Infections due to Chlamydia trachomatis.
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Biomedical subjects
Publications and source records attributed to M R Hammerschlag.
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The activities of seven broad spectrum cephalosporins, four other beta-lactam antibiotics, and one monobactam against Chlamydia trachomatis were measured in a cell culture system. The minimal inhibitory concentration of four of the seven cephalosporins was greater than or equal to 128 micrograms/ml; those of the other three were from 16 to 32 micrograms/ml. Of the other agents, only mecillinam had activity against C. trachomatis comparable to that reported for ampicillin (minimal inhibitory concentration, less than or equal to 0.5 micrograms/ml).
A case is reported of isolated cryptococcal osteomyelitis in an 11-year-old girl without any detectable underlying disease. The patient was successfully treated for six weeks with intravenous amphotericin B and oral 5-flucytosine. There is only one other case of cryptococcal osteomyelitis reported in the English medical literature in a child. Over 50 per cent of individuals with this infection will have an underlying condition which may have predisposed them to acquiring this disease.
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We compared the efficacy of erythromycin ophthalmic ointment vs 1% silver nitrate drops for the prevention of neonatal conjunctivitis or respiratory tract infection from Chlamydia trachomatis. The organism was isolated from the cervix of 67 (12%) of 572 pregnant women. They gave birth to 559 infants who were randomly assigned to either prophylaxis immediately after birth. Thirty-six of 60 infants born to Chlamydia-positive women received silver nitrate; 24 received erythromycin. Twelve (33%) of the 36 infants who received silver nitrate had chlamydial conjunctivitis, but none of the 24 infants who received erythromycin did. Ten (29%) of 36 infants receiving silver nitrate had chlamydial nasopharyngeal infection (three later had pneumonia), as opposed to five (21%) of 24 who received erythromycin (one had pneumonia). Thus, erythromycin ointment is effective in prevention of chlamydial conjunctivitis, but it may not reduce nasopharyngeal infection or subsequent pneumonia.
Liquefaction and homogenization have been recommended to ensure accurate, representative sputum cultures. We evaluated dithiothreitol (DTT) as mucolytic agent for culturing sputum samples obtained from 79 cystic fibrosis (CF) patients. Liquefaction with DTT was not superior to direct plating of specimens for routine qualitative cultures. Unliquefied sputum cultures failed to direct 3 of 47 Pseudomonas aeruginosa isolates; DTT-treated specimens missed 5 of 13 Candida albicans isolates. Neither treated nor untreated sputum cultures were completely successful in detecting Staphylococcus aureus or Enterobacteriaceae. Since Haemophilus influenzae was recovered from only two qualitative cultures, we could not evaluate the effect of DTT on the receovery of this organism. However, 27 of 29 strains of H. influenzae were inhibited by concentrations of DTT near the recommended final working concentration of 50 micrograms/ml, suggesting that liquefaction might impair isolation of this organism. Liquefaction with DTT permitted quantitative cultures of CF sputum. The predominant pathogen in our CF population was P. aeruginosa; 37 of 43 (86%) patients were colonized with this organism. Median densities of rough and mucoid strains were 3.2 x 10(7) and 4.3 x 10(7) colony-forming units per ml, respectively. Previous oral antistaphylococcal therapy may have accounted for the observed low density of S. aureus (mean density, 3.5 x 10(3) colony-forming units per ml). We conclude that DTT treatment does not improve recovery of organisms from qualitative cultures but does facilitate quantitative studies of S. aureus and P. aeruginosa in CF sputum.
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We examined the prevalence of chlamydial infection in a population of pregnant women and observed their infants to determine the risk of development of ocular or respiratory infection. We examined endocervical and serum specimens from 322 pregnant women for Chlamydia trachomatis and chlamydial antibody. The cultures were obtained at the first prenatal visit. Six (2%) of the women were infected with C trachomatis. Chlamydial antibody was present in the genital secretions of 47% and 73% of the serum samples. The six infants born to infected women, 61 infants born to women who were culture-negative, but local antibody-positive, and 28 control infants born to culture-negative, antibody-negative women were followed for up to six months. Four of six infants born to infected women developed chlamydial infection: two developed culture-positive conjunctivitis, one had asymptomatic nasopharyngeal infection, and one infant developed pneumonitis. Three of 61 infants born to mothers who were culture-negative and local antibody-positive developed conjunctivitis due to C trachomatis. None of the 28 control infants developed chlamydial infection. Most (79%) of the infants had chamydial antibody in their serum at 2 to 4 weeks of age. The correlation between maternal and infant serum antibody titer was r=0.71 suggesting that antibody was placentally transferred.
Vaginal cultures from 25 healthy girls from two months to 15 years of age were examined for aerobic, facultatively anaerobic, and obligately anaerobic bacteria. An average of 8.7 species (3.7 aerobic and facultatively anaerobic species; 5.3 obligately anaerobic species) were isolated from these cultures. Staphylococcus epidermidis (21), diphtheroids (20), bacteroides (19), peptococci (19), peptostreptococci (14), and Bacteroides melaninogenicus (14) were most prevalent organisms.
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The immune response to intravenously administered bacteriophage phiX 174 and subcutaneously administered tridecavalent pneumococcal polysaccharide vaccine was studied in 31 patients with anatomical or functional asplenia. Antibody responses to primary immunisation with phiX 174 were significantly decreased while clearance was normal. Secondary responses were quantitatively normal; however, production of antibody did not switch from IgM to IgG as seen in controls. All groups of asplenic patients accept those patients with Hodgkin's disease demonstrated significant seroconversions in response to pneumococcal polysaccharide antigens. One patient with Hodgkin's disease, treated with local irradiation only, demonstrated normal responses to pneumococcal capsular antigens. 10 of the 12 capsular antigens for which antibody was measured stimulated threefold increases in antibody in the 26 asplenic patients without Hodgkin's disease, which is similar to that observed in controls. Since the majority of cases of overwhelming postsplenectomy infection are caused by Streptococcus pneumoniae, all patients with either anatomical or functional asplenia should receive pneumococcal polysaccharide vaccine.
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Vaginal cultures from 100 healthy girls, 2 months to 15 years of age, were examined for the presence of normal and potentially pathogenic microorganisms. Corynebacterium vaginale, yeast species, and genital mycoplasmas were isolated from vaginal cultures from 13.5 %, 28%, and 28% of the girls examined, respectively. Colonization with these organisms was not associated with signs or symptoms of vaginitis. Neisseria gonorrhoeae was isolated from a 4-year-old with purulent vaginitis. Trichomonas vaginalis was recovered from two 13-year-olds, both of whom had an abnormal vaginal discharge. Vaginal antibody to Chlamydia trachomatis was found in two girls 4 and 13 years of age. In neither girl was the organism recovered from the vaginal culture. Chlamydia trachomatis was recovered from the vaginal culture of another 4-year-old who had no abnormal findings on examination. Cultures from 59 of the girls were examined for aerobic and facultatively anaerobic bacteria. Diphtheroids and Staphylococcus epidermidis were the most frequently isolated organisms. Lactobacilli were isolated most frequently from the older girls, whereas enteric organisms were isolated most frequently from the younger girls.
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Cultures from the vagina, pharynx, and anal canal of 100 healthy girls, 2 months through 15 years of age, were examined for the presence of group B streptococci. Of the 100 participants, 20% were colonized at one or more of these three sites. Pharyngeal colonization was detected in 15% of the girls under 11 years of age and in 5% of those over 11 years of age. Colonization at anogenital sites were observed in 19% of participants under 3 years of age, in 25% of those 11 years of age and older, and in only 4% of those between the ages of 3 and 10 years (P less than .025). The concentration of serum antibody directed against the polysaccharide capsular antigen isolated from type III, group B Streptococcus appeared, in part, to be related to increasing age.
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