Vaginal lactobacillosis.

OBJECTIVES: Our purpose was to study a cyclic condition characterized by vaginal discharge and discomfort occurring 7 to 10 days before menses and associated with the occurrence of long serpiginous rodlike organisms, visible in wet mount preparations. STUDY DESIGN: Thirty-seven patients and 30 controls were studied prospectively. The vaginal flora was analyzed, including isolation of anaerobic bacteria and fungi. Species of lactobacilli isolated from some of the women were identified and the antibiotic susceptibility was determined. Recent episodes of vaginitis and therapy were recorded. RESULTS: Ninety-two percent of the patients had a history of recent episodes of vaginosis lasting for an average of 22.2 months, and 57% had received triazole or imidazole antifungal therapy. Anaerobic lactobacilli were isolated from 97% of the vaginosis patients and from 40% of the controls. The average length of the organism seen was 60 microns in the patients and 10 microns in the comparison group. Amoxicillin and clavulanate potassium proved to be an effective therapy symptomatically and resulted in disappearance of the extremely long organisms in vaginal smears. CONCLUSIONS: Lactobacilli vaginosis is associated with extremely long lactobacilli. The cause of this morphologic transformation is unknown. The condition can be effectively treated with antibiotics.

Chronology of a hospital-wide measles outbreak: lessons learned and shared from an extraordinary week in late March 1989.

In March 1989, Mount Sinai Hospital, a community hospital in Hartford, Connecticut, faced a potential hospital-wide outbreak of measles when eight cases of measles occurred among medical personnel during several days. This article describes the chronology of events, from the initial discovery of the outbreak to the evolution of the hospital-wide containment program designed to protect patients and staff members. Measles IgG immune status was determined for 1249 employees during a 9-day period. Measles vaccine and immune serum globulin were administered to patients and employees. We offer advice from our experience for infection control practitioners who may face outbreak situations in their institutions.

Treponema pallidum and Helicobacter pylori recovered in a case of chronic active gastritis.

A 49-year-old man complaining of epigastric pain underwent endoscopy, during which thickened stomach folds below the fundus were observed. Microscopic examination of gastric tissue biopsy specimens revealed chronic active gastritis. Dieterle stain revealed overwhelming numbers of "corkscrew-like" spirochetes. These were proved to be consistent with Treponema pallidum. A comprehensive study of the tissue revealed the added presence of Helicobacter pylori. This appears to be the first case report describing the involvement of H. pylori and T. pallidum together in a case of chronic active gastritis.

The emergence of methicillin resistant Staphylococcus aureus in extended care facilities in northern Connecticut between 1986 and 1990.

Methicillin resistant Staphylococcus aureus (MRSA) is recognized as a pathogen of significant morbidity in hospital facilities. The microorganism can also be recovered from clinical specimens taken from patients who are residents of extended care facilities (ECFs). This report is a five-year retrospective review of the emergence and spread of MRSA isolates within ECFs located in north central Connecticut and their susceptibility profile over that time span.

Human necrotizing splenitis caused by Borrelia burgdorferi.

A 25-year-old Hispanic male presented to the emergency room with complaints of severe left upper quadrant pain. Physicians determined that the patient had an acute inflammatory process with a possible diagnosis of splenic abscess. A splenectomy was performed. Histologic examination of the tissue sections revealed extensive necrosis and inflammation, but no etiologic agent was discernible. Microbiologic cultures of the tissue had negative results. A Dieterle silver stain revealed an overwhelming number of spirochetal bacteria most closely resembling Borrelia spp. The patient's serum was tested for serologic evidence of antibody to Borrelia burgdorferi with the following results; by indirect fluorescent antibody 1:32; by enzyme-linked immunosorbent assay for IgM, 1:320; and Western blotting had positive results for the presence of B. burgdorferi outer-surface protein antibodies. This is the first human case report of an acute necrotizing splenitis resulting from B. burgdorferi.

Bacteremia caused by Vibrio hollisae.

Vibrio hollisae was recovered from the bloodstream of a 36-year-old man with chronic active hepatitis who was admitted to the hospital with signs of gastrointestinal illness. V. hollisae is an infrequent human pathogen associated with seafood ingestion. No etiologic link to seafood was demonstrated in this case report.

Chemotaxis of human polymorphonuclear leukocytes toward Neisseria gonorrhoeae.

Chemoattractive properties of Neisseria gonorrhoeae were studied by measuring leukocyte migration in agarose gel. Human serum albumin (0.5%) was present in the gel and normal human serum was excluded from all components of the assay. Viable cell populations and lysates of colonial types F62T1, F62T2 and F62T3 induced migration of polymorphonuclear leukocytes. Chemotactic activity of the lysate was not altered by heating at 100 degrees C for 10 min and was retained in the 12 100 g supernatant fraction of the heated lysate. Fractionation of the supernate by Sephadex G-100 chromatography showed that the chemotactic activity was associated primarily with an absorbance peak at 280 nm of relatively low mol. wt. The chemotactic activity of this fraction was lost after dialysis and the peak was no longer present in the Sephadex G-100 elution profile of the dialysed supernate. The gonococcal leukotaxins were sensitive to digestion by trypsin, pronase and amyloglucosidase, but insensitive to treatment with RNAase, DNAase or lipase at pH 5.7-7.1.