ABSTRACT
Gas liquid chromatography was performed on synovial fluid of 94 patients with exudative arthritis. A relatively constant pattern of peaks was obtained in all synovial fluid samples. Lactic acid was increased in synovial fluid of patients with septic arthritis excluding gonococcal arthritis. In addition 2 constant peaks with retention time of 546 and 848 seconds in the chromatogram usually showed a significant increase in the synovial fluids of patients with septic arthritis (including gonococcal arthritis) but not in those from patients with sterile inflammatory or degenerative arthritis. In 1 patient with pseudomonas arthritis an increase in the peaks was noted with clinical and bacteriological relapse and subsequently there was a gradual return to normal levels during clinical improvement. Increase in synovial fluid lactic acid is useful in the diagnosis of septic arthritis. Identification of the compounds represented by the 2 peaks, which presumptively correspond to n-valeric and n-hexanoic acid, may provide further information on diagnosis, prognosis and pathogenesis of arthritis and may help in the differentiation between gonococcal and nongonococcal arthritis.
Subject(s)
Arthritis, Infectious/metabolism , Synovial Fluid/analysis , Adolescent , Adult , Aged , Arthritis/diagnosis , Arthritis/metabolism , Arthritis, Infectious/diagnosis , Child , Child, Preschool , Chromatography, Gas , Diagnosis, Differential , Fatty Acids, Volatile/analysis , Female , Humans , Joint Diseases/metabolism , Lactates/analysis , Male , Middle AgedABSTRACT
Lactic acid concentrations in the synovial fluid of 84 patients with acute monoarticular arthritis were determined by gas liquid chromatography. Lactic acid values in 27 cases of nongonococcal septic arthritis were strikingly higher (mean 1170 mg/100ml) than in 45 cases of inflammatory or degenerative arthritis (mean 34 mg/100 ml), as well as in 12 cases of gonococcal arthritis (mean 27 mg/100 ml). With the proper equipment, determination of lactic acid can be a relatively rapid, reliable procedure. Synovial fluid lactic acid concentrations therefore can be used as a rapid, supplemental diagnostic aid in differentiating nongonococcal septic arthritis from both gonococcal and nonseptic acute arthritis.
Subject(s)
Arthritis, Infectious/diagnosis , Lactates/metabolism , Synovial Fluid/metabolism , Adult , Aged , Arthritis/diagnosis , Arthritis/metabolism , Arthritis, Infectious/etiology , Arthritis, Infectious/metabolism , Female , Glucose/metabolism , Gonorrhea/metabolism , Humans , Male , Middle Aged , Pseudomonas Infections/metabolism , Staphylococcal Infections/metabolismABSTRACT
The concentration of lactic acid in cerebrospinal fluid (CSF) was determined by gas-liquid chromatography in 205 samples of CSF from 97 patients with or without infections of the central nervous system. Patients without infection or those with nonbacterial (presumably viral) meningitis consistently had low concentrations of lactic acid in CSF (i.e., less than or equal to 35 mg/100 ml), whereas patients with bacterial or tuberculosis meningitis consistently had concentrations of lactic acid in CSF of greater than 35 mg/100 ml. There was no overlap in concentrations of lactic acid between these two groups. Further, lactic acid concentrations in CSF from patients partially treated for meningitis were generally greater than 35 mg/100 ml through the third day of therapy and, thereafter, progressively declined to less than 20 mg/100 ml by the seventh to 10th day of therapy. Relapse of bacterial infection was consistently documented by a recurrence of an increased concentration of lactic acid in CSF. Preliminary experience with determination of the concentration of lactic acid in CSF suggests that it may be useful in distinguishing bacterial (with or without positive cultures) and tuberculous meningitis from meningitis due to nonbacterial causes.
Subject(s)
Lactates/cerebrospinal fluid , Meningitis/diagnosis , Adolescent , Adult , Aged , Child , Child, Preschool , Haemophilus Infections/diagnosis , Humans , Infant , Infant, Newborn , Middle Aged , Streptococcal Infections/diagnosis , Time Factors , Tuberculosis, Meningeal/diagnosisABSTRACT
Fifty-eight human isolates of Bacteroides melaninogenicus, 42 from a variety of clinical infections and the rest from normal flora, were studied for pigment production and ultraviolet light fluorescence and by forty biochemical and other tests, including end-product analysis by gas-liquid chromatography. In a number of instances, tests were repeated several times and the results were reproducible. Agar plate dilution susceptibility tests were also performed to 12 antimicrobial agents. These 58 strains could be reliably placed into three groups, corresponding to the three subspecies described, based on seven characteristics. These included acid production in peptone-yeast-glucose medium, production of n-butyric acid from peptone-yeast-glucose medium, esculin hydrolysis, starch hydrolysis, indole production, effect on milk, and lipase production. Production of hydrogen gas in peptone-yeast-fructose medium may be another distinguishing characteristic. In general there was not much difference in the susceptibility of the three groups to the various antimicrobial agents tested. Two strains had a minimal inhibitory concentration of penicillin G of 16 and 32 U/ml, respectively. Three strains did not produce a black pigment in spite of prolonged incubation on blood-containing media.
Subject(s)
Bacteroides/classification , Prevotella melaninogenica/classification , Anaerobiosis , Anti-Bacterial Agents/pharmacology , Bacteroides Infections/microbiology , Butyrates/metabolism , Carbohydrate Metabolism , Drug Resistance, Microbial , Esculin/metabolism , Fluorescence , Humans , Hydrolysis , Indoles/metabolism , Lipase/biosynthesis , Pigments, Biological/biosynthesis , Prevotella melaninogenica/drug effects , Prevotella melaninogenica/metabolism , Starch/metabolism , Ultraviolet RaysABSTRACT
Fecal bacterial cultures from 40 normal humans yielded Megasphaera elsdenii from four individuals and Acidaminococcus fermentans from 10 individuals, with two individuals having both organisms.
