Recent prevalence of typhoid and paratyphoid carriers has been posing a problem to public health in this country. Although much effort has been devoted toward improvement of the medical treatment of these disorders, there is still almost as much difficulty as in pre-antibiotic era.
Since surgery is sometimes inadequate and removal of the gallbladder is not always successful in eradicating the carrier state, search for effective medical treatment should be continued.
For this purpose, it is believed useful to grab the present situation and judge the effectiveness of vari ous methods adopted in this field. In this attempt, the author asked many clinical organizations in various parts of Japan to contribute to him their case-records as many as possible. Finally, the author was able to review 111 case-records from 20 clinical organs and carried out an analysis of the data from the therapeutical point of view.
Some remarks to the definition of the carrier state and the recognition of the perfect cure are described first, and then an analysis of the data was summed up.
1) The criterion adopted in this paper for the chronic biliary carrier state from the autor's empirical and practical viewpoint is that the finding of positive bile or stool cultures persists for over one year. (The recent progress in the field of the germ culture made the stool culture almost equivalent to the bile culture as far as the isolation rate is concerned.)
2) Likewise, the author believed that at least one year period of negative follow-up examinations is necessary to confirm the cure of the carrier state.
3) If strictly applied the above mentioned standard, only one case treated with the combination of Aminobenzyl-Penicillin (AB-PC) and Nalidixic Acid could be considered cured.
4) Based on comparative observations of the lenghth of the pause of negative culture after the medical treatment, AB-PC seemed to be moderately effective and gave the impression that larger daily -dose and longer administration period are recommendable.
5) Chloramphenicol, as being pointed out by many other authors, has shown no effectiveness to any extent.
6) Though tried to only a few cases, T-ran (a compound of nitrofuran and thiadiazole) seemed pro -duced fairly good results. Further trial is needed.
7) The other formulas of medical treatment, amounting as many as more than 40, have no value to be described here.
8) Any mehods tried to those 16 cases who were still in carrier state after surgery failed to show any encouraging data, except that in only one case the stool cultures turned negative for about three months after i.m. Penicillin administrations for consecutive 5 days.

View full abstract

Through pharyngeal swab cultures, isolation of Streptococcus haemolyticus (S.h.) was carried out fon 11893 persons who were among the patients visiting the department of internal medicine of this hospital as outpatients during a 10-year-period (1956-1965). On isolated S.h., grouping and typing were attempted by Lancefield's test. In most positive cases quantitative colony counting was done.
Further, from epidemiological viewpoint, the authors divided the patients into two categories. One (Group 1) is the patients group having such diseases as Angina Lacunalis, Angina Simplex, Acute and Chronic Nephritis, Grippe Syndrome, Bronchitis, Empyema, and Rheumatic Arthritis. The other (Group 2) is the group not having these diseases. The authors' consideration is that some relationship with S.h. is referred to these diseases and the S.h. positive patients in Group 2 are considered to be non-manifested carriers. In this respect, some observations were made separately on Group 1 and Group 2.
The results were as follows:
1) The positive cultures as a whole were 819 (6.8%) out of 11893, Group A being 396 (48.3% of 819), Group G 217 (26.4%), and C 89 (10.9%). The positive cultures for S.h. groups other than A, C, and G were 117 (14.4%), 0 and K being prominent, and F, L the rarest.
2) The total number of Group 1 was 2552 (21.5%), Group 2, 9341 (78.5%).
3) In Group 2: The number of positive cultures was 523 (5.5%), Group A occupying about a half (229), being numerically followed by G and C. It is noticeable that the distribution of all kinds of S.h.groups could be seen in this group. In this group, the S.h. possesing rate was highest (12.3 %) in the Lage group 12-14, followed by 7.7% in 15-19. and 4.3-6.4% in 20-29. 30-39, 40-49, over 50 each. The curve of S.h. possessing rate was highest (10.3%) in 1956, then kept declining until it reached to the bottom (2.8%) in 1964, and was in upward trend in 1965 (3.3%). Out of isolated 229 Group A, a half (115) could be typed into 24 types, among which Type 1 and Type 12 were prominent in number.
4) In Group 1: The positive cultures were 296 (11.6%) out of total 2552. The incidence was highest in Angina Lacunalis (42 out of 71, 59.1%), followed by Angina Simplex (23.3%), Acute and Chronic Nephritis (17.8%, 15.3%). In those cases, Group A was always remarkably predominent. The result of quantitative colony counting demonstrated the strong relationship between Group A and the above mentioned diseases and Empyema. Contrarily, Grippe Syndrome, Brochites, and Rheumatic Arthritis were proved rarely related with it.
5) Group B, DF, F, and L, however, did not happen to be isolated from Group 1. The relationship between isolated S.h. belonging to the groups other than Group A, C, and G and diseases has not sufficiently clarified yet.

View full abstract

Some laboratory experiments and clinical applications of Pantofenicol (PF), a newdrug, a compound of chloramphenicol and panthotenic acid calcium, were performed.
Antimicrobial activity to Shigella in vitro, drug concentration level in human blood in oral administration of PF, and evaluation of PF in the treatment of Bacillary Dysentery, Scarlet Fever, and Typhoid diseases are the main subjects of this series.
The following results were obtained:
Antimicrobial activity of PF against 40 strains of Shigella except some chloramphenicol (CP)-resistant strains was almost as same as CP (0.8-6.2mcg/m)
In oral administrations of 1.0g of PF and CP, maximum drug concentration level inthe blood was obtained earlier (one-two hours after the administration) and was higher in the case of CP than PF. Maintenance of the drug concentration was proved longer in PF than CP, however.
Clinical effects of PF to 52 cases of Bacillary Dysentery were nearly the same asCP. To the CPresistant cases, the combination use of PF and Chlor-Acetoxi-Quinolin (Silital) brought about fairly good results to the clinical course and the stoppage of bacillary discharge.
In the clinical application of PF to 12 cases of Scarlet Fever, only 50% of them were made negative for the pharyngeal Streptococcus haemolyticus. PF seemed to be less effective to Scarlet Fever than Penicillin.
In the treatment of two cases of Typhoid Fever and a case of Paratyphoid A with PF, though none of bacillary reappearance or recurrence cases were encountered, slight prolongation of febrile period, compared with CP cases, seemed not to be deniable.

View full abstract

Forteen patients and 16 carriers of the bacillary dysentery were treated with pantofenicol (PF). Daily dose of 6 capsules (one capsule contains 344mg of PF which is equivalent to 250mg of chloramphenicol) in adult was administrated every 8 hours for 5 days.
1) In the patients with PF-sensitive strains (6 cases), clinical effects were as follows: remission of fever was seen within 1.2 days, normalization of the defecation frequency within 1.7 days and recovery of stool findings within 2.8 days.
The bacilli disappeared within 1.7 days in the patients (6 cases) and 2.0 days in the carriers (6 cases).
Reappearance of the bacilli was observed in 25% of them.
2) In the cases with resistant strains (18 cases), clinical effects were so slight, if any, that the recovery seems to be almost spontaneous.
Continuous discharge and reappearance of the bacilli were seen in about 56%.
3) No remarkable side effects were encountered.
4) The sensitivity test of shigellae to PF was carried out.
The MIC was 12.5-1.56mcg/ in 17% and more than z in 83%.
The authors conclude that ^^ surely u useful drug for the bacillary dysentery due to sinsittive strains. However, nowadays, the number of cases with PF-resistant strain has markedly increased in this country, so practically the choice of PF in the traetment of bacillary dysentery must be said to be considerably limited.

View full abstract