James P. Harnisch

Asymptomatic gonorrhea in men. Diagnosis, natural course, prevalence and significance.

Abstract Urethral gonococcal infection was detected in 40 per cent of asymptomatic male contacts of women with symptomatic gonorrhea. Culture was more sensitive than fluorescent antibody or Gram-stained smears in detecting asymptomatic genital infection in men, and Neisseria gonorrhoeae was detected more often in the anterior urethra than in prostatic secretions by all three methods. Among 28 asymptomatically infected men followed without treatment for seven to 165 days, 18 remained asymptomatic carriers of N. gonorrhoeae. N. gonorrhoeae was cultured from 59 (2.2 per cent) of 2628 sexually active United States Army enlisted men undergoing routine examinations, and 68 per cent of the infected men were asymptomatic. Asymptomatically infected men constitute a definite reservoir of N. gonorrhoeae, and a major factor in the current gonorrhea pandemic is the failure of physicians to identify and treat asymptomatic male contacts of women with gonorrhea that is either symptomatic or detected by routine culturing....

Etiology manifestations and therapy of acute epididymitis: prospective study of 50 cases.

There were 50 patients with acute epididymitis who were evaluated prospectively by history, examination and microbiologic studies, including cultures for aerobes, anaerobes, Neisseria gonorrhoeae, Chlamydia trachomatis and Ureaplasma urealyticum. Escherichia coli was the predominant pathogen isolated from the urine of men more than 35 years old, while Chlamydia trachomatis and Neisseria gonorrhoeae were the predominant pathogens isolated from the urethra of men less than 35 years old. The etiologic role of Escherichia coli and Chlamydia trachomatis was confirmed by isolation from epididymal aspirates from a high proportion of men with positive urine or urethral cultures for these agents. Chlamydia trachomatis epididymitis accounted for two-thirds of idiopathic epididymitis in young men and often was associated with oligospermia. Of 9 female sexual partners of men with Chlamydia trachomatis infection 6 had antibody to Chlamydia trachomatis, of whom 2 had positive cervical cultures for this organism and 2 others had non-gonococcal pelvic inflammatory disease. Antibiotic therapy with tetracycline was effective for the treatment of men with Chlamydia trachomatis epididymitis and should be offered to the female sex partners.

Diphtheria among Alcoholic Urban Adults: A Decade of Experience in Seattle

Three outbreaks of Corynebacterium diphtheriae infection occurred in Seattles Skid Road from 1972 through 1982. The first involved a single toxigenic, intermedius biotype clone, whereas the second and third outbreaks involved nontoxigenic mitis and gravis strains. Of 1100 total infections, 947 (86%) were cutaneous. The incidence was highest in winter and spring. In Skid Road, the estimated attack rate during 17 months in 1974 to 1975 was 5% for whites and 27% for native Americans. Streptococcus pyogenes was isolated from 73% of diphtheritic and 41% of nondiphtheritic skin lesions (P less than 0.001). Skin infection and environmental contamination by C. diphtheriae were correlated. Complications occurred in 21% of symptomatic nasopharyngeal and 3% of cutaneous toxigenic intermedius infections (P less than 0.001), and were significantly correlated with ages 60 years or more. Preferential use of erythromycin for diphtheria and pyodermas preceded plasmid-mediated resistance to erythromycin in C. diphtheriae. Diphtheria outbreaks in urban alcoholic persons are associated with poor hygiene, crowding, season, contaminated fomites, underlying skin disease, hyperendemic streptococcal pyoderma, and introduction of new strains from exogenous reservoirs.

Zoster in the elderly: clinical, immunologic and therapeutic considerations.

Herpes zoster is common in the elderly. Persons over the age of 50 years have an attack rate double that of patients less than 50 years old. In the very aged, this rate nearly doubles again. The loss of cell‐mediated immunity for the VZ virus appears to be the primary factor in the disruption of the dynamic containment process responsible for VZ virus latency within the sensory ganglion. Humoral immunity may play a role in the maintenance of latency, but the degree is unproven, except in the case of dissemination where loss of detectable antibodies seems to correlate with extradermatomal dissemination. Severe forms of the disease and its complications, e.g., postherpetic neuralgia, are likely among the elderly. Direct im‐munofluorescent staining or cytologic examination is useful for early diagnosis, and serologic changes can document the confusing clinical entity of zoster sine herpete.

Clofazimine in Nontuberculous Mycobacterial Infections: A Growing Niche

Abstract Infection secondary to rapidly growing mycobacteria (RGM) is associated with significant morbidity and mortality, especially in individuals with underlying structural lung disease or immune compromise. Such infections, particularly those caused by the Mycobacterium abscessus group, are challenging to treat due to high virulence, antibiotic resistance, and the lack of effective and tolerable therapies. Although novel antimycobacterials are under development, clofazimine—a drug historically administered as part of multidrug therapy regimens for Mycobacterium leprae—holds promise as a chemotherapeutic for the treatment of RGM. The history, pharmacologic properties of clofazimine, as well as in vitro and in vivo studies against RGM are described here and highlight a potential new niche for an old drug.