The combined value of chemoprophylaxis and pneumococcal vaccine in the prevention of recurrent pneumococcal meningitis.

We report the case of an immunocompetent patient who has been the subject of 39 episodes of recurrent pneumococcal meningitis over a 20 year period. The recurrences of bacterial meningitis due to cerebrospinal fluid leakage and the presence of chronic sinusitis were not influenced by the surgical repair of a fistula and the repeated surgical draining interventions on suppurating chronic sinusital foci. Phenoxymethylpenicillin treatment reduced the number of recurrences and the combination of pneumococcal vaccine and penicillin prophylaxis allowed a 5 year period free of any recurrences.

Epidemiology of meningococcal meningitis in Romania 1971-1991.

The paper describes the endemic epidemic picture of meningococcal meningitis in Romania over 1971-1991 period. After the epidemic of 1970 with 1051 cases and a morbidity of 5.2 %000, the incidence of the disease suddenly decreased; thus in 1972-1984 the number of cases ranged from 191 to 534 per year, corresponding to a morbidity rate of 0.9 - 2.3 %000. Starting with the autumn of 1985 the incidence of meningococcal meningitis increased rapidly, reaching a maximum value in 1987 (2623 cases) and a morbidity rate of 11.4 %000. A spectacular decrease to 250-270 cases per year in 1990-1991 and a morbidity rate of 1.1 - 1.2 %000 were reported. Mortality followed closely the morbidity curve with a maximum in 1987 (0.4 %000). By contrast, lethality was higher in endemic periods with a maximum of 7.9% (1972), 8.9% (1975) and 6.3% (1990-1991), in the remaining years the lowest index being 1.4% (1980). The meningococcal meningitis epidemic of 1987 was due to group A Neisseria meningitidis identified in 84.5% of isolates from patients, the same serogroup decreasing in endemic periods to 0 (1991) or 5.5% (1974).

Group B streptococci implicated in the etiology of acute pneumopathies in neonates.

111 neonates with acute respiratory insufficiency and/or severe pneumopathy (pneumonia, bronchopneumonia) occurring in the first 10 hours after birth were investigated during January 1990-September 1991 for the group B streptococci presence. 430 samples from these neonate cases: throat and nose exudates, necroptic material from died neonates (pulmonary, blood, bronchial secretion) and their mothers (lochia, vaginal and uterine secretion) were examined. 33% of the neonates and their mothers were positive with the same GBS. 65.30% from the GBS strains belonged to serotype Ia and 34.70% to Ib. 24.48% from the GBS strains were resistant to Penicillin G by diffusimetric method with a corresponding MIC of 0.1 UP/ml (22.12%) and 0.5 UP/ml (2.65%).

Sensitivity to penicillin of S. pneumoniae strains isolated from various pathological conditions.

297 S. pneumoniae strains isolated from patients with different pneumococcal infections during 1990-1991 were tested for the sensitivity to antibiotics--by the diffusimetric method to 9 antibiotics (Penicillin (6 micrograms), Ampicillin (10 micrograms), Erythromycin (15 micrograms), Oxacyllin (5 micrograms), Streptomycin (50 micrograms), Tetracycline (50 micrograms), Chloramphenicol (50 micrograms), Rifampicin (6 micrograms), and Kanamycin (30 micrograms) and by MIC determination to Penicillin and Erythromycin. 30% of S. pneumoniae strains were resistant to Penicillin and Erythromycin corresponding to a MIC > or = 1 UP/ml or > or = 1 microgram E/ml. The most active antibiotics were Chloramphenicol and Rifampicin and the less active: Tetracycline, Kanamycin and Streptomycin. A relation between the origin and serotype of the strains and the sensitivity to antibiotics was revealed. The strains from the throat, conjunctive and otic secretions and belonging to serotypes 19, 6 and 14 showed the highest levels of resistance to all antibiotics. A good correlation between MIC and diffusion method results was observed to Erythromycin and no correlation to Penicillin. In this last case the results of MIC determination to Penicillin were better correlated with the results of inhibitions diameters to Oxacyllin, method which have to be recommended.

Antibiotic resistance study of invasive S.pneumoniae.

121 invasive pneumococci isolated from meningitis, septicemia, pneumopathies and other clinical infections (osteo-arthritis, peritonitis, sinusitis, otilis, conjunctivitis, plagues) were screened for susceptibility to penicillin G (P), erythromycim (E), chloramphenicol (Cl), tetracycline (T), ceftriaxone (Cro), and sulfametoxazole trimethoprim (SxT) by diffusimetric method, by MICs to P and Cro by agar dilutions and E-test. 48.8% were penicillin resistant (MICs > 0.12 microgram/ml), 22.7% being highly resistant (MICs 3-8 micrograms/ml). Any strain was resistant to P only, but patterns with P included were frequent (55.8%). Resistance to SxT was highest (monoresistance 25.6% as well as polyresistance 69.8%). 72.9% were resistant strains to > or = 1 antibiotic with 12 patterns of resistance (1-5 antibiotics). All of the strains were susceptible to Cro (MICs-0.003-0.5 microgram/ml). Resistance was closely correlated to serotypes 6,9,14,19,23 to site of isolation and diagnosis. Pneumococci from meningitis were 2-3 times more susceptible to P,E,Cl,T and SxT than the isolates from pneumopathies or other infections.

Bacteriological study of Neisseria strains isolated in Romania 1971-1992.

1496 Neisseria strains isolated from patients and carriers from 24 counties in Romania and Bucharest in 1971-1992 were studied. Serogroup A identified in 84.5% in 1987 shows a remarkable decrease in pre- and post-epidemic periods when serogroups B and C reach rates varying from 0 to 66.6% in 1975 for B and 38.8% in 1974 for C. Non-groupable strains were more frequently isolated in inter-epidemic periods, especially in carriers. Sensitivity to antibiotics of the meningococcal strains revealed a law rate of resistant strains, the most active antibiotics in decreasing order being: penicillin, chloramphenicol, tetracycline, ampicillin, rifampicin and erythromycin. Serogroup A was the most resistant to sulfamides as compared to the other serogroups, its resistance rate rising from 18.1% strains resistant to sulfathiazole in 1980-1985 to 60.7% in 1987 and to 83.3% in 1988.

Study of the sensitivity to antimicrobial drugs of some S. pneumoniae strains isolated from different pathological states.

76 Str.pneumoniae strains isolated from different clinical disease forms were studied for the sensitivity to antimicrobial drugs using the diffusimetric method and the dilution in agar method (MIC to penicillin). The results revealed that 44.74% of pneumococci were sensitive to penicillin, the remaining pneumococci being resistant; 18.42% showed a high resistance (MIC > or = 2 micrograms/ml). A close relationship was seen between sensitivity to penicillin on the one hand and the Pneumococcus origin and serotype on the other. As concerning the multiresistance to antimicrobial drugs, 47.4% of the strains presented resistance to > or = antibiotics belonging to different classes, the most frequent resistance pattern being P, E, Te, SxT. The most active antimicrobial drugs were vancomycin, amoxiclave, rifampicin, followed by ceftriaxone and amoxicillin.

[Current status and prospects in the diagnosis and epidemiology of streptococcal infections]. / Actualitati si perspective in diagnosticul si epidemiologia infectiilor streptococice.

In the first part of the paper the author stresses the importance, and the necessity of laboratory investigation of streptococcal infections, in view of the establishment of the clinical and of the etiologic diagnosis, for assessing the efficiency of the treatment applied, for monitoring the recovery of patients, as well as of chronic patients, and for the prevention, and detection of late complications. The complex methodology of laboratory methods of diagnosis in streptococcal infections is presented, stressing the use, and the efficiency of micromethods and of rapid techniques for diagnosis. In the second part of the paper are presented a series of data concerning the epidemiology of streptococcal infecstions in our country, as well as in other countries, with reference to various forms of the acute disease, and of late complications, stressing some particular aspects of the streptococcal infection. Morbidity indexes are presented, as well as death rates for scarlet fever, acute rheumatic fever and rheumatic cardiopathies, as well as the incidence of different serologic groups of the haemolytic type, and the fluctuation of group A serotypes, which have been prevalent over the last years in our country. In view of lowering the morbidity the author recommends an extensive surveillance, organized along the lines of a primary prophylaxis program, as well as of a secondary program of streptococcal infections in high-risk collectivities.

[Laboratory diagnosis of group D Streptococcus]. / Diagnosticul de laborator al streptococului de grup D.

After taxonomic listing of group D streptococci, the authors discuss the methodology of the bacteriologic diagnosis of infections produced by these bacteria, showing the way in which the pathological products are collected, the strains isolated and seeded. The strains are identified in two stages: (1) group identification by group antigen identification, resistance to oxacillin, development at +45 degrees, development on bilaesculin media; (2) species and variety identification by biochemical, physiologic and metabolic tests, by lysotyping and enterocinotyping. A description is given of the testing of sensitivity of the strain to antibiotics by determination of the minimal inhibitory concentration. The formulas of the media used for culture and identification are given.

The anti-MAP and anti-group A carbohydrate antibodies response in streptococcal human infections.

The streptococcal infection cases from two outbreaks were serologically examined against two components of the streptococcal cellular wall; the M associated protein (MAP), by a latex agglutination test and the group A carbohydrate (A-CHO), by passive hemagglutination technique. Many positive cases with high levels of both antibodies were found, in rheumatic fever and glomerulo-nephritis, comparatively with the acute streptococcal infections. The differences were statistically significant. The results were correlated with the ASO titres and with the dermic cellular response.

A latex agglutination test for meningococcal infection diagnosis.

Immunodiagnosis is very useful especially in cases where bacteriological diagnosis cannot be made because of the high sensitivity of Neisseria meningitidis. A sensitive reaction is described for the detection of antimeningococcal antibodies using as antigen a latex suspension specifically sensitized with saline extracts from N. meningitidis groups A, B and C. The results prove the genus, species and serotype specificity of this reaction. The method is quick and easy to carry out, even in laboratories which do not possess elaborate equipment. The latex-antigen has the advantages of stability and possibility of standardization.

[Sero-epidemiological surveillance, a method of prevention of complications of streptococcal infections]. / Supravegherea seroepidemiologica - metoda de profilaxie a complicatiilor poststreptococice

In order to find methods for the prevention and control of streptococcal infections of 711 day schoolchildren and boarders, aged 7 to 14 years, were followed up during the 1969-1973 period. The clinical and epidemiologic investigations revealed a great number of acute infections with varied clinical manifestations and high proportions of the acute articular rheumatism (3.1%) in the boarding schools as compared to the day schools (0.5%). The bacteriologic examinations confirmed and established the etiology of the cases, revealing moreover the role of carriers in maintaining and spreading the infection. The ASLO test showed persistent and high gammaglobulin titers in the children of the boarding schools, pointing to a state of hypersensitivity consequent to repeated streptococcal infections.

The immune cellular response tested by lymphocyte transformation in the streptococcal infections.

Thirty-five children between 6 and 17 years treated in the clinic for scarlet fever, rheumatic fever and other non-streptococcal infections as controls, were tested by lymphocyte transformation to four streptococcal antigens. In all cases of scarlet fever and especially of rheumatic fever the lymphocytes were better stimulated by streptococcal products than in the control group. The SO and the MAP fraction showed a good stimulating activity. The response in the rheumatic fever patients was not influenced by the steroid treatment, nor by the stage of the illness. A parallelism with high humoral and cellular responses to SO at the beginning of the acute rheumatic fever was observed, followed by a dissociation of both responses during the evolution with the maintenance of the cellular one and the decrease of the ASO titre.

[Results of the use, for a period of 3 years (1974-1977), in pilot districts, of the complex program of measures for prevention of streptococcal infections and their complications]. / Rezultatele aplicarii timp de 3 ani (1974--1977) în statiile pilot a programului complex de masuri pentru prevenirea infectiilor streptococice si a complicatiilor lor.

Starting with the year 1974 a total 11 pilot units have been organized, in as many counties in which a complex program of surveillance of streptococcal infections was applied, that had the following objectives: 1. Prevention and fight against acute streptococcal infection ; 2. Prevention of severe complications of acute rheumatic fever of rheumatic carditis and acute glomerulonephritis ; 3. Prevention of relapses of acute rheumatic fever. The establishment and verification of methods for clinical and laboratory diagnosis was followed, as well as of therapeutic techniques and dispensarization. The analysis of results obtained after the application for a period of 3 years of the program in high-risk collectivities, and in the conditions of an intensive circulation of some epidemic strains of streptococcus has shown the decrease each year of the incidence of scarlet fever, the increased efficiency of detection of acute non-eruptive (non-rash) streptococcal infections, as well as a significant decrease in the number of cases that developed a first attack of acute rheumatic fever and acute glomerulonephritis. A significant decrease was also obtained in the number of relapses and of severe evolution of rheumatic carditis, due to active detection, continuous evidence, prophylaxis and periodic control of cases with acute rheumatic fever.

Autoantibodies detected in rabbits hyperimmunized with group A, C, and G streptococcal vaccines.

Rabbits hyperimmunized with group A, C, and G streptococcal vaccines developed autoantibodies with affinities for different tissues (smooth muscle, cytoplasmic, and myocardial antibodies) and for autologous proteins (anti-albumin and anti-immunoglobulin antibodies). The presence of anti-albumin and smooth muscle antibodies, associated with a high level of immunoglobulin, suggests the development of hepatic disorders in the hyperimmunized rabbits.