J. Vandepitte

Widespread occurrence of multiple drug-resistant Salmonella typhi in India

Sixteen multiple drug resistant strains ofSalmonella typhi belonging to Vi-phage types E1 (14) and O (2) and isolated in Southeast India in 1991 were characterized. All strains were resistant to chloramphenicol and the majority to trimethoprim and ampicillin. In all strains these resistances were encoded by plasmids of the H1 incompatibility group with molecular weights ranging from 110 to 120 megadaltons. Physicians in European countries should be aware that treatment may fail if patients with typhoid fever who have recently returned from the Indian sub-continent are given first-line treatment with chloramphenicol, trimethoprim or ampicillin. With the possible exception of young children, ciprofloxacin is currently the best choice for treatment of such patients.

Antimicrobial susceptibility and serotype distribution of Streptococcus pneumoniae from Rwanda, 1984–1990

A total of 383 clinical isolates of Streptococcus pneumoniae, obtained from an equal number of patients in Kigali, Rwanda, was tested for resistance to penicillin G with a 1 microgram oxacillin disc. Of these isolates, 99 (25.8%) showed reduced zones of inhibition. By means of an agar dilution method, 21% all isolates were confirmed as relatively resistant (MIC > or = 0.12- < or = 1.0 mg/l) strains of Streptococcus pneumoniae (RRSP). A high degree of resistance to penicillin G (MIC > or = 2 mg/l) was not observed. Resistance to chloramphenicol (MIC > or = 8 mg/l) was found in 31% RRSP and in 6% penicillin susceptible strains (PSSP). Doxycycline resistance was common in both RRSP and PSSP strains. All isolates remained fully susceptible to erythromycin. Children more often harboured a strain giving a reduced inhibition zone than did adults (74/230 versus 25/153; P = 0.0005). A total of 32 serotypes or serogroups were identified, seven of them relating to 64.8% all isolates typed. Of all the isolates 84% belonged to a serotype represented in the 23-valent vaccine or to a cross-reacting serotype. Serotype 25, not included in the vaccine, accounted for 10.7% typed isolates from adults but only for 2.0% typed isolates from children. Results of susceptibility testing and clinical experience suggest that penicillin G, ampicillin and chloramphenicol should not be used alone as empirical treatment for pneumococcal meningitis in patients in Rwanda.

Meningitis due toCryptococcus neoformans biovargattii in a zairean AIDS patient

Cryptococcosis is one of the most frequently diagnosed opportunistic infections in acquired immunodeficiency syndrome (AIDS) patients in Africa. Cryptococcus neoformans is a heterogeneous species comprised of 2 biovars: the classical biovar neoformans and the biovar gattii. A review of 47 clinical isolates of Cryptococcus neoformans collected in Zaire between 1951-85 revealed that whereas 6 of the 7 isolates from the pre-1969 period belonged to the biovar gattii all 40 isolates received after 1969 belonged to the biovar neoformans and 35 of these isolates were from AIDS patients. In a separate analysis all 30 strains isolated from Rwandan AIDS patients belonged to the biovar neoformans. The apparent absence of the biovar gattii in AIDS patients has been observed in the US as well. However a case from Zaire suggests that this may not be an absolute phenomenon. This 28-year-old AIDS patient who died less than 1 month after presenting with headache and mental confusion represented the 1st report of isolation of Cryptococcus neoformans biovar gattii from an AIDS patient as well as the 1st documented isolation of this variety in Central Africa in 17 years.

Surveillance of human Yersinia enterocolitica infections in Belgium: 1963–1978

Summary Details are given on the epidemiology of human Yersinia enterocolitica infections in Belgium, based on 3167 isolations from 1963 to 1978. A continuing increase of the number of isolations is noted, with 1386 isolations in the last three years covered, excluding repeated isolations from the same patient. Serotype 3 remains predominant accounting for 84 per cent of all isolations. However, a changing pattern of serotypes distribution has been observed in recent years, with an increasing proportion of serotype 9 and serotypes other than 3 or 9. Most isolations are from faeces. From blood and deep abscesses only serotypes 3 and 9 were recovered. In Belgium only the latter serotypes are clearly associated with human disease, such as enteritis, pseudo-appendicular syndrome and septicaemia. The pseudo-appendicular syndrome is seen at an older age than is enteritis, and is relatively more frequent in serotype 9 infections. In contrast, serotypes other than 3 or 9 are relatively more common in persons without any illness or with atypical symptoms. There is evidence that they are non-pathogenic.

Age-related rheumatoid factors. Incidence and characteristics.

The prevalence of the RA factor in sera of healthy young or middle-aged subjects has been found to be approximately 4 per cent. During the past few years, however, it has become increasingly clear that positive reactions are much more frequent when subjects 65 years of age and older are tested (Table I). Review of these studies reveals that the prevalence of positive reactions is consistently greater in aged than in young persons. There is considerable variation among populations from different geographical areas and also according to the different techniques used in testing for the RA factor. The present work compares the prevalence of RA factor in the serum of a well-defined hospitalized population with that in a healthy ambulatory population and in a group of patients seen at a rheumatology out-patients department; it also compares the results obtained with a Hyland RA slide test with and without inactivation of the serum, with a modification of this slide test (Watson, 1965) with a

Surveillance des maladies infectieuses en Belgique par un réseau de laboratoires vigies. Application à Campylobacteret Yersinia enterocolitica. Expérience de sept années

Resume Dans le cadre de la surveillance des maladies infectieuses en Belgique, un reseau national de laboratoires de microbiologie realise, depuis 1983, lenregistrement hebdomadaire dun certain nombre dagents pathogenes. Cet article decrit les principes de base de lorganisation de ce systeme ainsi que les resultats qui peuvent en etre attendus. Tout indique un excellent niveau de participation puisquenviron 90 % des formulaires denregistrement ont ete completes et renvoyes par les participants.