Detection of Chlamydia trachomatis in urine from men with urethritis.

The performance of a commercial EIA (Chlamydiazyme) for detection of Chlamydia trachomatis in urine specimens was compared with that of culture of urethral samples from men with urethritis. The incidence of chlamydial infection on the basis of culture results was 34% (56/167). The sensitivity, specificity, positive and negative predictive values for the EIA were 55% (31/56), 98% (109/111), 94% (31/33) and 81% (109/134), respectively, compared with culture. Although this EIA has a high specificity, the low sensitivity makes it valueless as a clinical tool for demonstrating chlamydial antigen in urine from men with urethritis.

The origin of Staphylococcus saprophyticus from cattle and pigs.

Staphylococcus saprophyticus is a common cause of urinary tract infections. We have earlier shown that the bacterium is a contaminant of food of animal origin. In order to trace the natural reservoir of the bacterium, samples were taken from farming environment and from slaughtered carcasses. S. saprophyticus was found in 7.1% of rectal swabs from cattle carcasses and in 7.3% of rectal swabs from slaughtered pigs. The seasonal variation of these isolates paralleled the seasonality of urinary tract infections due to the same bacterium. S. saprophyticus was also isolated in 1.1% of rectal swabs from living cows, in 1.6% from pasture grass and from 12.4% of various indoor fodder. The fodder presented a seasonal distribution with a peak incidence of S. saprophyticus some months earlier than in rectal swabs. The bacterium was especially frequent in samples of fodder taken from the managers. S. saprophyticus is most likely a bacterium with a zoonotic origin.

Urinary tract infections caused by Staphylococcus saprophyticus. A matched case control study.

Epidemiological and clinical aspects of 270 episodes of urinary tract infection caused by Staphylococcus saprophyticus were studied. The cases were randomly selected and matched consecutively with 276 others of urinary tract infection according to sex, age and temporal occurrence. Such infections were found typically among young women in the outpatient health service. They were common among professionals handling meat products and were especially associated with prior outdoor swimming. Common symptoms of inflammation of the lower urinary tract, haematuria and pyuria were seen more often among patients with S. saprophyticus infections. Some cases of asymptomatic S. saprophyticus infection, however, were seen. We found S. saprophyticus as the cause of 13% upper urinary tract infections, an incidence which is higher than has been reported for other bacteria. Staphylococcus saprophyticus was less correlated to nephrolithiasis and was not a common cause of catheter-induced infections.

Plasmid-identified Staphylococcus saprophyticus isolated from the rectum of patients with urinary tract infections.

Among 15 strains of Staphylococcus saprophyticus of various origin, 13 presented different plasmid patterns, making plasmid identification a useful epidemiological marker. In a consecutive study of 14 young female patients with urinary tract infection caused by S. saprophyticus, 6 patients were simultaneously positive for the same bacterium in the stools. Three paired samples contained the identical plasmid-identified clone of S. saprophyticus indicating that the rectum may be a reservoir of this urinary pathogen.

Staphylococcus saprophyticus found to be a common contaminant of food.

The mode of transmission of Staphylococcus saprophyticus, a urinary tract pathogen, was investigated in three related studies. The presence of this organism was sought, during a period of 1 year, in 1331 specimens of various foods, in 920 beef and pork carcasses and on 107 cultures which had been inoculated directly from abattoir workers' protective gloves. Staphylococcus saprophyticus was found to contaminate 16.4% of the various food samples with a high prevalence of 34% in raw beef and pork. It was common in both domestic and imported raw meat products. There was no seasonal variation in the presence of S. saprophyticus in the samples obtained from carcasses. The bacterium was found in 69% of all cultures from the workers' protective gloves. We conclude that S. saprophyticus, originating from slaughtered animals, contaminates food and eventually colonizes the human intestinal tract.

Evaluation of a commercial enzyme immunoassay versus culture for the detection of Chlamydia trachomatis.

A commercial EIA (Chlamydiazyme) for detection of Chlamydia trachomatis was evaluated in comparison to culture using genital specimens from 472 men and 279 women. The sensitivity of the EIA compared with culture was 66.0% in men and 71.4% in women, while the specificity was 99.7% and 95.9% respectively. The EIA failed more often to detect chlamydial antigen when the number of inclusion bodies found in the corresponding cultures was less than or equal to 100/well. A direct test (MicroTrak) was performed on the EIA samples which showed discordant results compared to corresponding cultures. One of 17 EIA positive samples, and 12 of 36 EIA negative samples were positive in the direct test (p less than 0.05). A cut-off absorbance value of 0.1 is recommended by the manufacturer in the EIA. However, 84.2% of the EIA negative samples in the negative absorbance interval 0.05-0.099 corresponded with a positive culture. In view of variations in the sensitivity of the culture technique between laboratories and the low sensitivity of the EIA found in this study, it is recommended that each laboratory using the EIA compare it to culture. It is also recommended that an equivocal zone around the cut-off value be used in the EIA, the zone to be established by each laboratory using the test.

Levels of erythromycin in tear fluid and serum in infants with conjunctivitis.

38 newborns with purulent conjunctivitis were treated with oral erythromycin ethylsuccinate 25 mg/kg every 12 h for 14 days. 3-4 days after initiation of therapy, erythromycin levels in serum and tear fluid were measured 1 and 12 h after the administration of erythromycin. The level of erythromycin in tear fluid was significantly higher than that in serum 1 and 12 h after administration of the antibiotic. On both occasions the concentrations of erythromycin in tear fluid and in serum exceeded the minimum inhibitory concentration (MIC) in vitro for Chlamydia trachomatis.

Corynebacterium group JK in a hematological ward: infections, colonization and environmental contamination.

Because 2 patients with acute leukemia expired in septicemia with multiresistant Corynebacterium group JK (JK) the occurrence and significance of these bacteria in a hematological ward was analysed. During the following year JK was isolated in 6 other patients with acute leukemia, in 5 as a colonizing agent and in 1 as cause of an anorectal abscess. The environmental investigation with cultures from all patients, personnel and rooms in the ward disclosed heavy contamination with JK in 2 isolation rooms housing JK-colonized patients. Contamination with JK in other rooms was very sparse and there were no JK-positive cultures from personnel or other patients in the ward. Repeated environmental cultures taken after the JK-colonized patients left the isolation rooms showed sparse contamination with JK. Thus, JK strains can survive in the environment for a long time.

Comparison between serological classification and auxotyping in the analysis of Neisseria gonorrhoeae infections.

Auxotyping and serological classification, using monoclonal antibodies, were performed on 730 gonococcal strains. These strains were isolated from 725 consecutive patients seen at the Venereal Outpatients Clinic at the Department of Dermatology, Södersjukhuset, Stockholm, during one year, up to April 1983. Strains from patients with repeated gonococcal infections were, besides auxotyping and serological classification, analysed with restriction endonuclease cleavage. The strains were distributed into 16 auxotypes, of which the eight most common accounted for 97.4% of all isolates. The same strains were distributed into 38 serovars, of which the eight most common accounted for 88.4% of all isolates. When the two methods were combined, 98 combinations of auxotypes and serovars were seen. The eight most common combinations included 60.0% of all strains. Correlations were found between auxotypes and serogroups as well as serovars. The serological classification gave a better resolution compared with auxotyping; however, when the two systems were combined the sensitivity was highly increased.

Gonorrhoea in heterosexual men. Correlation between gonococcal W serogroup, Chlamydia trachomatis infection and objective symptoms.

Among 292 heterosexual men with gonorrhoea seen during one year, 59 (20%), had a co-existing chlamydial infection. Of the men infected with a serogroup WI strain 30% had a chlamydial infection compared with 16% of those infected with a serogroup W II/III strain (p less than 0.01). Heterosexual men infected with WI strains had less objective symptoms as judged by the number of leucocytes per high power field and by discharge, than men infected with W II/III strains (p less than 0.05 and p less than 0.01, respectively).

Analysis of serovar distribution as a tool in epidemiological studies in gonorrhoea.

During one year 738 gonococcal isolates from 731 consecutive patients with gonorrhoea were collected and classified by co-agglutination using W I and W II/III specific monoclonal antibodies. Eight W I and 30 W II/III serovars (serovariants) were seen. In both serogroups the most frequent serovar among isolates from women and heterosexual men differed from that among isolates from homosexual men. Forty-two per cent of the serovars, were confined only to one subpopulation, i.e. women, heterosexual men or homosexual men, representing 19 (3%) of the 738 isolates. Out of these 19 isolates 42% were acquired abroad compared with 12% of the 653 isolates in the serovars shared between two or all three subpopulations (p less than 0.005). Imported W I isolates were often of the same serovar that dominated in Stockholm. W II/III isolates acquired abroad were often of unusual serovars (p less than 0.0005) and might be a source of future changes of the serovar pattern in Sweden. In this way we can follow the introduction of new serovars into our society and their circulation between the subpopulations.

Gonococcal serovar distribution in Stockholm, with special reference to multiple infections and infected partners.

Serological classification with co-agglutination, using monoclonal antibody reagents, was used to classify gonococcal strains from 731 consecutive patients seen at the Venereal Outpatients clinic at the Department of Dermatology, Södersjukhuset, Stockholm, up to April 1983. The strains could be divided into two serogroups, WI and WII/III. For the identification of strains belonging to serogroup WI, six Protein IA specific antibody reagents were used, and for strains of serogroup WII/III, seven Protein IB specific antibody reagents. The serogroup WI could be further subdivided into eight different serovariants (serovars), and serogroup WII/III into 30 different serovars. All strains reacted with at least one monoclonal antibody reagent and no strain reacted with both WI and WII/III specific reagents. In both serogroups there was one serovar that was common among women and heterosexual men and another which was more frequent among homosexual men. The 84 contact pairs had strains of corresponding serovar in 95%. Among 258 patients with two or more gonococcal isolates on the same occasion, the isolates from 93% had the corresponding serovar. Repeated gonococcal infections were more frequent among heterosexual men than among women and more frequent among homosexual than among heterosexual men. The serological classification of N. gonorrhoeae is a stable and rapid method and a useful epidemiological tool.

Use of gonococcal W serogrouping in the evaluation of a clinical trial of rosoxacin.

Serogrouping by co-agglutination was used for the characterization of isolates of Neisseria gonorrhoeae in a clinical trial of rosoxacin in Stockholm. Twenty-four isolates (56%) belonged to serogroup WI, 17 (40%) to WII, and two (5%) to WIII. The proportion of WI isolates in Stockholm was reported in earlier studies to be approximately 40%. On the basis of serogrouping data and clinical information, five (10%) of 48 patients in this study were classified as therapeutic failures. Of the initial WI isolates, 22 (92%) of 24 were inhibited by less than or equal to 0.03 microgram of rosoxacin/ml, as compared with ten (59%) of 17 of the initial WII isolates (.05 greater than P greater than .01). Thus, this study might underestimate the failure rate as compared with that for patient populations in which WII isolates are more prevalent, since WI isolates are more susceptible to rosoxacin than WII isolates. A certain WII serovar was correlated with decreased susceptibility to rosoxacin (P less than .001). Correlations were found between decreased susceptibility to rosoxacin and decreased susceptibility to other antibiotics (P less than or equal to .01). A high frequency of side effects (40%) was seen among the patients studied.

Treatment of pharyngeal gonorrhea due to beta-lactamase-producing gonococci.

Between March 1978 and October 1980 seven patients with beta-lactamase-producing gonococci in the pharynx were treated wit spectinomycin of cefuroxime or both. One-day treatment with spectinomycin was effective in only one of six patients and with cefuroxime in only one of four patients. Prolonged treatment with cefuroxime was successful in all five cases so treated.

Campylobacter fetus subsp. jejuni as a cause of gastroenteritis in Jakarta, Indonesia.

Campylobacter fetus subsp. jejuni was isolated from the feces of 15 out of 144 (10%) children (0 to 9 years old) and 4 out of 251 (2%) adults with gastroenteritis and was found together with another enteric pathogen in 2 of the children and in all 4 adults. It was isolated from 2 out of 7 (28%) children and 3 out of 160 (2%) adults with suspected typhoid fever. The bacterium was recovered from 3 out of 4 orphanage children with diarrhea and from 1 without symptoms and was isolated from only 1 child in a control group of 221 persons.