Responses to tuberculin in the guinea-pig eye as a model of cell mediated immune responses in the external eye.

The clinical and histological findings in an animal model of ocular cell mediated immune responses are described. These were evoked in sensitised guinea-pigs by dropping tuberculin into the conjunctival sac or injecting it under the palpebral conjunctiva. When tuberculin was dropped into the conjunctival sac, higher doses were required to evoke a strong response than when it was injected subconjunctivally. When high doses of antigen were used for challenge, a mild response was observed in unchallenged contralateral eyes. The cellular response at low doses of tuberculin consisted predominantly of mononuclear cells. At higher doses the cellular infiltrate was more pronounced, and polymorphonuclear cells tended to predominate 24 hours after challenge, while at 48 hours mononuclear cells predominated.

Unusual features in the conjunctiva and cornea of the normal guinea-pig: clinical and histological studies.

Clinical and histological studies of the outer eyes of newborn and adult female guinea-pigs were carried out together with histological studies of fetal eyes. Fine superficial corneal vessels, extending from the limbus, were seen in most newborn and adult eyes and were also present in histological preparations of fetal eyes. These vessels were therefore considered to be features of the normal guinea-pig eye. Masses of tissue composed of lymphoid cells, which were often organised into germinal centres, were found in the fornices of newborn and adult eyes. Smaller accumulations of lymphoid cells were found in fetal eyes, and this lymphoid tissue was therefore also considered to be a normal feature of the guinea-pig eye. In adult eyes mild but short-lived oedema or hyperaemia of the palpebral conjunctiva was quite common. There were no differences in the amounts of conjunctival cellular infiltration in these eyes c found in fetal eyes, and this lymphoid tissue was therefore also considered to be a normal feature of the guinea-pig eye. In adult eyes mild but short-lived oedema or hyperaemia of the palpebral conjunctiva was quite common. There were no differences in the amounts of conjunctival cellular infiltration in these eyes c found in fetal eyes, and this lymphoid tissue was therefore also considered to be a normal feature of the guinea-pig eye. In adult eyes mild but short-lived oedema or hyperaemia of the palpebral conjunctiva was quite common. There were no differences in the amounts of conjunctival cellular infiltration in these eyes compared with normal eyes, and these inflammatory changes were therefore not considered to be significant.

Guinea-pig inclusion conjunctivitis as a model for the study of trachoma: clinical, microbiological, serological, and cytological studies of primary infection.

The course of primary ocular infection with guinea-pig inclusion conjunctivitis agent was followed in 2 groups of animals. One group of fully grown animals was repeatedly scraped; the other of small animals was used on 1 occasion only and scraped after clinical examination. The intensity of conjunctival inflammation was measured, conjunctival scrapings were taken, and the numbers of polymorphonuclear cells, mononuclear cells, and epithelial cells containing chlamydial inclusions were counted, and the level of antibodies in serum was measured. It was found that inflammation of the conjunctiva lasted for about 30 to 40 days, and the clinical features (oedema, hyperaemia, papillary reaction) were very similar in the 2 groups. Inclusions and polymorphonuclear cells were found for up to 21 days, and mononuclear cells were found on days 7 to 25. Serum antibodies were first detected on day 10 and reached a peak on day 21. The intensity of inflammation was significantly higher on day 2 in the animals which had been scraped. After this the severity of the inflammation and the course of disease were similar in the 2 groups.

Development of chronic conjunctivitis with scarring and pannus, resembling trachoma, in guinea-pigs.

Guinea-pigs were repeatedly infected with guinea-pig inclusion conjunctivitis agent. Reinfection caused severe conjunctival inflammation, and repeated reinfection led to chronic inflammation lasting for many months. This was followed by the development of pannus, follicles on the palpebral conjunctivae, scarring of the lower palpebral conjunctiva, and deformities of the lower lid. Reinfection was accompanied by small numbers of inclusion-bearing cells, small numbers of polymorphonuclear cells, and high numbers of mononuclear cells. There was no increase in the level of serum antibodies. The chronic conjunctivitis was associated with high numbers of mononuclear cells and no inclusions or polymorphonuclear cells. The response to reinfection appears to be a delayed-type hypersensitivity reaction, and we suggest that the chronic inflammation, pannus, scarring, and lid deformities associated with hyperendemic trachoma may be due to repeated reinfection combined with delayed-type hypersensitivity.

Bacteraemia and antibiotic resistance of its pathogens reported in England and Wales between 1990 and 1998: trend analysis.

OBJECTIVES: Determination of causes, trends, and antibiotic resistance in reports of bacterial pathogens isolated from blood in England and Wales from 1990 to 1998. DESIGN: Description of bacterial isolates from blood, judged to be clinically significant by microbiology staff, reported to the Communicable Disease Surveillance Centre. SETTING: Microbiology laboratories in England and Wales. SUBJECTS: Patients yielding clinically significant isolates from blood. MAIN OUTCOME MEASURES: Frequency and Poisson regression analyses for trend of reported causes of bacteraemia and proportions of antibiotic resistant isolates. RESULTS: There was an upward trend in total numbers of reports of bacteraemia. The five most cited organisms accounted for over 60% of reports each year. There was a substantial increase in the proportion of reports of Staphylococcus aureus resistant to methicillin, Streptococcus pneumoniae resistance to penicillin and erythromycin, and Enterococcus faecalis and Enterococcus faecium resistance to vancomycin. No increase was seen in resistance of Escherichia coli to gentamicin. CONCLUSIONS: Reports from laboratories provide valuable information on trends and antibiotic resistance in bacteraemia and show a worrying increase in resistance to important antibiotics.

Management and prevention of ocular viral and chlamydial infections.

A majority of cases of preventable and/or curable ocular morbidity and blindness are caused by ocular infections. They may account for 70 to 90% of all ocular morbidity seen by family doctors, general practitioners, health centers, and local ophthalmologists in both developed and developing countries. Unfortunately, most health authorities and doctors, including ophthalmologists, consider these diseases to be of little or no importance because they are not fully aware of the high prevalence of these infections and the blinding sequelae which may occur following incorrect diagnosis and treatment. Also, they are not aware of the social and economic impact of these infections in the absence of proper management and implementation of preventive measures. In this review, we examine present knowledge of chlamydial and common viral ocular infections. We discuss the problems of diagnosis, management, and prevention and propose solutions relevant to developed and developing countries.

Ocular and dermal delayed hypersensitivity reactions in guinea-pigs following infection with guinea-pig inclusion conjunctivitis agent (Chlamydia psittaci).

Guinea-pigs which had been sensitized to guinea-pig inclusion conjunctivitis agent by ocular infection, were given ocular and dermal challenges with a range of doses of agent. Ocular delayed-type hypersensitivity responses were elicited by a wide range of doses. Such responses were associated with the presence of chlamydial inclusions and inflammatory cells. The EID50 for ocular reinfection was only slightly higher than that for primary ocular infection. Dermal delayed-type hypersensitivity reactions were produced only when high doses of agent were used. The relevance of these observations to human chlamydial eye disease is discussed.