Meningitis and encephalitis at the Abbassia Fever Hospital, Cairo, Egypt, from 1966 to 1989.

A total of 7,809 patients with meningitis or encephalitis were admitted to the Abbassia Fever Hospital in Cairo, Egypt from November 1, 1966 to April 30, 1989. The etiology was Neisseria meningitidis (mostly group A) in 27.3% of the patients, Mycobacterium tuberculosis in 19.7%, Streptococcus pneumoniae in 7.3%, and Haemophilus influenzae in 4.1%. Almost 27% of the cases had purulent meningitis but without detectable etiology; however, the epidemiologic data suggest that most of these had meningococcal meningitis. Encephalitis was suspected in 12.5% of the patients. Most of the meningococcal, pneumococcal, and Haemophilus cases occurred during the winter months. The number of meningococcal and culture-negative purulent cases per year reached a maximum three times during the 22.5 years of this study. There were more males than females in all etiologic groups, with the ratio for the total patient population being 1.6:1. The average age ranged between 11.7 and 16.5 years for all groups except for Haemophilus patients, who had a mean age of 2.5 years. The mortality rate was almost 55% for tuberculous patients and was approximately 40% for both pneumococcal and Haemophilus patients; it was 8.5% in patients with meningococcal disease.

Epidemic Shiga bacillus dysentery in Central Africa.

An outbreak of dysentery began late in 1979 in Central Africa and spread to involve a major portion of Zaire as well as Rwanda and Burundi. We traveled to a mission hospital in northeast Zaire during the epidemic and isolated Shigella dysenteriae, type 1, from most of the patients studied. All isolates were resistant to ampicillin, tetracycline, chloramphenicol, sulfathiazole, and streptomycin but sensitive to trimethoprim-sulfamethoxazole. Antimicrobial resistance was transferable to Escherichia coli, and at least three plasmids were identified in the donor Shigella isolates by using agarose gel electrophoresis. One was coded for ampicillin, tetracycline, and chloramphenicol resistance while a second conferred resistance to ampicillin and chloramphenicol but not tetracycline. A third large plasmid of approximately 120 megadaltons could not be transferred to E. coli recipients. All S. dysenteriae isolates yielded identical kinetic growth curves when analyzed on the Abbot MS-2 Research System. This is the most extensive outbreak of dysentery caused by S. dysenteriae reported since the Central American epidemic of 1969, and the first epidemic caused by a strain resistant to ampicillin.

A simple kit system for rapid diagnosis of cerebrospinal meningitis in rural areas of developing countries.

A simple, easily operated, portable diagnostic kit, employing coagglutination reagents, has been developed for the rapid, bedside diagnosis of cerebrospinal meningitis. Field trials using this kit were conducted in a rural area of sub-Saharan Africa for identifying the etiological agents of meningitis outbreaks. West African village medical attendants were taught to use this kit and succeeded in making rapid specific diagnoses of meningitis cases. Other acute infections such as cholera and typhoid fever can also be rapidly diagnosed in a similar manner. This rapid diagnostic system offers appropriate technology in support of primary health care delivery in the rural areas of developing countries.

Rapid, economical diagnosis of enteric fever by a blood clot culture coagglutination procedure.

Coagglutination tests with Salmonella A, D, Vi, and polyvalent antiserum-sensitized staphylococcal cells were compared with conventional culture methods for detecting salmonellae in ox bile cultures of blood clots from enteric fever patients. The coagglutination tests appeared equally as effective as conventional subculture methods for detecting positive cultures (95% agreement). In addition, the coagglutination method yielded earlier results at reduced cost.

Epidemic group C meningococcal meningitis in Upper Volta, 1979.

Group C meningococci were isolated during an epidemic of meningococcal meningitis which occurred between January and May 1979 in eastern Upper Volta, an area previously associated with endemic and epidemic group A disease. A total of 539 cases of meningitis, 55 of which were fatal, were reported, giving an attack rate of 517 cases per 100 000 inhabitants. Attack rates were higher for children under 15 years of age. Clinical and bacteriological data suggested that the group C meningococci were sulfonamide-resistant. The last meningococcal epidemic in Upper Volta occurred in 1970 and was nationwide. Epidemic cycles of group A meningococcal meningitis have occurred at 10-15 year intervals in the sub-Saharan region, raising concern that the current increase in activity may presage more wide-spread disease in the next dry season.

Enrichment culture coagglutination test for rapid, low-cost diagnosis of salmonellosis.

Specific diagnosis of salmonellosis by conventional culture and identification methods usually requires 2 to 4 days. Since Salmonella may be disseminated from infected individuals during this period, this amount of time required for diagnosis may be too slow to aid in epidemic control. To obtain earlier diagnoses of salmonellosis, a coagglutination test was used for rapid, simplified detection of Salmonella oranienburg antigens in enrichment broth cultures of fecal specimens from infants involved in a nursery outbreak. Two selective enrichment broths were used, selenite cystine and dulcitol selenite. These were compared in parallel for efficiency by subculture on deoxycholate lactose sucrose, MacConkey, xylose lysine deoxycholate, and tryptic soy lactose teepol agars. These overnight enrichment broth cultures of stool specimens were also examined by a coagglutination slide test with stabilized protein A-containing staphylococci sensitized with antisera for Salmonella antigens C1, E, and Vi. Of 113 diarrhea stool specimens tested, 86 were positive by conventional culture, 82 were positive by dulcitol selenite-coagglutination, and 55 were positive by selenite cystine-coagglutination. All these tests were negative on 50 stool specimens from infants in a noninfected nursery. Salmonellae were specifically detected in stool cultures within 20 h by the coagglutination technique. This early detection of Salmonella antigens provided a useful adjunct to culture for rapid diagnosis of salmonellosis.

A coagglutination method for presumptive identification of Salmonella typhi.

Salmonella group D, Vi and d antisera were used to sensitize A-containing staphylococcal cells. The coagglutination (COAG) reagents thus obtained, termed D-COAG, Vi-COAG and d-COAG were used to test growth taken from Kligler Iron Agar slants following 8-10 hours incubation. In 188 recently isolated strains of S. typhi, the D antigen was detected in 134 (71%) by direct reaction with the D-COAG reagent and 51 (27%) others following a simple treatment with 50% ethanol. Group D antigen was detected in the remaining 3 only following boiling of a suspension of each culture. The Vi-COAG reagent reacted with 184 (98%) of the cultures. The 4 remaining cultures were also negative for Vi antigen by the conventional slide agglutination test but D-COAG reagent was specific for other group D Salmonella but with none of the other groups tested, while the Vi-COAG reagent also reacted with a strain of Vi-containing Citrobacter furendii. The d-COAG reagent agglutinated with all S. typhi strains but none of the other non-S. typhi isolates tested.

Salmonellosis in Indonesia: phage type distribution of Salmonella typhi.

The distribution of phage types was studied among 577 strains of Salmonella typhi from Indonesia. Chemotype, colicinogeny, and tetrathionate reductase activity were also studied for most of these strains. The current phage type formula for Java was determined to be: A, D2, D6, E1a, E2, M1, and 46, but two other large groups of strains were also found, I + IV and degraded Vi+ strains. Significant differences in S. typhi strain distributions were noted between two localities on Java with respect to phage type and tetrathionate reductase activity. Comparisons were made with past phage typing studies in Jakarta as well as with more recent studies in other parts of south-east Asia. Phage types A, D1, D2, and E1 persisted at a rather steady level in Jakarta for 28 years. Evidence was found for epidemiological links to European and Asian areas. Antibiotic resistance among these Indonesian S. typhi strains was rare.

A question on the use of antibiotics in the treatment of acute diarrhoeal disease.

PIP: 310 patients with acute infantile gastroenteritis were divided into 2 groups. Group 1 was treated with oralyte only and group 2 was treated with oralyte plus antibiotics. Of the 310 patients, 201 (113 boys and 88 girls) returned for followup and are included in this report. There were 99 patients in group 1 and 102 patients in group 2, with the average age of 10 months, ranging from 2-24 months in both groups. Most patients (80%) had concomitant diseases such as upper respiratory tract infections, OMA, sugar intolerance, undernutrition, etc. The degree of dehydration in group 1 was mild in 78, moderate in 19, and severe in 2 patients, whereas in group 2, it was mild in 81, moderate in 20, and severe in only 1 patient. Pathogenic bacteria were recovered from 21 patients in group 1 and from 22 patients in the second group. The results of the treatment in both groups through clinical observation revealed no difference. Thus, the benefits of antibiotic use in the treatment of acute infantile gastroenteritis are open to question.^ieng

Diarrhoeal disorders of bacterial origin in Jakarta.

During a 21-month period from April 1974 to February 1976, 948 children with gastroenteritis were studied. Aetiologic agents were identified in 43% of these patients. Isolates were identified as follows: V. cholera El Tor, 273 (67%); Salmonella enteritidis, 64 (16%); enteropathogenic E. coli, 28 (7%); Shigella, 28 (7%); Vibrio (NAG), 9 (2%): and V. parahaemolyticus, 7,2%). Gastroenteritis with dehydration is a serious continuing pediatric problem in Jakarta, constituting 30% of admissions to Sumber Waras hospital. The incidence of both cholera and salmonellosis increased during the past 2 years, as judged by the distribution of enteric bacteria isolated from the rectal swabs of gastroenteritis patients in Sumber Waras hospital.

Salmonellosis in Indonesia: phage type distribution of Salmonella paratyphi A.

The distribution of phage types among 221 human strains of Salmonella paratyphi A in Indonesia was studied. Approximately 50% were phage type 5, a rare type elsewhere in the world. Most other isolates were the cosmopolitan phage type 1. The ratio of phage type 1-5 was compared for two cities on Java, Jakarta and Yogyakarta. The ratios were significantly different, phage type 5 predominating in Jakarta. The ratio of phage types among 10 S. paratyphi A strains isolated from Jakarta river water was similar to that found in Jakarta patients.