Four patients infected with Cyclospora cayetanensis who sought medical care at the Tokyo Metropolitan Komagome Hospital are herein presented. All were Japanese males, and their ages ranged from 22 to 50 years of age. One patient, who was HIV-positive with a CD4+lymphocyte count of 141/μl demonstrated no AIDS-defining illness. This patient acquired HIV in some Southeast Asian country/countries through heterosexual contact. This patient presented with watery diarrhea with a frequency of up to 18 times a day for more than two months. The other three cases were not considered to be debilitated hosts. Diarrhea occurring from one to ten times a day continued for 6 to 26 days in all of these three patients. The presumed origin of the infection was considered to be Southeast Asian countries and the season of onset of diarrhea was March to July in all four cases.
Treatment with a sulfamethoxazole/trimethoprim compound was performed for both the HIVinfected patient and the other non-debilitated patient. Both symptomatic and parasitologic improvements were quickly observed in these patients.
A prospective study was performed using fecal specimens from the diarrheal patients to identify the presence of C. cayetanensis during the period from 1996 to 2001. Protozoa-positive specimens were found in 3 of 410 (0.7%) specimens from patients who had traveled overseas, is one of 148 (0.7%) for HIV-infected (the C. cayetanensis-positive patient also acquired the protozoa in Southeast Asia), and in none of 513 (0%) patients who developed diarrhea in Japan.
In summary, C. cayetanensis infection is rare in Japan and most patients infected with this pathogen tend to be overseas travelers and HIV-infected individuals at present.

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The virulence of 5 strains of M. intracellulare and 6 strains of M. avium to mice were examined. The former bacteria were obtained from the patients with mycobacterial pulmonary disease and the latter were from AIDS patients respectively. C57BL/6 (NRAMP-1 susceptible) and its NRAMP-1 congenic mice (resistant) were used to evaluate the virulence of these bacteria. Three of the 5 strains of M. intracelllulare showed a relatively high virulence. They grew in the liver, spleen and lungs of susceptible mice and even in the lungs of resistant mice. On the other hand, none of 6 strains of M. avium could grow in either susceptible or resistant mice. In conclusion, our mouse model may be a useful tool for evaluating the virulence of bacteria isolated from mycobacteriosis patients.

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Although various cell lines have been used for virus isolation, few study of virus isolation using MRC-5 cell, a human embryonic lung fibroblasts, have been reported in Japan. MRC-5 and other cell lines (Caco-2, Vero, RD-18s, LLC-MK2, HeLa, MDCK, FL, B95a and HMV-II), and suckling mouse were compared for isolation of viruses from clinical specimens. A total of 3, 284 specimens, collected from clinics and hospitals in Saitama Prefecture between July 1997 and August 2001, were inoculated in these cells. A total of 1, 252 viral strains were isolated and 1, 190 viral strains of these were identified. MRC-5 detected 209 of specimens positive for various viruses. As for adenovirus, a total of 132 viral strains were isolated using cell lines described above, and 100 of 132 viral strains were isolated in MRC-5. MRC-5 showed the highest sensitivity for isolation of adenovirus 3 and 7 (79.1% and 100%) of all other cells. The sensitivity in isolation of these viruses in HeLa was 58.1% and 50.0%, respectively. It showed that MRC-5 is able to isolate enterovirus, especially coxsackie virus A 16 and enetrovirus 71 with a high sensitivity (85.7% and 73.7%). RD-18s detected 35.7% and 26.3% of coxsackie virus A16 and enterovirus 71 isolates, LLC-MK2 detected 60.7% and 47.4%, and Vero detected 48.6% and 52.6%, respectively. Coxsackie virus B group was not isolated, except for a few coxsackie virus B5 strains. Enteroviruses except coxsackie virus A 16 and enterovirus 71 were isolated more frequently in Caco-2 and RD-18s. Seven hundred thirteen strains of influenza viruses were isolated in MDCK and Caco-2, but none was isolated in MRC-5. It was probably due to the maintenance medium without trypsin. The isolation rate of herpes simplex virus in Vero was 88.9% and MRC-5 showed 77.8%, it was high secondary to Vero by MRC-5. However, the CPE was detected in a few days in MRC-5, it was earlier than in Vero. The MRC-5 is possible to be maintained without changing the maintenance medium and passaged for 2 weeks, and clear CPE was observed. On the other hand, the disadvantages in using the MRC-5 were that the passage was limited and that the split ratio was only 1: 2. However, the MRC-5 was used successfully for virus isolation, especially coxsackie virus A16, enterovirus 71 and adenoviruses, from clinical specimens.

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We investigated the occurring tendency of enterohemorrhagic Escherichia coli (EHEC) infection in the prefectural and municipal public health institutes in the Chugoku-Shikoku area from 1996 to 1999, and the bacteriological characteristics of EHEC isolated from these cases. Consequently, epidemiological analysis of the EHEC infection in this district was performed.
22 outbreaks in the various facilities showed the tendency occurred in infants andaged groups, and the serotypes of EHEC isolated from these outbreaks were O26, O111 etc. as well as O157. In 4 cases, EHEC were isolated from specimens of buckwheat noodles, salad, sand box, and goat feces, and these were determined as the source of infection.
In 898 sporadic cases, including familial infection, the EHEC isolates were classified into 24 serotypes, and the genotypes of EHEC O157: H7 isolates by pulsed-field gel electrophoresis (PFGE) also varied. Moreover, since many asymptomatic carriers were detected in the adult group with familial infection, the existence of healthy carriers is as important as the source of infection.
The drug-resistance test of EHEC isolates showed that 24% of the 924 isolates wereresistant to drugs.

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An outbreak of diarrheal disease in a Japanese home for aged is reported. Out of 202 residents, 47cases complained of diarrhea (23.3%) during a month. Clinical symptom were diarrhea (100%) vomiting (40.4%) and fever (31.9%). Fecal examination of 9 cases revealed positive A-group rotavirus antigen. Bacterial and small round shapedvirus infection was excluded.
Examination of rotavirus antibody, CF titer was positive in about 50% in each age group but the titer decreased year by year.
In Japan, rotavirus infection has been epidemic only in nursing home for baby and titer of antigen has been believed to be sustain by repeated provocation.
However, Japanese situation is changing to be west Europe and north America.

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We experienced two cases of infectious mononucleosis-like syndrome associated with human herpesvirus 6 (HHV-6). One of the patients had been under medication for depression and the other one for schizophrenia. Both of them were taking carbamazepine for more than a week along with the other drugs. The manifestation of the symptoms of those two were almost same, such as high fever, generalized eruption, liver dysfunction, lymph-adenopathy, and existence of atypical lymphocytes. Serological tests for EB virus, cytomegalovirus and herpes simplex virus showed no significant change while the tests for HHV-6 showed increased titers of IgG antibody during the courses . We also examined HHV-6 DNA by real time quantitative PCR tests for HHV-6, and they appeared significantly high in the peripheral blood samples.

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The patient was 39-year-old male who had been administrated 20mg of prednisolone for control of chronic eosinophilic pneumonia. He consulted the hospital with fever, headache and gait disturbance. The laboratory data of peripheral blood revealed a smoldering adult T cell leukemia. Computed tomogram of the chest and MRI of the brain revealed a mass in the right middle lobe of the lung and a brain abscess in the left hemisphere respectively. Biopsized specimens from the lung and brain abscess showed an Aspergillus like fungus. In spite of placement of an Ommaya reservoir for administration of AMPH-B and control of intracranial pressure, he died. During the course, specific antigen and specific gene were not detected in the peripheral blood, and no viable organism was isolated from the specimens. Post mortem examination revealed multiple nodular lesions in the lung, parietal pleura, liver, heart and kidney.
After autopsy, disseminated aspergillosis was confirmed through a tissue examination using nested PCR for Aspergillus DNA. In this case, we think that viable fungi could endure in the tissue while circulating Aspergillus markers remained undetectable.

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A 71 year-old male, with no recent history of travelling abroad and a past history of lung cancer two years prior to presentation, which had been successfully treated, developed a sudden onset of watery diarrhea more than ten times a day on February 26, 2001, which gradually became bloody. The next day he visited the Department of Integrated Medicine of the Tokyo Metropolitan Komagome Hospital by ambulance because his conciousness was deteriorating and he was hospitalized. He was hypotensive on admission, and a dopamine preparation was used throughout. The peripheral WBC was 3, 800/μl and the lymphocyte count was 76/μl which thus suggested the presence of cellular immune suppression. HIV was nottested. He died seven hours after admission. His stool culture yielded a growth of Shigella flexneri 2a, and a blood culture on admission was sterile. No verocyte toxin-producing Esherichia coil was not detected. The causes of death in cases with shigellosis have been reported in the literature to be an electrolyte imbalance, septicemia and disseminated intravasucular coagulation (DIC) in developed countries. Our present case was considered to be a debilitated patient complicated with hemolytic uremic syndrome due to an infection with Shigella bacteria which resulted in death despite performing intensive treatments.

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