Large Doses Of Antibiotics Research Articles

Buzhong Yiqi Decoction ameliorates spleen deficiency syndrome by regulating gut microbiota

This study aims to decipher the mechanism of Buzhong Yiqi Decoction(BZYQD) in the treatment of spleen deficiency syndrome via gut microbiota. The mouse models of spleen deficiency syndrome were established by fecal microbiota transplantation(FMT, from patients with spleen deficiency syndrome) and administration of Sennae Folium(SF, 10 g·kg~(-1)), respectively, and treated with BZYQD for 5 d. The pseudosterile mice(administrated with large doses of antibiotics) and the mice transplanted with fecal bacteria from healthy human were taken as the controls. The levels of IgA, interleukin(IL)-2, IL-1β, interferon(IFN)-γ, tumor necrosis factor-alpha(TNF-α), and 5-hydroxytryptamine(5-HT) in the intestinal tissue of two models were measured by enzyme-linked immunosorbent assay, and the CD8~+/CD3~+ ratio was determined by flow cytometry. The composition and changes of the gut microbiota were determined by 16S rRNA high-throughput sequencing and qPCR. Furthermore, the correlation analysis was performed to study the mediating role of gut microbiota in the treatment. The results showed that BZYQD elevated the IgA level, lowered the IL-1β, TNF-α, and 5-HT levels, and decreased the CD8~+/CD3~+ ratio in the intestinal tissue of the two models. Moreover, BZYQD had two-way regulatory effects on the levels of IL-2 and IFN-γ. BZYQD inhibited the overgrowth and reduced the richness of gut microbiota in the SF model, and improved the gut microbiota structure in the two models. Algoriphagus, Mycobacterium, and CL500＿29＿marine＿group were the common differential genera in the two models compared with the control. Acinetobacter, Parabacteroides, and Ruminococcus were the differential genera unique to the FMT model, and Sphingorhabdus, Lactobacillus, and Anaeroplasma were the unique differential genera in the SF model. BZYQD was capable of regulating all these genera. The qPCR results showed that BZYQD increased the relative abundance of Akkermansia muciniphila and decreased that of Bacteroides uniformis in the two models. The correlation analysis revealed that the levels of above intestinal cytokines were significantly correlated with characteristic gut microorganisms in different mo-dels. The IL-1β level had a significantly positive correlation with Acinetobacter and CL500＿29＿marine＿group in the two models, while the different levels of IL-2 and IFN-γ in the two models may be related to its different gut microbiota structures. In conclusion, BZYQD could regulate the disordered gut microbiota structure in different animal models of spleen deficiency syndrome to improve the intestinal immune status, which might be one of the mechanisms of BZYQD in treating spleen deficiency syndrome.

Images of deep neck space infection and the clinical significance

Deep neck infection is not difficult to diagnose clinically, but correct localization of the involved space for timely incision and drainage is not easy without assistance of imaging. To investigate the images of deep neck space infection of phlegmon and abscess and the role of imaging examination in correct localization and treatment. Between June 2004 and June 2010, 28 patients were diagnosed with deep neck infection (14 men, 14 women; age range, 17-72 years; mean age, 46 years). Clinical presentations included neck swelling, pain, dysphagia, fever, and elevated white blood cell count. Of the 28 cases, 20 had computed tomography (CT) scans, 18 had magnetic resonance imaging (MRI) examinations, and 10 had both CT and MRI. All 28 patients were confirmed by CT and/or MRI to have deep neck infection, with 11 cases in the retropharyngeal space, five in the parapharyngeal space, four in the masseteric space, and eight in multiple spaces. Thirteen cases had abscesses that were successfully treated with incision and drainage under CT guidance in combination with large doses of antibiotics, and 15 had phlegmon managed with large doses of antibiotics. Followed up for 5-20 months, all patients recovered completely. Two patients were confirmed by imaging examination to have retropharyngeal infection spreading to the superior mediastinum with abscess formation and another two patients had multiple space infection because inappropriate puncture or incision for drainage without imaging guidance in these patients caused the spread of infection. Clinical diagnosis was not accurate with only 12 patients (42.9%) being correctly diagnosed of the exact deep neck space involved before imaging confirmation. CT and/or MRI made the correct diagnosis in all 28 patients. CT and/or MRI also directly changed the treatment plan in seven patients and contributed to the recovery of these patients. CT and MRI play a crucial role in both the diagnosis and correct puncture and incision for drainage of the deep neck space infection.

Addition of Clidinium-C to the 14-Day Proton Pump Inhibitor Based Triple Therapy for Helicobacter pylori Eradication\

Helicobacter Pylori (HP) is a Gram-negative, spiral-shaped, motile micro-organism that infects approximately half of the world population and the prevalence of asymptomatic infected patients appears to be age-related (1). The human is its reservoir and the transmission of this microorganism involves oral‑oral and fecal‑oral routes. The infection takes place usually in childhood, within one’s own family (between parents and children or between siblings) (2). Gastric infection by HP is actually considered to be the most relevant cause of chronic gastritis and peptic ulcer disease (PUD). It is also associated with an increased risk of mucosa associated lymphoid tissue (MALT) lymphoma and gastric cancer (3). Selection of the best drug regimens for effective eradication of HP infection is challenging. Some recent studies have suggested that the effectiveness, compliance and side-effects of quadruple regimen containing a gastric acid inhibitor, a bismuth compound and two antibiotics might be comparable with proton pump inhibitors (PPI) -based triple therapy when administered as first-line treatment for HP infection (4-6). However, in other studies showed superiority of quadruple therapy (7). Antibiotic resistance due to frequent and uncontrolled administration and high prevalence of antibiotic side effects are the most common causes of treatment failure. To increase eradication rate, as defined in the Maastricht IV report (8), several clinical trials have been initiated involving extended treatment duration, use of new antibiotics or the addition of probiotics or other drugs regimens (9). In the Maastricht Consensus Report, the 14-day treatment course was superior to the 7-day treatment. Because of the higher antibiotic resistance rates, in developing countries such as Iran, the 14-day treatment regimens is preferred. It has been shown that the large doses of antibiotics used in the triple therapy change the normal bowel flora. This may result in further gastrointestinal adverse events (8, 9). Clidinium bromide in combination with chlordiazepoxide (clidinium –C) is an anticholinergic drug which may help symptoms of cramping and abdominal stomach pain by decreasing gastric acid secretion and slowing the intestinal movement (10). Chlordiazepoxide component of this drug exerts anxiolytic, sedative, hypnotic, anticonvulsant and skeletal muscle relaxant effects. The drug may inhibit monosynaptic and polysynaptic reflexes by acting as an inhibitory neuronal transmitter or by blocking excitatory synaptic transmission. This drug may also directly depress motor nerve and muscle function. The aim of this study was to assess the effect of clidinium-C on HP eradication with a triple therapy including omeprazole, clarithromycin and amoxicillin (OCA) in patients with peptic ulcer disease (PUD). The secondary aim of the study was to investigate the efficacy and safety of clidinium-C in the prevention of side-effects related to HP eradication.

Bacteria Evolve to Go Against the Grain

Since Alexander Fleming discovered in 1928 that a substance secreted by a mold could kill bacteria, we have become used to the ease of administering cocktails of antibiotics to fight bacterial infections. However, the use and misuse of antibiotics in human medicine and livestock farming over many decades has had the serious side effect of selecting for bacteria that survive drug attack: many bacterial strains have emerged that are resistant to antibiotics, most famously the multi-drug-resistant Staphylococcus aureus strain, the source of Staph infections, that represents a major threat to hospital patients. The pool of effective antibiotics is running out, and finding new strategies to prevent the rapid evolution of drug resistance has become a pressing challenge for global health. Now, two independent theoretical studies, one published in Physical Review Letters by Philip Greulich at the University of Edinburgh, UK, and colleagues [1], and the other by Rutger Hermsen at the Center for Theoretical Biological Physics, San Diego, and colleagues in Proceedings of the National Academy of Sciences[2], address how the evolution of drug resistance can be profoundly influenced by how drugs are distributed in biological tissues. Once administered, drugs do not spread evenly throughout the human body, which is compartmentalized and composed of tissues that have different affinity for retaining the drugs. The new research suggests that variations in the drug concentration may play an important role in selecting bacterial strains that are able to survive exposure to antibiotics. The rapid evolution of drug resistance is an impressive demonstration of the efficiency of bacterial adaptation. Bacterial populations are large and cells are able to replicate rapidly (sometimes in minutes) and to exchange genetic material. These are ideal conditions for Darwinian evolution to act: slight changes, or mutations, in the genomes arise by chance from one bacterial generation to the next. While most of these changes are deleterious, some, such as resistance to an antibiotic substance, may confer an advantage to bacteria living in human tissues, allowing the population of resistant mutant strains to rapidly increase. As a consequence, unless a bacterial infection is completely wiped out by a large dose of antibiotics, drug resistant strains emerge. Yet when a mix of antibiotics is administered, the buildup of drug resistance requires multiple mutations and becomes harder to explain [3]; in this case, the bacterial population should be driven to extinction, unless a resistant multimutant arises. This, however, becomes prohibitively unlikely for just a handful of required mutations. Why then does drug resistance evolve so readily? The work of Greulich et al. and Hermsen et al. could solve this puzzle because it demonstrates that spatial variations in drug concentrations allow for a gradual selection of drug resistant mutants. Heterogeneities in drug concentrations have been previously recognized as a potential driver of drug resistance [4, 5], as was demonstrated in a recent microfluidic experiment [6]. Yet quantitative models have been lacking so far. The new theoretical studies fill this gap and help identify parameters that may be key to controlling drug resistance evolution. In a gradient of drug concentration, resistance can evolve following the stepwise dynamics illustrated in Fig. 1. Initially, only a small population of wild-type (i.e., nonmutant) cells can be sustained in the regions where drug concentration is low. The growth of bacteria in this suitable habitat is balanced by the death of bacteria that move by chance into less hospitable regions of higher drug concentration. During this continual population turnover, a mutant will eventually appear that is slightly more resistant than the wild type. This mutant will then be able to endure higher drug concentration and move up the concentration gradient. Thereby the mutant population can overgrow the wild type and reach a steadystate distribution that covers a slightly larger region than

Analysis of risk factors of pulmonary infection in critically ill ICU patients with tracheotomy and nursing countermeasures

Objective To analyze the risk factors of pulmonary infection for critically ill ICU patients with tracheotomy,and investigate the methods to prevent nosocomial lung infection. Methods 94 patients in ICU with pulmonary infection after tracheotomy from March 2008 to March 2010 were analyzed retrospectively,they were set as the observation group.100 patients in synchronization without pulmonary infection after tracheotomy were set as the control group.The general condition,diagnosis and treatment methods and care,the environment,etc.were studied,the risk factors for nosocomial pulmonary infections after tracheotomy were analyzed.The care methods and points to prevent lung infections for critically ill ICU patients after tracheotomy were summarized. Results The study showed that the respiratory system diseases in critically ill patients,smoking history,low seniority of nursing staff,long-term use of large dose of antibiotics,application of H2 blockers and antacids,and many patients in the same ward were risk factors for critically ill patients with pulmonary infection. Conclusions Lung infection after tracheotomy in critically ill ICU patients was affected by many factors.In the actual operation,we should targeted to avoid infection led by treatment and care factors,environmental factors,control and prevention measures should especially be strengthened for patients with respiratory diseases to prevent lung infection. Key words: Critically ill patients; Tracheotomy; Lung infection; Risk factors; Care strategy

Successful Treatment of Bacillary Hemoglobinuria in Japanese Black Cows

Four pasture-fed Japanese Black cows showed the main clinical symptoms of severe hemoglobinuria at different periods between 2003 and 2007. Hematological analyses at the first consultation revealed severe anemia, and biochemical analyses indicated both severe hemolysis and disruption of hepatic function. Although the first 2 patients died, the hemoglobinuria and general condition of the remaining 2 cows, who were immediately initiated on large doses of antibiotics, improved within 3 days. Clostridium haemolyticum was detected by polymerase chain reaction (PCR) analysis of the blood sample of 1 of the infected cows. Anti-fascioliasis medicine is administered, and since then, no case of hemoglobinuria has been observed. The cows were diagnosed with bacillary hemoglobinuria, and they represent the first few cases in Japan.

The Compressive Properties of Bone Cements Containing Large Doses of Antibiotics

The addition of large amounts of antibiotics to bone cement provides a convenient local delivery, but may influence the compressive properties of the cement. Flucloxacillin and vancomycin were added to Simplex P (Stryker, Limerick, Ireland) and VersaBond (Smith & Nephew) cements. Tripling the antibiotic dose from 2 to 6 g had little effect on the static compressive properties 24 hours after curing. After 4 weeks in phosphate-buffered saline, there was marked decrease in properties with the addition of antibiotics. Compressive strength of cements with 6 g of antibiotic was reduced to near or below the ASTM and ISO minimum of 70 MPa after 4 weeks in phosphate-buffered saline. Microcomputer tomography revealed increased porosity and clumping of the radiopacifier with the addition of antibiotics.

Lung abscess in a professional rugby player: an illustration of overtraining syndrome?

As in other endurance sports, the intensity of training sessions and the pace of competition has significantly increased since rugby union became a professional sport. The case history is presented...

Cure of a man with solitary abscess of the brain-stem

A 25-year-old man with lung abscess and signs of an abscess in the rostral brain-stem was cured by large doses of antibiotics and stereotactic aspiration of the abscess.

急性前頭どう炎より高度視力障害を来たした症例

This paper reported a case of acute frontal sinusitis which had resulted in severe impairment of visual acuity. A 33-year-old male patient visited our hospital on November 18, 1980. The chief complaint was severe impairment of visual acuity which had begun eight days before the first visit. He also complained of orbital pain, proptosis, immobility and chemosis. X-ray and coronal CT demonstrated mass formation which infiltrated from the frontal sinus to the left orbita. The fundus had a fern-like pattern along the retinal artery.Suspecting orbital involvement, frontal and ethmoidal sinectomies were performed. It was revealed that almost all of the orbital periosteum was stripped off the orbital bone and there was a small perforation in the frontal bone.After operation, he was given corticosteroids, vasodilators, anticoagulants, and large doses of antibiotics. His visual acuity recovered gradually and became 0.05 forty days after operation.It was suspected that the severe sight impairment in this case resulted from both the circulatory disturbance of cilliary and retinal arteries, and the inflammation and atrophy of the optic nerve.

Oral aspects of osteopetrosis

The characteristic feature of osteopetrosis is a lack of osteoclastic activity, leading to a series of somatic problems for afflicted persons. The life span of osteopetrotic patients has increased in recent years, thereby making oral aspects of the disease more evident. Four children with malignant osteopetrosis, born between 1967 and 1975, were examined. In all patients the anterior teeth were of normal shape, and erupted on schedule. Primary molars and all permanent teeth were greatly distorted, and remained totally or partly embedded in basal bone. Vertical growth of alveolar ridge was very limited. Where a fenestration of overlaying mucosa had occurred, a localized progressive osteitis developed, leading to soft tissue inflammation and, in two cases, extraoral mandibular fistulas. Peridontal attachment was very poor, spontaneous exfoliation had occurred in all patients. In two children tooth germs and necrotic bone were surgically removed. No beneficial effect of the treatment was observed. Large doses of antibiotics were needed to control recurring infections. No means of curing progressive osseous destruction of mandibular bone has been found. The general prognosis is poor.

Electrolyte and Acid-Base Disturbances in the Management of Leukemia

AbstractElectrolyte disturbances in leukemia can be the result of the disease process or drug therapy. One group of electrolyte abnormalities is related to the stage of the leukemic process. Included in this group are newly diagnosed patients who may show elevated serum potassium, phosphorus, and magnesium--a result of their release from malignant cells after cytotoxic therapy or their accumulation due to urate nephropathy. Patients in remission usually have normal serum electrolyte concentrations, but acute leukemia patients during relapse may have hypokalemia, hypophosphatemia, and hypomagnesemia. This imbalance may be related to cellular uptake of these electrolytes in the presence of inadequate dietary intake. Other factors contributing to electrolyte derangements, and related to the leukemic process, include hyponatremia and hypochloremia secondary to the SIADH, hypokalemia in acute monocytic or acute myelomonocytic leukemia due to lysozyme-induced tubular damage, hypercalcemia possibly secondary to leukemic infiltration of bone or parathyroid glands (with PTH release), or production of a PTH-like substance by leukemic cells. Nonspecific factors related to the disease process which may aggravate the electrolyte imbalance include gastrointestinal loss through nausea, vomiting, and malnutrition. The drug-related electrolyte abnormalities include cyclophosphamide- and vincristine-induced SIADH; decreased serum sodium, chloride, potassium, and calcium concentrations as a result of polymyxin B nephrotoxicity; hypokalemia and hypomagnesemia secondary to amphotericin B; hypocalcemia, hypophosphatemia, and hyperphosphaturia due to L-asparaginase-induced hypoparathyroidism; hypokalemia due to a nonreabsorbable anion effect of antibiotics in the distal tubule or changes in membrane ionic transport of all cells by large doses of antibiotics. Electrolyte disturbance in leukemia thus have a multifactorial pathogenesis which can best be delineated according to the stage of the leukemic process and the drugs being used. Recognition of the cause or causes in a particular patient is essential for an effective approach to management. This review emphasizes the need for routine measurement of serum electrolytes during all phases of the leukemic process.

Electrolyte and acid-base disturbances in the management of leukemia

Electrolyte disturbances in leukemia can be the result of the disease process or drug therapy. One group of electrolyte abnormalities is related to the stage of the leukemic process. Included in this group are newly diagnosed patients who may show elevated serum potassium, phosphorus, and magnesium--a result of their release from malignant cells after cytotoxic therapy or their accumulation due to urate nephropathy. Patients in remission usually have normal serum electrolyte concentrations, but acute leukemia patients during relapse may have hypokalemia, hypophosphatemia, and hypomagnesemia. This imbalance may be related to cellular uptake of these electrolytes in the presence of inadequate dietary intake. Other factors contributing to electrolyte derangements, and related to the leukemic process, include hyponatremia and hypochloremia secondary to the SIADH, hypokalemia in acute monocytic or acute myelomonocytic leukemia due to lysozyme-induced tubular damage, hypercalcemia possibly secondary to leukemic infiltration of bone or parathyroid glands (with PTH release), or production of a PTH-like substance by leukemic cells. Nonspecific factors related to the disease process which may aggravate the electrolyte imbalance include gastrointestinal loss through nausea, vomiting, and malnutrition. The drug-related electrolyte abnormalities include cyclophosphamide- and vincristine-induced SIADH; decreased serum sodium, chloride, potassium, and calcium concentrations as a result of polymyxin B nephrotoxicity; hypokalemia and hypomagnesemia secondary to amphotericin B; hypocalcemia, hypophosphatemia, and hyperphosphaturia due to L-asparaginase-induced hypoparathyroidism; hypokalemia due to a nonreabsorbable anion effect of antibiotics in the distal tubule or changes in membrane ionic transport of all cells by large doses of antibiotics. Electrolyte disturbance in leukemia thus have a multifactorial pathogenesis which can best be delineated according to the stage of the leukemic process and the drugs being used. Recognition of the cause or causes in a particular patient is essential for an effective approach to management. This review emphasizes the need for routine measurement of serum electrolytes during all phases of the leukemic process.

Generalized pustular psoriasis. A report on thirteen patients

Generalized pustular psoriasis shows a fluctuating pattern, its course varying with time and from patient to patient. The prognosis and results of treatment are therefore extremely difficult to assess. The patients in this series have been followed up by us with regard to the natural course of the illness including complications and precipitating factors. Oral drug therapy has suprisingly often provoked acute pustular eruptions, and these patients have also strikingly often and rapidly developed contact allergy to topical applications. The undesirable effects of long-term systemic corticosteroid therapy have been confirmed in this series, chiefly by severe rebound phenomena, notwithstanding that such treatment has proved the only means of rapidly reversing life-threatening states. The effects of methotrexate and hydroxyurea were at times good but, not uncommonly, mediocre and occasionally even useless. Large doses of antibiotics have also failed to achieve the results described by others. On the contrary, secondary infection with beta-hemolytic streptococci has caused serious problems in several cases. Apart from careful protection from infection and precipitating factors, little can be done to influence the course of generalized pustular psoriasis, but trial with cytostatics is justified during severe bouts, pending the appearance of new lines of therapy.

Retroperitoneal rupture of duodenum with complicating gas gangrene.

Two patients suffered duodenal rupture as a result of blunt trauma and developed gas gangrene of the peritoneal and retroperitoneal areas. Diagnosis of the rupture was delayed, as is often true in such cases. Both patients died despite antitoxin, large doses of antibiotics, and as much debridement as could be done within limits compatible with life. Both patients had undergone previous partial gastrectomy and vagotomy for duodenal ulcer. We suggest that the alterations in bacterial flora in the upper gastrointestinal tract attendant on gastrectomy and vagotomy may place patients with duodenal rupture at greater risk from gas gangrene than those with normal gastroduodenal segments.

Survival of Burned Patients

ABSTRACT To the Editor:— The recent article by McCoy et al, Discriminant Function Probability Model for Predicting Survival in Burned Patients. (203:644, 1968), purports to enable one to determine prognosis in severe burn cases, but does not take into account improvements in burn survival that are made possible by the control of sepsis with large doses of antibiotics (200:939, 1967).Assuming that the statistical methods of McCoy et al are valid, the accompanying Table shows the difference in survival as predicted by their discriminant function model and the survival achieved at St. Mary's Burn Center, Milwaukee, with a prophylactic regimen of the highest tolerated doses of antibiotics and complete exposure.We point this out to avoid undue anxiety or pessimism that may discourage maximum treatment, especially in the case of older persons, who, as the comparison Table shows, have a much better chance of survival than McCoy et al

Effect of Fluid and Antibiotic Administration on Experimental Fecal Peritonitis

In a previous report, rapid development of by povolemia, severe metabolic acidosis and bacteremia of gram-negative bacilli were demonstrated in dogs with experimental fecal peritonitis. Therefore, the effect of fluid administration was examined. In gastric juice peritonitis, the experimental animals recovered from shock only after fluid administration even in the late stage. In the fecal peritonitis, however, fluid therapy was far less effective. Although intravenous instillation of a large amount of fluid, which was started immediately after intraperitoneal injection of fecal material, maintained systemic blood pressure at normal level for a con-siderable period and prolonged the survival time, it was not effective in preventing elevation of hematocrit and severe metabolic acidosis. On the other hand, rapid administration of a large amount of fluid in cases of already advanced fecal peri-tonitis showed only transient improvement of systemic blood pressure and could not improve metabolic acidosis, nor caused it any significant prolongation of survial of the animals. The effect of intraperitoneal administration of antibiotics was evaluated in the fecal peritonitis. Even large doses of antibiotics could not prolong the survival time of experimental animals when an extremely large amount of fecal material had been injected intraperitoneally. The treatment was effective only when intraperitoneal contamination was not so severe.

STUDIES ON THE INTESTINAL FLORA OF PIGS : II. INFLUENCE OF ANTIBIOTICS ON THE FECAL AND INTESTINAL FLORA

In their previous investigation, the authors studied the normal bacterial flora of therectal feces in the healthy pig, and particularly clarified changes in the species and numbersof organisms appearing in the rectal feces with the advance in growth of the pig. Ill thepresent investigation, experiments were carried out to determine what changes would occurin the normal bacterial flora of the rectal feces and contents of intestinal tract of the pigwhen large doses of various antibiotics were aclrrninistered to this animal.The results obtained are summarized as follows.1. No remarkable changes occurred in the normal bacterial flora after the administ-ration of a single dose of any antibiotic. Only Escherichia coli and Lactobacillus organismsshowed a decrease in number for several days after the single administration. Accordingly, it was made clear that the composition of tlte normal bacterial flora was of rather solidstability.2. It was extremely difficult to remove all Line bacteria from the bacterial flora ofthe rectal feces even by means of the consecutive administration of large doses of antibiotics.Such type of administration finally allowed Streptococcus exclusively to multiply in therectal feces.3. Characteristic changes were observed in the bacterial flora of each portion of thedigestive tract in a pig administered consecutively with large doses of antibiotics. Whenthe relationship between the section of the alimentary canal and the number of microbialspecies isolated was examined>the section covering tlre duodenum through the cecum wasfound harboring Yeasts at 5 to 8, as expressed by Log count per gram of sample, and theduodenum and ileum eontained Bifidobacterium at 4.5 and 8, respectively. The value ofStreptococcus detected was 10 in the rectum and decreased gradually as the intestinalcanal was followed upward, reaching 5 in the duodenum.4. It is very diflicult to detect any abnormality on the part of the animal body byexamining the bacterial flora of the rectal feces alone. In order to attain these p

Candida complications after antibiotic therapy.

Comparative clinical and laboratory studies were carried out on patients withCandida complication due to antibiotic therapy. Pathological and clinical peculiarities of the causative organism, the mycological and serological diagnoses have been investigated and diverse criteria of a definiteCandida etiology of the complications have been developed. AsCandida complications those afflictions have been considered which developed in connection with the antibiotic therapy and which disappeared after cessation of the same. The general symptoms ofCandida complications observed are the following: 1) a direct relation with a prolonged treatment with large doses of antibiotics, often in combination of three to five preparations; 2) the presence of symptoms of a hypo- and/or avitaminosis; 3) the emaciation of the organism due to a severe infection or to a chronic pathological process; 4) a prevalent occurrence in children of early age and in older persons suffering of metabolic or hormonal disturbances. Candida complication of the skin and the mucous membranes have been the most frequent ones, less frequent were the attacks on internal organs or the septicopyemic forms. As evidence of theCandida etiology of the complications has been considered: an intensive development of yeast-like organism in the affected areas; the presence of antibodies as agglutinins, precipitins, and complement fixing antibodies; the intensity of allergic skin tests during the development of the pathologic processes. The complement fixation test had a definite advantage compared with the other serologic methods due to its specificity and stability of the results. In the treatment ofCandida complications a great number of useless preparations were eliminated and instead, Nystatin, Iodides, vitamins andCandida vaccine were used. The authors conclude that a constant clinical and laboratory control of the effect of antibiotics, an early recognition and treatment of the primary forms ofCandida complications on the skin and mucous membranes are of great advantage in the prevention ofCandida complications of an antibiotic therapy.

DISTRIBUTION OF CANDIDA IN THE MOUTH

Deep-seated submucous Candididiasis of the mouth and pharynx is calling attention of the Otochino-laryngologist. because this disease shows strong resistance to any treatment.The author and co-operators are studying on this disease and had investigated distribution of Candida myces in the mouth of the patients without Candidiasis as a part of their study.The investigation was done randomly selected 200 patients, 100 out-patients and 100 in-patients admitted to Nagasaki University Hospital.72 strains of fungi were found from specimens of these patients (30%). As for the identification of Candida the slide aggultination test which was developed by Prof. Tsuchiya was employed.Among these cultured fungi C. albicans was identified in 42 strains (30% of all fungi cultured), C. parakrusei in 6, C. tropicalis in 5, C. krusei in 2, Cryptoccus and Aspergillus each in 2 strains. 13 strains of fungi were not classified.Fungi were identified from the mouth of the admitted inpatients in 46%, higher than in that of the out-patients.Patients of malignants with caries teeth and prothesis revealed the highest incidence of 65.5%.In the first decade of life fungi were cultured more frequently than in the fourth decade.Further more, the relationship between the distribution of Candida myces and administration of antibiotics was investigated.More Candida was cultured from the patients who were treated with the large dose of antibiotics than from the patients with minum chemotherapy.Achromycin was given experimentally to 20 patient for 2 weeks and Candida cultivation was carried out. As the results, catarrh stomatitis has occured in 80% of these patients, but Candida was identified only in 25% and the relationship between the dose of antibiotics and the incidence of Candida was not significant.Stomatitis with catarrh symptomes and occasionally associated with the brown or black coated tongue is not the manifestation of Candidiasis, such as acute and chronic thrush, and it is doubtfull of this type of stomatitis could be ascribed to Candida infection.