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We treated two cases of primary pulmonary cryptococcosis with fluconazole (FLCZ), the clinical usefulness of FLCZ was evaluated. FLCZ was administered orally in doses of 300 mg daily for about six months. Concentrations of FLCZ were measured in the serum of the two cases and in the bronchoalveolar lavage (BAL) fluid in one case. The following results were obtained: 1. Clinical cures were obtained in the two cases. 2. The serum levels of FLCZ was 15.1 microliters/ml, 13.6 micrograms/ml two hours after administration of 100 mg in case 1, that of levels were 11.1 micrograms/ml, 8.9 micrograms/ml one hour and 4.5 hours, respectively, after administration of 100 mg in case 2. BAL was performed 4.5 hours after administration of 100 mg in case 2, the BAL fluid level of FLCZ was 0.7 microgram/ml. 3. The minimal inhibitory concentration of FLCZ against one strain obtained from the cytology brush in case 1 was 4.0 micrograms/ml. 4. The cryptococcal antigen titer decreased with the improvement of clinical signs and the resolution of chest X-ray abnormalities within about six months, and there was no relapse. From these results, we consider that FLCZ is a useful antifungal agent for primary pulmonary cryptococcosis, and we therefore recommend a six month treatment.

We treated nine patients of mycoplasmal pneumonia with sparfloxacin (SPFX) the clinical efficacy, safety and usefulness of SPFX were evaluated. SPFX was administered orally at doses of 200 or 300 mg once daily, and we performed bronchoalveolar lavage (BAL) examinations in five patients. BAL was performed 5 hours after oral administration of 100 mg in one case, 19 hours after oral administration of 200 mg in four cases. Concentrations of SPFX and alubumine were measured in serum and in BALF (bronchoalveolar lavage fluid). The following results were obtained. 1. Nine patients were evaluated; eight patients judged as Good, one patient as Excellent. 2. The serum and BALF levels of SPFX was 0.79 microgram/ml, 0.107 microgram/ml 5 hours after single oral administration of 100 mg in one case and 19 hours after oral administration of 200 mg in four cases, those of levels of SPFX were 0.835 +/- 0.274 microgram/ml and 0.081 +/- 0.033 microgram/ml, respectively. 3. The ratio of SPFX/albumin in BALF was significantly higher than in the serum. From these results, we consider that SPFX is a useful antimicrobial agent for mycoplasmal pneumonia.

A 44-year-old female with diabetic ketoacidosis was admitted due to right back pain and dyspnea. A chest roentgenogram showed accumulation of fluid in the right pleural space. A drain was inserted into the right thoracic cavity and pleural fluid yielded a putrid odor. Gemella morbillorum was diagnosed based on culture of the fluid. She was treated with clinidamycin and panipenem/betamipron intravenously and insertion of a drainage tube. The in vitro activity of CLDM and PAPM/BP against G. morbillorum were less than 0.025 micrograms/ml and 0.05 micrograms/ml, respectively. She was cured and discharged after 28 days of hospitalization, the portal of entry was thought to be connected with dental caries.

We have performed serial bronchoalveolar lavage (BAL) examination in two patients with asperigilloma and compared that of total cell count and cell population with control groups (5 non-smokers, 10 smokers) and other pulmonary infectious diseases: 7 each with mycoplasmal pneumonia and pulmonary tuberculosis, 6 with bacterial pneumonia, and 5 with chlamydial pneumonia. Miconazole (MCZ) by drip intravenous infusion of 400 mg/day and flucytosine (5-FC) by oral intake of 4.5 to 6.0 g/day were administered to one patient with aspergilloma, and we studied the serum and BALF concentration about 5 hours after administration. The followings results were obtained: 1. In aspergilloma, the cell population of neutrophils in BALF increased compared with control groups (p < 0.01) and other pulmonary infectious disease. 2. The serum and BALF levels of MCZ ranged from 0.1 to 0.3 micrograms/ml, < 0.1 14.4 micrograms/ml, respectively. On the other hand, the serum and BALF levels of 5-FC ranged from < 0.2 to 9.3 micrograms/ml, and < 0.4 to 1.5 micrograms/ml, respectively. From these results, we consider that neutrophils play the main role in the immune host defense in aspergilloma, and the combination of intracavitary infusion of MCZ and oral administration of 5-FC should be the treatment of choice.

We carried out the bacteriological examination of sputum and bronchoscopy specimens from 31 cases with pneumonia due to C. psittaci. The results obtained were as follows: 1. The positive culture of sputum and bronchoscopy specimens were 38.7% (12/31). 2. The organisms detected from them were 13 strains of gram-negative bacilli, 2 of gram-positive cocci and one gram-positive bacillus. 3. Significant differences were observed in the white blood cell count between the cases of positive culture and those of normal upper respiratory tract flora (p less than 0.05). From the results we conclude that it would be better that we add the proper antimicrobial drugs to chlamydial antibiotics in the treatment of patients with leukocytosis.

We treated three patients of chlamydial pneumonia with OFLX, two patients were diagnosed as psittacosis and one as pneumonia associated with TWAR strain by serologic test. Three hundred mg of OFLX was orally administered three times per day and the duration of treatment was from seven to fourteen days, and we compared the clinical effectiveness of OFLX in three cases (mild: 1, moderate: 2) with that of MINO in eleven cases (mild: 3, moderate: 8), who were administered two hundred mg of MINO two times per day orally or intravenously. We isolated C. psittaci from three pet birds including case 2 and the in vitro activity of OFLX and MINO against three strains of C. psittaci was determined. Clinical effectiveness were observed and obtained results were as follows. 1) In OFLX group, three patients judged as "Good", and in MINO, one patient as "Excellent", ten as "Good". 2) The duration of pneumonic shadow was 9.33 +/- 3.21 in OFLX group, 10.3 +/- 3.50 in MINO group, and there was no significant difference between both groups. 3) The in vitro activity of OFLX and MINO against 3 strains was 0.78-1.56 micrograms/ml and 0.025 microgram/ml, respectively. From these results, it was concluded that OFLX was considered to be a useful antichlamydial agent in the treatment of mild or moderate cases of chlamydial pneumonia.