Spirochaetosis: a remediable cause of diarrhoea and rectal bleeding?
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Adult↗
Biomedical subjects
E M Cooke
Publications and source records attributed to E M Cooke.
Endoscopic aspiration of duodenal juice in the diagnosis of small bowel bacterial colonisation.
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Bacteria↗
A sequential study of the relationship between faecal Klebsiella aerogenes and the common clinical manifestations of ankylosing spondylitis.
An 8-month sequential study at 4-weekly intervals of faecal Klebsiella aerogenes and clinical activity of ankylosing spondylitis is described. Similar frequencies of faecal K. aerogenes were found in the 44 patients and 36 healthy controls studied. Eighteen patients on 19 occasions had K. aerogenes cultured from their faeces, when the preceding specimen had been negative. Six (31.6%) of these occasions were associated with a deterioration in clinical state compared with a similar deterioration associated with only 17 (9.8%) of the remaining 174 faecal culture sequences (p less than 0.02). These results suggest that clinical deterioration in ankylosing spondylitis may be associated with the acquisition of faecal K. aerogenes.
Acute Disease↗
Simultaneous culture of saliva and jejunal aspirate in the investigation of small bowel bacterial overgrowth.
Both saliva and jejunal aspirate were cultured from 22 patients with suspected small bowel bacterial overgrowth and from eight controls. Large numbers of organisms (greater than 10(6)/ml) were recovered from the jejunal aspirate of 16 subjects, in five of whom the same organisms were present in similar relative proportions in the saliva, suggesting contamination of the sample with saliva, while in 11 the jejunal organisms differed from those in saliva. In eight of these the jejunal flora was a typical 'faecal' flora usually associated with small bowel bacterial overgrowth but, in three, the jejunal floral was superficially similar to that of saliva. Distinct subpopulations of bacteria, typically Gram-positive non-sporing rods, were, however, evident in the jejunum of these patients, and were also recovered, in smaller numbers, from the jejunum of controls, suggesting that they form a distinct jejunal microflora. Culture of saliva in addition to jejunal aspirate may be useful in the recognition of contamination of the proximal small bowel with saliva, and in the diagnosis of small bowel bacterial overgrowth.
Bacteria↗
The use of oral and topical antibiotics in acne.
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Acne Vulgaris↗
The ability of strains of Klebsiella aerogenes to survive on the hands.
The ability of Klebsiella aerogenes strains isolated from outbreaks of infection, from sporadic infections and from the environment to survive on hands were compared. Considered as groups, the outbreak strains survived best and the environmental strains least well. The possible importance of these observations in relation to outbreaks of Klebsiella infection in hospitals and to heterogeneity of pathogenic potential and transmissibility in Klebsiella aerogenes is discussed.
Disease Outbreaks↗
Effect of klebsiella capsular antisera on lymphocytes from patients with ankylosing spondylitis.
The cytotoxicity of klebsiella capsular antisera for lymphocytes from 10 HLA B27-positive patients with ankylosing spondylitis and eight B27-negative normal control subjects was examined. None of the antisera was cytotoxic for lymphocytes from nine patients but several antisera were cytotoxic for the lymphocytes from one patient. There were no differences between the results obtained with lymphocytes from the nine patients and those with lymphocytes from the normal controls. If klebsiella carriage is important in the pathogenesis of ankylosing spondylitis, the results of this investigation suggest that the capsular antigen is probably not involved.
Antibodies, Bacterial↗
Secretory IgA: immune defence pattern in ankylosing spondylitis and klebsiella.
Saliva secretory IgA (sIgA), secretory component (SC); serum immunoglobulins (IgG, IgA, IgM), complement (C3, C4), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were performed in 32 patients with ankylosing spondylitis and 29 normal controls. They were investigated for carriage in the faeces of Klebsiella spp. on 3 occasions over the previous months. Throat swabs and urine were cultured at the same time as immunological estimations were done. 24-hour urine sIgA specimens were studied in 13 patients and 12 normal controls. Significantly raised mean values of saliva sIgA and serum IgG, IgA, C3, and C4 were found in patients with raised values of serum ESR and CRP levels when correlated with controls. Raised values of sIgA in saliva, which is an important factor of the local immune defence mechanism of mucosal surfaces, suggests the presence of an antigenic stimulus from the gastrointestinal system in ankylosing spondylitis during activity of disease.
Adult↗
Evaluation of the Phadebact Gonococcus Test in the identification of Neisseria gonorrhoeae in a routine diagnostic laboratory.
The Phadebact Gonococcus Test, a coagglutination procedure for the confirmation of identity of presumptive N gonorrhoeae isolates, was evaluated under normal working conditions in a routine diagnostic laboratory and compared with an immunofluorescence technique. Of 166 isolates of N gonorrhoeae from urogenital, rectal, and pharyngeal sites, 164 gave a positive coagglutination reaction, and one of the two negative isolates gave a positive reaction on retesting after subculture. There were no cross-reactions with other organisms tested. This was in contrast with the immunofluorescence technique; with this method, three of 46 isolates of N meningitidis fluoresced brightly, and a further 17 isolates of N meningitidis gave reactions that were difficult to interpret. The coagglutination test is rapid, simple and a more specific alternative to immunofluorescence.
Agglutination Tests↗
Isolation of intestinal spirochaetes from homosexuals.
Spirochaetes were isolated from rectal swabs of two homosexuals and the faeces of a third, using simple isolation techniques not previously applied to specimens of this type. The ease of culture of these organisms will enable their distribution and pathogenicity to be studied, particularly in relation to their significance in homosexuals.
Adult↗
A comparative study of gram-negative aerobic bacilli in the faeces of babies born in hospital and at home.
Examination of the faeces of 50 babies born at home showed that bottle-fed babies carried significantly more Klebsiella, Proteus and Pseudomonas spp. and antibiotic-resistant Escherichia coli than did breast-fed babies. Bottle-fed babies born in hospital had a less mixed faecal flora than bottle-fed babies born at home. The possibility that bacterial contamination of home-prepared feeds may account for these differences requires investigation.
Bottle Feeding↗
Klebsiella species in hospital food and kitchens: a source of organisms in the bowel of patients.
Hospital food was examined for the presence of Klebsiella species. Salads and cold meat were most frequently contaminated, often containing more than 10(3) organisms per g. Klebsiella species were also widely distributed in the kitchen environment which was considered, at least in part, to be the source of the organisms in food. By the use of serological and bacteriocin typing, intestinal carriage of strains ingested in food could be demonstrated.
Bacteriological Techniques↗
Adhesive properties of Escherichia coli from urinary-tract infections.
Strains of Escherichia coli from upper and lower urinary-tract infections and from faeces were examined: for their ability to adhere to urinary-tract epithelial cells, buccal epithelial cells and HeLa cells; to invade HeLa cells; to cause keratoconjunctivitis in the guinea-pig eye (Serény test) and for the presence of type-I fimbriae. Strains from infections of the upper and lower urinary tract more commonly adhered and invaded than did faecal strains, but none of the strains gave a positive result in the Serény test. Adhesive strains adhered to best to urinary epithelial cells, less well to buccal epithelial cells and poorly to HeLa cells. All adhesive strains were fimbriate, but not all fimbriate strains adhered.
Animals↗
A comparison of the properties of Klebsiella strains isolated from different sources.
The ability to form gas in lactose bile-salt broth at 44.5 degrees C (the "faecal coliform" or FC test), growth in nutrient broth at 10 degrees C, indole production and pectin liquefaction were studied in 480 strains of Klebsiella isolated from human and animal infections, from various sites in the hospital environment and hospital food, and from river water and flowers. A positive FC response was correlated inversely with the ability to grow at 10 degrees C. Most strains of human and animal clinical origin were FC positive, whereas strains from water and flowers were mainly FC negative. The frequency of a positive FC response in strains from the hospital environment fell between these two extremes. The production of indole and liquefaction of pectin by klebsiellas was correlated directly with the ability to grow at 10 degrees C and a negative FC response. Nearly all of the strains could be allocated to one of four groups on the basis of these tests. The capsular serotype, bacteriocine-inhibition patterns and antibiotic sensitivities of the strains were examined. No correlation was evident between the first two properties and klebsiellas from any particular source. Strains of clinical origin were more often resistant to five or more antibiotics than were strains from the hospital environment, which in turn showed a greater frequency of antibiotic resistance than did strains from river water and flowers.
Anti-Bacterial Agents↗
Frequency of faecal Klebsiella aerogenes in patients with ankylosing spondylitis and controls with respect to individual features of the disease.
A study of 59 patients with definite ankylosing spondylitis and 41 comparable hospital outpatients with fractures has been undertaken to determine if the presence of faecal Klebsiella aerogenes is related to clinical activity of the spinal disease and its extraspinal features. The frequencies of fecal K. aerogenes were similar in both patients and controls and were not significantly related to spinal disease activity. Careful inquiry about antibiotic treatment, dietary habits, and hospitalisation did not significantly influence the results. A significant association was found between the presence of faecal K. aerogenes and both acute non-granulomatous anterior uveitis (P less than 0.01) and peripheral synovitis in HLA B27 positive patients (P less than 0.05). These results suggest that K. aerogenes may have an aetiological role in the development of non-granulomatous anterior uveitis and peripheral arthritis in patients with ankylosing spondylitis but do not lend support to this organism having such a role in the spinal disease itself.
Acute Disease↗
Increased incidence of faecal coliforms with in vitro adhesive and invasive properties in patients with ulcerative colitis.
Faecal samples were collected from 23 patients with active ulcerative colitis, 15 patients with established ulcerative colitis in remission, 20 patients with active colitis of cause other than ulcerative colitis, and 20 normal control subjects. Ten coliform colonies were randomly selected from the faecal sample cultures and serotyped before the testing of each different serotype from each sample for adhesive or invasive properties on HeLa cell monolayers. In the patients with both active ulcerative colitis and ulcerative colitis in remission and those with other types of colitis one serotype tended to dominate the faecal coliform flora. In normal controls more variety was encountered. Thirty-five per cent of the patients with active ulcerative colitis and 27% of the patients with ulcerative colitis in remission had at least one adhesive or invasive faecal coliform as compared with 5% of the patients with other types of colitis and 5% of the normal controls. These findings are significant (P < 0.05) and may have aetiological and therapeutic significance.
Adhesiveness↗
Serious infection caused by group C streptococci.
Group C streptococci commonly cause infection in animals but only occasionally give rise to severe infection in man. We report here three cases of serious human infection due to this organism and discuss its pathogenicity in relation to the clinical manifestations of the disease.
Aged↗
A double-blind trial of a single intravenous dose of metronidazole as prophylaxis against wound infection following appendicectomy.
One hundred patients undergoing appendicectomy through a right iliac fossa incision were randomized to receive normal saline or 500 mg metronidazole as an intravenous infusion during the operation. One patient in the saline group developed an erythematous rash. There were 13 wound infections (as defined by the discharge of pus), 12 (out of 51) in the saline group and 1 (out of 49) in the metronidazole group. Bacteroides spp. were frequently cultured from the lumen of removed appendices and from pus obtained from infected wounds. This work supports the value of metronidazole but suggests that a single-dose regimen is adequate for prophylaxis.
Adolescent↗