Isolation of Gardnerella vaginalis from routine genito-urinary tract specimens

Routine screening of 2374 high vaginal swabs yielded 132 cultures (5.6 per cent) which were positive for Gardnerella vaginalis. Thirty-four of the strains were isolated together with Candida albicans and 46 with Trichomonas vaginalis. One hundred and twenty (90.9 per cent) of the isolates were from females between the ages of 16 and 40 years. One hundred and nineteen (90 per cent) patients sought medical advice because of a history of discharge (88) or inflammation (31). The other 13 (10 per cent) had some other complaint or underlying disease. All 132 strains hydrolysed hippurate and fermented starch. Ninety-three (70.5 per cent) were isolated from swabs without clue cells. Seventy-seven were from nonpurulent samples; the remainder were from samples with varying numbers of pus cells. All but two strains appeared sensitive to metronidazole when tested with discs containing 50 micrograms, but none when discs contained 5 micrograms of the drug. During the study C. albicans was isolated from 571 swabs (24 per cent) and T. vaginalis was found in 112 (4.7 per cent); in 19 (0.8 per cent) swabs both were detected. Five of 71 (7 per cent) specimens of uncentrifuged urine with more than 100 pus cells/microliter and two of 30 (6.6 per cent) seminal fluids with moderate numbers of pus cells yielded moderate to profuse growth of G. vaginalis. The patients concerned were not receiving antibiotics and other significant organisms had not been found by conventional cultural techniques.     

Increased incidence of faecal coliforms with in vitro adhesive and invasive properties in patients with ulcerative colitis.

Faecal samples were collected from 23 patients with active ulcerative colitis, 15 patients with established ulcerative colitis in remission, 20 patients with active colitis of cause other than ulcerative colitis, and 20 normal control subjects. Ten coliform colonies were randomly selected from the faecal sample cultures and serotyped before the testing of each different serotype from each sample for adhesive or invasive properties on HeLa cell monolayers. In the patients with both active ulcerative colitis and ulcerative colitis in remission and those with other types of colitis one serotype tended to dominate the faecal coliform flora. In normal controls more variety was encountered. Thirty-five per cent of the patients with active ulcerative colitis and 27% of the patients with ulcerative colitis in remission had at least one adhesive or invasive faecal coliform as compared with 5% of the patients with other types of colitis and 5% of the normal controls. These findings are significant (P < 0.05) and may have aetiological and therapeutic significance.     

Seroepidemiological study of malaria in a rural population of Chandigarh

A total of 1689 peripheral blood smears and serum samples were collected from healthy subjects from four villages of U.T. Chandigarh during the pre-monsoon season (February to May 1987) while 1809 such samples were collected during the post-monsoon season (October 1987-January 1988). None of the peripheral blood smears examined by Giemsa and acridine-orange stains showed malarial parasite. Out of 1689 serum samples tested by indirect haemagglutination (IHA) test during pre-monsoon season, 81 per cent showed malarial antibody titres of less than 1:8 and only 19 per cent showed titres of 1:8 or above. In contrast, out of 1809 serum samples tested during post-monsoon season, 58.3 per cent showed antibody titres of less than 1:8 while 41.6 per cent samples showed titres of 1:8 and above. Total number of malaria cases from these villages from June 1987 to January 1988 was also low (total 65 cases) as compared to corresponding period of previous year (total cases 191). Serological findings independent of positive cases of malaria suggest that though, no proved clinical cases of malaria were observed in the population surveyed, malaria transmission had certainly taken place as evidenced by higher antibody titres observed during the post-monsoon season compared to pre-monsoon season.     

Lactobacillemia--report of nine cases. Important clinical and therapeutic considerations

Serious infections due to lactobacilli have been rarely cited. We report our findings in nine recent patients with lactobacillemia. In the combined literature and current experience, endocarditis and sepsis from localized suppuration were the most common clinical syndromes, most frequently arising from prior oropharyngeal infections. Lactobacillus endocarditis showed a predilection for left-sided cardiac involvement (100 per cent) and systemic arterial embolization (55 per cent). The nine clinical isolates were tested for minimal inhibitory and bactericidal concentrations (MICs and MBCs) against five drugs with broad gram-positive spectrums; of note, these organisms demonstrated a high incidence of both unachievable MBCs (64 per cent) and widely disparate (greater than 100 fold) MIC:MBC ratios (38 per cent). This is in accord with observations in Lactobacillus endocarditis of poor in vivo clinical response despite "appropriate" regimens and achievable MICs of the organisms. Bactericidal synergistic studies on two endocarditis isolates indicated that the penicillins plus aminoglycosides may be potentially useful in the treatment of deep-seated Lactobacillus infections when single antimicrobials fail to achieve a cure.     

Seroepidemiological study of Japanese encephalitis in Dimapur, Nagaland

A seroepidemiological study of Japanese encephalitis (JE) in Dimapur, Nagaland was carried out following an outbreak of the disease between July, 1985 and February, 1986. Altogether 50 persons were affected with 30 (60 per cent) deaths. The attack and death rates per 1000 were more in Nagas viz. 0.55 and 0.34 than non-Nagas viz. 0.33 and 0.20 respectively. All ages and both sexes were affected. Of the nine mosquito species encountered Culex vishnui showed the highest density (44.5/MH). Culture of mosquito pool did not yield any viral agent. A total of 311 serum samples comprising 95 humans, 166 animals and 50 birds were tested for the presence of haemagglutination inhibition (HI) antibodies against Chikungunya and three flavirus antigens, viz. JE, WN and DEN-2. The overall flavivirus HI antibody in humans was positive in 26 (27.3 per cent) almost identical to JE antibody prevalence. The per cent positivity of HI antibodies to JE, WN and DEN-2 were 42.2 per cent, 22.2 per cent and 13.3 per cent in the affected and 14.2 per cent, 10 per cent and 6 per cent in the unaffected area. The activity of Alpha (Chikungunya) virus though very low was significantly higher (chi 2 = 5.57) in the affected area. The prevalence of JE antibody was 77.7 per cent in dogs, 52 per cent in cattle, 34 per cent in pigs and 21.1 per cent in goats. Of the five species of birds, flavivirus and JE antibodies were detected in 21.4 per cent pigeons and 22.2 per cent heron egrettes. Neutralisation test established the distinct role of JE virus over other related flavivirus antigens.     

A bacteriological study of some frozen and nonfrozen foods.

Over a period of 19 months, a total of 331 food samples were submitted to the Food Section of the Bacteriology Division for bacteriological examination. These included 184 samples of frozen seafoods from exporters and 147 samples of fresh, nonfrozen foods from food caterers. The total bacterial count for frozen seafoods ranged from 1 x 10(2) to 2.98 x 10(6) per gm with a mean of 2.14 x 10(5) per gm. Coliforms, Escherichia coli and Staphylococcus aureus were present in 48.9%, 3.3% and 8.2% of the samples examined respectively. Two of the cooked prawn samples showed the presence of Vibrio parahaemolyticus. For the fresh, nonfrozen foods, the total bacterial count ranged from 1 x 10(2) to 3.87 x 10(6) per gm with a mean of 2.58 x 10(5) per gm. The examination also showed that 74.8% were coliform positive, 14.9% were E. coli positive, and 4.8% were S. aureus positive. V. parahaemolyticus was not isolated in any of the samples tested. Other pathogens, namely, Vibrio cholerae, Salmonella and Shigella were not isolated from any of the foods examined. The bacterial levels in these foods were determined and their sanitary and public health significance is discussed.     

Monitoring of temephos (abate) application as a cyclopicide under the guineaworm eradication programme in India.

Temephos application in unsafe water sources at a dose of 1ppm, which started in 1986, is an important activity of the guineaworm eradication programme in India. During March 1989, monitoring of temephos application was carried out in six villages in each of the five guineaworm endemic districts: Kurnool (Andhra Pradesh), Gulbarga (Karnataka), Dhar (Madhya Pradesh), Thane (Maharashtra) and Jhalawar (Rajasthan), selected for the study. Out of 62 unsafe water sources targeted in the sampled villages for temephos treatment, 43 were treated during 1989 in the five districts (coverage 69.35 per cent). Out of these 43 treated sources 79.1 per cent were free of cyclops and the rest 20.93 per cent showed a variable cyclops count. 117 adult cyclops identified from these sources included Mesocyclops byalinus (82) and M. leuckarti (35). People's perception of utility of chemical treatment of water sources varied from negligibly low to moderate levels. Those areas which received timely application of temephos during the preceding year, al sharp decline in the number of cases in 1989 was observed. However, in those villages where no temephos was applied or where application was started as late as April or May, there was no impact on prevalence of the disease.     

Incidence of hepatitis B antigen in Mangalore

A random survey of 360 patients suffering from hepatitis and 90 patients suffering from suspected glomerulonephritis was carried out for HBs Ag by micro ELISA method. One hundred and twenty-four positive results were obtained in case of hepatitis, out of which 76 (35.19 per cent) were males and 48 (33.33 per cent) were females. The highest prevalence of HBs Ag was found in the age group of 21-30 (62.5 per cent) followed by 31-40 (46.15 per cent) and least between 11-20 (11.11 per cent). Comparatively it was found more common in Hindus followed by Muslims and Christians. All 90 cases of glomerulonephritis were negative for HBs Ag. A comparative study of ELISA test with CIEP in detection of HBs Ag was done in all ELISA positive samples. ELISA was found far more sensitive than CIEP.     

Prevalence of toxoplasma antibodies among women with BOH and general population in Delhi

One thousand and thirty-six serum samples obtained from women with bad obstetric history (BOH) were subjected to detection of toxoplasma antibody by indirect immunofluorescent antibody test (IFAT) using whole promastigotes of Rh strain of Toxoplasma gondii as antigen. Thirtyone (2.99 per cent) samples were found to be positive (titre greater than or equal to 1:64). Of these 31 patients' sera 27 (87.09 per cent) showed rising titre of antibody when second samples were drawn after 4 weeks. Two hundred serum samples from general population were also assayed and only 2 (1 per cent) were found to be having toxoplasma antibodies in titre of 1:64. The observations suggest low prevalence of toxoplasmosis in and around Delhi which is in consonance with the food habits of local people and their infrequent contact/association with cats.     

Seroprevalence of brucellosis in man

A total of 352 human serum samples were screened for brucellosis. A combination of serological tests including Rose Bengal plate test (RBPT), standard tube agglutination test (STAT) and dot-enzyme linked immunosorbent assay (dot-ELISA) were employed for the purpose. The study revealed a prevalence rate of 4.97 per cent in samples that included specimens from persons occupationally exposed to animals. The number of seropositives through all tests used was higher among males (5.95 per cent) than females (3.15 per cent). A markedly higher prevalence of 17.39 per cent was recorded among field veterinarians. A low prevalence (2-6 per cent) was observed in humans with unknown history of animal contact. Dot-ELISA yielded 4.97 per cent positives compared to 1.38 and 0.82 per cent through RBPT and STAT respectively.     

Effect of fermented soy milk on the intestinal bacterial ecosystem

AIM: To investigate the effect of fermented soy milk on human ecosystem in the intestinal tract by way of examining the population of different microorganisms isolated from fecal samples. METHODS: A crossover experimental design was applied. Twenty-eight healthy adults completed this experiment. Each subject consumed 250 ml, twice a day between meals, of either fermented soy milk or regular soy milk first for 2 wk, then switched to the other drink after 2 wk. Fecal samples were collected from all subjects every week starting from the second week to the end of the experiment. The microorganisms analyzed were Bifidobacterium spp., Lactobacillus spp., Clostridium perfringens, coliform organisms, and total anaerobic organisms. RESULTS: In the period of fermented soy milk consumption, the populations of Bifidobacterium spp. and Lactobacillus spp. increased (P<0.05) as well as the ratios of Bifidobacterium spp. and Lactobacillus spp. to Clostridium perfringens (P<0.05). The population of coliform organisms decreased (P<0.05) when subjects were in the period of fermented soy milk consumption. CONCLUSION: Intake of fermented soy milk significantly improved the ecosystem of the intestinal tract in the body by increasing the amount of probiotics.     

Studies on anthrax in food animals and persons occupationally exposed to the zoonoses in Eastern Nigeria

A total of 221 blood and 174 carcase swab samples obtained from food animals (cattle, sheep, goats, pigs and horses) slaughtered at urban and rural slaughter houses in Nsukka area were studied. 51 blood samples and 180 samples of vesicle fluid were also collected from persons occupationally exposed (butchers/skinners, meat retailers, meat inspectors, veterinarians and tanners) to these animals and their products. All the samples were studied culturally and microscopically. Confirmation of infection was by subcutaneous inoculation of guinea pigs and mice with samples of human and animal blood, carcase swabs and vesicle fluid got from suspected cutaneous lesions on the hands of persons studied in this survey. Of the blood samples obtained from food animals, 5 per cent (3/60) of cattle and 3.3 per cent (1/30) of sheep were positive. The rest of the blood samples from other animals were negative. For the carcase swab samples, 5.7 per cent (5/88) from cattle and 3.1 per cent (1/33) from sheep were positive. The rest of the carcase swabs from goats, pigs and horses were negative. Only the blood samples from butchers/skinners, 20 per cent (2/10), meat retailers, 9.1 per cent (1/11) and tanners, 11.1 per cent (1/9) were positive. Malignant pustule was confirmed in 13.3 per cent (6/45) of butchers/skinners, 10 per cent (3/30) of tanners and 6 per cent (3/50) of meat retailers. The results show that food animals and their products constitute a potential danger to those persons whose occupation necessitates handling animal products or contact with animals.(ABSTRACT TRUNCATED AT 250 WORDS)     

Hospital-acquired fungemia. Its natural course and clinical significance.

Eighty-five episodes of hospital-acquired fungemia in 77 adult patients were reviewed. The predominant risk factors associated with fungemia were prior antibiotic therapy (100 per cent), indwelling intravenous (100 per cent) and Foley catheters (97 per cent), concomitant bacterial infections (88 per cent), recent surgery (69 per cent) and parenteral hyperalimentation (66 per cent).The clinical picture was indistinguishable from sepsis of a bacterial origin. Laboratory data were nonspecific. Hence, diagnosis could only be made by blood culture. Patients followed one of four clinical courses: (1) spontaneous resolution of fungemia (42.8 per cent), (2) endophthalmitis after apparent spontaneous resolution of fungemia (5.1 per cent), (3) illness of a severity or duration requiring antifungal therapy (including the five patients in category 2) (36.3 per cent), or (4) no antifungal therapy and death from fungemia (20.7 per cent). Endophthalmitis was documented in 14 per cent of the patients with fungemia. The over-all mortality was 56 per cent whereas 29 per cent died as a result of fungemia.The data suggested that fungemia of a duration of greater than 72 hours, evidence of endophthalmitis or critically ill clinical status were all reasons for instituting amphotericin B therapy. Speciation of Candida organisms may be important, as patients with nonalbicans Candida fungemia were less likely to require antifungal therapy than patients with Candida albicans fungemia. All patients with fungemia require routine periodic ophthalmologic examinations.     

Persistence of Vibrio cholerae in inter epidemic period--preliminary observations on analysis of water

Out of the 61 water samples collected from hand pumps and wells from cholera endemic areas of Varanasi City, Vibrio cholerae non 01 was detected in only one sample. However, seven (18.9 per cent) samples out of 37 samples of river water were positive for V. cholerae non 01. None of the samples showed Vibrio cholerae. These observations indicate transmission and dilution of Vibrio cholerae bacillus in environment.     

Advantages of cytodiagnostics in ascites (author's transl)

Investigations were made on 253 patients. In 44 patients with peritoneal carcinosis, cell imprints and histological investigations of tissues from the changes in the peritoneum, taken during laparoscopy have been performed. In 122 out of 151 patients with neoplastically stipulated ascites (80.8 per cent) tumour cells have been found in the ascitic fluid. The false negative results represented 19.8 per cent and the false positive results--2.0 per cent. In all cell imprints from peritoneal tissues tumour cells have been detected even when these were absent in the ascitic fluid. In 2 out of 49 patients (4 per cent) the histological investigation of bioptic material from the peritoneum showed no neoplastic changes. The activity of gamma-glutamyltransferase and alkaline phosphatase in the ascitic fluid of patients with carcinosis was higher than in the remaining patients, whilst the 5'-nucleotidase did not show particular deviations. The cytologic method was well tolerated by the patients and showed higher specificity, sensitiveness, simplicity and realization and in 80.8 per cent solved the diagnostic problems and made useless the application of other labour-consuming, burdensome and more expensive methods of investigation.     

Randomized trial of empiric antibiotic therapy with ticarcillin in combination with gentamicin, amikacin or netilmicin in febrile patients with granulocytopenia and cancer.

A randomized trial of ticarcillin plus gentamicin (group 1), ticarcillin plus amikacin (group 2) and ticarcillin plus netilmicin (group 3) as empiric antibiotic therapy in patients with granulocytopenia and cancer was carried out at the Baltimore Cancer Research Center. The response rate for all infections was 97 per cent in group 1, 91 per cent in group 2 and 95 per cent in group 3. Patients with bacteremias showed improvement in 93 per cent (group 1), 78 per cent (group 2) and 82 per cent (group 3) of cases. All failures were among patients with gram-negative bacteremias. Both antibiotic susceptibility of the bacteremic organism and granulocyte recovery correlated with patient improvement. Nephrotoxicity and ototoxicity were rare and were not significantly different in three groups of patients. Therefore, ticarcillin plus gentamicin, ticarcillin plus amikacin and ticarcillin plus netilmicin appear to be equally efficacious and minimally toxic in this patient population. Excellent over-all results can be expected with these combinations provided the etiologic agent is susceptible.     

The relationship between frequency of ventilator circuit changes and infectious hazard.

The relationship between frequency of ventilator circuit changes and risk of ventilator-associated pneumonia was studied using 2 independent approaches. The first was an in-use aerosol contamination study with patients on 8-hour, 16-hour, or 24-hour ventilator changing schedules. The second approach was a study comparing the incidence of pneumonia in patients on ventilators for 2 one-year periods when the ventilator circuit changing time differed. In-use aerosol sampling of 513 ventilator treatment periods showed bacterial contamination greater than 100 organisms per aerosol in 1.8 per cent of 8-hour cycles, in 2.5 per cent of 16-hour cycles, and in 5.4 per cent of 24-hour cycles. These differences were not significant. The incidence of ventilator-associated pneumonia was the same for one-year periods when ventilator circuits were changed either every 8 or every 24 hours. It was concluded that changing ventilator circuits every 24 hours provides adequate protection from ventilator-associated pneumonia.     

Inhibitory effect of natural honey on Helicobacter pylori

Honey is widely used in folk-medicine throughout the world. However, it has a limited use in modern medicine due to lack of scientific support. Based on some recent reports, an in vitro study was undertaken to evaluate its antibacterial activity on Helicobacter pylori and a few other pathogenic organisms. All isolates of H. pylori were inhibited by 20 per cent of honey. Most of the other bacteria examined (including both Gram-positive and Gram-negative) were also inhibited at concentrations of 20 per cent of honey; and half of them were inhibited by 10 per cent of honey. Furthermore, it was observed that some isolates were resistant to various antimicrobial agents but honey inhibited these organisms and the sensitive ones equally. Our study advocates carrying out clinical investigation of the effect of honey on gastroduodenal disorders colonised by H. pylori.     

Can septicemia and ascitic fluid infections in cirrhotic patients be treated by the oral route alone?

The aim of this study was to determine the efficacy of oral antibiotics in the treatment of severe infections in cirrhosis. Twenty-two patients (17 males, 5 females) with spontaneous bacteremia (n = 7) or bacterial peritonitis (n = 15) were treated with oral pefloxacin 400 mg per 24 hr alone (n = 1) or in combination with another oral antibiotic, trimethoprimsulfamethoxazole (n = 13), amoxicillin (n = 6), cefadroxil (n = 2), or metronidazole (n = 1). In patients with spontaneous bacteremia, all organisms were found to be sensitive to oral antibiotics, and a favorable response was elicited in 6 out of 7 (86 p. cent) within 3 days (mean) of treatment. In patients with spontaneous peritonitis, ascitic fluid cultures were positive in 11 cases, and organisms were sensitive to pefloxacin in 9 out of 11 cases. A favorable response was elicited in 13 out of 15 within 2 to 8 days of treatment. Fourteen patients died (64 p. cent), 3 of infection (bacteremia n = 1, peritonitis n = 2), and 11 patients of causes unrelated to infection, mainly variceal hemorrhage, hepatorenal syndrome or hepatocellular carcinoma, although the clinical symptoms of infection were controlled. One-year survival was 57 p. cent in patients with bacteremia and 33 p. cent in those with bacterial peritonitis. Oral treatment was well tolerated in all patients. We suggest that most bacteremia and spontaneous bacterial peritonitis in cirrhotic patients can be treated with oral antibiotics. In some patients, this may be accomplished on an out patient basis.     

Review of 152 patients with bacteremias treated wih amikacin

The efficacy of amikacin treatment of 152 patients with bacteremia was reviewed from case reports submitted by 53 investigators. Eighty-one per cent of these patients had a favorable outcome; 73 per cent were cured and 8 per cent partially cured. Analysis of the 29 treatment failures revealed that the majority (21) were in patients with either pneumonia, leukemia or mixed aerobic-anaerobic infections. Forty-five patients were infected with gentamicin-resistant organisms; 66 per cent of these patients were cured following amikacin therapy, and 14 per cent had a partial cure. These results indicate that amikacin is effective in the therapy of gram-negative bacteremia, even in seriously ill patients with gentamicin-resistant pathogens.