Bat predation and its influence on calling behavior in neotropical katydids

Insectivorous bats have influenced the development of antipredator behavior in moths, green lacewings, crickets, and mantids; until recently, such adaptations were unknown in katydids. Foliage-gleaning bats in Panama can use the female-attracting, airborne calling songs of nocturnal katydids to locate prey. They also feed heavily on these insects. Katydid species sympatric with these bats exhibit markedly reduced calling song duty cycles. Males supplement shortened songs with complex, species-specific tremulations that generate vibrations that are inaudible to bats but reach conspecific females through a shared plant substrate. Female katydids do not call audibly but are also preyed on in large numbers, perhaps as a result of moving toward calling males.

Bilateral absence of the superior vena cava

Congenital anomalies of the superior vena cava are rare and often coexist with other cardiac abnormalities. In this report, we present a case of absent bilateral superior vena cava with no associated cardiac anomaly. Blood from the arms, head, and upper torso returned to the right atrium through the azygos vein and the inferior vena cava, mimicking chronic superior vena cava obstruction.

Peripheral frequency mis-match in the primitive ensiferan Cyphoderris monstrosa (Orthoptera: Haglidae)

Peripheral auditory frequency tuning in the ensiferan insect Cyphoderris monstrosa (Orthoptera: Haglidae) was examined by comparing tympanal vibrations and primary auditory receptor responses. In this species there is a mis-match between the frequency of maximal auditory sensitivity and the frequency content of the species' acoustic signals. The mis-match is not a function of the mechanical properties of the tympanum, but is evident at the level of primary receptors. There are two classes of primary receptors: low-tuned and broadly tuned. Differences in the absolute sensitivity of the two receptor types at the male song frequency would allow the auditory system to discriminate intraspecific signals from sounds containing lower frequencies. Comparisons of tympanal and receptor tuning indicated that the sensitivity of the broadly tuned receptors did not differ from that of the tympanum, while low-tuned receptors had significantly narrower frequency tuning. The results suggest that the limited specialization for the encoding of intraspecific signals in the auditory system of C. monstrosa is a primitive rather than a degenerate condition. The limited specialization of C. monstrosa may reflect the evolutionary origin of communication-related hearing from a generalized precursor through the addition of peripheral adaptations (tympana, additional receptors) to enhance frequency sensitivity and discrimination.

Mycobacterium sp. as a possible cause of hypersensitivity pneumonitis in machine workers

Hypersensitivity pneumonitis (HP) in workers exposed to metal removal fluids (MRFs) is increasing. This study supports the hypothesis that aerosolized mycobacteria colonizing the MRFs likely cause the disease. Three case studies of HP outbreaks among metal workers showed potentially high exposures to a rare and newly proposed Mycobacterium species. Retrospective review of samples submitted to our laboratory showed an association between presence of mycobacteria and HP.

Pharmacokinetics of flosequinan in patients with heart failure

OBJECTIVE

The pharmacokinetics of flosequinan were studied in a group of 18 patients with chronic cardiac failure.

RESULTS

After a single dose of 100 mg, Cmax of the parent compound (2.52 mg.l-1) was recorded at 1.4 h, and of the sulphone metabolite flosequinoxan at 21.7 h. The plasma elimination half lives of the parent compound (6.4 h) and of the metabolite (54.3 h) were prolonged compared to previous studies in normal volunteers. After repeated dose administration for 36 days, the kinetics of the parent compound and metabolite remained essentially unchanged with an expected significant accumulation of metabolite (Cmax 8.4 vs 3.21 mg.l-1). No adverse effects were observed.

CONCLUSION

It is possible that altered drug kinetics in patients with heart failure, probably related to altered hepatic blood flow, could contribute to drug toxicity.

Long-term evaluation of treatment for chronic heart failure: a 1 year comparative trial of flosequinan and captopril

Two hundred and nine patients with moderate to severe chronic heart failure, all of whom remained symptomatic despite at least 80 mg of frusemide daily, were randomized to 12 months treatment with flosequinan or captopril. The patients were stratified into two groups, a treadmill group and a corridor walk test group, depending upon their exercise capability. Sixty-five out of 102 patients randomized to flosequinan and 43 out of 107 randomized to captopril (p < 0.001) did not complete the study. There was no difference between the groups in mortality: 19 patients died while taking flosequinan and 15 while taking captopril. Both drugs had similar effects on treadmill exercise tolerance; the mean increase at week 52 was 117 seconds in the flosequinan group and 156 seconds (p = 0.57) for the captopril group. For those patients stratified to the corridor walk test only, there was also very little difference in the improvement at 52 weeks; the mean increase for patients randomized to flosequinan was 61 meters and captopril was 75 meters (p = 0.65). However, when the walk tests from all patients are examined, captopril produced a significant improvement compared with flosequinan at week 52 (p = 0.015). Flosequinan has similar long-term efficacy to captopril but is associated with a higher incidence of adverse events.

How the Blues are using health care data

Insurers are investing in information technology to provide the data that are essential to the management of their delivery systems. A Blue Cross and Blue Shield medical director explains some practical applications, including outcomes evaluation, provider selection and practice pattern comparisons.

Streptokinase neutralisation titres up to 866 days after intravenous streptokinase for acute myocardial infarction

OBJECTIVE

To follow the change in streptokinase neutralisation titres in a group of patients after treatment with streptokinase for acute myocardial infarction.

DESIGN

Venous blood samples suitable for analysis were obtained up to 866 days after treatment with 1.5 million units of streptokinase in 189 patients. The ability of the patient's plasma to inhibit lysis of a thrombin clot by streptokinase was assessed.

SETTING

A coronary care unit in a district general hospital.

PATIENTS

A retrospective review of coronary care records and the district health authority computer showed that 329 patients who had received streptokinase were alive. All were invited for venepuncture and 220 (67%) attended. Satisfactory samples were obtained from 189 patients.

RESULTS

Raised titres of antibody sufficient to neutralise a standard dose of 1.5 million units of streptokinase were found in 90% of patients. There was a fall in streptokinase neutralisation titre with increasing time after administration of streptokinase (r = -0.35, P < 0.0001) and though there was considerable variation among the group the neutralisation titre was higher than in the general population in all patients, even those who had received streptokinase at least two years previously.

CONCLUSION

The ability of streptokinase to lyse a thrombin clot was appreciably inhibited in vitro by the plasma from patients who had received 1.5 million units of streptokinase. High streptokinase neutralisation titres persisted for a long time after the use of streptokinase as thrombolytic treatment for acute myocardial infarction. Readministration of streptokinase may not be efficacious for considerably longer than the one year currently advocated. Until the in vivo effects of streptokinase readministration are known a non-antigenic thrombolytic agent should be used instead.

Tumour necrosis factor alpha in severe congestive cardiac failure

OBJECTIVE

To examine the concentration of circulating tumour necrosis factor alpha (TNF alpha) in patients with severe congestive heart failure (New York Heart Association class IV) during one year and to correlate changes in this cytokine with changes in plasma noradrenaline, plasma renin activity, and weight.

DESIGN

A prospective study of the role of TNF alpha in severe chronic heart failure. Blood samples were collected at intervals of three months.

SETTING

Medical research centre of a teaching hospital.

PATIENTS

16 patients with chronic stable severe heart failure.

INTERVENTIONS

Vasodilator treatment with captopril or flosequinan.

MAIN OUTCOME MEASURES

Changes in TNF alpha and the correlation with changes in plasma noradrenaline, plasma renin activity, and weight during optimal medical treatment for one year.

RESULTS

The mean concentration of TNF alpha was greater than the upper 95% confidence interval for healthy controls throughout the year of the study but there was considerable between and within patient variation. No correlation was seen between TNF alpha and plasma noradrenaline, plasma renin activity, or weight.

CONCLUSIONS

The stimulus resulting in enhanced plasma concentrations of TNF alpha in congestive heart failure remains unclear and concentrations at any particular time were not prognostic.

Intracardiac thrombus formation in association with hydatid disease

Cardiac hydatid disease is rare, but life threatening. A pedunculated hydatid cyst which mimicked a left atrial myxoma was diagnosed on two-dimensional echocardiography. The degree of cardiac involvement at necropsy was much greater than indicated by either echocardiography or limited cardiac catheterization. The suggestion that only echocardiography be performed before surgery is undertaken may be inappropriate in many cases.

Antistreptokinase titres after intravenous streptokinase

Streptokinase neutralisation titres were measured in a series of 25 patients who received streptokinase for the treatment of acute myocardial infarction. Before treatment, neutralisation titres were low (0.3 X 10(6) neutralisation units or less) in all patients. 3 months after treatment, neutralisation titres in 24 were such that a typical therapeutic dose of 1.5 million units of streptokinase would have been fully neutralised. At 4 1/2-8 1/2 months, 18 of 20 patients had neutralisation titres such that at least 50% of a dose of 1.5 million units of streptokinase would have been neutralised. After 8 months, neutralisation titres ranged from 0.4 to 2.0 million units in 8 patients. A decision to readminister streptokinase within 8 months (and probably up to 1 year) of previous thrombolytic treatment should take account of the neutralising capacity of plasma and the dose should be adjusted accordingly.

Physicians' attitudes to four common problems: hypertension, atrial fibrillation, transient ischaemic attacks, and angina pectoris

A questionnaire was completed by 341 senior physicians on their attitudes to four common cardiovascular problems. Their replies showed that uncertainty about the end point for diastolic blood pressure still prevails and that their approach to the management of hypertension of differing severity in men and women of varying ages stems more from personal belief than from the results of clinical trials. Unless patients with atrial fibrillation also had mitral valve disease anticoagulation was not thought to be necessary, thereby making it ethically possible to carry out a trial of anticoagulants in stroke prevention on patients with atrial fibrillation but no valvular disease. The physicians' suggestions for very active management in transient ischaemic attacks extended beyond the evidence available to them, whereas their approach to the use of coronary arteriography closely reflected the results of clinical trials. These findings may indicate that recent cardiovascular trials that have provided definitive results have had more impact than earlier inadequate studies.

Utilization of exogenous siderophores by Campylobacter species

The availability of iron to potentially pathogenic bacterial strains is restricted by the iron-binding proteins of the host. In this study, we examined 40 strains of Campylobacter species grown under iron-limiting conditions. While the strains produced no detectable siderophores, all the isolates freely utilized exogenous siderophores produced by other organisms as iron carriers. These data suggest that the use of an exogenous siderophore (either purified or present in a coinfecting microorganism) may be important in developing a suitable laboratory model for campylobacteriosis.

Comparison of four hippurate hydrolysis methods for identification of thermophilic Campylobacter spp

The test for hippurate hydrolysis is critical for separation of Campylobacter jejuni and C. coli strains. Glycine and benzoic acid are formed when hippurate is hydrolyzed by C. jejuni. The test used in most laboratories is one of several variations of the ninhydrin tube test described by Hwang and Ederer (M. Hwang and G. M. Ederer, J. Clin. Microbiol. 1:114-115, 1975) for detection of glycine. We evaluated three modifications of the Hwang and Ederer method and the gas-liquid chromatographic (GLC) method described by Kodaka et al. (H. Kodaka, G. L. Lombard, and V. R. Dowell, Jr., J. Clin. Microbiol. 16:962-964, 1982) for detecting benzoic acid. Campylobacter strains comprised 22 C. jejuni, 11 C. coli, and 8 C. laridis strains. The species identification of each strain was confirmed by DNA relatedness. All strains of C. jejuni were positive and all strains of C. coli and C. laridis were negative by the GLC method for detecting hippurate hydrolysis, whereas three strains of C. jejuni gave negative or variable results in the tube tests. The GLC method is more sensitive than the tube methods for detecting hippurate hydrolysis and should be used on cultures yielding variable or questionable test results.

Epidemiologic and laboratory investigation of an outbreak of Campylobacter enteritis associated with raw milk

An outbreak of gastroenteritis occurred in March-April 1981, in Wichita, Kansas, and involved more than 250 persons who drank raw milk from a single local dairy. Campylobacter jejuni was recovered from 60 of 116 (52%) persons in households that had one or more ill family members. A cohort study of families that belonged to a food cooperative that purchased raw milk from the implicated dairy showed a significant association between illness and having drunk raw milk. Thirty-nine of 55 (71%) persons who drank raw milk became ill compared with four of 36 (11%) persons who did not drink raw milk (p less than 0.01, t test, accounting for clustering). Peak (convalescent) antibody titers to C. jejuni, determined by indirect immunofluorescence, in 20 raw-milk drinkers showed a geometric mean of 1:27 in contrast to geometric mean titer of 1:6 in 10 well persons from the cohort who did not drink raw milk (p less than 0.002, t test). C. jejuni was recovered from 21 of 34 (66%) raw-milk drinkers, versus none of 26 people who did not drink raw milk (p less than 0.001, Fisher's exact test, one tailed). C. jejuni of the same serotype was isolated from the case-patients and from rectal swabs of cows in the dairy. These findings indicate that raw milk contaminated by Campylobacter was the vehicle for this outbreak.

Comparison of the Penner and Lior methods for serotyping Campylobacter spp

We compared two Campylobacter serotyping systems by using 1,405 isolates of Campylobacter collected from human, animal, and environmental sources during epidemiologic investigations and special studies. We found 96.1% of isolates to be typable by the Penner method for heat-stable antigens, which involved the use of an indirect hemagglutination technique, and 92.1% of isolates to be typable by the Lior method for heat-labile antigens, which involved the use of a slide agglutination technique and absorbed antisera. Absorbed antisera were not required for the Penner method, making that method less difficult to implement. The Lior method was simpler to perform and gave more rapid results than did the Penner method. Cultures frequently reacted in multiple antisera with the Penner method, whereas multiple reactions were rare with the Lior method. Thus, results were easier to interpret with the Lior system. Strains of a single serotype in one system were sometimes found to be multiple serotypes in the other system; hence, the two methods have the potential to be complementary. Both systems were comparable in serotyping isolates from human and nonhuman sources and for evaluating the relationship of strains collected during outbreak investigations.

Comparison of gauze swabs and membrane filters for isolation of Campylobacter spp. from surface water

The epidemiology of Campylobacter jejuni indicates that waterborne transmission is important; the organism has been isolated from seawater, fresh water, and estuarine sites. Membrane filtration, with and without use of an enrichment broth, has been the most common method for isolating C. jejuni from water. We evaluated two methods for isolating C. jejuni from water: membrane filtration and gauze filtration. The membrane filters evaluated included 0.22- and 0.45-micron-pore Millipore filters (Millipore Corp., Bedford, Mass.), 0.2- and 0.4-micron-pore Nuclepore filters (Nucleopore Corp., Pleasanton, Calif.), and a 0.45-micron-pore Zetapor filters (AMF Cuno, Meridian, Conn.). The gauze filters included both Moore and Spira swabs. Of the membrane filters evaluated, the 0.45-micron-pore Millipore and Zetapor filters were the most sensitive for recovery of C. jejuni from seeded waters. The 0.45-micron-pore Millipore filter placed in Oosterom broth was better for recovery of C. jejuni from seeded stationary surface waters than either the Spira or Moore swab. However, the 0.45-micron-pore Millipore filter placed on a plate or in enrichment broth was equivalent to the Spira gauze swab when used to examine water from Atlanta area streams. C. jejuni organisms were isolated from 9 of 24 surface water samples representing 5 of 12 streams.

Biochemical and genetic characteristics of atypical Campylobacter fetus subsp. fetus strains isolated from humans in the United States

During a 2-year period, 14 biochemically atypical Campylobacter fetus subsp. fetus-like strains were received by the Campylobacter Reference Laboratory at the Centers for Disease Control. Sources of the isolates were blood, nine strains; stools, two strains; amniotic fluid, one strain; and abscesses, two strains. Atypical phenotypic characteristics exhibited by one or more strains were growth at 42 degrees C, 10 strains; no H2S by lead acetate paper, 3 strains; resistance to a 30-micrograms cephalothin disk, 2 strains; and nonmotility, 1 strain. By DNA-DNA hybridization, all 14 isolates and the type strain of C. fetus subsp. fetus (ATCC 27374) were 94 to 100% related in reassociation reactions at 50 degrees C, with 0.0 to 0.5% divergence, and were 86 to 100% related in reassociation reactions at 65 degrees C. Thus, all of these atypical strains were C. fetus subsp. fetus. MICs of 11 antimicrobial agents for these 14 strains were variable. All strains were susceptible to chloramphenicol, erythromycin, gentamicin, and tetracycline, and most were susceptible to ampicillin, clindamycin, and penicillin. Eleven strains were resistant to cephalothin (MIC greater than or equal to 16 micrograms/ml), nine were resistant to rifampin (MIC greater than or equal to 8 micrograms/ml), and all were resistant to nalidixic acid (MIC greater than 32 micrograms/ml) and vancomycin (MIC greater than 32 micrograms/ml). One can expect to see biochemical variability in C. fetus subsp. fetus strains and to encounter such strains from a variety of human sources, the most important of which appears to be blood.

Addition of three new serotypes of Shigella boydii to the Shigella schema

No new serotypes have been added to the Shigella schema since 1958, although several provisional serotypes have been described. We conducted biochemical and serological studies on three provisional Shigella boydii serotypes. Four strains of serotype 2710-54 from four widely separated countries, 7 strains of serotype 3615-53 from three different countries, and 31 strains of serotype 1344-78 (E10163) from six different countries were included. Reactions of all three serotypes were consistent with those of S. boydii. On the basis of these results and other published research, we propose that these three provisional serotypes be admitted to the Shigella schema as S. boydii 16, 17, and 18.

O:13a,13b, a new pathogenic serotype of Yersinia enterocolitica

Forty strains of a new Yersinia enterocolitica serotype isolated in the United States from nonhuman primates and humans were characterized as serotype O:13a,13b. Most of the human strains were isolated from a large multistate outbreak of milkborne enteritis. A common antigenic factor between this new serotype and four previously described Y. enterocolitica (O:7,13; O:18; O:44; and O:44,45) led to recharacterization of the latter as serotypes O:7,13a,13b; O:18,13b; O:44,13a; and O:44,13a,45.

Laboratory investigation of hemorrhagic colitis outbreaks associated with a rare Escherichia coli serotype

Two outbreaks of hemorrhagic colitis, a newly recognized syndrome characterized by bloody diarrhea, severe abdominal pain, and little or no fever, occurred in 1982. No previously recognized pathogens were recovered from stool specimens from persons in either outbreak. However, a rare E. coli serotype, O157:H7, was isolated from 9 of 20 cases and from no controls. It was also recovered from a meat patty from the implicated lot eaten by persons in one outbreak. No recovery of this organism was made from stools collected 7 or more days after onset of illness; whereas 9 of 12 culture-positive stools had been collected within 4 days of onset of illness. The isolate was not invasive or toxigenic by standard tests, and all strains has a unique biotype. Plasmid profile analysis indicates that all outbreak-associated E. coli O157:H7 isolates are closely related. These results suggest that E. coli O157:H7 was the causative agent of illness in the two outbreaks.

Selective enrichment broth medium for isolation of Campylobacter jejuni

A new selective Campylobacter enrichment broth for the isolation of Campylobacter jejuni has been tested with fecal specimens of human, poultry, and bovine origin. We compared the isolation rate with that from the simultaneous direct plating of a duplicate specimen. Of the 380 duplicate specimens examined comparatively, we obtained a 46.3% increase in isolation of C. jejuni by using the new Campylobacter enrichment broth medium.

Isolation of Legionella spp. from environmental water samples by low-pH treatment and use of a selective medium

A selective medium was developed and used successfully to isolate Legionella pneumophila and Legionella-like organisms from environmental specimens previously positive by animal inoculation methods. This medium consists of charcoal-yeast extract agar to which have been added cephalothin (4 micrograms/ml), colistin (16 micrograms/ml), vancomycin (0.5 microgram/ml), and cycloheximide (80 micrograms/ml). Pretreating of the environmental water samples with an acid buffer (pH 2.2), followed by plating on the selective medium, improved the rate of recovery of both Legionella and Legionella-like organisms relative to that with direct plating on selective media.

Evaluation of transport methods for isolating Shigella spp

Recovery of Shigella spp. from fecal specimens transported in buffered glycerol saline and Cary-Blair media held at frozen, refrigerated, or room temperature was compared with recovery by direct plating of fecal specimens. Buffered glycerol saline was the better transport medium for the recovery of Shigella spp. Refrigerated or frozen transport temperatures were superior to room temperature for recovery from either medium.

Legionella gormanii sp. nov

A new species of Legionella was isolated from soil collected from a creek bank. The name Legionella gormanii sp. nov. is proposed.

Laboratory studies of disinfectants against Legionella pneumophila

Legionella pneumophila suspended in tap water was exposed to biocides recommended for inhibiting biological growth in cooling towers and evaporative condensers of air-conditioning systems. Chlorine, 2,2-dibromo-3-nitrilopropionamide, and a compound containing didecyldimethylammonium chloride and isopropanol were effective in destroying concentratiois of 10(5) to 10(6) viable cells per ml. Formulations consisting of 5-chloro-2-methyl-4-isothiazolin-3-one and 2-methyl-4-isothiazolin-3-one, disodium ethylene bis(thiocarbamate) and sodium dimethyl dithiocarbamate, and a phenolic with pentachlorophenate and sodium salts of other chlorophenols were less effective.

Prevention of venous thromboembolism. A survey of methods used by orthopaedic and general surgeons

752 orthopaedic and 663 general surgeions were sent a questionnaire asking how they attempted to prevent venous thromboembolism; the survey concerned prophylaxis offered routinely to elderly patients with hip fractures, to patients undergoing elective hip replacement arthroplasty, and to patients undergoing major abdominal and thoracic operations. The response rate was more than 70%. The results suggest that the provision of prophylaxis against venous thromboembolism is inversely related to the frequency with which it occurs--e.g., the proportions of surgeons offering no routine prophylaxis or ambulation and physiotherapy only was 72% for hip fractures, 52% for hip replacement, and 38% for general surgery.

Isolation of Vibrio-like group, EF-6, from patients with diarrhea

The Vibrio-like organism EF-6 was isolated from more than 500 patients with diarrhea in Bangladesh between October 1976 and June 1977. Bacteriological studies indicate that EF-6 is a member of the family Vibrionaceae and that it should be provisionally placed in the genus Vibrio. EF-6 was isolated from patients who had diarrhea, but was not conclusively implicated as the etiological agent. Pending further study, EF-6 should be considered a potential enteropathogen.

Use of Moore swabs for isolating Vibrio cholerae from sewage

The Moore swab method was shown to be a practical and sensitive technique for the isolation of Vibrio cholerae from sewage. In each of three instances in which cholera patients lived in homes connected to municipal sewers, V. cholerae was isolated from the community sewage plant intake at the time of the patients illness. Sewer systems became negative within 1 day after patients were treated with tetracycline. Sewer surveillance using the Moore swab also found evidence of infections occurring in areas where surveillance of diarrheal illness failed to detect cholera. Culturing community sewage by the Moore swab method proved to be an economical and effective way of determining areas where V. cholerae infections were occurring.

Foodborne outbreak of shigellosis caused by an unusual Shigella strain

A family outbreak of foodborne shigellosis caused by an unusual strain of Shigella is described. The strain was a mannitol-positive variant of Shigella dysenteriae and agglutinated in antiserum prepared against provisional serotype 3341-55.

Isolation of the Legionnaires' disease bacterium from environmental samples

We analyzed 24 environmental samples collected in or near the Indiana Memorial Union, where an epidemic of Legionnaires' disease occurred in early 1978. We conducted fluorescent antibody analyses and culture on F-G and charcoal yeast extract agars of each sample directly; splenic tissue of guinea pigs inoculated with the sample; and yolk sacs from embryonated eggs inoculated with splenic tissue of guinea pigs injected with the sample. Legionnaires' disease (LD) bacterium was isolated from seven of the 24 samples: one water sample from the air-conditioner cooling tower of the Union; three water samples from a stream near the Union; and three mud samples from the same stream. The LD bacterium strains were of three different serotypes. These findings indicate that LD bacteria may be widespread in nature.

A major focus of Legionnaires' disease in Bloomington, Indiana

Thirty-nine cases of Legionnaires' disease in a 16-month period were identified in visitors to and residents of Bloomington, Indiana. Thirty-five patients had spent at least one night at the Indiana Memorial Union in the 2 weeks before becoming ill. Five of 32 sporadic cases nationwide between 1 January and 31 March 1978 were retrospectively shown to be in persons who had recently visited the Union. The risk of acquiring Legionnaires' disease as a Union visitor was at least 17 times greater than that for Bloomington residents 20 years or older. Employees who had worked at the Union 5 years or longer were more likely to be seropositive than workers in other Bloomington hotels. Legionnaires' disease bacterium was isolated from five environmental sites in Bloomington. A cooling tower may have been involved in disease spread, but it was not the only source. Hypochlorite solution was added to cooling tower water as a precautionary measure; however, one case was confirmed in a man with Union exposure 9 days after hypochlorite treatment had begun.

Comparison of four plating media for isolating Vibrio cholerae

Two brands of thiosulfate citrate bile salts sucrose agar and Monsur taurocholate tellurite gelatin (TTG) agar were compared with two newly developed media, sucrose tellurite teepol agar and Vibrio parahaemolyticus agar for isolation and identification of Vibrio cholerae. The thiosulfate citrate bile salts sucrose and TTG agars were the best selective media, whereas sucrose tellurite teepol agar was the poorest. Both TTG and sucrose tellurite teepol agars were good for use in follow-up serological tests, whereas only TTG agar could be used for follow-up oxidase tests. In our opinion TTG agar has more advantages for cholera research laboratories routinely culturing large numbers of patients for cholera on a daily basis and where media needs can be accurately predicted. In contrast, in smaller clinical laboratories or in laboratories investigating epidemics, thiosulfate citrate bile salts sucrose agar is best because it is commercially available and easy to prepare and can be used to distinguish colonies of suspect V. cholerae from V. parahaemolyticus.

Quality of Cary-Blair transport medium after aging nineteen months

Cary-Blair medium retains its ability to serve as a transport medium after 19 months of aging at room temperature. This eliminates the necessity for the frequent replacement of the stored supplies of this medium.

Yersinia enterocolitica: a review of the bacterium and recommended laboratory methodology

Only in the last few years has Yersinia enterocolitica been recognized as an etiologic agent. The organism, however, is widespread in both the animate and inanimate environments. It has been isolated and recovered from a variety of sources including fecal material, foodstuffs, and water, but vehicles of disease transmission are not fully delineated or understood. The bacteriology of Y. enterocolitica is reviewed and recommended laboratory methodology is described.

The aetiology of acute pulmonary embolism and the identification of high risk groups

Although the cause of venous thrombosis remains obscure, preventive methods have been described. The fact that pulmonary embolism continues to cause a high death toll suggests that there is still a failure to recognize the need for prevention or to employ those prophylactic methods that are known to be effective. While it may be impracticable to offer prophylactic treatment to all patients at risk, an awareness of the important predisposing factors and the application of effective prophylaxis to high risk cases could bring about a reduction in the mortality rate from a disease that at present causes as many unnecessary deaths as motor vehicle accidents.

Cholera on Guam, 1974: epidemiologic findings and isolation of non-toxinogenic strains

In August 1974, six cases of cholera occurred on Guam. The index case had severe diarrhea and metabolic acidosis and died from pneumonia on the ninth day of illness; the other five cases had only mild to moderate diarrhea. Fish caught in Agana Bay and home-preserved was found to be the vehicle most likely responsible for the cases. Vibrio cholerae, El Tor Ogawa, was isolated from two patients, the Guam sewerage system, and a river emptying into Agana Bay. V. cholerae, El Tor Inaba, was isolated from the sewerage system, three storm drains imptying into Agana Bay, and Agana Bay. The Ogawa and Inaba isolates differed in their sucrose fermentation and hemolysis reactions, phage type and ability to produce toxin. Although this was the first reported cholera outbreak on Guam, the isolation of differentV. cholerae strains suggested that multiple introductions of V. cholerae had occurred on the island.