To investigate the mechanism of hypergammaglobulinemia in HIV infected patients, the effect of highly active antiretroviral therapy (HAART) on the hypergammaglobulinemia was analyzed. Involved in this study were 34 untreated, 21 HAART-effective (complete response) and 14 HAARTnon-effective (partial response) patients. Serum levels of HIV-RNA and gammaglobulin and immunoglobulin (Ig) isotypes were measured. Mean HIV-RNA levels of untreated and partial response patients were 1.6×10⁴ copies/ml and 0.4×10⁴ copies/ml, respectively. HIV-RNA levels of all complete response patients were below 4.0×10² copies/ml. Mean gammaglobulin percentages of untreated, partial response and complete response patients were 24.4%, 21.8% and 17.9%, respectively (p<0.01in untreated vs complete response patients). Mean IgG levels in the three groups were 2, 489 mg/dl, 1, 947 mg/dl and 1, 618 mg/dl, respectively (p<0.001 in untreated vs complete response patients). IgA levels were high in some untreated patients and lower in complete response patients. IgE levels were increased in some untreated and partial response patients, but there was no significant difference among the three groups. These results suggested that the hypergammaglobulinemia found in HIV infected patients was associated with HIV replication. The activation mechanism might differ by Ig isotypes.

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Recently, Vancomycin-resistant enterococci (VRE) have become important nosocomial pathogens in the world. In Japan, the VRE-infection was first reported in 1996. However, an epidemiological study on VRE has not been aggressively done in Japan. We conducted a survey study to explore the incidence and antimicrobial susceptibility of vancomycin-resistant enterococci isolated from fecal samples at 45 hospitals in the east area of Japan (Kanto, Koshinetsu, Tohoku, and Hokkaido) during June 1998 to March 1999.
The Enterococcosel agar containing vanocomycin (BBL) was used for screening VRE from fecal samples in each hospital. The suscceptibilities of the isolates to 8 antimicrobials were determined by the broth microdilution method and the definitions of resistance were based on current standards of the NCCLS standards. The VRE genotypes (vanA, vanB, vanC, and vanC_2/3) were confirmed by amplifying the respective genes by PCR. Eight hundred and ninety four strains of enterococci were tested by the microtiter plates hybridization method (WAKUNAGA SEIYAKU, Japan).
One thousand five hundred eighty three strains of enterococci were collected from 6, 914 patients in 45 hospitals. These strains included 72 (4.5%) strains Enterococcus faecalis, 33 (2.1%) strains Enterococcus faecium, 17 (1.1%) strains Enterococcus avium, 1, 040 (65.7%) strains Enterococcus gallinarum, 386 (24.4%) strains Enterococcus cassliflavus, and 35 (2.2%) strains Enterococcus flavescens.
These strains of vancomycin-resistant E. faecalis were isolated from 3 patients, two of these 3 strains had van A gene and other one had van B gene. Those 3 strains were in the Kanto area, and 2 of 3 strains were in Tokyo, Generally, though van A type VRE was highly resistaant to both vancomycin and teicoplanin. In our study, two strains of van A type E. faecalis were highly resistant to vancomycin (MICs>128μg/ml) and susceptible to teicoplanin with MICs 4μg/ml. Those two strains were different in susceptibilities of minocycline and ofloxacin, The result of the analysis of PFGE had also different patterns. VanB type E. fecalis was highly resistant to vancomycin and susceptible to teicoplanin (MICs 0.251μg/ml). For ampicillin and imipenem, 3 strains of E. faecalis were susceptible (MIC≤1μg/ml). One of 562 strains of E. gallinarum had vanB and vanC1 genes and was moderately resistant to vancomycin and susceptible to teicoplanin. All strains of E. casseliflavus and E. flavescens had vanC2/C3 gene only. All strains of E. faecium and E. avium did not detect van genes.
From this result, it was supposed that VRE were very rare in the east of Japan.

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We investigated the drug susceptibilities of Neisseria gonorrhoeae by using 98 strains of clinical isolates at Toho University Omori Hospital from 1994 to 1998. Minimum Inhibitory Concentrations (MICs) of 15 antimicrobial agents were determined with agar dilution methods according to the guidelines of NCCLS. Among these isolates, only 4 strains (4.1%) were found to be penicillinase producing N. gonorrhoeae. Ceftriaxone showed the most potent activity of which MICs of all strains were 0.06μg/ml or less. Macroride antimicrobial agents and minocycline also showed strong activities of which MICs of most of the strains were 0.06μg/ml or less. With the creiteria of NCCLS, 10 strains (10.2%) were found to be resistant to ciprofloxacin and these 10 strains also showed cross resistance to other fluoroquiolones we tested. Our results also revealed that the number of resistant strains against fluoroquiolones abruptly increased from 1996 and indicate the needs of further surveillance of antimicrobial resistance in clinical isolates of N. gonorrhoeae.

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Sequential serologic testing for IgG and IgM titers to Bartonella henselae were evaluated by an indirect fluorescence assay (IFA) in patients with CSD. The IFA test for the detection of IgG and IgM antibodies to B. henselae in 52 CSD patients showed that 40 (76.9%) were positive for IgG antibody and 9 (17.3%) were positive for IgM antibody. Two or more consecutive serum samples from 30 patients with CSD were assessed. In regard to the detection of IgG antibody, 5 patients had rapidly elevated titers in the acute phase, 12 patients had high titers from the acute phase, and 5 patients had a positive titer 24 weeks after the onset. B. henselae IgM antibody kinetics varied widely between patients with CSD. The seropositive rate for the antibody to B. henselae was analyzed at overtime after the onset and we found that the IgG-seropositive rate was high from 2 weeks after the onset and low after 25 weeks. The sensitivity of the IgM IFA was low, and IgM antibody to B. henslelae was not detected from 9 weeks. The detection from consecutive serum samples of antibodies to B. henselae by IFA is very useful for diagnosis in the case of clinically susupected CSD.

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There has been much attension to the association between Chlamydophila pneumoniae and athrosclerosis since C. pneumoniae was demonstrated in macropharges, and vascular smooth muscle cells of atheroma tissues.
There are few data demonstrating whether C. pneumoniae is present in other tissues than atherosclerotic tissues. We surveyd samples of heart tissue from 10 patients with ischemic heart disease and 10 patiens with other disease by immunohistochemical staining with monoclonal antibodies against C. pneumoniae and Chlamydia stress protein 60 (C. HSP-60). In all, 11 out of 20 (55.0%) samples were positive for C. pneumoniae and 7 out of 20 (35.0%) for Chlamydia HSP-60. In patients with ischemic heart disease, positive rates were found significantly higher, that is, 9 out of 10 (90.0%) were positive for C. pneumoniae and 6 out of 10 (60.0%) for Chlamydia HSP-60. These results indicate the common presence of C. pneumoniae in heart tissue in older patients with ischemic heart diseases.

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Rhabdomyolysis is a syndrome resulting from skeletal muscle injury with release of muscle cell contents into the plasma. It is often associated with alcohol abuse, muscle compression and generalized seiszure. It may also follow viral infections like influenza.
Tecnetium-99m phosphate compounds are useful for bone scintigraphy. But proper interpretation of this bone agent scintigrams must include careful analysis of extraskeletal accumulations, such as cerebrospinal lesions. carcinoma, acute myocardial infarction. myocarditis and inflammatory myopathy.
This case was a 74-year-old female who developed rhabdmyolysis associated with influenza A viral infection. We report the usefulness of tecnetium-99m phosphate scintigraphy for early diagnosis, location and extent of the muscle damage of viral induced rhabdomyolysis.

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