Epidemiological study of Mycoplasma pneumoniae infections in japan based on PCR-restriction fragment length polymorphism of the P1 cytadhesin gene

Two hundred fifty strains of Mycoplasma pneumoniae isolated during the past 20 years in Japan were classified into two groups (I and II) based upon different PCR-restriction fragment length polymorphism patterns of their P1 cytadhesin genes. Clear shifts between the M. pneumoniae groups were observed but did not appear to be correlated with M. pneumoniae epidemic cycles. Patients' sera showed relatively higher levels of antiadhesin antibodies to M. pneumoniae strains homologous with the infecting strain.

[An outbreak of waterborne Cryptosporidiosis in Kanagawa, Japan]

An outbreak of diarrhea due to infection with Cryptosporidium occurred among the staff members and customers who visited one of the 10 public houses or a dancing school in a building in Hiratsuka, Kanagawa Prefecture, at the end of summer in 1994. The epidemiological surveys by a questionnaire revealed that 461 out of 736 persons investigated complained of cholera-like or flu-like illness. The clinical manifestations included mucous and/or watery diarrhea (96.7%), abdominal pain (61.6%), fever (54.2%: lower than 39 degrees C = 84.1%, higher than 39 degrees C = 15.9%), malaise (37.1%), nausea (32.8%) and headache (29.3%). The polluted drinking water was strongly suspected to be the immediate cause of infection. Although several species of pathogenic bacteria were isolated both from stool and water samples, they were not supposed to be linked to the outbreak. No known enteropathogenic virus was found in either of the samples. Oocysts of Cryptosporidium parvum were identified in 12 (48.0%) of the 25 stool samples. The oocysts were also found in tap water and other water samples from a receiving tank which was directly connected with the public waterworks, and an elevated tank on the roof, a wastewater pits, a soil pit and artesianspring water tank. These tanks and pits except for the elevated tank were built adjucent to each other on an underground floor of the building. These tanks and pits were connected with openings in the upperpart of the tank walls. These openings might have functioned to discharge excess of drinking water in the receiving tank to the wastewater pit. The water level of the wastewater pit is kept down below the openings by pumping out the sanitary sewage to the public drain. According to the declaration of the owner of the building, however, the wastewater pump was broken at the time of outbreak. Accidental malfunction of the drainage system caused contamination of drinking water with sanitary sewage through the connecting pipes.

Infantile digital fibromatosis: a study of the development and regression of cytoplasmic inclusion bodies

An 8-yr-old Japanese boy developed infantile digital fibromatosis in the right ring finger with recurrence and another lesion in the right middle finger. Histologic investigation of the tumor disclosed that the size and frequency of inclusion bodies were inversely proportional to the degree of fibrosis. Electron microscopic study revealed a variety of stages in the development of inclusion bodies, ranging from small, dense aggregates of filaments into bundles with dense bodies traversing the cytoplasm to typical inclusion bodies that also contained cytoplasmic organelles. In areas of dense fibrosis, the cytoplasm of the tumor cells showed areas of constriction and compression by adjacent bundles of collagen. The tendency for a decrease in the number of inclusion bodies in these areas necessitated a differential diagnosis from other fibrous or fibro-histiocytic lesions. Our findings suggest that the tumor may undergo a decrease in the numbers of inclusion bodies and spontaneously may become fibrotic with time. Thus, even as a form of fibromatosis featuring both recurrence and multiple lesions, it may not have a consistently aggressive nature. These findings support the concept that infantile digital fibromatosis should be managed by limited excision rather than by immediate aggressive surgical treatment.

A long surviving case of amyotrophic lateral sclerosis with atrophy of the frontal lobe: a comparison with the Mitsuyama type

A female patient with amyotrophic lateral sclerosis (ALS) showing psychiatric symptoms during her last 2 years of life is reported. Although pseudobulbar signs were seen at the onset of ALS and no respirator was used, the period from onset to death was rather long (9 years). The spinal lesions showed features common to ordinary ALS, while the marked atrophy with destructive changes throughout the frontal lobe seemed to be considerably more severe than that seen with either ordinary ALS or the Mitsuyama type of ALS. Since the clinical manifestations and histological characteristics are apparently different from those of the Mitsuyama type, our case may be a new nosological variant of ALS with psychiatric manifestations.

Oscillatory phenomena in model membrane: electrical oscillation in lipid-impregnated membrane filter induced by alamethicin and controlled by bacteriorhodopsin

A lipid-impregnated membrane filter was able to show reproducibly of an electrical oscillation under constant current stimulation when alamethicin and protamine were present in the chamber whose salt concentration was higher than the other and the membrane was left for about 12 h. In addition, bacteriorhodopsin, which is a light-activated proton pump, was found to control the oscillation. The oscillatory phenomenon was considered to be driven by the alternating change in the ion-selectivity of the membrane between cation and anion. Impedance measurement indicated the existence of lipid rearrangement which might prepare an environment for both alamethicin and protamine to cause the oscillation.

Hyper-IgM immunodeficiency with disseminated cryptococcosis

We describe two siblings with X-linked hyper-IgM immunodeficiency. One patient developed disseminated cryptococcosis. Co-culture of this patient's T cells with normal B cells suppressed IgG and IgA production. The CD40 ligand gene of one patient was examined and contained a nonsense mutation at nucleotide 475. CD40 ligand is a membrane protein which is expressed on activated T cells and induces B-cell proliferation. These results suggest that there is a defect in T- and B-cell interactions in this immunodeficiency syndrome. It is also possible that patients with this syndrome are predisposed to cryptococcal infections.

Geographic distribution of Gongylonema pulchrum and Gongylonema macrogubernaculum from Macaca fuscata in Japan

After a first report on the gullet nematode, Gongylonema pulchrum Molin, 1857, being found in the Japanese macaque, Macaca fuscata, in Kyushu, Japan, the geographic distribution of the parasite, a causative agent of gongylonemiasis in cattle and man, was examined in 181 monkeys transferred to the Japan. Monkey Centre from 23 sites in Japan, including Yaku-shima (Island). Yaku-shima is included in the World Natural Heritage List of the United Nations for its subtropical forests, which have an unusual variety of plant and animal species. G. pulchrum was found in M. fuscata yakui monkeys inhabiting Yaku-shima and M. fuscata fuscata monkeys inhabiting Honshu and an is and near Honshu. G. macrogubernaculum was found in M. fuscata yakui monkeys. Comparison of the two kinds of parasite specimens obtained from the variety M. fuscata yakui confirmed that G. macrogubernaculum Lubimov, 1931 is a valid species. Thus, the finding of G. macrogubernaculum constitutes a record of a newly identified host. M. fuscata yakui, and shows that Yaku-shima, Japan, is a natural locality of G. macrogubernaculum.

Peripheral immunoglobulin secreting cells in immunodeficiencies; effects of intravenous immune globulin

Peripheral blood B cells secreting IgG, IgA, IgM, and IgE were quantitated in normal adults (n = 12), newborns (n = 8), patients with antibody deficiency (n = 5), and patients with elevated IgE (four patients) using a reverse enzyme-linked immunospot (RELISPOT) assay. This technique measures immunoglobulin secreted by B cells by capture on an antibody-coated plate, and identified as a plaque on a nitrocellulose-membrane plate. Hypogammaglobulinemic patients and newborns (cord blood) showed no detectable IgG, IgA, or IgE secreting cells. Several cord blood and hypogammaglobulinemic patients, however, showed normal adult numbers of IgM secreting cells. One IgA-deficient patient showed increased numbers of IgA secreting cells, but a second IgA-deficient patient showed normal numbers of IgA secreting cells. Three patients with the hyper-IgE syndrome and a patient with severe eczema had very high numbers of IgE secreting cells. The effects of intravenous immunoglobulin on this system in vivo and in vitro were also examined. High dose intravenous immunoglobulin therapy did not decrease the immunoglobulin secreting cells in two neurologic patients given high dose IVIG. In vitro exposure of normal B cells to either IVIG or cycloheximide (a protein synthesis inhibitor) decreased the number of IgA and IgM secreting B cells. Cycloheximide also decreased the number of IgG secreting B cells in vitro. IgG spots, however, were present when cycloheximide-treated cells were incubated with a high concentration of IVIG. Since IVIG may bind directly to cells, its effect on in vitro B-cell IgG synthesis could not be determined.

Primary chondrosarcoma of the lung. A clinicopathologic study

BACKGROUND

Primary pulmonary chondrosarcoma is a rare neoplasm. A 73-year-old Japanese man had chondrosarcoma in the right lung. The tumor was considered to be of pulmonary origin because of the absence of extrapulmonary primary lesions for 2 years after lung resection.

METHODS

The histologic sections were stained with hematoxylin and eosin, conventional special staining, and immunohistochemical staining. The authors discussed the differential diagnosis and growth pattern, in addition to the histopathologic findings in the tumor cells. In a review of the literature, the authors compared the characteristics between the major bronchus (MB) and lung types.

RESULTS

Histopathologically, the tumor cells showed atypical cartilaginous differentiation without osteoid formation, benign or malignant-appearing epithelium, or sarcomatous components other than chondrosarcoma. The tumor showed expansive proliferation, invasion through the alveolar spaces, massive proliferation along the bronchial lumen, significant invasion into small vessels, and extrathoracic metastases. The review of the literature showed that the clinical period ending with surgical treatment was longer in the lung tumors than in the MB tumors.

CONCLUSIONS

Although MB tumors were reported to be discovered early, the invasion to major arteries or trachea often led to inoperability; however, lung tumors were considered to be resectable until they grew very large, even though the clinical period from onset to surgical treatment was longer in this type. Recent advancements in diagnostic and surgical techniques are expected to promote early discovery and improve prognosis whether the tumor occurs in the MB or lung.

Freeze-fracture study of the site of attachment of Cryptosporidium muris in gastric glands

The mode and organization of the attachment site of Cryptosporidium muris to gastric glands of stomach were investigated by the freeze-fracture method. Cryptosporidium muris was enveloped by a double membrane, of host plasma membrane origin, which formed the parasitophorous vacuole. The outer membrane of the double membrane was continuous with host plasma membrane, while the inner membrane was connected with the anterior part of the parasite plasma membrane at the annular ring. The density of intramembranous particles (IMP) was severely altered at the above two junctures. The parasitophorous outer membrane showed low IMP-density when compared to the host plasma membrane, although both membranes were continuous at the dense band. The inner membrane had few IMP, whereas the parasite plasma membrane showed numerous IMP, although both membranes were continuous at the annular ring. The size of dense band and annular ring was similar in diameter. The feeder organelle was clearly visible as membrane folds in freeze-fracture and some of them were connected with small vesicles of cytoplasm, indicating that the feeder organelle may play an important role for incorporation of nutrients from the host cell.

Immune responses to Cryptosporidium muris and Cryptosporidium parvum in adult immunocompetent or immunocompromised (nude and SCID) mice

Adult murine models of Cryptosporidium infection involving Cryptosporidium muris and C. parvum were used to study immunity to cryptosporidiosis in the mammalian host. Immunocompetent BALB/c or C57BL/6 mice developed a highly patent infection with the RN 66 strain of C. muris but overcame the infection and were immune to reinfection. In contrast, severe combined immunodeficiency (SCID) mice or nude mice had a chronic infection lasting at least 109 days. The development of the C. muris infection appeared to be confined to the gastric epithelium in immunocompetent and immunocompromised mice. SCID mice injected intraperitoneally with histocompatible spleen or mesenteric lymph node cells from uninfected BALB/c mice were able to recover from the C. muris infection. The protective effect of donor spleen cells was not reduced by depletion of the B cell population but was significantly reduced by depletion of Thy.1 cells. Treatment of C57BL/6 or BALB/c mice during infection with a gamma interferon-neutralizing monoclonal antibody, but not a tumor necrosis factor-neutralizing monoclonal antibody, resulted in a significant increase in oocyst production. In the C. parvum model, a severe and eventually fatal chronic infection with a cervine isolate was established in SCID mice, with parasitization occurring in the ileum, cecum, and colon. SCID mice injected with unprimed BALB/c spleen cells prior to inoculation of C. parvum oocysts were resistant to infection. These results suggested that the two animal models should be valuable in the study of immunity to cryptosporidial infection.

Analysis of oocyst wall and sporozoite antigens from three Cryptosporidium species

A comparison was made of the antigenic composition of oocyst walls and sporozoites from Cryptosporidium baileyi from turkeys, C. muris from rodents, and C. parvum from ruminants, employing immunoblotting and immunofluorescence. In immunoblotting, oocyst antigens were subjected to sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Western blotting (immunoblotting) and detected with rabbit polyclonal anti-C. muris or -C. parvum antibodies or murine monoclonal antibodies developed against C. parvum. Immunofluorescence was used to investigate the reactivity of these monoclonal antibodies with air-dried excystation mixtures of sporozoites and oocysts of the different species. The results from both types of experiment indicated that the three Cryptosporidium species could be differentiated immunologically. In comparison, few antigenic differences were found between a number of isolates of C. parvum in immunoblotting. There was also evidence to suggest that C. parvum and C. baileyi were more closely related antigenically to one another than to C. muris.

Chemotherapeutic effect of azithromycin and lasalocid on Cryptosporidium infection in mice

Prednisolone-immunosuppressed mice (ICR, 7-wk-old female) were each inoculated with 1 x 10(5) oocysts of Cryptosporidium parvum. Medication with azithromycin (400 mg/kg/day) or lasalocid (64, or 128 mg/kg/day) was started 13 h after inoculation and continued for 3 days. The number of oocysts discharged by each mouse was calculated on days 4-12 post-inoculation. Compared with non-medicated controls, oocyst production by the medicated mice was markedly reduced; some mice did not discharge oocysts and the remaining mice discharged less than 1/100 the number of oocysts of the control mice. These results indicate that both azithromycin and lasalocid have prophylactic or therapeutic activity against Cryptosporidium.

Freeze-fracture studies of Cryptosporidium muris

The attachment site of Cryptosporidium muris to host cells was investigated using the freeze-fracture method. Cryptosporidium muris was enveloped by a double membrane of host plasma membrane origin, which formed the parasitophorous vacuole. The outer membrane of the double membrane was continuous with the host plasma membrane at the dense band, while the inner membrane was connected with the anterior part of the parasite plasma membrane at the annular ring. The density of intramembranous particles (IMP) was dramatically altered at the above two junctures. The outer parasitophorous membrane showed low IMP-density as compared to the host plasma membrane, although both membranes were continuous. The inner parasitophorous membrane had few IMP, whereas the parasite plasma membrane showed numerous IMP. When the attachment sites of parasites and host cells were fractured, circular-shaped fractured faces were observed on both sites of the parasite and host cell. These exposed faces corresponded to the dense bands and were very similar in size in each parasite.

Renal pathology in Saimiri monkeys during a vaccine trial using the recombinant circumsporozoite protein of Plasmodium vivax

Renal specimens of squirrel monkeys (Saimiri sciureus boliviensis) were studied by light microscopy and immunohistochemistry to examine the pathologic changes during vaccine trials with four recombinant circumsporozoite (CS) proteins (rPvCS-1, rPvCS-2, rPvCS-3, NS1(81) V20) of Plasmodium vivax. The monkeys were vaccinated and later challenged with P. vivax sporozoites. Among the 33 posttrial biopsies, 17 had mild to moderate mesangial proliferation and nine had interstitial nephritis. Immunohistochemistry by the peroxidase-antiperoxidase (PAP) method revealed IgG deposits in only three of 24 specimens and failed to demonstrate C3 deposits and P. vivax antigens in their glomeruli. There was no relationship between the severity of nephropathy and intensity of parasitemia. The intensity of parasitemia was the same in the vaccinated and control groups. Vaccinated monkeys from the groups (rPvCS-1, rPvCs-2, rPvCS-3) had no differences in renal pathology from the unvaccinated controls, but one group vaccinated with NS1(81) V20 did not develop renal changes.

[Diphtheria antitoxin levels in Japanese adults (10-20 years after the last vaccination)]

The serum diphtheria antitoxin levels in Japanese adults were investigated and the persistence of diphtheria toxoid effect was evaluated. The subjects consisted of 56 volunteers (20-31 years of age) who had received regular inoculations of diphtheria and pertussis vaccine (I and II or III phases). They had been immunized according to the Vaccination Law (old version) revised in 1958. The length of time after the last inoculation of diphtheria toxoid was speculated to range from 10 to 20 years. Serum diphtheria antitoxin was determined by passive hemagglutination method. Antitoxin level was 0.025 HAU/ml in 1 subject (1.8%), 0.05 in 2 (3.6%), 0.1 in 2 (3.6%), 0.2 in 8 (14.3%), 0.4 in 7 (12.5%), 0.8 in 12 (21.4%), 1.6 in 7 (12.5%) and more than 1.6 in 17 (30.4%). Results indicated that 55 of 56 (98.2%) possessed a higher level than the prophylaxis standard (0.05 HAU/ml). Since the current Vaccination Law prescribes a lower amount and fewer inoculations than the old law, the number of adults possessing prophylactic antitoxin level may decrease in the future. Further investigation of antitoxin level in adults needs to be continued.

The pathology of human cerebral malaria

Blockage of the cerebral microvasculature by Plasmodium falciparum-infected erythrocytes appears to be the principal cause of human cerebral malaria. Knobs which appear on the membrane of the infected erythrocytes adhere to the endothelium, causing the obstruction of cerebral microvessels. Protein molecules such as CD36, thrombospondin, and intercellular adhesion molecule-1, which are present on the membrane of endothelial cells, may act as receptors for the attachment of knobs of P. falciparum-infected erythrocytes. Each of these candidate host molecules for infected-cell recognition and attachment are expressed in microvessels of the human brain. The presence of HRP1 and HRP2 in the cerebral microvessels of cerebral malaria patients may indicate the involvement of knob proteins in the pathogenesis of cerebral malaria. Owl monkeys infected with P. falciparum do not develop cerebral malaria. There is no blockage of cerebral microvessels by infected erythrocytes and knob proteins are absent. These findings support the contention that cerebral microvessel blockage and the presence of knob proteins are the probable causes of cerebral malaria.

Renal pathology in owl monkeys in Plasmodium falciparum vaccine trials

Renal specimens of 16 owl monkeys (Aotus vociferans) were studied by light microscopy and immunohistochemistry during a vaccine trial with recombinant proteins of the ring-infected erythrocyte surface antigen (RESA) of Plasmodium falciparum. Deposition of IgG, C3, and P. falciparum antigens in the mesangium was demonstrated by the peroxidase anti-peroxidase (PAP) method. A relationship between the severity of parasitemia at the time of death and the presence of nephropathy was not apparent.

A clinicopathologic study of tumors and tumor-like lesions of the penis

A total of 147 specimens from 93 patients with penile lesions were examined at Nagasaki University Hospital during a 27-year period from 1961 to 1987. The most frequent malignant tumor was squamous cell carcinoma (SCC, 33 cases, 35.5%), followed by extramammary Paget's disease, transitional cell carcinoma, and Bowen's disease. The benign tumors and tumor-like lesions included condyloma acuminatum, cyst of the genitoperineal raphe, and lymphangioma. SCC of the penis accounted for less than 0.1% of all specimens and less than 0.62% of malignant tumors in men filed at our hospital. True phimosis accompanied 81.5% of the SCC cases. The 5- and 10-year survival rates for SCC were 77.2% and 71.3%, respectively. Two patients died of penile SCC. It was considered that an absence of both keratohyaline granules in the granular layer and melanin pigment in the basal layer can serve as a useful histologic indicator for diagnosis of well differentiated SCCs that are otherwise difficult to identify.