Cerebral abscess on Merseyside 1980-1988.

We report a retrospective study of 62 patients presenting to The Walton Centre for Neurology and Neurosurgery with cerebral abscess in the 8-year period between 1980 and 1988. The study shows that while the incidence of cerebral abscess has not altered from the previous decade, aetiological factors have changed and major developments in the diagnosis and management of the condition have resulted in a marked reduction in the morbidity and mortality associated with brain abscess.

Antibody coated bacteria in urine of patients with recent spinal injury.

Twenty patients with an acute spinal injury were prospectively studied to assess the clinical importance of antibody coated bacteria (ACB) in the urine and the association among the different bacterial species with a positive antibody coated bacteria test. Clinical urinary tract infection was associated with a positive ACB test on 45% of occasions. Three hundred and ninety nine urine samples containing 541 bacterial isolates were assessed for the presence of ACB; 13% were found to be positive and 87% negative for ACB; 67% of urines contained a single bacterial isolate. Pseudomonas aeruginosa was most commonly associated with clinical urinary tract infection, found in 25% of episodes, followed by Proteus mirabilis (17.5%), Klebsiella sp (12.5%), and Proteus morganii (10%). Providencia stuartii, however, was most commonly associated with a positive ACB test (found in 17%). Other bacteria associated with a positive ACB test included Klebsiella sp (14%), Acinetobacter sp (12.5%), Pseudomonas aeruginosa (12%), Citrobacter sp (11.5%). A positive ACB test is not to be expected from a patient with spinal injury who has a catheter in place, and the test may provide a useful guide to identify those patients with an invasive infection. It is doubtful that a decision to treat or not treat bacteriuria could rest on the identification of the bacterial species alone.

Penetration of ceftazidime into intracranial abscess.

The penetration of ceftazidime into intracranial abscess was investigated in nine patients receiving intravenous ceftazidime. Concentrations of antibiotic in pus were measured by a microbiological agar diffusion assay (12 samples) and high performance liquid chromatography (8 samples) at varying times following ceftazidime administration. Concentrations of ceftazidime varying between 2.7 and 27.0 mg/l were detected. The role of ceftazidime in the therapy of intra-cranial abscess of otogenic origin is discussed.

An outbreak of Trichuris trichiura in a mental handicap hospital.

An outbreak of Trichuris trichiura in a ward for the severely mentally handicapped affected 22 of 29 patients. There was concurrent carriage of non-pathogenic Entamoeba histolytica in 59% of these patients. Heavy contamination of soil was found in the patients' recreation area. The management of the outbreak is discussed.

Monoclonal antibodies show Listeria monocytogenes in necropsy tissue samples.

Stable mouse monoclonal hybridoma cell lines secreting antibodies against Listeria monocytogenes were produced. Antibodies from two of these cell lines (designated CL2 and CL17) have been partially characterised. The specificities of these antibodies were assessed using indirect immunofluorescence antibody tests and L monocytogenes (166 strains) grown in vitro, other species of Listeria (21 strains), and bacteria from 14 other genera (87 strains). The antibodies were found to be specific for Listeria, and when used in combination, reacted with almost all strains of L monocytogenes. A simple and rapid direct immunofluorescence technique was developed, and the presence of L monocytogenes was shown in necropsy tissue from three patients where listeriosis had been confirmed by isolation of the bacterium. Bacteria were also confirmed using one of these antibodies in necropsy tissue from one further patient in whom listeriosis was suspected, but not confirmed by the cultivation of L monocytogenes.

Hospital outbreak of multi-resistant Acinetobacter anitratus: an airborne mode of spread?

During a 10-month period, from October 1984 to July 1985, a multi-resistant strain of Acinetobacter anitratus was isolated from 36 patients in three neurosurgical wards, one medical ward and the intensive care unit of a district general hospital, and from two patients in the intensive care unit of a hospital in another district. Fourteen patients developed significant infection including pneumonia (10), meningitis (2), septicaemia (2) and wound infection (4). The majority of cases (28) involved the respiratory tract of ventilated patients, although respiratory equipment was not implicated as a source of the infection. The epidemic strain was recovered from the skin, nose, mouth and rectum of colonized patients and from the hands of personnel. However, extensive air and environmental contamination in the vicinity of colonized patients was also demonstrated. This is the first outbreak of infection with Acinetobacter, of which we are aware, where airborne spread has been observed.

Serial concentrations of C-reactive protein as an indicator of urinary tract infection in patients with spinal injury.

C-reactive protein (CRP) was measured serially in 16 patients with an acute spinal injury. Twelve episodes of acute urinary tract infection (UTI) occurred during the study period. These were all associated with an increased concentration of CRP greater than 50 mg/l, which returned to normal after successful treatment. Thirteen episodes of asymptomatic bacteriuria associated with increased concentrations of CRP greater than 20 mg/l occurred, indicating tissue damage. More commonly, significant bacteriuria was associated with normal concentrations of CRP, and presumably, simple colonisation of the urinary tract, which, we suggest, does not require treatment with antibiotics. Serial measurement of CRP in patients with spinal injury may help distinguish between urinary tract colonisation and infection and be useful in monitoring the response to the treatment of clinical UTI.

Infections due to a 'Group JK' corynebacterium.

We report the case of a patient who developed bacteraemia with a 'Group JK' corynebacterium following multiple injuries sustained in a road traffic accident, and that of another patient whose cerebrospinal fluid shunt became colonised with a similar organism for over a year.

Tuberculous meningitis due to Mycobacterium bovis: a report of two cases.

Two Caucasian patients with bovine tuberculous meningitis are described. Classical Mycobacterium bovis was isolated from the cerebrospinal fluid on both occasions. Despite the elimination of cattle tuberculosis in this country, reactivated primary disease due to the bovine tubercle bacillus may still occur.

The evaluation of cefuroxime in the prevention of postoperative infection.

Patients undergoing biliary surgery received either 750 mg cefuroxime i.m. with the premedication and then 8 hourly for 3 days ((group A) or 1.5 g cefuroxime i.v. at the time of induction of anaesthesia (group B) or not treatment (group C). Wound infections occurred in 3 out of 35 patients in group A, 1 out of 40 patients in group B and 11 out of 39 patients in group C (group B significantly different than group C, P less than 0.05). Eight patients (23%) in group C had chest complications. Cefuroxime was effective in the reduction of wound sepsis following biliary surgery and 1.5 g i.v. administered during induction of anaesthesia is the dosage of choice. The incidence of chest infection tended to be lower in patients receiving cefuroxime but many more patients would have to be studied for a conclusive result.

e-Antigen: a link between immune response and infectivity in hepatitis B?

In a study of the distribution of e-antigen and anti-e in subjects whose blood was positive for hepatitis B surface antigen (HBsAg), patients with acute hepatitis B who were tested during the incubation period were all e-antigen-positive but after the onset of illness e-antigen was detected in only 11%. Persistence, and in some instances reappearance of e-antigen in those who became long-term carriers of HBsAg was associated with high titres of HBsAg. There was a high incidence of e-antigen in those conditions in which cell-mediated immunity may be depressed, including Down's syndrome and chronic renal failure. The majority of HBsAg carries identified as sources of infection were e-antigen-positive. A postive reaction for e-antigen is evidently associated with a defective immune response to hepatitis B virus infection which permits continued replication of virus in liver cells accompanied by high titres of HBsAg, numerous Dane particles and detectable DNA polymerase in the blood with consequently a greater likelihood of transmitting infection. Although it cannot be assumed that anti-e positive carriers of HBsAg are not infective, it may be necessary, in the assessment of passive or active immunization for the control of hepatitis B, to take into account the e-antigen/antibody status of possible sources of infection.

Hospital outbreak of Listeria monocytogenes septicaemia: a problem of cross infection?

A 74-year-old man was admitted to hospital with septicaemia and meningitis caused by Listeria monocytogenes. Subsequently 3 inpatients developed listeria septicaemia. Case-to-case transmission of the infection seems possible, although the method of transmission remains obscure.