Newly developed diagnostic kits for the detection of Anti-Chlamydia trachomatis, Peptide-Chlamvdia (LOY: Meiji Milk Products Co., Ltd., Tokyo; for IgG and IgA), were evaluated using the microimmunofluorescence assay (MIF) as the gold standard. These results were also compared to results of testing by Sero-IPALISA and immunoblot (I-B). Detection by LOY in based on enzyme immunoassay with synthetic peptides as the antigen. Thirty serum samples from pediatric patients and 130serum samples from gynecology patients were used. All26pediatric samples that were positive for Chlamydia pneumoniae IgG antibody tested negative with LOY, indicating that the presence of the antibody against C. pneumoniae did not affect the assay by LOY.
For 90 gynecological samples, the total, the positive and the negative agreement rates for IgG were quite high; i. e. 87.8%, 90.0% and 70.0% (LOY vs MIF), 85.6%, 85.0% and 90.0% (Sero-IPALISA vs MIF), and 92.0%, 94.9% and 70.0% (I-B vs MIF), respectively. On the other hand, many cases of MIF (-) and LOY (+) discrepancy were seen in IgA detection. In order to better understand the basis for such disagreement. 34serum samples were collected from patients whose cervical samples were negative for the Chlamydia group antigen based on the assay with IDEIA-Chlamydia^®. They were then assayed by MIF and LOY. The total, the positive and the negative agreement rates for IgG were 91.2%, 100% and 90.9%, while the total and the negative agreement rates for IgA were 88.2% and 88.2% (there were no IgA positive cases). Furthermore, 6 serum samples (1case of MIF (+) LOY (+) and5cases of MIF (-) LOY (+)) were provided to determine whether LOY detects C. trachomatis specific IgA antibody. Increasing amounts of C. trachomatis serovar L2were added to the serum samples resulting in a progressive decrease in their reactivity in the LOY assay. These results lead us to speculate that LOY can reveal even low levels of C. trachomatis specific IgA antibody.
In conclusion, LOY can be used as an useful kit for detecting C. trachomatis antibody.

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The clinical features of pulmonary complications were evaluated in 15patients with adult measles diagnosed by clinical and serologic investigations. Of those 15patients, 12 were admitted because of high fever, sever anorexia and dyspnea. Almost all patients werefound to have thrombocytopenia, elevations of LDH and aminotransferase. Pulmonary infiltrates were present in only2of the12patients (16.7%) on whom chest roentgenograms were performed, but hypoxemia (PaO₂<70Torr) were present in 8 of the 12patients (66.7%). Pulmonary function. tests in 8patients showed mild decrease in VC, moderate decrease in FEV₁and severe decrease in V₂₅. These findings suggest that hypoxemia in patients with normal chest radiographs may be largely caused by bronchiolitis. The observations of sequential peak flow rate measurement showed that severe pulmonary dysfunction continued for 4-5days after the onset of the rash. To avoid the development of respiratory failure, patients with measles should be carefully monitored for bacterial superinfections of the respiratory tract especially within several days after the appearance of the rash.

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Clinicobacteriological characteristics of nine cases isolated Mycoplasma hominis from the genital tract were studied, and the following results were obtained: elevation of IgG antibodies to M. hominis was measured by ELISA in all cases, but in the MI method only one case showed an elevation of metabolic inhibitory antibody. Convalescent sera from seven patients showed additional and high density bands which were not recognized by acute phase sera in immunoblotting. It was thought that in two patients M. hominis was a causal bacteria for pelvic inflammatory disease (PID). In three cases, it was suggested that M. hominis was related to a premature delivery and idiopathic labor. As infectious symptoms, two patients had body temperatures of more than 38°C but other cases showed 37-37.8°C.
Though all cases showed an elevation of CRP, six elevations were slight. As a medication β-lactam agents were administrated, but their efficacy was not recognized.
Furthermore, two patients showed spontaneous recovery in spite of improper antimicrobial agents administration or drainage combined with antimicrobial agents. From the above results, It was thought that M. hominis played a causative role in upper genital tract infection.

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In this study, we analyzed background factors and clinical courses of31patients having 32 episodes of urosepsis, which was defined as the disease when the same species of bacteria were simultaneously isolated both from urine and blood in a febrile (≥38°C) patient. Most of the patients had a malignant disease. These patients were classified into3groups by febrile patterns, based on [responder], [partial responder] and [non-responder]. [non-responder] was one in which fever persisted for more than7days. Background factors such as those of bacteria and host were compared among the three groups. Pseudomonas aeruginosa was more frequently isolated from both urine and blood of patients having not only the [responder] but also the [non-responder]. Patients having the [responder] and [partia responder] had a higher frequency of isolation of Escherichia coli (E. coli) from urine and blood, suggesting that urosepsis caused by E. coli may respond more easily to antimicrobial chemotherapy. While the direct cause of urosepsis was not identified in 6 patients, manipulations of the urinary tract were a direct cause of the disease in all 26 other patients. An indwelling catheter in the central vein or urinary tract alone did not influence the clinical courses of patients. However, when patients with respiratory or renal dysfunction, or a cerebrovascular accident had an indwelling catheter, the urosepsis was intractable for antibacterial chemotherapy. Antimicrobial chemotherapy using a single agent was effective in all patients having the [responder]. Combination chemotherapy or alternation of agents was eventually needed for treatment in more than half of the patients with the [partial responder] or [non-responder]. No patients died from the disease.

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To clarify whether the size of tuberculin reaction could be used as an useful index of the severity of tuberclosis, we analyzed the sizes of tuberculin reaction (TR) of 60 children below 4 years of age with active tuberculosis at the time of diagnosis. Of 60 patients, 53 (88.9%) had positive reactions to tuberculin. The mean size of TR of 60 patients was 24.0±13.9mm and maximum size was 60mm. Seven patients who had no reaction to the tuberculin skin test consisted of three primary complex and four serious tuberculosis (two miliary tuberculosis and two tuberculou meningitis). The patients without BCG vaccination showed significantly smaller TR than the patients with BCG vaccination (p<0.05). The patients less than1year of age showed significantly smaller TR than the patients of 4 years of age (p<0.05). The patients with serious tuberculosis showed significantly smaller TR than the patients with primary complex (p<0.05). Of patients with primary complex, there were no difference of the size of TR between the patients with pulmonary tuberculosis (III) and hilar lymphadenopathy (H).
Together with, it did not necessarlly mean that negative TR showed no infection with tuberculosis and the sizes of TR depended on the severity of tuberculosis in infantis and young children.

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Of pediatric patients with purulent meningitis seen at the institutions listed in the title page of this paper between1986and1994, 93patients treated with antibiotics and dexamethasone (DXM) were compared with91patients treated with antibiotics alone.
The patients receiving antibiotics with dexamethasone achieved overall improvement in inflammatory symptoms and signs and cerebrospinal fluid findings and became afebrile significantly earlier than those receiving antibiotics alone. However, some of the patients became febrile again. The secondary fever rate for the DXM group was much higher than that for the antibiotic alone group (p<0.0001). In most of the rebounded cases, the body temperature rose above 38°C and remained elevated for 2-4days.
Cerebrospinal fluid (CSF) was cultured daily in 54 and 32patients receiving antibiotics with and without DXM, respectively. Although this study was not a controlled study in a strict sense, these patients compared. In both groups, the CSF became mostly culture-negative within48hours. In a few patients receiving DXM, however, it became culture-negative after 72 hours or longer. DXM caused an adverse effect in a patient with meningitis caused by Streptococcus pneumoniae.The adverse effect was mild gastrointestinal bleeding, which recovered spontaneously.
From the findings described above, the use of DXM combined with antibiotic therapy was considered to accelerate the relief from fever and improvement of inflammatory symptoms and signs and CSF findings. The body temperature rose again in more than half of the patients receiving DXM, but fell to normal spontaneously without treatment. The elevation doubtlessly could not be distinguished from recurrence of the meningitis itself or complications. It seems to be likely that no treatment but careful observation is required even if the fever recurs as far as the CSF findings showed favorable progress with excelluent general conditions.
When DXM is given, it is essential that CSF tests and culture are repeated during the early stages and the progress is monitored carefully.

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We evaluated the clinical and bacteriologic features in the patients with bronchopulmonary infections isolated anaerobes from transtracheal aspirates between April 1990 and March 1998. Some anaerobe was isolated in 42 (10.9%) in 387 patients whom we performed transtracheal aspiration (TTA), in 42 (15.7%) of 268 in whom some organism was isolated from TTA, or in 42 (16.3%) of 257 patients in whom some bacterium excluding acid-fast bacteria, fungi or mycoplasma from TTA. The isolation rate of anaerobic bacteria was 93.3% in the patients with lung abscess, 22.7% in the patients with nosocomial pneumonia, 19.4% in the patients with community-acquired pneumonia, 26.7% in the patients with acute exacerbation of chronic lower respiratory tract infection (CLRTI), 1.6% in the patients with persistent infection of CLRTI, and 3.0% in the patients with acute bronchitis, respectively. The major anaerobes, isolated from TTA, were Peptostreptococcus micros and Prevotella melaninogenica. The aerobic bacteria were isolated with anaerobic bacteria in 32 of 42 patients at the same time. The quantitive grade of colonial growth of anaerobes was equal to or more than aerobes in the patients with lung abscess and pneumonia. We mostly administrated 3rd generation cephems or carbapenems with or without clindamycin for the treatment of anaerobic infections. Fortyone of 42 patients were cured only by the therapy of antimicrobial agents, but pneumonia patient with lung cancer died in spite of adequate antimicrobial therapy. These results suggest that the anaerobic infections are important in the bronchopulmonary infections.

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DUO is an automated HIV infection screening test kit based on the combined detection of p24 Ag and anti-HIV-1 and anti-HIV-2 IgG in human sera or plasma using the ELFA technique (Enzyme-Linked Fluorescent Assay).
The performance of DUO was compared with that of HIV-1/HIV-23rd generation EIA plus and particle agglutination (PA) test. A total of 141 seropositive sera, 3seroconversion panels, 300 seronegative sera and 387 potentially cross-reactive serum samples weretested.
One hundred and forty one seropositive sera in Japan and Cameroon were all positive with DUO. Three seroconversion panels (panel Q, Z, AE) were tested to evaluate sensitivity. In Panel Q, infecution was detected seven days earlier with DUO than with the 3rd generation EIA plus and PA. In Panel AE, infection was detected four days earlier with DUO than with the single antibody assays.
Three hundred seronegative sera from Kanagawa prefectural public health centers were all negative with DUO as well as PA test. Three hundred and eighty seven potentially cross-reacting samples were tested to challenge the specificity of the assay. These included samples from pregnant women and hepatitis patients. In four of the 204 samples from pregnant women, false-positive results were observed with DUO. In three of the 183 samples from hepatitis patients, false-positive results were also obtained with DUO. All samples of 7 DUO positive results were negative with western blot test. Five of them were negative with RT-PCR and 2 of them were nottested because there were not enough samples.
Thirty cross-reacting (false-positive) samples by PA test from blood donors were tested by DUO, and all of these were negative by DUO.

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Influenza vaccine is recommended for the elderly, a high-risk group for influenza infection. Unlike in many developed countries, the rate of influenza vaccination is extremely low in Japan. One of the primary reasons for this low level of vaccination use may be insufficient study on the costeffectiveness of influenza vaccination in Japan. We determined the cost of medical tests and medications for inpatients with influenza in a referred hospital. We compared the medical costs by (1) level of daily life activity, (2) presence of pneumonia, and (3) living/dead status, 9months after the infection. In addition, we set up a control group of patients for comparison of their medical costs to those of the influenza patients.
Mean costs were37, 279 (±26, 784) yen for patients, and 2, 361 (±4, 893) yen for controls. Mean costs were 32, 424 (±30, 935) yen for inpatients without limitations to activity, 44, 075 (±20, 937) yen for bed-bound inpatients, 44, 614 (±28, 609) yen for inpatients with pneumonia, 27, 009 (±22, 783) yen for inpatients without pneumonia, 57, 624 (±21, 041) yen for inpatients who died within9months of the onset of influenza, and16, 934 (±11, 920) yen for inpatients who were alive 9 month after influenza infection.

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The antimicrobial activities of aqueous cacao mass extract against enterohemorrhagic Escherichia coli (EHEC) O157: H7 006 strain were studied.
Hot water extract of cacao mass (cocoa extract) was shown to inhibit the growth of EHEC O157: H7 006 strain in PBS or CAYE medium. In addition, the production of verotoxins (types 1 and 2) of EHEC O157: H7 006 strain was significantly inhibited by 8.0% cocoa extract. The cocoa extract did not neutralize the cytotoxity of verotoxins, but had inhibitory effect on adhesion of verotoxins to the target Vero cells.
These results demonstrate that cacao mass has antimicrobial effects on EHEC O157: H7.

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The authors experienced granular lymphocyte-proliferative disorder (GLPD) with increased lymphocyte and CD4 cell counts after HIV treatment with a protease inhibitor indinavir in a 51-year-old male AIDS patient. GLPD proved to be the chronic type, but we could not differentiate whether it was the T-cell type or the NK-cell type. EB virus was found to be activated and its chronic activity was suggested. We should note in this case that EB virus was involved in the GLPD onset and that GLPD followed the treatment with a protease inhibitor.

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