Respiratory tract colonization and infection in patients with chronic tracheostomy. A one-year study in patients living at home.

The high rate of complications, especially respiratory tract infection (RTI), reported in patients with chronic tracheostomy (CT) has discouraged physicians from using this method. However, previous studies of CT have concerned mainly hospitalized patients. We have followed the bacterial colonization patterns of the upper and lower respiratory tract and recorded all RTIs in 39 outpatients with CT during a 12-mo period. Patients were colonized with one or more potential pathogens at the stomal site and in the trachea in 95% and 83%, respectively, of all sampling occasions. Staphylococcus aureus, gram-negative enteric bacteria (GNEB), and Pseudomonas aeruginosa were the most common colonizing bacteria at these sites. Seventy percent of bronchial-protected brush cultures were negative, despite simultaneous heavy colonization of the stomal site or the trachea. Only 18 of 39 (46%) patients were treated with antibiotics because of RTIs on a total of 30 occasions during the study year. Of these, only five episodes of pneumonia in four patients were registered, corresponding to an incidence of about 10 per 100 person years. We conclude that outpatients with chronic tracheostomy can be managed with a low risk for developing severe RTIs, despite massive airway colonization with potentially pathogenic bacteria.

Tick-borne Borrelia-meningitis in children. An outbreak in the Kalmar area during the summer of 1984.

Nine children, aged 5 to 11 years, with subacute or chronic meningitis were studied. Symptoms started during the summer season in all patients and in eight of the patients the disease began with a localized erythematous lesion (ECM), mostly in the face. In one patient only there was a history of an insect bite at the site of the erythema. The neurological abnormalities included aseptic meningitis, peripheral facial nerve palsy (5/9) and oculomotor nerve palsy (1/9). Most children complained of headache, fatigue, loss of appetite and had a low grade fever. High antibody titers to Borrelia spirochetes in serum and/or cerebrospinal fluid (CSF) were demonstrated by ELISA in eight of the nine patients and by indirect immunofluorescence assay (IFA) in three patients. All patients had a dramatic improvement in their general condition and became afebrile within three days of institution of i.v. penicillin G treatment (i.v. cefuroxime in one patient).

Artificial Salmonella vaccines: Salmonella typhimurium O-antigen-specific oligosaccharide-protein conjugates elicit opsonizing antibodies that enhance phagocytosis.

Outbred NMRI mice and rabbits were vaccinated with different artificial Salmonella typhimurium immunogens and the specificity and activity of elicited antibodies were studied in in vivo and in vitro phagocytosis assays. The Salmonella immunogens used were: (i) the synthetic disaccharide, abequose (formula see text) D-mannose, representative of Salmonella O antigen 4, covalently linked to bovine serum albumin (BSA); (ii) the octa- and dodecasaccharides, (formula see text) covalently linked to BSA; and (iii) whole heat-killed Salmonella. Rabbit antibodies passively administered to mice significantly enhanced the clearance of intravenously injected S. typhimurium challenge bacteria from the bloodstream. The clearance rate and the titer of anti-O-antigen-specific antibodies correlated. The clearance rate of an S. thompson (O6,7) strain, which has a different O antigen, was the same irrespective of the rabbit serum given. NMRI mice actively immunized with the various oligosaccharide-BSA conjugates had a significantly increased clearance rate of S. typhimurium only. In the in vitro assay, mouse antioligosaccharide-BSA sera promoted phagocytosis of S. typhimurium, but not S. thompson, when incubated with complement and mouse peritoneal exudate cells activated with Freund complete adjuvant.