Recently, the therapeutic guideline has been mentioned in opportunistic infection of the compromised host, and many observations regarding complication of infection in these hosts have been reported. However, there were few reports in the relationship between infection and immune function or nutritional status.
In this study, we confirmed that the nutritional status influences immune function in patients with lung cancer, hepatoma and renal failure, and that malnutrition markedly reduces their immunity. In patients after operation who where the pre-operative assessment of the nutritional status was performed an attempt to improve the nutritional status has been already made to improve their prognosis. Therefore, we emphasize that the management of the nutritional status even in hosts with many other diseases is thought to be important in protection against infection and prognosis of the disease.

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Vibrio cholerae O1 strains isolated mostly in Japan between 1977 and 1995 were typed according to restriction fragment patterns by cleavage of genomic DNA with Sfi I and Not I and separation by Pulsed-field gel electrophoresis (PFGE).
Two hundred sixty five strains from human were divided into 60 PFGE patterns (provisional types). Strains of type 2-3, 3-4, 4-5 and 51-54 were dominant in the Philippines, Thailand, India and Indonesia, respectively. Types 1-1, 2-3, 2-53, and 3-4 were detected over a long period of time in contrast to the other types. Strains of the same type (Types 1-1, 2-3, 2-53 and others) isolated from the Japanese who had never been outside Japan were often found among strains from Southeast Asia. Most strains from humans were cholera-toxin (CT)-positive, while those from the environment and the sea were generally not. 23 strains from the environment and the sea in Japan were divided into 12 types. Strains of the same types as CT-positive strains from humans could not be found in the environment and sea.
These results suggest that cholera in Japan is closely related with cholera in Southeast Asia and PFGE is useful for epidemiological analysis of cholera in Japan.

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To clarify the clinical features and select the appropriate antibiotic therapy for patients with severe pneumonia requiring mechanical ventilation, we performed a clinical analysis of 65 patients with this condition. The following results were obtained. The majority of the patients were elderly males, whose performance status was poor (PS 2.2) and who had an underying disease. Abnormal physical signs included tachypnea, tachycardia and consciousness disturbance. Abnormal laboratory findings included hypoalbuminemia, and liver and renal dysfunction. The causative microorganisms were isolated from half of these patients. A number of antibiotics were administered and steroid pulse therapy was also performed for half of these patients. Nevertheless the prognosis was poor because the percentage of deaths was high (50.8%).

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Toxic shock syndrome (TSS) is caussed by toxic shock syndrome toxin-1 (TSST-1) of Staphylococcus aureus. We studied the incidence of TSST-1 production by the clinical isolates of S. aureus, in order to clarify the possibility of TSS caused by S. aureus. One hundred and seventeen clinical isolates of S. aureus were tested. Of 117 strains, 74 were methicillin-cephem resistant S. aureus (MRSA), and 43 were methicillin-cephem sensitive S. aureus (MSSA). TSST-1 production and penicillinase (PCase) activity were measured by means of reversed passive Latex aggulutination method and acidmetric assay, respectively. The incidences of TSST-1 production by PCase positive MRSA, PCase negative MRSA, PCase positive MSSA and PCase negative MSSA were 92%(55/60), 78%(11/14), 21%(7/33) and 0%(0/10), respectively. TSS occurred in a patient with chronic complicated pyelonephritis after endopyelotomy for hydrone-phrosis. In this patient, PCase positive MRSA which produced TSST-1 was isolated from urinary tract, and he was cured after administration of arbekacin. These results indicsate that methicillin-cephem resistance and PCase production are the risk factors for TSST-1 production in S. aureus.

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Between May 1991 and December 1996, bacteriological and virological investigations on the fecal samples from patient of infantile diarrhea (155 cases), or infectious gastroenteritis (1, 409 cases) diagnosed with 9 medical institutions in Tama of Tokyo were carried out. Of 1, 564 samples, 722 (46.2%) were enteropathogen positive cases, and mixed infection was also observed in about 15% of the positive cases. Among 13 different kinds of enteropathogens identified, the most prevalent one was pathogenic E.coli (20.7%), followed by Campylobacter spp. (10.0%), Rotavirus (8.8%), Salmonella spp. (3.9%), Adenovirus (1.9%), ECHO virus (0.9%), Vibrio parahaemolyticus (0.8%), Poliovirus (0.7%), Aeromonas spp. and Coxsackie B virus (both 0.6%). Furthermore, SRSV was confirmed in 82 out of 619 patients (13.2%) for 2 years (1995 and 1996).In addition, Shigella sonnei (3 cases), S. Paratyphi-A (1 case) and enterohemorrhagic E. coli 0157: H7 (2 cases) were also detected. A higher detection ratio was recorded in February, August and November, reflecting respectively by month a highly frequency of Rotavirus, enteric bacteria causing food poisoning and SRSV. With reference to the isolates, the most of pathogenic E. colibelonged to enteropathogenic serotype E. coli (EPEC), and S. Enteritidis was most prevalent serotype.

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Quantitation of viral load in a HIV infected person gives important information for monitoring of the clinical status of the patients and evaluation of and viral effects of admininstred drugs. Although conventional Amplicor HIV-1 monitor system (Roche's conventional method) is used widely, the sensitivity of this system is not enough for measurement of subtype E and A giving lower titer of these subtype viruses than the actual quantity
In Japan, HIV-1 subytpe B cases used to be predominant but recently subtype E cases are increasing especially among heterosexuals thus it becomes required to increase the sensitivity of measurement of HIV-1 RNA of subtype E or A. Therefore we establised the Kanagawa primer method using newly developed subtype E and A primers added to the primers of Roche's conventional method. The results were compared with the conventional Amplicor and also with Roche's new version method which contained new primers.
Kanagawa primer method gave 4 to 16 times more sensitive results as compared with Roche's conventional method for subtype E measurement. As for subtype A case, Kanagawa primer method gave a value 1.2×104 copies/ml while it was undetectable by Roche's conventional method. Roche's new version method showed equal sensitivity to Kanagawa primer method. As for subtype B, the results of these three methods showed no difference
Addition of our newly developed subtype E and A primers to the Roche's conventional method enabled to measure subtype E and A with high sensitivity. For quantitative measurement of HIV-1 RNA, it is important to consider the subtype of the virus in test samples.

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In March 1996, an epidemic of Shigella sonnei infection occurred in Ooamishira-sato Town, Chiba Prefecture. Colicine typing, antibiotic resistance patterns, plasmid profiles, pulsed-field gel electrophoresis (PFGE) and random amplified poly-morphic DNA (RAPD) were used for the investigation of the epidemic. Ninety-four isolates from patients exhibited three different colicine types and five different antibiotic resistance patterns. But the patterns of plasmid profile, PFGE and RAPD were uniform among the isolates with different colicine type and antibiotic resistance pattern. It is possible that these isolates belonged to a single bacterial clone and circulated through human to human.

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It is well known that calcium oxalate crystals (crystal) arte commonly found in Aspergillus niger (A. niger) infection site. However, there have been no pathological reports of crystal production and tissue injury using an animal model. I experienced a case with pulmonary aspergilloma and infiltration shadow of the lung that I guessed resulted in crystal-induced inflammation. I performed animal experiments to investigate the posibility of crystals to cause tissue injury. Two different types of immunosuppresed rat models; i.e. cortisone acetate (CA) and CA + cyclophosphamide (CPM) induced-immunodeficiency models (CA model, CA + CPM model), were used for the experiments. In both models, rats were infected with A. niger. Then, the lungs were removed and examined histopathologicaly. The crystals were rarely found in both models on the third day after inoculation and it increased as time passed. However, more growth of hyphae and more production of crystals were observed in the CA + CPM model. In the CA model, crystal depositions in the bronchial epithelium and erosion of the bronchial epithelium adjacent to the crystals were observed. Crystal depositions in the bronchial epithelium were also seen in the CA + CPM model. In this lesion, severe erosions of the bronchial epithelium and invasion of A. niger mycelium into the tissue were observed. These findings suggest, the crystals in the bronchial epithelium may expand and destoroy the cells around them. Therefore, I think that the crystals can induce tissue injury. However, in alveolar portions, depositions of crystals were seen mainly in the margin rather than in the central part of mycelial growth, but no findings indicating injury of the alveolar epithelial cells by crystals were seen. Therefore, posibility of crystals to cause tissue injury in the alveolar portion is not yet clear.

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Alcaligenes xylosoxidans is a glucose-nonfermentative gram-negative rod which usually exisits in the environment. This organism while causing pneumonia, sepsis, meningitis and urinary tract infection in the compromized host, rarely causes thoracic empyema. We report a case of thoracic empyema and subcutaneous abscess due to A. xylosoxidans.
A 74-year-old male, who had undergone right total pneumonectomy for chronic necrotizing pulmonary aspergillosis a year ago, was admitted to our hospital because of fever. CT scans of the chest revealed a subcutaneous abscess and empyema. Empyema and subcutaneous pus were aspirated. Culture of materials produced A. xylosoxidans. There was no significant change onsymptoms and examinations depsite therapy with PIPC 4 g/day and thoracic drainage. Finally, surgical treatment was required and the patient was cured.

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We report a 26-year-old male patient with acute myelocytic leukemia and hepatosplenic candidiasis during his clinical course. His hepatosplenic candidiasis was refractoty to itraconazole and fluconazol. He developed serious side-effect such as renal dysfunction, when conventional amphotericin B was given.
Then he was treated with liposomal amphotericin B (Abelcet^®). This therapy was safe and effective for him. He was able to be treated with 3075 mg of a liposomal amphotericin B. Thiswas ten times as much as the dose of conventional amphotericin B which was given earlier until amphotericin B was stopped because of renal dysfunction.
Liposomal amphotericin B seems to be a safe and effective therapy for systemic fungal infectin and should be considered more in Japan.

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A case of the urachal sinus accompanied by umbilical infection is reported. A 21-day-old female infant was seen at the hospital because of umbilical granuloma, redness and umbilical purulent discharge. The separation of the umbilical cord in her neonate was delayed. IVP and CT examination revealed a urachal diverticulum from the urinary bladder to the umbilicus. The patient was diagnosed to have internal and external urachal sinus. In spite of systemic administration of antibiotic agents, the umbilical infection did not get well. After extruding of the external urachal sinus from the umbilicus, she had not had any symptoms. After 3 months the IVP did not revealed in urachal diverticulum.

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We reported a Thailander patient with isosporiasis accompanied by AIDS. The 34-year-old male, who had been living in Japan for six years, was admitted to our hospital complaining of diarrhea and body weight loss. After admission the patient developed acute renal failure due to dehydration resulting from diarrhea. Laboratory findings on admission showed neither significant microorganisms nor parasite ova in the stool. The patients was given both an intestinal drug and an antibacterial agent, but is vain. Frequent stool examinations disclosed Isospora oocyst in the feaces. Co-trimoxazole was administered resulting in remarkable diarrheal improvement. Renal function was also improved without dialysis. Although isosporiasis is rarely found in Japan, it is stressed that in the AIDS patient with persistent diarrhea who may develop a parasitic disease as did in this case, frequent fecal examinations should be conducted.

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A 42-year-old male type A hemophiliae who been using coagulates since 1971 was diagnosed Human Immunodefficiency Virus (HIV) positive in 1993. Medical history included liver disfunction in 1987, with chronic hepatitis C (CHC) diagnosed in 1989. He was admitted to the hospital in October, 1994 because of general fatigue. Serum transaminase was elevated, CD4 was 221/micro L, and CD8 was 990. CD4/CD8 ratio was 0.2. HCV was of genotype 2b and 10⁶ copies/50 micro L. 8-week-Interferon (IFN)-β-treatment was started. HCV RNA was eliminated by week 8 and was sustained for one year with no severe side effects. With caerful patient screening, IFN therapy for CHC with HIV may be an effective treatment.

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[in Japanese]

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