Identification of clinical isolates of Neisseria gonorrhoeae by a coagglutination test.

Ninety-eight per cent of laboratory isolates of Neisseria gonorrhoeae from a veneral disease clinic gave positive reactions with a gonococcal coagglutination test. The prototype reagent, however, was poor at distinguishing between different species of the genus Neisseria: 75% of strains of Neisseria meningitidis and 40% of other Neisseria species tested gave positive reactions. None of the origanisms other than Neisseria growing on the diagnostic cultures from the clinic gave positive reactions. We therefore suggest that the present reagent is unsuitable for testing isolates from the upper respiratory tract. The technique is simple, rapid, and convenient and with a more specific antibody could be useful. Results of coagglutination reactions of 126 strains of Neisseria grown on serum-containing and serum-free media were very similar and there is no need to use special serum-free media.

Streptococcal toxic shock syndrome: a description of 14 cases from North Yorkshire, UK.

OBJECTIVE: To analyze the clinical and laboratory features of patients diagnosed with streptococcal toxic shock syndrome (TSS) in North Yorkshire from 1986 to 1999. METHODS: Records of patients with features satisfying the published criteria for streptococcal TSS were reviewed from laboratory and clinical records made at the time and from the hospital case notes. Isolates of streptococci were analyzed for serotype and genes encoding for the production of streptococcal pyrogenic exotoxins. RESULTS: Fourteen patients satisfied the entry criteria. In one district, where the data were complete, the annual incidence of detected streptococcal TSS rose from 1.1 to 9.5 cases per million population in the 1990s. TSS was associated with various M serotypes of group A streptococci and various exotoxin genotypes. Two cases (14% of the series) were associated with severe group G streptococcal infection. The fatality rate was 64%, and the mode of time to death was 4 days. Local tissue necrosis occurred in 71% of cases, including necrotizing fasciitis, intrathoracic and intra-abdominal forms. Non-steroidal anti-inflammatory drugs (NSAIDs) had been taken around the time of onset of disease by 92% of the patients with TSS. CONCLUSIONS: There has been a dramatic increase in the number of detected cases of streptococcal TSS over the 14 years since the first case was recognized here. There was a wide range of invasive forms of infection, a high fatality rate even in fit young adults, and a rapid course from onset to death. There was a high association of TSS with aggressive streptococcal infection producing local tissue necrosis.

Actinomyces pyogenes bacteraemia in a patient with carcinoma of the colon.

A patient with carcinoma of the colon adherent to the pelvis developed Actinomyces pyogenes bacteraemia after uterine curettage but recovered with antibiotic treatment. This organism is a Gram-positive cocco-bacillus, beta-haemolytic when growing on blood agar and reactive with Lancefield group G antiserum. These features could easily lead to its misidentification as a streptococcus. Reports of human infection with A. pyogenes are summarised.

Invasive streptococcal infections in the era before the acquired immune deficiency syndrome: a 10 years' compilation of patients with streptococcal bacteraemia in North Yorkshire.

Significant streptococcal (non-pneumococcal, non-enterococcal) bacteraemia was detected in 100 patients in two Health Districts of North Yorkshire in the decade 1978-1988. Patients with these infections accounted for 11% of the total 902 patients in the districts in whom bacteraemia was diagnosed during the period. Infection was most often seen with beta-haemolytic streptococci (52 patients) comprising Lancefield group A (Streptococcus pyogenes) (20 patients), group B (13), group C (5), group G (9), haemolytic Streptococcus milleri and non-groupable streptococci (5). The wide variety of serious infections included cellulitis, abscess, septicaemia, pneumonia, septic arthritis, necrotising fasciitis, acute endocarditis and mycotic aneurysm. Of these 52 patients, 21 (40%) died. alpha-Haemolytic streptococcal bacteraemia was diagnosed in 38 patients of whom 24 (63%) suffered from endocarditis and three (8%) died. Three of ten patients with non-haemolytic or anaerobic streptococcal bacteraemia died also. Six of the 100 patients with streptococcal bacteraemia had concomitant acute virus infections. Of the total 56 patients with infective endocarditis diagnosed in the districts during the period, streptococci were responsible in 30 (54%) of them. The predisposing factors, clinical features and outcome of the infections are described and discussed.

The gut as a source of the haemolytic streptococci causing infection in surgery of the intestinal and biliary tracts.

In a retrospective review over nearly four years in two Health Districts 84 patients were found to have had non-epidemic, non-enterococcal beta-haemolytic streptococcal infection in surgical conditions of the intestinal and biliary tracts and peritoneum. One third of the patients yielded streptococci from established inflammatory lesions closed to the external body surface and there was strong circumstantial evidence that organisms originated from the intestinal tract. A review of published studies of beta-haemolytic streptococci in the faeces and reports of streptococcal infection associated with the intestines lends support to the concept of the gut as a source of infection.

Bacteraemia in streptococcal infections of the throat.

In two patients seen recently in North Yorkshire, systemic infection with Streptococcus pyogenes appeared to originate from the upper respiratory tract; such infection is now rarely reported from the more developed countries. A study was arranged to detect bacteraemia in patients with sore throat: of 343 patients tested 93 yielded beta-haemolytic streptococci from the respiratory tract, but streptococcal bacteraemia was detected in none. These results suggest that clinically unsuspected streptococcal bacteraemia is uncommon in such patients.

A profile of skin sepsis in meat handlers.

Four hundred and sixty-seven episodes of sepsis associated with meat handling and poultry processing occupations were seen in two Health Districts of North Yorkshire in a period of just over five years. Altogether 389 patients were infected in 16 outbreaks and 24 sporadic incidents; spread of infection was noted in families of nine workers. The variety of skin infections included septic cuts and scratches, paronychia, abscess, lymphangitis as well as infection in pierced ear lobes and in tattoos. Beta-haemolytic streptococci or Staphylococcus aureus were present in 96 per cent of the 303 episodes that yielded positive cultures. These included 203 episodes with Streptococcus pyogenes and 170 with S. aureus. Skin sepsis appears to be common among meat handlers in this part of England.

Intravascular infection with Lactobacillus paracasei.

A patient is described with sub acute but life-threatening intravascular infection with Lactobacillus paracasei. Intrasplenic rupture of a mycotic aneurysm led to haematoma and early abscess formation with some bleeding into the peritoneum. The infection was cured with splenectomy and a prolonged course of ampicillin and gentamicin.

Bacteraemic Streptococcus pyogenes infection in the peri-partum period: now a rare disease and prior carriage by the patient may be important.

OBJECTIVES: To describe the features of invasive peri-partum Streptococcus pyogenes infection as it occurs in current day practice in North Yorkshire. METHODS: The case and laboratory records of all mothers and/or babies with detected S. pyogenes bacteraemia in the Harrogate and Northallerton districts of North Yorkshire (combined catchment population 260 000) were reviewed for the 20 years 1980-99. An additional bacteraemic case occurring recently in the York district was included. RESULTS: In six recorded episodes, both mother and baby were affected in three, mother only in two and baby only in one. The incidence of detected infection was one such episode per million population per year, one episode per 11 000 live births and one infected baby per 18 000 live births. Maternal features included endometritis, septicaemia, peritonitis, necrotising fasciitis and toxic shock syndrome while, in babies, infection was manifest by stillbirth or septicaemia, cyanosis, jaundice, lethargy and cellulitis. CONCLUSION: Peri-partum S. pyogenes infection is rare in North Yorkshire, with a local incidence revealed in this study of 1/million population/year, or 1:11 000 live births. Invasive neonatal infection with S. pyogenes appears to be six times less frequent in this locality than with group B streptococci. Mothers and/or their babies can be affected. Data suggests that some infection is autogenous from streptococci carried in the mother's genital tract. Although data in this setting are currently few, when a mother has suspected invasive group A streptococcal infection we recommend that the newborn child should also receive antibiotics without delay.

Necrotizing proctitis caused by Streptococcus pyogenes.

We report the case of a 65-year-old patient with peritonitis, septicaemia and toxic shock syndrome in whom the primary focus of infection was acute purulent proctitis with necrosis. Streptococcus pyogenes serotype T28R28 was isolated from blood culture and peritoneal pus. The patient recovered after a prolonged period of intensive therapy and four abdominal operations including anterior resection of the rectum. We believe this to be the first clinical description of streptococcal necrotizing proctitis.

Acute peritonsillar abscess caused by Arcanobacterium haemolyticum.

A patient is reported with a peritonsillar abscess yielding Arcanobacterium haemolyticum. This appears to be only the fifth such case described in the medical literature and the first from Europe. The organism has been reported as an occasional cause of tonsillopharyngitis with rash, resembling infection with Streptococcus pyogenes but often unresponsive to penicillin therapy. A. haemolyticum easily passes unrecognized in bacteriological cultures as a result of its slow growth, coryneform appearance in the Gram's stain and weak haemolytic activity on conventional laboratory media.