To clarify the characteristic features of nursing home-acquired pneumonia in our community hospital, we performed a clinical analysis of 86 patients with nursing home-acquired pneumonia. The patients were divided into young and elderly groups. In the young group cerebral palsy was the nuderlying disease. In the elderly group, it was cerebrovascular attack. Although there were no differences in ADL, the nutritional condition of the young group was comparatively good, the isolated microorganism consisted of mostly Mycoplasma pneumoniae and the prognosis was good. The elderly group where the nutritional condition was poor, the patients were detected by non-respiratory symptoms and risk factors such as obvious episodes of aspiration led us to be concerned about the risk factors for nursing home-acquired pneumonia. The microorganism isolated from the sputum of the elderly group was frequently a multi-drug resistant microorganism such as Methicillin-resistant Staphylococcus aureus (MRSA) and polymicrobial infection. Their prognosis was poor despite treatment with multiple antibiotics.
In the comparative study between survivors and non-survivors in the elderly group, risk factors such as hypotension, consciousness disturbance, the extension of infiltration shadows, respiratory failure, multiple organ failure and metabolic acidosis were influenced for the prognosis, but the isolated microorganisms and the antimicrobial agents were not concerned.

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We evaluated 82 children with bacterial meningitis in 78 insitutions in Hokkaido, Japan between 1994 and 1998. The mean number of cases per year was 16.4 (range, 9 to 30). A male predominance occurred with 52 males and 30 females (1.7: 1). Median age was 11 months with a range from 1 day to 11 years. Seventy-eight (95%) of the total were less than 5 years old with 55 (67%) less than 2 years old and 45 (55%) less than 1-year old. Four deaths occurred, giving an overall case fatality rate of 4.9%. Sequelae were seen at discharge in 29%, predominantly sensorineural hearing loss, epilepsy and development delay of varying severity. The main causative organisms were Haemophilus influenzae in 49 patients, Streptococcus pneumoniae in 14, Streptococcus agalactiae in 10 and Escherichia coli in 5. The frequency of poor prognosis was 50% for patients with meningitis due to S. pneumoniae or S. agalactiae compared with 27% for patients with meningitis due to H. influenzae.

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A total of 118 nalidixic-acid (NA)-resistant Salmonella strains consisting of 68 domestic strains and 50 imported strains isolated during 1988-1998 in Tokyo were examined regarding their annual incidence, serovars, drug-resistance patterns, and minimum inhibitory concentrations (MIC) to fluoroquinolones (NFLX, OFLX, ENX, and CPFX).
NA-resistant strains accounted for 1.3% of all Salmonella (5, 302 strains) isolated from domestic cases, and 2.5% of all Salmonella (1, 981 strains) isolated from imported cases. The incidence of NAresistant strains has increased since 1995, and it has been remarkable in imported cases.
The results of the serotyping showed that the NA-resistant strains were classified into 25 serovars, excluding untypable strains. Among those, S. Enteritidis (21 strains), S. Blockley (13 strains), S. Litchifield (13 strains) S. Typhimurium (13 strains), S. Hadar (9 strains) and S. Virchow (8 strains) were predominant.
Drug-resistance patterns of NA-resistant strains, including other drugs (CP, TC, SM, KM, ABPC, ST, FOM, and NFLX) tested varied among the 26 types. Among those, multidrug-resistant strains accounted for 61.9% (73 strains), and one strain among them was high-resistant to NFLX.
MIC distribution of NA-resistant strains to fluoroquinolones showed that the ranges of all drugs were 4-128 times higher than NA-sensitive strains used for controls.

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Institutionalized elderly patients are at risk of nosocomial infection because of their compromised status by aging. To clarify the relationship between fever and disease in elderly patients, we analyzed 1, 105 febrile episodes, the etiology of which were already diagnosed, of 443 patients (136 men, 307 women). All patients who were 65 years of age or older and who had been admitted to the hospital for more than 7 days had fevers above 37.5°C recorded. The etiologies of the 1, 105 febrille episodes were respiratory tract infection in 381 (34.5%), urinary tract infection in 263 (23.8%), other diseases in 164 (14.8%) and in 297 (26.9%) unknown. The episodes were categorized into two groups by the degree of initial fever: group A, 559 episodes (50.6%) of 37.5-38.0°C and group B, 546 episodes (49.4%) of above 38.0°C. Of the episodes, 41.0% were one-day fevers, 21.4% two-day fevers, and 14.0 % three-day fevers. The frequency of two-or-more-day fevers was significantly higher in group B (69.0%) than in group A (49.2%) (p<0.001). In group B, respiratory tract infection (44.3%) was more frequent than urinary tract infection (16.1%) (p<0.001). Of the respiratory tract infections, 63.5% were in group B and, in contrast, 66.5% of the urinary tract infections were in group A. The white blood cell count and C-reacting protein levels were significantly higher in group B than in group A (p<0.001). The degree of initial fever is an important predictive marker of severity of disease in elderly patients.

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Sequences of HIV-1 pol gene were determined by direct sequencing from a Japanese patient with primary HIV-1 infection. The patient did not receive antiretroviral therapies. However we observed a HIV-1 mutant strain associated with zidovudine (ZDV) resistance. The patient had both the codon 70 and the codon 215 amino acid substitutions in the RT region. Our data indicated that the patient was infected with a HIV-1 mutant strain associated with ZDV resistance and this is the first report in Japan.

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The present study investigated fecal flora changes in 20 patients who received either the nonabsorbable antifungal agent amphotericin B, or the absorbable antifungal agent flluconazole, with tobramycin and vancomycin as preparation for undergoing allogeneic bone marrow transplantation (BMT). The oral antibiotic regimen consisted of tobramycin (540 mg/day, three times a day), vancomycin (1, 500 mg/day, three times a day) and either amphotericin B (2, 400 mg/day, twice a day) (AMPH group) or fluconazole (400 mg/day, twice a day) (FLCZ group) and was designed to prevent infections from microorganisms in the gut. Aerobic bacterial colonies were not detected on the day of BMT or 1 week after BMT, except in 1 case unable to take the full antibiotic regimen due to nausea and vomiting. Anaerobic bacterial colonies were not detected on the day of BMT except in this single case. Furthermore, there were no episodes of bacterial infection. In both groups, Candida colonies were detected in some case. Candida colonies were also detected in the pharynx and urine. However, there were no fungal infections. The present report suggests that amphotericin B and fluconazole administrations, with tobramycin and vancomycin, are equally effective for protection against bacterial and fungal infections in BMT recipients.

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One hundred fifty one O serotypable Escherichia coli strains which were assumed diarrheagenic E. coli among 2, 240 strains of E. coli isolated from the in-and outpatients stools with or without gastrointestinal symptoms at Kyorin University Hospital from February 1994 to September 1996 were examined for the relationship between the possession of eight pathogenic factor-related genes and gastrointestinal symptoms of the patients using the polymerase chain reaction (PCR) for these strains.
The rate of possession of pathogenic factor-related genes in the E. coli examined was 20.5% (31 strains) and gastrointestinal symptoms were found in all the patients with these strains except one. In the patients without gastrointestinal symptoms, E. coli isolates that possesses these genes was detected in only one case during 61 cases. The respective genes detected were eaeA and astA in each 14 strains, VT1 in 6, VT2 in 5, ST1b in 4, aggR in 3 and LT in 2, ST1a and invE gene was not detected. In particular, the O157 strains were found in 55.6% (5/9 strains) for these genes, and individual strains had VT1, VT2, eaeA and astA genes simultaneously. In contrast, none of these related genes was found in 9 strains of enteroinvasive serotype but enteropathogenic E. coli -related genes were found in 3 strains. The rate of possession of the genes related to enterotoxigenic E. coli, O159 which was most frequently isolated was low as 2.3% (1/43 strains, astA gene) and there were strains showing low correlation to the state of possession of the genes with the O serotype. Since the prevalence of the gastrointestinal symptoms is clearly high for the case which possesses the strain of which the pathogenic factor-related gene was detected, it was suggested that detection of pathogenic factorrelated genes in E. coli isolates from feces using the PCR could be an effective means to decide whether the bacteria concerned was a causal bacteria or not in clinical practice.

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Autopsies with solid-organ trans plantation (SOT) in UCLA Medical Center were reviewed, especially focussing on the deep-seated fungal infection and the incidence of fungal infections, causative fungi, and organs involved were evaluated.
Deep-stated fungal infections were demonstrated in 21.0% of the patients with SOT. The incidence of fungal infections were 26.1% in kidney transplantation, which was the highest rate in SOT autopsies we reviewed, 25.0% in liver transplantation. 14.3% in lung transplantation, and 13.2% in heart transplantation.
And the most common causative fungi were Aspergillus species, seen in 70.6% of SOT autopsies. In contrast, Candida species were observed in 25.5%. In addition, the incidence of deep-seated mycosis has been increasing since 1992, this was parallel to the increase of aspergillosis, most of which were found as a generalized spreading. In contrast, candidial lesions, were almost limited to the digestive tracts.
The above suggests that from this standpoint, improvement of prophylactic and therapeutic technique against aspergillosis is the greatest problem in deepseated mycosis in SOT patients.

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We evaluated the usefulness of a serological diagnostic kit (Bartonella IFA IgG, IgM; MRL Diagnostics) for Bartonella henselae infection.
Of the 110 healthy individuals, 107 (97.3%) were with titers being less than 1: 64 for IgG antibody to B. henselae, 2 were with titers being 1: 64 and 1 with 1: 128. IgM antibody to B. henselae was negative in all individuals.
Serological diagnosis of cat scratch disease (CSD) using indirect fluorescence antibody (IFA) methods (in-house and diagnostic kit) was made in either elevated titers of IgM (≥1: 20) or IgG (≥1: 256) antibodies, or a four-fold rise in IgG titer between acute and convalescent sera. Of the 18 individuals with serological diagnosis of CSD by in-house IFA method in 26 CSD clinical diagnosed patients, 15 (83%) were compatible with the results of the diagnostic kit, whereas 3 (17%) were not compatible. Of the 8 without serological diagnosis, 1 (13%) was serologically diagnosed as CSD, and the others were negative. Overall, the serological diagnosis was made in 16 of 26 (62%). The specificity and sensitivity of this kit were 100% and 62%, respectively. The cross-reaction between B. henselae and Bartonella quintana was observed in sera from comtrols and patients.
Our results show that the diagnostic kit as well as in-house method is an useful tool for the serological diagnosis of cat scratch disease.

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A neonatal varicella case confirmed early to be infected with varicella-zoster virus (VZV) using PCR analysis was reported. The mother devoloped an eruption on the following day the patient's birth and was diagnosed as varicella at 3 day of age. The neonate received immunoglobulin and acyclovir (17.5mg×twice). She was speculated to develop varicella on the 5 to 10 day of age.Eruptions were noted, however, on the 13 day of age, although she was confirmed to be infected with VZV using PCR on the 6 day of age, and her symptoms were much milder than that foreseen. Delay of development and mildness of her symptoms may be attributed to immunoglobulin and acyclovir given on the 3 day of age.PCR method was very useful in determining early that she was infected with VZV.

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