Two outbreaks of Legionnaires' disease in Bolton Health District.

In 1988, there were two outbreaks of legionellosis in Bolton Health District. Altogether 37 cases of Legionnaires' disease and 23 cases of non-pneumonic legionellosis were identified. Twenty-five patients with Legionnaires' disease were associated with an engineering plant, 4 with Bolton town centre, and 8 with both the plant and town centre. Twenty-two people with non-pneumonic legionellosis were linked with the engineering plant and one with the plant and the town centre. A case-control study carried out among 37 employees with legionellosis and 109 control subjects at the plant showed that infection was associated with one of the 15 cooling towers on the site. Legionella pneumophila indistinguishable by serological and genetic typing methods was isolated from this cooling tower and from sputum samples from two patients. In the town centre, no one tower was linked with infection and L. pneumophila was not cultured from any of the nine towers identified. Control measures were implemented and to date there have been no further cases of legionellosis associated with Bolton Health District.

Streptococcus milleri and surgical sepsis.

For many years Viridans streptococci have been considered as commensal organisms in a wide variety of sites in the human body and only regarded as significant pathogens in subacute bacterial endocarditis. However, in recent years some reports have suggested that a particular species, Streptococcus milleri, can be a virulent pathogen, producing life-threatening sepsis particularly in surgical patients. We review here our experience of this organism in 23 general surgical patients over a 3 year period, and postulate that prophylactic use of antibiotic combinations such as gentamicin and metronidazole in patients undergoing colo-rectal surgery may be a factor promoting its emergence as a significant pathogen. Patients with established sepsis due to Streptococcus milleri should be considered for long-term antibiotic therapy as part of the treatment of their abscesses.

Failure of delayed hypersensitivity skin testing to predict postoperative sepsis and mortality.

Delayed hypersensitivity skin reactions to a battery of recall antigens, haemoglobin and albumin concentrations, arm-muscle circumference, and percentage of ideal weight were determined before operation in 244 patients undergoing elective major surgery. Depressed skin reactions were found in 70 patients (28%), but this group did not have significantly higher sepsis or mortality rates when compared with patients with normal reactions. Significant associations were found between depressed skin reactions and increasing age, anaemia, hypoalbuminaemia, low arm-muscle circumference, and low weight. Patients with benign and malignant disease had similar distributions of skin reactions. Hypoalbuminaemia was associated with a higher rate of serious postoperative sepsis, and hypoalbuminaemia, low arm-muscle circumference, and low weight were all associated with a higher mortality. These results suggest that the routine use of delayed hypersensitivity skin testing in the preoperative assessment of surgical patients is not justified.

Haemophilus aphrophilus endocarditis.

Haemophilus aphrophilus was isolated from the blood of a 31-year-old man with subacute bacterial endocarditis. Subsequently the patient died with acute tubular necrosis of the kidney, probably secondary to cardiac failure. The characteristics of the species are described and pathogenicity to mice is reported for the first time.

Haemophilus influenzae type B septicaemia.

In the period November 1967 to September 1968 Haemophilus influenzae type b was isolated from the blood of 11 young children. Only three of these presented with meningitis; others had septic arthritis, oesteomyelitis, subcutaneous abscesses, cellulitis, respiratory infections, and undifferentiated pyrexia. During the preceding five years H. influenzae type b was isolated from the blood cultures of 15 patients, and all but two of these were cases of meningitis. Blood culture has proved of value in establishing the role of H. influenzae type b in a broad spectrum of acute infections, and the suggestion is made that meningitis may represent only a minority of cases of haemophilus septicaemia. Because H. influenzae is resistant to some antibiotics bacteriological diagnosis of such cases is important if the correct treatment is to be given.