BCG osteomyelitis. Case report and review.

A 6-month-old boy is described presenting with BCG osteomyelitis of the distal metaphysis of the left femur extending into the epiphysis. Epidemiological, diagnostic and therapeutical problems of BCG osteomyelitis after BCG vaccination in the newborn period are discussed reviewing 89 published records of this late onset complication of BCG vaccination.

[Microbiological aspects of Legionnaires' disease]. / Mikrobiologische Aspekte der Legionärskrankheit.

Legionella pneumophila was isolated in 1947 but its etiological role was only recognized after the Philadelphia outbreak in 1976. Since then, infections with Legionella pneumophila in patients with so-called atypical pneumonia have been found in different parts of the world in sporadic cases and outbreaks affecting up to several hundred patients. The etiological agent is a bacterium which can be found in dust, mud and water. Transmission to the human most likely occurs through water-cooled air condition units or showers. Air conditioning in hotels, hospitals and offices may transmit the organism and lead to infection which, moreover, is more frequent during the warm season. The diagnosis is based on clinical data and the demonstration of specific antibodies. Isolation of the agent is technically difficult and up to now only approximately 3% of the cases have been confirmed by isolation of the agent. Evidence of Legionella pneumophila infection in Switzerland was obtained by testing stored blood samples from transplanted patients in 1970. Sporadic cases were observed in the period 1977 to 1980. Acute infection was considered in 141 patients on the basis of serological results. Approximately 3% of all pneumonias in 1979 were caused by Legionella pneumophila. Isolation of the etiological agent has been achieved in 3 patients only.

[Legionnaire's disease in Switzerland]. / "Legionnaires' disease" in der Schwiez.

The sera from 2453 patients suffering from pneumonia were investigated for antibodies against the agent causing "Legionnaires' disease". A complement-fixing antigen developed in this institute was used for the screening of these sera, and the positive results were confirmed with the IF-test developed by CDC Atlanta. Antibodies were found in 23 Swiss patients. The clinical details from one of these patients are presented.

[Atypical mycobacterial infection due to Mycobacterium fortuitum]. / Atypische Mykobakteriose, hervorgerufen durch Mycobacterium fortuitum.

The case is presented of a 48-year-old woman who, in association with repeated septic temperatures, developed abscesses in the region of the right shoulder and in the right ankly. Histological examination from excisates revealed caseous tuberculoid granulomas. Mycobacterium fortuitum was isolated from the pus of both abscesses. Although the Mycobacterium fortuitum was resistant to nine commonly used tuberculostatics, it was found to be sensitive to ethionamide and capreomycine. The use of these two drugs in combination with local measures proved successful.

Determination of the bacteriostatic capacity of neutrophils and monocytes in mixed cell populations.

Cline [1, 2] described a method of determining the phagocytic and bacteriostatic activity of individual types of leukocytes within mixed cell populations. We tried to improve the applicability of this method for the investigation of clinical problems.--Bacteria in the log-phase of growth were incubated in test tubes with leukocytes separated from venous blood. After a short period of phagocytosis 3H-thymidine was added to label DNA-synthesizing organisms. Smears were prepared and processed by autoradiography. The labeling indices of extracellular bacteria and of those phagocytized by neutrophils and monocytes were determined microscopically. The intracellular inhibition of DNA-synthesis was taken as indicative of the bacteriostatic activity of the leukocytes. The proposed modification of Cline's assay is suited to investigate clinical problems of phagocyte dysfunction.

[Epidemiologic relationship of infections with Salmonella typhimurium in Switzerland studied by phage typing (author's transl)]. / Erfahrungen mit der Salmonella typhi-murium-Phagtypisierung zur Abklärung der epidemiologischen Zusammenhänge in der Schwiz

In the area, controlled by the Institute of Microbiology of St. Gall, 262 S. typhi murium strains could be isolated during 1973. By means of phage typing, according to GUINEE, 20 different phage types as well as 6 additional atypically reacting strains, with characteristic atypical pattern, were recognized. The phage type 650 was most frequently encountered (37.0%) folowed by types 61 (20.2%) and 505 (10.3%). An intensive change in phage types was noted among 114 cases, observed over 7 months, in the region of Wil SG. In the beginning, 5 different phage types were determined, but in the following 2 months, they were replaced by the type 650, and, finally, by the type 61. Phage typing enabled the understanding of epidemiologic relationship of two outbreaks occurring in Kirchberg (type 650) and Bütschwil (type 61) by consumption of infected slaughtered beef. Also, an outbreak of the infection in Wil, transmitted by an infected butcher, could be cleared. Testing of the resistance against tetracycline, chloramphenicol, ampicillin and trimethoprim-sulphamethoxazol showed that 80.1% of the strains were sensitive and 18.3% were resistent against tetracycline; some phage types were sensitive (2, 3, 4, 61 etc.), predominantly sensitive (650) or resistent (330, 450, 504, 505 ARS-12). Four strains were resistent against one or more chemotherapeutic agents used.

[Occurrence of Salmonella in healthy snakes and snake cadavers- isolation of a new Salmonella species belonging to the sub-genus IV (S. IV 18:Z36, Z38:-) (AUTHOR'S TRANSL)]. / Vorkommen von Salmonellen bei gesunden Schlangen und Schlangenkadavern - Isolierung einer neuen Salmonella-Species des Subgenus IV (S. IV 18: Z36, Z38:-)

Forty-seven isolation attempts performed with 20 fecal samples of exotic snakes yielded 27 Salmonella species belonging to the sub-genus I-IV. The majority of isolates (78.7%), however, was identified as sub-genus III (Arizona). The snakes under study were hold captured for less than one year (one part) or for longer than one year. Bacteriological investigations of the 7 snakes studied, repeated 7 to 21 months thereafter, revealed uniformly other Salmonella species in comparison to those found at primary examination. Necropsy investigations were performed with materials from 3 snakes. One Salmonella species (Arizona) was isolated from the colon of one snake presenting with massive necrotic enteritis. The results with blood, bile and other colon sections were negative. Several Salmonella species were found in the colon of two other snakes presenting with infiltrative and necrotic changes in the organs, but without any pathologic finding in the intestinal tract. A new Salmonella species belonging to the sub-genus IV (S. IV 18:Z36, Z38:-) was recovered from fecal sample of a Black Mamba (Dendroaspis polylepis) and another Cascabel snake (Crotalus durissus terrificus).

[Clarification of a Salmonella typhimurium epidemic in north-eastern Switzerland by means of bacteriological and serological methods]. / Abklärung einer Epidemie mit Salmonella typhi murium in der Nordostschweiz durch bakteriologische und serologische Metheden

An outbreak of Salmonella typhi murium caused by person-to-person contacts was observed in Kurhaus (NE Switzerland) in late 1973. In all, 18 patients with clinical symptoms and 8 asymptomatic carriers were registered. However, 1 1/2 months elapsed before the etiologic diagnosis could be established. The infection was then transmitted, probably by a visiting nurse, to the personnel of a neighbouring school. An outbreak followed thereafter including 31 clinically manifest patients and 10 asymptomatic carriers. Infected food was most probably responsible for the dissemination of the disease, since two asymptomatic carriers were detected among persons engaged in the preparation of food. The close correlation between the two epidemics was confirmed by phague typing of isolated Salmonella strains according to the method of GUINEE. A common Biotype I, Lysotype 650, was identified in all cases. Clinical findings revealed diarrhea in 77,6%, fever in 59,2% and vomiting in 18.4% of cases. Only two patients who were admitted to the hospital, were given chemotherapy. The excretion of Salmonellae in the stools was observed on average for about one month in clinical cases and for 12 days in asymptomatic carriers. All the strains, with one exception, were in vitro sensitive against tetracycline, Chloramphenicol and trimethoprim-sulfamethoxazole. In one case the tetracycline treatment resulted in homologous resistance. In this case the carrier state had been observed for 111 days. Serologic tests were made one month after the outbreak was detected using Widal reactions with antigens of homologous strain. In most patients with clinical symptoms antibody titers were at serum dilutions of more than 1:80, whereas only 4 of the 9 asymptomatic carriers investigated presented with titers in this range. Patients who were not excreting Salmonellae had uniform antibody titers of less than 1:80.

[Gas gangrene panophthalmitis (author's transl)]. / Panophthalmie durch Gasbranderreger

Gas gangrene panophthalmitis is a rare condition of penetrating injury to the globe. The infecting organism is usually Clostridium perfringens. Characteristic symptoms are a brawny swelling of the lids, marked chemosis, coffee-coloured discharge, hypopyon, ring abscess of the cornea, formation of gas bubbles in the anterior chamber, rise of intraocular tension and early amaurosis. Treatment consists in the evisceration or enucleation of the globe, rarely in the exenteration of the orbit. Antibiotics along (Penicillin, Tetracyclines) are insufficient. Administration of antiserum is almost completely abandoned, it is probably more dangerous than helpful. The use of hyperbaric oxygen is not indicated in cases of gas gangrene panophthalmitis. Extraocular extension of the infection and its danger for the individual is prevented by well-times surgical procedure.