Marvin Turck

Diagnosis of coliform infection in acutely dysuric women

We reevaluated conventional criteria for diagnosing coliform infection of the lower urinary tract in symptomatic women by obtaining cultures of the urethra, vagina, midstream urine, and bladder urine. The traditional diagnostic criterion, greater than or equal to 10(5) bacteria per milliliter of midstream urine, identified only 51 per cent of women whose bladder urine contained coliformis. We found the best diagnostic criterion to be greater than or equal to 10(2) bacteria per milliliter (sensitivity, 0.95; specificity, 0.85). Although isolation of less than 10(5) coliforms per milliliter of midstream urine has had a low predictive value of previous studies of asymptomatic women, the predictive value of the criterion of greater than or equal to 10(2) per milliliter was high (0.88) among symptomatic women the prevalence of coliform infection exceeded 50 per cent. In view of these findings, clinicians and microbiologists should alter their approach to the diagnosis and treatment of women with acute symptomatic coliform infection of the lower urinary tract.

Etiology of Nongonococcal Urethritis

Chlamydia trachomatis was isolated from the urethra from 48 (42 per cent) of 113 men with non-gonococcal urethritis (NGU), four (7 per cent) of 58 without overt urethritis, and 13 (19 per cent) of 69 with gonorrhea. Postgonococcal urethritis (PGU) developed in 11 of 11 men who had C. trum antibody to C. trachomatisis developed. The immunotype specificity of chlamydial antibody corresponded to the immunotype isolated. Among culture-negative patients. chlamydial antibody prevalence correlated with the number of past sex partners and with previous NGU. Herpesvirus hominis, cytomegalovirus, T-mycoplasma, Mycoplasma hominis, other bacteria, and Trichomonas vaginalis were not implicated in NGU or PGU. Thus, the cause of chlamydia-negative NGU and PGU remains obscure. Endocervical chlamydia were found in sex partners of 15 of 22 NGU patients with and two of 24 without urethral chlamydial infection (p smaller than 0.001). Tetracycline treatment of both sex partners appears advisable.

THE EPIDEMIOLOGY OF NON-ENTERIC ESCHERICHIA COLI INFECTIONS: PREVALENCE OF SEROLOGICAL GROUPS *

Escherichia coli is an ubiquitous microorganism which is found in the gastrointestinal tract of every individual, where it usually forms a part of the normal gut flora. Extensive epidemiological, clinical, and bacteriological observations have documented the pathogenic significance of certain serological strains of E. coli in infantile diarrhea. However, although they are frequently isolated in infected sites closely related to the gastrointestinal tract, such as the appendix, gall bladder, and peritoneal cavity, little is known about the serological specificity of coliform bacteria in non-enteric infections, particularly those involving the urinary tract. Ewing (1) has emphasized that complete serological typing of E. coli should provide accurate information concerning the incidence of specific strains associated with disease and permit evaluation of nosocomial spread. The concept that some strains of gram-negative organisms may be associated with infection more often than others is not new. Kauffman (2) advanced the hypothesis that certain coliform serotypes are more prevalent in appendicitis, and he also noted that strains of certain serological groups were more frequently isolated from the urine than from feces. Others have reported that strains of certain serological groups are more commonly isolated from infected sites than from fecal specimens (3). Vahlne (4) and Sjdstedt (5) performed serological typing on strains of E. coli from a variety of normal and abnormal sources and found that certain types were more commonly associated with human infections but that these types were not limited to the urinary tract. More recently, Rantz (6) suggested that E. coli with certain group specific antigens are more invasive for the urinary tract than others. A preliminary report from this laboratory indicated

Nosocomial infection of the urinary tract

Urinary tract infections appear to be responsible for 35 percent of all hospital-acquired infections, occurring in approximately two patients per 100 admissions. The great majority of infections are associated with urinary tract instrumentation. Female sex, advanced age and debilitating underlying illness appear to be associated with an increased risk of infection, but other risk factors have been poorly defined and case-control studies assessing excess morbidity and mortality associated with nosocomial bacteriuria have not been made. In most instances, the hospitalized patients are the reservoirs for the etiologic organisms, but cross-infection from other infected patients also occurs. Current preventive efforts have been primarily directed at aseptic catheter care techniques and reducing catheter use. Further developments in our prevention and control of these infections require an understanding of the mechanisms responsible for colonization of the urethra and bladder with gram-negative organisms and ways to discriminate patients at special risk.

A critical evaluation of nalidixic acid in urinary-tract infections.

NALIDIXIC acid, one of a series of 1, 8-naphthyridine derivatives, was first synthesized by Lesher et al.1 and introduced into general clinical use in 1964. It is absorbed after oral administration...

Relapse and Reinfection in Chronic Bacteriuria

ONLY about 20 per cent of patients with chronic infections of the urinary tract remain free from significant bacteriuria after cessation of treatment, regardless of the type or duration of chemothe...

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.

SUSCEPTIBILITY AND IMMUNITY TO COMMON UPPER RESPIRATORY VIRAL INFECTIONS—THE COMMON COLD

Excerpt Common upper respiratory viral infections, despite their frequency, have been something of an enigma to physicians and scientists in general. Little has been known about their specific etio...

Effect of Bacteriuria on Renal Concentrating Mechanisms

Abstract To examine the relationship between renal and vesical bacteriuria and maximal urinary concentrating ability (Umax), 38 patients with well-documented urinary tract infections were studied b...

Gentamicin nephrotoxicity: failure of three cephalosporins to potentiate injury in rats.

The possibility that gentamicin and cephalosporin antibiotics may act synergistically to produce nephrotoxicity was evaluated in an experimental model. Necrosis of the proximal tubules occurred when rats were treated with 60 to 120 mg/kg of gentamicin for 5 days but not when 15 to 20 mg/kg per day was given for up to 4 weeks. In all gentamicin-treated animals lysosomes of proximal tubules were increased in size and number and the lumens of many tubules contained a granular deposit. Examination by electron microscopy revealed that the abnormal lysosomes contained membranous whorls. The luminal deposits consisted of similar material; identical bodies were also present in the urinary sediment. To determine whether concurrent administration of a cephalosporin would augment the nephrotoxic potential of gentamicin, additional rats were treated for 4 weeks with daily injections of gentamicin (20 mg/kg) and either cephaloridine, cephalothin, or cefazolin (500 mg/kg). None of the combination regimens produced any more injury than did gentamicin alone. Images