Disseminated BCG infection in severe combined immunodeficiency presenting with severe anaemia and associated with gross hypersplenism after bone marrow transplantation.

An infant with severe combined immunodeficiency (SCID) is described, who presented with severe anaemia and hepatosplenomegaly due to disseminated Bacillus Calmette-Guérin (BCG) infection involving the bone marrow, liver and spleen. After BMT, huge splenic enlargement occurred, presumably due to proliferation of engrafted donor lymphocytes, leading to severe hypersplenism. Peripheral blood cell consumption was resolved by splenectomy, but gradual loss of the marrow graft followed.

A study of three blood culture media for isolating genital mycoplasmas from obstetrical and gynaecological patients.

Mycoplasma species are often found colonising the female genital tract. Their ability to become invasive and pathogenic, however, is often ignored, since attempts may not be made to culture these organisms from the bloodstream. We have investigated the ability of three types of blood culture media to support the growth of genital mycoplasmas. The media studied included brain-heart infusion broth, brain-heart infusion broth supplemented with 30% V/V sucrose and fastidious anaerobe broth. Genital mycoplasmas were cultured from the latter medium only. Since this was the sole medium which was liquoid-free, the inhibitory effects of liquoid on Mycoplasma spp. is discussed. This study comprised an investigation of 75 patients in obstetric and gynaecological wards with postpartum or post-operative fever. Genital mycoplasmas were isolated from five (6.7%) patients, four with Ureaplasma urealyticum and one with M. hominis. The value of considering these organisms in the differential diagnosis of fever in 'at risk' patients and of including appropriate media for their isolation is emphasised.

Failure of mebendazole to cure trichomonal vaginitis resistant to metronidazole: case reports.

After a recent report showing the in vitro susceptibility to mebendazole of a strain of Trichomonas vaginalis that was resistant to metronidazole, we present two cases of metronidazole resistant infection, both of which failed to respond to oral mebendazole.

An outbreak of viral gastroenteritis in a psychiatric hospital.

In September and October 1987, an outbreak of gastroenteritis due to small round structured viruses occurred in a large psychiatric hospital. A total of 149 people, 83 patients and 66 members of staff, were affected over a 26-day period. Most cases were associated with three psychogeriatric wards. The outbreak highlighted the special problems of infection control in long-stay psychiatric units and methods of overcoming these difficulties are discussed.

Trichomonal vaginitis refractory to treatment: case report.

A woman initially aged 25 was treated for seven years for symptomatic vaginal trichomoniasis. Throughout that period the patient received 5-nitroimidazoles at conventional and high dosages, antimicrobial agents to eliminate vaginal organisms capable of interfering with treatment, acidifying preparations, and vaccination with inactivated Lactobacillus acidophilus. Despite all the regimens used, the condition remained refractory to treatment.

A microbiological study of absorbent pads.

A study was carried out of the microbial content of three types of incontinence underpads and a clinical absorbent protection pad. Coagulase-negative staphylococci and Bacillus spp. were isolated from unused samples of all makes of pad examined. Clostridium spp., including C. tetani and C. perfringens, were isolated from a proportion of pads containing re-cycled waste material. We recommend that incontinence underpads are used solely for the purpose for which they were marketed, namely, the containment of excreta.

Competitive enzyme-linked immunosorbent assay for Treponema pallidum antibodies.

A competitive enzyme-linked Treponema pallidum immunosorbent assay (CETPIA) was compared with the standard serological tests for syphilis. Of 3081 serum samples submitted, 2883 gave negative results in the CETPIA and the routine screening tests. Positive results were obtained in the CETPIA and in one or more of the specific treponemal tests with 115 samples. Discrepancies in the results of the CETPIA and standard serological tests were found with 83 serum samples, most of these were attributed to biological false positive reactions in the Venereal Disease Research Laboratory (VDRL) test. CETPIA may have a role in the serological diagnosis of syphilis.

The effect of covert bacteriuria in schoolgirls on renal function at 18 years and during pregnancy.

Schoolgirls shown to have covert bacteriuria (CB) by a screening programme and followed up for 5 years to assess whether chemotherapy had any beneficial effect, underwent a further assessment of renal function at the age of 18 years and during subsequent pregnancies. At age 18, glomerular filtration rate (GFR) and urine concentrating ability were the same as in controls, but fractional reabsorption of glucose was significantly reduced in those who had previously been prescribed chemotherapy because of renal scarring or who had been randomly allocated not to receive prophylactic chemotherapy. Those who had had CB as schoolgirls had a higher frequency of CB in pregnancy than did controls, whether or not prophylactic chemotherapy had been given to the subjects when they were schoolgirls. Furthermore, compared with girls who had had such treatment, untreated patients had smaller increments in GFR, reduced fractional reabsorption of glucose, and more than usual degree of glycosuria during pregnancy. This suggests that subclinical renal damage may be prevented by prophylactic chemotherapy but this advantage is unmasked only by the physiological demands of pregnancy.

Motile curved bacilli. Isolation and investigation.

Motile curved bacilli seen in vaginal secretions have been isolated on Columbia agar supplemented with 5% human blood and vitamin K. Growth occurred both anaerobically and in 5% oxygen, but not under more aerobic conditions. There were two distinct groups of these organisms, distinguishable by morphology, biochemical activity, antigenic pattern and susceptibility to metronidazole. All isolates were sensitive to a wide range of antimicrobial agents, with the exception of nalidixic acid and polymyxin. One group was resistant to metronidazole.

Characteristics of motile curved rods in vaginal secretions.

Motile curved rods seen in vaginal secretions have been isolated on Columbia agar supplemented with 5% human blood and vitamin K. Growth occurred anaerobically and in 5% oxygen but not in more aerobic conditions. There were two distinct groups of these organisms, distinguishable by morphology, biochemical activity and susceptibility to metronidazole. All isolates were sensitive to a wide range of antimicrobial agents, with the exception of nalidixic acid and polymyxin, but one group was resistant to metronidazole. There was little difference between the results of tests of susceptibility to aminoglycosides or to metronidazole performed in anaerobic and microaerophilic conditions. Motile curved rods were isolated from 18 of 80 patients with a clinical diagnosis of non-specific vaginitis, but from only two of 39 without the disease.