Haemophilus influenzae Meningitis in Adults

Haemophilus influenzae meningitis though common in childhood is rarely seen in the adult. During the past four years eight cases of H. influenzae meningitis have been seen in St. Thomas''s Hospital and four of these were in patients over 20 years old. There was a possible predisposing condition in two patients. In each case there was difficulty in identification of the organism in the Gram-stained film of the cerebrospinal fluid deposit.     

Isolation and characterization of an aetiological agent in Whipple's disease.

A cell wall deficient form of an alpha-haemolytic streptococcus was grown from a prolonged monolayer cell culture of a lymph node taken from a patient with Whipple''s disease. Serological cross reactivity was shown between the organism and the material within Whipple''s disease macrophages positive for diastase-resistant periodic acid-Schiff (D./P.A.S.). In vitro studies characterized the organism as a facultative intracellular parasite which caused the accumulation within cells of D./P.A.S.-positive material. These results suggest that a pathogenic bacterium is the essential aetiological agent and that the culture of Whipple''s disease tissues in hypertonic media may have practical value.     

An Outbreak of Acute Enteritis Due to Campylobacter fetus Subspecies jejuni at a Nursery School in Tokyo

An outbreak of acute enteritis due to Campylobacter fetus subspecies jejuni involving a total of 35 out of 74 children occurred at a nursery school in Tokyo in January 1979 and lasted for 7 days. It was the first case of a community outbreak of the disease to be recognized in Japan. The major symptoms observed in the patients consisted of diarrhea (88%), fever (82%), abdominal pain (39%), and vomiting (6.1%). The rate of isolation of the organism from the patients was 39%. Sera of four patients showed elevated agglutinin titers against the organism ranging from 1 : 80 to 1 : 320. Although it is suggested that the outbreak was caused by a communal lunch or between-meal snacks prepared by and provided at the nursery school, the incriminated food, source and route of contamination could not be pinpointed.     

TRICHOPHYTON TONSURANS (CRATERIFORME) INFECTION OF THE SCALP

Of 484 cases of ringworm of the scalp observed in a period of two and a half years at a clinic in Los Angeles, 57 (11.78 per cent) were caused by Trichophyton tonsurans, an organism previously considered an infrequent cause of tinea capitis in the United States. The hairs at the site of infection with this organism are distinctively fluorescent when viewed under a Wood light—glowing white rather than green as do hairs infected with microsporum. Endothrix spore formation may be noted in microscopic examination of infected hairs. Material planted on Sabouraud''s media grows as a typical crateriform colony. Occasionally variant growths on cultures are obtained.Trichophyton tonsurans may cause either dry, scaly lesions or inflammatory reaction. In the present series the incidence of cure was higher and the period of treatment shorter for patients with the inflammatory variety. Various antifungal preparations were employed for topical application and although the results were extremely variable, it was felt that some benefit was derived from their use. For lesions of the dry, non-inflammatory type, roentgen ray epilation appeared to be the treatment of choice.     

Pregnancy complicated by psittacosis acquired from sheep.

Two cases of chlamydial infection in pregnant women are described, the first serologically proved and the second suspected. In both cases the infection was probably contracted from sheep suffering with enzootic abortion. Both patients were farmers'' wives who had helped their husbands and lambing and developed a non-specific febrile illness in late pregnancy. In the first case as there was no clinical improvement after 26 hours the patient was delivered by caesarean section of a live infant in good condition; the patient recovered fully. The second patient had presented a year earlier, the fetus had died in the uterus, and the patient himself died after spontaneous labour and forceps delivery 14 hours after admission. Both patients developed disseminated intravascular coagulation. As the casual agent in enzootic abortion in ewes has a predilection for the placenta, early delivery may be the management of choice in late pregnancy if infection with this organism if suspected.     

Chronic osteomyelitis due to Clostridium difficile.

Osteomyelitis caused by anaerobic bacteria is rarely reported, and a case of chronic osteomyelitis of the femur may be the first in which Clostridium difficile was the causative agent. The organism was isolated over several months and, although initially sensitive to penicillin, it developed resistance during this time. The organism''s repeated isolation may have been due to the presence of resistant spores. Although the patient had no gastrointestinal symptoms the source of the organism was probably the patient''s own gastrointestinal tract. Infection from the environment cannot, however, be excluded. Treatment was finally successful with metronidazole.     

MENINGITIS—A Review of One Year's Cases from an Active Children's Hospital Service

Fifty-six cases of bacterial meningitides, other than tuberculous, observed in a period of one year on an active children''s hospital medical service were reviewed. All age groups were involved but most commonly infected were patients in the first year of life. There was no inordinate incidence of infection with any one kind of organism in any specific age bracket, except possibly for infection with enteric organisms which in the present series occurred preponderantly in infants less than six months old. Meningococcus and H. influenza type B were the most common organisms; they were the infecting agents in 71 per cent of cases. Of the immediate complications noted, subdural effusions were the most common (23 per cent of this series). In all except two cases, effusion was resolved by multiple aspirations. In two cases craniotomy was done with good results. Ten electroencephalograms were made and all were abnormal. In most of the patients, multiple antibiotic and chemotherapeutic drugs were used, parenterally during the first few days of hospitalization and then orally as tolerated. Intraspinal therapy was not given. Four of the 56 patients died.     

Isolation of an aerobic vinyl chloride oxidizer from anaerobic groundwater

Vinyl chloride (VC) is a known human carcinogen and common groundwater contaminant. Reductive dechlorination of VC to non-toxic ethene under anaerobic conditions has been demonstrated at numerous hazardous waste sites. However, VC disappearance without stoichiometric production of ethene has also been observed at some sites and in microcosms. In this study we identify an organism responsible for this observation in presumably anaerobic microcosms and conclude that oxygen was not detectable based on a lack of color change from added resazurin. This organism, a Mycobacterium sp. closely related to known VC oxidizing strains, was present in high numbers in 16S rRNA gene clone libraries from a groundwater microcosm. Although the oxidation/reduction indicator resazurin remained in the clear reduced state in these studies, these results suggest inadvertent oxygen contamination occurred. This study helps to elucidate the dynamic behavior of chlorinated ethenes in contaminated groundwater, through the isolation of a strictly aerobic organism that may be responsible for at least some disappearance of VC without the concomitant production of ethene in groundwater considered anaerobic.     

Gastric MALT lymphoma and Helicobacter pylori.

Primary gastric low-grade B-cell lymphomas are neoplastic mimics of mucosa associated lymphoid tissue (MALT) as exemplified by Peyer''s patches in the terminal ileum. Architectural and immunophenotypic properties of the neoplastic cells suggest that they originate from MALT-derived marginal zone B-cells. Paradoxically, the normal human stomach is devoid of organized MALT within which a lymphoma can develop. Lymphoid tissue is acquired in the stomach in response to antigenic stimulation, predominantly associated with Helicobacter pylori infection. Studies of patients with low-grade MALT lymphoma have confirmed a high incidence of H. pylori infection and suggest that the infection predates neoplastic transformation. Certain morphological features of MALT lymphomas suggest that the tumor cells remain responsive to antigen drive. Given the close association between gastric MALT lymphoma and H. pylori, it is possible that this organism provides such a drive. In vitro studies have shown that the tumor cells proliferate in a T-cell-dependent way to the presence of H. pylori. Several studies have now demonstrated that eradication of the organism in patients with low-grade gastric MALT lymphoma can result in regression of the tumor. In cases with a high-grade component, the associated low-grade part may regress, but most high-grade gastric MALT lymphomas are unresponsive to this conservative therapy.     

Tuberculous pseudotumour of the liver developing during antituberculous chemotherapy.

A 29-year-old Chinese woman presented with a liver mass 2 months after initiation of chemotherapy for disseminated tuberculosis. A percutaneous liver biopsy revealed tuberculous pseudotumour. Although acid-fast bacilli were seen in the biopsy specimen, no organism could be cultured. No changes were made in the antituberculous chemotherapy, and the mass subsequently resolved. The patient was still well 18 months after presentation. To the authors'' knowledge, the features of tuberculous pseudotumour seen with ultrasonography and computerized tomography have not previously been described, nor has this condition previously been reported in patients already receiving antituberculous chemotherapy.     

Mutations that permit residual CFTR function delay acquisition of multiple respiratory pathogens in CF patients

Background

Lung infection by various organisms is a characteristic feature of cystic fibrosis (CF). CFTR genotype effects acquisition of Pseudomonas aeruginosa (Pa), however the effect on acquisition of other infectious organisms that frequently precede Pa is relatively unknown. Understanding the role of CFTR in the acquisition of organisms first detected in patients may help guide symptomatic and molecular-based treatment for CF.

Methods

Lung infection, defined as a single positive respiratory tract culture, was assessed for 13 organisms in 1,381 individuals with CF. Subjects were divided by predicted CFTR function: ''Residual'': carrying at least one partial function CFTR mutation (class IV or V) and ''Minimal'' those who do not carry a partial function mutation. Kaplan-Meier estimates were created to assess CFTR effect on age of acquisition for each organism. Cox proportional hazard models were performed to control for possible cofactors. A separate Cox regression was used to determine whether defining infection with Pa, mucoid Pa or Aspergillus (Asp) using alternative criteria affected the results. The influence of severity of lung disease at the time of acquisition was evaluated using stratified Cox regression methods by lung disease categories.

Results

Subjects with ''Minimal'' CFTR function had a higher hazard than patients with ''Residual'' function for acquisition of 9 of 13 organisms studied (HR ranging from 1.7 to 3.78 based on the organism studied). Subjects with minimal CFTR function acquired infection at a younger age than those with residual function for 12 of 13 organisms (p-values ranging: < 0.001 to 0.017). Minimal CFTR function also associated with younger age of infection when 3 alternative definitions of infection with Pa, mucoid Pa or Asp were employed. Risk of infection is correlated with CFTR function for 8 of 9 organisms in patients with good lung function (>90%ile) but only 1 of 9 organisms in those with poorer lung function (<50%ile).

Conclusions

Residual CFTR function correlates with later onset of respiratory tract infection by a wide spectrum of organisms frequently cultured from CF patients. The protective effect conferred by residual CFTR function is diminished in CF patients with more advanced lung disease.     

Linking Science and Literacy

We successfully integrated science and language arts in a third-grade classroom. The students used “scientist's eyes” and “poet's eyes” to write original poetry. In addition, they created habitat posters about a swamp organism. Scoring guides for the habitat poems and posters are also included.     

Immunofluorescence Identification of Thermopolyspora polyspora,the Causative Agent of Farmer's Lung

Farmer''s lung is a serious disabling pulmonary disease found in agricultural workers. The disease is believed to be a hypersensitivity to the thermophilic actinomycetes, principally Thermopolyspora polyspora. This organism is difficult to stain with the usual bacteriological stains and thus far has not been demonstrated in the lung tissue by microscopic methods. In this paper, it is demonstrated that the fluorescent-antibody technique is a simple method for the positive identification of T. polyspora. The technique can also be used as a rapid screening test for the detection of antibodies to T. polyspora in the patient''s serum. In addition, it opens up the possibility of the identification of T. polyspora in the lung tissue of patients with farmer''s lung and makes available a means for the study of the immunological reaction in the lung parenchyma. No false positive or cross-reactions with Thermoactinomyces vulgaris or Streptomyces griseus could be demonstrated.     

Ampicillin-Resistant Hemophilus influenzae: Emergence in California's Central Valley

Ampicillin-resistant Hemophilus influenzae had not been identified in Fresno, California, before June 1976. In the 12 months that followed, eight resistant type B strains and three resistant nontypable isolates were cultured from patients treated at two hospitals that provide nearly all of the acute pediatric inpatient care for the area. Two of the resistant strains were obtained from patients with invasive infections and represented 4.2 percent of Hemophilus influenzae isolated from blood, cerebrospinal fluid or joint aspirates during the 12 months. The remaining six resistant type B strains were obtained from 117 patients, and were the predominant organism in cultures of other sites, primarily respiratory secretions.In two of three patients infected with nontypable organisms, resistance appeared to emerge during therapy with ampicillin. Measurement of β lactamase was a practical and accurate method for differentiating between ampicillin-sensitive and resistant strains. All ten of the β lactamase-positive isolates tested had minimal inhibitory concentrations (MIC) for ampicillin of 15 μg per ml, or less. In contrast 30 β lactamase-negative strains had MIC''s of 1.5 μg per ml, or less, of ampicillin. Our results indicate that ampicillin resistance has become a significant problem in the Central Valley of California and probably the entire state.     

Utilization of methanol by rhodospirillaceae

Enrichment culture of organisms growing anaerobically in the light in methanol-bicarbonate medium resulted in isolation of strains of Rhodopseudomonas gelatinosa and Rhodopseudomonas acidophila. The pH optimum for growth on methanol for all strains tested was approximately one unit higher than for growth on carbon sources containing more than one carbon atom. At the appropriate pH, 17 strains of Rhodospirillaceae out of 39 in a culture collection grew anaerobically in the light on methanol-bicarbonate. Rhodopseudomonas acidophila strain 10050 showed the most abundant growth and was studied in more detail. Its growth on methanol was stimulated by yeast extract or vitamin-free casamino acids. The organism grew on methanol-bicarbonate, methanol-formate or formate alone as the sole carbon sources. No growth was observed on methylamine or formaldehyde. In the presence of excess bicarbonate a maximum yield of 98 g cell material from 100 g methanol was obtained. Ribulose diphosphate carboxylase was present in the methanol-bicarbonate-grown organism at six times the specific activity of that in the succinate-grown organism.     

Septicemia due to Yersinia enterocolitica

Despite the increasing number of reports of Yersinia enterocolitica infection in humans, septicemia with this organism has remained a rare complication. A 73-year-old woman presented with fever, jaundice, hepatomegaly and cellulitis. Microorganisms isolated from both skin lesion and blood were biochemically and serologically identified as Yersinia enterocolitica, biotype 4, serotype 3 and lysotype 9b. High agglutinating titres against this organism were demonstrated in the patient''s serum. Complete recovery followed a course of gentamicin sulfate. A household pet was considered, but not proved, to be the source of this infection.     

Pneumocystis Jirovecii detection and comparison of multiple diagnostic methods with quantitative real-time PCR in patients with respiratory symptoms

Pneumocystis jirovecii (PCP) remains a significant cause of mortality and morbidity in patients with respiratory infections. Accurate diagnosis of PCP is still a diagnostic challenge. Hence, the main objectives were to study the incidence of Pneumocystis Jirovecii pneumonia infection among respiratory problems patients and to compare the real-time quantitative PCR technique with various diagnostic methodologies. Patients who have respiratory symptoms of PCP like breathlessness, cough, and fever were enrolled. Bronchoalveolar lavage (BAL) samples were collected and homogenized, and then smears were prepared for examination by Gomorimethanamine silver staining (GMSS), Immunofluorescent staining (IFAT), Toludine blue O (TBO), and Giemsa staining. Further, RT-PCR was also performed for the detection of PCP. The mean patients’ age was 52 (SD ± 16) years. 41% were female, and 59% of the patients were male. Weight loss (80%), fever (92%), cough (100%), and dyspnea (76%) were the most common complaints. Twenty-eight patients have been diagnosed with pulmonary infiltrates using chest X-ray. Out of 100 patients, 35% were positive for PCP. The organism was detected using IFAT in all the 35 specimens, 15 of 35 (42.86%) by GMSS, 8 of 35 (17.6%) by Giemsa stain, and 1 of 35 (2.8%) was detected by TBO stains. RT-PCR showed that 39 patients was found to be positive for PCP. Thirty-five of these 39 patients had a positive IFAT (89.74%); the IFAT was negative or undefined in 4 samples. All 39 patients (100%) had signs and symptoms for PCP. Our results suggest that RT-PCR is still the most highly sensitive method for Pneumocystis Jirovecii detection. In poor resource settings where RT-PCR and IFAT is not available, diagnosis of Pneumocystis jirovecii pneumonia remains a complicated issue. In settings where RT-PCR & IFAT are not available, GMSS staining may be the next best choice to detect PCP.     

Occurrence of Aphelenchoides besseyi in Louisiana Rice Seed and Its Interaction with Sclerotium oryzae in Selected Cultivars

Aphelenchoides besseyi, the nematode causal agent of white-tip disease of rice, was recovered from 5.5% of 474 seed samples obtained from rice seed warehouses in Louisiana. Laboratory tests in which A. besseyi-infested rice seed was treated with Phostoxin®, a compound used for control of insects in stored grain, indicate that it also has nematicidal properties. In 18-week-duration greenhouse tests, populations of A. besseyi increased 4-5-fold on the cultivars Saturn and Melrose and 3-fold on Nova ''76. Green weights of Nova ''76 plants inoculated with A. besseyi and Sclerotium oryzae, the causal agent of rice stem rot, were significantly reduced below those of plants inoculated with either organism alone or with distilled water. Weights of Melrose plants were reduced significantly by treatments with A. besseyi alone and A. besseyi plus S. oryzae, but not by S. oryzae alone. Saturn plant weights were not reduced significantly by either organism alone or by the two in combination.     

Adhesive Escherichia coli in inflammatory bowel disease and infective diarrhoea.

The clinical features of ulcerative colitis and Crohn''s disease are similar to those of infections of the bowel, although their cause is uncertain. Many bacteria that cause intestinal diseases adhere to the gut mucosa, and adhesion of pathogenic Escherichia coli is resistant to D-mannose. The adhesive properties of isolates of E coli were assessed by assay of adhesion to buccal epithelial cells with mannose added. The isolates were obtained from patients with inflammatory bowel diseases (50 with a relapse of ulcerative colitis, nine with ulcerative colitis in remission, 13 with Crohn''s disease, and 11 with infectious diarrhoea not due to E coli) and 22 controls. The median index of adhesion to buccal epithelial cells (the proportion of cells with more than 50 adherent bacteria) for E coli from patients with ulcerative colitis in relapse was significantly higher (43%) than that for controls (5%) and patients with infectious diarrhoea (14%). The index was not significantly different among isolates from patients with ulcerative colitis in relapse, Crohn''s disease (53%), and ulcerative colitis in remission (30%). If an index of adhesion of greater than 25% is taken as indicating an adhesive strain 86% of isolates of E coli from patients with inflammatory bowel disease were adhesive compared with 27% from patients with infective diarrhoea and none from controls. The adhesive properties of the isolates from patients with inflammatory bowel disease were similar to those of pathogenic intestinal E coli, raising the possibility that they may have a role in the pathogenesis of the condition; the smaller proportion of adhesive isolates in patients with infective diarrhoea due to other bacteria suggests that the organism may be of primary importance rather than arising secondarily.