We isolated Streptococcus dysgalactiae subsp. equisimilis with Lancefield's group A antigen from a patient in Osaka City. This clinical isolate formed β-hemolytic large colonies on sheep blood agar, and was catalase-negative gram-positive cocci carrying Lancefield's group A antigen. Therefore, Streptococcus pyogenes and this clinical isolate could not be classified by the conventional method on the basis of Lancefield's group antigen. In addition, the rapid detection system of group A streptococci based on group A antigen detection techniques could not divide into two species. Recently, S. dysgalactiae subsp. equisimilis with Lancefield's group G antigen has been isolated from severe invasive streptococcal infection in an increasing frequency in Japan. A possibility that group A S. dysgalactiae subsp. equisimilis cause a serious infection from now on cannot be denied. Thus the discrimination of S. pyo-genes from group A S. dysgalactiae subsp. equisimilis is very important. To identify β-hemolytic streptococci, it is necessary to consider a serogrouping test as one of characteristics of streptococci, and to identify by checking biochemical tests like the PYR test.

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Syndromic surveillance was performed during the G8 Summit held in Fukuoka and Miyazaki City in July 2000. Any case suspected as acute infectious disease was reported from designated medi-cal facilities. Those cases were categorized in 5 clusters including “hemorrhagic and skin symptoms”, “respiratory symptoms”, “gastroenteric symptoms”, “neural symptoms”, and “miscellaneous symp-toms”. To compare how closely these incidence trends were representing those of the infectious dis-ease surveillance, these results were analyzed for two weeks. In Miyazaki, duplicated report were ac-cepted when more than one symptom were found. The ratio of weekly reported number for each cluster was calculated for two weeks, and then the ratio for former/latter week was calculated for each cluster. The results from Fukuoka and Miyazaki surveillance revealed the average former/latter ratio±SD=0.99±0.292, 95% CI; 0.71-1.28 and 1.19±0.298, 0.93-1.45, respectively. These results indicate that syndromic surveillance is well represented with the infectious disease surveillance trends. Single reporting, employed in Fukuoka, was easier for analysis. Reported number for acute respiratory syndrome was larger than that of infectious disease surveillance, indicating that the latter could not detect non-reportable adult cases. Sydromic surveillance enables us to show the trend quickly and it can be carried out with smaller costs and human resources. This study concluded that a syndromic surveillance is effective for such high-profile events, but sometimes it is hard to analyze the trend accurately, because of insufficient period of baseline data, number and size of the reporting sentinel facilities.

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To clear the route of STEC (Shiga toxin-producing Escherichia coli) infection to humans, we examined the serotype, Shiga toxin genotype and eae gene of STEC strains from humans and various animals. The most predominant serotype originated from humans was O157: H7, followed by O26: H 11, and other serotypes were O91: H21, O103: H2, O111: NM, O121: H19, etc. The eae gene was found in 79 of 93 strains from human origin. The serotypes of STEC from cattle were significant by similar to that of STEC from humans. The eae gene was found in 44 of 87 strains from cattle. Shiga toxin genotypes possessed O157 strains from humans and cattle, were divided into six groups, stx1, stx2, stx2c, stx1+stx2, stx1+stx2c and stx2+stx2c. Moreover, frequency rates of Shiga toxin genotypes of O157 were also similar to both human and cattle origins. The serotypes of STEC from sheep were also a little similar to that of STEC from humans. Seven of 8 strains from deer possessed stx 2d gene that the strains from humans seldom possessed, and none of the strains possessed eae gene. In STEC originated from swine, 15 of 25 strains were O139: H1 that Shiga toxin genotype was stx2e. It was thought that the sources of STEC infection to human are cattle and sheep, and deer and swine had little possibility to human STEC infection.

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The objective of our study is to understand the clinical features of patients with acute respiratory tract infection associated with Streptococcus millei group (SMG). Fifteen patients with SMG respiratory tract infection visited our hospital from July, 1997 through May, 2000. There were seven cases of pneumonia, two pulmonary abscess, three thoracic empyema and three acute bronchitis. The mean age of the patients was 57.8 years (range 16-87), twelve were males, and seven were smokers. The moderatery to severe underlying diseases existed in thirteen patients (86.7%) and included the following: respiratory diseases (20.0%), history of the esophageal or gastric surgery (26.7%), central nerve system diseases (13.3%), alcohol intake (60.0%), hepatitis and pancreatitis (33.3%), diabetes mellitus (13.3%) and malignancy (6.7%). The species of SMG detected were as follows: S. constellatus, 8, S. anginosus, 6 and S. intermedius, 1. Anaerobic orgasms and other microorganisms were detected in five patients. A patient with SMG nosocominal pneumonia who previously had thoracic surgery for esophageal cancer died. Antibiotics therapy with carbapenem or combination therapy, drainage and no surgery, were successful in 14 of the 15 cases (93.3%). The number of intermediately or complete resistant strains against penicillin G, ampicillin and cefmetazole were 5 (33.3%), 8 (53.3%) and 12 (80.0%), respectively in this series.
Recently, it is seemed that acute respiratory tract infections caused by SMG are increasing in the patients with moderately to severe underlying diseases, and several clinical strains of SMG are acquiring a tolerance to antibiotics.

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In Japan, an epidemic of measles occurs every few years. An estimated 100-200, 000 people contract the disease each year and 50-100 patients die. Following the eradication of poliomyelitis, the World Health Organization made plans for global eradication of measles, and the Japanese Association of Pediatricians began advocating vaccination to eliminate measles in Japan by 2005. However, no big response has occurred nationwide. Therefore, we retrospectively look at changes in epidemics and measles vaccination during the past 20 years in Kurashiki City, Okayama Prefecture and developed a strategy for elimination through the results. The Japanese surveillance showed the numbers of measles patient in Okayama to be a few times higher than the mean number nationwide. The number of persons vaccinated was approximately 2, 000-3, 000 per year, while the number of births was about 6, 000 per year. After passing a revised vaccination law in 1994, the number of vaccinations increased to more than 4, 000, and the epidemic situation decreased to the nationwide level. However, the number of measles patients older than 15 years of age who were admitted to our hospital in creased from 4% to 24% in the ratio to the whole. In the United States, school regulations require that children be vaccinated for MMR twice before admission to school, but the revised vaccination law in Japan was changed from a requirement to a recommendation. To eliminate measles, we should increase the vaccination rate for infants, and should vaccinate adolescents who have not been vaccinated or do not have a past history of measles. It is important to choose the subjects and then confirm their vaccination after the recommendation. We have developed a strategy that includes 1) advocacy for vaccination 2) selection for vaccination, 3) request for certification of vaccination, 4) convenience for vaccination. The goal after two years is for 1) a vaccination rate of more than 90% by end of one year of age, 2) a rate of vaccination and past history of measles in more than 90% of children before admission to kindergarten or public school.

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We studied whether the consolidation whose serum β-globulin demarcation showed more than 12% was bacterial pneumonia or not. The materials were the patients with fever (≥37°C) and the consolidation on chest-X ray film, the value of serum β-globulin demarcation was more than 12% from 1995 to 2000. There were 5 cases with drug-induced pneumonitis, 5 cases with BOOP, 2 cases with eosinophilic pneumonia, 1 case with lung cancer (adenocarcinoma), and 1 case with interstitial pneumonia with dermatomyositis. No one had bacterial pneumonia. These results suggested the con-solidation with fever whose serum β-globulin demarcation showed more than 12% was not bacterial pneumonia.

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We investigated the clinical characteristics separating pneumonia as a complication in elderly lung cancer patients into obstructive and non-obstructive pneumonia. Two hundred and five patients with pneumonia as a complication in elderly lung cancer patients were classified into two groups 64 patients with obstructive pneumonia and 141 patients with non-obstructive pneumonia. Most of the patients in both groups were male. Concerning histological findings, while most of the patients with obstructive pneumonia had squamous cell carcinoma, those with non-obstructive pneumonia had the same proportion of squamous cell carcinoma as all elderly patients with lung cancer. Most of the patients with obstructive pneumonia were in good general condition including their nutritional condition, but the patients with non-obstructive pneumonia were in significantly poor condition. A low percent of microorganisms were isolated from the sputum obtained from the patients with nonobstructive pneumonia, but a high percentage were obtained from those with non-obstructive pneumonia. Frequent involvement of gram-negative bacilli such as Pseudomonas aeruginosa and Klebsiella pneumoniae or Staphylococcus aureus containing MRSA was also found in these patients. Regarding treatment, although carbapenem was used either alone or in combination therapy as the regimen of treatment for pneumonia as a complication in elderly lung cancer patients with both the obstructive and non-obstructive pneumonia patients, the efficacy rate was poor in 50% with obstructive pneumonia and in 26% with non-obstructive pneumonia. The mortality rate was 11% in the patients with obstructive pneumonia, while it was 61% in the patients with non-obstructive pneumonia. The prognosis was significantly poorer in the patients with non-obstructive pneumonia.
We concluded that although the prognosis was not so poor for patients with obstructive pneumonia if the appropriate treatment was given, in the patients with non-obstructive pneumonia, the treatment for underlying diseases and the improvement of thier general condition, including the determination of causative microorganisms, was important.

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Human intravenous immunoglobulin (IVIG) preparation containing a variety of antibodies is widely used against severe infectious diseases. Although IVIG is supposed to promote phagocytosis of opsonized bacteria and neutralize several bacterial toxins, it is unclear what antibodies are responsible for the effect in clinical use. In this study, we found that IVIG showed neutralizing activity against toxic shock syndrome toxin-1 TSST-1, produced by methicillin-resistant Staphylococcus aureus (MRSA)
Whereas intravenous inoculation with culture medium of MRSA 1945 strain into ICR mice causes immediate death, all of the mice survived in case of previous administraation of IVIG. Such effect might be attributed to neutralization of TSST-1. Murine splenocytes incubated with TSST-1 (1.0ng/mL) for 48 hours produced IFN-γ. By addition of IVIG at 100μg/mL into culture medium, production of IFN-y was completely inhibited. From IVIG, anti-TSST-1 antibody was purified by affinity chromatography as one of the effective antibodies. MRSA 1945 mixed with dextran-based microcarrier beads and injected subcutaneously into mice resulted in the formation of abscess and excretion of TSST-1 in serum for 14 days. IVIG and anti-TSST-1 antibody neutralized TSST-1 in blood 24 hours after infection, although bacterial count was kept constant. Experimental rabbit TSS model was established by synergism with lipopolysaccharide (LPS) of Escherichia coli. Anti-TSST-1 antibody protected NZW rabbits from lethal challenge with TSST-1 (1μg/kg, i.v.) 4 hours before LPS in a dosedependent manner (10μg/kg, i.v.), whereas all of the NZW rabbits died in the control group.
Thus, IVIG may be a useful tool in the prevention and perhaps therapy of staphylococcal infections and TSS.

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In order to investigate the long-term prognosis and clinical efficacy of highly active antiretroviral therapy (HAART) in HIV-1-infected hemophiliacs, we compared clinical courses of 69 HIV-1-infected hemophiliacs and 29 non-hemophiliacs all of whom were asymptomatic between 1990 and 1993. Changes of CD4 count during 1990 through 2000 in both groups were not significantly different. The time to death due to AIDS in both groups were also not significantly different. The major causes of death not related to AIDS in hemophiliacs were bleeding, liver cirrhosis, and liver cancer. A total of 55 (39 hemophiliacs and 16 non-hemophiliacs) out of 98 patients survived in 1997. Since then, the 28 hemophiliacs and the 12 non-hemophiliacs received HAART. Although the percentage of patients whose viral loads (VL) decreased to below undetectable level (VL<400 copies/ml) by the initial HAART regimens without saquinavir were not significantly different, continuation of the same regimens in the hemophiliacs were significantly longer than non-hemophiliacs (84 weeks vs. 51 weeks, p<0.05). From starting HAART to July 2000, 35.7% of the hemophiliacs were changed regimens three times or more. That is higher prevalence comparing with non-hemophiliacs of 16.7%. This study suggests that there might be the patient group who have to been changed HAART regimens frequently in the hemophiliacs.

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A 48-year-old female with bronchiectasis after pulmonary tuberculosis was admitted to our hospital because of bloody sputum and multiple cavity formation in the right lung. Chest X-ray & CT films revealed diffuse nodular shadows and cavity formation with a thick wall.Nocardia asteroideswas isolated from the stum but no other pathogenic bacteria was isolated. Administration of sulfamethoxazole-trimethoprim is not effective. The results of an MIC test for antimicrobial agents led to treatment with sparfloxacin and the clinical symptoms and cavity formations in the rigth lung improved. Nocardia asteroides máy cause exacerbation of bronchiectasis.

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Four cases of the Ramsay Hunt syndrome were admitted to our hospital during the two years from February 1997 to January 1999. Though one of the 4 patients had been immunized with varicella vaccine, the causative virus was not a vaccine strain but a wild-type strain. These patients were not suffering from underlying diseases. Because the number of pediatric zoster patient without underlying diseases who visited our clinic between 1981 and 1999 was 35 cases, the Ramsay Hunt syndrome turned out not to be extremely rare even among children having no underlying diseases. The prognosis of the Ramsay Hunt syndrome is assumed to be good if the treatment begins at the early stage. To begin the treatment at the early stage, it is necessary to confirm the diagnosis with virological examinations.

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