Serovar-distribution and drug-resistance of a total of 421 Salmonella strains, which were 98 stains from sporadic diarrhea cases and 323 strains from healthy cases between 1991 and 2000 in Tama, Tokyo were investigated.
In serological typing tests, the strains tested were classified into 26 different kinds of serovar in diarrhea cases, 58 in food handlers, and 25 inindividuals for health care. Salmonella serovar Enteritidis (S. Enteritidis) was the most predominant serovar in three cases. Following, S. Typhimurium and S. Infantis in diarrhea cases, S. Hadar, S. Montevideo and S. Thompson in food handlers, or S. Typhimurium, S. Lichfield and S. Oranienburg in healthy individuals were frequent.
The drug-resistance test using 9 drugs (CP, TC, SM, KM, ABPC, SXT, NA, FOM, and NFLX) showed that 57.1% of the strains from diarrhea cases and 36.8% from the healthy cases were resistant to one or the other of the drugs examined. Drug-resistance patterns of those showed 13 types in diarrhea cases and 25 types in healthy cases. Out of them, strains which showed a predominant and common pattern in both cases were SM resistant-S. Enteritidis and CP·TC·SM·ABPC resistant-S. Typhimurium. In addition, the latter strains were also resistant to sulfiso-xazole (SU). In DNA analysis by RAPD method of their strains, common DNA finger-prints were observed in both cases through out the investigation period.

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In Japan, long-term 14-membered macrolide administration is chosen as a first line therapy against chronic lower respiratory tract infections (CLRTIs) such as diffuse panbronchiolitis, bronchiectasis and chronic bronchitis. However, sometimes acute exacerbations occur in these cases, even if therapy is effective. We investigated 18 episodes of CLRTIs exacerbations that were caused by Streptococcus pneumoniae during long-term macrolides therapy from 1991 to 1999 to clarify the clinical features and prevalence of antimicrobial resistance in S. pneumoniae. Exacerbations did not occur only in winter season, but also in other seasons. Among 18 episodes of exacerbation, only 7 episodes (39%) revealed infiltration in chest roentogenogram and few episodes revealed marked elevations of inflammation markers in laboratory data. Intermediate resistance or resistance rates of S. pneumoniae isolated from sputum or transtracheal aspiration were 100% to erythromycin, 67% to clindamycin or minocycline, 11% to ampicillin, and 0% to cephazoline or imipenem. Coresistance to erythromycin, clindamycin and minocycline was seen in a half of the episodes. Resistance was not correlated with the duration of macrolides administration. All episodes were mainly treated with beta-lactam agents or fluoroquinolones and cured successfully. These findings suggest that acute exacerbations in CLRTIs caused by S. pneumoniae during long-term macrolides therapy do not reveal severe clinical aspects and can be treated successfully at present, but attention should be paid to the trend of antibiotic susceptibility in S. pneumoniae.

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We examined the effectiveness of trivalent influenza vaccine in reducing illness, absenteeism, and health care use among health-care workers (HCW) of Ishikawa Prefectural Central Hospital from December 1999 through March 2000.
In recipients of vaccine (n=132), the numbers of febrile illness, severe illness, febrile upper respiratory tract illness were significantly reduced compared with HCW without vaccination (n=595). Use of prescription antibiotics and over-the-counter medications was also reduced. Influenza vaccine also reduced the reported days of work absence.
These data support a policy of annual influenza vaccination of HCW.

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The aim of this study was to assess the utility of the touch smear cytology for the detection ofHelicobacter pylori (H. pylori) infection compared with biological culture, immunohistochemistry and rapid urease test. 1) The diagnostic concordance rate of touch smear cytology compared with both immunohistochemistry and biological culture of the same specimen were 94.2% and 93.8%, respectively. Diagnosis using the touch smear cytology had no statistically significant relation with numbers of H. pylori in the samples determined by immunohistochemistry. 2) Compared with biologic culture, the sensitivity and specificity of rapid urease test were 85.0% and 96.3%, and that of touch smear cytology were 91.2%, 96.3%, respectively. 3) Two biopsies were taken from each lesion (all the patients had two lesions; at the body and antrum) and examined using touch smear cytology. In all the positive lesions, the two biopsies were positive and p value concerning the numbers of H. pyloriwas significant.
In conclusion, touch smear cytology is considered to be one of the reliable methods for the detection of H. pylori infection because of its high accuracy rate, convenience, rapidity, low cost and stability.

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We investigated an epidemiological study for fungus isolation in our hospital from 1976 to 2000. For 25 years, the total sample number of fungus examination were 64, 296, and after 1988, the total sample number increased suddenly. As a whole, the positive ratio was constantly about 40%. When our hospital opened, the obstetrical and gynecological samples showed 38.8% for fungus examination, but recently, samples of the respiratory organ has increased. Ratio of isolation for yeast, Candida albicanswas 53.8%, and another yeasts such as Candida glabrata, Candida tropicalis, Candida parapsilosis were 12.5%, 5.3%, and 3.4%, respectively. Recently, isolation of Candida glabrata showed a tendency to increase.
For genus Aspergillus, Aspergillus fumigatus was isolated, 48.1%, and Aspergillus nigar, Aspergillus terreus were isolated, 31.4% and 7.5%, respectively. For dermatophytes, Trichophyton rubrum was isolated, 63.6% indermatophytes, and another dermatophytes were Microsporum canis (17.9%), and Trichophyton mentagrophytes (15.9%), respectively. For dermatophytes, isolation of Microsporum canis showed a tendency to increase. Recently, the plural number of species showed a tendency to increase in the samples. Compared with the number of samples at the beginning in our hospital, the plural number of species in the samples increased about six times.

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Out of 79 cases of Mycobacterium tuberculosis isolated from clinical specimens at the Iizuka Hospital from 1996 to 1999, 24 cases were isolated from materials other than from the sputa and broncho alveolar lavage fluid (BALF).
For these 24 cases we investigated the clinical features and detection methods. Number of cases among each material was 8, 4, 3, 3, 3, 1, 1, 1 in pleural effusion, biopsied lymph node, pus, cerebrospinal fluid, urine, joint effusion, ascites, endometrium, respectively. By smear method, 5 cases of the 24 (20.8%) were positive, and the most frequent specimen positive for smear method was lymph node (3/4cases), but other specimens reveal a low positive rate. It takes 4 to 8 weeks for determination by culture method, and the number of colonies was few. Only two out of the examined 9 cases, in this study, showed positive results in rapid diagnosis using PCR.

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Chlamydia pneumoniae (C. pneumoniae) is an emerging pathogen recognized in 1989. Althogh C. pneumoniae infection is known to give a great impact on public health in western countries, many aspects remain unclarified in Japan. During December 1999 and March 2000, respiratory symptoms among residents and employees in a nursing home for elderly implicated an outbreak of C. pneumoniae infection. Field epidemiological investigation confirmed that this is the first outbreak recognized in a nursing home setting in Japan, involving 31/59 (15 confirmed) residents and 9/41 (2 confirmed) employees. Fifteen residents developed severe C. pneumoniae infections including one fatal outcome with pneumonia. Epidemiological analysis did not identify risk factors which induce infection or severe illness by C. pneumoniae for the residents. However, for the employees, frequent contact with the residents was demonstrated as a significant risk factor for the infection. None of 13 employees who had no contact with the residents presented C. pneumoniae infection, while nine out of 28 employees who had frequent contact developed C. pneumoniae infections (RR infinite, P=0.04). These results indicated that C. pneumoniae infection spread gradually by human-to-human droplet transmission without specific risk factors. This study raised current problems in diagnosing and treating the C. pneumoniae infection and the need to enhance the awareness of this disease.

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Incidence of various enteropathogenic bacteria was examined from diarrheal faecal samples that were collected from the patients of Kobe City General Hospital and some station hospitals (23, 862), and from overseas travelers (2, 855) over a period of decade (1989-1999) in Kobe. A total of 1, 580 strains were isolated from domestic and 331 strains from overseas travelers. The results are as follows.
1) Thirteen kinds of enteropathogenic bacteria were isolated from domestic diarrheal cases (6.6%). Salmonella was the most predominant bacteria followed by Campylobacter, Vibrio parahaemolyticus, enteropathogenic Escherichia coli and Shigella.
2) Eleven kinds of enteropathogenic bacteria were isolated from overseas diarrheal travelers (11.6%). The most frequently isolated species was Salmonella, followed by Vibrio parahaemolyticus, Shigella and Plesiomonas shigelloides.
3) Of Salmonella strains isolated from domestic and overseas diarrheal cases, serovar Enteritidis was the most predominant. Other frequent serovars in both cases were Typhimurium, Tennessee, Hadar, Infantis, Blockley and Montevideo.
4) Antibiotics resistant rate of the isolated Salmonella strains was 42.6% for domestic samples and 29.3% for overseas diarrheal cases. In domestic cases, Enteritidis was resistance to streptomycin only and the multiple antibiotic resistance was observed in Typhimurium serovars. In overseas samples, the multiple antibiotic resistance was seen in a few Typhimurium, Anatum and Blockley strains.
5) Among Shigella, S. sonnei was isolated from both domestic and overseas cases. The frequency of acquiring infection was the highest in India, followed by Indonesia, Thailand and Nepal.
6) With reference to the incidence of the members of the genus Vibrio, Aeromonas and Plesiomonas, V. parahaemolyticus were abundant from domestic samples where as V. parahaemolyticus, P. shigelloides, Vibrio cholerae non-O1 and Vibrio cholerae O1 were isolated more frequently from overseas samples. The frequency of acquiring infection was the highest in Thailand, followed by Indonesia and India.

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On January 17, 2001, a 39-year old female with sudden abdominal pain was admitted to her neighboring outpatient clinic and diagnosed as suspicious of infectious enteritis. However, on the next day (January 18, 2001) she was soon transferred to Toyoshina Red Cross Hospital with the chief complaint of severe abdominal pain, high fever, and of conspicuous leucocytosis. Laboratory data on her admission demonstrated apparent signs of inflammation and she was soon undergone an emergency operation. Neisseria gonorrhoeae was recovered from her ascetic fluid, otherwise Chlamydia ETA was negative.
The antibiotic chemotherapy of minocycline (200mg/day) was continued for the first 9 days and sulbactam/cefoperazone (2g/day) had been administered for the first 5 days. Her symptoms were discontinued on her 10th hospital day, and she was discharged on the 14th hospital day.
There have been few reported cases in Japan of bacterial peritonitis due to N. gonorrhoeae. This is, to the best of our knowledge, the first reported case of N. gonorrhoeae peritonitis in Japan.

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Toxic Shock Syndrome (TSS) secondary to mastitis is seldom described. We present a case of TSS due to postpartum mastitis caused by Methicillin-resistant Staphylococcus aureus (MRSA). Five weeks after giving birth to a healthy boy, a 23-year-old secundipara was readmitted to the hospital with a fever, systemic erythema, nausea, vomiting, diarrhea, diffuse myalgia, generalized itching, orthostatic syncopes, photophobia, oligurea and pain in the left breast. Laboratory data on admission revealed deteriorated renal and coagulation function. Adminstration of Vancomycin, Imipenem, dopamin and nafamostat mesilate was started immediately after admission, that was effective. The patient recuperated steadily over the next week with apparent desquamation of the skin on her face, breast and extremities especially palms and soles. MRSA isolated from her milk was coagulase type II producing toxic shock syndrome toxin-I (TSST-1) and enterotoxin C. Also immunoglobulin G against TSST-1 was not detected from her sera both on admission and on discharge, which suggested that the patient belongs to the high risk group of TSS recurrence.

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