Biomedical subjects
Publications and source records attributed to F J Nye.
A 59-year-old man developed septicaemia caused by Kingella denitrificans. Treatment was with ampicillin and an aminoglycoside. The illness was complicated by a cerebral embolus. An obvious source of infection was not found.
The results of cerebrospinal fluid (CSF) examination and other initial laboratory investigations have been analysed in one hundred and forty-nine patients with meningitis. The CSF differential leucocyte count clearly distinguished between bacterial and viral meningitis in 92 per cent of patients evaluated: CSF glucose and protein concentrations were less predictive by comparison. CSF glucose values were particularly unreliable because of hyperglycaemia in patients with bacterial meningitis and predictive accuracy increased when CSF levels were expressed as a percentage of blood glucose concentration. Results were not influenced by the age of the patients, and laboratory evidence of bacterial infection did not appear to be masked by prior antimicrobial therapy. A management algorithm based on the results of initial tests was applied retrospectively to the patients in whom Gram-stained CSF did not reveal bacteria. The algorithm indicated immediate antimicrobial therapy for all thirty patients with pyogenic infections, and for only one of sixty-three patients with a final diagnosis of viral meningitis.
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Thirty-six patients who had had infectious mononucleosis (IM) were followed up a year later and assessed by the Middlesex Hospital Questionnaire and by interview or (in five cases) by postal questionnaire. The results support the view that IM leads to depression in a considerable number of cases, but in this series only women were so affected.
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The socio-economic status of 80 patients with infectious mononucleosis was compared with the socio-economic distribution of the general population in the same area of south-west London. An excess incidence of infectious mononucleosis was observed among subjects from upper socio-economic groups. A possible relationship between this observation and the epidemiology of the Epstein-Barr virus is discussed.
Serological investigations were carried out on 147 patients with Paul-Bunnell positive infectious mononucleosis (IM) from the general population. All possessed antibody to the Epstein-Barr virus (EBV) and 63% showed serological evidence of recent infection. Contacts of 132 patients, 306 in all, were followed serologically; within 6 months of the index cases' illness twenty one contacts developed evidence of EBV infection or re-infection and of these five developed overt IM. The secondary attack rate of EBV infection among susceptible contacts was at least 19%; the corresponding figure for clinically apparent IM was 6%. EBV antibody prevalence among patients' siblings was significantly lower than among age-matched controls, suggesting that cases of IM come from families with a lower than normal previous experience of the virus. Of thirteen patients with persistently Paul-Bunnell negative ;glandular fever' four had serological evidence of recent EBV infection and two had probable cytomegalovirus mononucleosis. Recent EBV infection may have been associated with the illnesses of five of the remaining patients.
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Updated guidelines for the immunization of children and adults in the UK, incorporating a number of important changes, have recently been published. This article reviews the areas where recommendations have changed significantly and summarizes immunization guidelines in other problem areas.