Daniel Ivler

Meningitis due to Listeria monocytogenes. A review of 25 cases.

Abstract Twenty-five patients with bacteriologically proved Listeria monocytogenes meningitis were studied. Twenty-one were male. Nine of the 25 were neonates, and 11 were 55 years of age or older. Twenty-four patients received either ampicillin or penicillin, at times in combination with other antibiotics. One of the ampicillin-treated patients, and six of the penicillin-treated patients died. Recovery of the patient from meningeal infection seemed to correlate best with an initial cerebrospinal-fluid glucose level over 30 mg per 100 ml. These data, like those already appearing in the literature, suggest that intravenous ampicillin may be the therapy of choice, from the standpoint of both superior efficacy and relative lack of toxicity.

COMPARATIVE METABOLISM OF VIRULENT AND AVIRULENT STAPHYLOCOCCI

There is no entirely satisfactory in vitro test for virulent staphylococci. The standard tests (e-g., coagulase, alpha hemolysin) have been closely associated with pathogenicity of isolates for man and animals, but they are subject to variation. Coagulase-negative strains, for example, frequently cause human disease, especially in debilitated individuals (Quinn & Cox, 1963), and coagulase-positive strains can be isolated with ease from healthy individuals (Gillespie et al., 1939). Further, there is a paucity of information regarding the true activity of these bacterial products in viuo. Since virulence, or virulence factors, and pathogenicity are probably intimately related to the metabolic properties of a microorganism, a comparative study of the basic metabolic activities of “pathogenic” and “nonpathogenic” staphylococcal isolates has been initiated in an attempt to uncover fundamental metabolic markers of virulence. The present communication describes the general characteristics of endogenous respiration in coagulase-positive and negative staphylococci and documents the marked difference in the endogenous reserves of these two strains. Data are also presented to demonstrate differences in the oxidative metabolism of amino acids and the effect of glucose in the growth medium upon the oxidative capacity of resting cells.

H. INFLUENZAE MENINGITIS: A CONTROLLED STUDY OF TREATMENT WITH AMPICILLIN.

gitis, however, the drug was found in brain almost exclusively in animals with intensive signs of meningitis. Ampicillin, particularly in large doses, had a distinct therapeutic effect in experimental Hemophilus meningitis The pathological changes in the meninges corresponded to the clinical picture. In experiments with /3-streptococci and Haemophilus influenze, however, milld changes were discernible even before signs of meningitis had appeared.

Susceptibility of hemophilus influenzae, type b, to ampicillin at Los Angeles County/University of Southern California Medical Center: A reappraisal after ten years*

SINCE 1963 AMPICILLIN has been used extensively for treatment of meningitis and other infections due to Hemophilus influenzae, type b. Prior reports from this institution 1 have documented marked susceptibility of these organisms to ampicillin. Recently strains of H. influenzae, type b, resistant to ampicillin have been recognized.2. 3 Thes e reports prompted a review of the in vitro susceptibility to ampicillin and chloramphenicol of recently isolated strains compared to those isolated in earlier years. Susceptibility studies performed against groups of organisms isolated during 1971-1972 and 1974 were compared with results of similar studies 1 of strains to H. influenzae, type b, isolated ten years earlier during 1962-1964.

Direct Hemagglutination by Hemophilus influenzae.

Summary Thirty-four spinal fluid isolates of Hemophilus influenzae were found capable of directly agglutinating sheep, guinea pig and human “O” erythrocytes. The hemagglutination titer is directly related to concentration of the organisms employed in the HA test.

Twenty-eight-day courses of antibiotics for urinary tract infection

A prospective double-blind study was performed in which 30 adult patients with recurrent urinary tract infections due to Escherichia coli, and Proteus mirabilis organisms were treated by twenty-eight-day courses of either ampicillin, 500 mg. four times a day, or trimethoprim-sulphamethoxazole, 2 tablets twice a day. In terms of freedom from infection fifty-six days after the cessation of treatment in both complicated and uncomplicated infections, trimethoprim-sulphamethoxazole yielded results superior to those of ampicillin. In comparing the results of this study with those of a similar study in which the same agents were given for ten-day courses it appears that only in the complicated infection is there an advantage in giving a prolonged course of trimethoprim-sulphamethoxazole. This study did not generate any evidence to support the extension of ampicillin therapy for urinary tract infection beyond ten days.