Milton S. Saslaw

EXPERIMENTAL CARIES INDUCED IN ANIMALS BY STREPTOCOCCI OF HUMAN ORIGIN.

Summary Streptococci were isolated from human dental carious lesions which reacted with fluorescein-tagged antisera against rat or hamster “cariogenic” streptococci. The human strains fell into 3 different categories, in fluorescence, morphology, microprecipitin and gel diffusion studies. One category, similar to the hamster strain, produced caries when used to infect hamsters. This occurred in 55 animals of 55 tested, and in no controls. The other 2 categories of human isolates failed to produce hamster caries; one of these is being studied for possible cariogenicity in germfree rats.

Bactericidal properties of povidone-iodine and its effectiveness as an oral antiseptic☆

Abstract Povidone (polyvinylpyrrolidone)-iodine is an effective germicide. High dilutions are active in destroying, within fifteen seconds, the organisms commonly found in the mouth. It is effective in higher dilutions than the stock commercial preparations of the other common antiseptics studied. In 10 per cent aqueous solution, the antiseptic properties of polyvinylpyrrolidone iodine have been retained for more than one year. High dilutions, however, should be freshly prepared; color loss is accompanied by a weakening of germicidal activity. When povidone-iodine is used to prepare the oral mucosa for local anesthetic injection prior to dental procedures, the hazard of direct bacterial infection is removed almost completely. In the present study polyvinylpyrrolidone iodine was used in ninety-nine patients who received a total of 115 injections, and in only five instances were bacteria recovered from the injection needle.

The incidence of rheumatic heart disease in native school children of Dade County, Florida

Abstract A survey of the incidence of rheumatic heart disease in 1,001 school children born and reared in Dade County, Florida, is described and discussed. The frequency of such disease in these children is shown to be similar to that found in other surveys performed by the same method in areas having a mild subtropical climate and is of a smaller magnitude than that found in more northern localities.

Comparative pathogenicity of streptococci of human origin in hamster caries

A NUMBER of streptococci isolated from different host species, while possessing different antigenic and biochemical properties, appear to be related by their ability to induce experimental dental caries in animals. ORLAND (1955) induced experimental caries in germ-free rats with a strain of enterococcus; FITZGERALD, JORDAN and STANLEY (1960) also induced caries in germ-free rats, but with a different streptococcal strain (FA-1) of rat origin; and FITZGERALD and KEYES (1960) reported the development of experimental caries in hamsters with a streptococcal strain (HS-1) of hamster origin. The results of the work in experimental caries in animals suggested that dental caries in rodents was a specific bacterial disease in which certain strains of streptococci were of aetiologic significance. ZINNER et al. (1965a) reported the isolation of streptococcal strains from human carious lesions that were morphologically and antigenically similar to either the hamster (HS-1) or the rat (FA-1) strains. The human hamster-like strain, AHT, induced experimental caries in hamsters and the rat-like strain, BHT, induced caries in gnotobiotic rats (ZINNER et al. 1965b), both animal species requiring a special cariogenic diet (KEYES, 1959). In preliminary studies of human carious lesions it appeared that AHT-type strains were associated with severe, active, and rapidly progressive lesions while the BHTtype strains were associated with slowly progressive lesions (ZINNER ef al. 1965b). The present study compares the cariogenic activity of both strains in hamsters. Nineteen-day old hamsters, albino and golden, weighing 30 g, were maintained on a cariogenic diet (KEYES, 1959) and orally infected with AHT or BHT strains by established techniques (FITZGERALD et al. 1960). The albino hamsters were supplied originally by the National Institute of Dental Research and maintained at the National Children’s Cardiac Hospital for the past 5 years. The golden hamsters were purchased locally and the colony has been maintained since 1959.

Conditions clinically confused withthe rheumatic state

Summary Case records of 2,045 outpatientssuspected of having rheumatic or congenital heart disease were reviewed. It was found that 46.8 per cent had no heart disease, 23.5 per cent were in the “rheumatic state”, and 23.6 per cent had congenital lesions. “Nonrheumatic” conditions, inwhich prolonged fever, joint pain, and heart murmur were part of the picture, were mistakenly diagnosed as rheumatic fever or rheumatic heart disease in 117 cases (5.7 per cent). The signs and symptoms which confused these conditions with the rheumatic state and those which determined the final diagnoses were tabulated and discussed, with special emphasis on methods of preventing such mistaken diagnoses.

Frequency of rheumatic heart disease in Miami, Florida: Autopsy findings

Abstract Between 1950 and 1955 inclusive, 145,301 patients were admitted to Jackson Memorial Hospital, Miami, Florida. Of these, 6,358 died, and 2,967 (46.7 per cent) were autopsied. There were 75 (2.5 per cent) whose hearts showed rheumatic disease, as judged by the criteria of Wallach, Lukash, and Angrist. Only 52 (1.7 per cent), however, died of rheumatic heart disease or its complications. Data are presented for all deaths at Jackson Memorial Hospital, as well as information relative to the total deaths for Dade County, Florida. Of 2,899 autopsies in which birthplace was recorded, 25 per cent (725) listed their nativity as Florida. Only 8 per cent (6) of the autopsies showing rheumatic disease were among Florida-born individuals. Floridians in this series demonstrated a mortality rate from rheumatic fever and rheumatic heart disease of one-third the over-all death rate. Death rates for rheumatic heart disease are compared with similar findings elsewhere in the world. Factors which influence the rate are discussed. These factors include the criteria used for pathologic diagnosis; the economic strata from which the hospitals population is drawn; the years of study as affected by unusual economic, martial, or other critically stressful situations; the climate of the area in which the individual spent his years of childhood, when most prone to rheumatic attack; and, finally, the corollary effects of latitude, altitude, temperature, humidity, barometric pressure, diurnal change in temperature, and so forth. How these factors apply in the Miami area is indicated.

Prevention of rheumatic fever: Limitations†‡

Prevention of rheumatic fever depends on early recognition and treatment of antecedent streptococcal infection. Retrospective inspection of 922 acute rheumatic episodes in 6 cities revealed respiratory illnesses in 743. Of these, 168 rheumatic attacks followed in less than the presumed safe 10 day period. If these illnesses were of streptococcal origin, rheumatic fever theoretically could have been prevented in 77.9 per cent of all attacks. To reach this degree of efficacy, however, fluorescence microscopy is essential for earliest possible identification of Group A streptococci.

Problems associated with the use of antibiotics for the prevention of primary episodes of rheumatic fever

Abstract Based on the concept that the prevention of rheumatic fever can be attained by the early eradication of infection with the group A beta hemolytic streptococcus, the current program was devised to help evaluate its efficacy in the prevention of initial attacks of rheumatic disease. In a school with an average daily enrollment of 824, each absent child had his throat swabbed on the initial day of absence if the illness was of respiratory origin. On identification of beta hemolytic streptococci in the throat culture, the family and/or physician was notified, and antistreptococcal treatment was suggested. The investigation revealed that such an attempt to prevent rheumatic fever (1) was prohibitively costly; (2) encountered obstacles in obtaining cooperation from the lay public; (3) indicated lack of uniformity in attitude to therapy by different physicians; (4) demonstrated problems in bacteriologic technics; (5) posed difficulties in communication; and (6) ran the risk of inaccurate statistical appraisal. Because of the difficulties encountered, we believe any program of prevention of primary attacks of rheumatic fever by use of antibiotics is impractical on a community service basis and at the present time should be reserved for research only. Although primary attacks of rheumatic fever cannot yet be handled as a community-wide project, the secondary prevention program, as advocated by the American Heart Association, 5 is strongly urged, especially for those areas where rheumatic fever is known to occur frequently. According to this program, all known persons who have had one or more attacks of rheumatic fever should receive prophylactic antibiotic therapy indefinitely.

Five and ten year follow-up study of rheumatic patients: Role of climate and environment

Abstract 1. (1) Five- and ten-year studies were completed on 102 and 48 expatients of the National Childrens Cardiac Hospital, Miami, Florida, to determine whether or not the lives of these subjects were influenced by a period of convalescent care in this tropical area. 2. (2) Data were available on 92 of the five-year group, and 41 of the ten-year patients. In the total 133, the death rate was less than 7 per cent. 3. (3) Of the 124 survivors on whom we have information, 16 per cent had recurrences. 4. (4) Heart damage, more than minimal, was observed in only 31 per cent of the 124 survivors. 5. (5) The death rate, frequency of recurrences, and heart damage, all compare very favorably with similar reports from other centers.

EVALUATION OF FA AND CONVENTIONAL TECHNIQUES FOR IDENTIFYING GROUP A BETA HEMOLYTIC STREPTOCOCCI.

PROMPT RECOGNITION of group A beta h-remolytic streptococci by use of the fluorescent antibody technique (1-4) permits early and adequate treatment of streptococcal infections so that initial and recurrent attacks of rheumatic fever may be prevented. However, the degree of accuracy obtainied with the fluorescent antibody (FA) technique depends on the specific methodology used in its application. The study reported here was undertaken to determine the most rapid and accurate metlhiod to identify group A beta hemolytic streptococci among several modifications of the PA technique, and to compare these modifications with each other and with conventional bacteriological procedures.