[Positive phase periods of ImmunoCard Mycoplasma tests].

We evaluated the positive phase period of ImmunoCard Mycoplasma tests. The subjects were 74 penumonia patients (male : 38, female : 36, 17-94 years old) with positive ImmunoCard Mycoplasma tests. ImmunoCard Mycoplasma tests were performed every week for 8 weeks later, then every 4 weeks until negative conversion. The positive phase period was within a week in 30 of 74 patients (40.5%) and within 4 weeks in 52 patients (70.3%). In each generation the positive phase period of the most patients was within a week. The positive phase period of the elderly had no tendency to be longer than that of the young patients. These results indicated that about half of the patients with positive ImmunoCard Mycoplasma tests showed Mycoplasma infection which occurred within the past 1 week.

Coxiella burnetii and acute exacerbations/infections in patients with chronic lung disease.

The aim of the present study was to determine the incidence of Q fever in patients with an acute exacerbation of a chronic lower respiratory tract infection. Eighty patients treated for acute exacerbation of chronic lower respiratory tract infections during a 30-month period were studied. Q fever was diagnosed by ELISA. Two elderly woman with pre-existing bronchiectasis (2.5%) were diagnosed as having an acute infection by Coxiella burnetii. The acute illness was considered to be a result of mixed infection with Pseudomonas aeruginosa and Haemophilus influenzae with C. burnetii. Co-infection with C. burnetii can occur during a bacterial exacerbation of a chronic lower respiratory tract infection.

[Testing for Mycoplasma pneumonia using the ImmunoCard Mycoplasma rapid test].

We evaluated the effectiveness of ImmunoCard Mycoplasma rapid tests in all patients admitted with community-acquired pneumonia (CAP) between January, 2004 and December, 2005. ImmunoCard Mycoplasma rapid tests were performed on the 1st day of admission and we analyzed the frequency of positive cases among CAP cases according to month and age. A total of 82 of 270 (33.7%) and 41 of 257 (16.0%) were positive among CAP cases in 2004 and 2005, respectively. More positive cases were seen between spring and early summer and in cases aged 70 years or more, especially those over 80 years old. These results indicated that further evaluation is required among positive cases in elder group.

[Clinical effect of continuous infusion of meropenem on bacterial pneumonia in the elderly].

We studied the clinical effect of continuous infusion over 24 hours of meropenem (MEPM) on bacterial pneumonia in the elderly (over 65). The subjects were 26 patients (community-acquired pneumonia: moderate, n = 9; severe, n= 4; hospital-acquired pneumonia: group III, n = 13) whose performance status was 3 or 4. MEPM 1.0g/day was infused continuously for 7-14 days, and its clinical efficacy, bacteriological efficacy, and side effects were examined prospectively. It was effective in 23 of the 26 patients (community-acquired pneumonia: moderate, 8/9; severe, 3/4; hospital-acquired pneumonia: group III, 12/13; efficacy rate: 88.5%). Bactericidal effects were obtained in 3 strains of Klebsiella pneumoniae, 2 strains of Streptococcus pneumoniae, 2 strains of methicillin-sensitive Staphlococcus aureus, 1 strain of Streptococcus agalactiae and 1 strain of Proteus mirabilis, but not in 2 strains of methicillin-resistant S. aureus, 1 strain of Pseudomonas aeruginosa and 1 strain of Serratia marcescens. Mild abnormal laboratory findings were observed in 2 patients: elevation of GPT, gamma-GTP, BUN and elevation of ALP. Based on the above, continuous infusion of MEPM on bacterial pneumonia in the elderly obtained excellent clinical effects. Further study is needed to compare the efficacy of continuous versus intermittent administration of MEPM.

Clinical effect of gatifloxacin, 200 mg daily, on bacterial community-acquired pneumonia in the elderly.

The clinical effect of gatifloxacin (GFLX) at 200 mg daily (half of common dosage) on bacterial community-acquired pneumonia in the elderly was examined. Subjects were 30 patients with bacterial community-acquired pneumonia aged 65 years or more (mild, 21 patients; moderate, 9 patients), and GFLX at 100 mg per dose was administered twice daily for 4-14 days. The results included clinical effectiveness in 21 of 21 mildly affected patients (efficacy rate, 100%), in 8 of 9 moderately affected patients (efficacy rate, 88.9%), and 29 of a total of 30 patients (efficacy rate, 96.7%). With regard to bacteriological effect, 28 of 29 strains were eradicated (eradication rate, 96.6%). Abnormal laboratory findings included mild elevations in GPT, GOT, and ALP in only 1 patient. Based on these findings, we concluded that administration of GFLX at 200 mg daily is recommended for bacterial community-acquired pneumonia in the elderly.

[Q fever in acute exacerbation of chronic lower respiratory tract infection].

We studied the effect of Q fever in acute exacerbation of chronic lower respiratory tract infection. The subjects consisted of 80 cases with acute exacerbation of chronic lower respiratory tract infection treated during the period from March 2002 till October 2004. Q fever was diagnosed using a PanBio Coxiella burnetii ELISA test kit. Two cases (2.5%) were positive for IgM in the acute stage, and were diagnosed as having acute infection by C. burnetii. They were elderly women with bronchiectasis, aged 76 and 82. They had no history of keeping cats or dogs, but the onset of acute exacerbation of chronic lower respiratory tract infection was June and March which is the breeding seasons for cats and dogs. Acute exacerbation of chronic lower respiratory tract infection were considerd to be a mixed infection with Pseudomonas aeruginosa (the 76-year-case) and Haemophilus influenzae (the 82-year-case). It is concluded that C. burnetii can induce exacerbation of chronic lower respiratory tract infection, their cases were considerd to be mixed infection with C. burnetii and other bacteria.

[PFGE analysis of Mycobacterium kansasii isolates in Okayama Prefecture].

OBJECT: To investigate the epidemiology of M. kansasii infections in Okayama Prefecture and to consider the mode of infection of M. kansasii on the basis of the PFGE results. MATERIALS AND METHODS: 22 M. kansasii isolates of pulmonary infections from 22 patients treated between 1977 and 1993 in Okayama Prefecture were investigated by pulse-field gel electrophoresis (PFGE) using restriction endonuclease Vsp I. In addition, the tap water from five companies in the Mizushima Industrial Area was cultured to investigate the source of infection of this disease. RESULTS: These M. kansaii isolates were found to be clustered into four or five by PFGE during different. From the tap water, M. kansasii was not detected. CONCLUSIONS: From the result of the PFGE, it was considered that the infection sourse of M. kansasii in Okayama Prefecture was living in a common environment or a district.

[Comparison of clinical presentation of mixed pneumonia with Chlamydia pneumoniae and Streptococcus pneumoniae and S. pneumoniae pneumonia].

Chlamydia pneumoniae is a significant cause of both lower and upper acute respiratory illnesses, including community-acquired pneumonia. Furthermore, C. pneumoniae has been reported to frequently cause pneumonia in association with other respiratory pathogens, mainly Streptococcus pneumoniae. In this study, we investigated the clinical presentation of mixed pneumonia with Chlamydia pneumoniae and S. pneumoniae and compared it with S. pneumoniae pneumonia. A total of 13 cases of mixed pneumonia and 58 cases of S. pneumoniae pneumonia identified at Kawasaki Medical School and related hospitals between April 1996 and March 2001 were analyzed. The diagnosis of C. pneumoniae infection was based on isolation and serologic testing of antibodies by the microimmunofluorescence test. The clinical presentation of mixed pneumonia and S. pneumoniae pneumonia was almost identical and no statistical differences were observed between the two groups. This is the same as what was observed before except eleven out of the 13 of the mixed pneumonia patients responded to treatment with only beta-lactam antibiotics. Our results indicated that C. pneumoniae may not be the primary cause of community-acquired pneumonia but it might descript the normal clearance mechanisms, enabling other pathogens to invade.

[The trend of M. kansasii infection in Okayama Prefecture between 1994 and 2000].

The first case of pulmonary Mycobacterium kansasii infection in Okayama Prefecture was discovered in the Mizushima industrial area in 1976. Thereafter pulmonary M. kansasii infection spread to neighboring areas and increase in the number of the patients was reported in 1995. In the present study, new patients with M. kansasii infection between 1994 and 2000 were surveyed by questionnaires sent to 32 main hospitals in Okayama Prefecture. The results showed that 110 patients with pulmonary M. kansasii infection were documented by 20 hospitals. The number of new patients was 10 to 20 annually, and the number of new patients was stable after 1995. The new patients were documented in the center of the Mizushima industrial area and the geographic spread to the new neighboring area was not confirmed.