Induction of tumor necrosis factor alpha (TNF-α) of human leukocytes by overnight culture supernatants of Staphylococcus aureus (S. aureus) (CS) (4 strains) and then the effect of the complement on production of TNFα by the treated cells were examined. One-tenth diluted solution of CS was added to Heparinized blood and was incubated for 6 hrs at 37C in a 5% CO-air humidified incubator. TNFα level in the plasma was measured by ELISA. The level in the plasma was different in different CS. The induction of TNFα was not found in EDTA -added blood but was found in the EGTA-added them treated with CS, though different levels were showed. Western blotting assay of these plasma samples without EDTA-added blood found the presence of both C5a and C3a. Neither C5a and C3a was found in Heparinized blood treated with a relative concentration to TSST-1, enterotoxin C and alpha (α) homolysin contained in CS. Mixture of these toxins induced only 1/6.5 of the TNFα amount obtained with the CS. Human leukocytes isolated by Mono.-Poly. resolving solution were cultured with CS in RPMI 1640 medium with or without 10% fresh or heated serum. Production of TNFα by the isolated leukocytes was not found under the condition of serum free. But it was found in the presence of fresh serum and also in the presence of heated serum. The addition of CS to RPMI 1640 containing heated serum did not occur naturally in the production of C5a. These results suggest that there is a difference in TNFα inductivility to human leukocytes in each strain and that other bacterial components without TSST-1, SEC and α-hemolysin are more important to induce TNFα. Serum may be necessary to produce TNFα by CS-treated cells as a source of factor (s) to interact with bacterial components rather than a source of complement.

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We experienced 530 elderly cases with pneumonia among 930 patients with pneumonia in Kawasaki Medical School Kawasaki Hospital between April 1986 and September 1998. Clinical analysis of all these patients and a comparison of one group consisting of 418 patients with communityacquired pneumonia and another group composed of 112 patients with nosocomial pneumonia were performed. In all of the elderly patients with pneumonia, respiratory symptoms and inflammatory findings were less frequent, but were frequent for those in poor general and nutritional condition.
The causative microorganism was isolated in 42% of these patients. Streptococcus pneumoniae, MSSA and Klebsiella pneumoniae were frequently isolated from the sputum of the patients with community-acquired pneumonia, while Methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, Methicillin-sensitive Staphylococcus aureus (MSSA) were frequently isolated from that of nosocomial pneumonia patients. Mycoplasma pneumoniae, Chlamydia pneumoniae and some viruses were less frequent for patients in both groups. Although many intravenous antibiotics, such as cephem or carbapenem were administered to patients in both groups, the prognosis was relatively good for those with community acquired pneumonia but was extremely poor for those with nosocomial pneumonia despite mechanical ventilation or steroid pulse therapy for many patients.

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Recently. in Japan newly neonatal exanthematous disease was elucidated to be caused by staphyloccocal superantigcnic exotoxins, mainly TSST-1.
We studied exotoxins producibility of 43 strains ofS. aureusisolated from neonates with exanthematous disease and examined antibody titers to staphylococcal enterotoxin A, B, C (SEA, SEB, SEC) and toxic shock syndrome toxin 1 (TSST-1) of the patients and control (umbilical cord blood from term infants). The results were as follows
1. 34 of 43 strains (79%) isolated from the patients were SEC and TSST-1 producing MRSA, 5 strains (12%) were SEB, SEC, and TSST-1 producing MRSA, 1 strain (2%) was SEB and TSST-1 producing MRSA, 2 strains (12%) were SEB producing MSSA and did not produce TSST-1. The 1 strain (2%) was MSSA which produced SEC and TSST-1
2. 16 neonates with exanthematous disease, who showed typical clinical signs and laboratry findings of thrombocytopenia, with SEC and TSST-1 producing MRSA isolates had significantly low anti-TSST-1 antibody titers at onset (p<0.05), compared with the control (umbilical cord blood from term infants): TSST-1 appeared to the causative agent for the disease.
In two neonates with exanthematous disease, with SEB-and non-TSST-1--producing MSSA isolates, anti-SEB antibody titers were low at onset, so SEB appeared to the causative agent for the disease.
3. In Japan, low anti-TSST-1 antibody titers were found in the umbilical blood samples from about 70% of term infants; and low anti-SEB or anti-SEC antibody titers were found in samples from only about 10% of them, that is, a number of term infants had anti-SEB and anti-SEC antibodies.
The majority of S. aureus isolated from neonates with exanthematous disease were enterotoxinand TSST-1-producing MRSAs.
The results of our study by measuring antitoxin antibody titers suggested that SEB and SEC might not be pathogenically responsible, but TSST-1 was considered to be responsible for the majority of exanthematous disease.
Prevalence of TSST-1-producing MRSA in the neonatal and premature baby ward is the main cause for the high incidence of this disease in Japan, whereas the low antibody titer to TSST-1 in the mother, in comparison with the anti-enterotoxin antibody titers, may also be a predisposing factor.

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Twenty-eight cases of bacterial meningitis during the recent ten years were analyzed retrospectively, and the following results were obtained.
1. Pathogens were as follows; H. influenzae 13 (46.4%), S. pneumoniae 8 (28.6%), S. agalactiae 4 (14.3%), E. coli 2 (7.1%), and L. monocytogenes 1 case (3.6%).
2. Twelve out of the thirteen H. influenzae cases were caused by serotype b (Hib), and 2 strains were β-lactamase producer. Fifty percent of the S. pneumoniae cases were caused by penicillinresistant strains. And all these resistant strains belonged to serotype 19 or 23.
3. Underlying diseases related to the onset of meningitis were found in 46% of the cases, and these consisted of CNS shunt operated 5, asplenia or polysplenia 2, Mondinrs anomaly 1, sacral dermal sinus 1, and neonate 4 cases.
4. Prognosis of these cases were three deaths, four with neurologic sequelae, and twenty-one complete recoveries.
5. On admission, 85% (17/20) of the cases were diagnosed correctly by the rapid antigen detection. Sensitivity and specificity of the rapid antigen detection by using latex particle agglutination is 90% and 100% in the Hib cases, and 83% and 100% in the S. pneumoniae cases respectively. Moreover, the bacteriologically unknown 2 cases caused by parenteral partial treatment were also diagnosed by the detection of antigen in concentrated urine.

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It is well known that the emergence of syncytium inducing (SI) variant correlates accelerated CD4 decline and disease progression during the course of HIV infection. We have conducted a clinical study to investigate whether or not detection of SI by MT-2 cells (MT-2 assay) can be a clinical marker to decide when to start anti-HIV therapy since 1995. We examined 483 blood samples obtained from 172 HIV-infected patients by the MT-2 assay. SI was detected from 20 patients. There were five untreated patients whose CD4 counts were 300/μl or more. Anti-HIV combination therapies were started soon after detection of SI in all of them. We have followed their clinical courses for more than 4 years, so far, in three of them. Their CD4 counts and clinical courses were both stable. In contrast, in another patient who could not receive any anti-HIV therapy even though SI positive, decline of CD4 was very rapid (200/μl/year) and the disease progressed to AIDS within one year as like other SI positive cases before the era of several approved anti-HIV drugs. According to these distinct prognosis, the MT-2 assay might be a useful clinical marker for deciding anti-HIV therapy at least in our limited cases.

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In 1998, the worst flood disaster in Bangladesh ravaged more than half of its land and diarrheal epidemics broke out. We examined fecal specimens of diarrheal patients at rural hospitals in Chand-por district located 140 km southeast of Dhaka to analyze the enteric bacterial pathogens in post-flood period October. Of the 76 patients stools examined, Vibrio choleraeO1 biotype El Tor, serotype Ogawa, andVibrio choleraeO139 Bengal were detected in 25 (33%) and in 14 (18%) respectively. Other enteropathogenic bacteria confirmed wereVibrio choleraeO5, Vibrio fluvialisand Enteropatho-genicEscherichia coliO44. NeitherShigellanorSalmonellaspecies was detected in this study.
A drug susceptibility test was performed using TC, DOXY, CPFX, NA, and AMPC disks to chol-era Vibrios. The O1 Vibrios showed the same susceptible pattern as O139 excluding NA susceptibil-ity. TC resistant strain among the Vibrios was not detected though TC is a common therapeutic drug for diarrhea in this area. Our result clearly suggested that the epidemic potentiality of O139 still existed in rural Bangladesh.

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We conducted a molecular epidemiological analysis to evaluate the epidemiologic patterns of Shigella sonnei isolates from outbreak cases in Yokohama to clarify the epidemiologic linkages by con-tact tracing and sources of infection. In the first case (case A), all of the 6 isolates were the colicin O type and resistant to both streptomycin (SM) and trimethoprim/sulfamethoxazole (ST). The 5 iso-lates have plasmid of 230kb. By RAPD analysis with 2 kinds of primers specific for Shigella, every 6 isolates showed the same pattern. But the DNA fingerprint analysis by PFGE that was performed ac-cording to 2 standardized restriction endonucleases revealed a discriminative pattern.However, the resemblance of all isolates, which was calculated by the UPGMA methods, was 0.90 or higher. In the second case (case B), all of the 14 isolates were the colicin 6 type and sensitive to 16 drugs. The sero-type of 13 isolates was phase I. The 11 isolates have plasmids of 230kb and 3kb. The resemblance of all isolates, which was calculated by the UPGMA methods, was 0.89 or higher.
The analysis with a combination of the plasmid, RAPD analysis and PFGE profiles may be effec-tive in investigating detailed epidemiological features of isolates.

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A 55-year-old male was admitted to our hospital because of fever and left submaxillary, right ax-illary, and left inguinal lymphadenopathy. A presumptive diagnosis of rickettsiosis was made and treatment with oral doxycycline was started. Lymphadenopathy was partialy resolved after antibiot-ics treatment. Ablation of the left inguinal node was done and histopathological examination showed non-Hodgkin's lymphoma. Lymphadenopathy was resolved by chemotherapy. The second patient, a 40-year-old male, developed a tender submandibular node. Excisional biopsy of the node was per-formed to eliminate lymphoma. Histopathological examination revealed granulomatous lymphadeni-tis with follicular hyperplasia. The patients had no history of cat contact, but owned a dog. Diagnosis of both cases was confirmed by the detection of IgG antibodies toBartonella henselaewith an enzyme immunoassay. Our findings suggest that dogs are implicated inB. henselaeinfection and can serve as a reservoir of the organism as well as cats. In the abscence of other bacterial and especially after ex-posure to dogs, B. henselaeshould be included as possible cause of lymphadenopathy.

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[Case report] A 65-year-old male war admitted to a local hospital because of fever.He was treated with piperacillin and clindamycin without noticeable effect.He began to complain of loss of vi-sion on the third hospital day and culture of the blood specimen yieldedKlebsiella pneumoniae.He was diagnosed as endophthalmitis and referred to our hospital for further examination.The hematologi-cal laboratory test showed leukocytosis (12, 700/ul) and increased CRP (20.4mg/dl).A computed to-mographic (CT) scan of the thorax revealed multiple lung abscesses.An abdominal ultrasonographic scan and a CT scan of the abdomen revealed multiple liver abscesses.We drained the abscess in the liver andKlebsiella pneumoniaewas detected from the sample of aspirated fluid and his sputum.Mero-penem was administered intravenously.Fever started to improve on the tenth hospital day and the size of both liver and lung abscesses were reduced. He has lost vision of his right eye.He was dis-charged after sixty days.He did not have any immunosuppressive underlying disease including HIV infection and diabetes mellitus which cause these lesions.

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Mycoplasma pneumoniae infection is often experienced as community-acquired pneumonia, whereas Chlamydia trachomatis pneumonia is sometimes experienced as a vertical infection frommother to child through delivery, but is rare after six months of age. We reported the first case todate of a seven-year-old boy with coinfection of C. trachomatis and M. pneumoniae. The patient, whowas referred to our hospital because of suspected pneumonia, had had severe cough and pyrexia forfour days before his admission. The coinfection was confirmed because the antibodies to both bacteria were significantly increased. In addition the PCR for C. trachomatis detected the presence of C. tra-chomatis in the throat even after treatment. The PCR from a cervix swab of his mother and from athroat swab of his father were negative, but their antibodies to C. trachomatis were positive. We think that this may have been community-acquired pneumonia or due to persistent infection after a vertical transmission.

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