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In 1998, the worst flood disaster in Bangladesh ravaged more than half of its land and diarrheal epidemics broke out. We examined fecal specimens of diarrheal patients at rural hospitals in Chandpor district located 140 km southeast of Dhaka to analyze the enteric bacterial pathogens in post-flood period October. Of the 76 patients stools examined, Vibrio cholerae O1 biotype El Tor, serotype Ogawa, and Vibrio cholerae O139 Bengal were detected in 25 (33%) and in 14 (18%) respectively. Other enteropathogenic bacteria confirmed were Vibrio cholerae O5, Vibrio fluvialis and Enteropathogenic Escherichia coli O44. Neither Shigella nor Salmonella species was detected in this study. A drug susceptibility test was performed using TC, DOXY, CPFX, NA, and AMPC disks to cholera Vibrios. The O1 Vibrios showed the same susceptible pattern as O139 excluding NA susceptibility. TC resistant strain among the Vibrios was not detected though TC is a common therapeutic drug for diarrhea in this area. Our result clearly suggested that the epidemic potentiality of O139 still existed in rural Bangladesh.

The serum bilirubin of malaria patients was investigated in an effort to show that jaundice occuring in malaria patients differs from hepatocellular (hepatitis) and obstructive jaundice.1. The incidence of abnormally high serum total bilirubin (≥ 1.1 mg/dl) was more frequent in cases of falciparum than in vivax and ovale malaria patients put together (71% vs 49%, p

We have previously reported that there exists a time limit for effective treatment of falciparum malaria. In short, four days after the onset of the illness was found to be the time limit beyond which severe, life-threatening complications may develop.In order to elucidate the level of laboratory variables beyond which the patient's prognosis is poor, we examined the correlation between time lag in days vs maximum parasite count, minimum red blood cell (r.b.c.) count, minimum hemoglobin (Hb), maximum blood urea nitrogen (BUN) and creatinine concentration of each patient during the period of admission. A linear correlation was found between time lag (x) and the maximum parasite count in log units (y), y= 4.031+0.124x, r =0.3579. All variables among patients whose treatment was started after 5 to 11 days of time lag (6th to 12th day of illness) were significantly worse than the variables of patients whose treatment was started after only 1 to 4 days of lag time. However, the most conspicuous change was observed in the abrupt increase of BUN and creatinine in the members of the late-treatment group : the mean BUN and creatine levels in the early and late treatment groups were 16.0 vs 57.1 and 1.2 vs 3.4 mg/dl (p

Our retrospective study for ultrasonic nebulised pentamidine in 13 patients shows that 7 of 8 patients with Pneumocystis carinii pneumonia (PCP), proven by biopsy examination, were cured (recovery rate, 88%). Two of these 8 patients were mainly treated by nebulised pentamidine and the other 5 patients were administered parenteral pentamidine before the nebulised pentamidine therapy and the final 1 patient died on day 9 without clinical improvement with nebulised pentamidine as well as conventional therapy (trimethoprim-sulphamethoxazole, parenteral pentamidine). No relapse occurred in the 7 cured patients. The inhalation increased the cough in 4 of 13 cases and caused vomiting in 1 patient. Two patients discontinued the nebulisation because of the side-effect. No extra-pulmonary side-effects of nebulised pentamidine were seen. These results show that an efficacy of nebulised pentamidine is at least equal to conventional therapy with fewer side-effects and that only patients with mild PCP without severe hypoxaemia are eligible for the inhalation therapy.

Biochemical parameters of blood were analyzed statistically in the same way as in the groups of malaria patients mentioned in the accompanying paper. The parameters which directly or indirectly reflect intravascular hemolysis, i.e., lactic dehydrogenase (LDH), total bilirubin (TBil), blood urea nitrogen (BUN), creatinine (Crt), serum alanine aminotransferase (SGPT) and serum asparate aminotransferase (SGOT) were elevated in malaria patients infected by P. falciparum (P.f.) significantly more than in malaria patients infected by P. vivax (P.v.) or P. ovale (P.o.). The differences in the biochemical parameters of the last two groups were not significant. The total protein (Tp) levels also showed the same order of decrease. Cholesterol (Chol) was decreased equally in malaria patients irrespective of the infecting parasite species. The maximum values of LDH (15, 290 u/l), TBil (42.3 mg/dl), BUN (204 mg/dl), Creat (16.9 mg/dl), SGPT (455 u/l), and SGOT (653 u/l) and the lowest figures of Chol (50 mg/dl) and Tp (3.2 g/dl) in Pf malaria indicate the seriousness of this infection. The same parameters in vivax malaria are LDH (5, 140), TBil (6.4), BUN (26), Creat (1.9), SGPT (260), SGOT (180), Chol (51) and Tp (5.2). The early treatment of falciparum malaria, within 5 days of the onset of illness, is emphasized to avoid serious complications.

Parasite count and hematological studies were made on 170 falciparum, 220 vivax and 23 ovale malaria patients to see whether hematological parameters differ in malaria infected by three different species of malaria parasites, P. falciparum (PI), P. vivax (P. v.) and P. ovale (P. o.) The mean and percentage of abnormal values of each parameter were analyzed statistically. The parasite count was significantly large in the order of P. f.>P. v.>P. o. The maximum parasite count of P. f. was 2, 138, 000 per μl of blood. The mean parasite count for the 3 species was 18, 200, 3, 240 and 350 perμl of blood. The red blood cells (rbc) and hemoglobin (Hb) decreased significantly in the same order and the minium rbc count was 0.98 milion per μl and the lowest Hb concentration was 3.2 g/dl in falciparum malaria. The mean r. b. c. count in P.f., P.v. and P.o. malaria was 3.50, 3.81, and 4.12 million perμl and the mean Hb concentration was 11.0, 12.4 and 13.6 g/d/, respectively. The changes, either increase or decrease, in white blood cells and the decrease of platelets were not significantly different in P. f., P. v. and P. o. malaria. Nine cases of falciparum malaria were given blood transfusion, and its lifesaving merits in severely anemic patients and demerits of NANB hepatitis were discussed. Early treatment, within 5 days of the onset of illness, with rapidly acting antimalarial drug was emphasized.

We have analyzed the clinical data of 189 patients with malaria to establish antimalarial regimens in Japan. The causative parasite species were Plasmodium falciparum in 56 cases (30%), P. vivax in 132 (70%) and P. malariae in 1 (1%). The outcomes f malaria cases are as follows: Cure rats in falciparum and vivax malaria are 86% and 91%, respectively. Two patients died of falciparum malaria and recurrence occurred in 6 cases (11%) of falciparum malaria. Relapse was seen in 12 (9%) of vivax malaria. Chloroquine was most frequently used among antimalarial agents (in 123 cases, 65% of the total) for suppressing acute attacks. The efficacy of chloroquine was evaluated by classifying each case into three groups: chloroquine alone in group one, chloroquine in combination with other antimalarials in group two and other antimalarials except chloroquine in group three. The cure rate among each group is about 80% and there is no difference among them. However, it is noticeable that recurrence occurred when patients were treated with a combination of chloroquine and quinine. We have found a similar result as this in another old report in Japan. Primaquine is effective for eliminating hepatic tissue schizonts but in this study, relapse occurred in 12 cases of vivax, although primaquine had been used in 10 out of 12 cases. In primaquine group, relapse occurred at a similar rate between chloroquine and Fansidar cases. Further studies are needed to decide whether a larger dose of primaquine is appropriate for treatment of vivax malaria. Recovery periods from fever and parasitemia were compared between chloroquine and Fansidar cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Fourty eight patients with falciparum malaria (14) and vivax malaria (34) were evaluated retrospectively as to whether DIC (disseminated intravascular coagulation) had been complicated or not. Serum concentration of fibrin-degradation products (FDP) was elevated in 8 cases (57%) of falciparum malaria and 3 cases (9%) of vivax malaria. Thrombocytopenia was found in 12 cases (88%) of falciparum malaria and in 30 cases (86%) of vivax malaria. Prothrombin time elongated in 4 cases (8%) and plasma concentration of fibrinogen decreased in 3 cases (17%). Only 4 patients, all of them were infected with falciparum malaria and all of three cases of cerebral malaria were included, met the criteria for the diagnosis of DIC complication and one case in vivax malaria suspected of the DIC. Abnormality grades in FDP concentration has closest association with DIC among the coagulation tests, therefore FDP test is indispensable for checking complication of DIC in malaria cases. The clinical profiles of 3 cases of cerebral malaria complicated with DIC are presented in this report.

Since many important antiparasitic drugs are not registered in Japan, a research group, for the past 7 years, has managed the use of non-registered orphan drugs. Initially there were 16 orphan drugs under control of the group, these were as follows; chloroquine, Fansidar, Fansimef, quinine (iv), primaquine, mebendazole, praziquantel, thiabendazole, quinacrine, dehydroemetine (iv), pentamidine, Pentostam, suramin, stibophen, nifurtimox and pyrimethamine. Of these drugs, Fansidar, thiabendazole, mebendazole and praziquantel were recently registered. The number of cases treated with these drugs was nearly one thousand (920). The number of malaria cases treated in this group was 201, corresponding to 22% of the total cases treated with orphan drugs. Mebendazole was used in 210 cases, praziquantel in 163, thiabendazole in 120, quinacrine in 125, pentamidine in 67, dehydroemetin in 28, Pentostam in 5 and suramin in 1. Most drugs were evaluated as effective in their antiparasitic actions but severe adverse reactions occurred at relatively high incidences.

A countercurrent immunoelectrophoresis test has been used for detection of circulating antigens of Pneumocystis carinii in humans; however, this study describes another experiment by sandwich enzyme-immunoassay. Antiserum was prepared by immunizing rabbits with P. carinii cysts which had been propagated in athymic nude rats. Profiles of time course in patients with the positive antigenemia show that P. carinii antigens are detectable prior to an onset of acute pneumonia. Since the sandwich enzyme-immunoassay has an ability of comparing serially monitored levels of the antigen in a quantitative value, the method is to be widely used as a clinical laboratory examination.

Hepatitis B surface antigen (HBsAg) was reconstituted into liposomes composed of phosphatidylserin. An isolated membrane fraction of HeLa cells was mixed with the liposomes, then the liposomes were incubated with HeLa cells in the presence of Sendai virus. In this system the attachment of HBsAg to the cell surface was enhanced and became resistant to treatment with trypsin-EDTA. The presence of the HBsAg on the cell surface was revealed by immunoelectron-microscopy. This technique may provide a model system for studying immunological reactions to HBsAg-bearing target cells in vitro.

The cytoplasmic 5S ribosomal RNA (5S rRNA) sequence from Pneumocystis carinii was determined. A sequence comparison matrix of 382 eukaryote 5S rRNA sequences and an evolutionary tree were constructed to establish the phylogenetic position of Pneumocystis . The data suggest that Pneumocystis is associated with the Rhizopoda/Myxomycota/Zygomycota group (= ‘Protista fungi’) but not with common fungi, such as Ascomycota or Basidiomycota, nor with other protozoa.

The cytoplasmic 5S ribosomal RNA sequence from Pneumocystis carinii was determined and compared with those of 382 eukaryotes and an evolutionary tree was constructed to establish the phylogenetic position of Pneumocystis. The data suggest that Pneumocystis is associated with the Rhizopoda/Myxomycota/Zygomycota group but not with common fungi, such as Ascomycota or Basidiomycota, nor with other protozoa.

Persistent rabies virus infection with a cyclic rising and falling pattern was easily initiated in BHK cells. In striking contrast with the same chronic infection established by T. J. Wiktor and H. F. Clark ((1972) . Infect. Immun. 6, 988–995), this virus and cell interaction was not mediated by interferon, and the infected cells were not resistant to a heterologous virus challenge. The persistently infected cells produced small-plaque viruses (SPV) and, after a number of subcultures, these SPV replaced entirely the wild large-plaque viruses (LPV). Due to the marked cytopathic effects (CPE) on BHK cells, SPV was less efficient than LPV for the establishment of viral persistence. A fraction containing defective interfering (DI) rabies virus particles was obtained by density gradient centrifugation of virus stocks from the persistently infected cells. The DI particles could be quantitatively assayed to the degree that they suppressed the CPE by the standard rabies virus. Cyclic production of DI particles in the persistent infection was demonstrated by this method. This evidence plus the fact that the homologous virus resisted superinfection indicate that the DI particles of rabies virus play a major role in the establishment and maintenance of a persistent state of infection in vitro .

The actual situation of the treatment of malaria for the past 10 years in Japan was investigated and analyzed. As a result, it was revealed that there were not a few cases which had been treated improperly probably because of the difficulty of getting antimalarial agents. Moreover, it was made clear that the death rate on falciparum malaria was constantly high, 8.7%, as expected and the relapse rate of vivax malaria was still as high as 18.0%. There was the recrudescence of falciparum malaria at 8.1%, maybe because of the influence of the prevalence of the drug-resistant strains of Plasmodium falciparum . The trouble in getting antimalarial agents has been overcome since 1980. Study Group on Pharmacotherapy of Imported Tropical Diseases was organized by the Ministry of Health and Welfare in 1980, and antimalarial agents have been supplied free of charge through the Study Group for the treatment of the disease. The number of cases of imported malaria has increased in our country. There are a lot of problems to be solved quickly to cope with the situation: people who travel abroad should be enlightened on the danger of the infection of malaria and take prophylactics for the disease and physicians should get familiar with the disease being supplied with information about it.

Electron microscopy revealed multi-layered membranes within the cytoplasmic inclusion (accumulation of nucleocapsids) produced by rabies virus. When infected BHK cells were maintained at 31 C, an enhancement in production of these membranes occurred in approximately 60% of inclusion-containing cells. Multi-layered membranes were composed of an alternate array of two different layers; an electron-dense, thin membrane and a less dense layer which was thicker. SDS-polyacrylamide gel electrophoresis and immune electron microscopy of isolated multi-layered membrane preparations demonstrated that the structures contained viral G and M2 polypeptides. Our observations suggest that these membranous structures are not a degenerative product of rabies virus infection but rather are related to the replication of viral envelope constituents, although they represent themselves to be an abortive form of viral assembly.