The Journal of infectious diseases
-
Comparative Study
Laboratory diagnosis of pneumonia due to Streptococcus pneumoniae.
The diagnostic reliability of the Quellung reaction of sputum and the gram stain-directed sputum culture (SC) for bacteriologic diagnosis of pneumonia due to Streptococcus pneumoniae was determined. Detection of pneumococcal polysaccharide in sputum by counterimmunoelectrophoresis (CIE) or isolation of pneumococci from blood or pleural fluid (BPF-positive) was considered indicative of definite pneumococcal infection. Specimens were obtained from 211 patients with community-acquired bacterial pneumonia. ⋯ CIE, QR, and SC were positive in similar numbers of BPF-positive cases. All BPF-positive and CIE-positive cases were detected by both QR and SC. Use of both the QR and directed SC offers a rapid, accurate bacteriologic diagnosis of pneumococcal pneumonia.
-
Comparative Study
Single versus combination antibiotic therapy for pneumonia due to Pseudomonas aeruginosa in neutropenic guinea pigs.
Studies of therapy for experimental pneumonia due to Pseudomonas aeruginosa have failed to document beta-lactam-aminoglycoside synergy for most antibiotics examined, in contrast to results usually observed with pseudomonas infections at other sites. The neutropenic guinea-pig model of pseudomonas pneumonia was modified to resemble more closely therapy for clinical infections. ⋯ Among single-drug regimens, those in which peak antibiotic levels did not exceed the minimal bactericidal concentration for the organism were significantly less effective. Resistance to aminoglycosides did not develop during therapy, and therefore, in this study does not explain the mechanism of synergy observed with beta-lactam antibiotics.
-
Diarrhea is a leading cause of death in tropical countries. One of the highest childhood mortalities is in northeastern Brazil, where little is known about the morbidity, etiology, and risk factors of diarrhea. Prospective village surveillance over 30 months revealed diarrhea attack rates of more than seven episodes per child-year at six to 11 months of age among the children of the poorest families. ⋯ Enterotoxigenic Escherichia coli and rotaviruses were the most common pathogens, accounting for 21% and 19% of cases, respectively, followed by Shigella species (8.0%), Campylobacter jejuni (7.5%), Giardia species (6.7%), Strongyloides species (5.3%), and enteropathogenic E coli serotypes (4.6%). Most (84%) enterotoxigenic E coli were isolated during the rainy season of October to March (P less than 0.03), whereas 71% of rotaviral illnesses occurred during the drier months of June to October (P less than 0.03). In the present study, the early occurrence and nutritional impact of diarrhea and weaning, as well as the major etiologic agents of diarrhea and their different seasonal patterns have been defined for this region in which life-threatening diarrhea is endemic.
-
The epidemiology of Vibrio cholerae O1 El Tor in rural Bangladesh was examined with a new phage-typing system for characterization of individual strains. During a two-year period, 537 strains were typed with a set of standard and experimental phages. Four major and many minor patterns were identified, some associated with discrete outbreaks of disease and others persisting for the entire period. ⋯ The yearly cholera seasons began with the emergence of strains of many different phage types in many different locations; this pattern is consistent with an environmental reservoir for V cholerae. Each patient with cholera excreted only one phage type over time, whereas some family members were infected with strains of different phage types. Phage typing can be a useful marker with which the spread of cholera strains can be traced in endemic settings.
-
MRSA strains have become increasingly prevalent in the United States and are now an important cause of nosocomial infections in many large, medical school-affiliated hospitals. In affected institutions, from a few percent to 50% of all hospital-acquired S aureus infections are caused by MRSA strains. It has been suggested that the overall incidence of nosocomial S aureus infections may not increase in hospitals where MRSA strains have become epidemic or endemic and that MRSA strains merely replace methicillin-susceptible strains as a cause of hospital-acquired infections. ⋯ At the University of Mississippi Medical Center, MRSA strains have been recovered from patients with increased frequency since an outbreak of MRSA infections occurred in the burn unit in June 1979 [3]. Continuing surveillance has revealed that the incidence of nosocomial MRSA infections was significantly higher in 1980-1982 than during 1979 (P = 0.002 by Mann-Whitney U test). MRSA strains accounted for 11% of nosocomial S aureus infections in 1979, 38% in 1980, 50% in 1981, 36% in 1982, and 32% in early 1983.(ABSTRACT TRUNCATED AT 250 WORDS)