Acute bacterial meningitis in Cairo, Arab Republic of Egypt, 1 January 1971 through 31 December 1975.

Between 1 January 1971 and 31 December 1975, 1,333 patients with acute bacterial meningitis were admitted to the meningitis ward of the Abbassia Fever Hospital. These cases are tabulated by distribution of diagnosis, seasonal distribution, age and sex distribution, and age-specific case fatality ratio. Results are compared with those of other large series of cases reported from other parts of the world. The annual incidence of acute bacterial meningitis in Egypt varies widely. Recent data show this to be due to variations in the incidence of group A meningococcal meningitis. The study includes the declining phase of an epidemic of that disease and confirms a previously reported finding that the case fatality ratio in group A meningococcal meningitis varies inversely with the annual number of cases.

Interaction of Salmonella paratyphi A and Schistosoma mansoni in hamsters.

It has previously been shown that Salmonella paratyphi A associates with adult Schistosoma mansoni worms in animal models and in patients with schistosomiasis, resulting in Salmonella infections that are difficult to manage unless the helminthic parasite is eliminated. In the present study, characteristics of this association were explored. In vitro, fresh serum, but not heat-inactivated (56 degree C, 30 minutes) serum, from normal hamsters (NH) and schistosome-infected hamsters (SIH) equally inhibited bacterial growth. When either group of animals was given S. paratyphi A intracardially, there was a decline in recoverable bacteria in the blood for 3 days, but after the third day, the number of bacteria increased in SIH whereas NH blood became sterile. Co-cultivation of S. paratyphi A in Earle's medium with live worms yielded more bacterial growth than occurred in the medium without worms, suggesting that nutritional factors are involved in the relationship. An intimate association in vivo of bacteria and trematodes was confirmed by culturing Salmonella from both worm surfaces and homogenized worms, with more bacteria being recovered from female worms. Although the bacterial infection induced a significant hepatic shift of adult worms in SIH, oogram analyses were normal and no lethal effect of bacteria on worms was noted.

Salmonella paratyphi A in hamsters concurrently infected with Schistosoma mansoni.

The present work deals with the development of an improved animal model to study the association of salmonellosis and schistosomiasis. The animal chosen was the hamster, Mesocricetus auratus, which can be readily infected with Schistosoma mansoni. Normal hamsters and schistosome-infected hamsters (SIH) were given approximately 2.0 x 10(7) Salmonella paratyphi A intracardially. It was found that S. mansoni infections enhanced and prolonged the growth of S. paratyphi A in hamsters. Animals with dual infections had increased mortality in comparison with those infected with just bacteria or parasite during the 50 days post-bacterial challenge. Further studies showed that in SIH, S. paratyphi A persisted in various organs for up to 8 weeks post infection. In contrast, concurrent Leishmania donovani infections have no effect on S. paratyphi A infections. Significant numbers of bacteria were cultured from well-washed schistosome worms recovered from SIH 6--8 weeks post-bacterial challenge. These findings suggest that a direct physical relationship between the bacteria and worms facilitates the establishment and growth of S. paratyphi A in vivo, and that a deficit in host immune response is not a major factor involved in the enhanced growth of S. paratyphi A.

Bacteriuria in urinary schistosomiasis in Egypt a prevalence survey.

An epidemiologic survey to assess the prevalence of bacteriuria in urinary schistosomiasis was carried out in a region endemic for urinary schistosomiasis in Egypt. Twenty of 390 (5.1%) school boys aged 5--16 years were bacteriuric. This prevalence rate is more than 10 times greater than that found in comparable surveys in areas non-endemic for urinary schistosomiasis. In this endemic population bacteriuria was found in 6.5% of active egg excreters and 2.3% of non-egg excreters.

Bone marrow aspirate culture superior to streptokinase clot culture and 8 ml 1:10 blood-to-broth ratio blood culture for diagnosis of typhoid fever.

We compared the sensitivities of bone marrow aspirate culture (BMAC), 3 ml 1:4 and 8 ml 1:10 blood-to-broth ratio blood cultures (BC), 8 ml streptokinase clot culture (STKCC) and rectal swab culture (RSC) for isolating Salmonella typhi and S. paratyphi A from 61 patients with typhoid or paratyphoid fever in Jakarta, Indonesia. BMAC (92%) was significantly more sensitive than 8 ml BC (62%), 8 ml STKCC (51%), 3 ml BC (44%), RSC (56%) and the 19 ml combination of all three BC methods (71%). The combination of the three BC methods and RSC had an isolation rate of 87%. In Jakarta the diagnosis of typhoid fever cannot be confidently excluded unless a BMAC is done.

Streptokinase clot culture compared with whole blood culture for isolation of Salmonella typhi and S. paratyphi A from patients with enteric fever.

The sensitivities of whole blood and clot cultures were compared in 155 patients with typhoid or paratyphoid fever. Salmonella typhi or S. paratyphi A were isolated from 98.7% of 5 ml 1:10 blood:broth ratio blood cultures and 94.8% of 5 ml streptokinase clot cultures (P greater than 0.05). There was no difference in the speed of isolation. Whole blood culture and clot culture were of nearly equal sensitivity in this group of patients.

Isolation of Salmonella typhi from standard whole-blood culture vs blood-clot cultures.

The use of 10% oxgall and bile broth medium, both supplemented with freshly prepared 100 u/ml streptokinase, for isolating Salmonella typhi by clot culture technique was evaluated and compared against whole blood culture systems (3 ml blood in 9 ml media and 8 ml blood in 72 ml media). These gave a 1:4 and 1:10 blood to medium ratio, respectively. Clot cultures in 10% oxgall (CLOX) gave a 57% positive isolation rate for S. typhi. A similar result was obtained from clot cultures in bile broth medium (CLBB). A total of 184 samples identified as positive for S. typhi were tested. There was no significant difference between the use of 10% oxgall or bile broth medium when used for clot culture. The whole blood culture systems still showed a significantly better rate of isolation than the clot culture methods.

Gas-liquid chromatography-frequency pulse-modulated electron-capture detection in the diagnosis of infectious diseases.

The extremely sensitive and selective gas-liquid chromatography-frequency pulsed-modulated electron-capture detection (GLC-FP-ECD) procedure has been applied to the diagnosis of bacterial, fungal, viral, rickettsial, and parasitic diseases by the examination of various body fluids, effusions and exudates, and excretion products. Carboxylic acid and alcohol, hydroxy acid, and amine product profiles of microbial or host-response origin, have been used to establish specific etiologies, these profiles are reproducible, and can be used to aid in the diagnosis of infections. In addition, we have used the GLC-FP-ECD procedure to analyze microbial metabolic products in vitro and to provide data for identification and classification. We also explored computer time-sharing for data analysis, profile library comparison, and eventual profile matching for diagnosis.

Listeria monocytogenes L forms. I. Induction maintenance, and biological characteristics.

L forms were induced from 15 of 16 strains of Listeria monocytogenes on penicillin gradient plates incubated under aerobic conditions. The culture medium for maintenance of these L forms must contain an electrolyte in a concentration of 1% or sucrose in a concentration of 10%. The electrolytes NaCl, KCl, or MgSO(4) were used in both induction and maintenance media. Induction of L forms occurred more rapidly on media containing KCl. Listeria L forms had the same fermentation reactions as the parent bacterium. The L-form growth in liquid medium was slow, not extensive, and appeared as clumps on the bottom of culture tubes. The morphology of Listeria L forms was similar to that reported for other bacterial L forms. The L forms derived from strain 10403, serotype 1, were stable after two or more passages on penicillin media. They did not revert to the bacterial form after 40 subcultures on penicillin-free media. Some L-form colonies derived from strain 10403 did revert to the bacterial form when transferred directly from induction plates to penicillin-free media. Studies of the growth characteristics for L forms derived from strain 10403 gave the following results: an optimal temperature of 30 C, high electrolyte or sucrose concentration necessary for induction and maintenance, and no requirement for serum.

Analysis of fatty acids of the genus Rochalimaea by electron capture gas chromatography: detection of nonanoic acid.

The fatty acid compositions of Rochalimaea quintana, strains Fuller and Guadalupe, and R. vinsonii, the Canadian vole agent, were determined in an effort to further characterize these bacteria. The cells were saponified with 5% NaOH in 50% methanol and acidified to pH 2. The methanolysates were extracted with chloroform, derivatized with 2,2,2-trichloroethanol, and analyzed using a Hewlett-Packard gas chromatograph equipped with a frequency pulse-modulated electron capture detector and a 3% OV-101 packed-glass column. The fatty acid profiles of the three Rochalimaea strains were similar, with octadecenoic acid (C18:1) the most abundant, followed by octadecanoic (C18:0) and hexadecanoic (C16:0) acids. Moderate to trace amounts of other acids were also present. Unexpectedly, well-defined peaks of nonanoic acid (C9) were found consistently. A portion of this acid, but not all, was extractable with chloroform. Since C9 is not reported as a usual component of bacteria and most analyses do not include a search for this fatty acid, this study was extended to three strains of Legionella and one of Campylobacter. Comparable results were obtained. Since these bacteria were grown in complex media which contain some C9, it is possible that the medium is the source of bacterial C9. Whether this compound can be synthesized by the bacteria remains to be investigated.

Gas chromatography in the identification of microorganisms and diagnosis of infectious diseases.

Gas-liquid chromatography (GLC) continues to find increasing applications in the characterization of microorganisms and the diseases associated with them. GLC has been used to characterize microorganisms through qualitative and quantitative analyses of cellular structural components and soluble extracts and metabolic by-products. Chromatographic patterns, or fingerprints, can be used to differentiate between very closely related microorganisms, even strain differences, and provides a potentially powerful tool for future taxonomic studies and more precision in definitive microbial classification. However, the most valuable use of GLC is in the identification of disease through patterns obtained by direct analysis of body fluids. Chromatographic fingerprints of microbial metabolites and compounds associated with the host response to infection and even noninfectious disease can be used to develop relatively simple GLC diagnostic methods. These methods are specific, sensitive, and rapid. This review examines the use of GLC for identification of infectious diseases through the analysis of body fluids, spent culture media, and cellular materials and suggest other clinical areas where its diagnostic potential has yet to be developed.

Comparative in vitro activity of five cephalosporin antibiotics against salmonellae.

The in vitro activities of five cephalosporin antibiotics against 121 strains of salmonellae were compared. Cefamandole and cefaclor were more potent than cefazolin, and these three drugs were more active than cephalothin and cephalexin.

Rifampicin in the treatment of tuberculous meningitis.

Seventy-one patients diagnosed to have tuberculous meningitis were treated with isoniazid, streptomycin plus either rifampicin (36 patients or ethambutol (35 patients). Results of therapy were identical in both treatment-groups (approximately 50 per cent mortality). Rifampicin appears to be as effective as ethambutol in the treatment of this infection.

Frequency-pulsed electron capture gas-liquid chromatography and the tryptophan color test for rapid diagnosis of tuberculous and other forms of lymphocytic meningitis.

A total of 260 samples of cerebrospinal fluid received from Egypt, the United States, Canada, and South America were examined by frequency-pulsed electron capture gas-liquid chromatography (FPEC-GLC) for tuberculous and other forms of lymphocytic meningitis. Thirty-four of the specimens were culture positive for M. tuberculosis, and four cerebrospinal fluid specimens of herpes meningitis were established by immunological techniques. The compound, 3-(2'-ketohexyl)-indoline, was found in about 60% of the Egyptian tuberculous specimens and none of the culture-positive American specimens. the carboxylic and hydroxy acid FPEC-GLC profiles were used effectively in conjunction with other clinical data to make the diagnosis even in the absence of 3-(2'-ketohexyl)indoline. Herpes meningitis and mixed infections of Myeobacterium tuberculosis-herpes, M. tuberculosis-leptospira, and M. tuberculosis-Haemophilus influenzae produced profiles different from each other and from pure culture cases. The color test for tuberculous meningitis was evaluated, and free tryptophan was eliminated as the source of color reaction. Indications are that 3-(2'-ketohexyl)indoline, in most cases, is not responsible for the positive color reaction. Differences in the clinical and FPEC-GLC data obtained from samples from different geographical regions are discussed.

Hearing impairment in meningococcal meningitis.

Hearing affection as a sequel of meningococcal meningitis and its relation to age, sex, severity and duration of disease was studied in Cairo, Egypt during the period December 1966--December 1973. The total incidence of impaired hearing in the 775 cases was 5.8%. This incidence was higher in the younger age groups, females, severe cases of meningitis and in patients who received specific therapy shortly after the onset of signs and symptoms of the disease. The aetiology of hearing impairment in meningitis was reviewed.

Treatment of chronic enteric fever with amoxicillin.

Twelve patients with proven Salmonella typhi or Salmonella paratyphi A bacteriuria and recurrent bacteremia associated with schistosomiasis were treated for four weeks with amoxicillin (250 mg four times daily). Seven of the 12 patients were seriously ill and febrile before treatment. They showed a dramatic response, and, within three to six days of initiation of amoxicillin therapy, they were afebrile and much improved clinically. Amoxicillin was rapidly and highly concentrated in the urine of all patients; peak levels of 115-2,700 mug/ml were obtained within 2-4 hr of the first dose. Concentration of the drug in serum was also rapid and in all but two patients exceeded the minimal inhibitory concentration of the organism within 4 hr of the first dose. Within one week after treatment started, all urine and blood specimens obtained from the patients became negative for Salmonella and remained so throughout the four-week follow-up period, during which the patients were hospitalized.

Protection against experimental Pseudomonas aeruginosa infection in mice by active immunization with exotoxin A toxoids.

The immunoprophylactic effect of chemically inactivated Pseudomonas aeruginosa exotoxin A in experimental pseudomonas infections was studied. Exotoxin A toxoids were prepared by Formalin (f-TXD) or glutaraldehyde (g-TXD) treatment. Immunization of mice with three or four doses (10 micrograms each) of f-TXD and the synthetic adjuvant N-acetylmuramyl-L-alanyl-D-isoglutamine (50 micrograms) induced high levels of antiexotoxin A antibodies as measured by passive hemagglutination assay and enzyme-linked immunosorbent assay. Immunization with toxoid alone did not elicit antitoxin. A significant increase in survival time and survival rate (P less than 0.01) was seen in immunized (f-TXD) and in burned and infected mice (50 to 85%) as compared with control mice immunized with formalinized bovine serum albumin (6 to 20%). Virtually 100% survival was obtained when preinfection immunization weas combined with single-dose gentamicin treatment within 24 h of infection. Immunization with g-TXD increased survival time (P less than 0.01) but did not consistently increase survival rate, and the results were not as satisfactory as those with formalinized exotoxin. The data presented indicate that active immunization with formalinized exotoxin A toxoid and adjuvant induced protective immunity to various degrees against infections in mice and could be potentially useful in prophylaxis of P. aeruginosa infections.

Penetration of amoxicillin into cerebrospinal fluid.

The penetration of amoxicillin into cerebrospinal fluid (CFS) in the presence of meningeal inflammation was evaluated in patients with tuberculous meningitis. Serum and CSF concentrations of amoxicillin were measured at 2 h in nine patients who received a 1-g oral dose and at 1.5 and 4 h in ten patients who received a 2-g intravenous injection of sodium amoxicillin. After the oral dose, CSF concentrations ranged from 0.1 to 1.5 mug/ml. After the intravenous injection, CSF concentrations ranged from 2.9 to 40.0 mug/ml at 1.5 h and from 2.6 to 27.0 mug/ml at 4 h. These data on penetration suggest that parenterally administered sodium amoxicillin may be of value in the therapy of acute bacterial meningitis.