We investigated the efficacy of infection control measures against nosocomial pneumonia in geriatric wards. Cases with nosocomial pneumonia were retrospectively analyzed between January 1991 and March 1995. The study period was divided into four annual periods (periods 1, 2, 3 and 4). Period 1, January to December 1991, was applied as the cotrol. We investigated patients with nosocomial pneumonias in geriatric wards (190 beds) of AINO Memorial Hospital, affiliated with Nagasaki University.
During the study period, nosocomial pneumonia significantly diminished.(period 1 vs periods 2, 3 and 4, p<0.05, p<0.05, p<0.05, respectively). Major causative organisms of nosocomial pneumonia were MRSA and Pseudomonas aeruginosa. During the four periods, a significant reduction in cases with MRSA-and P. aeruginosa-induced nosocomial pneumonia was observed (MRSA: period 1 vs periods 2, 3 and 4, p<0.05, p<0.05, p<0.01, respectively, P. aeruginosa: period 1 vs period 3, p<0.01, period 2 vs periods 3 and 4, p<0.01, p<0.05, respectively).
On the other hand, the improvement of decubitus ulcers was associated with a significant reduction in nosocomial pneumonia (period 1 vs. periods 2 and 3, p<0.05 and p<0.05, respectively). In conclusion, stringent infection control programs, including a cleaning in the upper airways by povidone iodine, are necessary in geriatric wards to reduce and prevent nosocomial pneumonia.

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A novel anti-HIV antibody detection kit, by which anti-HIV-1/2 antibodies were detected based on the counting immunoassay using an auto analyser (PAMIA-50), was evaluated. In an examination using 100 sapmles each of HIV-1 antibody positive and negative sera, either sensitivity and specificity was 100%. This kit was able to detect all antibodies tested including against HIV-1 subtype A to F, E/F, C/E, B/O, HIV-1 group O, and HIV-2. However, by one of the comercially available kits, one serum containing anti-subtype A antibody was missed. In other comparative studies with the conventional kits using various commercial available panel sera, the same results were obtained. This method was completed within 15 min and was able to examine many samples at one assay. Therefore, this kit is a useful and reliable one if hospitals or institutions had PAMIA-50 in their clinical laboratory.

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We experienced a hospital outbreak of salmonella food poisoning after ingestion of omelet which was the hospital evening meal on August 8, 1999. Total number of patients was sixty-two (Male 25: female 37) and the mean age was 52.1 years old. Salmonella Enteritidis was isolated from the stool in 59 cases. Twenty-one of them were associated with the immunosuppression (12 with malignancy, 6 with DM, one with nephrotic syndrome, one with chronic nephritis and one with allergic purpura) Clinical symptoms of the patients were composed of watery diarrhea (100%), fever (88.7%), abdominal pain (82.3%), nausea (45.2%) and vomiting (25.8%). The laboratory data revealed leukocytosis (15/47=31.9%), increased CRP (44/46=95.7%), elevated creatinin (1/37=2.7%) and hypokalemia (5/42 =11.9%). MICs of 20 strains isolated in our laboratory almost coincided with each other indicating that the source of bacteria was probably the same. In vitro, S. Enteritidis were sensitive to OFLX, TFLX, FOM, most of PCs, CEPs, AGs but resistant to MPIPC, CAM, CLDM, VCM. Therefore we administered LVFX to 59 cases (alone in 45cases, combination with FOM in 6 cases), NFLX to two children and FMOX to one pregnant woman. Lactobacillus was administered to 28 cases (45.2%) and antidiarrhetics were given to 6 cases (9.7%). Finally all patients improved within two weeks.
We suspect that the salmonella food poisoning was due to infected egg. The partially cooked omelet would permit the growth of a sufficient inoculum to cause disease. To prevent food poisoning, we have to be consistent in cooking the food well (at 75°C, for more than 1 minute) and should not have omelets during the hot summer season.

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A total of 2, 277 non-typhoidal Salmonella strains consisting of 1, 807 domestic strains and 470 imported strains isolated from sporadic cases during 1995-1999 in Tokyo, were examined regarding their serovar-distibution and their drug-resistance.
The serological typing results showed that the domestic strains were classified into 17 0-groups and 99 serovars, and the imported strains were classified into 12 O-groups and 58 serovars. Among the serovars identified, Salmonella serovar Enteritidis (S. Enteritidis), S. Thompson, S. Hadar, S. Infantis, S. Typhimurium, and S. Litchfield were predominant in the domestic strains, whereas S. Enteritidis, S. Anatum, S. Hadar, and S. Weltevreden were predominant in the imported strains.
The drug-resistance test using 9 drugs (CP, TC, SM, KM, ABPC, ST, NA, FOM, and NFLX) showed that 34.0% of the domestic strains and 33.0% of the imported strains were resistant to any of the drugs examined. The serovars of a high resistant rate during this period were S. Blockley (100%), S. Hadar (96.6%), S. Typhimurium (63.6%), and S. Enteritidis (622%) in the domestic strains and S. Blockley (100%), S. Hadar (97.1%), S. Rissen (88.9%), S. Emek (83.3%), S. Panama (83.3%), and S. Typhimurium (77.8%) in the imported strains. Drug-resistance patterns of the resistant isolates varied to 60 types. Prevalent patterns recognized were SM, TC·ESM, TC, TC·SM·KM·ST, TC·SM·KM, and CP·TC·SM·ABPC in the domestic strains and TC·SM, TC, NA, TC·SM·KM·NA, and TC·SM·NA in the imported strains.

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The isolation frequency of pathogenic bacteria for acute respiratory infection (ARI) in the pharynx and nasal vestivulum was investigated. Age group-matched children with or without ARI including 109 individuals in each group were examined.
Any of the organisms, which are widely regarded as the pathogens causing ARI such as Haemophilus influenzae, Streptococcus pneumoniae, β-haemolytic Streptococcus, Staphylococcus aureus, and Moraxella catarrhalis, were isolated from 91% of the patient group and from 77% of the healthy group. The isolation frequency of S. pneumoniae in the nasal vestivulum of the patient group was outstanding. The healthy carrier rates of S. pneumoniae in the pharynx and nasal vestivulum were 9% and 8%, respectively. Whereas the isolation frequencies from the patient group were 7% and 28%, respectively. α-haemolytic Streptococci except S. pneumoniae revealed different tendency from S. pneumoniae. These organisms were almost always isolated from their pharynx but rarely isolated from the nasal vestivulum. The isolation frequency of H. influenzae from the pharynx of the patient group was 41%, which was slightly higher than 34% in the healthy group, but the difference was statistically not significant. H. influenzae was not isolated from the nasal vestivulum of the healthy group, nevertheless it was isolated from 25% of the patient group. The isolation of H. influenzae from the nasal vestivulum may have some important information about ARI. S. aureus was isolated from the pharynx with higher rate than the nasal vestivulum in both groups, and moreover, the isolation frequency of S. aureus in the healthy group was higher than the patient group. It means that the diagnosis of staphylococcal infection should be made very carefully. Considering the results of this study, it could be said that bacteriologic examination of the specimens from nasal vestivulum is valuable to determine S. pneumoniae and H. influenzae as the etiologic agents of ARI.

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We studied on the infection of domestic cat and dog fleas with Bartonella henselae by polymerase chain reaction (PCR). A total of 62 fleas (36 Ctenocephalidis felis from cats, 24 C. felis from dogs and 2 Ctenocephalidis canis from dogs), stored in 70% ethanol, were analyzed by PCR for B. henselaes pecific DNA. Of the 62 fleas, C. felis from cats and dogs were positive for B. henselae specific DNA in 12 of the 36 (33.3%) and in 5 of the 24 (20.8%), respectively, and C. canis from dogs was positive in 2 of the 2 (100%). Our results demonstrated that pet fleas were infected with B. henselae, and suggest that flea transmission of B. henselae between cats or dogs may occur, and direct transmission of B. henselae from pet fleas to human may cause cat scratch disease.

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This study investigated the influences of lansoprazole (AG1749), a proton pump inhibitor (PPI), and its active derivative (AG2000) on Candida albicans growth and the anti-Candida activity of macrophages. Under concentration of 100μM, AG1749 and AG2000 had no effect on Candida growth. Murine peritoneal macrophages inhibited the growth of C. albicans in vitro. AG2000 suppressed the anti-Candida activity of macrophages dose-dependently, but AG1749 didn't. The suppressing activity of AG2000 for macrophages was neutralized by adding a SH-compound (L-cysteine) in the medium. This suggests that AG2000 may suppress macrophage function in a similar manner with inhibition of proton pump through binding to SH-molecules. When macrophages were preincubated with AG2000 for lhr and washed, their anti-Candida activity remained to be partially inhibited for 14hrs. These results were discussed in relation to the pathogenesis of esophageal candidiasis.

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We prospectively surveyed gram-negative bacteria in patients and hospital environment in a room in the geriatric ward which was specifically under the infection control against MRSA once every two weeks between September and December 1996. We investigated the inpatients in an 8-bed room in the geriatric wards (190 beds) of AINO Memorial Hospital, affiliated with Nagasaki University. During the study period, we performed a total of 431 cultures. The number of specimens cultured was 116 from airways (nose, 42; pharynx, 42; sputum, 32), 24 from decubitus ulcer, 40 from urine, 42 from feces, a total of 125 from skin (head, 42; forearm, 42; inguinal region, 41), and 84 from the hospital environment (floor swab, 42; settled agar plate, 42), respectively. A total of 15 species were isolated from the hospital environment. Some species were the same as those which were recovered from the hospital environment were those observed on each body site. In the hospital environment, the isolation rates of Acinetobacter baumanii and Klebsiella pneumoniae were significantly high in the settled agar plate (A. baumanii, p<0.01; K. pneumoniae, p<0.05, respectively). Isolation rates of Pseudomonas aeruginosa, Citrobacter spp., and Enterobacter sakazakii were also high in the settled agar plate (p=0.078, 0.078, 0.078, respectively)
In conclusion, gram-negative bacteria in patients may be associated with the environmental bacteria in the room in the geriatric wards.

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Loiasis is quite common in the endemic regions of Central and West Africa. But only three cases were reported in Japan. This is a report of a 28 year old male from Gabon infected with Loa loa with eye symptoms as the chief complaint. For the first time in Japan he was treated with Ivermectin (IVM) which is recently attracting attention as the drug for filariasis world wide. IVM therapy was effective, and decreased the counts of microfilarias in the patient's blood. No adverse effect was seen in this patient. This case suggested that IVM is an useful drug for loiasis, and further study is warranted.

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We have reported two women, aged 86 and 84 years, with cardiac aspergillosis with initial onset of arrhythemia during chemotherapy of acute myeloblastic leukemia and primary plasma cell leukemia, respectively. In leukopenia followed by chemotherapy, they suddenly had arrhythemias with high fever. The former had cardiac infarction with complete atrioventricular block and the latter was also cardiac infarction following to atrial fibrillation. In both cases, cardiac aspergillosis was not diagnosed by echocardiagraphy but by autopsy. Since cardiac aspergillosis dose not have characteristic features clinically or examinationally, we need to consider arrhythemias revealed in leukopenia as one symptom of cardiac aspergillosis.

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