Emanuel Wolinsky

Clinical Forms of Gonococcal Arthritis

Abstract Of 30 patients with gonococcal arthritis seen between 1963 and 1967 the characteristic skin lesions of gonococcemia were noted in 15 and often served as an early clue to the diagnosis. Two clinical forms were observed. Patients with the septic form characteristically had, early in the course of their illness, chills and fever, polyarthritis, skin lesions of gonococcemia and relatively little joint effusion. Patients with the nonseptic form reported to a physician relatively late, generally did not have chills and fever and had monoarticular disease and joint effusions bacteriologically positive for gonococci. The response to antibiotic therapy was striking, and all patients recovered completely.

Importance of the carrier state as a source of Staphylococcus aureus in wound sepsis

The relationship of pre-operative nasal and skin carriage of Staphylococcus aureus to wound colonization and sepsis was studied in 269 patients. Thirty-seven per cent of 96 carriers developed wound colonization as compared to 16 % among non-carriers (a statistically significant difference). The wound sepsis rates were 17 % and 9 % respectively. The combination of nasal and skin carriage was an important factor, since the sepsis rate among skin carriers (most of whom were nasal carriers as well) was 22%. Among carriers, the homologous strain was recovered from the majority of wound colonizations and from all instances of wound sepsis. A carrier strain also was recovered from 52% of the wounds colonized and from 50% of septic wounds in the entire study group. Profuse nasal carriage resulted in a significantly greater number of septic wounds (31%) than sparse carriage (9%). Wound cultures before closure, and skin from the initial incision site only once yielded a patients carrier strain or a strain of Staph. aureus that was later recovered from the wound. The results indicate that measures designed to control the carrier state or to isolate the wound from the external environment should reduce wound sepsis by approximately one half. Excellent technical aid was furnished by Eleanor Ford, R. N., Edith E. Silverman, Adrienne Marus, M. S., and Patricia Welch.

Skin lesions caused by Mycobacterium haemophilum.

Excerpt Mycobacterium haemophilum is a newly recognized pathogen first described and named in 1978 (1). Of nine reported cases, all but one occurred in patients from Israel and Australia who had ly...

Transmission of Streptococcal and Staphylococcal Infections

Excerpt In 1955, Colebrook (1), a bacteriologist who had studied infections of burns and wounds during two world wars, reviewed the problem of the transmission and control of hospital-acquired infe...

THE ROLE OF SCOTOCHROMOGENIC MYCOBACTERIA IN HUMAN DISEASE

Among the mycobacteria which are found in soil and water are strains which grow slowly to produce soft, smooth, yellow to orange colonies whose pigment is not light-dependent. Generally referred to as the “scotochromogenic group”, such strains are devoid of pathogenicity for laboratory animals, and relatively resistant to isoniazid, streptomycin and p-aminosalicylic acid. They often are isolated as commensals in cultures from diagnostic material, especially gastric washings; in such situations the cultures usually grow only one or two colonies of the bacilli. I n a study from the Ohio Tuberculosis Hospital, small numbers of these mycobacteria were found in gastric washings from healthy people as often as from patients in the hospital.’ Scotochromogenic mycobacteria similar to those found in nature are frequently grown in pure culture from the diseased nodes in subacute lymphadenitis of children, and rarely from the sputum and resected lung tissue of adults with chronic pulmonary disease.

In vitro susceptibility of Mycobacterium marinum to eight antimicrobial agents.

The in vitro susceptibilities of 16 Mycobacterium marinum strains to eight antimicrobial agents were determined by the agar dilution technique. The most active drugs were amikacin and kanamycin. Tetracycline, doxycycline, and minocycline were inhibitory, predominantly at concentrations slightly below the expected blood and tissue levels. Trimethoprim-sulfamethoxazole and erythromycin demonstrated activity only at concentrations greater than those usually attained in serum and tissues. Gentamicin was relatively inactive.

Streptomycin and penicillin resistant staphylococci; influence of pH, body fluids on streptomycin action.

Summary and Conclusions 1. Certain organisms of the Smith strain Staphylococcus aureus possess a natural increased resistance to streptomycin. This resistance is not based on the production of a “streptomycinase.” 2. A strain of staphylococcus, highly resistant to streptomycin, can be produced in vitro from the streptomycin-sensitive organisms. 3. Streptomycin resistance is a relatively permanent characteristic, and is not affected by several passages through mice. The resistant organisms retain their virulence for this host. 4. Streptomycin resistance and penicillin resistance are independent of each other. Staphylococci originally penicillin-sensitive, retain their sensitivity to penicillin after being made resistant to streptomycin, and vice versa. Treatment with relatively large amounts of streptomycin is ineffective in mice infected with a streptomycin-resistant strain of Staphylococcus aureus. These mice can be cured, however, with penicillin. 5. The bacteriostatic effect of streptomycin diminishes considerably as the acidity of the culture medium increases from pH 7.7 to 5.2; the greatest diminution in effect occurs between pH 6.6 and 5.9. This must be taken into consideration in making in vitro assays and sensitivity tests, as well as in evaluating the action of the drug in vivo. 6. Streptomycin is not destroyed after contact with broth of pH 3.5 for 2½ hours. 7. Streptomycin is not destroyed, nor are its bacteriostatic and bactericidal powers appreciably influenced, by serous body fluids, pus, or normal tissue juices.

OTITIS MEDIA: MICROBIOLOGY AND EVALUATION OF THERAPY*

Acute otitis media is still one of the most common problems in pediatrics. A bacterial agent can be demonstrated in only 70% of cases,1,2 but not many attempts have been made to isolate other microbial agents or viruses. The pathogenesis of the syndrome is poorly understood, and current treatment regimens have not been optimal. The purpose of the present study was twofold: to investigate the associations of bacteria, viruses, mycoplasma and L forms in otitis media, and to determine the influence of two antibiotic regimens and placebo on the outcome. In this report the results of the treatment study will be emphasized.

A case of chronic meningococcemia with unusual features.

A patient with chronic meningococcemia with the unusual features of subungual splinter hemorrhages, a pericardial friction rub, and a culture positive skin lesion is presented. Group specific and homologous antibody responses were absent and the nitroblue tetrazolium test for infection was negative. The clinical features and the difficulty in explaining the mechanism of the relatively benign course that characterizes this disease are discussed.

The tuberculostatic action of terramycin in vitro and in the experimental animal.

Since the discovery of streptomycin, investigators have gathered a considerable body of knowledge regarding the therapeutic effect of this agent in certain types of experimental and clinical tuberculosis and the limitations of its use when the tubercle bacillus becomes resistant to the drug. Efforts are now being directed toward the search for an agent that may be used in combination with streptomycin to delay the emergence of streptomycinresistant organisms, or that may prove to be highly active against such resistant strains. One such combination, which is finding a place in therapy, is the simultaneous use of streptomycin and PAS. In this report, we are presenting some preliminary data on terramycin,1-6 with emphasis on its in vifro and in vivo activity upon streptomycin-resistant tubercle bacilli, together with a comparison of its activity with other agents that are being used both experimentally and clinically in tuberculosis. of Pulmonary Discate, Tr J MU, New York