Viral conjunctivitis with special reference to adenovirus type 37 and enterovirus 70 infection.

The clinical and etiological findings in 727 patients with viral conjunctivitis treated from January 1982 through December 1984 at Aoki Eye Clinic in Sapporo, Japan, were presented. The age of the patients ranged from 11 days to 88 years, and the monthly incidences of the disease from 18 to 131 cases, with a clustering in the summer season. The etiological diagnosis was established in 399 (54.9%) of the 727 patients: adenovirus (Ad) 3 in 45 cases; Ad4 in 98 cases; Ad8 in 57 cases; Ad19 in 23 cases; Ad37 in 51 cases; untyped Ad in 33 cases; enterovirus (EV) 70 in 60 cases; herpes simplex virus type I in 24 cases and varicella-zoster virus in 4 cases. The clinical pictures of adenovirus 37 conjunctivitis were generally similar to those of adenovirus 8 conjunctivitis, and subconjunctival hemorrhage was more frequently seen in cases of EV70 conjunctivitis. EV70 cases showed nosocomial infection. In addition to Ad8, Ad37 seems to play an important role as a causative agent of epidemic keratoconjunctivitis in Japan.

Molecular epidemiology of adenoviral conjunctivitis in Sapporo, Japan, and Manila, the Philippines.

DNA restriction endonuclease analysis was carried out on 48 adenovirus isolates from the conjunctival swabs of patients with acute conjunctivitis. Samples were obtained in Sapporo, Japan, and Manila, the Philippines, from October 1983 to October 1984. We identified new genomic variants among the isolates of Ad3 in Sapporo, and Ad4 and Ad11 in Manila, and these were designated as Ad3f, Ad4b, Ad11a and Ad11b, respectively. Ad7 isolates in Manila were identical to Ad7b reported by Wadell et al. In Sapporo, no Ad7 was isolated during the period of this study. One isolate in Sapporo, which was neutralized by both Ad34 and Ad35 antisera, showed identical restriction patterns to Ad35 prototype strain (Holden) with SmaI, BamHI and HpaI. However, with HindIII, the pattern was identical to that of Ad34 prototype strain (Compton). This isolate was tentatively designated as Ad34/35. Ad8 isolates in Sapporo were identical to Ad8B detected there from 1977 to 1981, while Ad8 isolates in Manila were prototype (Trim) strains. In both cities Ad19 isolates were all identical to Ad19a and Ad37 isolates were all prototype (GW). Genomic variants of Ad isolates in both cities are as follows: (Table: see text).

An epidemic of acute hemorrhagic conjunctivitis in the city of Sao Paulo.

This is a clinical and laboratory report on 98 patients with acute viral conjunctivitis who were referred to the Eye Clinic of the Escola Paulista de Medicina of Sao Paulo, Brazil, from February 1983 to February 1984. It was planned with the objective of confirming the importance of adenovirus and enterovirus 70 as etiological agents of viral conjunctivitis. The occurrence of an outbreak of acute hemorrhagic conjunctivitis during the summer of 1984 permitted a better study of enterovirus 70. In addition, we could demonstrate that sporadic cases, from March to July 1983, were caused by the same virus. This fact confirmed the idea that the spread of the disease was not related to the recent arrival of the virus in the community, but to weather conditions of heat and high humidity.

[Virological surveillance of acute respiratory tract illnesses of children in Morioka, Japan. III. Human respiratory coronavirus].

In the virological surveillance of children with acute respiratory tract illnesses, five human respiratory coronaviruses (HRCV) were recovered. Three of these strains were isolated from nasopharyngeal swabs of patients with influenza-like illness collected in Kuji City on March 29, 1979. This may suggest the association of HRCVs and influenza-like illness. The other 2 strains were yielded from nasopharyngeal swabs of patients with afebrile acute upper respiratory tract illness collected in Morioka City on March 16 and April 27, 1979. These 5 isolates exhibited typical properties of HRCV; distinctive morphology, resistant to BUDR, chloroform sensitivity, and electron microscopic features of growth in L132 cells. These isolates were identified as 229E-like HRCV by indirect immunofluorescence test, but these were considerably different to HRCV (strain 229E) in antigenicity. Reciprocal neutralization titers of antisera against HRCV (strain 229E) and each isolate were determined by 50% plaque reduction tests in monolayers of L132 cells. The neutralizing activities of anti-HRCV (strain 229E) serum against each isolate were 40- to 100-fold lower than that of homologous reaction. The remarkable differences of antigenicity among the isolates did not be observed.

[Virological surveillance of acute respiratory tract illnesses of children in Morioka, Japan. II. Rhinovirus infection].

Rhinoviruses (HRVs) were isolated from 307 children (7.1%) in the virological surveillance of 4334 children with acute respiratory tract illnesses in Morioka, Japan (September 1973-December 1983). Although HRVs were isolated throughout the year, frequency of HRV infection was significantly higher (p less than 0.001) during the April-November (233/2853; 8.2%) than during the December-March (47/1481; 5.0%). There were two peaks of incidence in May (9.5%) and September (9.1%). During the May-September, the rate of HRV infection was higher in patients under the age of 11 months than the next higher group of 1-2 years old (p less than 0.001). The incidence decreased with increasing age. The illnesses of HRV infection were analysed in 294 patients, except one patient who had symptoms of measles, from whom HRV was isolated singly. Although HRV-associated illnesses were generally mild (57.5%). Upper respiratory tract illnesses (URTIs) with fever were found in 22.1% and lower respiratory tract illnesses (LRTIs) in 20.4% of these. The rate of LRTI was higher during the epidemic period (April-September) than other periods (p less than 0.02). Major symptoms of HRV-associated illnesses observed were sore throat (87.4%), cough (84.0%), and nasal obstruction and/or discharge (72.8%). Wheezing was observed in 21.8% of these. From 19 (21.8%) of 47 patients clinically diagnosed as asthmatic bronchitis in this survey, viruses were isolated. HRV was detected most frequently in 12.8% of these patients, followed by respiratory syncytial virus (RSV, 6.4%) and adenovirus (2.1%). HRV- and RSV-associated asthmatic bronchitis were observed during April-September and November-February, respectively. Viral dual infections were detected in total 20 cases included 12 HRV-associated cases. In no case was the illness of greater severity than might have been caused by either agent acting singly.

[Susceptibility of RD-9H8 cells derived from RD cells to enteroviruses and its application for measuring neutralizing antibodies against coxsackievirus group B].

We carried out cloning of RD cells and obtained cloned cell line RD-9H8, which is highly sensitive to enteroviruses. Cytopathic effect (CPE) of RD-9H8 cells was more remarkable than that of original RD cells. The RD-9H8 cells were used to measure the neutralizing antibodies to coxsackievirus group B in sera from 93 medical students collected in Oct. 1990 at Iwate Medical University. The proportions of confirmed positive sera were coxsackievirus type B1 44.1%, type B2 50.5%, type B3 46.2%, type B4 64.5%, type B5 53.8% and type B6 4.4%.

[Virological surveillance of acute respiratory tract illnesses of children in Morioka, Japan. I. Epidemiological patterns of infection with respiratory viruses over a 10-year period].

A virological surveillance of acute respiratory tract illnesses (RTI) of children in Morioka, Japan, was maintained from September 1973 to December 1983. Nasal and throat swabs were collected from 4,334 children with RTI. These patients consisted of 3,500 children (80.8%) with upper RTI (URTI) and 834 children (16.2%) with lower RTI. When these patients with URTI were classified by maximum temperature recorded into 4 groups (less than or equal to 37.0 degrees C, 37.1-37.9 degrees C, 38.0-38.4 degrees C, and greater than or equal to 38.5 degrees C), the number of patients in each group was 1,909 (44.0% of all patients), 702 (16.2%), 378 (8.7%), and 512 (11.8%), respectively. The viruses were recovered from 932 patients (21.5%). The most frequently recovered virus was rhinovirus (HRV; 31.7% of positive patients). The other common viruses were respiratory syncytial virus (RSV; 15.3% of positives), enteroviruses (13.9%), adenoviruses (13.6%), and influenza viruses (11.1%). Coronaviruses (HCV) were isolated from 2 patients and dual infections were detected in 20 patients (2.1% of positives). HRVs were isolated from 8.9% of afebrile URTI, in addition to 7.4% of bronchitis and 12.8% of asthmatic bronchitis. RSVs were mainly isolated in the winter, but some of them were isolated in the summer of 1974 and 1975. HCVs were isolated from 2 patients with afebrile URTI in the spring of 1979. Consistent patterns have been observed in clinical manifestation, seasonal occurrence, and age distribution of infections; we indicated that HRV was not only most important pathogen of URTI, but also it was important in bronchitis and asthmatic bronchitis of children.

Differentiation of herpes simplex virus types 1 and 2 by plaque appearances on semicontinuous rabbit lens epithelial cells in the clinical laboratory.

Herpes simplex virus type 1 (HSV1) and type 2 (HSV2) were differentiated on the basis of different plaque appearance on semicontinuous rabbit lens epithelial (RLE) cells. Plaques produced by HSV1 strains were small; the mean diameter was 1.29 +/- 0.37 mm 3 days after inoculation. HSV2 strains produced large and small plaques, with the ratio of large to small about 20:1. The mean diameters of the large and the small plaques of HSV2 were 3.34 +/- 0.56 mm and 0.97 +/- 0.31 mm respectively 3 days after inoculation. The clones from the large plaques consistently produced large and small plaques and the small-plaque clones produced only small plaques. Round cells plus heterokaryotes were characteristic of the CPE of HSV1. Large plaques of HSV2 were produced by a large membranous syncytium that was liable to lyse. Small round cells were characteristic of the CPE of the small-plaque clones of HSV2. Glycoprotein C-negative (gC-) strains produced intermediate-sized plaques and a few pin point ones that consisted of membranous syncytia and round cells, respectively. Except for the HF strain (a reference strain of HSV1 producing a membranous syncytium on RLE cells), the result of the differentiation of HSV1 (179 strains) and HSV2 (40 strains) with the RLE plaque assay system was consistent with that of Syva's monoclonal antibody assay system and the restriction endonuclease digestion method.

[Three cases of lower respiratory tract infection worsened after rhinovirus infection].

We experienced three cases of lower respiratory tract infections worsened after Rhinovirus infection. Case 1: A 42-year-old male with diffuse panbronchiolitis was admitted to our hospital with the complaint of dyspnea on November 21, 1988. Rhinovirus was isolated from nasal washing and P. aeruginosa was cultured from transtracheal aspiration (TTA). Case 2: A 67-year-old male, whose underlying disease was pulmonary asbestosis, was admitted to our hospital complaining of pyrexia on June 12, 1990. Rhinovirus was isolated from TTA and H. influenzae and others were cultured from TTA. Case 3: A 64-year-old male with pulmonary emphysema was admitted to our hospital with a complaint of dyspnea on August 11, 1989. On December 17, 1989 the patient developed rhinorrhea and complained of purulent sputum, pyrexia and dyspnea after five days. Rhinovirus was isolated from nasal washing and TTA and S. nonhaemolyticus and others were cultured from TTA. As indicated in this report, it is interesting to study the relationship between viral infection of the upper respiratory tract and bacterial infection of the lower respiratory tract.

[Geographic localization of three variants of herpes simplex virus type 1 in Japan].

We previously reported that a variant of herpes simplex virus type 1 (HSV-1) designated variant type A was isolated at a much higher frequency in Western Japan than in Eastern Japan. We examined the localization of two other variant types designated B and C. The proportion of the type B and type C variants among 553 fresh HSV-1 isolates from 10 areas in Japan were 5.4% and 1.3%, respectively. The isolation frequency of type B variant in Eastern Japan was 8.3%. It was as high as 20.5% in Iwate area. The frequency in Western Japan was only 3.0%. Type C variant showed no specific geographic localization. These results were discussed in terms of characteristic mode of HSV infection and the history of the Japanese nation.

[Diagnosis of varicella-zoster virus (VZV) infection by using FITC-labeled monoclonal antibodies].

Anti-varicella zoster virus (VZV) mouse monoclonal antibodies conjugated with fluorescein isothiocyanate were evaluated for their usefulness as a practical diagnostic tool in the clinical field by examining cells infected with isolated herpes viruses and 431 clinical samples. The kit stained clearly the cells infected with 14 isolated VZV strains without cross reaction to 15 isolated herpes simplex virus type-1 strains (HSV-1) and 14 type-2 (HSV-2) strains. In clinical specimens, viral antigens of VZV were detected in 92/105 (87.6%) cases of varicella and in 176/190 (92.6%) cases of herpes zoster. Specific fluorescence of VZV was also observed in 5 out of 96 cases diagnosed as HSV infections, although these samples had no specific reaction to HSV when tested by the commercially available diagnostic kit. In 24 cases which could not be clinically diagnosed as herpes zoster or herpes simplex, the VZV antigen was demonstrated in 9 cases. All 109 VZV-positive cases in virus isolation by culture were also judged VZV-antigen positive by the kit, while all 69 HSV-positive cases in virus isolation were VZV-antigen negative. Furthermore, the VZV antigen was detected by the kit in 53/60 clinical diagnoses of varicella or herpes zoster without successful virus isolation. These results clearly indicate the usefulness of the kit as a practical VZV diagnostic reagent, especially in terms of specific sensitivity and easy technical manipulation.

[In vitro synergy between cefotaxime and its main metabolite, desacetylcefotaxime].

In vitro synergistic interaction between cefotaxime (CTX) and its main metabolite, desacetyl-cefotaxime (DCTX), against 7 species of clinical isolates (23-27 strains per species) was examined. Complete or partial synergy was noted with a 1:1 combination of CTX and DCTX against 22-78% of the Bacteroides fragilis, Staphylococcus aureus, Citrobacter freundii, Pseudomonas cepacia and Enterobacter cloacae isolates examined. Antagonistic effects of the drugs appeared against 11% of Proteus vulgaris and 4% of Serratia marcescens. When combined at various ratios by the checkerboard method and tested against B. fragilis, CTX and DCTX were found to act synergistically, and no antagonism occurred. The combined use of CTX and DCTX exhibited strong bactericidal activity against B. fragilis and inhibited bacterial regrowth. An experiment with concentrations of CTX and DCTX simulating human serum levels after intravenous administration also showed that the coexistence of DCTX augmented bactericidal activity of CTX against B. fragilis and brought inhibitory effects on bacterial regrowth. It is presumed from the present results that clinically applied CTX would have more potent effects than expected from in vitro sensitivity test data.

[Antimicrobial susceptibility patterns of the Proteeae in Japan, 1989].

We discussed the antimicrobial susceptibilities of Proteeae isolated in Japan, 1989. Eight hundred six clinical isolates were collected from 47 hospitals. These were comprised of 431 strains of Proteus mirabilis, 155 Proteus vulgaris, 154 Morganella morganii, 44 Providencia rettgeri and 22 Providencia stuartii. Antibiotics tested in this study were 2 penicillins, 5 cephems, 1 carbapenem and 2 aminoglycosides. The MIC's were determined using the standard method of the Japan Society of Chemotherapy. Susceptibilities of the above strains to these antibiotics are described below; 1. Latamoxef, ceftizoxime and imipenem had excellent activities with no evident differences among the species of Proteeae. 2. Ampicillin and cefazolin were less active against Indol-positive Proteeae. 3. Piperacillin and cefmetazole were also strongly active drugs against P. mirabilis, P. vulgaris and P. stuartii, and cefotiam against P. mirabilis and P. stuartii. 4. Gentamicin and netilmicin showed excellent activities against M. morganii.

[Nosocomial infections].

Nosocomial infections are caused by various factors, therefore it is very important for doctors, nurses and other medical staffs to cope with counter plans in their own situations. In terms of pathogens causing nosocomial infections, bacteria, fungi and viruses are equally important. The pathogens are transmitted either directly or indirectly in a medical facilities through medical treatments including surgical operations, catheterizations, handling the lines for chemotherapies, and so on. An increasing tendency of opportunistic infections in patients with protracted illness is seen lately. It must be emphasized that in each medical facility, a committee for control of nosocomial infection must be established. Infection surveillance and control programs must be provided and each person should have access to it. One of the most important activity of the infection control committee is to give a good education to medical workers to prevent nosocomial infections. Ministry of Health and Welfare has launched control programs for nosocomial infections since a nationwide MRSA-panic spread. The Japanese Association for Infectious Diseases and Japanese Society of Environmental Infections have been contributing to control nosocomial infections for more than a decade. These organizations will promote research programs as well as surveillance and control programs for preventing nosocomial infections.