Studies on the Izumi-Fever Epidemic at the Minamiota Primary School of Yokohama City I. Clinical Symptoms

• Published in: Journal of the Japanese Association for Infectious Diseases Vol. 30; no. 2; pp. 90 - 98
• Main Authors: KANAO, Shuhatsu, KAGIWADA, Shigeru, ROKUGO, Masahiro, HOSHINO, Juji, OGUCHI, Tetsuo, ASANAGI, Shigeo, OKASHITA, Tomoko
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Association for Infectious Diseases 20.05.1956
• ISSN: 0021-4817; 1884-5681
• DOI: 10.11552/kansenshogakuzasshi1926.30.90

It is generally accepted that Izumi-fever is always associated with a f avourable prognosis. In spite of relatively long lasting high fever, complications are rare, and recovery takes place usually without any specific treatment. Mortal cases have hitherto been only exceptionally recorded, although mass incidences in various districts are reported by many investigators. The authors experienced an Izumi-f ever epidemic among school. children of the Minamiota Primary School of Yokohama City in March 1954. The total number of children, attending this school, was 1.409, out of which 1.019 were presumed to be infected. The authors investigated 288 hospitalized cases in which definite diagnosis of Izumi-fever was confirmed. The reported epidemic was characterized by so severe clinical symptoms as had not yet been described in the literature. Including mortal cases some patients exhibited severe ekiri-like disorders. 1) In general, the investigated 288 cases had rather severe symptoms, especially those of the gastrointestinal tract. 2) Ten cases were accompanied by severe ekiri-like symptoms. They showed beside pathognomonic symptoms of Izumi-fever, symptoms of remarkable circulation disturbance, such as weak and accelerated pulse, cyanosis, etc., psychoneurological symptoms represented by disturbance of consciousness, delirium, etc. and gastrointestinal symptoms such as vomiting, diarrhea, abdominal pain, greenish mucous stool, etc. On account of these symptoms such cases had a striking resemblance to those of ekiri. 3) Because the so-called “ekiri” and ekiri-like symptoms are commonly caused by intestinal flora, and on the other hand, the gastrointestinal symptom, as one of thecharacteristic symptoms of Izumi-fever, indicates possible inducement of ekiri symptoms from the intestinal tract, it was suspected that Izumi-fever might develop on the basis of intestinal infection. However, the culture of intestinal flora of the above-mentioned severe cases as well as of several other cases was not contributory to demonstrate an intestinal origin of the disease. Although dysentery bacilli (Shigella sonnei) were demonstrated in 4 of 70 Izumi-fever cases and in 2 of the above-mentioned cases with severe ekiri-like symptoms, they had of course nothing to do with Izumi-f ever. Nor could ekiri-like symptoms in Izumi-fever, with the exception in the two cases, ascribed to concomitant dysentery bacilli. Staphylococci were further isolated from other 2 cases with severe ekiri-like symptoms and from several other cases. But the rate of isolation was not significantly different from that of the control group, consisting of dysentery patients. The role of these kinds of bacteria, however, in the pathogenesis of Izumi-fever should not yet be disregarded utterly, until the etiology of this disease is ultimately determined.