An outbreak of shingles?

7 of 101 staff within one department of a large office complex had shingles, as diagnosed by a general practitioner, within a three-month period. This incidence was significantly greater than that in the remaining workforce. Varicella-zoster-specific IgM antibody was detected in all 4 cases from whom early convalescent serum samples were obtained but in none of 22 controls. Within the index department there was evidence of clustering in time and by work area. A case/control study showed that a recent preceeding illness might have been a risk factor for shingles in the outbreak cases, but not for sporadic cases in other departments of the same office complex. This outbreak suggests that shingles can be provoked by reexposure to varicella-zoster virus.

Diphtheria in Europe.

A letter of inquiry was sent to 21 countries in Europe to ascertain their experience of diphtheria during the last 20 years. An analysis of the 15 replies showed that all relied on childhood vaccination and that this had reduced the annual incidence of the disease to a very low level. There was mention of three epidemics during the last ten years, and three countries identified several cases of skin diphtheria, mostly in patients who had contracted infection abroad.

Comparison of a latex agglutination test with other serological tests for the measurement of antibodies to Toxoplasma gondii.

One hundred sera from 49 patients with glandular toxoplasmosis were examined by a latex agglutination test, the dye test, an indirect haemagglutination test, and a double antibody sandwich enzyme linked immunosorbent assay (ELISA) for antitoxoplasma IgM. The results support previous findings that the dye test, indirect haemagglutination test, and latex agglutination test measure different antibodies to Toxoplasma gondii. In early glandular toxoplasmosis, when specific IgM was detected, the titres of both the latex agglutination test and the indirect haemagglutination test were lower than the dye test. Repeat specimens from 11 of the patients showed four cases in which the latex agglutination test titres never exceeded 1/256, whereas both the dye test and the indirect haemagglutination test showed significant titres and specific IgM was detected in every case. We conclude that the latex agglutination test should not be used as a substitute for the dye test in the serological diagnosis of glandular toxoplasmosis. All sera giving a positive latex agglutination test result should be referred for further tests. A combination of the dye test and double antibody sandwich ELISA gives the most reliable serological diagnosis of early glandular toxoplasmosis.

Detection of toxin production by Corynebacterium diphtheriae: results of a trial organised as part of the United Kingdom National External Microbiological Quality Assessment Scheme.

Four strains of Corynebacterium diphtheriae were sent to UK participants in the UK National External Microbiological Quality Assessment Scheme, who were asked to examine the strains for toxin production by in vitro methods. Laboratories achieved 162/176 (92%) and 160/175 (91%) correct results with two rapid toxin producers and 145/175 (82%) with a slow toxin producer. With a non-toxigenic strain 26/175 (15%) laboratories reported toxin production. Of the 173 laboratories reporting on all four strains, only 120 (69%) achieved the correct result for all. There was no significant association between the use of various methods and results, with the exception that laboratories using a full set of positive, weak positive, and negative controls made fewer errors than those not using controls. A number of unsatisfactory practices were revealed by the trial, however, and recommendations on preparation of inoculum, media, peptones, animal sera, and use of controls are made.

Bordetella pertussis isolation in general practice: 1977-79 whooping cough epidemic in West Glamorgan.

Some of the factors influencing the isolation rate of Bordetella pertussis during a whooping cough epidemic in West Glamorgan, Wales, are reported. The organism was isolated from 39% of patients with clinical whooping cough, pernasal swabbing being much more successful than cough plates. Isolation rates were increased in the non-immunized, particularly in the first year of life. Erythromycin and co-trimoxazole significantly reduced the isolation rate of B. pertussis but this did not occur with penicillin. In this study 20% of patients were culture positive 6 weeks after the onset of their infection. It is suggested that the Department of Health and Social Security recommendation of a minimum period of three weeks exclusion of children from school is inadequate. During the epidemic, the proportion of strains of B. pertussis containing antigen 2 more than doubled.

Age-sex distribution of various diseases with particular reference to toxoplasmic lymphadenopathy.

An account is given of some human diseases which affect one sex more than the other. An age-sex realtionship has been noted among British patients with acquired toxoplasmic lymphadenopathy. This is compared with the findings of other European workers. A possible explanation is offered taking all these diseases into consideration together with some of the experimental work done in animals and some of the variations in immunological responses by man.

Isolation and preservation of Toxoplasma gondii.

Thirteen isolations of Toxoplasma gondii were made from 110 specimens of various human tissues and tissue fluids. Twelve of these were from lymph nodes and one from a specimen of cerebrospinal fluid; all isolations were from cases with dye test titres of 1/512 or more. A description of the deep freeze method used to preserve the T. gondii strains isolated is included. It is hoped that attempts at isolation of this organism will be made more frequently in future.