[Chlamydia pneumoniae infection in patients with acute bronchitis and bronchial asthma].

In this study, a total of 60 patients with acute bronchitis, 71 patients with bronchial asthma and 20 healthy volunteers were serologically and bacteriologically analyzed to investigate whether Chlamydia pneumoniae infection is associated with the onset and the exacerbation with acute bronchitis and bronchial asthma. Antibody titers to Chlamydia pneumoniae were also measured and compared by ELISA method. The antibody-positive rate in the patients with acute bronchitis (88.4%) was significantly higher than that in the patients with bronchial asthma (73.3%) or that in the healthy volunteers (60%). And the levels of the IgA antibody in the patients with acute bronchitis were significantly higher than those in the patients with bronchial asthma or those in the healthy volunteers. The rate of acute C. pneumoniae infection in the patients with acute bronchitis (20%) did not show significantly differences compared with that in the patients with bronchial asthma (15.5%) or that in the healthy volunteers (10%). The cases of acute C. pneumoniae infection had both as a single etiologic agent and as a mixed infection, most often with Streptococcus pneumoniae. Therefore, we demonstrated that the acute C. pneumoniae infection may be associated with the onset and the exacerbation in acute bronchitis and bronchial asthma.

[The antimicrobial susceptibilities and serotypes of Pseudomonas aeruginosa isolated from sputum].

During the period of January 1992 and August 1995, 75 strains of Pseudomonas aeruginosa were isolated from sputum at the Hiroshima Prefectural Hiroshima Hospital. The antimicrobial susceptibilities and serotypes of those strains were investigated. The results are summarized as follows: 1. The analyses of antimicrobial susceptibilities revealed that meropenem (MEPM) was the most active among the carbapenems tested against those P. aeruginosa strains with MIC of < or = 6.25 micrograms/ml. All of the strains were thus found to be susceptible to MEPM, while 9 strains out of 75 (12%) were resistant to imipenem showing cross-resistance to biapenem. 2. The activities of the beta-lactams other than carbapenems were found to be the order of cefozopran > or = ceftazidime > aztreonam > piperacillin with MIC50 and MIC90 ranging of 3.13-6.25 micrograms/ml and 25- > or = 100 micrograms/ml, respectively. 3. Among aminoglycosides tested, 3 strains (4.0%) of the strains showed resistance to amikacin, however none of them were resistant to tobramycin. 4. Distribution of serotypes among the strains was; type G 22.7%, type M 21.3%, type A 16.0%, type B 13.3% and type E 8.0%. Strains of types M and E showed multiple resistance to beta-lactams except carbapenems. As documented in this study, the frequency of isolation of beta-lactam-resistant P. aeruginosa (including carbapenem-resistant) is steadily increasing. Continuous surveillance of antimicrobial susceptibility among clinically isolated P. aeruginosa seems to be necessary.

[Desensitization immunotherapy on patients with mite-positive bronchial asthma using purified mite feces antigen fractions].

At present, we are performing desensitization immunotherapy on patients with mite-positive bronchial asthma using purified mite feces antigen fractions. We obtained the following results in 13 patients 4 to 12 months after the start of treatment. 1) The fraction showing the maximum reaction in the skin test was HM1-2 (molecular weight: 150-155 kD) in two patients, HM2 (30-40 kD) in nine patients and HM3 (10-20 kD) in two patients, and immunotherapy was performed using these fractions. None of the patients showed the maximum skin reactions or was treated with HM4 (less than 10 kD). 2) In nine patients with perennial asthma, the effects of treatment were excellent in four and moderate in three, while two cases remained unchanged. In four patients with seasonal asthma, the treatment was effective in all cases. 3) In patients in whom immunotherapy was effective, specific IgG antibody increased after the treatment, but it did not increase in the unchanged cases. Among the subclasses of specific IgG antibody increased by the treatment, no clear changes were seen in IgG4 antibody and no conclusion has been reached at present. 4) None of the patients had definite adverse reactions such as the occurrence of asthma attacks or anaphylaxis. These results suggested that purified mite feces antigens are safe and effective. We plan to continue this study with more patients in the future.

[Results of 29-year study of hoya (sea-squirt) asthma in Hatsukaichi, Hiroshima prefecture].

As remarkable improvements have been made to the working environment and working methods of oyster shucking workers during the past 30 years, a study was made on the effects of these improvements on hoya (sea-squirt) asthma and the following results were obtained. 1) The prevalence of hoya (sea-squirt) asthma among oyster shucking workers was 36.0%, 30.1%, 21.7%, 22.0%, 18.0%, and 26.6% in 1963, 1968, 1976, 1984, 1988, and 1992, respectively. Accompanying the improvements made to the working environment and working methods, asthmatic symptoms failed to develop in some of the patients through engaged in oyster shucking work. Thus, those with symptoms actually accounted for 36.0%, 18.7%, 15/8%, 7.4%, 8.4%, and 8.0% of the workers, respectively. 2) The proportion of serious cases among the patients rapidly decreased from 29.2% in 1963 to 0% after 1984. On the other hand the proportion of slight cases was 35.4% in 1963, but after 1988 all the cases were slight cases. 3) During the period from 1984 to 1992, the number of those newly engaged in oyster shucking work was 74. The number of those who developed hoya (sea-squirt) asthma during this period was 8 or 10.1%. All the cases were asthma of the rhinitis type. 4) The number of workers who did not develop asthmatic symptoms though engaged in oyster shucking work was 53 in 1984, 40 in 1988, and 49 in 1992. Of this number, 31% are now under hyposensitization therapy, 57.0% have received this therapy in the past, and 12.0% have not received any therapy.

[Immunotherapy using high concentration purified antigen showed remarkable effect in all cases].

Hoya (sea-squirt) asthma is a typical type I occupational asthma. A total of 22 females with this disease whose age ranged from 22 to 69 years were treated for two years with high concentration purified sea-squirt antigen named Ei-M having a molecular weight of 22,800. One case who developed ordinary bronchial asthma abandoned the immunotherapy during the early stage of the therapy, but in the remaining 21 cases remarkable effects were rapidly observed from the early stage of treatment. These cases did not develop asthmatic attacks even through they engaged in oyster shucking work and no symptomatic therapy was indicated. Serum anti-Ei-M IgG antibody was significantly elevated after the therapy. None of the treated cases developed any side effects.

[Clinical and pharmacokinetics studies of ceftriaxone upon 2g once daily administration in respiratory tract infections].

Clinical studies on ceftriaxone (CTRX) were conducted with 2 g once daily administration to respiratory tract infections. In addition, CTRX concentrations in serum, sputum and urine were determined. The results obtained are summarized as follows: 1. Clinical responses to CTRX in a total of 29 cases with respiratory tract infections were excellent in 7 cases, good in 13, fair in 8 and poor in 1 with a response rate of 69.0%. 2. CTRX concentrations in serum, sputum and urine (total and free body) were determined in 3 cases after intravenous drip infusion of 2g CTRX. Peak levels in sputum were 2.6 to 7.8 micrograms/ml, and CTRX maintained high sputum levels for 12 to 24 hours after administration.

Therapeutic effect and titers of the specific IgE and IgG antibodies in patients with sea squirt allergy (Hoya asthma) under a long-term hyposensitization with three sea squirt antigens.

Hyposensitization therapy with each of three sea squirt antigens, Gi-rep (molecular weight [MW] 106,000), Ei-M (MW 22,800), and DIIIa (MW 9980), have succeeded in 72%, 90%, and 36% of patients with sea squirt allergy, respectively, within the first year, and the effect has been maintained during subsequent 4-year maintenance therapy. All available sera from some of the hyposensitized patients were also examined for IgE and IgG titers against the most effective therapeutic antigen, Ei-M, and it was revealed that the Ei-M-specific IgG titer increased rapidly in the successfully hyposensitized patients, regardless of the therapeutic antigen used, except for a few patients. Furthermore, the high specific IgG titer, as well as the therapeutic effect, was maintained during the subsequent maintenance therapy. No such increase in the specific IgG titer was detected in all unsuccessfully hyposensitized patients. In contrast, the Ei-M-specific IgE titer was practically unchanged in all allergic patients, independent of the therapy. Therefore, the effect of the hyposensitization therapy was closely dependent on the induction of the specific IgG capable of competing with the specific IgE for a certain asthma-inducing antigen, like DIIIa. The apparently low therapeutic efficiency of DIIIa was attributed to its relatively low immunogenicity to induce the specific IgG.

[Laboratory and clinical studies of norfloxacin in respiratory tract infections].

Norfloxacin (NFLX), a new quinolone antibacterial agent, was investigated for its antibacterial activity and clinical efficacy on respiratory tract infections. The results obtained are summarized as follows: 1. Antibacterial activities were evaluated against 127 strains of various bacteria isolated from clinical sources. MIC80's of this drug were: against Staphylococcus aureus and Streptococcus pyogenes 1.56 micrograms/ml; Haemophilus influenzae 0.05 microgram/ml or less; and Klebsiella sp. and Enterobacter sp. 0.10 microgram/ml. These antibacterial activities were superior to these of ampicillin and cephalexin, except against S. pyogenes. 2. Clinical responses to NFLX in a total of 32 cases with respiratory tract infections were excellent in 9 cases, good in 12, fair in 9, poor in 2, with an efficacy rate of 65.6%. Neither adverse reactions nor abnormalities of laboratory test results were observed.

[Clinical studies on cefoxitin in the treatment of respiratory tract infections].

The clinical effects of cefoxitin (CFX) were studied in 31 cases of respiratory tract infections. The results were as follows: As for the clinical effects, CFX was excellent in 5 cases, good in 13, fair in 8 and poor in 5 out of 31 patients; the efficacy rate was 58.1%. The efficacy rate was 57.1% in bronchopneumonia, 61.1% in pneumonia and 50.0% in acute exacerbation of chronic respiratory tract infections. The efficacy rate was 70.6% in the group of 4 g/day or less and 42.9% in the group of 6 g/day or more. The efficacy rate was 50.0% in 6 cases that had not been responded to other antibiotics previously. As for side effects, skin eruption was observed in only 1 patient. No abnormality was observed in laboratory tests due to CFX. In conclusion, CFX is a useful drug in the treatment of respiratory tract infections.