CHLAMYDIAL INFECTIONS

SUMMARY Chlamydiae are among the most successful bacterial pathogens, and there are few branches of medicine on which chlamydial infection and its sequelae do not impinge. Chlamydia trachomatis is responsible for many million cases of blindness, pelvic inflammatory disease, urethritis, epididymitis, infertility and ectopic pregnancy annually; it also causes lymphogranuloma venereum, reactive arthritis, ophthalmia neonatorum and infantile pneumonia. C. pneumoniae is among the most common causes of community-acquired pneumonia, and recent evidence suggests that it may play a part in the pathogenesis of coronary heart disease. C. psittaci is a highly prevalent zoonotic infection with a wide host range. It is of great economic importance, and causes sporadic but sometimes devastating disease in humans. Most chlamydial infections are subclinical, but even if the initial illness is mild there may be serious long-term sequelae. It is therefore important to identify and treat chlamydial infections in their early stages, but diagnosis usually depends on laboratory tests. Recent trials have shown that single doses of the long-acting macrolide azithromycin are effective in the treatment of genital and ocular C. trachomatis infection, but longer courses of antimicrobials remain the mainstay of treatment for C. pneumoniae and C. psittaci infections.     

消毒供应中心物流过程中的感染控制关键点

目的建立消毒供应中心物流过程医院感染控制关键点程序。方法采用制定关键点控制程序,贯彻实施关键点控制管理。结果消毒供应中心实施回收、清洗、包装、消毒灭菌、储存发放和物流控制等6个关键点管理,可以确保可靠的无菌物品质量。实施密封回收,可避免污染扩散;严格的清洗,可保证消毒与灭菌效果;正确的包装,不仅满足了灭菌要求,也便于储存和安全输送;合格的灭菌质量,保证医院感染控制的有效性;无菌储存发放及安全的物流控制,可有效防止无菌物品损坏和再污染。结论医院消毒供应中心实施物流过程感染控制程序,可明显提高供应室无菌物品管理质量。     

INTRACEREBRAL HAEMORRHAGE IN A YOUNG ADULT: CONSIDER AMPHETAMINE ABUSE

SUMMARY We present the case of a young female who suffered a massive intracerebral bleed following the ingestion of a small quantity of amphetamine (speed). Physicians should be aware that amphetamine abuse can lead to cerebrovascular events in young adults.     

LYMPH PRESSURES IN STERILE INFLAMMATION

1. The normal lymph pressure in the legs of anesthetized dogs is not measurable. 2. The maximum pressure of lymph in the quiescent leg under conditions of sterile inflammation is around 120 cm. of lymph. 3. Venous pressure rises immediately in a region subjected to sterile inflammation and then slowly returns to normal. The rise in lymph pressure follows the rise in venous pressure. 4. Changes in lymph flow, lymph pressure, and protein concentration of the lymph occur when the part producing lymph is subjected to external temperatures between 50° and 60°C.     

包外加无菌塑料袋与否的灭菌器材无菌存放期

为了解压力蒸汽灭菌后的器材包外加封无菌塑料能否延长无菌期,于存放不同时间取样,进行无菌检测。结果,加无菌塑料袋密封的器材包,于无菌间放置１３周,包内器材仍无菌;未加塑料袋者仅能维持５周无菌。加无菌塑料袋密封保存,可延长器材无菌期,减少重复灭菌次数。     

医院灭菌包装材料成本效益分析

目的了解国内医用包装材料使用成本效益状况,推动医用灭菌包装材料科学使用。方法采用问卷调查方法,对国内部分医院医用包装材料使用情况进行了调查。结果所调查的6所医院中,有3所医院基本淘汰了棉布包装材料,改用硬质灭菌盒。以1万台手术量计算,棉布包装材料投入费用为21.07万元,硬质灭菌盒包装材料投入费用为8.74万元,每进行一台手术可节约经费12.33元。结论硬质灭菌盒贮存有效期长,且与纯棉包布包装材料相比可大幅度节省成本费用。     

STUDIES ON PNEUMOCOCCUS INFECTION IN ANIMALS : SECOND PAPER: ACTION OF IMMUNE SERA ON PNEUMOCOCCUS INFECTION.

From the results of this study of the action of immune sera on pneumococcus infection it is evident that immune sera vary greatly in their curative value. Immune sera possess protective action, but protective action is not necessarily indicative of curative action. Treatment with the serum of normal rabbits may prolong the course of pneumococcus infection in the rabbit. This action, however, is slight and not always manifest. Sera from animals immunized with dead pneumococcus cells which had been washed free from their products, failed to exert materially greater curative action than normal sera. Sera from animals immunized with culture filtrates free from pneumococcus cells possessed, in some instances, a slight curative value, but often this curative action was not apparent. In animals actively immunized, however, the presence of an immunity to culture filtrates was readily demonstrated. In the immunity produced by injections of dead culture material the strength was not sufficiently exalted for the sera to possess a practical curative value. It was only after immunization with virulent living cultures that the blood serum acquired marked curative action. After pneumococcus infection in the rabbit had become established, treatment with this serum induced crisis and cured the animals. From the results of the study of the mechanism of recovery it is evident that, despite the fact that virulent pneumococci are singularly insusceptible to the action of immune sera in the test-tube, pneumococcus infection nevertheless conforms to the general law of infection. Diphtheria and tetanus organisms give rise to powerful toxins, but the parasitism of these organisms is slight and their development is localized. Diseases produced by these organisms are toxemias and neutralization of their toxins by antitoxin puts an end to the disease. The pneumococcus gives rise to toxic substances which are less active or are active only in the body tissues, but the parasitism of this organism is marked and its development is rarely localized. Nevertheless, the manifestations of the disease arise from the action of the bacterial poisons on the tissues. The neutralization of the pneumococcus poisons by immune serum puts an end to the symptoms of the disease, but the pneumococci survive as harmless parasites until destroyed by lysis or phagocytosis. The neutralization of the pneumococcus poison may take place suddenly and completely as in crises; or, it may be incomplete with exacerbations of infection, as in lysis. Crisis, as it occurs in the lobar pneumonia of man and in the bacteriemia of the rabbit, is simply one phase of recovery, and recovery does not differ fundamentally, whether it is sudden and complete as in crisis, or incomplete and prolonged as in lysis, or whether the pneumococci are destroyed by lysis extracellularly as in the rabbit, or intracellularly as in the phagocytosis of the dog and man. Since the recovery of animals from pneumococcus infection differs in no essential from that of man, since the unaided protective mechanism of man as compared with that of susceptible animals is exceptionally efficient, and since it is possible by treatment with sera from animals highly immunized with living cultures of virulent pneumococci to cure pneumococcus infection in the most susceptible animals, it is difficult to conceive of the infection in man failing to yield similarly to the administration of such sera.     

A MECHANICAL MEASURING INSTRUMENT FOR STERILE LIQUIDS

An instrument is described by which aliquot portions of a liquid may be mechanically measured and delivered. It was devised especially for use in immunological experiments, to take the place of a graduated pipette in setting up serum tests. The instrument may be set for any quantity within its capacity and measures sterile liquids without danger of contamination. It may therefore find a wider application in other procedures requiring sterile measurements of small amounts of liquid.     

MICROBIAL PERSISTENCE : II. CHARACTERISTICS OF THE STERILE STATE OF TUBERCLE BACILLI

The capability of tubercle bacilli to assume a long continued sterile state in the tissues when exposed to pyrazinamide and isoniazid is a highly specific drug-microbe phenomenon in which host participation is not critical. Although it is the pyrazinamide that possesses the sterilizing type of action, the role of the isoniazid is specific and essential. The isoniazid serves to convert a phenomenon that occurs irregularly with pyrazinamide alone into one that occurs with a high degree of uniformity. The observations suggest a competition between isoniazid and the pyrazinamide (or its parent nicotinamide) for a site or entrance in or on the tubercle bacilli and for sterilization, the isoniazid apparently must reach the site first. The rare failures to attain complete sterilization, appear to depend on the emergence of pyrazinamide-resistance which prevents the necessary dependent action of the two drugs. Populations already in the sterile state are nevertheless subject to a continued drug influence. Whether this represents a direct action on the sterile bacilli or an indirect effect produced by making the environment hostile to microbial revival, cannot be determined from the present observations.     

METHEMOGLOBIN FORMATION BY STERILE CULTURE FILTRATES OF PNEUMOCOCCUS

1. Sterile filtrates of aerobic cultures of pneumococcus which contain hydrogen peroxide are capable of converting catalase-free solutions of crystalline oxyhemoglobin into methemoglobin. This action is dependent upon the hydrogen peroxide in the filtrates and occurs only in the absence of blood catalase. 2. In catalase-containing solutions of hemoglobin from laked corpuscles, the actual methemoglobin-forming system of Pneumococcus involves a labile constituent of the bacterial cell. This intracellular substance is itself susceptible to oxidizing agents and may be rendered inactive, if exposed to peroxide or similar substances previous to its introduction into oxyhemoglobin solutions. The activity of this function in the case of sterile filtrates of pneumococcus cultures depends, therefore, upon the liberation of cell constituents into the medium and upon the protection of these cellular substances from the oxidizing agents which are formed when pneumococcus cultures are freely exposed to air. When these cultural conditions are fulfilled sterile culture filtrates of Pneumococcus convert oxyhemoglobin into methemoglobin independent of the presence of blood catalase.     

OBSERVATIONS ON THE OXIDATION-REDUCTION PROPERTIES OF STERILE BACTERIOLOGICAL MEDIA

Sterile plain broth contains an active oxidation-reduction system, the characteristics of which have been analyzed. 1. Intensity factor: Under vaseline seal, the lot of broth used in these experiments reaches a reduction potential corresponding to reduced indigo disulfonate (rH = 10). All the indicators with a more positive E₀'' are reduced, the others are not affected. It seems probable that fresh broth, which has not undergone oxidation by molecular oxygen, would give a higher reduction potential. 2. Capacity factor: The maximum amounts of different indicators that can be reduced correspond to equimolecular concentrations. This seems to indicate either (a) that the broth does not contain several "independent" reducing systems (at least in appreciable amounts), or (b) that these hypothetical "independent" systems all have about the same reduction potential. 3. Time factor: The different indicators of oxidation-reduction potentials are reduced in the order of the electromotive series. 4. Nature of the system: The system seems to be reversible (this not excluding the possibility of irreversible autoxidations) and does not appear to be of the nature of a sugar. The relation of these phenomena to the cultivation of different species of bacteria will be reported later.     

UDDER INFECTION WITH STREPTOCOCCI OF THE SCARLET FEVER TYPE : I. SPONTANEOUS AND EXPERIMENTAL UDDER INFECTION.

The clinical and bacteriological findings in two cows the udders of which became infected under natural conditions with hemolytic streptococci of the scarlet fever type are discussed. One of the cows was found in a herd supplying raw milk to a small town where a milkborne outbreak of scarlet fever had occurred a short time before. When small numbers of the streptococcus obtained from this case were injected into the udder of a normal cow severe mastitis accompanied by a well marked general reaction resulted. Evidence leads to the conclusion that a severe attack of mastitis due to this organism in one quarter does not sufficiently immunize the other quarters to protect them completely since the streptococcus can be readily implanted in them. The secondary infections were much milder than the original process.     

EXPERIMENTAL TRANSMISSION OF INFLUENZA VIRUS INFECTION IN MICE : III. DIFFERING EFFECTS OF IMMUNITY INDUCED BY INFECTION AND BY INACTIVATED INFLUENZA VIRUS VACCINE ON TRANSMISSION ON INFECTION

Immunization of mice by infection or intraperitoneal injection with homotypic A₂, heterotypic A₀, or recombinant A₀A₂ virus have differing effects on transmission of influenza A₂ virus infection. Immunization by infection with A₂ virus resulted in refractoriness to reinfection either by artificial aerosols or by exposure to infected cage-mates. Immunization by inoculation with inactivated A₂ virus vaccine resulted in a decreased susceptibility to transmitted infection in immunized contacts, but following A₂ virus challenge, transmission of infection by immunized infectors was not altered. Immunization by infection with influenza A₀ virus or recombinant A₀A₂ virus resulted in a decreased susceptibility to transmitted A₂ virus infection in immunized contacts, and to decreased transmission after A₂ virus infection in immunized infector mice. These differing effects on transmission of infection are attributed to differences in specific local immunologic responses following the various immunization procedures.     

PRIMARY PULMONARY COCCIDIOIDOMYCOSIS : EXPERIMENTAL INFECTION WITH COCCIDIOIDES IMMITIS

1. The literature concerning inhalation infection with Coccidioides immitis is briefly reviewed. 2. A laboratory technique for exposing animals to inhalation of the spores of Coccidioides immitis is described. 3. Primary pulmonary infection was produced in 42 per cent of 72 animals exposed by this method. 4. No marked weight loss was apparent in the animals infected. 5. Skin tests with coccidioidin were not entirely satisfactory in diagnosis. Positive skin tests with coccidioidin were obtained in many of the infected animals, but inconsistencies occurred. 6. The gross and microscopic lesions are briefly described and illustrated.     

EXPERIMENTAL TRANSMISSION OF INFLUENZA VIRUS INFECTION IN MICE : II. SOME FACTORS AFFECTING THE INCIDENCE OF TRANSMITTED INFECTION

Evidence has been presented that with the experimental model described, infected mice vary in their ability to transmit influenza virus infection. This variation is not explained by differences in titers of influenza virus in the nose, throat, trachea, or lungs of good transmitters. Older mice acquire transmitted influenza virus infection more readily than younger mice. Seasonal variations in the incidence of transmitted influenza virus infection occur.     

医院感染现患率调查情况分析

目的了解医院感染的横断面情况,为提高医院感染管理水平提供依据。方法采用病房查看和查阅临床资料的调查方式,填写个案调查表,对全院所有住院患者进行1天的医院感染横断面调查。结果共调查当日住院病人1254例,发生医院感染病人86例,现患率为6.86%。发现社会感染病人255例,感染率为20.33%。医院感染部位构成中,呼吸道感染居首位,其次为手术切口感染。结论通过医院感染现患率调查,发现了医院感染管理中存在的问题,可以有针对性地加强医院感染管理。     

CELLULAR RESISTANCE TO INFECTION

The mouse was found to be natively susceptible to Listeria monocytogenes. Its susceptibility was attributed to the capacity of the organism to survive and multiplying in host macrophages. During the first 3 days of a primary infection the bacterial populations of spleen and liver were found to increase at a constant rate. On the 4th day of infection the host became hypersensitive to Listeria antigens and at the same time bacterial growth ceased. A rapid inactivation of the organism ensued. Convalescent mice were resistant to challenge, but no protective factor could be found in their serum. Histological evidence suggested that acquired resistance was the result of a change occurring in the host's mononuclear phagocytes. When challenged in vitro, the macrophages of convalescent mice were found to resist infection with Listeria monocytogenes. Listeria-resistant cells appeared during the course of infection at a time which corresponded with the development of the antibacterial mechanism in the spleen. They persisted for as long as the antibacterial mechanism remained intact in this organ. This period of absolute resistance to Listeria lasted about 3 weeks. Thereafter, the host remained hypersensitive but unable to inactivate a challenge inoculum of Listeria. However, it remained capable of producing an accelerated response to reinfection. This was thought to depend upon an ability to generate a new population of resistant cells from a residuum of specifically sensitized macrophages or macrophage precursors still surviving in the tissues as a result of the immunological activation which occurred during the primary infection.     

医院感染状况分析

近年来,随着现代医学的发展,院内感染越来越受到国内外的重视。美国从20世纪50年代开始对院内感染控制进行研究,到70年代已成立了全美国医院内感染监控网,并将院内感染率控制在5％左右。我国院内管理监控工作较晚,到1986年才成立了全国医院感染监控系统,并将院内感染控制在10％左右。     

STUDIES OF MOUSE POLYOMA VIRUS INFECTION : V. RELATION OF VIRUS INFECTION TO LYMPHOCYTIC NEOPLASMS OF THE MOUSE

The relationship of polyoma (parotid tumor) virus infection to spontaneous and x-ray induced lymphocytic neoplasms (leukemia) in mice has been studied in two sublines of the high leukemic AKR strain, in the high leukemic C58 strain and in the x-ray responsive C3Hf/Bi strain. There was found to be no correlation of hemagglutination-inhibiting (HI) antibody with leukemia appearing at various times throughout life, and there was no evidence of increased risk of developing leukemia in mice with prior antibody to polyoma virus. Virus isolation experiments accomplished with AKR leukemic mice showed that HI antibody status of these mice had the same significance with regard to presence or absence of detectable virus as was previously observed for non-leukemic mice from infected colonies. The results of this study were interpreted as supporting the concept that the repeated association of polyoma virus and experimental transmission of leukemia is fortuitous.