken to suppress the spread and development of liver diseases in this country.
A latex agglutination test (LA) for astrovirus types 1-4 detection and typing was used on rotavirus-and adenovirus-negative stool samples from children with diarrhea between 1991 and 1996. Of the 478 samples tested, 30 were identified as astrovirus-positive. Most of the patients with astrovirus infections were under 2 years old. Astrovirus type 1 was the most prevalent serotype; 20/30 (66.7%), followed by type 4 (16.7%), type 3 (13.3%), and type 2 (3.3%). A prevalence of astrovirus-associated diarrhea was observed between January and June each year
In our laboratory, children born to women are known to be infected with Human T-cell Leukemia Virus type-1 (HTLV-I) have been followed using, detect of gean by PCR and antibodyWestern Blot Assay (WB) and Immunofluorescence Assay (IFA) test from 1990 through 1996. Four children out of 123 delivery cases have been confirmed to be infected with HTLV-I. We analyzed the corelation between the concentration of cytokines (IL-2, sIL-2R, IFN-γ) and HTLV-I infection. IL-2 and sIL-2R in sera increased after HTLV-I infection. There was nocorelation between the concentration of IFN-γ and HTLV-I infection. These result suggested that detection of IL-2 and sIL-2R might be the marker of HTLV-I infection.
We studied the clinical aspects of 25 patients (17 male, 8 female, median age 79.4 y.o.) whom MRSA was colonized in sputum from 1989 January to 1994 December. Main underlying diseases were 16 chronic bronchitis and 15 Cerebrovascular damage. Nineteen cases (76%) had catheters, for example 15 urinary tract catheters and 8 nasogastric tube. Twenty-two cases (88%) usedprevious antimicrobial agent. Fifteen cases (60%) were dead during previous period, and that 14 cases were dead because of respiratory failure within a year after MRSA was colonized insputum. Nine cases (36%) were able to remove MRSA in sputum, but mortality rate was not different whether MRSA disappear or continue. MIC50 against MRSA (19 strains) were minocycline 12.5μg/ml, arbekacin 6.25μg/ml, vancomycin 0.78, μg/ml and 16 cases (84.2%) were coagulase type II.
Forty four isolated strains of Coxsackievirus group A were tested for antigenic variation with antiserum against each prototype strain by neutralization test. Isolates of type 2, type 4, type 5, type 8 and type 10 of Coxsackievirus group A, were not confirmed antigenic variation by neutralization test with immunsera to the prototype virus strain. However, 57.1% of type 9 isolates of Coxsackievirus A group were confirmed as variants. In isolates of Coxsackievirus group A type 16, the isolate in 1982 was neuralized with antiserum against the prototype strain, ' but the isolates after 1984 were neutralized to low titer not at all by immue sera to the prototype virus strain. Therefore, the isolated strains were tested with immunesera against the isolated strain in 1988. So that, the isolated strains in 1982 after 1984, were neutralized with the serum against the isolate in 1988, and moreover, the neutralizing titer of prototype strain was a third of the isolate. So that, for identification of type of Coxsackievirus group A, it is necessary to use the immuneserum against recently isolated strains.
One hundred forty seven sera of children in Gifu Prefecture, were tested for positive rate of neutralization antibody against Coxsackievirus group A (Cox. A). The results were as follows; 1. The positive rate of antibodies against Cox. A 4, Cox. A 10 and Cox. A 16 were detected in over 45%, but the positive rate of antibody against Cox. A 2 thought isolated rarely, was detected in the same rate. However, both the rate of isolation and positive rate of antibody against Cox. A 8 showed lower levels than other types. 2. The positive rate of antibodies against Coxsackievirus group A were different in every areas in the prefecture. In Seino area, the positive rate of antibodies of Cox. A 2, Cox. A 8 and Cox. A 10 were higher than in other areaes. In Gifu area, the positive rate of antibodies against Cox. A 4 and Cox. A 16 were highest but the positive rate of antibody against Cox. A 8 was the lowest than other areaes. In Hida (G) area, the positive rate of antibodies against Cox. A 2 and Cox. A 16 were the lowest levels than other areaes. In Hide (T) area, the positive rate of antibodies against Cox. A 4 and Cox. A 10 of these viruses, were the lowest than other areaes. 3. The positive rate of antibodies by age group, was showed the same pattern in Cox. A 2, Cox. A 4 and Cox. A10, that is, there was a raise with age and reached to 80-90%. In Cox. A 8, the positive rate of antibody rose with age, but the highest positive rate of antibody reached only 35.5%. In Cox. A 16, the positive rate in 0-1 year olds showed a higher positive rate in 44%, which rose with age, but the rate dropped once at 6-7 age and again rose and reached to 86.7% in the 8-9 age group.
To introduce rapid detection of E. coli O157 in the stool without culturing, nine different commercial kits for detection of E. coli O157 were compared. VIP, Reveal, Path Stik, Quix, Now EH and EZ coli were found to detect E. coli O157 greater than 106 CFU/ml. TECRA and Novapath could detect more than 105 CFU/ml. VIDAS reacted positive with more than 104CFU/ml. TECRA, Novapath, Quix could detect 1: 4, 1: 4, 1: 9 dilution of stool specimen spiked with E. coli O157 respectively, but others could not detect with 1: 9 dilution of stool specimen. When stool specimens spiked with E. coli O157 were diluted ten times, centrifuged slightly and supernatants were tested, Path Stik, Quix and EZ coli could detect 107 CFU/ml. TECRA and Novapath could detect 106 CFU/ml, whereas VIDAS could detect 105 CFU/ml Quix is therefore one of the most suitable kit for detection of E. coli O157 in the stool at the bedside, although some non-specific reactions were observed. Path Stik is also convenient kit at bedside. VIDAS, although it requires special equipment, is the most sensitive kit for detection E. coli O157 and is suitable for detection of low levels of E. coli O157 in the clinical laboratory.
Chlamydia trachomatis is one of the important pathogens of STD in our country. Therefore, rapid accurate, reliable and convenient tests for its detection are required. So far, IDEIATM Chlamydia has been employed as a useful diagnostic kit. Now, IDEIATM PCE Chlamydia, applied as a dual amplification EIA method, has been developed. In our present studies, the sensitivity, reproducibility, cross reactivity, and reliability of IDEIATM PCE Chlamydia were investigated and compared with those of IDEIATM Chlamydia and LCR Chlamydia. The sensitivity of IDEIATMPCE Chlamydia showed 2.4×102 IFU/ml for C. trachomatis D, 1.2×102 IFU/ml for C. trachomatis E, 3.8×10 IFU/ml for C. trachomatis F, and 1.25×102 IFU/ml for C. trachomatisL2. With regard to reproducibility, more than 2.4×102 IFU/ml of all strains of C.trachomatisand negative samples gave highly reproducible values. Though no cross reactivity was recognized among three strains of Straphylococcus aureus with concentrations of more than 109 IFU/ml, non-heated samples of over 106 CFU/ml showed cross reactivity. In our observations, phosphate, Mg2+, Ca2+, and Fe3+ inhibited the efficacy of both IDEIATM and IDEIATM PCE Chlamydia. Ca2+Per se could be an inhibitor in the case of urine samples analyzed by IDEIATM and IDEIATM PCE Chlamydia. These results indicate that IDEIATM PCE Chlamydia kit for detection of C. trachomatis may be clinically useful because of its improved sensitivity over IDEIATM Chlamydia and its invariable specificity and reliability.
We treated nine patients of mycoplasmal pneumonia with sparfloxacin (SPFX), the clinical efficacy, safty and usefulness of SPFX were evaluated. SPFX was administered orally at doses of 200 or 300 mg once daily, and we performed bronchoalveolar lavage (BAL) examinations in five patients. BAL was performed 5 hours after oral administration of 100 mg in one case, 19 hours after oral administration of 200 mg in four cases. Concentrations of SPFX and alubumin were measured in serum and in BALF (bronchoalveolar lavage fluid). The following results were obtained. 1. Nine patients were evaluated; eight patients judged as Good, one patient as Excellent. 2. The serum and BALF levels of SPFX was 0.79μg/ml, 0.107μg/ml 5 hours after single oral administration of 100 mg in one case and 19 hours after oral administration of 200 mg in four cases, those of levels of SPFX were 0.835±0.274μg/ml and 0.081±0.033μg/ml, respectively. 3. The ratio of SPFX/albumin in BALF was significantly higher than in the serum. From these results, we consider that SPFX is a useful antmicrobial agent for mycoplasmal pneumonia.
To determine the impact of influenza epidemics among geriatric inpatients and to monitor the clinical efficacy of influenza vaccination, the influenza infection rate in non-vaccinated inpatients was determined serologically and the incidence of febrile episodes and death were compared between the vaccinees and non-vaccinees hospitalized in the referred hospital from January through September, 1995. Three influenza subtypes, influenza A/H1N1, A/H3N2, and B, were endemic simultaneously from January to March in 1995. The pattern of incidence of febrile episodes varied for each ward. A total of 123 non-vaccinated inpatients were tested for elevation of serum hemagglutina-tion inhibition titer to the three subtypes of influenza virus. Of these, 58 (47.2%) patients were infected with at least one of the influenza viruses during the epidemic of 1995. No patient with pre-existing HI titer over 128X was infected with any of three types of influenza, indicating that HI titer over 128X is the protective level. The febrile episode frequency was significantly higher in the non-vacciness than in the vaccinees (49.6% vs. 32.6%), but it was quite comparable in the two groups after the influenza epidemic (34.9% vs. 35.8%). The number of observed deaths from January to September of 1995 was 4 (4.9%) in the vaccinee group and 12 (9.8%) in the nonvaccinee group. These results suggest that influenza epidemics have a striking impact on geriatric impatients and that influenza vaccination has significant efficacy for the reduction of harmful events associated with influenza infection.
Ten patients who suffered from acute hepatitis with various clinical forms due to hepatitis B virus (HBV) were studied. HBV variants with a mutation in the precore region were dominant in two patients with fulminant hepatitis and in a patient with the most severe acute hepatitis. However, these mutant viruses were not detected in a patient who had the fulminant form of acute HBV infection on chronic liver damage or in most patients who had severe acute hepatitis. Furthermore, mutant viruses were also not detected in a patient with complicating myopathy and in one who had an atypical clinical course with three transaminase peaks. These results suggest that precore mutants may be involved in the pathogenesis of some cases of severe acute hepatitis, the same as for fulminant hepatitis, but not in other clinical forms of acute hepatitis.
Pathological changes were seen in the lungs of ddY mice one week after repeated intraperitoneal injections of lipopolysaccharide (LPS) of Klebsiella pnemmoniae. The infiltration of polymorphonuclear cells (PMN), mainly neutrophils, and lymphocytes into the alveolar septum, the infiltration of PMN into perivascular areas and microthrombi were recognized in this murine model. The blood levels of TNFα and IL-1αdid not rise at this time, suggesting that the most important cytokine promoting inflammation one week after LPS stimulation was neither TNFα nor IL-1α. In the lungs of mice administered minocycline together with LPS, lymphocyte infiltration of alveoli and perivascular areas as well as microthrombi were suppressed. The blood levels of TNFα, IL-1α, IL-4 and IL-6 were elevated in these groups, suggesting the suppression of pathological changes to be associated with the anti-inflarnmatory effect of IL-6 and/or persistent elevation of TNFα and/or IL-1α levels. In conclusion, subacute pathological changes in the lung were induced by repeated intraperitoneal injections of LPS to mice. These pathological changes were suppressed by minocycline, suggestirlg the anti-inflammatory effects of this antibiotic to be the result of stimulating certain cytokines.