External quality assessment for clinical microbiological laboratories in Norway 1984

The results of the external quality assessment for clinical microbiology in Norway in 1984 are evaluated. Four distributions, each consisting of four simulated clinical specimens, were carried out. The assessment has, as in previous years, revealed some problem areas concerning laboratory procedures which are discussed.

Prevalence of chlamydial eye infection in patients attending an eye clinic, a VD clinic, and in healthy persons

Chlamydial eye infection was detected in 28 of 983 ophthalmological patients with conjunctivitis or keratoconjunctivitis, with a peak frequency of over 9% in patients aged 16-20 years and with decreasing frequency thereafter. In patients aged 1 to 15 years chlamydial conjunctivitis was not observed. Chlamydial eye infection could not be detected in patients at a venereal diseases clinic, though chlamydial genital infection was rather frequent in these patients. Nor was Chlamydia trachomatis found in the eyes of healthy young adults. In patients with proved chlamydial conjunctivitis unilateral symptoms were the rule. Pseudoptosis was the most conspicuous presentation in two cases. A prolonged course can be expected in chlamydial eye infection if the condition is unrecognised and effective treatment delayed. The venereal background of the condition must also influence the management.

Experimental guinea pig ocular infection by Salmonella typhimurium

The clinical, microbiologic, and cytologic features of the guinea pig model of keratoconjunctivitis with enterobacteria, Salmonella typhimurium were elucidated. Guinea pig eyes were instilled with S. typhimurium and the eyes were studied by biomicroscopy, culture, cytology, pathology, and electron microscopy. All animals developed moderate to severe conjunctivitis that was present in 18% of the animals on day 1. It became more intense, appearing in all of the eyes on day 10 and disappeared before day 30. The cultures for S. typhimurium were almost all positive on days 1 and 2, declined steadily to 10% on day 10, and were negative after that. A coarse, epithelial punctate keratitis was present in more than 90% of the infected eyes at some time during the experiment. The keratitis had a biphasic clinical course. The first peak correlated with the maximum culture results, but during the second peak only 10% of the cultures were positive. Electron microscopy of the cornea showed the S. typhimurium at the epithelial surface within surface epithelial cells during the early phases of infection. The later phase keratitis, with negative culture results, resembles the keratitis of Reiter's syndrome.

[Characteristics of staphylococci isolated from newborn infants]

The microflora of the skin and the nasal mucosa was studied in 14 healthy newborns, 3 newborns with purulent infections and a nurse working in a neonatal ward. To make this study, washings were obtained with the use of 0.1% Triton X-100 solution. The determination of the number of microorganisms, the percentage of staphylococci, the percentage of lecithinase-positive staphylococci and the number of colonies with antagonistic properties revealed that these characteristics differed according to the state of health of the newborns and the time elapsed after their birth, and that changes in the number of antagonistically active bacteria occurred in parallel with changes in the total number of bacteria. Among S. aureus strains isolated from the subjects covered by the survey strains belonging to phagovar 80, as well as untyped strains, and among S. epidermidis strains those belonging to biovars I and II occurred most frequently. Strains belonging to the same biovar or phagovar differed in their plasmid markers.

Establishment of genital tract infection in the CF-1 mouse by intravaginal inoculation of a human oculogenital isolate of Chlamydia trachomatis

A human oculogenital strain of Chlamydia trachomatis was instilled intravaginally in the outbred CF-1 mouse to establish cervical infection. The mice were neither hormonally nor immunologically manipulated before inoculation. Duration of chlamydial excretion varied from two to ten days. In the culture-positive animals, IgG and IgM antibody titers were elevated in 38% and 17%, respectively. Neither intracytoplasmic inclusions nor elementary bodies of C. trachomatis were detected in genital tissues. Infection was limited primarily to the cervix and only rarely extended into the uterus. Chlamydial infection could only be established during specific periods of the estrus cycle (metestrus-2, diestrus, and proestrus; P less than .001), stages when leukocytes are present in the vaginal smear. Thus, chlamydial infection of the cervix is cycle-dependent in the mouse. In summary, infection of the cervix of the mouse has been established with a human oculogenital strain of C. trachomatis and may be useful as a model of human chlamydial cervicitis.

Microbial causes of neonatal conjunctivitis

We assessed the microbial causes of neonatal conjunctivitis by comparing 55 infants with purulent conjunctivitis and 60 healthy control infants. A mean of greater than 5 leukocytes per 1000X microscopic field was seen in Gram-stained smears obtained from the more inflamed eye in 77% of 30 untreated patients but none of 57 controls. Pathogens isolated more often from untreated patients than from controls included Haemophilus spp. (17% vs 2%, P = 0.01), Staphylococcus aureus (17% vs 2%, P = 0.01), Chlamydia trachomatis (14% vs 0%, P = 0.01), enterococci (8% vs 0%, P = 0.05), and Streptococcus pneumoniae (11% vs 2%, P = 0.06). One or more of these pathogens were isolated from the conjunctivae in 58% of patients and 5% of controls (P less than 0.001). Bacterial morphology seen on smear correlated with the pathogens cultured. Isolation of Haemophilus spp. or S. pneumoniae was associated with dacryostenosis. We conclude that several microbial pathogens are implicated in neonatal conjunctivitis. These organisms have differing susceptibilities to antimicrobial agents, so culture and sensitivity testing are required as a guide to therapy.

Interferon treatment of adenoviral conjunctivitis

We conducted a randomized, double-masked, placebo-controlled study to evaluate the efficacy of topical interferon in the treatment of adenoviral conjunctivitis. The study was designed to determine the efficacy of plasmid-derived alpha-2 interferon treatment with regard to the duration of clinical disease, virus shedding, and the occurrence of bilateral infection and subepithelial infiltrates. Interferon therapy was not found to have a statistically significant effect with regard to these factors in the 14 patients who completed 14 days of treatment in the study with interferon or a placebo. Interferon therapy was, however, associated with a tendency toward asymptomatic infection in the second eye when compared to the controls.

Detection of enterovirus 70 with monoclonal antibodies

To improve the ability to identify enterovirus-70 (EV-70) from patients with acute hemorrhagic conjunctivitis, we developed four monoclonal antibodies (MAbs) to EV-70. We reacted the four MAbs against nine previously characterized strains of EV-70 and heterologous viruses by virus neutralization, indirect immunofluorescence, and enzyme-linked immunosorbent assay (ELISA). Two of the MAbs neutralized all nine strains of EV-70 and none of the other enterovirus types tested. Two of the MAbs gave a positive reaction with all nine strains by indirect immunofluorescence, and three reacted with all nine strains by ELISA. None of the MAbs gave a positive reaction with heterologous viruses, including those associated with eye disease, by indirect immunofluorescence or ELISA. The two neutralizing MAbs failed to give a positive reaction with some of the strains of EV-70 by indirect immunofluorescence and ELISA, yet they neutralized these viruses. By ELISA with a polyclonal serum as capture antibody and a mixture of MAbs as detector antibody, we were able to detect from 10(2.2) to 10(5.8) 50% tissue culture infective doses of virus and to type lyophilized isolates of EV-70 sent from Taiwan from which we could not recover infectious virus. By choosing the appropriate MAb, or mixture of MAbs, we could construct a test which had the type specificity and strain sensitivity needed to type isolates of EV-70.

Prevalence of acute conjunctivitis caused by chlamydia, adenovirus, and herpes simplex virus in an ophthalmic casualty department

The causes of acute conjunctivitis in 140 consecutive patients attending an ophthalmic casualty department in London were investigated. Laboratory evidence of infection with Chlamydia trachomatis, adenovirus, or herpes simplex virus was found in 52 (37%) cases. In 70 cases (50%) no evidence of infection with these agents was found. In the remaining 18 cases (13%) laboratory results were inconclusive. The importance of these findings, the role of laboratory investigations in the differential diagnosis of acute conjunctivitis, and their cost-benefit are discussed.

[Evaluation of infectious, inflammatory external eye diseases]

Over a period of 4 months the authors observed 240 outpatients with 302 "red eyes." Oculogenital strains of Chlamydia trachomatis were diagnosed in 12.5% of these cases. Bacterial monoinfections were found in 13.9%, coinfections in 63.9%. The remaining 9.7% included Candida sp. (4%) and Herpes I (1.4%) infections, while 4.3% remained unidentified. Allergic conjunctivitis and "dry eye" syndromes were not considered separately in this study. Specific antibiotic therapy improved the clinical condition due to "saprophytic" bacterial coinfections, indicating the pathogenic importance of this type of infection.

Ureaplasmas as a cause of disease in man and animals: fact or fancy?

There is reluctance by some to regard ureaplasmas as a cause of nongonococcal urethritis in men largely because the organisms may also be found in healthy persons. Could they be no more than passengers in disease? A review of past work suggests that this is not likely, a notion supported by the results of more recent studies. In certain other human diseases, such as urethritis and arthritis in hypogammaglobulinemic patients, the pathogenicity of ureaplasmas appears beyond question. In a variety of other conditions, such as the urethral syndrome in women, infertility, various pregnancy-related problems, and respiratory distress in infants, the situation is confused. It is possible that ureaplasmas have some part to play in all these conditions. However, both old and new information indicates that they do not have a major role in most of them, and that assertions to the contrary are fanciful. In the veterinary field, it is easier to come to conclusions about the role of these organisms, although their involvement in genital tract disease is least well validated. Finally, the occurrence of ureaplasmas in a colony of male and female chimpanzees, some with infertility problems, is presented, and the possible value of this situation in attempting to define the role of ureaplasmas in the human condition is mentioned.

A study of the incidence of neonatal conjunctivitis and of its bacterial causes including Chlamydia trachomatis. Clinical examination, culture and cytology of tear fluid

Out of 300 newborn infants who had conjunctival swabs inoculated for detection of Chlamydia trachomatis and other bacteria, 72% had bacteria isolated 4 to 6 days after birth. Of these, Staph. albus constituted 51% and Staph. aureus 19%. None of the infants were Chlamydia positive. Five out of 112 mothers (4.5%) were Chlamydia positive from the cervix just before delivery. Nineteen of the neonates were treated for conjunctivitis within the first month of life. Chlamydia trachomatis was isolated from 2, and Staph. aureus, alpha-Streptococci, Pneumococci and Haemophilus influenzae from some of the other infants. A likely diagnosis could be made in 46% of these cases, while the remaining cultures showed only apathogenic bacteria or no growth. There was a fairly good accordance with observation of inflammatory cells in the tear fluid and the clinical picture, 17/19 = 90% showing neutrophilia. Despite failing aetiological diagnosis in several cases, the infants responded satisfactorily to local antibiotic treatment. 75% of the parents replied to questionnaires 2 months after birth concerning conjunctivitis within the first month of life. The replies showed that 58 = 25% had had conjunctivitis, of whom 17% had been treated with antibiotics.

Acute conjunctivitis caused by an atypical chlamydial strain: Chlamydia IOL 207

A case of acute conjunctivitis in man caused by Chlamydia IOL 207 is described. Chlamydiae were isolated from the eye, and rising titres of type-specific antibodies to C. IOL 207, in serum and tears demonstrated an aetiological role for this agent. C. IOL 207 is an atypical chlamydial strain which serological studies suggest is widespread in some communities.

Rapid culture test for adenovirus isolation

A rapid culture test has been developed and evaluated for the detection of adenovirus in ocular infections. The test requires only two days' incubation of the inoculated cell monolayers on coverslips in flat bottomed tubes followed by detection of adenovirus inclusions using immunofluorescence staining method. The sensitivity of the rapid test is found to be comparable with that of the conventional tissue culture test which depends on the development of a cytopathic effect requiring 2-21 days' incubation (mean 9 X 4, SD 4 X 9).

Chromobacterium violaceum infection of the eye. A report of two cases

We report what we believe to be the first two known cases of Chromobacterium violaceum infection of the eye. One patient had conjunctivitis as the initial manifestation of an ultimately fatal infection. In the second patient, who suffered from chronic granulomatous disease of childhood, orbital cellulitis developed as part of a disseminated C violaceum infection from which he subsequently recovered. Infections caused by C violaceum may involve the eye and orbit. These infections are frequently fatal, but early recognition and aggressive treatment may result in a higher cure rate.

Isolation of Chlamydia psittaci from cases of conjunctivitis in a colony of cats

This report describes the isolation in cell cultures of Chlamydia psittaci from cases of conjunctivitis in a colony of cats. The organism was identified in McCoy cell monolayers by staining the intracytoplasmic chlamydial inclusions with a fluorescent antibody technique, and serological evidence of chlamydial infection in cats was obtained by indirect immunofluorescence. The possible role of C psittaci as an ocular, upper respiratory and reproductive tract pathogen in cats is discussed.