The purpose of our investigation was the detection of S.pneumoniae and the isolation frequency of PRSP/PISP from the patients of the area. 457 strains of S.pneumoniae were isolated from the clinical specimens which had been requested for cultivation from the individual general practitioners in the city.
Screening of the PRSP/PISP in 457 strains was carried out with the oxacillin (MPIPC) disk method. The MIC (benezylpenicillin: PCG) was measured at the same time in 73 strains, and compared with the disk method.
The results were as follows:
1) Regarding the detection rate of S.pneumoniae, nose discharge was the highest (11.4%) in all the specimens.
2) There was a greater number of isolation of S. pneumoniae in one year from November to March. Then it was scarce in August and September. This change in seasons was noted.
3) There were many 9-year olds and over-60 year olds in the age group of the patients in whom the S.pneumoniae was isolated.
4) All 30 strains where a 6mm diameter was found when a MIC was compared with the MPIPC disk method were resistant (PRSP/PISP). All 20 strains with a>20mm diameter were sensitive (PSSP).
But in the 23 strains which had a 7mm-19mm, 7 strains (30%) were PSSP, and 16 strains (70%) in the intermediate (PISP).
5) A diameter of 6 mm was found in 194 strains (42.5%) with the MPIPC disk method, among the 457 strains isolated from the clinical specimens. 141 strains (30.9%) were found with diameter of 7mm-19mm and 122 strains (26.7%) with a diameter of≥20mm.
6) More than 70% in PRSP/PISP were multiple antimicrobiotics resistant strains to PCG, EM and MINO.
7) The distribution of the serotype in PRSP/PISP was in the order of 19 type (41.3%), 23 type (21.7%), 6 type (13.0%). Moreover, it was in the order of 3 type (18.5%), 6 type (11.1%), 19 type (11.1%), and there were few 23 type (3.7%) for PSSP. The distribution of the serotype was different for PRSP/PISP and PSSP.

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Neisseria species other than N. meningitidis and N. gonorrhoeae are generally regarded as commensal bacterial flora of the oropharynx, and little is known regarding cases of these non-pathogenic Neisseria species in the lower respiratory tract. We clinically examined respiratory tract infections from which non-pathogenic Neisseria species were isolated by transtracheal aspiration (TTA).
The incidence of non-pathogenic Neisseria isolated was 54 (15.7%) out of 344 episodes of respiratory tract infections with isolated microorganisms from TTA, and was 17.6%, 15.8%, 14.3% for pneumonia, acute bronchitis, and chronic lower respiratory tract infection, respectively. All 54 episodes were isolated with other microorganisms such as α-Streptococcus spp. (75.9%), Haemophilus influenzae (25.9%) and anaerobics (22.2%). The isolation ratio according to the age group increased at 45 years of age or more, but did not increase with the advance of age. Predisposing factors were identified such as overt aspiration, iatrogenic procedure and heavy smoking. Cases withuot overt aspiration that had fevers of 38°C or more or hypoxemia of less than PaO2 70 torr when detecting non-pathogenic Neisseria were observed more frequently in the aged than the non-aged.
The findings suggest the detection of non-pathogenic Neisseria by TTA is influenced by the host state that the fall of microorganisms from the upper to lower respiratory tract cannot be defended or excluded by mucociliary transportation disorder due to underlying disease and smoking, or deterioration of physical status other than overt or silent aspiration.

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We examined the in vitro bactericidal effects and efficacy on handwashing of water containing electrolytic products of sodium chloride (electrolytic water). The electrolytic water, whose pH and concentration of free residual chlorine were 6.7-6.9 and 20-22 ppm, respectively, showed equal reduction of both Staphylococcus aureus and Escherichia coli to dilution of commercially available sodium hypochlorite containing 60 ppm of free residual chlorine. This bactericidal effect was calculated to be due to hypochlorous acid, based on the pH and the amount of chlorine in solution Handwashing with the electrolytic water reduced the numbers of S. aureus on hands by 1/10², while running water and 0.2% benzalkonium chloride with 80% ethanol gave a 1/10 and 1/10⁵ reduction respectively. We conclude that electrolytic water might be applicable for handwashing in place of running water.

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Bordetella parapertussis can occasionally be isolated in the late period of epidemic pertussis and even from the same patient infected with B. pertussis, thereby closely related to B. pertussis. Compared with B. pertussis, it is more frequently isolated from vaccinated individuals as well. Based on the findings, we carried out an experimental study to establish their interrelationship in mice infected with B. parapertussis alone or with both bacteria.
The total of 4 groups, each of which constituted ten 10-12 day-day-old mice were in this study. Each 10 mice from mothers which were either unimmunized or immunized with filamentous hemagglutinin-predominant pertussis vaccine were infected with either freshly isolated 1.2×10⁴ CFU strain 422 of B. parapertussis alone or mixed with 6×10³ CFU strain 18-323 of B.pertussis and 6×10³ CFU strain 422 of B. parapertussis transnasally. We then compared bacterial colonization 1, 2 and 3 weeks after challenge, using the numbers of bacteria in the lungs and peripheral white blood cell count.
In the B. parapertussis infection group, B. parapertussis could colonize neither the lungs regardless of pertussis antibodies. In the group infected with a mixture of B. pertussis and B. parapertussis, 10⁶ CFU of B. pertussis was primarily found in mice not given the pertussis antibodies, however, 10⁵ CFU of B. parapertussis was found in mice given the pertussis antibodies. These results suggest that B. pertussis helps B. parapertussis to colonize in the presence of the pertussis antibodies, thus explaining above the clinical findings.

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A 69-year-old Japanese man with hepatocellular carcinoma (HCC) associated with triple heptitis viruses [hepatitis B virus (HBV), hepatitis C virus (HCV), and hepatitis D virus (HDV)] infection is reported. The patient had a past history of intravenous drug abuse and a tattoo on his back. A liver biopsy, performed in November 1989, showed HCC associated with cirrhosis. HBsAg and anti-HD antibody had been detected repeatedly starting in August 1984 and anti-HCV antibody was detected in 1990. By indirect immunoperoxidase staining the HD antigen was detected in the nuclei of hepatocytes of biopsy specimens and noncancerous liver cells obtained from autopsy specimens.
Liver cirrhosis associated with triple hepatitis virus infection developed to hepatocellular carcinoma, and transcatheter arterial embolization treatment for HCC was effective. Despite having HCC and cirrhosis, the patient lived well beyond the expected time.

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We have diagnosed lung abscess according to findings of infiltration with cavity formation on chest X-ray and/or CT-scan and pathogens isolated from transtracheal aspirates. We evaluated the clinical features of 20 patients with lung abscess (18 males and 2 females, mean age; 54.3 years).
Diabetus mellitus and periodontal diseases were prominent underlying diseases in patients with lung abscess. Cough was complained in 13 patients, chest or back pain in 9, purulent sputum in 8 and hemosputum in 5 when the patients admitted to our hospital. A temperature higher than 38°C was present in 12 patients but temperature les than 37°C in 2. Multiple microorganisms were cultured from TTA in 15 patietns. A mean of 2.7 bacterial species per patient was isolated, aerobes alone being isolated in 2 patients, anaerobes alone in 3, and mixed aerobic and anaerobic isolates in 10. Seventeen strains of aerobes and 35 of anaerobes were isolated. Major pathogens were Streptococcus pneumoniae, Streptococcus intermedius and other in aerobes, and Peptostreptococcus micros, Fusobacterium necrophorum, Prevotella melaninogenica and others in anaerobes. Abnormality of chest X-ray was located on the right upper lobe in 6 patients, the right lower lobe in 6, the left upper lobe in 6, the left lower lobe in 4 and the right middle lobe in 1. All patients were cured only by treatment of antimicrobial agents, but cavity formation on chest X-ray remained in 4 patients after the treatment.

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Between July 1988 and June 1998, 22 pediatric patients without underlying diseases were diagnosed as bacteremia caused by community-acquired infection in Asahikawa Kosei Hospital. The age range of the patients was from 7 days to 4 years. Their diseases were meningitis in 6, urinary tract infection in 6, respiratory tract infeciton in 4, skin infection in 2, and unknown origin in 4. The causative organisms were Escherichia coli in 7, Haemophilus influenzae in 4, Streptococcus pneumoniae in 4, Staphylococcus aureus in 2, Streptococcus pyogenes in 1, Streptococcus agalactiae in 1, Listeria monocytogenes in 1, Moraxella catarrhalis in 1, and Rahnella aquatilisin 1. Though 21 patients recovered with antimicrobial treatment, only one patient with H. influenzae meningitis had lateral deafness and paresis in the lower limbs as sequelae.

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Application of the polymerase chain reaction (PCR) method for detection of subgenus B adenoviruses (types 3, 7 and 11) was investigated. It is based on a simple (nonnested) PCR using primer pairs specific for the hexon-coding region. The PCR allowed amplification of DNA from subgenus B adenovirus prototype strains (types 3, 7 and 11) and adenovirus isolates (types 3 and 7), whereas it did not amplify DNA from subgenus A (type 31), C (types 1, 2, 5 and 6), D (types 8, 19 and 37), E (type 4) and adenovirus isolates (types 1, 2, 5 and 6). These results suggest that subgenus B adenoviruses (types 3, 7 and 11) are detectable selectively by means of PCR with primer pairs developed in this study. Amplified fragments from adenovirus types 3, 7 and 11 could be differentiated with restriction endonuclease analysis with Rsa I.

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Itraconazole, an oral antifungal agent, was evaluated for the clinical efficacy and safety in patients documented or suspected of systemic fungal infection (SFI) complicated with hematological malignancies. The data was also evaluated according to serological tests and fungal culture.
Out of a total of 79 patients, the clinical efficacy of itraconazole was evaluated in 52 patients, comprising 4 patients with proven SFI, 33 with clinical SFI, and 15 with suspected SFI.
The overall efficacy was 67.3%(35/52), in which 25.0% in the established SFI group (1/4), 78.8% in the clinical SFI group (26.33), and 53.3% in the suspected SFI (8/15). When assessed according to the severity of SFI, the effectiveness rates were 75.0% in the mild group (15/20), 76.2% in the moderate group (16/21), and 36.4% in the severe group (4/11), resulting in significantly higher rates in the mild and the moderate groups than in the severe group (p=0.0479). Out of the 10 patients who were switched from the previous antifungals, 7 patients were judged as showing marked or good responses. All of these patients were switched from intravenous fluconazole therapy.
With respect to the safety of itraconazole, among 79 patients eligible for safety evaluation, adverse events such as hepatic dysfunction, increase in GOT and/or GPT, nausea and vomiting, and chest pain were observed in 6 patients (7.6%), and itraconazole may have been associated with them.
As a conclusion, itraconazole proved to be effective and safe on SFI developed in patients with various hematological malignancies.

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The purpose of this study was to determine the usefulness of the hybrid capture HPV DNA assay, a new nonradioactive solution hybridization assay, as a diagnostic tool for human papillomavirus infection. In a total of 234 women, samples for the hybrid capture assay and polymerase chain reaction (PCR) assay were obtained by wiping a swab across the cervix and external os (either a Dacron swab or a cotton swab was used). The papanicolaou smear test (Pap smear) was carried out on all 234 women. Tissue samples for biopsy were obtained by colposcopy from 118 of the women. Fisher exact test was used for statistical analyses. Using the hybrid capture assay, HPV DNA of high-and intermediate-oncogenic-risk type was detected in 23 (13.9%) of 166 samples from women with Pap smear Class I or II, and 48 (70.6%) of 68 with Pap smear Class III, IV or V (p<0.0001). The HPV DNA type was detected in 18 (29.0%) of 62 samples from those with no evidence of cervical intraepithelial neoplasia and 44 (78.6%) of 56 with cervical intraepithelial neoplasia or squamous cell carcinoma (p<0.0001). Correlation of the test results between the hybrid capture test and PCR was determined by using the 217 samples in which both test results were available PCR test results were not obtainable in 17 samples. When PCR is set as a gold standard, the hybrid capture test has high sensitivity (74.6%) and specificity (92.7%). These findings suggest that the hybrid capture HPV DNA assay is a useful method for diagnosing HPV infection in the clinic.

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To study the pathogenesis of Streptococcus pneumonieae, we established mouse models with acute pneumonia caused by the penicillin susceptible S. pneumoniae strain (J4) and the clinically isolated penicillin resistant S. pneumoniae (RSTY045). The MICs of the J4 and RSTY045 strain against penicillin G were 0.016 and 2.0μg/ml, respectively. In the therapeutic experiment, the ED50 of penicillin G against the J4 strain was 14, 800 IU/kg and that of the RSTY045 strain was 92, 000 IU/kg. In the pathological study, both lungs infected with J4 and RSTY045 showed typical bacterial pneumonia. The pathogen infected with the J4 strain showed septic pneumonia in which neutrophils were more invasive to the vascular area than that infected with RSTY045. All of the J4 strain blood cultures tested positive 24 hours into the pneumonia course, whereas only two of the RSTY045 strains showed positive at the end of the pneumonia course. The pneumolysins of J4 and RSTY045 were 191 HU/ml and 1, 622 HU/ml respectively. There seemed to be no association between pneumolysin and the blood culture results in our model. To investigate these results, we infected mice with four PSSP and six PRSP clinically isolated strains (RSTY strains) containing J4 and RSTY045, respectively. Blood cultures were performed at 24 hours and 3 days after infection and death rates were calculated 3 days after infection. In the PSSP infection groups, 81.7% showed a positive result at 24 hours and 100% at 3 days after infection showed positive results, whereas in the PRSP 40.0% at 24 hours and 59.0% at 3 days after infection. The average levels of pneumolysin in PSSP and PRSP were 473.0 HU/ml and 835.2 HU/ml, respectively. There seemed to be no association between pneumolysin, death rates and the of blood culture results. (p>0.05).

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A 58-year-old male experienced a sudden stroke-like onset of right hemiplegia and numbness of his right upper limb while engaged in his desk-work on April 7, 1997. He had a past history of diabetes mellitus and hyperlipidemia. On admission, he had no fever and the blood pressure was 140/70 mmg. General physical examination was unremarkable. Neurological examination showed 4/5 strength of his right unilateral extremities and numbness of his right upper limb. Clinical features and computed tomography (CT) without contrast medium at the onset of hemiplegia suggested a stroke. Seven days after admission, his consciousness worsened and body temperature fluctuated between 37 and 38. Subsequent Gd-enhanced magnetic resonance (MR) which demonstrated an irregular shaped ring-enhancement lesion and lumbar puncture 9 days after admission was compatible with the diagnosis of brain abscess. Surgical drainage confirmed the presence of brain abscess due to-streptococcus. It improved following surgical drainage and antibiotic therapy with PAPM.BP 2g/day and PIPC 4g/day. An afebrile patient of sudden stroke-like onset may be a rarity to be added to the differential diagnosis of brain abscess.

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A 73-year-old male was admitted to our hospital because of productive cough and infiltrate on the chest roentogenogram. The underlying diseases was found to be multiple myeloma. He received a physical examination in June, 1996. The chest X-ray and CT scan on admission showed an infiltrative shadow with multiple bulla in the left upper lung field. Internal use of antibiotics and drip infusion of IPM/CS were ineffective.
The chest X-ray showed air-fluid level in left upper peripheral bullous lesion and a percutaneus needle aspiration of the lung was performed. The specimen was pus with blood and microscopical examination of smears revealed no acid-fast bacilli, but Mycobacterium szulgai was isolated and identified by DNA-DNA hybridization method. the patient was treated with isoniazid and rifampicin, and improved in a few months.
There are a few case reports of pulmonary infection due to M. szulgai associated with emphysematous bulla of the lung in Japan. M. szulgai infection of the lung is similar to M. kansasii infection in respect to clinical features (improvement of chest abnormal shadow, efficacy of drug).

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The genus Clinostomum is a cause of parasitic laryngo-pharyngitis. We report the 15th case of Clinostomum sp. infection in Japan. A 29-year-old female visited our hospital because of throat discomfort and expectoration of a worm by sneezing on November 17, 1997. The pharyngitis was caused by the worm. The worm was morphologically identified as the adult of the genus Clinostomum.

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