[A case of loiasis].

Loiasis is quite common in the endemic regions of Central and West Africa. But only three cases were reported in Japan. This is a report of a 28 year old male from Gabon infected with Loa loa with eye symptoms as the chief complaint. For the first time in Japan he was treated with Ivermectin (IVM) which is recently attracting attention as the drug for filariasis world wide. IVM therapy was effective, and decreased the counts of microfilarias in the patient's blood. No adverse effect was seen in this patient. This case suggested that IVM is an useful drug for loiasis, and further study is warranted.

Concurrent infection with Legionella pneumophila and Pneumocystis carinii in a patient with adult T cell leukemia.

A 48-year-old woman was admitted to our hospital with high fever, chills, cough, and exertional dyspnea. On admission, the chest roentgenogram and computed tomography scan showed bilateral alveolar infiltration in the middle and lower lung fields. Microscopic examination of the bronchial lavage fluid showed flower cells typical for adult T-cell leukemia (ATL) and cysts of Pneumocystis carinii, and Legionella pneumophila serogroup 1 grew on buffered charcoal yeast extract (BCYE)-alpha agar. The patient was successfully treated with antibiotics including trimethoprim/sulfamethoxazole, erythromycin, and sparfloxacin. Remission of ATL was achieved after three courses of antileukemic chemotherapy. Mixed infection of opportunistic pathogens should be considered in patients with ATL.

Radiation enterocolitis: overview of the past 15 years.

From April 1980 to April 1995 a total of 54 patients (53 women, 1 man) were hospitalized in our department for the surgical treatment of radiation enterocolitis. Two surgical protocols were applied for these patients: intestinal decompression procedures alone (intestinal bypass, colostomy, or both; n = 18) or an intestinal resection in addition to decompression (n = 36). The clinical factors contributing to survival after irradiation were retrospectively reviewed by a multiple variate proportional hazards model. As a result, patients treated with decompression procedures alone had an 11 times higher risk for death than those treated with the addition of intestinal resection. In the former group, 5 of 18 patients died of bleeding from the remaining intestine after operation. We concluded that surgical resection of the diseased intestine is a useful procedure for treating radiation enterocolitis to reduce intestinal bleeding from the irradiated intestine.

Detection of Mycobacterium tuberculosis in clinical specimens by polymerase chain reaction method.

An insertion sequence repeated multiple times in the chromosome of Mycobacterium tuberculosis was used as a target for amplification using the polymerase chain reaction (PCR) assay for detecting Mycobacterium tuberculosis in clinical specimens. The sequences of primers were 5'-CCTGCGAGCGTAGGCGTCGG-3' (primer 1) and 5'-CTCGTCCAGCGCCGCTTCGG-3' (primer 2). One cycle of amplification consisted of denaturing at 94 degrees C for 2 min, primer annealing at 68 degrees C for 2 min, and extension at 72 degrees C for 2 min. DNA (5 fg) extracted from M. tuberculosis was detected by gel electrophoresis and Southern blot hybridization after 40 cycles of amplification. The amplification products were not obtained by DNA extracted from M. kansasii, M. intracellulare, M. avium, M. fortuitum, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Legionella pneumophila and Staphylococcus aureus; only from the M. tuberculosis complex. PCR results were compared with conventional cultural, pathological and microscopic findings in the detection of M. tuberculosis in 112 clinical specimens. There were 25 specimens that were positive for M. tuberculosis by cultural or pathological examination, of which 20 (80%) were positive by PCR. PCR detected the organism in 5 (83%) of 6 smear-positive specimens and 15 (79%) of 19 smear-negative specimens in which culture or pathology revealed M. tuberculosis. In addition, 2 smear-negative specimens and 8 smear-negative and culture-negative specimens were positive by PCR. These 10 samples were collected from the patients suspected as having tuberculosis by the clinical diagnosis based on the clinical history, characteristic radiographs, a positive PPD skin test and the effectiveness of anti-tuberculous drugs.(ABSTRACT TRUNCATED AT 250 WORDS)

[Identification of Legionella pneumophila strains by polymerase chain reaction method which isolated from cooling tower water].

We studied the polymerase chain reaction (PCR) method with 5 strains of Legionella pneumophila serogroup 4, 7 strains of L. pneumophila serogroup 5, 7 strains of L. pneumophila UT and 15 strains of Legionella like organisms (LLO). We used mip-primers reported by Mahbubani et al and LEG-primers reported by Starnbach et al. Positive PCR results were obtained by all strains of L. pneumophila serogroup 4, L. pneamophila serogroup 5, L. pneumophila UT and 11 strains of LLO using mip-primers. Using LEG-primers, positive results were obtained by 2, 6, 5 and 8 strains respectively. All strains that showed positive results using LEG-primer PCR, were contained by the strains that showed positive results using mip-primer PCR. Conversely, there were some strains that were positive in mip-primer PCR and negative in LEG-primer simultaneously. Therefore, mip-primers is recommended to detect L. pneumophila in clinical specimens by PCR method.

Analysis of cellular response and gamma interferon synthesis in bronchoalveolar lavage fluid and lung homogenate of mice infected with Pneumocystis carinii.

The cellular and cytokine responses in the lungs of mice infected with Pneumocystis carinii were examined on both lung homogenates and bronchoalveolar lavage (BAL) fluids. In the lungs of infected mice, the number of P. carinii cysts rapidly decreased by day 7, then started to increase with a peak on day 14, and thereafter decreased gradually. When the presence of P. carinii was examined at the DNA level by dot blot hybridization, a similar clearance curve was obtained, and the organisms were shown to be completely eliminated on day 28. In the late phase of infection, leukocytes, mainly lymphocytes, increased in number when analyzed on lung homogenates, while no significant increase of inflammatory cells was observed in BAL fluids. An accumulation of both CD4+ and CD8+ T cells and an increase of activated T cells expressing IL-2R alpha were observed in lung homogenates of the infected mice. In addition, a considerable amount of IFN-gamma was detected in lung homogenates, but not in BAL fluids. These data indicate that lung homogenates are more suitable than BAL fluids for the analysis of cellular and cytokine responses in the lungs of mice infected with P. carinii. To define the involvement of IFN-gamma in host defense against P. carinii, the effect of this cytokine on the killing activity of macrophages against P. carinii was examined in vitro. IFN-gamma was found to augment this activity by increasing nitric oxide synthesis of the macrophages. Thus, it is suggested that IFN-gamma plays an important role in the protection of mice from P. carinii infection.

[Usefulness of polymerase chain reaction method in the early diagnosis of Pneumocystis carinii pneumonia].

We evaluated the sensitivity and specificity of polymerase chain reaction (PCR) method in the detection of Pneumocystis carinii, and compared its clinical usefulness with that of a previous method, toluidine blue-O (TBO) staining in diagnosis of P. carinii pneumonia (PCP) using clinical samples such as sputum and bronchoalveolar lavage fluid (BALF). Using P. carinii obtained from BALF of the infected rats, we showed that PCR showed 100 fold more sensitivity than TBO staining as indicated by the comparison of their detection limits (78 cysts/ml vs 7800 cysts/ml). In addition, the detection using PCR in this study was specific for P. carinii because all other pathogens examined were not positive. In the clinical study we analyzed 44 patients including 10 with definite PCP, 8 with portable PCP and 26 with other diagnosis. In the sputum, the sensitivity and specificity were 100% and 95%, respectively, in PCR, while 13% and 100% in TBO staining. These results revealed that PCR was much superior to TBO staining in sensitivity especially when the sputum was used as samples, and suggested that examination of the sputum by PCR was clinically very useful in early diagnosis of P. carinii pneumonia.

[Study of Legionella pneumophila detection by two step polymerase chain reaction].

We studied the usefulness of two sets of primers in macrophage infectivity potentiator gene sequence of Legionella pneumophila. PCR by 1st step primers produced 649 bp DNA bands and 2nd step primers 489 bp DNA bands. Two step PCR by these primers produced 489 bp DNA bands specific for L. pneumophila. Two step PCR detected 10 fg of pure DNA extracted from L. pneumophila, Philadelphia-1 strain. PCR sensitivity by these primers was superior to former primers reported by us using intratracheal aspirates collected from the patient with L. pneumophila serogroup 2 pneumonia.

[An animal model of Pneumocystis carinii pneumonia and therapeutic efficacy of interferon-gamma in this model].

To evaluate the efficacy of drugs for treatment, we tried to make an animal model of Pneumocystis carinii (P. carinii) pneumonia. Specific pathogen free (SPF) rats immunosuppressed with corticosteroid were intratracheally inoculated with P. carinii. Six weeks after the inoculation, the lung sections of infected rat lung showed increased numbers of P. carinii in the alveoli and thickening of alveolar septa with mononuclear cell infiltration. From 7 to 9 weeks after inoculation, the intensity of infection became more severe, and some rats died at this period. Then, to evaluate drug efficacy in this model, we finished the drug therapy by the 6th week and used the number of P. carinii in the lung and the inflammation score as an indicator of drug efficacy. In this P. carinii pneumonia animal model, both sulfamethoxazole-trimethoprim clinically established anti P. carinii drug and interferon-gamma which is one of the lymphokines mainly produced by T lymphocytes indicated therapeutic and synergistic efficacy against P. carinii pneumonia.

[Renal autotransplantation and graft replacement for DeBakey IIIb dissecting aneurysm--a case report].

A successfully repaired case, a 53-years old man, who suffered DeBakey IIIb type dissecting aneurysm and renal dysfunction was reported. The right kidney, of which artery was originated from the false lumen, was autotransplanted to the right iliac system to improve the renal blood circulation. Then the descending aorta was segmentally replaced with the prosthesis under profound hypothermia, circulatory arrest and retrograde cerebral perfusion without cross-clamping the aortic arch. Three months later, aortography and catheterization study suggested that the reperfused left kidney resulted in renin-dependent hypertension. Kidney, therefore, was resected to improve blood pressure control. Patient recovered successfully, with no evidence of neurological complication.

[Histopathological study of the aging process in the human sacroiliac joint].

It has not been well defined the morphologic characteristics of the aging process of the sacroiliac joints in man. We have, therefore, studied the sacroiliac joints of human subjects by light and scanning electron microscopy. The joints were collected from 55 Japanese fetuses and adult cadavers. The articular cartilages on both sacral and iliac sides were composed of hyaline cartilage in the fetuses and adults. In fetuses, loose fibrous strands were found in the articular space and appeared to represent a residue of the intermediate layer during formation of the articular space. In adults who were older than 30, the joints showed definite degeneration which was more severe on the cartilage at the iliac side than that of sacral side. Scanning electron microscopic observations supported the light microscopic findings. Fusion of the two articular surfaces was observed in 24% of the adult joints. These findings strongly suggest that the buffering capacity of the sacroiliac joints decreases with aging which appears to relate to the clinical symptom of low back pain.

An improved micromethod for infectivity assays and neutralization tests of dengue viruses.

An improved micromethod for infectivity assays and neutralization (N) tests of dengue (DEN) type 1-4 viruses was developed, using 96-well plates and the PAP (peroxidase-antiperoxidase) staining technique. The foci formed on BHK-21 cell monolayers in wells of the plate were readily countable under an ordinary stereomicroscope. This micromethod has the advantages over the micromethod of the Lab-Tek 8 chamber slide system of lower cost, requirement for smaller volumes of test sera and applicability to larger number of serum specimens for N tests of DEN viruses.

A seroepidemiological study of Japanese encephalitis and dengue virus infections in the Chiang Mai area, Thailand.

As part of a virological and epidemiological survey of encephalitis in the Chiang Mai area, the neutralizing (N) antibody levels of healthy persons to Japanese encephalitis (JE) and dengue (DEN) type 1-4 viruses were examined. A total of 985 blood samples was collected by the filter paper method from subjects of nine age groups in five districts, four (Pasang, Sarapee, Doi Saket and Mae Taeng) in the Chiang Mai Valley and one (Fang) in another valley separated by several ranges of mountains from the Chiang Mai Valley. From analyses of the results of N tests on the specimens, the following conclusions were drawn about the prevalences of JE and DEN viruses in the Chiang Mai area: (1) In the Chiang Mai Valley, the percentage incidences of N antibodies to JE and DEN viruses increased with age and by the age of 15, two thirds or more of the residents had been infected with JE and all DEN viruses except DEN type 2 virus, which showed the lowest prevalence. (2) In the Fang district, the percentage incidence of N antibody to JE virus increased with age, but those to DEN viruses did not, indicating much lower prevalences in the past of all four serotypes of DEN viruses in this district than in the Chiang Mai Valley. (3) At present, most infants in the Chiang Mai area, including the Fang district, seem to be exposed to DEN viruses first and later to JE virus.