Whooping cough--a study of severity in hospital cases.

In an attempt to determine the clinical severity and prognosis of children admitted to hospital with whooping cough, 127 patients were studied prospectively during a 12-month period. Clinical and laboratory criteria were used and the impression gained was that most cases were mild, although 3 children were dangerously ill and at least 30% had symptoms lasting 2 months or longer. There were no deaths, and no permanent sequelae were noted. The mean age of patients was higher than in other series, which might have accounted for the fairly low severity. Although there was some evidence of a decline in severity and mortality, whooping cough is still an unpleasant and protracted illness.

Diphtheria carriers in Manchester: simultaneous infection with toxigenic and non-toxigenic mitis strains.

A toxigenic strain of Corynebacterium diphtheriae mitis was isolated from a 10-week-old baby with membranous tonsillitis, and over the next 6 months thirty-nine symptom-free carriers of nitrate-positive mitis strains were found. All carriers were cleared by 14 days' treatment with erythromycin, though several relapsed after a 5-day course. Four contacts carried both toxigenic and non-toxigenic mitis strains; epidemiological evidence and phage studies suggest that these had a common origin. These findings have implications for the epidemiology of diphtheria and for the routine testing of isolates for toxigenicity.

Mecillinam in enteric fever.

Twelve consecutive patients with enteric fever entered a trial of 14 days' treatment with mecillinam. Only three patients became afebrile within three days; four continued unimproved with fever and toxaemia for seven to nine days, when treatment was changed to chloramphenicol with good results. In one case the fever did not settle until the 13th day, and five days later the patient had a clinical relapse. Although all organisms recovered were fully sensitive to mecillinam, this drug is not an effective or consistent treatment for enteric fever.

Campylobacter colitis.

Eleven consecutive patients with diarrhoea from whose stools campylobacter were isolated were investigated by sigmoidoscopy and rectal biopsy. Eight had definite proctitis, and in seven biopsy specimens were abnormal with histological changes ranging from non-specific colitis to gross colitis with goblet-cell depletion and crypt-abscess formation. Nine of the patients passed blood in their stools, and in all but one abdominal pain was a feature of the illness. Severe campylobacter colitis may be clinically, sigmoidoscopically, and histologically difficult to differentiate from ulcerative colitis and is a differential diagnosis in acute colitis.

Toxic dilatation of the colon in salmonella colitis and inflammatory bowel disease.

Toxic dilatation of the colon may be due to inflammatory bowel disease, either ulcerative colitis or Crohn's disease of the colon, but recent experience has shown that infective colitis due to salmonella can produce this complication. We present 13 cases with toxic dilatation (9 inflammatory bowel disease and 4 salmonellosis) and outline the diagnostic features and treatment in these patients. It is important to distinguish salmonellosis at an early stage because, whilst toxic dilatation in inflammatory bowel disease is an absolute indication for surgical treatment, cases with this complication due to salmonellosis may be treated conservatively in the majority of instances.

Radioactive bromide partition test in differential diagnosis of tuberculous meningitis.

In 19 cases of lymphocytic meningitis, the radioactive bromide partition test showed that four were tuberculous and 15 viral in origin. In all the tuberculous cases the serum/cerebrospinal fluid bromide ratio was below a critical value of 1.6, and in all the cases of viral meningitis the ratio was above this value. The test may be particularly helpful when diagnosis is difficult. The test may prove to be a valuable and justified additional procedure in the early diagnosis of tuberculous meningitis.

A survey of infantile gastroenteritis.

In 1967 we admitted 339 cases of infantile gastroenteritis; one-third of these were dehydrated, and in this group the commonest biochemical abnormality found was hypernatraemia, sometimes with metabolic acidosis. A higher incidence of dehydration was found in the patients who had received oral glucose fluids before admission. EnteropathicEscherichia coliwere isolated from the faeces of 16% of the cases. Associated infections, especially of the respiratory tract, were common. Treatment was aimed at the restoration of fluid and electrolyte balance. Usually this was achieved with oral fluids, though intravenous fluids were used in the most severely dehydrated cases. Recovery was complete in 320 cases and a further 14 cases were discharged as carriers of enteropathicE. coli. There were five deaths (1.5%) in the series; three occurred immediately after admission.