The intrinsic antimicrobial activity of selected sclerosing agents in sclerotherapy.

BACKGROUND: Detergent sclerosing agents may have intrinsic antimicrobial properties. In addition, they may have synergistic effects with other antibiotics such as penicillin. They may induce suppression of intrinsic resistance to penicillin in Staphylococcus aureus. OBJECTIVE: It is in this setting that the present study was carried out in order to determine the degree of suppression of resistance to methicillin and oxacillin in S. aureus by two detergent sclerosing solutions. METHODS: Four strains of S. aureus including a quality control strain were isolated. The minimal inhibitory concentration (MIC) of Sotradecol 1.0% and Polidocanol 0.5% were determined in Mueller Hinton Broth. These dilutions were subsequently seeded with 10(5) organisms of the strain of S. aureus being tested. Serial dilutions of penicillin were made and then the sclerosing agents were added in the appropriate dilutions. RESULTS: Sotradecol 1.0% produced a MIC of 1/64 in two strains of S. aureus and 1/128 in two other variant strains. Polidocanol 0.5% produced a MIC of 1/64 against two strains of S. aureus and an MIC of 1/8 and 1/4 with two other variant strains. In addition, in three of the four S. aureus strains both sclerosing agents had synergistic activity with penicillin and augmented its activity approximately 16-fold. CONCLUSION: This study presents the first successful modification in which detergent sclerosing solutions influence methicillin resistance in a Staphylococcal species. This points out a new potential therapeutic indication for this class of agents.

Quantitative bacterial tissue cultures from 209 prostatectomy specimens: findings and implications.

To define the prevalence of prostatic bacterial infection or colonization, tissue from 209 patients undergoing prostatectomy (204 transurethral and 5 suprapubic) was submitted for quantitative bacterial tissue cultures. Tissue from 44 patients (21 per cent) yielded positive, single organism bacterial growth. In an attempt to identify preoperatively this patient subgroup, multiple preoperative and intraoperative variables were examined. Although the presence of a preoperative indwelling catheter was associated with positive prostate cultures, only 34 per cent (24 of 70) of the patients with preoperative catheters had positive prostate cultures. Of the 44 patients with positive prostate cultures 36 (82 per cent) had sterile urine cultures documented preoperatively, all urine specimens having been obtained in the absence of antibiotics. The data support a significant prevalence (21 per cent or more) of prostatic infection in patients undergoing prostatic surgery for obstructive symptoms and an apparent paucity of reliable indicators by which to identify preoperatively this patient population.

Nosocomial hepatitis A infection in a paediatric intensive care unit.

Seven members of staff in a paediatric intensive care unit and two of their relatives developed hepatitis A over a period of five days. A 13 year old boy who was incontinent of faeces prior to his death, was presumed to be the source of infection. Two hundred and sixty seven other members of staff underwent serological testing and were given prophylactic pooled gamma globulin. Twenty three per cent were immune before exposure. Of people born in the United States, those at highest risk of developing the disease are physicians, dentists, nurses and those under the age of 40. Of those born outside the United States, being white and under the age of 30 are the two main risk factors. Data from a questionnaire sent to 19 nurses at risk (six cases, 13 controls) suggested that sharing food with patients or their families, drinking coffee, sharing cigarettes and eating in the nurses' office in the intensive care unit were associated with an increased incidence of hepatitis. Nurses with three or four of these habits were at particular risk. The costs of screening and prophylaxis were US $64.72 per employee, while prophylaxis alone would have cost US $8.42 per employee. Assessing risk factors on the one hand and costs of prophylaxis on the other are important elements in the control of nosocomial infections.

Laboratory diagnosis of mycoplasma infections.

The relative efficiency of different media for the isolation of M. pneumoniae is discussed, with emphasis on the utility of SP-4 medium as a primary medium for isolation. Media available for isolation and identification of ureaplasmas are also described. Rapid methods of identification of isolated mycoplasmas are surveyed. The use and value of serologic procedures in the clinical laboratory are evaluated with particular reference to the complement fixation procedure and its value as compared to other methods. The possibilities for the development of direct antigen detection procedures for clinical use are discussed with particular reference to ELISA and other antigen capture methods. The problems that arise in susceptibility testing of isolates are raised, and a usable procedure is proposed both for minimal inhibitory concentration and minimal bacteriocidal concentration determination. A general procedure for the laboratory diagnosis of mycoplasmal infection that is adaptable to various laboratory circumstances and needs is proposed.

Secondary amenorrhoea associated with Chlamydia trachomatis infection.

Chlamydia trachomatis was isolated from the ovaries of a 39-year-old married woman who presented with secondary amenorrhoea. Treatment with doxycycline was given and menstruation resumed spontaneously.

Host discrimination of Mycoplasma pneumoniae proteinaceous immunogens.

The immune response of experimentally infected hamsters and human patients to Mycoplasma pneumoniae was examined by radioimmunoprecipation in conjunction with gel electrophoresis and fluorography. Both intrinsically and extrinsically labeled mycoplasma proteins were coincubated with acute and convalescent sera in a radioimmunoprecipitation assay. Two M. pneumoniae proteins were selectively precipitated by convalescent sera. These predominant immunogens were trypsin-sensitive, antibody-accessible surface proteins that co-migrate on polyacrylamide gels with proteins P1 and P2, which were previously implicated by us as mediators of cytadsorption. Anti-M. pneumoniae antiserum did not precipitate radiolabeled antigens derived from Mycoplasma orale or Mycoplasma salivarium. These data indicate that M. pneumoniae infection stimulates a specific and highly targeted host antibody response to key proteinaceous immunogens.

Early pregnancy testing: a comparison of hemagglutination inhibition and radioreceptor assay.

Two methods of early pregnancy testing, Neocept hemagglutination inhibition assay, and Biocept-G radioreceptor assay, were compared using 508 female patients from whom both urine and serum specimens were submitted for routine testing. A conventional urine HAI test was also used to support results. Neocept and biocept-G were found to be equally effective, detecting 98% and 96% respectively of pregnant patients. Laboratory personnel determined the HAI methods to be simpler and more convenient, consuming less time and requiring less overhead.

PIP: Early pregnancy was tested in 508 women with 3 different types of tests: Neocept, a new hemagglutination inhibition assay (HAI), Pregnosticon Accuspheres, a conventional HAI test, and Biocept-G, a radioreceptor assay (RRA). The 1st 2 tests indicate the presence of human chorionic gonadotropin in the urine; the 3rd test indicates the presence of human chorionic gonadotropin in blood serum. In this series, there were 241 confirmed pregnancies; Neocept detected 98%, Biocept-G 96%, and Pregnosticon 90%. It seems apparent that Neocept and Biocept-G are of the same order of clinical reliability; pregnosticon is somewhat less effective, and therefore will be most useful with specimens collected after the missed period when human chorionic gonadotropin levels have risen into the sensitivity limits of this test. Given the equal effectiveness for the RRA and the new HAI test, it must be kept in mind that the Neocept procedure requires only 5 steps to RRAs 9, and that it requires less time for set up. The RRA test requires segregate storage and test areas, special disposal, and can be possibly hazardous.

Postpericardiotomy syndrome in adults: incidence, autoimmunity and virology.

While continuing a study of immunologic and virologic aspects of the postpericardiotomy syndrome (PPS) in infants and children, we undertook a companion study in adults. Whereas the incidence in 119 children was 27.8%, as is usual for our hospital, the incidence in 142 adults was 17.6%. Most of the operations (95 of 142) were performed on patients who were 50-69 years old. Incidence decreased as age increased: 28.5% for ages less than 40 years, 19.7% for ages 40--59 years, 14.2% for ages 60--69 years, and 10% for ages 70 years and older. Heart-reactive antibody in high titer was found in all patients with PPS; a rise in antiviral antibody to one or more of a battery of eight common viruses (adenovirus, cytomegalovirus, and coxsackie-virus B 1 to 6) was identified in 68% of these with PPS but in only 5% of those without clinical manifestations. We conclude that in adults, as in children, PPS may be an autoimmune phenomenon triggered by viral illness.

Viral illness and the postpericardiotomy syndrome. A prospective study in children.

Postoperative fever and pericardial-pleural reaction, designated postpericardiotomy syndrome (PPS), is a common complication of cardiac surgery involving entry into the pericardium. To determine whether the etiology of PPS is viral or immunologic, we undertook a prospective, triple-blind study of consecutive long-term survivors of intrapericardial surgery in the pediatric age group. We evaluated clinical evidence of syndrome and concurrent appearance of antiheart antibody (AHA) by indirect immunofluorescence and antiviral antibody (AVA) by complement fixation in sera preoperatively and serially postoperatively. Incidence of PPS was 27% overall in 400 subjects, but only 3.5% in infants younger than 2 years of age. AHA in high titer appeared in all patients with PPS. A fourfold or greater rise in titer to AVA was found in 70% of these but in only 5% of those with negative AHA and no PPS. AVA rise, tested in 280 consecutive patients, was to no single one of the eight viruses studied (adenovirus, cytomegalovirus, and coxsackievirus B 1-6). Instead, the rise and fall, consistent with antiviral response to a recent infection, was exhibited usually to one but occasionally to two or more viruses, and the viral prevalence changed from year to year, as did that in the community. The study suggests that concurrent fresh or reactivated viral illness plays a role in triggering the immunologic response that characterizes the PPS.

Herpes simplex in the amniotic fluid of an unaffected fetus.

A woman with a 7-year history of herpes progenitalis was delivered by cesarean section after herpes simplex virus was isolated from the cervix 2 weeks prior to delivery. No overt signs of herpes progenitalis had been observed during this pregnancy. At amniocentesis done the day of delivery to assess fetal maturity, herpes simplex virus was isolated from the amniotic fluid. An unaffected infant was delivered; she remains healthy at 18 months of age. Immunoglobulin levels in fetal serum and amniotic fluid did not indicate fetal infection.

Arthralgia associated with acute urinary retention. A syndrome of probable viral etiology.

Four patients are described in whom paresthesia and arthralgia developed in association with acute urinary retention. Neurologic and musculoskeletal complaints persisted for varying periods, up to five year, after cessation of urinary symptoms. Significantly elevated titers to Herpes simplex and Herpes zoster viruses were observed in three and four subjects, respectively, although none exhibited cutaneous lesions of herpetic infection. The symptom complex, presumably the result of viral radiculitis, may present in varying patterns that can be confused with lumbar disc protrusion, obstructive uropathy or primary rheumatic disorder. Diagnostic studies requisite for documentation of a viral etiology of the syndrome are discussed.

Parainfluenza type 3 in a transplant unit.

We observed an epidemic of parainfluenza type 3 viral infection in a renal transplantation service among 16 recent transplant recipients. To assess the effect of infection on transplant function, we retrospectively compared the infected patients with a matched, uninfected control group. In addition to symptoms of a mild upper respiratory tract infection associated with the epidemic, there was an increase in the frequency of acute rejection episodes during the period of infection in the infected group. Nevertheless, outcome in terms of patient and graft survival at six months was not affected when compared with the survival rates of the control group.

The postpericardiotomy syndrome then and now.

The postpericardiotomy syndrome is a febrile illness with pericardial and pleural reaction that either persists or appears beyond the 1st postoperative week. We believe that it begins in the 1st week after intrapericardial cardiac surgery, and that clinical signs of illness correlate with appearance of AHA and with significant rise in titer to AVA. Our present working hypothesis is that myocardial damage with bleeding into the pericardial sac at the time of surgery combines with concurrently acquired or reactivated viral illness to set the stage for the syndrome. The immune response is triggered by viral invasion of traumatized myocardium and an immune response is mounted, not against autologous myocardium per se but against the neo-antigen, the virus-infected myocardium. The illness is self-limited. It sometimes recurs but it seems to leave no sequelae other than the bad memory of a painful postoperative complication that prolonged hospitalization and delayed the realization of the full benefits of that heart operation.

Persistent infection of cells in culture by respiratory syncytial virus.

The virus-cell relationship of RS virus and the HEp-2 cell line has been examined. The production of cytopathic effect (c.p.e.) on HEp-2 cells has been found to be dependent upon the passage level of the cell line. Cells at lower passage levels exhibit c.p.e. in the form of syncytium formation, while those at higher passage levels no longer exhibit this effect. Cells infected at higher passage levels are covertly infected and continue to produce large amounts of infectious virus which remains cell-associated. On continued passage, these cells remain infected with virus but show no c.p.e. and release little if any infectious virus into the medium. Examination of the RNA species present in infected cells revealed that similar species are present in both the overtly and covertly infected cells.

Immunologic and virologic studies in the postpericardiotomy syndrome.

A prospective, triple-blind study was undertaken to determine whether antiheart antibody or a rise in titer to a virus occurred in patients after intrapericardial surgery and, if so, whether either was related to clinical evidence of the postpericardiotomy syndrome. In 257 patients, AHA in high titer appeared in 62 (24%), all of whom had the syndrome. None of the 102 patients with no AHA had the syndrome. In 137 subjects, a rise in titer to one or more viral agents occurred in 21 of 31 (68%) of those with AHA and PPS. This study suggests that an immunologic response and viral illness are related to PPS.

The protean manifestations of Mycoplasma pneumoniae infection in adults.

Mycoplasma pneumoniae is a well recognized respiratory pathogen in children and young adults. In addition, M. pneumoniae infections may also involve other organ systems. Reviewed here are the various clinical syndromes in adults caused by this infectious agent, with emphasis on those which have recently been seen at The New York Hospital. Two previously unreported manifestations of M. pneumoniae infection, cranial nerve mononeuropathy and hepatitis, are described, and the laboratory methods for diagnosis are discussed.