The combined value of chemoprophylaxis and pneumococcal vaccine in the prevention of recurrent pneumococcal meningitis.

We report the case of an immunocompetent patient who has been the subject of 39 episodes of recurrent pneumococcal meningitis over a 20 year period. The recurrences of bacterial meningitis due to cerebrospinal fluid leakage and the presence of chronic sinusitis were not influenced by the surgical repair of a fistula and the repeated surgical draining interventions on suppurating chronic sinusital foci. Phenoxymethylpenicillin treatment reduced the number of recurrences and the combination of pneumococcal vaccine and penicillin prophylaxis allowed a 5 year period free of any recurrences.

Carriage of antibiotic-resistant Streptococcus pneumoniae by children in eastern and central Europe--a multicenter study with use of standardized methods.

With use of standardized techniques, a study of nasopharyngeal pneumococcal carriage in children in six Central and Eastern European cities was undertaken during the winter of 1993-1994. Nasopharyngeal swab specimens were collected from 954 children (predominantly under the age of 5 years) who were hospitalized or attending outpatient clinics or day-care centers. Susceptibility of isolates was determined by disk diffusion (on Mueller-Hinton agar with 5% sheep blood). Disks containing 1 micrograms of oxacillin were used to screen for susceptibility to penicillin G. Pneumococci were recovered from 258 (27.0%) of the 954 children. A variety of strains were recovered, and most penicillin-resistant strains were resistant to multiple agents. Minimum inhibitory concentrations of penicillin for selected resistant strains were 0.125-8 micrograms/mL. Resistance to penicillin was common in strains from Bulgaria, Romania, and Slovakia. Resistance to erythromycin and chloramphenicol occurred in Bulgarian and Romanian strains. Strains from Poland were all susceptible to penicillin, but many were resistant to tetracycline. Resistance to trimethoprim-sulfamethoxazole was common in Bulgarian, Romanian, and Slovak strains. Czech and Russian strains were predominantly susceptible to antibiotics. Most resistant strains were of serotypes 6, 14, 19, and 23.

Study of the sensitivity to antimicrobial drugs of some S. pneumoniae strains isolated from different pathological states.

76 Str.pneumoniae strains isolated from different clinical disease forms were studied for the sensitivity to antimicrobial drugs using the diffusimetric method and the dilution in agar method (MIC to penicillin). The results revealed that 44.74% of pneumococci were sensitive to penicillin, the remaining pneumococci being resistant; 18.42% showed a high resistance (MIC > or = 2 micrograms/ml). A close relationship was seen between sensitivity to penicillin on the one hand and the Pneumococcus origin and serotype on the other. As concerning the multiresistance to antimicrobial drugs, 47.4% of the strains presented resistance to > or = antibiotics belonging to different classes, the most frequent resistance pattern being P, E, Te, SxT. The most active antimicrobial drugs were vancomycin, amoxiclave, rifampicin, followed by ceftriaxone and amoxicillin.

Antibiotic resistance study of invasive S.pneumoniae.

121 invasive pneumococci isolated from meningitis, septicemia, pneumopathies and other clinical infections (osteo-arthritis, peritonitis, sinusitis, otilis, conjunctivitis, plagues) were screened for susceptibility to penicillin G (P), erythromycim (E), chloramphenicol (Cl), tetracycline (T), ceftriaxone (Cro), and sulfametoxazole trimethoprim (SxT) by diffusimetric method, by MICs to P and Cro by agar dilutions and E-test. 48.8% were penicillin resistant (MICs > 0.12 microgram/ml), 22.7% being highly resistant (MICs 3-8 micrograms/ml). Any strain was resistant to P only, but patterns with P included were frequent (55.8%). Resistance to SxT was highest (monoresistance 25.6% as well as polyresistance 69.8%). 72.9% were resistant strains to > or = 1 antibiotic with 12 patterns of resistance (1-5 antibiotics). All of the strains were susceptible to Cro (MICs-0.003-0.5 microgram/ml). Resistance was closely correlated to serotypes 6,9,14,19,23 to site of isolation and diagnosis. Pneumococci from meningitis were 2-3 times more susceptible to P,E,Cl,T and SxT than the isolates from pneumopathies or other infections.

Bacteriological study of Neisseria strains isolated in Romania 1971-1992.

1496 Neisseria strains isolated from patients and carriers from 24 counties in Romania and Bucharest in 1971-1992 were studied. Serogroup A identified in 84.5% in 1987 shows a remarkable decrease in pre- and post-epidemic periods when serogroups B and C reach rates varying from 0 to 66.6% in 1975 for B and 38.8% in 1974 for C. Non-groupable strains were more frequently isolated in inter-epidemic periods, especially in carriers. Sensitivity to antibiotics of the meningococcal strains revealed a law rate of resistant strains, the most active antibiotics in decreasing order being: penicillin, chloramphenicol, tetracycline, ampicillin, rifampicin and erythromycin. Serogroup A was the most resistant to sulfamides as compared to the other serogroups, its resistance rate rising from 18.1% strains resistant to sulfathiazole in 1980-1985 to 60.7% in 1987 and to 83.3% in 1988.

Epidemiology of meningococcal meningitis in Romania 1971-1991.

The paper describes the endemic epidemic picture of meningococcal meningitis in Romania over 1971-1991 period. After the epidemic of 1970 with 1051 cases and a morbidity of 5.2 %000, the incidence of the disease suddenly decreased; thus in 1972-1984 the number of cases ranged from 191 to 534 per year, corresponding to a morbidity rate of 0.9 - 2.3 %000. Starting with the autumn of 1985 the incidence of meningococcal meningitis increased rapidly, reaching a maximum value in 1987 (2623 cases) and a morbidity rate of 11.4 %000. A spectacular decrease to 250-270 cases per year in 1990-1991 and a morbidity rate of 1.1 - 1.2 %000 were reported. Mortality followed closely the morbidity curve with a maximum in 1987 (0.4 %000). By contrast, lethality was higher in endemic periods with a maximum of 7.9% (1972), 8.9% (1975) and 6.3% (1990-1991), in the remaining years the lowest index being 1.4% (1980). The meningococcal meningitis epidemic of 1987 was due to group A Neisseria meningitidis identified in 84.5% of isolates from patients, the same serogroup decreasing in endemic periods to 0 (1991) or 5.5% (1974).

Group B streptococci implicated in the etiology of acute pneumopathies in neonates.

111 neonates with acute respiratory insufficiency and/or severe pneumopathy (pneumonia, bronchopneumonia) occurring in the first 10 hours after birth were investigated during January 1990-September 1991 for the group B streptococci presence. 430 samples from these neonate cases: throat and nose exudates, necroptic material from died neonates (pulmonary, blood, bronchial secretion) and their mothers (lochia, vaginal and uterine secretion) were examined. 33% of the neonates and their mothers were positive with the same GBS. 65.30% from the GBS strains belonged to serotype Ia and 34.70% to Ib. 24.48% from the GBS strains were resistant to Penicillin G by diffusimetric method with a corresponding MIC of 0.1 UP/ml (22.12%) and 0.5 UP/ml (2.65%).

Sensitivity to penicillin of S. pneumoniae strains isolated from various pathological conditions.

297 S. pneumoniae strains isolated from patients with different pneumococcal infections during 1990-1991 were tested for the sensitivity to antibiotics--by the diffusimetric method to 9 antibiotics (Penicillin (6 micrograms), Ampicillin (10 micrograms), Erythromycin (15 micrograms), Oxacyllin (5 micrograms), Streptomycin (50 micrograms), Tetracycline (50 micrograms), Chloramphenicol (50 micrograms), Rifampicin (6 micrograms), and Kanamycin (30 micrograms) and by MIC determination to Penicillin and Erythromycin. 30% of S. pneumoniae strains were resistant to Penicillin and Erythromycin corresponding to a MIC > or = 1 UP/ml or > or = 1 microgram E/ml. The most active antibiotics were Chloramphenicol and Rifampicin and the less active: Tetracycline, Kanamycin and Streptomycin. A relation between the origin and serotype of the strains and the sensitivity to antibiotics was revealed. The strains from the throat, conjunctive and otic secretions and belonging to serotypes 19, 6 and 14 showed the highest levels of resistance to all antibiotics. A good correlation between MIC and diffusion method results was observed to Erythromycin and no correlation to Penicillin. In this last case the results of MIC determination to Penicillin were better correlated with the results of inhibitions diameters to Oxacyllin, method which have to be recommended.

Diagnosis of pneumococcal meningitis by coagglutination method.

It was tested the possibility to evidence the pneumococcal capsular antigen, by coagglutination, directly in CSF, using a specific coagglutinating reagent for all the 10 serological types of S. pneumoniae more frequently encountered in our country. Were investigated 134 CSF from purulent meningitis, out of which 37 were of probable pneumococcal etiology, on the basis of bacterioscopic examination, 26 of other etiology and 71 of unknown etiology. The results obtained showed 28 (75.7%) positive reactions in the fluids from probably pneumococcal meningitides on the basis of the positive bacterioscopic examination. The specificity of the reactions is demonstrated by the negative reactions with the fluids from meningitides of other etiology, as well as by the concordance between the antigen serotype from the liquid and that of the isolated S. pneumoniae strain. For a good test sensitivity could argue the positive reactions obtained with 6 CSF from meningitides of unknown etiology.