症例. 59歳.男性.発熱にて発症.入院時白血球数23400/μl (peak 33800/μl),好酸球26% (max 78%),肝機能異常を認めた.血清学的沈降反応にてイヌ回虫抗原に沈降線を認め,イヌ回虫幼虫移行症と考えチアベンダゾール投与を行ったところ,白血球数,肝エコー所見,肝機能の改善を認めた.本症は牛レバーの生食により感染し,チアベンダゾールが有効であったイヌ回虫幼虫移行症の興味深い1例と考えられた.

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A 42 years old man was suspected of suffening from psittacosis. The disease began with a continuing high fever and diarrhea. The fever subsided by chloromycetin in 4 days. Recurred signs and symptoms such as coughing, sputum, ronchus at the right lower back and fever were benefitially combatted by another application of 8 grams of chioromycetin.
All the clinical investigations aiming at typhoid fever failed. Atypical pneumonia was next suspected from a series of X ray examinations showing a marked shadow on the right hilum. Cold hemagglutination test by O-type human erythrocytes, however, was negative.
On the other hand, the complement fixation test for psittacosis turned positive in 32 times dilution on the 30th day and the 68th day, the antibody titer coming down to 8 times on the 166th day.
It was learned in addition that the patient had kept many birds including a parrot before falling ill. He had not only looked after them, but also kissed them directly. Birds died successively after the breakout of the disease. These facts together with the above montioned clinical observations would be enough to diagnose psittacosis.

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A housewife who had kept 15 birds as her pets was admitted with the chief complaints of fever and general malaise.
The X-ray film taken at the admission revealed fan-shaped ground-glass-like shadow extending over S2+S3 of the right lung.
She became afebrile within 48 hours after the beginning of propionylmaridomycin administration and recovered without relapse.
Serological examination for psittacosis, i.e. CF test demonstrated a significant rise in antibody titer conclusive of psittacosis.
From sputum at the onset of her illness, an agent belonging to chlamydia was isolated through intraperitoneal inoculation in mice.

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1956年来, 日本国内でも人のPsittacosis (オーム病) が発生していることが徐ら1), 北本ら2), 藤井ら3), 後藤ら4) によって明らかにされている。われわれ5～8)も, 1966年以来本症の6例を経験し, その臨床, 胸部X線所見, 病因的検索, さらに治療薬剤としてのTetracycline系薬剤, Macrolide系薬剤, Penicillin剤, Cephalosporin剤の効果についても報告した。現在, 本症に対する抗生剤の効果については, すでに諸家9～11)によって多くの検討が加えられ, Tetracycline系薬剤が第1選択剤とされている。
1973年に徐12)は,Chlamydia psittaciの発育卵黄ノウ内接種とマウス鼻腔内接種における治療実験で, Rifampicin はTetracvclineとほぼ同程度の効果を示したが, マウス脳内接種に対してRifampicinはTetracyclineより多少すぐれた治療効果を示したと報告した。また, TRIBBYら18)(1973) は, 組織培養中のマウス線維芽細胞 (L細胞) 中におけるChlamydia psittaciに対するRifampicinの作用を観察し, 本剤はそのRNA合成っづいて蛋白合成をそれぞれ阻害し, さらに同時に検討したChloramphenicolにくらべ, 著るしく低濃度でChlamydiaの分裂増殖を阻止すると報告した。したがって, Rifampicinの本症に対する臨床効果の観察が強くのぞまれたが, 私どもは最近, 本症の1例にRifampicinを投与し, その臨床効果を検討することができたので報告する。

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For the last five years and half, from January 1956 to June 1961 at the Sagamihara National Hospital, using the psittacosis antigen the complement fixation test and hemagglution test were made. The patients examined were consisted of 253 cases with primary atypical pneumonia and 216 cases with miscellaneous diseases excluding acute bronchtis.
Epidemiological Findings:
1) The incidence of the antibody of CF was significantly higher in the group of pneumonia (38.0 per cent) than in the group of the miscellaneous diseases (22.5 per cent). The incidence in the group of patients with pneumonia was already high in the age group of 0-9 years and showed significant difference among the age groups, while the miscellaneous diseases group showed an increase in incidence with age. These findings suggest that the group of pneumonia containins many psittacosis patients. The similar tendency was recognized on the HI antibody titer, too.
2) The incidence of the antibody did not show any difference between male and female.
3) The CF and HI titer was generally low. In the group of miscellaneous diseases no case of CF antibody titer indicates 2.4 ≤ and HI antibody titer 80 ≤. This indicated that the patients with CF antibody titer 2.4 ≤ and HI antibody 80 ≤ had recently been infected with psittacosis.
4) Patients with a definite increase and or decrease in titer or an unusually high titer were found in 16 per cent (42 cases) in the pneumonia group. While in the group of miscellaneous diseases no cases were found. The clinical picture of these patients was in accordance with that psittacosis.
5) In spring and fall more cases with psittacosis are seen than the other seasons of the year. And there is no significant difference between male and female. Among people who have had contact with pet bird, we have more patients with psittacosis than in others.
Clinical Observations:
1) Clinically the above described 42 cases have similar symptoms with those which are described in literatures. In general the symptoms are mild and the complications are hardly encountered.
2) Many mild cases recover spontaneously and the serious cases are treated and cured by administering Penicillin, Chioramphenicol, Tetracycline and Erythromycine, Sulfonamide is nearly ineffective.
3) There were no deaths.

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アメーバ性肝膿瘍は本邦では稀れな疾患と考えられているが,われわれは最近本症の1例を経験したので若干の文献的考察を加えて報告する.
症例は29歳男子.昭和52年8月2日,感冒様発熱. 8月8日,弛張熱(39～40℃)と右季肋部痛を訴えて入院.苦悶状顔貌を呈し,腹部膨満,右上腹部緊張,圧痛著明. WBC 20,800 AIK-P 25.2, T. Bil 0.5, GOT 24, GPT 38, CRP(+),検便でアメーバ(-),肝シンチ,右葉に巨大孤立性SOL (Space Occupied Lesion) (+).アメーバ性肝膿瘍の疑いで外科的肝ドレナージ,チョコレート様膿汁約1,000cc,膿中アメーバ(-),術後Latex凝集反応強陽性.フラジール, Tc, AB-Pc, DKB投与. 41病日治癒退院.本症例は国際航空路線乗務員であり,外地感染が考えられる.膿,糞便中アメーバ(-)で,確定診断はLatex凝集反応によった.

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Ampicillin (AB-PC) とDicloxacillin (MDI-PC) の協力作用を臨床的に検討し, 前報1) において出したが本報では, 徳島大学泌尿器科の外来および入院患者の尿から分離され左臨床分離株に対するAB-PC, MDI-PCおよびAB-PC・MDI-PC合剤め抗菌作用および寒天平板拡散法による協力作用の検討をおこなつた。

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オウム病の家族内発生例を2例報告した. 症例1は激症型であり多臓器障害を伴っていた. 患者は62歳男性で発熱, 息切れ, 意識障害で緊急入院した. 胸部X-Pでは両側広汎な肺炎を認め肝腫大を伴っていた. 検査所見では血沈の亢進, 貧血, 肝機能異常, CPKの上昇, 尿蛋白の陽性所見を認め, 心エコーで心嚢水貯留を認めた. 上記所見とインコの飼育歴からオウム病を強く疑い, 入院当日からDOXYを投与したが呼吸不全, 意識障害が進行し人工呼吸管理を施行した. 治療により胸部陰影の改善がみられ, 人工呼吸管理から離脱した. 経過中DICを併発したがヘパリン投与で改善した. 血清オウム病CF抗体価は64倍から256倍へと上昇しオウム病と診断した. 症例2は症例1の妻であり, オウム病肺炎に肝障害を伴っていた. DOXYの投与により翌日には解熱し, 2週間後に退院した. オウム病は多臓器障害を伴う例があり, 全身感染症として捉えるべき疾患である.

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グラム陰性菌尿路感染症のうち, 尿流障害を伴なうものおよび変形菌, 緑膿菌による尿路感染症は, 難治のものが多く, 経口剤投与による難治性・慢性尿路感染症の治療には困難な面が多い。したがつて, 変形菌, 緑膿菌等を含む抗菌スペクトラムをもっ内服抗菌剤の開発が待たれていた。今回我々が大日本製薬株式会社から供与をうけたPipemidic acid (PPA) は, Piromidic acid (PA) の誘導体であり, 経口投与後の吸収, 尿中排泄がよく, 主としてグラム陰性菌に有効であり, 緑膿菌, 変形菌およびPA, Nalidixic acid (NA) 耐性菌にも有効であるといわれている1, 2)。今回我々は, 27例の尿路感染症の患者に本剤を投与し, 治療経験を得たので, その成績を報告する。

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小児呼吸器感染症におけるChlamydia感染の実態調査を目的として, Chlamydia CF価, Mycoplasma CF (HA) 価を測定し, 血清学的並びに臨床的検討を肺炎例を中心に行い, 以下の成績を得た.
1) 調査対象は肺炎107例, 肺炎を除く下気道感染症323例の計430例で, Chlamydia CF価陽性は前者21例 (19.6%), 後者43例 (13.3%) であった.
2) Chlamydia CF価陽性肺炎21例中9例はChlamydia CF価単独陽性であり, 12例はMycoplasma CF (HA) 価も同時に陽性であった. そこで両者の臨床症状および検査所見を比較すると, 平均咳漱持続期間は前者12.9日, 後者14.1日であり, 38℃以上の発熱をみた症例は前者44.4%, 後者75.0%で, その平均持続期間はそれぞれ3.0日, 7.1日であった. また白血球増多を示した症例は両者に差はないが, CRP強陽性, 赤沈充進例は後者により多くみられた. 胸部X線所見での肺炎像は陰影消失まで前者は平均6.3日, 後者は平均8.5日を要した.
3) 鳥類飼育および接触機会の有無とChlamydia感染との関係は, 鳥類飼育あるいは接触機会の多い患児ではChlamydia CF価陽性例が45.0%にみられた.
4) 治療はTetracycline系およびMacrolide系抗生剤により, 臨床的並びに検査所見の改善を認めた.

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A 47-year old man was admitted to the Ohmori Red-Cross Hospital because of recurrent high fever associated with systemic bone and joint pain on September 25, 1978.
On admission, hematologic examination showed no anemia nor thrombocytopenia and moderate leukocytosis with appearance of immature granulocytes and erythroblasts in a low percentage.
Recurrent bone narrow aspiration was all dry tap. At the beginning of October, pancytopenia developed rapidly with transient remarkable elevation of serum LDH activity up to 26,000 IU/ml, and serum uric acid 27 mg/dl, previous to the initiation of antileukemic chemotherapy.
He died of sepsis on October 18. Autopsy showed diffuse proliferation of promyelocytes in the bone marrow and a diagnosis of acute promyelocytic leukemia was established.
Multiple bone marrow necroses were seen in the vertabrae, costae, sternum and iliac bone. The remarkalde elevation of serum LDH and uric acid in this case is attributed to the necrosis of leukemic cells in the bone marrow.

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In order to investigate factors affecting postmortem lung cultures in the aged, 90 autopsies were made during the period from July 1979 to September 1982. The following results were obtained:
1) Cerebral vascular disease was the most frequent underlying disease, and was present in 50% of 54 culture-positive patients, followed by cancer and cardiac failure (20% each).
2) The elapsed time between death and postmortem examination had no significant effect on the incidence of positive cultures.
3) The incidence of positive cultures in cases with an activities of daily living (ADL) score of 0 to 5 was significantly higher than that of cases with an ADL score of 6 to 15.
4) The incidence of positive cultures in cases of total protein less than 6.0g/dl was significantly higher than that of cases of 6.0g/dl or more total protein.
5) Antibiotic therapy given prior to death influenced both the percentages of cases with positive cultures and the bacterial amount isolated postmortem.
6) The incidence of positive cultures according to the cause of death was 81% in pneumonia, 54% in cancer, 50% in cerebral vascular disease, 29% in cardiac failure, and 50% in others.

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化学療法の進歩した現在においても, Compromised host にとり肺炎の合併は重篤で死に至ることも多い. そこで終末期肺炎の病態を知るべく, 昭和53年～60年までの本院剖検例1,183例中剖検時広範に肺炎のみられた260例を検討した. まとめると以下の如くなる. (1) 剖検時陽性菌は, 血液培養・肺培養共 Pseudomonas aeruginosa・Klebsiella sp. が多く, グラム陰性桿菌が大半を占めた. (2) 起炎菌を決定し, 感受性のある抗生剤を投与しながら剖検時に同一菌が残存する例もみられた. (3) 菌交代がよく起こる可能性が示唆され, 頻回な菌検索が必要と思われた. (4) 抗生剤投与が長期化するにつれ P. aeruginosa の出現頻度は上昇し, Klebsiella sp. ・Escherichia coli の頻度は低下した. (5) 肺炎症状が軽微でありながら, 剖検時広範な肺炎を生じている例もあり, Compromised host においては注意深い観察が必要と考えられた.

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The most striking change of Candida albicans cells injected into the peritoneal cavity or subcutaneous tissue of the mouse was the transformation, within one hour, of the majority of the organisms to the filamentous form. The other pathogenic members of the genus Candida studied did not exibit this change except C. stellatoidea.
In tissue culture medium C. albicans transformed to the fillamentous form as rapidly as in the animal body.
The filamentous transformotion was more rapidly and frequently observed in the HeLa maintenance medium containing HeLa cells. Yeast-like fungi in tissue culture together with antifungal antibiotics contributed much to evaluation of the effects of the antifungal agent and the cytopathogenicity on HeLa cells.
Regarding with the phagocytosis of the yeast-like fungi using the intraperitoneal monocytes of mouse, the phagocytic rate, intracellular propagation or digestion, and the grade of cell degeneration were different between the species of yeast-like fungi. Only C. albicans developed pseudomycelia rapidly from phagocyte cells. The phagocytic rate on Cryptococcus neoformas was distinctly lower than that on Candida. By adding cortisone, especially in a higher concentration, phagocytic rate was decreased and elongation of pseudomycelia from phagocytes was stimulated.
Adding antifungal agent, antifungal activity and cyto-toxicity can be tested by phagocytic rate, degeneration of cells and elongation of pseudomycelia of C. albicans from phagocytes.
The use of the HeLa tissue culture technique is useful not only for the studies on the interrelationship between host cells and pathogenic fungi, identification of pathogenic fungi but fundamental studies on infection, immunology and therapy of fungus diseases.

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In order to determine causative organisms in terminal pneumonia in the aged, 90 autopsies were made during the period from July 1979 to September 1982. The results of routine bacteriological cultures from the lung were analyzed with respect to the correlation between bacteriologic and histologic findings. The following results were obtained.
1) One hundred and twenty strains were isolated from 54 culture positive cases. K. pneumoniae, S. faecalis, E. coli and P. aeruginosa were the more frequently isolated strains of bacteria. Gram-negative bacilli were apparent in 63% of 120 strains.
2) It was very difficult to assess causative organisms of terminal pneumonia from the bacteria isolated in antemortem sputum.
3) The cases showing bacterial amounts of (+) or more isolated from the postmortem lung have greater likelihood of pneumonia as a cause of death.
4) Forty-eight strains were isolated from 30 terminal pneumonia cases. In terms of bacterial amount, K. pneumoniae, glucose non-fermentative gram-negative bacilli, S. aureus, and E. coli were most frequently isolated.
5) The incidence of positive cultures in alveolar pneumonia was significantly higher than that of mixed-type pneumonia.

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Two cases of Mycoplasma pneumoniae pneumonia, which were first diagnosed as acute nasopharyngitis and acute pharyngo-laryngitis by an ENT doctor, were presented. The characteristics of the cases were as follows:
1) The chief complaints were sore throat, intermittent fever and ear fullness.
2) Diffuse inflammation of the upper respiratory tract was noticed. One patient had a strong inflammation of the nasopharynx and it looked like a nasopharyngeal tumor. Whitish coating covered on the nasopharyngeal inflammatory site.
3) One patient had a tubal stenosis, and the other one had acute otitis media. Hearing examinations of the two cases showed a conductive deafness with a stiffness curve.
4) Paracenthesis of the tympanic membrane was carried out on the acute otitis media case. A milky and sereous middle ear effusions was found in the middle ear cavity.
5) Many kinds of examinations were carried out to make the correct diagnosis. Rising titers of blood coagulutiation were discovered, and sera tested for complement fixation antibodies was extremly elevated. From these results, the two cases were diagnosed as M. pneumoniae infection.
6) Although patients were treated with many antibiotics, aminobenzylpenicillin, cephalosporin and aminoglycoside, they were not cured. Tetracyclin and clindamycin were very effective.

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