During the thirty one-year period between 1969 and 1999, a total of 6, 876 strains of group A streptococci isolated in Sapporo City General Hospital were classified by T-agglutination method. This research consisted of 5, 866 strains of scarlet fever-patients (scarlet fever-strains), 450 of childpatients (child-strains), 141 of adult-patients (adult-strains) and 409 strains of the indistinct. The results were summarized as follows: 1. Total of 6, 866 strains were clasified to sixteen kinds of T-types such as T12 (44.1%), T4 (21.7%), Ti (9.2%), T6 (4.4%), T3 (2.8%), T22 (2.1%), T18 (1.9%), T28 (1.6%) & others. This pattern of type distribution, three prevailing types of T12/T4/T1, have been reported in other areas generally. But original increase of isolation rates of strains of some T-types as T6, for example, also appeared in Sapporo. 2. Long-term observations demonstrated that the isolation rates of individual T-type, especially T4 or T1, had been forming a small epidemic-wave having a 4 to 8 year-interval and these of type T3 or type T6 on the other hand were repeating sudden prevalance every several years. 3. The isolation rates of type T12 or type T4 in scarlet fever-strains, were significantly higher than in child-strains or adult-strains. It was shown that Type Ti was distributed widely irrespective of patient-group and age-group. It was also characteristic to be distributed to many T-types in adult-strains
During the fifteen-year period between 1985 and 1999, a total of 1, 985 strains of Group B Streptococci isolated in Sapporo City General Hospital were classified by agglutination method . The results were summarized as follows 1. Type distribution of 1, 513 isolates of group B streptococci in and after 1992 when type NT6 and type JM9 were started to be typed for the first time was as follows; according to rate isolation it was in the order of type NT6 (412 strains 27.3%), JM9 (257 17.0%), III (220 14.5%), Ia (182 12.0%), following IV, Ib, V and II. 2. As for proportion of origin-materials of isolates, vaginal discharge was 49.5%, urine 26.8%, throat swab 6.8%, sputum 6.6%, pus or exudate 4.2%, blood or spinal fluid 1.8% and stomach contents was 1.3%. A proportion of vagina-origin strains went up to 55% in the second half (1992-1999) from 23% in the first half (1985-1991). 3. In type distribution of isolates in terms of origin-materials, the proportion of type III was significant by high in the stomach contents and blood and spinal fluid. Proprtion of type Ia was significant by high in the sputum or throat swab. 4. Thirteen out of 28 strains (46.4%) from newborns were type III; 3 out of 4 (75.0%) from spinal fluid, 5 out of 10 (50.0%) from blood, 5 out of 13 (35.7%) from stomach contents.
In order to evaluate the economic efficacy of influenza vaccination for the elderly inpatients, we have investigated the health insurance fee of elderly inpatients in Japan. It was revealed that the health insurance fee varied by patients largely, ranging from 7, 000 yen to 90, 000 yen. Primary reason of this variation was due to the existence of the same effective drugs with variant prices and there were no rules concerning the period of drug medication. Thus, it was found that it would be improper to use the medication fee as a measure in evaluating the effects of influenza vaccinations. In this study, we used the length of days of testing and medication such as oral antibiotics, blood cell count, etc. as a measure to evaluate the effect of influenza vaccination. We compared these measures among elderly hospitalized patients with influenza vaccination or without influenza vaccination by ADL. Mean length of days of oral antibiotics was 2.64 (±6.40) days for those with vaccination, and 3.92 (±7.31) days for those without vaccination. Mean length of days of injection antibiotics was 2.52 (±5.53) days for those with vaccination, and 8.82 (±15.1) days for those without vaccination. Mean length of days of cells blood counter was 2.63 (±2.22) days for those with vaccination, and 4.44 (±320) days for those without vaccination. Mean length of days of chest X-ray was 1.30 (±2.07) days for those with vaccination, and 2.56 (±3.49) days for those without vaccination. These results suggest that influenza vaccination reduces medical utilization of resources. It was also revealed that influenza vaccination is most effective when elderly patients who are bed-bound are vaccinated.
We evaluated the efficacy of combination therapy with sulbactam/cefoperazone (SBT/CPZ) and amikacin salfate (AMK) in eligible patients with hematological disorders of neutrophil count less than 1, 000/μl. The clinical efficacy rate in 157 evaluated patients was 65.6%. The clinical efficacy rates were related to neutrophil counts and serum albumin levels at the 1 week later. The clinical efficacy rates were 87.1% in patients with neutrophil counts over 500/μl and 34.8% in patients with serum alubumin levels under 3g/dl after 1 week. G-CSF treatment were not significant but tended to be more effective in patients with sepsis, and the neutrophil counts increased significantly. The group using G-CSF before the antibiotic treatment had a high clinical efficacy rate. It is suggested that GCSF is effctive in patients with neutropenia with the high risk to infection and in those who already have severe infections.
We classified 1017 patients with community-acquired pneumonia requiring hospitalization experienced in Kawasaki Medical School Kawasaki Hospital during the past 15 years into five age groups (≤54 years old, 55-64 years old, 65-74 years old, 75-84 years old, ≥85 years old).With particular emphasis on the elderly patients, we then compared the clinical and microbiological findings in the five groups. The results were as follows; (1) Half of patients in the over 85 years old group were bed-ridden.(2) The proportion receiving antibiotics before hospitalization decreased with age.(3) There were striking atypical pneumonic symptoms, such as dyspnea and consciousness disturbance in the two age gropus over 75 years old.(4) Hypotension (shock) increased with age.(5) Markers of nutritional conditions, such as serum protein, albumin, cholineesterase, and hypoxia remarkably increased in the two age groups over 75 years old.(6) There were no significant differences in the isolation rate of etiological microorganisms.(7) The number of polymicrobial agents in the≤54 years old group was lower than that in the other age groups.(8)Mycoplasma pneumoniaewas most significantly higher in ≤54 years old group, Haemophilus influenzaein patients 55-64 years old, and Streptococcus pneumoniaein both 65-74 and 75-84 years old groups.(9) The isolation rate of MSSA, gram-negative bacilli such asKlebsiella pneumoniae, Pseudomonas aeruginosa, respiratory viruses increased with age.(10) The amount of sepsis increased with age.(11) The prognosis was poor in the two groups over 75 years old because the mortality rate (over 10%) was higher that for the other age groups.
A study was conducted during the period from July to October in 1999, surface water samples were collected from 13 rivers in Hyogo Prefecture serving as tap water sources and examined for Cryptosporidium oocysts and Giardia cysts using the immunomagnetic separation method. In 9 (69%) of the 13 rivers, Cryptosporidium oocyst was detected. Giardia cyst was detected in 5 (38%) of the 13 rivers. The Cryptosporidium oocyst positive rate was comparable to that of fecal bacteriological indicators, which was also examined and detected in 10 (77%) of 13 rivers. Water samples were collected at 69 points in the 13rivers. Cryptosporidium parvum oocyst was detected at 38 (55%) of the 69 points, demonstrating widely spread contamination. Comparing 3 areas which were divided on the basis of agricultural circumstance as well as geographical locating, the Cryptosporidium positive rate varied widely according to the area, ranging from 37% to 100%. To elucidate the reason for these differences, the relationship between positive rate and the species and number of livestock animals raised in each respective region was investigated. The results showed a strong correlation (r=0.91) between the number of raised cattle and contamination with the rate of Cryptosporidium in each area. Furthermore, genetic analysis by PCR-restriction fragment length polymophism method revealed that C. parvum oocyst detected in the rivers studied was the bovine type, probably indicating that the oocyst was excreted from the cattle in the river basins. The degree of contamination with Cryptosporidium in river water was comparable to that of fecal bacteriological indicators, suggesting the possibility that fecal bacteriological indicators examination might be used as a criterion of Cryptosporidium contamination.
An 11-year-old girl was admitted to our hospital with complaint of disturbance of consciousness and muscle weakness. We diagnosed her as having meningoencephalitis because of the pleocytosis in the cerebrospinal fluid (CSF) and diffuse slow EEG waves. Laboratory tests in admission showed that serum passive hemagglutinin titer to Mycoplasma pneumoniae (M. pneumoniae) was 1: 5, 120, serum antibody titer to galactocerebroside (Gc) was 1: 160, and CSF interleukin-6 (IL-6) level was 20, 500pg/ml, but a specific DNA to M. pneumoniae was not detected in CSF using the polymerase chain reaction. Cranial and whole spine MRI were unremarkable. These results suggest that anti-Gc antibody and IL-6 play some roles in the development of mycoplasmal central nervous system involvement.
A 56-year-old Japanese male was admitted to Toyohashi Municipal Hospital becase of fever, cough, and dyspnea. Chest X-ray film showed bilateral alveolar infiltrates. He suffered from severe hypoxemia and was given a diagnosis of acute respiratory distress syndrome. He was also complicated with disseminated intravascular coagulation and pseudomembranous colitis. He fully recovered by intensive treatment with antibiotics, mechanical ventilation and endotoxin eliminating therapy. Legionella longbeachae was isolated from his respiratory specimens and was regarded as the etiologic agent of his pneumonia.