A purpose built MRSA cohort unit.

The control of hospital-acquired infection, in particular methicillin-resistant Staphylococcus aureus (MRSA) remains a challenge. Our hospital has established a purpose built 11-bed cohort unit with on-site rehabilitation for care of patients colonized with MRSA, in an attempt to improve their quality of care. Prior to the opening of this unit a number of concerns were voiced and the aim of this study was to address these. First, to establish if patient cohorting reduces the likelihood of successful decolonization, second, to evaluate the risk of staff colonization, and finally to see if successful environmental control of MRSA is possible.A patient database was established detailing patient demographics, infection rates, eradication and reacquisition rates. Staff screening was performed weekly, at the start of a period of duty. Sixty environmental sites were screened before unit opening, at 48h, six weeks and at six months. There were 88 admissions in the first six months; 62 patients were colonized with MRSA, and 26 patients (10 surgical, 16 medical) had MRSA infections. Twenty-three of 88 patients (26%) were successfully decolonized, which compares favourably with an eradication rate of 20% for the rest of the hospital. Twenty staff members participated in weekly screening. Five staff members colonized with MRSA were detected and all were successfully decolonized. Environmental control was achieved with a combination of a daily detergent clean and a once weekly clean with phenolic disinfectant. Our preliminary data suggest that, despite cohorting patients colonized with MRSA, with proper education and supervised cleaning protocols, it is possible to control environmental MRSA load, successfully decolonize patients and limit the risk of staff colonization.

Induction of an auto-anti-IgE response in rats. II. Effects on mast cell populations.

Immunization of rats with purified rat IgE myeloma (IR2) induces an IgG class autoantibody directed specifically against the IgE isotype. This has variable stimulatory effects on the serum IgE concentration in high IgE-producing BN rats but significantly decreases the serum IgE concentration in the conventional PVG.RT1u strain. We have examined the effects of inducing such an auto-anti-epsilon response on mast cell populations, as defined by their staining characteristics in BN rats. A persistent anti-epsilon response changed the proportions of mast cell types. Those containing highly sulfated, Safranin-positive granules which equate with cells described as connective tissue mast cells (CTMC) were reduced in number in skin, tongue and bone marrow, whereas the less highly sulfated, Alcian Blue-positive mast cells were increased in number in these tissues as well as in the gut, a site rich in the so-called mucosal mast cell. The overall number of mast cells in nonmucosal sites was not significantly changed in anti-IgE-producing rats. The direct effects of anti-epsilon antiserum on mast cells in vivo were investigated using an immediate skin response (ISR) technique. The IgG component of serum from IR2-immunized rats, fractionated by high performance liquid chromatography or eluted from Sepharose 4B-coupled IR2, gave positive ISR in naive rats. The ISR was inhibited by prior incubation of immuno-purified rat anti-IR2 with solid-phase IR2 or with two unrelated IgE myeloma proteins but not with rat IgG. Histological examination confirmed that degranulation of CTMC had occurred at the ISR sites.

Acute community-acquired pneumonias.

Of 81 adult patients with community-acquired pneumonia, bacterial infections were found in 37%, mycoplasma and viral infections in 21%, and tuberculosis in 6%; no pathogen could be identified in 46% of cases. More than one agent was identified in 12% of patients. Streptococcus pneumoniae, the most common pathogen, was found in 63%, Haemophilus influenzae in 26,7%, Staphylococcus aureus in 6,7%, and other Gram-negative organisms in 10% of patients with proven bacterial pneumonia. Most clinical and radiographic features were of little value in differentiating between different aetiological agents, but Gram-stained sputum gave a valuable early guide to therapy in 60% of cases of proven bacterial pneumonia. Blood culture was positive in 13,6% of cases. All the organisms conformed to their usual sensitivity patterns. Since Strept. pneumoniae is the predominant pathogen, penicillin should be the drug of choice in the immediate 'blind' treatment of community-acquired pneumonia.

Smoking in White high-school children in Cape Town.

A questionnaire was completed by 1716 White high-school children in Cape Town as part of an investigation into the smoking habits and respiratory symptoms in South African schoolchildren. Of the children surveyed 51% had never smoked, 28% claimed to be ex-smokers and 21% were smoking at the time of the survey. The average cigarette consumption by current smokers was 170 cigarettes per month, and 39% of smokers smoked more than 150 cigarettes per month; 71.3% admitted to inhaling. Peer influence was the single most important determinant of the smoking habit. Chronic cough and sputum production, symptoms suggesting asthma, dyspnoea on exertion, and a parental history of lung disease were all more common in ex-smokers and current smokers than in children who had never smoked.

Disseminated tuberculosis. A study of 62 cases.

Sixty-two cases of disseminated tuberculosis seen over a 6-year period in a large teaching hospital are reviewed. The commonest symptoms were cough, loss of weight and appetite, fever and general malaise. Headache, when present, was highly specific for meningeal involvement. Pyrexia, hepatomegaly, evidence of weight loss and adventitious chest sounds were the commonest physical signs. Hyponatraemia, hypo-albuminaemia and abnormal liver function were common. Severe haematological abnormalities were not present in any of the patients. The best diagnostic sources were sputum, bronchial brushings and biopsies of liver and bone marrow. Forty patients (64%) died, 31 deaths being directly attributable to disseminated tuberculosis. Twenty-five patients had associated diseases. More female patients and Black patients died than did males, Whites or Coloureds (mixed race). The duration of symptoms prior to admission was, in general, long in comparison with the interval between admission and death. We should like to re-emphasize the need to consider disseminated tuberculosis early in the differential diagnosis of a wasting pyrexial illness with chest symptoms and signs, even in the absence of a miliary or miliary-like chest radiograph.