Norman B. McCullough

Fever, Infection and Host Resistance in Acute Leukemia*

Abstract 1.1. Fever and infection were studied with comprehensive bacterial, fungal and viral technics in thirty-six consecutive patients with acute leukemia. 2.2. As a group, these patients were febrile for almost one-half of the total 2,614 patient days. Only two patients had no febrile episodes during the period of observation. Of the ninety-two febrile episodes recorded, fifty-nine appeared to be related to infection. In the remaining thirty-three febrile episodes, bacterial, viral or fungal infection could not be incriminated as a cause for fever. 3.3. Age and type of leukemia did not influence the frequency of febrile episodes. However, more febrile episodes related to proved or presumptive infection developed in adults than in children. 4.4. The most common clinical illnesses associated with the proved infections were pharyngitis, pyelonephritis and septicemia. On occasion, relatively avirulent bacteria were capable of causing serious clinical infection. The most frequently encountered organisms were E. coli, M. pyogenes var. aureus, coagulase-positive, and Ps. aeruginosa. Infections due to Ps. aeruginosa were the most difficult to treat. 5.5. Survival after infection was common, in the absence of bacteremia, if intensive and appropriate antimicrobial therapy was employed. Nevertheless, infection remained a leading cause of death in those patients who died during the study. 6.6. The majority of the presumptive infections were related to infections of the respiratory tract. 7.7. In the initial evaluation of the febrile leukemic patient it is to be emphasized that a negative physical examination does not exclude infection as a cause for fever in a patient with acute leukemia. 8.8. Of the fourteen fevers of undetermined origin which persisted after two weeks of antibiotic therapy, eight eventually terminated in serious bacterial infection. Appropriate management for persistent fever of undetermined origin requires continual reappraisal to insure that a superimposed infection, masked by preceding unexplained fever, has been detected.

CRYPTOCOCCOSIS: CLINICAL STAFF CONFERENCE AT THE NATIONAL INSTITUTES OF HEALTH

Excerpt Dr. N. B. McCullough: In our clinical research program on the granulomatous diseases we have studied 10 cases of cryptococcosis. We are taking this opportunity to present some of the clinic...

Survey of Brucellosis in Slaughtered Hogs

Submaxillary lymph nodes were obtained from hogs slaughtered in one of the large packing plants in Chicago. Samples were obtained each week for a period of 6 months. The lymph nodes were removed from the carcass immediately after the initial Bureau of Animal Industry inspection of head glands. Each specimen was removed with sterile instruments and placed in an individual sterile screw-capped glass jar. Upon return to the laboratory, the samples were promptly cultured. Each node was trimmed of fat and excess tissue, seared in a flame, sectioned, and the cut surface serrated and streaked directly on the surface of trypticase-soy agar medium. Sterile instruments were used throughout. The inoculated plates were incubated at 370 C. in an atmosphere of 10 percent added C02. In cultures heavily overgrown with other organisms, Brucella cannot be detected. Hence, all plates showing an overgrowth were discarded and not included in the series. During the entire investigation, 152 plates were discarded for this reason. Plates streaked with nodes from which Brucella was not recovered have in most instances remained sterile or contained only scattered colonies of ubiquitous bacteria. Plates yielding Brucella have uniformly contained numerous colonies of the organism.

Incidence and Distribution of Brucella abortus in Slaughtered Bang's Reactor Cattle

In considering the occurrence of brucellosis in packing-house workers, the Bangs reactor cow has received inadequate attention. It has been frequently stated that in reactor cattle the organism is found mainly in the uterus and the udder; hence, the remainder of the carcass provides little or no exposure hazard to the worker. The prevalence of this view is somewhat surprising. It has long been known that early in the course of the disease the organism may be widely disseminated (1). Brucella has been isolated from the blood stream of cattle in a number of studies (2, 3, 4). Recently, Manthie and Carter performed blood cultures on artificially infected cattle (5). Of 270 cows, Brucella abortus was recovered from the blood of 172 animals. In 18 animals studied over a prolonged period, bloodstream infection persisted in over 80 percent for 5 months and in one animal for almost 2 years. These studies suggest an exposure hazard greater than that usually recognized. More definitive information seemed to be needed on the extent of infection in a substantial number of animals actually sent for slaughter. In this study the carcasses of 100 Bangs reactor cattle were examined. Materials and Methods To conduct the study, arrangements were made with one of the large packing plants in the Chicago area. Over a period of 6 months, 100 Bangs reactor cattle sent for slaughter were examined. They were unselected except for the known positive Bangs reaction. They were all of dairy breeds. The series comprised 88 cows, 9 heifers, 2 calves, and 1 bull. They were derived from herds in five Midwestern States. During bleeding, a blood sample was obtained for an agglutination test. At various stages of the dressing process, tissues were obtained for culture. Accessible lymph nodes in widespread areas of the carcass, tonsil, and sections of liver, spleen, uterus, and membranes and fetus, if present, were obtained. Under plant conditions, the

BRUCELLA ANTIBODIES FOLLOWING CHOLERA VACCINATION

Excerpt Brucella agglutinins appearing after vaccination against cholera have been reported to occur in six of seven individuals.1We have suggested that this phenomenon may be a source of confusion...

Oral Administration of Killed Brucella to Man.

Brucella agglutinins have been observed in many persons who have had no illness suggestive of brucellosis and no known adequate exposure to live Brubcella organisms. It is also recognized that there is a high incidence of dermal sensitivity to Brucella products in the absence of a history of illness or exposure. This is true even among persons who have always lived in large cities and can give no history of raw milk consumption. The possibility occurs that the ingestion of dead Brucella in pasteurized dairy products may be responsible for the presence of Brucella agglutinins. The following experiments were designed to clarify this point.