Immunoglobulin M, A, and G antibody response to lipopolysaccharide O antigen in symptomatic and asymptomatic Shigella infections

The antilipopolysaccharide antibody response in sera obtained from subjects involved in 10 outbreaks of shigellosis occurring in Israeli military field units was determined by an enzyme-linked immunosorbent assay and a passive hemagglutination test. Both tests were found to be sensitive and specific for the diagnosis of shigellosis. A significant antibody response was detected in 73 to 82% of the symptomatic and 48 to 60% of the asymptomatic subjects during the Shigella sonnei and Shigella flexneri outbreaks. Fifty percent of the symptomatic and none of the asymptomatic subjects showed a significant antibody response in the Shigella boydii outbreaks. An examination of the kinetics of the antibody levels over a 10-week period after the onset of disease revealed that immunoglobulin A (IgA) levels were highest 2 weeks after infection and had declined to initial levels within 2.5 months. In contrast, IgG levels at the late convalescent stage were half those measured at early convalescence, still being about twice as high as the initial titers. Although the IgM levels showed a pattern similar to that of IgA, their elevation at the early convalescent stage was less pronounced. We conclude that the detection of an increase in the level of the IgA fraction appeared to be the best indicator for recent symptomatic, as well as symptomatic, infections due to Shigella organisms.

Prostatic abscess in the antibiotic era

The clinical and bacteriologic features of 269 cases of prostatic abscess (PA) reported during the last 40 years were reviewed. In the pre-antibiotic era, PA not uncommonly had a dramatic presentation and frequently was caused by Neisseria gonorrhoeae. Currently, PA may be difficult to differentiate from prostatitis and other diseases of the lower urogenital tract. Prostatic enlargement is found in 75% of cases, whereas fever and urinary retention each occur in only one-third of cases. The organisms most frequently isolated from PA are Escherichia coli and other gram-negative bacilli; other isolates include Staphylococcus species and an expanding spectrum of bacteria and fungi. PA due to Staphylococcus species may also occur in neonates. Transrectal ultrasonography and computerized tomography are valuable methods for the preoperative diagnosis of PA. Although transurethral resection of the prostate is the most commonly used therapy for PA, transperineal aspiration of pus guided by transrectal ultrasonography appears to be promising.

Pseudomonas stutzeri causing late prosthetic valve endocarditis

Images

A prospective epidemiologic study of shigellosis in the Israel Defense Forces: implications for the use of shigella vaccines

Recent development of new shigella vaccines has renewed interest in the current epidemiology of shigellosis in endemic regions. A prospective epidemiologic study of 5,774 soldiers was carried out in the Israel Defense Forces, between the months of May and September 1984. Shigellosis was found to be responsible for half the diarrhea epidemics and only rarely presented as sporadic cases of diarrhea. The epidemics occurred after exposure to field conditions, whereas under fixed military base conditions the finding of a case of shigellosis generally was not associated with an epidemic spread of the disease. It was concluded that, in this population, effective shigella vaccines may provide an important means of preventing epidemics of shigellosis in military units operating outside of permanent bases.

Immunogenicity of a single dose of trivalent influenza vaccine including A/Philippines (H3N2): results of a field trial

During 1982, a new A(H3N2) influenza virus subtype, A/Philippines/2/82, was identified, and this strain was combined with previous A(H1N1) and B influenza virus strains in the trivalent inactivated vaccine recommended for the 1983-1984 influenza season. Prior to the widescale use of this vaccine in Israel, a group of 106 young male soldiers was vaccinated under controlled conditions. Before vaccination, antibody titers greater than or equal to 1:40 were found in 14.1% against A/Philippines (H3N2), 18.1% against A/England/333/80 (H1N1), and 13.3% against B/Singapore/222/79. Two weeks following vaccination, 78.9% of the vaccinees for whom repeated blood samples were available, had antibody titers in this range for A/Philippines (H3N2), 92.9% for A/England (H1N1), and 80.0% for B/Singapore. The vaccine was only mildly reactogenic, and there were no cases of absence from work following vaccination. Thus the antibody response of young subjects to a single dose of a vaccine containing a new A(H3N2) subtype was found to be satisfactory, and the side effects experienced were minimal.

Aquarium-borne Mycobacterium marinum skin infection. Report of a case and review of the literature

A 33-year-old fish fancier developed a protracted skin infection that ultimately was found to be caused by Mycobacterium marinum. The organism was isolated from the lesion as well as from infected fish taken from his home aquarium. The lesion resolved after a six-week course of oral sulfamethoxazole and trimethoprim. Forty-four additional cases of culture-proved M marinum skin infections acquired from aquariums and reported in the English-language literature are reviewed. Almost universally, the lesions remained circumscribed and were either single nodular (14 patients) or multiple sporotrichoid (31 patients). Diagnosis was supported by acid-fast smears (15 patients) and isolation of the organism from skin lesions (43 patients) or from fish (two cases). In vitro studies, as well as clinical outcomes, suggest sulfamethoxazole-trimethoprim or ethambutol hydrochloride plus rifampin to be the drugs of choice.

Polymorphonuclear leukocyte adherence and chemotaxis in stressed and healthy neonates

Defects in polymorphonuclear neutrophil (PMN) adherence and chemotaxis in neonates are thought to be an important cause of their increased susceptibility to overwhelming bacterial infection. Few studies of these functions have been carried out in stressed neonates who are at even greater risk of infection. PMN adherence and chemotaxis were examined in 33 stressed neonates with acute lower respiratory illness, 13 healthy neonates, and 43 healthy adults using whole blood PMN adherence and chemotaxis assays. PMN chemotaxis was significantly decreased in stressed neonates (locomotion index of 38.4 +/- 9.7 micron) compared with that of healthy neonates (48.9 +/- 12.8 micron, p less than 0.01) or adults (61.6 +/- 11.9 micron, p less than 0.001). PMN chemotaxis was studied during illness and recovery in 13 of the 33 stressed neonates and showed significant improvement during recovery (41.6 +/- 9.9 and 53.2 +/- 11.9 micron, respectively, p = 0.012). PMN adherence was decreased in stressed neonates (1.4 +/- 1.6%) compared with that of adults (12.3 +/- 11.4%, p less than 0.01) but was similar to that of healthy neonates (1.1 +/- 1.4%). These findings suggest that further impairment of PMN chemotaxis in stressed neonates helps account for their increased susceptibility to overwhelming bacterial infection.

The role of bougienage in the management of achalasia--the need for reappraisal

Passive dilatation, advocated in the past by a number of gastroenterologists as the initial therapy for achalasia, has fallen into disrepute in the last 15 years. Our recent experience with five achalasia patients, four of whom were judged too fragile for esophageal myotomy or forcible dilatation, indicates the need for reappraisal of bougienage therapy.

A multicentre study of the susceptibility of a variety of bacteria to cephalothin, cefamandole, tobramycin and gentamicin

A multicentre study of antibiotic susceptibility was performed in South Africa. Sensitivity to cephalothin, cefamandole, tobramycin and gentamicin was tested on a variety of aerobic and anaerobic bacteria. Two disc susceptibility techniques were used, i.e. the Kirby-Bauer technique (aerobes) and the broth-disc method (anaerobes); minimum inhibitory concentrations (MICs) were determined according to the International Collaborative Study techniques, and regression lines for individual centres were constructed. Satisfactory lines were obtained for cephalosporins, but, in some centres, problems were experienced with the aminoglycosides. Variations in MICs for Haemophilus influenzae were probably due to an inoculum effect. Accumulative percentage tables of the number of strains inhibited were compiled, and the comparative performance of the antibiotics was assessed.