J. Neal Middelkamp

Escherichia coli diarrhea; the relationship of certain serotypes of Escherichia coli to sporadic and epidemic cases of infantile diarrhea.

Summary 1. Certain serotypes of Esch. coli can produce diarrhea in infants. 2. In an attempt to establish the etiology of an infants diarrhea, it is essential to perform routine serotyping of the Esch. coli isolated from the infants stool. 3. Esch. coli serotyping is simple to perform and can be done in any routine bacteriology laboratory. 4. Esch. coli diarrhea may spread rapidly through hospital wards despite the use of modern isolation techniques. 5. Patients with Esch. coli diarrhea cannot be distinguished on clinical grounds from patients with nonspecific diarrhea. 6. The treatment of patients with Esch. coli diarrhea consists in the employment of well-established principles of treatment of infantile diarrhea plus the administration of oral neomycin.

Septic arthritis due to Moraxella osloensis

Summary The first case of septic arthritis associated with vaginal discharge in a young child caused by Moraxella osloensis is reported. The similarity of clinical appearance to gonococcal disease and of microscopic morphology of the organism to Neisseria gonococcus emphasize the necessity for confirming a suspected clinical diagnosis with careful laboratory studies.

Infection due to a " related " Vibrio.

Summary 1. A “related” Vibrio was isolated from the blood of an infant with bloody diarrhea. 2. The unusual growth requirements of this organism may have prevented its isolation previously and precluded its association with the disease in human beings. 3. The eight cases previously reported are briefly reviewed and a possible epidemiologic association with Vibrio infection of chickens is raised.

Light and electron microscopic studies of the guinea pig cytomegalovirus.

The guinea pig cytomegalovirus produces both nuclear and cytoplasmic inclusions in vivo , but only nuclear inclusions in vitro by light microscopy. Three distinct, spherical nuclear virus particles are seen by electron microscopy. Three other definite structures are also present within the nucleus of virus-infected cells. One is a thin strand that appears as a “bead” on cross section. These strands palisade and form parallel rows of “beads” that assume a larger lattice-like structure. The second structure is a long tubular form which is spherical on cross section. The last is a multilamellated structure. Virus particles leave the nucleus either as single particles or in clusters. Two distinct cytoplasmic virus particles are seen. Extracellular virus particles are similar to one of the cytoplasmic virus particles.

Intranuclear structures in paracrystalline array.

Intranuclear structures in paracrystalline array, interpreted as possible microtubules, are present within reactive cells associated with vaccinia virus-infected human skin. These structures are observed within nuclei of cells not in any apparent stage of mitotic division and not containing virus particles. If there is a microtubular structure to these elements, the present study indicates that they can be synthesized and developed in this particular fashion at a time other than during mitosis. It is not known whether the vaccinia virus plays a role in this process.

The ultrastructure and histogenesis of molluscum contagiosum

Biopsies of lesions from molluscum contagiosum from 3 children were studied by light and electron microscopy. The lesion appears to be a mass of proliferating epidermal cells extending in grapelike clusters into the dermis. These epidermal cells undergo various stages of differentiation culminating in the formation of cytoplasmic inclusions. The cytoplasmic inclusions contain virus particles in different stages of maturation. “Uninfected” epidermal cells, in stages of normal maturation, are interspersed among “infected” cells containing virus particles. A maturational sequence of virus particle development is suggested on the basis of the electron microscopic observations.

Simultaneous mixed bacterial meningitis in children

Of 534 infants and children with acute bacterial meningitis, 20 were found to have meningitis resulting from simultaneous infection by 2 distinct bacterial species. Simultaneous mixed bacterial meningitis occurs most frequently in young infants. The mortality rate and incidence of sequelae are relatively high. The importance of accurate diagnosis and broad coverage antibiotic therapy are stressed. A system of nomenclature for simultaneous mixed meningeal infection by two or more species of microorganisms is proposed.

Pail Immersion Accidents

An unusual type of immersion accident is that involving a pail or bucket of water in the home. We describe four cases of drownings or near drownings in pails and summarize the literature. A review of this type of submersion resulted in a morbidity of 15.4% and mortality of 61.5%. Stable vital signs and normal neurologic examination initially are good prognostic indicators. A number of questions remain to be answered about the pathophysiological effect of these pail contents to the lungs. This hazard must now be included as a part of every discussion of poison prevention by pediatricians.

Herpes simplex: Clinical aspects and electron microscopic findings

Abstract An unusual case of an infection with the herpesvirus hominis (HVH) has been presented. Vesicular and ulcerative lesions involved the vulva, the perineum, and the anus, including hemorrhoids. Gangrenous bullous lesions occurred on the skin of seven fingers. The typical clinical appearance and the absence of bacterial pathogens justify the diagnosis of herpetic whitlow. The clinical course was complicated by incapacitating constitutional symptoms and fever. The diagnoses of a HVH infection was confirmed by positive virus cultures, the electron microscopic demonstration of the HVH in biopsy specimens of an ulcerative lesion, and by a fourfold increase of the neutralizing antibody titer in the patients serum. Three morphologically different stages of the HVH and phagocytosis of the virus by leukocytes has been observed and illustrated by electron micrographs. It has been discussed how the electron microscope can be used as a diagnostic method, how it can aid in clinicopathologic research concerning the mechanisms involved in virus infections, and how it could aid in the development of new modes of therapy.