Outbreak of Salmonella food poisoning amongst delegates at a medical conference.

An outbreak of Salmonella typhimurium DT9 food poisoning due to contaminated chicken pieces affected at least 196 delegates at a medical conference. Twelve per cent of the cases reported suffering parasthaesiae. Nine reported serious complications of infection which included rectal prolapse and perianal abscess. Antibiotic therapy did not measurably reduce the duration or severity of diarrhoea. Over 1,600 doctor-days were lost to the NHS. Most doctors sought expert infection control advice before returning to work but the advice given differed between hospitals.

Legionella pneumophila in coal miners.

Legionnaires' disease was diagnosed in three mineworkers at a colliery. Investigation of water samples from various sites at the colliery did not discover a source of the infection. Results of serological surveys undertaken on the workmates of the patients and other miners showed only one additional positive Legionella indirect fluorescent antibody test. There was, therefore, no justification for any alteration in the water supply or the ventilation at the colliery.

Relation between the mucosal flora and Paneth cell population of human jejunum and ileum.

The Paneth cell population in surgically resected human jejunum and ileum was estimated using image analysis of the granule area in patients who had not received antibiotics. The mucosa was cultured aerobically and anaerobically. In the jejunum 22 samples were sterile and five yielded bacteria; in the ileum four were sterile and three were non-sterile. The mean Paneth cell granule area in the sterile jejunum was 122.7 +/- 37.2 micron2 and in the non-sterile samples 67.2 +/- 36.6 micron2 (p less than 0.006). The corresponding values for the ileum were 137.9 +/- 109.8 and 100.5 +/- 9.1 (NS). Thus an increase in the Paneth cell population may occur in response to changes in the intestinal luminal environment. Failure of this response and resultant Paneth cell deficiency may lead to bacterial overgrowth.

Mucosal flora of the small intestine and the effect of preoperative antibiotics.

Samples of mucosa from the small intestines of 100 patients undergoing intestinal surgery were examined bacteriologically. Sixty four patients had received chemotherapy, 12 for more than 24 h before operation. Most of the jejunal samples were sterile unless there was a carcinoma, previous surgery, or potential intestinal stasis. Ileal mucosa was more likely to contain intestinal organisms. Most of the strains isolated were sensitive in vitro to the antibiotics given in vivo, but short term treatment may not have allowed sufficient time for the treatment to have become effective. The findings suggest that antibiotics are not needed for most operations on the duodenum or jejunum but may be required for operations on the ileum.

Urethral syndrome: a self limiting illness.

Thirty nine adult women who were not pregnant and had the urethral syndrome in a general practice underwent detailed microbiological investigations. Patients monitored their own symptoms, and those with persisting symptoms were entered into a randomised controlled trial of treatment with doxycycline and placebo. Chlamydia trachomatis and Neisseria gonorrhoeae were not isolated and fastidious organisms were not causally associated with the urethral syndrome. Treatment with doxycycline showed no benefit; each episode of the urethral syndrome was short and self limiting and there were no recurrences in a median observation period of 12 months.

A comparative trial of pivmecillinam/pivampicillin and amoxycillin/clavulanate in the therapy of urinary tract infection in a general practice population.

Fifty-eight patients seen in general practice presenting with symptoms of acute urinary tract infection were entered consecutively into an open randomized trial of 200 mg pivmecillinam plus 250 mg pivampicillin twice daily or 250 mg amoxycillin plus 125 mg clavulanate 3-times daily for 5 days. The results were analyzed in 41 patients with significant bacteriuria (23 on pivmecillinam/pivampicillin and 18 on amoxycillin/clavulanate). Both antibiotic combinations produced good overall bacteriological cure, but there were a considerable number of persisting symptoms despite the absence of significant bacteriuria. Eight patients in the pivmecillinam/pivampicillin group and 5 in the amoxycillin/clavulanate group had side-effects, principally thrush, vomiting and abdominal pain, and 1 patient from each group ceased treatment for this reason. Sensitivity profiles of urinary isolates (41 trial, 135 non-trial) to both combinations and to ampicillin and mecillinam showed that the majority were fully sensitive to amoxycillin/clavulanate and to a lesser extent to pivmecillinam/pivampicillin; resistance was highest to ampicillin.

A survey of nasal Streptococcus pneumoniae in children.

Nasal swabs were taken from 369 four-year-old children in two South Wales towns and cultured for Streptococcus pneumoniae. The organism was isolated in 34% of the specimens, similar rates being found in boys and girls in the two towns. The children were swabbed again a year later, when the prevalence of nasal pneumococci had fallen to 25%. There was no association between the presence of the organism on the two occasions. Types 6 and 23 were most often isolated. After excluding children who had received an antibiotic, the proportion carrying a pneumococcus was higher in those who had recently had a respiratory infection than in the rest, although the difference was not quite statistically significant. There was a significant negative association between the presence of Staphylococcus aureus and Strep. pneumoniae.

Nasal staphylococci in children--a follow-up study.

Nasal carriage of Staphylococcus aureus was studied in a cohort of infants born to the residents of two towns in South Wales. The children were followed up to the ge of 5 years, nasal swabs being taken annually after a more detailed survey during the first year. The carriage-rate of S. aureus reached a minimum of 10-15% at one year and then rose steadily to 41% at five years. From the age of two years about 90% of the organisms isolated were resistant to penicillin. There was a marked tendency for children to carry the same strains from year to year, but carriage during the first year of life did not predict carriage at the age of five.

Changes in the heparin neutralising activity of platelet poor plasma after immunisation.

Acute myocardial disease, which may be associated with abnormal platelet activity, has been reported after routine immunisation. Thirty-two army apprentices undergoing immunisation were studied for changes in the heparin neutralising activity (HNA) of platelet poor plasma. HNA increased after immunisation. This increase in HNA may represent an increase in platelet activation but may also relate to changes in acute phase proteins. These changes were not observed in elderly subjects undergoing immunisation with influenza vaccine.

The effects of immunisation upon the natural history of pertussis. A family study in the Cardiff area.

During an outbreak of pertussis in the Cardiff area in 1974, 229 children with the disease were studied to assess the effect of immunisation upon its natural history and severity. The typical clinical features of pertussis, such as paroxysmal cough, whooping, vomiting, cyanosis, and irregular breathing, were less prevalent in both the immunised and the older children. Immunisation is the main factor in protecting against complications such as fits; and, together with older age, it protects against hospitalisation. Nevertheless, pertussis today can be just as severe as it was 40 years ago, and the vaccine remains the major factor ameliorating its natural history. The immunisation programme needs more active support by all child health workers.

Antibiotic resistant staphylococci acquired during the first year of life.

Nasal swabs were taken from 492 babies born consecutively to residents of two South Wales towns soon after their discharge from maternity hospitals. Staphylococcus aureus was isolated from 352 babies (72%) and in 79 (22%) of these it was resistant to at least one antibiotic. By the time these babies were a year old the prevalence of both sensitive and resistant strains had fallen, so that only 12% still carried nasal staphylococci, but 64% of these organisms were then resistant to penicillin. Administration of penicillin to the baby seemed to be a more important factor in selecting resistant organisms than other antibiotics given to the baby, any antibiotic treatment to other members of the household, or discharge from hospital.

A programme for collaborative influenza surveillance. A report of a working group of the Public Health Laboratory Service.

A surveillance programme is described which is intended to assess the effects of influenza virus infections on communities at large by collating influenza virus isolations and consultations for respiratory infections from general practices with new claims for sickness benefit and deaths from all causes. Particular importance is attached to relating virus isolations to symptomatic respiratory disease seen in practices of known age and sex structure.

Contamination of fluids from a hospital pharmacy.

An investigation into the cause of bacterial contamination of bottles of noninjectable water has been reported. A method of monitoring such bottles has also been described. The roles played by autoclave spray-cooling water and inadequate bottle seals in the contamination of fluids have been examined. Possible methods of reducing the risk of contamination are discussed and the design of an improved method of closure of sterile bottled fluids is stressed. Bacteriological examination is shown to be a more accurate index of the true rate of contamination than measurement of dye concentrations of bottle contents.