Since 1985. nosocomial infections have been frequently treated with a new fluoroquinolone, pefloxacin, at the Cardiological and Neurological Hospital in Lyon. From 1986 to 1988. the incidence of resistance of clinical Staphylococcus epidermidis strains to pefloxacin increased from 31 to 57%. Dispersion of these resistant strains in the hospital environment was recognized when they were detected on 22% of staff members' fingers (139 samples were investigated) and in 28% of the environmental samples (180 were investigated). There was an association between carriage rate and work place. Most of the pefloxacin-resistant S. epidermidis were resistant to oxacillin, gentamicin. erythromycin, cotrimoxazole and fosfomycin. Intensive use of pefloxacin selected multiresistant S. epidermidis which became ubiquitous in the hospital environment.

Lipopolysaccharide (LPS) extracts obtained from Treponema hyodysenteriae of serogroups A, B, D and E, and from T. innocens were examined by SDS-polyacrylamide gel electrophoresis (SDS-PAGE), silver-staining, and immunoblotting with hyperimmune rabbit sera. All organisms possessed multiple LPS bands, but their position and number differed.

Immunoblotting of LPS with grouping sera identified three or four major antigenic LPS components in the 10-42 kDa range in all organisms: these components were largely specific to each type-organism of a serogroup, and presumably represented group antigens. Although some minor cross-reactivity occurred between LPS from organisms in the different groups, this was insufficient to merit changes to the current LPS serogrouping system for T. hyodysenteriae. Besides this LPS ‘complex’, other higher-molecular-weight material which appeared to be a common component of the treponemes examined was present in low concentrations. Organisms with different serotypes within a serogroup apparently possessed common LPS bands, but also had unique LPS bands which may account for their serotype specificity. One ‘untypable’ organism lacked group-specific LPS and was thought to be a mutant of a group B organism. The loss of serogroup LPS by the isolate suggested that this material is an external component of the cell wall. The availability of an atypical organism lacking LPS components may facilitate further studies on the pathogenesis of swine dysentery.

One hundred and sixty-eight strains ofEscherichia coli isolated from 84 men and 84 women who had urinary tract infections (134 cases) or bacteremia of urinary tract origin (34 cases) were assessed for their carboxylesterase B electrophoretic types B and B α-haemolysin production, the presence of mannose resistant haemagglutinin (MRHA) and antibiotic susceptibility. Electrophoretic type B was phenotypically linked with α-haemolysin and MRHA productions. The strains isolated from males were more frequently of type B, haemolytic and both haemolytic and haemagglutinating than those isolated from females. The strains isolated during bacteremia were more frequently haemolytic and haemag glutinating than those obtained from urinary tract infections. Type B strains were more frequently resistant to antimicrobial agents than type B strains. The results reinforced the distinction, in terms of virulence and antibiotic sensitivity, between B and B strains and demonstrated the influence of the sex of patients on the host-parasite interaction during urinary tract infections.

The study was conducted to determine whether pre-enrichment would increase sensitivity of detecting Streptococcus (Str.) aqalactiae, Staphylococcus (S.) aureus, and mycoplasma in bovine milk. Two procedures were followed, one involving direct inoculation of milk on bovine blood agar, and the other involving preenrichment in broth followed by inoculation on agar. Logistic regression was used to predict the probability of isolation as a function of culture procedure and two additional covariates. the California Mastitis Test (CMT) score of the milk and the type of sample (indicating sample storage temperature and herd mastitis status). A total of 13778 milk samples was cultured for each of the three bacteria. By using results of both direct inoculation and pre-enrichment, the probability of isolation compared to use of direct inoculation only and adjusted for effects of other variables was increased 3·6-fold for Str. agalactiae, 1·6-fold for S. aureus and 1·7- fold for mycoplasma. The probability of isolation for all three bacteria increased as the CMT score increased. For Str. agalactiae, there was a statistical interaction predicting that enrichment improved the odds of isolation more from milk with high CMT scores than from milk with low scores. Results indicate that preenrichment can substantially increase the sensitivity of bacteriological screening of dairy cows for mastitis caused by Str. agalactiae, S. aureus, and mycoplasma.

Sixty-three environmental water samples from various sources were examined for the presence of Legionella pneumophila with a commercially available direct fluorescent monoclonal antibody (GS), an indirect fluorescent antibody test (IFAT) and culture. GS detected L. pneumophila in 94% and 100% of environmental water samples which were culture and IFAT positive for L. pneumophila, respectively. IFAT detected 69% of L. pneumophila culture positive samples. Cultures of L. pneumophila serogroups 1 to 12, 14 and non L. pneumophila bacteria which may be found in water, and bacteria containing non-specific binding proteins, were stained by GS and IFAT. GS identified all serogroups of L. pneumophila and did not cross react with any non-L. pneumophila bacteria. L. pneumophila in environmental samples was easy to detect against a clear dark background when stained with GS.

In October 1985, six cases of legionnaires' disease were associated with a police headquarters building. Four were amongst staff who worked in or visited the communications wing of the headquarters and two cases occurred in the local community. A case-control study implicated the operations room of the communications wing as the main area associated with infection. This wing was air-conditioned and smoke tracer studies showed that drift from the exhaust as well as from the base of the cooling tower entered the main air-intake which serviced the air-conditioning system. Legionella pneumophila serogroup 1 subgroup pontiac was isolated from water and sludge in the cooling tower pond. Contaminated drift from the top of the cooling tower was probably responsible for the two community cases. An additional discovery was that symptoms suggestive of the sick-building syndrome were associated with working in this wing.

The possible relationship between the results of a microbiological sampling programme and visual inspections carried out in local food-manufacturing premises was examined. Using five main parameters—overall appearance, personal hygiene, risk of contamination, temperature control, and training and education –a visual inspection rating score was established for each of the premises. A variety of high-risk processed foods, and specimens from hands, wiping cloths and environmental swabs were examined. The results from two study Periods indicated that there was an overall poor agreement between microbiological results and inspection ratings. On its own, neither sampling nor visual assessment reliably monitored the performance of the premises. A combined approach, using selective microbiological examination to support a system of standardized inspections, is suggested for monitoring food hygiene standards in premises selling high-risk foods

Infections caused by mycobacteria other than Mycobacterium tuberculosis (MOTT) have often been described as common in AIDS patients. To evaluate whether infections with MOTT are specific for HIV related immunosuppression or are also frequent in patients with immunosuppression of different aetiology, data on the frequency of isolation from immunosuppressed patients with HIV infection are important. Blood, stool and urine specimens from 134 patients with non-HIV related immunosuppression, and from 55 immunocompetent subjects were examined for mycobacteria. MOTT have been isolated from one immunocompetent person but from none of the immunosuppressed patients. Since in AIDS patients an initial colonization of the gastrointestinal tract (GI-tract) with MOTT is common, GI-tract biopsy specimens from an additional 80 patients were examined microscopically and histologically for mycobacteria. Mycobacteria were not isolated from these specimens.

In the same period of time 72 AIDS patients have been examined: 7 (10%) had infections with M. tuberculosis whereas MOTT have been isolated from 16 (22%) of these patients. Mycobacteria have been found only rarely in immunocompetent patients and have not been isolated from patients with non-HIV related immunosuppression. The isolation of MOTT is highly correlated with an HIV-related immunosuppression.

The investigation of plasmid similarity is an important component in the surveillance of antimicrobial resistance and in the detection of epidemic plasmids. The use of restriction endonucleases in the classification of transferable, multiply-resistant plasmids from faecal Enterobacteriaceae isolated at the Children's Emergency Hospital, Khartoum was investigated. Twenty-four transconjugant plasmids, coding for 11 different resistance patterns, each of molecular weight 62 MDa. were studied using four restriction enzymes; Pst I, Eco R I, Hind III and Ara II. Fifteen different digest profiles were obtained. Restriction profiles discriminated between plasmids with differing resistance patterns and demonstrated homology of plasmids with common resistance patterns. Restriction endonuclease digest patterns provide a potentially rapid and reproducible method of plasmid classification, that could contribute towards surveillance systems in tropical countries with a high prevalence of antimicrobial resistance.

The data accumulated from 1972 to 1987 on the distribution and prevalence of tuberculosis in the badger population in Great Britain is reviewed. The current information on the influence of Mycobacterium bovis infection on badger population dynamics and its clinical effect on badgers is also summarized.

The membrane-filter assay, GM1-ELISA, and DNA-DNA hybridization assay, were used to detect enterotoxigenic Escherichia coli (ETEC) in samples of water, weaning food, food preparation surface swabs, fingerprints of mothers, and the fingerprints and stools of children under 5 years of age, in 20 households in a Malaysian village. Weaning food and environmental samples were frequently contaminated by faecal coliforms, including ETEC. The membrane-filter assay detected and enumerated faecal coliforms and LT-ETEC in all types of water and weaning food samples. Highest concentrations of faecal coliforms and LT-ETEC were found in weaning food, followed by well-water, stored water and stored drinking water. The GM1-ELISA detected LT-ETEC in weaning food, food preparation surfaces, fingerprints and stool samples. The DNA-DNA hybridization assay detected a larger proportion of STa2-ETEC than the other toxotypes, either singly or in combination. All the assays in combination detected the presence of ETEC in all types of samples on at least one occasion in each household. It was not possible to classify households as consistently more or less contaminated with ETEC. On individual occasions it was possible to show a significant association of the presence of LT-ETEC between the fingerprints of children and their stools, fingerprints of mothers and children, and weaning food and the stools of the child consuming the food.

A total of 210 new cases of tuberculosis due to Mycobacterium africanum were registered at the South-East Regional Centre for Tuberculosis Bacteriology, Dulwich, between 1977 and 1987 inclusive. This represented 1·25% of bacteriologically-confirmed cases of tuberculosis in South-East England, an incidence slightly higher than that of disease due to M. bovis. Two variants were identified: 150 strains were typed as African I (a type associated with East Africa) and 60 as African II (a type more prevalent in West Africa). Over half the patients infected with African I strains were of Indian subcontinent ethnic origin; patients of African ethnic origin predominated in the African II group while about a fifth of patients infected with either type were of European origin. The European patients with tuberculosis due to M. africanum were notably younger than those in the same region with disease due to other tubercle bacilli. The distribution of lesions due to M. africanum was similar to that due to other tubercle bacilli in the various ethnic groups, except that genito-urinary tuberculosis was uncommon. The importance of a clinical awareness that M. africanum is a highly pathogenic and transmissible tubercle bacillus rather than an opportunist or ‘atypical’ mycobacterium is stressed.

A total of 250 cerebrospinal fluid (CSF) specimens were analyzed using a rapid enzyme immunoassay (Pharmacia Meningitis ETA-Test) (EIA) for the detection of antigens of Haemophilus influenzae type b, Neisseria meningitidis (serogroups A, B, C) and Streptococcus pneumoniae (25 selected types). The test is performed in less than 1 h and read by the naked eye. EIA and coagglutination (CoA) were compared with a constructed reference that comprised samples which were either positive by culture and/or on direct microscopy (DM), or in which there were positive results with both EIA and CoA for the bacteria covered by the assays. Using this reference for CSF samples assayed in a period between two meningococcal meningitis epidemics, the sensitivity was 0·86 for EIA and 0·69 for CoA, the specificity 0·95 (EIA) and 0·97 (CoA), the predictive value for a positive result 0·81 (ETA) and 0·87 (CoA) and, the predictive value for a negative result 0·96 (EIA) and 0·93 (CoA). Antibiotics had been given to 54% of the patients before admission. All of the 56 samples that were positive in any of the tests taken during an epidemic of group A meningococcal disease were detected by EIA; CoA was negative in 45% and culture/DM was negative in 32%. Sequential dilutions of two CSF samples from which H. influenzae type b had been isolated, showed the EIA to be 16–32 times more sensitive than CoA. With both technical feasibility and good sensitivity and specificity, the EIA seems to be useful and reliable for the rapid diagnosis of bacterial meningitis, especially in situations where pretreatment with antibiotics are likely.

Eight hundred and sixty-four Escherichia coli isolates from workers at the University of Ibadan Teaching and Research Poultry Farm, and 216 isolates from poultry attendants at a commercial poultry farm in the city were found to be resistant to streptomycin, sulphafurazole and tetracycline. In contrast, all 576 and 288 E. coli isolates from village fowls and from villagers respectively were sensitive to these drugs. Isolates from birds in a modern university poultry unit (3744) exhibited the same resistance patterns as those isolated from workers who were in direct contact with the birds. No nalidixic acid-resistant E. coli was isolated from farm workers prior to their assignment to the experimental pen. Following experimental oral infection of birds with E. coli K12 J5 NA Lac, the organism was recovered from the workers who manned the experimental pen. Neither before nor after the experimental infection was any nalidixic acid resistant E. coli isolated from workers who manned the pen from which birds used in the experiment were selected. Similarly, no drug resistant organisms were isolated from workers outside the poultry unit of the university or commercial farm. The MIC of the drugs against the avian and human E. coli isolates at the university and commercial poultry farms were similar.

During the last week of May 1986, a 1-week prospective study on antibiotic utilization in surgical patients was held in 104 (42%) of the 247 Belgian acute care hospitals. All surgical patients with a post-operative stay of at least 3 days were studied, involving 3112 patients. Each patient was observed for 7 days, starting from the day before surgery. Antibiotics were administered to 71·9% of all patients; 21·9% received therapeutic antibiotics and 52·9% prophylactic antibiotics; 2·9% received both. Of the 1285 patients undergoing a surgical procedure with no indication for antimicrobial prophylaxis, 50·7% nevertheless received prophylaxis; 92·8% of patients with a generally recognized indication for prophylaxis received antibiotic prophylaxis. Less than one fifth (17·1 %) of all prophylactic courses were stopped on the day of the intervention whilst 26·3% were continued up to the fifth post-operative day or beyond. The most frequently prescribed drugs for this indication included first and second generation cephalosporins and nitroimidazoles. The number of different generic drugs utilized per hospital ranged from 1 to 18 (mean: 7·7).

Diarrhoea, abdominal pain, malaise and fever affected 75 of the 88 conscript soldiers in Utti, Finland after an outdoors infantry drill. Campylobacter jejuni, heat-stable serotype 3/43/59. was isolated from 37 out of 63 men investigated. A clear serological response was evident in the risk group and negligible in the control group. The entire population at risk was interviewed.

A serological survey for leptospiral agglutinins was undertaken between 1980 and 1983 in over 500 Barbadian and 500 Trinidadian school-children aged 7–14 years. The children were selected randomly from urban and rural schools, and examined three times at approximately annual intervals. A total of 12·5% of the Barbadian children and 9·5% of the Trinidadian children were seropositive at a titre of 50 using the microscopic agglutination test. On both islands, seroprevalence was higher in males than females, the difference being significant in rural schools. There was no evidence of a difference in prevalence between urban and rural schools, or between junior and secondary age-ranges. Analysis of the association of serology with socio-economic and behavioural factors showed a significant association in Trinidad with father's occupation, but most other variables on both islands showed only weak non-significant associations. Fourteen children in Trinidad and three in Barbados seroconverted. Seroconversion in Trinidad occurred at a rate of 1·6% per annum and was significantly associated with livestock contact and with absence of a tapped water supply. In Trinidad, Autumnalis was the most commonly recorded serogroup, but this accounted for less than a quarter of seropositives. In Barbados, Panama accounted for over half the seropositives and was about four times more common than the next most common serogroup, Autumnalis. In Barbados, 39 persons aged 19 or less were hospitalized with leptospirosis between November 1979 and December 1986. Average annual incidence rates were 2·2, 4·9 and 13·3 per 100000 in the 5·9, 10·14 and 15·19 age-groups, respectively.

Replicate faecal samples from healthy individual pigs and cows were examined for the presence of Aeromonas sp. over a 12-month period. Aeromonads were found to be minor components of the faecal flora, only 8·8 % of 520 samples from pigs and 4·6% of 481 samples from cows proving positive. Isolation rates in both groups of animals were seasonal. A. hydrophila (62% of the isolates) was the predominant species in cows, followed by A. caviae (32%) and A. sobria (15%). This pattern was also recorded in the natural waters that the animals drank from during the period when the faecal carriage rate was at its highest. In pigs, A. caviae (59%) was more common than A. hydrophila (41%). A. sobria was not found in any of the pig-associated samples. It seems that cattle acquire their faecal aeromonads from drinking water. The source of the organisms in pigs is less clear.

Selective decontamination of the digestive tract (SDD) employs oral antibiotics to eliminate aerobic Gram-negative bacilli while retaining the anaerobic flora. A combination of SDD and parenteral cefotaxime has recently been reported to strikingly reduce the incidence of infection in patients treated in an intensive therapy unit. The present study describes the effects of SDB and of cefotaxime on the immune response of mice to protein antigens. The in vivo cellular response to ovalbumin and sheep red blood cells was unchanged. However, SDD appeared to decrease the in vitro mitogenic response of spleen cells to phytohaemagglutinin, and cefotaxime similarly affected the response to Concanavalin A. The antibody response to sheep red blood cells was increased in the period after discontinuation of SDD. The antibody response was otherwise not affected. These results indicate that SDD is unlikely to have adverse effects on the immune response to protein antigens.

The overall pattern and consequences of myxomatosis in wild rabbit populations were studied at three farmland sites in lowland southern England and upland central Wales between 1971 and 1978. When results from all years were combined, the disease showed a clear two-peaked annual cycle, with a main autumn peak between August and January, and a subsidiary spring peak during February to April.

Rabbit fleas, the main vectors of myxomatosis in Britain, were present on full-grown rabbits in sufficient numbers for transmission to occur throughout the year, but the observed seasonal pattern of the disease appeared to be influenced by seasonal mass movements of these fleas. However other factors were also important including the timing and success of the main rabbit breeding season, the proportion of rabbits which had recovered from the disease and the timing and extent of autumn rabbit mortality from other causes.

Significantly more males than females, and more adults and immatures than juveniles, were observed to be infected by myxomatosis. Only 25–27% of the total populations were seen to be infected during outbreaks. Using two independent methods of calculation, it was estimated that between 47 and 69% of infected rabbits died from the disease (much lower than the expected 90–95% for fully susceptible rabbits with the partly attenuated virus strains that predominated). Thus it was estimated that 12–19% of the total rabbit populations were known to have died directly or indirectly from myxomatosis.

Although the effects of myxomatosis were much less than during the 1950s and 1960s, it continued to be an important mortality factor. It may still have a regulatory effect on rabbit numbers, with autumn/winter peaks of disease reducing the numbers of rabbits present at the start of the breeding season.