Specific IgE response in patients with brucellosis

In the search to find discriminative serological markers to differentiate between patients with acute brucellosis and those with chronic brucellosis, an enzyme-linked immunosorbent assay (ELISA) was used to determine and compare the brucella-specific IgE response in 80 sera from patients with acute brucellosis, 37 sera from patients with chronic brucellosis, 26 sera from patients with positive blood cultures for bacteria other than brucella and 51 sera from healthy controls. The IgE findings were compared to brucella-specific IgG, IgM, IgA and IgG1-4 demonstrated by ELISA, and to microagglutination test (MAT) results. Elevated (positive) antibrucella IgE titres were detected in 89 and 81% of sera from patients with acute and chronic brucellosis respectively. The predominant antibodies found in patients with acute brucellosis were of the IgG, IgM, IgA, IgE, IgG1 and IgG3 types while in chronic brucellosis IgG, IgA, IgE and IgG4 were found. Although IgE can be detected in patients with brucellosis, it does not discriminate between the acute and chronic stages of the disease.

Neurological complications of brucella spondylitis

Twenty-two patients with brucella spondylitis and neurobrucellosis were studied during a 2-year period. The diagnosis was based on history of exposure, compatible signs and symptoms, high antibody titre and/or positive culture of a clinical specimen(s). Spondylitis was confirmed by plain radiographs, bone scan, CT and in some cases by histology. Neurobrucellosis was confirmed by CSF examination and culture, myelography, NCV, EMG and CT head. The spondylitis was early in 4 cases, chronic active in 12, smouldering "partially healed" in 3 and healed in 3 cases. Of these, 15 patients (68%) had neurological complications of various types. Plain radiographs were not a good index of activity of spondylitis. Tc99 bone scan was not specific and it remained positive long after the completion of therapy. CT was superior in revealing details of bone destruction, soft tissue swelling and entrapment of nerve roots and cord. The 3 modalities were complementary. Spondylitis is commonly associated with neurobrucellosis and symptoms of one may over shadow those of the other and in some cases neurobrucellosis may be subclinical. In all cases of spondylitis, a thorough search for neurobrucellosis should be made and vice versa. Prolonged treatment with a combination of 3 anti-brucella drugs is recommended and prolonged follow-up is necessary.

Determination by enzyme-linked immunosorbent assay of immunoglobulin G (IgG), IgM, and IgA to Brucella melitensis major outer membrane proteins and whole-cell heat-killed antigens in sera of patients with brucellosis

An enzyme-linked immunosorbent assay was used to compare Brucella melitensis major outer membrane proteins (MOMP) and whole-cell heat-killed antigens (HK) in measuring antibrucella immunoglobulin G (IgG), IgM, and IgA in sera of brucellosis patients and controls. Antibodies to MOMP were generally similar to those against HK, and the correlation coefficients between the two antigens and IgG, IgM, and IgA in patients varied between 0.73 and 0.94. Both antigens are comparably suitable in detecting antibrucella immunoglobulin isotypes for the serologic diagnosis of patients with brucellosis, with high (greater than or equal to 95%) sensitivity and specificity.

Brucellosis: atypical presentation with peritonitis and meningitis

A case of brucellosis associated with peritonitis, intestinal obstruction, granulomatous hepatitis, inappropriate antidiuretic hormone (ADH) secretion and meningitis is reported. Initially, the patient was diagnosed as a case of disseminated tuberculosis and treated accordingly. However, the serologic tests for brucellosis were strongly positive and the patient was subsequently treated as a case of brucellosis and recovered fully. The gastrointestinal manifestations of brucellosis are reviewed.

Pulmonary brucellosis

Pulmonary abnormalities in brucellosis are rare. We report on nine cases (five adults and four children) with pulmonary brucellosis. All presented with fever, cough and mucopurulent sputum, and most had abnormal signs in the chest. Radiography of the chest showed pneumonic patches or consolidation in five patients, pleural effusion in three, granuloma of the lung in one and a picture of interstitial pneumonitis in one. All the patients had a brucella agglutination titre of 1:320 or more, and an elevated titre in the brucella-specific enzyme linked immunosorbent assay of IgM, IgG and IgA. Blood cultures grew Brucella melitensis in six patients while the pleural fluid aspirate grew the same organism in two of three patients. Treatment with oral oxytetracycline, doxycycline, rifampicin, trimethoprim-sulfamethoxazole alone, in combination with each other or together with intramuscular streptomycin was successful in all patients. All our patients recovered and none relapsed.

Neurobrucellosis in children

Reports on nervous system involvement in brucellosis are rare in children. We report nine children with neurobrucellosis. The clinical presentation included meningitis in six patients, one with encephalitis, one with meningoencephalitis and one with meningomyeloencephalitis. The blood from all patients showed elevation in Brucella microagglutination test titers (greater than or equal to 1:640) and in Brucella-specific enzyme-linked immunosorbent assay for IgM (greater than or equal to 1:800), IgG (greater than or equal to 1:800) and IgA (greater than or equal to 1:800) antibodies. Brucella melitensis was recovered from the blood in five patients and from the cerebrospinal fluid in three patients. The cerebrospinal fluid showed lymphocytic pleocytosis in eight patients with elevated protein in three, decreased glucose in four and a Brucella microagglutination test titer of greater than or equal to 1:80 in all. Treatment with a combination of oral tetracyclines with intramuscular streptomycin was successful in five patients, rifampin with streptomycin in two, tetracycline with rifampin in one and tetracycline, rifampin and streptomycin in one. No relapses, mortality or sequelae occurred in our patients.

A multicenter therapeutic study of 1100 children with brucellosis

A 6-year multicenter therapeutic study was performed on 1100 children with brucellosis in order to compare several antibiotic combinations and duration of treatment. The patients were randomized to receive oral therapy with oxytetracycline, doxycycline, rifampin and trimethoprim-sulfamethoxazole (TMP/SMX) either alone or in combination with each other or combined with streptomycin or gentamicin injections. The patients were also randomized into three groups based on the duration of oral therapy: 500 patients were treated for 3 weeks; 350 for 5 weeks; and 250 for 8 weeks. When intramuscular aminoglycosides were used, streptomycin was given for 2 weeks and gentamicin for 5 days. In oral monotherapy oxytetracycline, doxycycline and rifampin showed comparable results with low relapse rates (less than or equal to 9%) and no statistically significant differences were found among 3-, 5- or 8-week durations of therapy. TMP/SMX alone showed an unacceptably high relapse rate (30%) with all durations of therapy. In combined oral therapy rifampin plus oxytetracycline, rifampin plus TMP/SMX and oxytetracycline plus TMP/SMX showed comparable results with low relapse rates ranging from 4 to 8% in patients receiving therapy for 3 or 5 weeks, no relapses occurred in patients treated for 8 weeks. When oral monotherapy was combined with either streptomycin or gentamicin, very few relapses were seen, irrespective of the duration of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiovascular and pulmonary complications of epidemic typhus

A case of typhus fever associated with cardiac and pulmonary complications is reported. The patient was a 24-year-old Egyptian female with characteristic clinical presentation of rickettsial infection, though no rash was present throughout the course of the disease. We could not find a report of such complications in the English medical literature.

Assessment of Brucellosis Card test in screening patients for brucellosis

The Brucellosis Card test (Brewers' Diagnostic Kits, Hynson, Westcott and Dunning, Inc., Baltimore, Md.) was evaluated in relation to the Brucelloslide test (bioMérieux, France), the microagglutination test (MAT) and the demonstration of brucella-specific IgG, IgM and IgA in an enzyme-linked immunosorbent assay (ELISA). A total of 573 serum specimens was tested. These included sera from patients with acute brucellosis (159), chronic brucellosis (23) and patients who had been diagnosed previously as having had brucella infection (155). Control groups consisted of patients with diseases other than brucellosis (52), others with non-infectious diseases (20), and healthy individuals (164). The Card test detected 100% of the patients with acute and 61% of the patients with chronic brucellosis. The sera from the control groups were all negative. Similar results were obtained with the Brucelloslide test and the MAT. The ELISA test detected brucella-specific Ig of all classes in the serum of patients with acute brucellosis, and IgG and IgA in the serum of patients with chronic brucellosis. In the latter group, IgM was also detected in 32% of the sera. Twenty-three per cent of sera with titres of 20 by the MAT were positive on the Card test and had ELISA titres for IgM, IgG and IgA of 400. Characterization of the antibodies involved in the Card test showed that sera with IgM ELISA titres of 1600, or an IgM titres of 800 together with IgG and IgA titres greater than or equal to 200 were Card test positive. Higher IgG (greater than or equal to 1600] plus IgA (greater than or equal to 400) titres were required to produce a positive Card test in the absence of IgM or when the IgM titre was less than or equal to 200. The Card test has a potential value as a rapid screening test for humans with acute brucellosis and shows similar results to Brucelloslide and MAT tests. ELISA, however, remains the most reliable test for diagnosis of brucellosis especially in patients with chronic and complicated stages of the disease.

ELISA versus routine tests in the diagnosis of patients with systemic and neurobrucellosis

Sera from patients in different stages of brucellosis as well as sera and cerebrospinal fluid (CSF) from patients with central nervous system (CNS) brucellosis and controls, were tested by ELISA for Brucella-specific IgG, IgM and IgA. The results were compared with culture findings, micro-agglutination (MA), slide agglutination with Rose Bengal (RB), and Brucella melitensis stained antigens (SA). In sera of patients with acute brucellosis (296), ELISA was positive for IgM (100%), IgG (97%) and IgA (98%), and comparable results were found in sera of patients with subacute brucellosis (44): IgG (100%), IgM (86%) and IgA (100%). However, in patients with chronic brucellosis (40), IgG and IgA were consistently positive (100%) while IgM was only positive in 33% of their sera. The MA and RB showed similar results, being more positive in patients with acute (98%) and subacute (84%) than in chronic (61%) brucellosis. The SA and culture showed significantly lower positive results. In the CSF of patients with CNS brucellosis (45), ELISA was positive in 100%, 20% and 85% for IgG, IgM and IgA, respectively, compared to 13% positive by culture, 25% by MA and 22% by RB. ELISA was negative in the CSF specimens from patients with brucellosis without CNS involvement (66), or meningitis other than Brucella (62), and no meningitis (144). Thus, ELISA with its IgG, IgM and IgA profiles is the test of choice in the diagnosis of patients with brucellosis, especially those with chronic or CNS infection.

Human brucellosis in Kuwait: a prospective study of 400 cases

The clinical pattern of 400 cases of brucellosis in Kuwait is presented. The disease was acute in 77 per cent, sub-acute in 12.5 per cent and chronic in 10.5 per cent of cases. Raw milk was the major source of infection. The major features on presentation, irrespective of the course of the disease, were fever, sweating, headache, rigors, arthralgia, myalgia, and low back pain. Hepatosplenomegaly was present in 41 per cent of cases and in 32 per cent neither liver nor spleen were palpable. The haematologic findings were not specific and hepatic dysfunction (shown by liver enzyme abnormalities) was common. Skeletal (26 per cent) and genital (8.5 per cent) changes and neurobrucellosis (7 per cent) were the major complications. The ELISA was the most sensitive and reliable diagnostic test especially in relation to chronic brucellosis and neurobrucellosis. ELISA allowed the determination of brucella-specific immunoglobulins (Ig)G, IgM and IgA in the CSF, and provided profiles of Ig, in sera, which were different in patients with chronic (elevated IgG and IgA) from those with acute (elevated IgM alone or IgG, IgM and IgA) brucellosis. Treatment with tetracycline, doxycycline or rifampicin gave a cure rate of over 91 per cent in acute and subacute brucellosis. Co-trimoxazole was associated with a relapse rate of 50 per cent. Two drug combinations of streptomycin and tetracycline, streptomycin and rifampicin or streptomycin and doxycycline were effective, but one of five patients with chronic brucellosis relapsed. A combination of streptomycin, tetracycline and rifampicin with or without steroids was used successfully in neurobrucellosis, septicaemic shock and subacute bacterial endocarditis.

Detection of Salmonella spp. in clinical specimens by capture enzyme-linked immunosorbent assay

A capture enzyme-linked immunosorbent assay (ELISA; Kirkegaard and Perry Laboratories, Gaithersburg, Md.) was used to detect Salmonella spp. in clinical and artificially inoculated specimens. In patients with bacteremia caused by Salmonella spp., 48% (12 of 25) and 82% (13 of 16) of serum and urine specimens, respectively, were positive for Salmonella spp., as determined by ELISA. All serum and urine specimens collected from healthy individuals (25 specimens) or patients whose blood cultures grew gram-negative bacteria other than Salmonella spp. (18 specimens) were negative for Salmonella spp., as determined by ELISA. For blood culture bottles in which Salmonella spp. (16 specimens) was grown the ELISA was positive (100%), while it was negative for all the 65 blood culture bottles in which gram-negative bacteria other than Salmonella spp. (42 specimens) or gram-positive bacteria (23 specimens) were grown. All samples of urine (16 specimens), stool (8 specimens), serum (16 specimens), culture media (12 specimens), and blood culture bottles (reported sterile after 2 weeks of incubation; 16 specimens) that were artificially inoculated with 10(3) to 10(7) CFU of four species of Salmonella per ml were positive by ELISA. Similar specimens inoculated with or containing various species other than Salmonella were negative by this test. Thus, ELISA offers a promising opportunity for the rapid detection of Salmonella spp. in clinical microbiology laboratories.

Surgery in combined pulmonary and neural cryptococcosis

A 39-year-old previously healthy patient with combined pulmonary and neural cryptococcosis was successfully managed by pulmonary resection and antifungal chemotherapy. The pulmonary mass was removed under cover of miconazole and 5-fluorocytosine even though the patient had concomitant active meningitis. He recovered dramatically after the surgical procedure and remained well 2 years later. We suggest that, as in our patient, early removal of a pulmonary cryptococcal mass under antifungal cover may in other similar patients obviate the need for protracted antifungal therapy and lead to an excellent response of the neural cryptococcosis.

Clinical categories of neurobrucellosis. A report on 19 cases

Brucellosis rarely can present with involvement restricted to the nervous system. We describe a total of 19 cases of neurobrucellosis in whom the clinical presentation lay in three distinct categories. The first was an acute presentation with meningoencephalitis. The disease also presented in a chronic form where the brunt of the illness can either be in the peripheral or the central nervous system (CNS). The chronic peripheral form is that of a proximal polyradiculoneuropathy. The central form is that of diffuse CNS involvement, predominantly with myelitis or cerebellar involvement with or without cranial nerve palsies. Although the two chronic forms, 'peripheral' and 'central', are distinct, some overlap is possible. This was not observed for the acute form. The pathology of the three presentations may be different, being a direct effect of infection in the acute form, and an immune-related process, possibly demyelinating in nature, in the chronic forms. The response to treatment in the acute and chronic forms is also different, being much better in the acute form. Awareness of the condition and performance of the appropriate serological tests will differentiate neurobrucellosis from other chronic CNS infections, especially tuberculosis and neurosyphilis.

Evaluation of ELISA in the diagnosis of acute and chronic brucellosis in human beings

An enzyme-linked immunosorbent assay (ELISA) was used to determine the levels of brucella-specific IgG, IgM and IgA in 173 patients with acute brucellosis, 22 patients with chronic brucellosis and in 281 controls consisting of 98 patients with other infectious etiologies, 20 patients with non-infectious diseases and 163 normal healthy adults. The ELISA results were compared with culture findings, the results of slide agglutination tests with Brucella melitensis (M), B. abortus (A) and Ross Bengal (RB) antigens, and of tube and microagglutination tests. Brucella cultures were positive in 53 and 5% of patients with acute and chronic brucellosis respectively. The slide agglutination tests with A, M, A plus M and RB antigens were positive in 42, 44, 51 and 98% of patients with acute brucellosis and in 23, 27, 27 and 64% of patients with chronic brucellosis. There was no significant difference in the results between the tube and microagglutination tests regardless of the type of antigen used. At a titre of greater than or equal to 80 or greater than or equal to 160 these tests were positive in 98% and 92% of patients with acute brucellosis and 60 and 40% of patients with chronic brucellosis. The brucella culture and agglutination tests were negative for all the controls. Brucella ELISA immunoglobulins (Ig) were detected in some individuals in the control groups but the majority of these had titres of less than or equal to 100 for IgG, IgM, and IgA. However, patients with brucellosis had significantly higher ELISA titres in all classes of Ig than controls but the sensitivity and specificity within each Ig class varied with the titre considered. At a titre of greater than or equal to 1600 the brucella IgG had a sensitivity and specificity of 98% for patients with acute or chronic brucellosis; this decreased with lower reciprocal titres. The brucella IgM titre of greater than or equal to 400 had a sensitivity of 98% and a specificity of 98% for patients with acute brucellosis. However, in patients with chronic brucellosis the brucella IgM was very low. The brucella IgA titre of greater than or equal to 200 showed a sensitivity of 98% and a specificity of 99% for patients with either acute or chronic brucellosis. This study indicates that brucella ELISA is a rapid, sensitive and specific assay, provides a profile of Ig classes in the diagnosis of acute and chronic brucellosis, is useful for mass screening and could be considered the method of choice for the serological diagnosis of brucellosis.

In vitro activity of antibacterial agents on Haemophilus influenzae isolates

One hundred and eight clinical isolates of Haemophilus influenzae, consecutively occurring and epidemiologically unrelated, were examined for susceptibility against twelve antibacterial agents by disc diffusion and agar dilution. These were also serotyped and tested for beta-lactamase production. All isolates were sensitive to erythromycin, trimethoprim, chloramphenicol and cefotaxime. Six (5.5%) strains were ampicillin resistant (MIC 128 mg/1), and five of them were beta-lactamase producers. Tetracycline resistance was seen in 52.8% of the isolates. This is probably related to the high consumption of tetracyclines in our population. Cefotaxime (modal MIC 0.03 mg/1) and cefaclor (modal MIC 0.03 mg/1) were the most active parenteral and oral cephalosporins respectively.

Measurements of serum gentamicin concentrations by a biological method, fluorescence polarization immunoassay and enzyme multiplied immunoassay

Serum gentamicin levels were assayed in patients receiving the aminoglycoside to determine dosage adjustments. The accuracy and reproducibility of three methods were compared; bioassay, enzyme multiplied immunoassay (Syva EMIT) and fluorescence polarisation immunoassay (Abbott TDx). Each assay method offered acceptable precision. The bioassay method correlated well with both the enzyme multiplied immunoassay and the fluorescence polarisation immunoassay (correlation coefficients 0.854 and 0.937, respectively). The automated methods provide results within 15 min and are not influenced by combinations of antibiotics, hence they are the methods of choice for aminoglycoside determinations.

Rapid diagnosis of central nervous system brucellosis by ELISA

The diagnosis of central nervous system (CNS) brucellosis was made by determining Brucella-specific IgG, IgM and IgA in cerebrospinal fluid (CSF) specimens, using an enzyme-linked immunosorbent assay (ELISA) method. A total of 68 CSF specimens including 10 from patients with brucellosis of the nervous system, 4 with Brucella infection but without CNS involvement, 38 with meningitis other than due to Brucella and 16 with no meningitis were studied. Of the 10 CSF specimens from patients with CNS brucellosis, Brucella-specific IgG was detected in all 10, IgM in 7 and IgA in 8. The 10 patients were also seropositive for anti-Brucella IgG and IgM, and 9 were seropositive for IgA. No Brucella-specific IgG, IgM or IgA was detected in the CSF of 4 patients with brucellosis but without CNS involvement, even though the blood of these patients had high titres of anti-Brucella IgG, IgM and IgA. In addition, none of the CSF specimens from the 38 patients with meningitis other than due to Brucella, or from the 16 patients without meningitis, had detectable anti-Brucella antibodies. This study indicates that the Brucella ELISA on CSF is a reliable, rapid, sensitive and specific assay in the diagnosis of CNS brucellosis.

Evaluation of a two-minute strep A direct swab test (SADST) on patients with pharyngitis at a primary care clinic

A two-minute strep A direct swab test (SADST) was used to detect the presence of Lancefield group A streptococci (GAS) from the throats of 207 patients with pharyngitis at a primary-care clinic. The results were compared with a standard culture method. Fifty-one specimens were positive and 156 specimens were negative for GAS by culture. The SADST had a sensitivity of 96% (49 of 51) and specificity of 98.7% (154 of 156). The predictive values of a positive and negative SADST, for GAS, were 96% and 98.7% respectively. The SADST showed negative reactions with five specimens containing beta-haemolytic streptococci other than GAS and 34 known stock cultures other than GAS. Our results indicate that SADST is a rapid, simple, convenient and reliable test to use for diagnosis of GAS pharyngitis at primary care clinics, physicians' offices and clinical laboratories.

Antibiogram of urinary tract isolates in Kuwait

1253 urinary tract isolates collected during 9 months (April-December 1984) were analysed by the agar diffusion method for sensitivity to 13 antimicrobial agents commonly used for the treatment of urinary tract infections in children and adults. We noticed an agitatingly high resistance of Escherichia coli to ampicillin, sulphonamide and trimethoprim/sulphamethoxazole and of Proteus spp. to ampicillin. As Kuwait is one of the countries where the total consumption of antibiotics is very high as compared to most of the western countries, we are inclined to assume that this generous policy for the prescription of especially ampicillin and other broad spectrum antibiotics in uncomplicated infections has generated this serious consequence.

Neurobrucellosis in an eight-year-old child

An 8-year-old boy, presenting with signs of chronic meningitis, and involvement of cranial nerves, was found to have neurobrucellosis. The diagnosis was rapidly established by an enzyme-linked immunosorbent assay (ELISA) that detected high titres of IgG, IgA and IgM brucella antibodies in CSF and in serum. Brucella melitensis was subsequently isolated both from blood and CSF. Neurobrucellosis, which has been considered to be very rare in childhood, should be suspected in cases of meningitis of obscure aetiology in brucella-endemic areas. Brucella-specific antibodies in serum and CSF should be determined in these cases using sensitive serological techniques.

Use of 9-chloro-9-(4-diethylaminophenyl)-10-phenylacridan as a primary medium for recovery of Pseudomonas aeruginosa from clinical specimens

Several concentrations of 9-chloro-9-(4-diethylaminophenyl)-10-phenylacridan (C-390), ranging from 5 to 100 micrograms/ml, were incorporated in brain heart infusion agar, MacConkey agar, and xylose-lysine-deoxycholate agar to evaluate the recovery of Pseudomonas aeruginosa from 538 sputum, 174 urine, and 22 stool samples. Seventy-six sputum samples containing P. aeruginosa grew this bacterium alone on brain heart infusion and MacConkey agars with a C-390 concentration of 25 micrograms/ml or greater. Other microorganisms present in these specimens grew only on media without C-390, and significantly less growth was observed on media with less than 20 micrograms of C-390 per ml. In few samples containing Klebsiella pneumoniae (3 of 30) and Serratia spp. (3 of 10), these organisms grew on all C-390 media and concentrations tested. The remaining sputum samples grew other bacteria and yeasts only on media without C-390. Brain heart infusion and MacConkey agars with C-390 were equally effective in recovering P. aeruginosa and suppressing the growth of a wide range of bacteria and yeasts from urine and stool samples. Xylose-lysine-deoxycholate agar with C-390 did not show a selective or suppressive advantage over xylose-lysine-deoxycholate agar alone for recovering P. aeruginosa from stool specimens. These results indicate that use of the correct medium and C-390 concentration would provide a suitable primary medium for inhibiting a wide range of bacteria and yeasts and would select the growth of P. aeruginosa from clinical specimens.

Clinical laboratory evaluation of a bacteriuria detection device for urine screening

The BAC-T-SCREEN (BTS) (Marion Laboratories, Inc., Kansas City, MO) is a 2 1/2-minute urine screen designed to detect culture-negative specimens. A total of 1,609 urine specimens were tested by the BTS, and results were compared with quantitative culture methods. One hundred and forty-eight (9.2%) specimens were not screened successfully by the BTS because they contained interfering pigments or clogged the test filters. A total of 1,461 specimens were tested successfully. The sensitivity, specificity, positive predictive value, and negative predictive value for specimens containing greater than or equal to 10(5) CFU/mL were 98.0, 72.2, 57.3, and 99.0%, respectively. These values for specimens containing greater than or equal to 10(4) CFU/mL were 93.2, 77.2, 69.2, and 95.5%, respectively.

4-h Identification of Pseudomonas aeruginosa with 9-chloro-9-(4-diethylaminophenyl)-10-phenylacridan

A total of 361 gram-negative bacilli were evaluated for their ability to grow in the presence of 9-chloro-9-(4-diethylaminophenyl)-10-phenylacridan. The minimum time required for the production of visual turbidity in brain heart infusion broth was determined to be 4 h in shake cultures at 35 degrees C. The minimal inhibitory concentration (MIC) of 9-chloro-9-(4-diethylaminophenyl)-10-phenylacridan in brain heart infusion broth was determined for 174 isolates. The MICs for all 40 Pseudomonas aeruginosa isolates tested were greater than 50 micrograms/ml. The MICs for the other 53 pseudomonads tested were less than or equal to 5 micrograms/ml. Among 81 other gram-negative bacilli tested, the MICs for 4 were 15 micrograms/ml, the MICs for 15 were 10 micrograms/ml, the MICs for 21 were 5 micrograms/ml, and the MICs for 41 were less than or equal to 1 micrograms/ml. Based on these data, 361 gram-negative bacilli were inoculated into brain heart infusion broth containing 15 micrograms of 9-chloro-9-(4-diethylaminophenyl)-10-phenylacridan per ml and incubated on a shaker for 4 h. The only bacteria that produced visual turbidity were identified as P. aeruginosa (170 of 170 isolates).

Diagnostic value of the enzyme-linked immunosorbent assay for detection of Candida albicans cytoplasmic antigen in sera of cancer patients

To diagnose systemic candidiasis we developed an enzyme-linked immunosorbent assay (ELISA) for the quantitation of Candida albicans cytoplasmic antigen in sera of cancer patients. The antigen concentration was evaluated in 59 patients divided into several groups according to clinical, histological, and microbiological findings as well as antimicrobial treatment. All of seven patients with proven disseminated candidiasis had elevated antigen concentrations (mean = 1,200 ng/ml). Among 13 patients with suspected disseminated candidiasis, 9 had elevated antigen concentrations (mean = 1,039 ng/ml). The remaining four patients showed negative antigen (less than 125 ng/ml). In a group of patients with fever of unknown origin, 5 of 17 had high antigen concentrations (mean = 1,220 ng/ml) and the rest were negative. Patients with bacterial infection (6 patients), aspergillosis (3), cryptococcosis (4), coccidioidomycosis (3), and no infection (6), as well as normal healthy adults (31), had antigen concentrations of less than 100 ng/ml. This ELISA is rapid, sensitive, and specific and is a helpful diagnostic tool in the evaluation of candidiasis in cancer patients.

Valuable of terminal subcultures from negative BACTEC blood culture bottles

Terminal subcultures from 5,354 negative BACTEC blood culture bottles did not significantly improve the detection of positive cultures. Only 15 of the 545 total isolates were recovered from the terminal subcultures. All 15 of these isolates were either considered contaminants or had been previously detected.

Comparison of the carcinoembryonic antigen levels by dialysis and sephadex column methods

Duplicate plasma samples from 64 human donors were tested and compared for the levels of carcinoembryonic antigen (CEA) by the conventional dialysis and sephadex column methods. Results from the column method were similar to those from the dialysis method, with a correlation coefficient of 0.9959. In addition, the assay time by the sephadex column was only four to five hours, as compared with 18 to 24 hours for the dialysis procedure. The potential usefulness in substituting the sephadex column for the dialysis method in CEA determinations is discussed.

The host response in secondary hydatidosis of mice. II. Cell mediated immunity

The presence of cell mediated immunity to Echinococcus granulosus antigen was detected in syngeneic mice with secondary hydatidosis. Significant increases of thymidine uptake were observed in spleen cells from infected animals exposed to protoscolex or hydatid fluid antigens. A definite decrease in the number and size of cysts occurred in mice following the simultaneous intraperitoneal injection of viable protoscolices and a suspension of 1 x 10(7) sensitized spleen cells.

The host response in secondary hydatidosis of mice. I. Circulating antibodies

The infection of young albino mice by the intraperitoneal injection of viable hydatid protoscolices provided a suitable model for the investigation of the factors controlling the subsequent host immune response. Antibodies detectable by haemagglutination and complement fixation appeared around the 14th week after infection. Increases in antibody titres were related to the potency of the antigenic impulse(s) produced by the healthy germinal membrane and viable protoscolices. Our results suggest that qualitative and quantitative variations in excretory, secretory and somatic antigens, occurring during the different phases of parasite development, incite the production of a multitude of antibodies, only a few of which are detectable by conventional methods.

Serologic evidence of the postoperative persistence of hydatid cysts in man

The sensitivity of the haemagglutination, complement-fixation and indirect fluorescent antibody tests in the diagnosis of primary and recurrent hydatid disease is presented. In the first, diagnostic titres were obtained in 90% of 50 patients with hepatic and 64%, 60%, and 68% of 25 patients with pulmonary cysts, respectively. In the postoperative study of 62 patients, elevated titres of HA, CF and IFA antibodies in 30 led to the presumptive diagnosis of recurrent disease, confirmed later by radiological and surgical follow-ups. In the 32 others the proportion of positive reactors was 29%, 6% and 28% in HA, CF and IFA tests. These patients had no detectable cysts. This indicates that in postoperative patients a negative CF test may be of a better prognostic value in indicating absence of cysts than the HA and IFA tests.