A penicillinase test incorporated in the rapid carbohydrate fermentation method for rapid detection of beta-lactamase producing Neisseria gonorrhoeae.

A modification of the acidometric (phenol red) test for penicillinase producing N. gonorrhoeae was incorporated into the rapid fermentation method for rapid screening and identification of PPNG strains. Two hundred and twenty-four non-penicillinase-producing N. gonorrhoeae, 55 penicillinase-producing N. gonorrhoeae, 87 N. meningitidis and 89 N. lactamica were included in this study. Results of the modified test were comparable with the iodometric and penicillin disk diffusion susceptibility and were obtainable within 1 to 5 minutes.

The Widal slide agglutination test, a valuable rapid diagnostic test in typhoid fever patients at the Infectious Diseases Hospital of Jakarta.

The Widal slide agglutination test was evaluated as a rapid diagnostic test in typhoid fever patients at the Infectious Diseases Hospital, Jakarta, Indonesia from 1980-1982. The results of the test can be available within 45 minutes of patient admission. The study showed that, among 229 patients with Salmonella typhi-positive typhoid fever and 179 control fever patients, when the Widal O antibody titer was greater than or equal to 1:20 the sensitivity was 53%, the specificity 98%, the positive predictive value 96%, and the negative predictive value 68%. A negative Widal test (O antibody titer less than 1:20) does not provide useful information, but when the O antibody titer is greater than or equal to 1:20 the clinician at the Infectious Diseases Hospital of Jakarta can be 96% certain that the patient has typhoid fever.

A CAMP phenomenon between Vibrio cholerae biotype El Tor and staphylococcal B-hemolysin.

A CAMP phenomenon was demonstrated by Vibrio cholerae biotype El Tor and B-lysin producing Staphylococcus aureus in 5% sheep red blood cells-tryptic soy agar medium. All 394 El Tor vibrio strains tested, all showed a crescent-shaped hemolysis (positive CAMP) when the cultures were incubated in a candle jar whereas 67% were CAMP positive when incubated aerobically. Only 9% of the isolates produced detectable hemolysin in a standard tube test using heart infusion broth and 72% in a tube test using heart infusion broth containing 1% glycerol. Seven classical V. cholerae tested were CAMP negative. The CAMP reaction is easy to perform and may be useful for routine use in the differentiation of V. cholerae biotype El Tor from classical V. cholerae.

An evaluation of alkaline peptone water for enrichment of Vibrio cholerae in feces.

A comparison was made to determine the sensitivity of direct inoculation of thiosulfate citrate bile salts agar (TCBS) and alkaline peptone water (APW) enrichment prior to direct inoculation of TCBS to culture Vibrio cholerae from feces of patients with gastroenteritis. V. cholerae was isolated from 611 feces specimens. Of those, 535 were isolated in TCBS and APW-TCBS, 15 in only TCBS and 61 in only APW-TCBS. V. parahemolyticus (21) and non-agglutinating vibrios (11) were also isolated but more often in direct inoculated TCBS than APW-TCBS cultures. Maximum isolation sensitivity of V. cholerae and V. parahemolyticus from feces is obtained by both direct inoculation of TCBS and enrichment in APW prior to TCBS inoculation.

Duodenal string-capsule culture compared with bone-marrow, blood, and rectal-swab cultures for diagnosing typhoid and paratyphoid fever.

The sensitivity of duodenal string-capsule culture (DSCC) was compared to that of bone-marrow-aspirate culture (BMAC), single 3-ml blood culture (BC), and rectal-swab culture (RSC) for isolating Salmonella typhi and Salmonella paratyphi type A from patients with typhoid and paratyphoid fever. In 36 of 154 patients DSCC could not be used, usually because the patient was too ill to swallow the capsule. In the remaining 118 patients DSCC was positive in 57.6%, RSC in 35.6%, BC in 54.2%, and BMAC in 85.6%. The sensitivity of DSCC was improved by an additional 4.7% if subcultured daily for seven days. The DSCC has no advantage over the combination of RSC and BC and is inferior in sensitivity to the BMAC. However, when a BMAC cannot be obtained, the addition of the DSCC to BC and RSC can be expected to improve the isolation rate by greater than 17%, to at least 85%.

Reduction of mortality in chloramphenicol-treated severe typhoid fever by high-dose dexamethasone.

We compared high-dose dexamethasone (initial dose, 3 mg per kilogram of body weight) with placebo in a randomized, double-blind trial involving 38 patients with culture-positive, specifically defined severe typhoid fever. The patients in the two treatment groups ranged in age from 5 to 54 and were comparable at the outset. All patients received chloramphenicol. The case-fatality rate of 10 per cent (2 of 20 patients) in the dexamethasone group was significantly lower than the fatality rate of 55.6 per cent (10 of 18) in the placebo group (P = 0.003). There was no significant difference in the incidence of complications among the survivors in either group. Delirium, obtundation, and stupor were grave prognostic signs that were useful for predicting which patients were at high risk of dying before they became comatose or went into shock. Dexamethasone is unnecessary for most patients with typhoid but is recommended for all patients with suspected typhoid fever who are delirious, obtunded, stuporous, comatose, or in shock.

Improved method, using staphylococcal beta-hemolysin, for detection of hemolysin(s) produced by Vibrio cholerae biotype El Tor.

A tube test using brain heart infusion broth and staphylococcal B-lysin (HIBL) was devised to improve the detection of Vibrio cholerae El Tor hemolysin. Fifty six (100%) strains of V. cholerae serotypes Ogawa (28) and Inaba (28) were positive by the hemolysin test whereas 4 Inaba and 2 Ogawa were positive by a standard tube test using heart infusion broth (HIB) and 20 Ogawa and 18 Inaba were positive by another tube test using HIB containing glycerol (HIBG). Seven classical V. cholerae strains tested were negative by the 3 methods. The HIBL tube test was faster and more sensitive than the other 2 methods and showed that hemolysin was present that would otherwise have gone undetected by the other 2 methods using HIB or HIBG.

Tetracycline resistance of Corynebacterium diphtheriae isolated from diphtheria patients in Jakarta, Indonesia.

Of 133 Corynebacterium diphtheriae isolates from diphtheria patients in Jakarta, Indonesia, 86% were resistant to greater than or equal to 32 micrograms of tetracycline per ml. All isolates were sensitive to ampicillin, cephalothin, chloramphenicol, clindamycin, penicillin, erythromycin, and kanamycin. The general resistance of C. diphtheriae to tetracycline in this part of Indonesia appears to be unique compared with resistance reported in studies done in other parts of the world.

Susceptibility of Neisseria gonorrhoeae isolates from Jakarta, Indonesia, to antibiotics.

The minimum inhibitory concentration (MIC) of penicillin, tetracycline and spectinomycin was determined for 6 beta-lactamase (PPNG) and 73 non beta-lactamase producing Neisseria gonorrhoeae isolates from Jakarta, Indonesia. All PPNG were resistant to greater than or equal to 128 micrograms/ml penicillin. Forty-six percent of the non-PPNG strains were inhibited by less than or equal to 1.0 microgram/ml of penicillin and 97% by less than or equal to 4 micrograms/ml. Most of the PPNG and non-PPNG isolates (90%) were inhibited by less than or equal to 4 micrograms/ml tetracycline and less than or equal to 16 micrograms/ml spectinomycin. Two non-PPNG strains were resistant to 64 micrograms/ml of tetracycline, 8 micrograms/ml penicillin and 32 micrograms/ml spectinomycin. The non-PPNG strains generally were more resistant to penicillin and tetracycline compared to strains tested from other parts of the world in previously reported studies.

Slide coagglutination for Salmonella typhi antigens in broths inoculated with feces from typhoid fever patients.

Salmonella typhi antigens D, Vi and d were readily detected, by slide coagglutination, in mannitol selenite (MSB) and dulcitol selenite (DSB), Salmonella enrichment broths 4 hours after inoculation with feces from 60 patients with bacteriologically confirmed typhoid fever. Positive coagglutination also occurred using MSB and DSB inoculated with fecal specimens obtained from 16 patients from whom S. typhi was not cultured. Twelve of these later seroconverted to Salmonella O antigen. None of the MSB or DSB inoculated with feces from 50 healthy control subjects, gave a positive coagglutination test. The coagglutination method appears to have potential as a rapid test for the detection of antigens of S. typhi in MSB and DSB broths inoculated with feces from patients with suspected typhoid fever.

Neisseria gonorrhoeae and penicillinase producing N. gonorrhoeae among some patients in Jakarta Indonesia.

Neisseria gonorrhoeae was isolated from 14 out of 50 (28%) of one group and 35 out of 60 (58%) of a second group of females in different areas of Jakarta, Indonesia. four (7%) of the patients in the second group were infected with penicillinase producing Neisseria gonorrhoeae (PPNG). This may be the first reported isolation of PPNG in Indonesia.

Chloramphenicol resistant strains in salmonellosis in Jakarta.

During an observation period of 20 months (from January 1978 to September 1979) 123 children with clinically suspected salmonellosis were admitted to the Department of Pediatrics, 70 males and 53 females varying in age from 17 days to 14 years. S. typhi or S. enteriditis was isolated from the stool, urine, blood or cerebrospinal fluid in 85% (105/123) of the cases. The results of the microbiologic examination showed that 28 out of the 105 cases (27%) were resistant to chloramphenicol of which the S. sero-group C1 was predominant. It appeared that 28 cases conformed to the clinical data. In all these cases chloramphenicol was replaced by other antibiotics according to the sensitivity test. The mortality rate was 7% (9/123). Four of the fetal cases were from the chloramphenicol resistant group.

Detection of Salmonella C1, D and V1 antigens, by coagglutination, in blood cultures from patients with Salmonella infections.

Protein A-containing Staphylococcus aureus was coupled to Salmonella C1, D and Vi monovalent antisera to produce C1-, D- and Vi-COAG reagents. The reagents were used to detect their homologous Salmonella antigens in blood cultures (BC). The D and Vi antigens were detected in 79 of 239 BC from patients with suspected typhoid fever and Salmonella typhi was later isolated from the same 79 BC. The C1 antigen was detected in 8 BC from which only S. oranienburg was later isolated. The COAG test was generally positive at the same time the BC became culture positive. However, because of subculture and biochemical identification requirements the COAG test could be interpreted 1-2 days before culture results were available. The COAG test can be used to presumptively identify Salmonella typhi and Salmonella group C1 in blood cultures before the culture results are available.

Campylobacter fetus subsp. jejuni as a cause of gastroenteritis in Jakarta, Indonesia.

Campylobacter fetus subsp. jejuni was isolated from the feces of 15 out of 144 (10%) children (0 to 9 years old) and 4 out of 251 (2%) adults with gastroenteritis and was found together with another enteric pathogen in 2 of the children and in all 4 adults. It was isolated from 2 out of 7 (28%) children and 3 out of 160 (2%) adults with suspected typhoid fever. The bacterium was recovered from 3 out of 4 orphanage children with diarrhea and from 1 without symptoms and was isolated from only 1 child in a control group of 221 persons.

Paecilomyces lilacinus as the cause of chronic maxillary sinusitis.

Paecilomyces lilacinus was isolated on two separate occasions from the left antrum of a patient with chronic maxillary sinusitis. The clinical presentation and characteristics of the fungus and the sinus debris histopathology are discussed.

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.