Trachoma in a rural Haitian community

We selected 43 patients, aged 15 days to 57 yesrs, for intensive study after screening 975 people for clinical evidence of trachoma in rural Haiti. Trachoma was present in Haiti with low endemicity and was followed by relatively mild sequelae. Laboratory studies confirmed the disease through demonstration of conjunctival inclusion bodies by immunofluoresence and serotyping of antibody in sera or eye secretions, or both. Of 23 patients (age 1 to 36 years) with active trachoma, all had serum antibody to chlamydia (range 1:10 to 1:640), nine had eye secretion antibody (range 1:10 to 1:1280), and one was inclusion positive. The remaining 20 patients (age 15 days to 57 years) had the following diagnosis: atypical follicles (eight), conjunctivitis with or without mucopurulent discharge (ten) innactive pannus only (one), and severe anemia (one). Only 16 of the 20 were tested for serum antibody and all were positive (1:10 to 1:5,120), 11 of 20 had eye secretion antibody (1:10 to less than or equal to 1:640), and one was inclusion positive. Serotyping attempted on 22 patients yielded 16 patients with antibodies specific for type A, one patient with type B, and five who were not typed.

Septic complications following gastric surgery: relationship to the endogenous gastric microflora

The microflora of the stomach is derived from both the ingestion of food and saliva and the reflux of proximal intestinal contents through the pylorus. Normally, this microflora is inhibited by gastric acid and normal gastric motility. In disease states, however, such as bleeding or obstructing duodenal ulcer, gastric ulcer or carcinoma, the level of gastric acid is reduced or the gastric motility is altered. Thus, endogenous microflora persists and often becomes the source of postoperative wound infections following gastric resection.

Gas in the wound: what does it mean?

Gas-forming infections on the surgical service are usually due to anaerobic microorganisms such as clostridia, peptostreptococci or bacteroides, or to one of the aerobic coliforms. Factors that predispose to the development of gas infections include lower extremity vascular disease and diabetes mellitus. Early treatment based on the inital Gram-stain study as well as the clinical presentation is helpful in reducing tissue losses and increasing overall survival. Treatment for nonclostridial gas infections includes prompt adequate surgical debridement and appropriate parenteral antibiotics. When available, hyperbaric oxygen should be added to the treatment plan in all extensive clostridial infections.

Intragastric microbial colonization in common disease states of the stomach and duodenum

Forty-nine patients undergoing elective or emergent gastric surgery have been included in this study. Gastric needle aspiration was performed at the time of surgery in each case, followed by qualitative aerobic and anaerobic bacteriologic analysis. In 18 patients undergoing elective operation for chronic nonobstructing duodenal ulcer a gastric microflora was present in only three patients and no postoperative wound infections were observed. In 29 of 31 patients, in the other groups of patients with bleeding or obstructing duodenal ulcer or in those with gastric ulcer or malignancy, intragastric micro-organisms were present. Six of the 7 postoperative wound infections which developed in these groups of patients were due to one of the same bacteria isolated at the time of original needle aspiration. It appears that the endogenous intragastric microflora is a significant factor in the development of postoperative wound sepsis following gastric resection, in those groups of patients with a compromise of their normal gastric antibacterial inhibitory mechanisms.

Modern approach to the diagnosis of anaerobic surgical sepsis

Oxygen-sensitive anaerobic bacteria comprise the largest group of organisms among the human endogenous microflora. The oral cavity, the vagina, and the colon are the areas of the human body where the obligate anaerobes are predominant and can be isolated in very high numbers. Sepsis following surgery of any of these organs is frequently due to the escape of these endogenous bacteria during the course of the operative procedure. To enable the isolation and successful identification of most of these anaerobic microorganisms from clinical exudate, special collection and bacteriologic techniques are necessary. The acceptable anaerobic collection techniques have been reviewed in this paper. All of these techniques minimize the exposure of the clinical specimen to atmospheric oxygen during collection and transfer. The modern equipment used in sophisticated anaerobic bacteriologic workup has been discussed. Clinical clues that indicate anaerobic sepsis include a putrid odor of the exudate and evidence of abscess, necrosis, or associated gas formation. The importance and value of the gram-stain in the early identification of surgical sepsis has been stressed.

Chlamydin trachomatis in cell culture. I. Comparison of efficiencies of infection in several chemically defined media, at various pH and temperature values, and after exposure to diethylaminoethyl-dextran

Three chemically defined cell culture media, Eagle minimum essential medium (MEM) with Earle basal salt solution, Eagle MEM with Hanks basal salt solution, and a modified Eagle MEM, were tested and found capable of supporting the development of Chlamydia trachomatis in (60)Co-treated McCoy cells. The enhancement of trachoma infection by diethylaminoethyl-dextran (DEAE-D) was greater at pH values closer to neutrality than at any other pH values measured at the start of the experiments. Centrifugation of the trachoma inoculum onto cell monolayers at 33 C increased the number of inclusions when compared to centrifugation at 20 C. When the inoculum was centrifuged onto cell monolayers and subsequent incubation was at temperatures ranging from 34 to 39 C, the greatest number of inclusions was observed after incubation from 35 through 37 C. Enhancement of the trachoma infection by DEAE-D was tested at temperatures ranging from 35 to 37 C. These cultures had three- to fivefold increases in inclusions when compared to previously reported experiments in which DEAE-D-treated cultures were incubated at 34 C.