In 1998, we developed a Total Infection Control System in Saga Medical School Hospital, and would like to introduce it for the practical use.
This system was named “Dr. FLEMING” (Flexible Microbiological Test & Information System for the New Generation) and is expected to help physicians by providing highly valuable test results and useful information. For example, bacterial identification and drug susceptibility test can be completed within 4-6hrs after bacterial colony is isolated, and the test report the contains full-colored pictures to enhance understanding. In addition, we have made an information center for infectious disease, where physicians can have access to various data bases outside our hospital. Furthermore, we offer many kinds of useful information to physicians working at other medical facilities to assist their clinical practice of infectious diseases.

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In the study of prevalence of hemolytic streptococci in Kitakyushu-city from 1994 to 1997, both seasonal variation of the number of group A hemolytic streptococci isolates and their age distribution fitted in well with the cases of streptococcal infection which is monitored in the Japanese infectious disease surveillance system. Dominant serotypes of group A hemolytic streptococci in Kitakyushucity were T-12 and T-3 from 1994 to 1995, T-28 and T-12 in 1996, T-2 and T-4 in 1997. Compared. with prevalent seropypes of group A hemolytic streptococci in the City and those in Japan, the geographically close relation was observed. The epidemic serotypes in the City tended to fall behind those in Honshu, the main land of Japan
Most of the isolates were resistant to kanamycin (KM). Few isolates were resistant to other drugs except tetracycline (TC), to which 14% of the isolates were resistant. Strains of multiple-drug resistant were less than 5%.
Gene of spe B was detected in all group A strains by PCR method, and a close relationship was observed between T-type and SPE gene type.

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An outbreak of cryptosporidiosis occurred in Ogose Town, Saitama Prefecture. Japan, in June 1996. Of 12, 345 respondents to a questionnaire sent to households in the town (population; 13, 809), 8, 812 (71.4%) reported an acute gastrointestinal illness some time between May and July. In addition, 274 traceable visitors at local inns, golf courses, and the like during this period and 54 employees from out of town were infected. Cases of cryptosporidiosis were estimated to 9, 140. Of these, 2, 856 subjects were treated at outpatient clinics and 24 subjects were hospitalized (some subjects counted twice). No deaths were attributed to the outbreak. Among the visitors to Ogose who were traced, 7 persons who stayed only one day during the outbreak and drank half a glass to 2 glasses (100 to 360ml) of tap water had cryptosporidiosis confirmed by laboratory tests. The median incubation period for the 14 persons for whom this calculation was possible was 6.4 days (range, 5 to 8 days). Of 469 pupils reporting details of their fever and diarrhea, abdominal cramps, or these combined signs and symptoms, the median maximum body temperature was 37.8t (range, 36.7 to 40.3°C). The duration of illness, reported by 608 of the pupils, was 5.2 days (range, 1 to 15 days), and that reported by 187 employees was 4.8 days (range, 1 to 18 days). The longest known time for discharge of oocysts after onset was 44 days. Blood was not found in the 609 stool specimens examined.
The outbreak was caused by contamination of the town's potable water by Cryptosporidium parvum oocysts. The town's water treatment plant treated river water by coagulation, sedimentation, sandfiltration, and chlorination. Contamination arose because of various natural and artificial factors: one was that the monthly precipitation in May was much lower than average, causing the river water level to drop. Another factor was heavy rainfall one night in May that increased water turbidity. The amounts of the coagulant added seemed to be insufficient. There are two inns, three public lavatories, and two smallscale wastewater treatment plants upstream 400m and 1, 200m of the intake point of the town's water treatment plant. However, there are no farms with livestock in the area. We suggest that the location of the water treatment facilities was inappropriate, and that oocysts had circulated from the potable water to humans to sewage to the river and back to the potable water.

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We investigated the conditions of enrichment cultures preceding the immunomagnetic separation (IMS) procedure to detect Escherichia coli O157 (E. coli O157) from human stool specimens in routine laboratory examinations. Samples were made by adding either of the three selected strains of E. coli O157 to stools from three healthy human subjects in three different doses. The enrichment cultures were done for 18 hours at 37°C or 42°C, using five different media such as trypticase soy broth (TSB), TSB containing cefixime, tellurite and vancomycin, modified EC broth (mEC), mEC containing novobiocin (N-mEC) and BGLB.
The IMS procedure following enrichment culture increased the detection rate of E. coli O157, irrespective of the kinds of the media and the temperatures. It recovered E. coli O157 in 42 samples out of 90, while only 31 samples were positive when the IMS was not applied. The N-mEC showed the best recovery rate of the five enrichment media, and it was the only media that recovered the E. coli 0157 Gunmma 298 strains at a level of 2-3 cells per ml.
In 73 stool samples collected from probable patients with E. coli 0157 infection and subjects who made close contact with the patients, positive results were obtained in six samples with the N-mEC enrichment followed by the IMS procedure, while only three samples were positive by the direct isolation culture.
It was concluded, therefore, that, in routine laboratory examinations of E. coli O157 from human stools, the N-mEC enrichment culture for 18 hours followed by the IMS procedure is a sensitive method even when the dose of E. coli O 157 in the stool is minimal.

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Growth of Aspergillus was observed in the necrotic tissue of non-cavitary lung cancer. Case 1 was a 60-year-old male complaining of cough and fever and was found to have left lower lobe atelectasis on chest X-ray. Bronchoscopic examination showed the yellow soft lesion occluding the left upper and lower lobe bronchus. Specimen from the lesion demonstrated adenocarcinoma and hyphae of Aspergillus in the necrotic tumor. Case 2 was a 53-year-old male who was found to have a left upper lobe mass by chest X-ray screening. Bronchoscopic examination showed the yellow polypoid lesion occluding the left upper division bronchus. Pneumonectomy was done and resected specimen of the lesion demonstrated adenocarcinoma and the hyphae of Aspergillus growing in both necrotic tissue and cancer tissue.
As both patients had hyphae of Aspergillus in the necrotic tumor, it is considered that the presence of necrosis may cause the growth of Aspergillus.

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In this roport, we describe three patients with pulmonary tuberculosis with acute respiratory failure with an extensive tuberculous consolidation in bilateral lung fields. Disseminated intravascular coagulation (DIC) was present in one patient and miliary tuberculosis in two patients. They all developed acute respiratory distress syndrome (ARDS), nessecitating management by mechanical ventilation with a combination therapy of antituberculous agents and methylprednisolone (m-PSL) pulse therapy. Only one patient survived in whom the Pa02/Fi02 ratio recovered rapidly after the initiation of therapy. Two patients whose systemic condition upon admission was critically ill eventually died of hepatic failure and bacterial pneumonia, even though ARDS and pulmonary tuberculosis were successfully treated. Prognosis of pulmonary tuberculosis complicating ARDS and DIC is poor, and these patients need systemic intensive treatment, in which m-PSL therapy may be beneficial

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Using a kit for the rapid detection of Streptococcus pneumoniae, we examined 3 clinical cases, clearly diagnosed as pneumococcal pneumonia. Case 1 was a 63-year-old man hospitalized for right middle lobular pneumonia. Streptococcus pneumoniae was detected by blood culture initiated on the day of admission. His urine sample was found to have Streptococcus pneumoniae antigen at hospital day 4, and positive test results were observed 3 times thereafter. The other 2 cases had negative sputum and blood cultures, but they were positive for urine antigen, with clinical courses consistent with those of pneumococcal pneumonia. The kit used was determined to provide a test result within 15 min for each urine sample, and it was easy to perform. Thus, this kit is expected to serve as a very useful clinical tool.

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A 53-year-old male was admitted to Gifu Red Cross Hospital with the complaints of diarrhea, abdominal pain, and fever. He had a temperature of 38.4°C and diffuse abdominal tenderness without guarding or rebound. Plain film of the abdomen showed marked dilatation of the transverse colon. Sigmoidoscopy showed multiple aphthoid erosions and pseudomorphic ulcers, and mucosal biopsies demonstrated numerous trophozoites of Entamoeba histolytica. The patient was treated with oral metronidazole with rapid improvement. Barium enema and colonoscopy after improvement showed multiple cicatricial strictures. Although prompt diagnosis and therapy prevented fulminant changes, the patient was cured with multiple cicatricial strictures, a rare complication of amebic colitis. It is important to keep in mind severe amebic colitis in the differential diagnosis of patients with diarrhea and high fever.

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