Studies on a combination therapy of fosfomycin (FOM) and norfloxacin (NFLX) against chronic otitis media were performed, and the following results were obtained. 1. The fractional inhibitory concentration index (FTC index) ≤0.5 between FOM and NFLX showed 66.7% (4/6) against S. aureus isolated from chronic otitis mediaand 80.5% (4/5) against P. aeruginosa. 2. Clinical effects was excellent in 2 cases (18.2%), good in 6 cases (54.5%) and poor in 3 cases (27.3%). 3. Bacteriologically 9 strains out of 11 patients were eradicated after the combination treatment; 5/6in S. aureus and 4/5in P. aeruginosa. 4.No adverse effect and abnormal laboratory findings were observed in this study. It is suggested that the combination of FOM otic solution and NFLX isuseful for the treatment of chronic otitis media.
In the D ward of Nagoyashi-Koseiin geriatric hospital (36-beds), upper respiratory illnesses were recognized in all the inpatients between July and August in 1995, and we studied 7 elderly subjects with parainfluenza 3 infection diagnosed by serology and viral culture. The outbreak of upper respiratory illnesses occurred in the ward during the 17 days from July 21 through August 6, 1996. Fifteen of the 18 elderly persons with upper respiratory illnesses were tested by serology; parainfluenza 3 infection was identified in 7. One of the 7 patients, parainfluenza 3 virus was isolated. Seven elderly subjects with parainfluenza 3 infection were 2 males and5females and five of them (71.4%) were bedridden. The most common complaint was fever and coughing in 7/7 (100%), followed by sputum in 5/7 (71.4%), wheezing in 4/7 (42.9%). The pyrexial period in the parainfluenza-infected group ranged from 1 to 4 days (average 3.1 days), and was significantly shorter than that of the influenza group. The maximum recorded temperature in the parainfluenza-infected group ranged from 37.0 to 39.2°C (average 38.1°C), and was significantly lower than that of the influenza group. Two of the 7 patients with parainfluenza 3 virus infection had pneumonia, but nobody died, and all 7 patients recovered without sequele. It is possible that parainfluenza 3 virus infection among elderly subjects cause secondary bacterial infection, so we think that prevention of nosocomial parainfluenza infection should be a high priority in the case of outbreak of such an infection in a ward.
It was investigated that Bifidobacterium breveYIT4064 (B. breveYIT4064), Which had augmented IgA production and prevented rotavirus-induced diarrhea in mice, prevented rotavirus infection in infants. The effect of B. breveYIT4064was evaluated in ten infants from an infants home who received 50mg of the bacterium every day for 28 days (the B. brevegroup). Nine infants did not receive this (the control group). Though rotavirus shedding in the control group was detected from 2 (a total of 5 stool samples) of 9 infants (a total of 112 stool samples), it was not detected in any infants (a total of 133 stool samples) in the B. brevegroup during the administration period. From day 8 to day 14 of the test, rotavirus shedding was detected from 4 of 32 stool samples in the control group, but was not detected at all from 38 stool samples in the B. brevegroup. The frequency of rotavirus shedding in the B. brevegroup was significantly lower than that in the control group. Further, the frequency in appearances of anti-IgA in stool samples in the B. brevegroup showed a tendency to increase in comparison with the control group from day 8 to 14 of the test. The oral administration of B. breveYIT4064 significantly decreased rotavirus shedding in stool samples and prevented rotavirus infection.
Moraxella catarrhalis is recognised as a major pathogen in chronic respiratory diseases. Patients with pneumoconiosis have repeated respiratory infections, and the control is very important for good prognosis. From 1988 to 1993, fifty strains of Moraxella catarrhalis were obtained from 9 patients with pneumoconiosis attended at Nagasaki Rosai Hospital. Restriction enzyme analysis of chromosomal DNA by Hind III, Hae III, Cla I was performed on 50 strains of M. catarrhalis. Twelve strains (56%) out of 23 isolates with interval of less than 5 months had identical bacterial restriction endonuclease digestion patterns with three different enzymes, and all isolates with interval more than 6 months had different patterns. Tweny out of 13 episodes by the same strains occured during 3 months. The acquisition and clearance of M. catarrhalis from the respiratory tract is a dynamic process.
Enterohemolysin production on Beutin's washed sheep blood agar plate has been used as an epidemiological marker for selective screening of Verocytotoxin-producing/Enterohemorrhagic Escherichia coli(VTEC/EHEC). In this study, we examined about the component of Beutin' s washed sheep blood agar for further improvement of hemolysin production media. The following items were studied: the numbers of washings of sheep blood with phosphate buffered saline (PBS) (pH7.2), concentration of sheep blood, kind and concentration of divalent metal ion (Ca2+, Mg2+) and basal medium. Twenty-seven strains of VT-producing E. coliof 7 different O-serotypes, 74 strains of VT-nonproducing E. coliof 24 different O-serotypes and one strain of O157 coded Escherichia hermaniiwere used for this basic study. In comparison of washing times of sheep blood with PBS, 5 times washing was better than 3 times, the original. In sheep blood concentration, supplement with 4% sheep blood was best for hemolysis observation. In experiment of addition of 2 divalent metal ions, Ca2+and Mg2+, supplement with Ca2+was more suitable than Mg2+for hemolysis, and the supplement with 10 mM CaCl2, the original, was the best concentration. On the basal medium used in Beutin's sheep washed blood agar, 4 kinds of media were compared. In addition to Soybean-Casein Digest (SCD) agar, the original, Nutrient agar, Heart Infusion (HI) agar and Brain Heart Infusion (BHI) agar were examined, HI agar was the best blood agar base in the four media. As the above experimental results, the composition of the better Beutin's washed sheep blood agar may be summarize as follows: Heart Infusion agar ‘Eiken’®used for blood agar base, supplemented with 10mM CaCl2 and 4% defibrinated sheep blood (Japan Biosupp. Center) washed five times in phosphate-buffered saline, pH 7.2.
We examined the production of CD11b, CD62L and H202by human peripheral blood granulocytes after treatment with soluble proteins prepared from five different pressure-disrupted strains of Staphylococcus aureus (SaSP) by flow cytometory. Peripheral blood was treated with final SaSP concentrations of 0.05, 0.5and 5.0μg for 20 min at 37°C. The ratio of CD11b positive granulocytes did not increase at concentrations from 0.05 to 5.0μg, but fluorescence intensity showed about two and threefold increase, respectively, at concentrations of 0.5 and 5.0μg, in comparison with that of control cells. The ratio CD62L positive cells decreased as follows: 0.5μg, 53.8% and 5.0μg, 19.0%, respectively, whereas the control value was 79.8%. Fluorescence intensity also decreased as follows: 0.5μg, 10.4 and 5.μEg, 92, respectively, whereas the control value was 46.8. Slight induction of H202 was found at 5.0μg concentration only. In addition, SaSP treatment granulocytes that stimulated with PMA (1 ng) increased H202production. Thus, SaSP has no beneficial effect against H202production by granulocytes. All of the SaSP preparations indicated similar results for the production of CD11b, CD62L and H202by granulocytes. SaSP effects activation of granulocytes, and the activation may occur independently of protein kinase C.
Twenty-eight cases of systemic infections due to Haemophilus influenzae diagnosed from October 1988 to December 1998 were analyzed retrospectively. The clinical manifestations were 13 meningitis (15 episodes), 9 septic arthritis, 4 acute epiglottitis, 1 septicemia and 1 lung abscess. In the 15 meningitis episodes, 13 had positive CSF culture results, and the other 2 episodes of pretreated with antibiotics were diagnosed by H. influenzae type b (Hib) antigen detection by using concentrated urine specimens. In the 9 septic arthritis cases, 6 had positive synovial fluid culture results. Of the 3 cases with negative results on Gram stain and on synovial fluid and blood cultures, etiological diagnosis was established by Hib antigen detection in synovial fluid. Results of Hib antigen detection were positive in all 8 cases (100%). In 6 of these 8 cases, antimicrobial therapy was started by the results of antigen detection. In the 4 acute epiglottitis, 2 had positive blood culture results, and the other 1 case was diagnosed by Hib antigen detection by using concentrated urine specimen. In 3 of these 4 cases, H. influenzae strains isolated from nasopharyngeal swab or aspirated sputum were serotyped as type b. In this study, rapid antigen detection has several advantages in the rapid laboratory diagnosis of systemic infections due to Haemophilus influenzae. (1) The detection of Hib antigen is the only way to diagnose bacterial etiology of infection in patients who had received partially treatment with antimicrobials. Urine is as an appropriate specimen for antigen testing as CSF in patients with suspected Hib meningitis. Moreover, to detect Hib antigen in synovial fluid is clinically useful in septic arthritis.(2) Both the antigen detection and Gram stain made the rapid presumptive identifications and effected therapeutic decision making. (3) Antigen detection methods have also been used in serotyping of clinical isolates. We conclude that rapid antigen detection is a very useful tool for the rapid etiological diagnosis and guideline for the choice of antimicrobials in systemic infections due to Hib. It is necessary to diagnose bacterial etiology as a routine procedure using not only Gram stain and culture but also rapid antigen detection technique in patients with suspected Hib systemic infection.
A 34-year-old male with a history of chickenpox developed primary abdominal non-Hodgkin's lymphoma (diagnosed in August 1995). Treatment with cyclophosphamide, doxorubicin, vincristine, and prednisolone achieved a partial remission. In July 1996, the disease recurred, and the patient recieved chemotherapy with carboplatine, etoposide, mitoxantrone, and prednisolone, but no response was noted. Involvement of the central nervous system and meninges was diagnosed on September 12, 1997. Blast cells were detected in the peripheral blood on September 26. Based on these findings, he was diagnosed as having leukemia. On September 27, painless vesicles developed on the left gluteal region. On October 13, the patient was hospitalized because the vesicles had spread over his entire body. Pathologic examination of the roofs of the blisters showed masses of inclusion bodies. Based on this, a diagnosis of varicella-zoster infection was made. Treatment with acyclovir (750mg/day) for seven days failed to form crusts. New vesicles developed after the drug was discontinued, but crusts formed after acyclovir therapy was resumed. He died of interstitial pneumonia on December 21. Autopsy could not be perfomed. Histopathologic examination of pulumonary tissue obtained by necropsy did not reveal the presence of inclusion bodies characteristic of herpes simplex or varicella-zoster infection. Varicella-zoster virus (VZV) antigen was negative by an immunochemical staining methed using monoclonal antibodies against VZV. Continuous long-term administration of acyclovir has been reported to be effective for non-Hodgkin's lymphoma complicated by recurrent intractable herpes zoster.
A 32-year old male was admitted to our hospital conplaining of cough, fever, and skin eruptions. He was coctacted with a child who had chickenpox 3 weeks before the onset. He showed the elevating of antibody to varicella-zoster virus. Despite of the administration of Acyclovir for four days, cough was not relieved and a chest X-ray film showed infiltrative shadow in right middle lobe of the lung. Bronchoscopic examination revealed vasicle and edema, and the varicella-zoster virus (VZV) DNA was detected in the bronchoalveolar lavage by the polymerase chain reaction. The patient in first case confirmed by the virus DNA in the bronchial washing by thePCR.
Cutaneous Kaposi's sarcoma (KS) is a well-known complication of theacquired immunodeficiency syndrome. KS in the internal organs, however, is rare inJapan. We present here a 33-years-old Japanese homosexual man who had AIDS complicated with cytomegalovirus (CMV) infec tion and KS. He was found to be HIV-seropositive, when he was 31-years-old. He visited our hospital in June 1996 because of high fever. The peripheral blood CD4+lymphocyte counts were 2 per cubic millimeter, and CMV antigenemia was noted (p65 antigen positive cells; 240/50, 000 white blood cells). Thereafter he was successfully treated with parental ganciclovir. On admission, some browncolored flat nodules were found on the skin, and the diagnosis of KS was made by skin biopsy. We administrated human chorionic gonadotropin (hCG) for the treatment ofKS, but had no clinical response. In September 1996, he complained of severe cough, shortnessof breath, and vomiting. A chest radiogram showed nodular lesions and pleural effusion in bilateral lungs. A computed tomography of his chest also revealed nodular and linear densities distributed along the bronchovascular bundles. The ultrasonic examination of his abdomen revealed a duodenalnodule . Both nodules in the lungs and duodenum were proved to be KS based on the autopsy findings. Intranuclear inclusionbodies pathognomonic for CMV infections were detected in the stomach and the colon.
Small round structured viruses (SRSV) are the major cause of acute non-bacterial enterogasritis and have a characteristic of breaking out with mass victims as food poisoning. The outbreak usually occurs among school children from school lunches in Japan. A case in adults is relatively rare. The SRSV food poisoning with 644 adult victims carried through lunch box broke out, which may be the biggest number in adult cases in the world. This is the report describing its outlines, analytical result of clinical symptoms and fecal microbial examination. The average latent period was 37 hours, the time was mostly (47%) between 24-36 hours. The most emerged symptom was diarrhea and followed nausea, abdominal pain, vomiting and high fever. The older patients showed a higher rate of diarrhea and fewer one of nausea and fever. 15 patients complained of eye symptom. This number should not be neglected. It may be a characteristic of the disease. SRSV detection test with PT-PCR method of feces was done on 36 patients and 24 patients were positive. The most sensitive primer was Yuri/nested/22F/R. In Japan, lunch-service has become a industry advancing monopolization and wide areazation. SRSV make easily contamination to food, therefore if mass victim food-poisoning occurs, this should be considered initially.