We analyzed anti-Cytomegalovirus (CMV) IgG and IgM antibody (EIA) and anti-Epstein-Barr virus (EBV) viral capsid antigen (VCA) IgG and IgM antibody (FA) in adults during 1994-1999. We examined these IgM sero-positive patient's medical records, and diagnosed CMV mononucleosis and EBV mononucleosis. Anti-CMV antibody positive rates decreased from 87.6% in 1994 to 77.8% in 1999. Especially in twenties, anti-CMV antibody positive rates decreased from 65.2% in 1994 to 53.3% in 1999. On the other hand, anti-EBV VCA antibody posi-tive rates were not changed (91-94%). Number of cases of CMV mononucleosis increased from 2 cases in 1994 to 16 cases in 1999, but EBV mononucleosis was not changed. These results suggested that incresing cases of CMV mononucleosis was influenced by decreasing anti-CMV antibody positive rate.

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We reported ten cases, (four female and six male), whose sputum cultures positive for Pasteurella multocida from 1990 to 2000. In the past eleven years increasing numbers of cases have appeared in our hospital. The majority of the cases with P. multocida possessed some underlying pulmonary diseases (seven cases, 70%), inactive lung tuberculosis or bronchiectasis. There were compromised hosts such as high ages person, steroids dependent person and diadetes mellitus patients. P. multocida was almost susceptible to antibioticus (penicillin and cephalosporins), although some erythromycin resistant strains were identified. The cats' oral cavitys in our two cases were cultured and P. multocida were isolated. In our survey the prevalence of this organism is as high as 85% in cats. Our data suggests that patients who are in the high infection risk category are easily infected to P. multocida.

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Drug resistance trends were investigated for 1, 318 enterotoxigenic Escherichia coli (ETEC) isolated from overseas traveler' s diarrheal cases in Tokyo during 1988-1999. A total of 1.6% (21 strains) were nalidixic-acid resistant and fluoroquinolones (NFLX, OFLX, CPFX, LVFX, TFLX, SPFX; FQ) low-sensitive (or low-level-resistant). None of the strains were high-level-resistant to FQ. The FQ low-sensitive strains were isolated in 1996 for the first time, and increased from 3.4% in 1996 to 15.8% in 1999.
Countries visited by travelers with the FQ low-sensitive ETEC were India (16 cases), Nepal (3 cases), Cambodia (1 case), and Egypt (1 case).
Drug resistance-patterns of the FQ low-sensitive strains, including other drugs (CP, TC, SM, KM, ABPC, ST, NA, and FOM) tested, varied among the 6 types. Among those, multidrug resistant strains accounted for 57.1% (12 strains). The enterotoxin producing types of strains were LT (4 strains), ST (10 strains), and both (7 strains). The serotypes of the strains were classified into 16 types.
The quinolone resistance determining regions (QRDRs) of the gyrA genes of the FQ lowsensitive strains were sequenced. The mutations of a Ser to a Leu at position 83 (Ser-83-Leu) was found in 19 strains, and Asp-87-Tyr was found in 2 strains.

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We have evaluated a new rapid detection kit for influenza A and B viruses, known as the Quick Vue Influenza test (Quidel Coporation, USA); which is based on immunochromatography using virus isolates and clinical specimens.
Twelve strains of influenza A and B were tested for evaluate the reactivity and detection limits of this test. The Quick Vue Influenza test showed a positive result for all twelve strains of influenza virus and a negative result for fourteen different kinds of other respiratory viruses. The detection limits for six strains were 5 to 30 pfu/ml for a cell culture, 1.0×10³ to 6.0×10⁴pfu/ml for 1st PCR, 1 to 50pfu/ml for nested PCR, 3.0×10⁵ to 6.0×10⁵pfu/ml for the Quick Vue Influenza test, 1.5×10⁵ to 1.0×10⁶ pfu/ml for the Directigen Flu A, and 7.5×10⁵ to 5.0×10⁶pfu/ml for the FLU OIA.
Furthermore, the Quick Vue Influenza test were clinically evaluated using 92 throat swab specimens collected from patients with influenza-like illnesses.
By cell culture, influenza viruses were detected in 49 of the 92 specimens (AH1N1: 20, AH3N2: 7, B: 22); the titers of the influenza viruses were between 2.5pfu/ml and 7.0×10⁵pfu/ml. Compared to cell culture, the Quick Vue Influenza test showed a sensitivity of 75.5%, a specificity of 93.0%, a positive predictive value of 92.5%, a negative predictive value of 76.9%, and an efficiency value of 83.7%. On the other hand, influenza viruses were detected in 54 of the 92 specimens (AH1N1: 19, AH 3N2: 10, B: 25) by RT-PCR. Compared to RT-PCR, the Quick Vue Influenza test showed a sensitivity of 72.2%, a specificity of 97.4%, a positive predictive value of 97.5%, a negative predictive value of 71.2%, and an efficiency value of 82.6%. Overall, only one throat swab specimen produced a false positive result using the Quick Vue Influenza test; thus, this test appears to have a high specificity.
We conclude that the Quick Vue Influenza test is a simple one-step test with a sensitivity and specificity equivalent to those of other conventional diagnostic kits. The test is useful and suitable for the diagnosis of influenza and for identifying influenza patients requiring antiviral therapy.

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Patients clinically diagnosed as influenza who were prescribed zanamivir were surveyed from December 2000 to March 2001 in Japan. A total of 723 survey questionnaires were returned. Following the first zanamivir treatment, symptom relief was reported by 34.9% of the patients within 12 hours, 63.1% within 24 hours and 85.7% within 48 hours. 46.1% of the patients resumed normal activities within 48 hours and 78.0% within 72 hours. 98.8% of the patients reported that the Diskhaler could be used as instructed by the doctor or pharmacist and 92.5% found the device easy or very easy to use. 70.8% of the patients were satisfied or very satisfied with zanamivir, and 89.0% of the patients would recommend zanamivir to a friend. These results showed that 1) the effect of zanamivir started very fast, especially for the vaccinated patients where the effect was more rapid, 2) most of the patients managed to use the diskher properly and felt “very easy to use” or “easy to use”, 3) there is no difference of efficacy in spite of with/without underlying disease, and the diskhaer was well accepted by pediatric and elderly patients.

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Two patients were reported as having been infectd with Bartonella henselae after having contact with a dog. Both of the patients owned a dog, but had no contact with cats.
One patient was a 10-year-old boy who had experienced a fever of 38-39°C for 11 days, as well as having bilateral cervical lymphadenopathy. The boy's serum IgM antibodies to B. henselae were negative on the 6th and 16th day of his illness, whereas his IgG value, using indirect fluorescence antibody (IFA) method, was found to be elevated from 1: 256 to 1: 1, 024. B. henselae DNA was detected, by PCR method, in swabs from the gingiva and buccal membrane of the dog with which the boy had been in contact. The boy was first treated with cefdinir (300mg daily) for 6 days without beneficial effect. He responded, however, to minocycline (100mg daily) with symptom resolution in four days.
The other patient was a 64-year-old man who had experienced a fever of 38-39°C for 27 days, as well as having right inguinal lymphadenopathy. The man's serum IgM antibody to B. henselae was negative, although his IgG value, determined by IFA, was 1: 1, 024. In addition, B. henselae DNA was detected, by PCR method, in parafin-embedded tissue obtained from the biopsied inguinal lymph nodes. The man was treated with cefazolin (2g daily). His fever resolved, but his lymph nodes remained swollen. After a regimen of erythromycin (1, 200mg daily), the swelling in his inguinal lymphnodes gradually disappeared.
Careful review of suspected CSD victims' history of contact with animals is important in making a prompt diagnosis of B. henselae infection.

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A 35-day-old male infant was admitted to our hospital, presenting a high fever, vomiting, and diarrhea. Multidrug-resistant and fluoroquinolon-resistant Salmonella serotype Typhimurium was isolated from his stool. The phage type of the strain was DT12. The strain was resistant to ampicillin, streptomycin, gentamicin, tetracycline, chloramphenicol, sulfamethoxazole-trimethoprim, and fluoroquinolones (levofloxacin; MIC 8μg/ml, norfloxacin; 24μg/ml, ciprofloxacin; 16μg/ml, sparfloxacin; 32 μg /ml). He was cured by antibiotic therapy using fosfomycin (≤1μg/ml). We could not determine a route of infection. Domestic surveillance for fluoroquinolon-resistant Sallmonella is necessary.

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We reported a case of gonococcal abscess in the prepuce not accompanied with urethritis. As initial therapy fluoroquinolone was ineffective, the abscess spread to the subcutaneous tissue around the penile root. After intravenous administration of cefodizime, the clinical symptoms improved, and Neisseria gonorrhoeae was eradicated.

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The case was a 47-year-old Nigerian male who was thought to have contracted malaria in Nige ria and then manifested fever with chill, arthralgia and diarrhea in Japan. The blood test at Interna tional Medical Center of Japan revealed thrombocytopenia and anemia. Ring forms of 0.03% of his RBCs and ICT^TM Malaria P. f /P. v test was also positive for Plasmodium falciparum. We prescribed mefloquine to him, but the number of the paresites in his peripheral blood did not decrease, and, in fact, they came to increase (maximum 6.66%) 20 hours after the drug treatment. As clinical condition of malaria were liable to change seriously, intravenous Artesunate (a qinghaosu derivative) was decided to be given additionally to the patient. Consequently the parasites disappeared in 20 hours from his blood but a low grade fever still continued possibly because of cholecystitis . At the same time of Artesunate treatment, hemoglobinuria started and anemia worsened partly because of his G-6-PD deficiency. All pending problems were improved by the time he left Japan and those parasites were finally found to be susceptible for mefloquine by the in vitro susceptibility test. This is the first reported case of falciparum malaria successfully treated with intravenous Artesunate in Japan.

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