Lucien B. Guze

Circulating immune complexes in infective endocarditis.

To examine further the role of immune-complex deposition in infective endocarditis, we studied 29 patients with infective endocarditis for presence of complement-containing circulating immune complexes. Ninety-seven per cent (28 of 29) had serum levels of immune complexes greater than 12 mug per milliliter. Mean levels in these patients were significantly higher than in patients with sepsis without endocarditis or in normal controls (P less than 0.05). Circulating immune-complex levels were correlated with longer duration of illness (P less than 0.025), extravalvular manifestations of endocarditis (P less than 0.025) and hypocomplementemia (P less than 0.05). Patients with right-sided endocarditis had significantly higher circulating immune-complex levels than patients with left-sided involvement (P less than 0.025). In general, levels fell to zero with successful antimicrobial or surgical therapy. This drop was concurrent with disappearance of extravalvular signs, blood cultures becoming sterile, and rise in serum complement levels. These findings support the concept that immune complexes may be important in the pathogenesis of infective endocarditis.

Fungal Arthritis. I. Candida Arthritis: Diagnostic and Prognostic Implications and Therapeutic Considerations

T HE INCIDENCE of Candida infections, both focal and generalized, has been increasing rapidly in recent years.‘-4 Septic arthritis due to Candida, however, has been uncommonly described, and extensive literature review turned up only 17 reported cases. ‘-I!’ We document our experience with two such patients and review the previously cited cases. The wide spectrum of clinical disease and certain diagnostic, therapeutic, and prognostic features are emphasized.

PERSISTENCE OF BACTERIA IN "PROTOPLAST" FORM AFTER APPARENT CURE OF PYELONEPHRITIS IN RATS.

Appropriate antibiotic treatment of experimental enterococcal pyelonephritis in the rat appears to effect the removal of the infecting organisms from the kidney, as judged by the culturing of kidney homogenates on standard bacteriological media. When the homogenates were cultured on media containing 0.3M sucrose, osmotically stabilized, it was demonstrated that bacteria were present in the protoplast form, and that this form persisted in the kidney for at least 13 weeks after therapy.

CLINICAL EXPERIENCES WITH KANAMYCIN

THIS report describes our experience with kanamycin§ in the treatment of 25 severe and acute infections in the adult. In general, the new antimicrobial agent has been administered for two kinds of infections—those caused by penicillin-resistant staphylococci and those resulting from invasion by a number of common gram-negative bacilli. Since the results of therapy are encouraging in both areas this preliminary report seems warranted. The drug deserves wider clinical trial, however, before final decision about its efficacy in management of human infections can be made. Extensive studies of the pharmacologic properties of kanamycin in man and animals have been reported, .xa0.xa0.

Fungal arthritis. II. Coccidioidal synovitis: clinical, diagnostic, therapeutic, and prognostic considerations.

This is the second phase of a review of fungal arthritis that will be presented in three parts. Coccidioidal synovitis will be discussed in this issue. Part I was a review of Candida arthritis; part III will be a review of cryptococcal, sporotrichal, histoplasmal, and blastomycotic arthritis.

Mycoplasmal Arthritis of the Mouse: Development of Cellular Hypersensitivity to Normal Synovial Tissue

Summary Cellular hypersensitivity to normal mouse synovial tissue was found in arthritic mice infected by iv injection of Mycoplasma pulmonis but not in uninfected normal mice. Hypersensitivity was determined by inhibition of migration of peritoneal macrophages in the presence of an antigen made from normal mouse synovium. Since, in a previous study, no correlation was found between the presence of mycoplasmas in arthritic joints and the extent of arthritis, this data suggests that both microbiological and immunological mechanisms are involved in the pathogenesis of the disease. Addendum. An additional experiment was performed to test the specificity of the reaction to synovial antigen. Cells from 12 mice infected 14 to 35 weeks and 12 age-matched controls were incubated in the presence or absence of an antigen prepared from normal mouse kidney by the method outlined for synovial antigen. Using 12.5 μg/ml (the highest concentration not affecting cells from normal mice) the migration area from the infected animals with antigen was 65.47 ± 7.97 cm2; without antigen, 60.49 ± 5.58 cm2; controls with antigen 40.74 ± 4.25 cm2; without antigen 38.69 ± 3.05 cm2. Thus no significant effect was seen in either infected or control animals. We thank Gussie Goldberg, Jessie Hardin, Mike Y. Kubota, Judy Noel, and Melvaline Oliver for their excellent technical assistance.

Action of Erythromycin on "Protoplasts" in vivo

Bacteria may persist in protoplast form in kidneys after treatment of experimental enterococcal pyelonephritis with penicillin. Erythromycin, while ineffective against the bacterial form of infection, was able to kill protoplasts in vivo. This finding is consistent with the hypothesis that intact cell wall interferes with the ingress of erythromycin into the cellular area in which it acts.

Pyelonephritis. III. Observations on the association between chronic pyelonephritis and hypertension in the rat.

Summary Chronic, progressive, non-obstructed, enterococcal pyelonephritis in the rat is not associated with hypertension. It is suggested that this may be related to the absence of significant arteriolar nephrosclerosis.

PYELONEPHRITIS. V. ROLE OF SERUM BACTERICIDAL ACTIVITY AND ANTIBODY IN ACUTE PYELONEPHRITIS IN THE RABBIT.

Summary Intravenous injection of rabbits with Str. faecalis produced an acute pyelonephritis which spontaneously resolved in a few weeks. This infection was accompanied by vigorous antibacterial antibody (agglutinating and hemagglutinating) production which was not associated with increase in serum bactericidal activity as tested. There appeared to be no correlation between individual rabbit pre-infection serum bactericidal activity and the quantitative bacteriological findings in the kidney. The difference between the outcome of infection in the rabbit and rat has not been explained by the immunological studies performed.

Pigment Formation in L-forms of Serratia marcescens

SUMMARY: L-forms of Serratia marcescens were produced and serially transferred in osmotically stabilized agar with penicillin. The bacterial form was pigmented, while the L-form colony was not. Lack of colour in the L-form colony was not due to pigment diffusion into the agar; an extract of agar with L-form growth did not show an absorption spectrum for prodigiosin.