Comparison of gram stain and latex agglutination for diagnosis of meningococcal meningitis.
Explore the source record for details and available documents.
Gentian Violet↗
Biomedical subjects
Y M Coovadia
Publications and source records attributed to Y M Coovadia.
A laboratory-confirmed outbreak of rifampicin-methicillin resistant Staphylococcus aureus (RMRSA) in a newborn nursery.
The routine laboratory monitoring of methicillin-resistant strains of Staphylococcus aureus (MRSA) at a large teaching hospital led to the detection of a new, multiply-resistant strain of MRSA, which was resistant not only to penicillin, oxacillin, methicillin, cephamandole, erythromycin, tetracycline, kanamycin and gentamicin but also to rifampicin and sulphamethoxazole-trimethoprim. The rifampicin-methicillin resistant strain of S. aureus (RMRSA) was first detected in blood cultures of babies from the newborn nursery. A bacteriological investigation of the nursery revealed the source to be a paediatric medical officer who was colonised with the resistant strain, and who at the time was receiving rifampicin for pulmonary tuberculosis. The rifampicin resistance was presumably acquired during rifampicin therapy. The outbreak in the nursery was brought to an abrupt end by treatment of the colonised medical officer with mupirocin, applied nasally twice a day for a week, and by the introduction of standard infection-control measures. Reference laboratory assistance was needed to confirm the initial assumption that the outbreak was caused by a single strain.
Bacterial Typing Techniques↗
Hospital-acquired neonatal bacterial meningitis: the impacts of cefotaxime usage on mortality and of amikacin usage on incidence.
All cases of bacterial meningitis in the neonatal unit at King Edward VIII Hospital, Durban for the period 1 January 1981 to 31 December 1987 were reviewed. In particular, we looked at the impact of cefotaxime on mortality rates and amikacin on the incidence of hospital-acquired Gram-negative bacillary (GNB) meningitis. Klebsiella was found to be the commonest cause of neonatal meningitis, followed by Escherichia coli and Streptococcus agalactiae. Eighty-four per cent of all cases of GNB meningitis presented more than 3 days after birth, with the vast majority being caused by gentamicin-resistant Klebsiella. A decline in the incidence of meningitis from 1.27/1000 live births in 1981 and 0.95/1000 for the period 1981-1986 to 0.22/1000 live births in 1987, with no cases of Klebsiella meningitis being seen in that year, coincided with the exclusive use of amikacin as the parenteral aminoglycoside in place of gentamicin in the unit after August 1986. The initial decline in the incidence of meningitis from 0.93/1000 in 1985 to 0.46/1000 in 1986 was attributed to the introduction in 1985 of strict hand disinfection measures to prevent cross-infection in the unit. The case mortality rate (CMR) fell from 0.65 for the period 1981-1984 to 0.42 for the period 1985-1987, and we believe this was largely a result of the introduction of cefotaxime in 1984 as first-line therapy for GNB meningitis, together with better patient care facilities.(ABSTRACT TRUNCATED AT 250 WORDS)
Amikacin↗
Aetiological factors of infantile diarrhoea: a community-based study.
A community-based study was undertaken to compare the organisms responsible for diarrhoea in children living in formal housing with indoor water supply and sanitation with those from a deprived environment. The role of "home remedies" was also assessed. Among 373 children with diarrhoea, rotavirus was detected in 15% (in 371 symptom-free controls, 9%), and proved to be the single most common causative agent. Bacterial pathogens were found in 20% of patients, with enteropathogenic Escherichia coli (EPEC) being isolated most frequently (9%; controls 3%), followed by Shigella species (4%; controls 1%), Campylobacter jejuni (4%; controls 1%), Salmonella species (2%; controls 1%) and enterotoxigenic E. coli (ETEC) (2%; controls 1%). Giardia lamblia and cryptosporidium were detected in 6% (controls 6%) and 3% (controls 1%) of patients, respectively; 7% (controls 1%) harboured more than one enteropathogen and no pathogens were detected in 58% (controls 78%). The vast majority (greater than 90%) of both patients and controls received some form of "home remedy" which included disinfectants and traditional herbs. The findings of this study therefore confirm the extremely complex nature of diarrhoea in developing communities and indicate that environmental factors are compounded by other issues.
Child, Preschool↗
Potential pathogenicity of Leuconostoc.
Explore the source record for details and available documents.
Female↗
A competition ELISA for the detection of mycobacterial antigen in tuberculosis exudates.
An enzyme-linked immunosorbent assay (ELISA) was designed to detect the inhibition of BCG-anti-BCG reactions by soluble antigens of Mycobacterium tuberculosis. Eighty-four samples were tested of which 59 were of cerebrospinal fluid (CSF) (25 control, 10 bacterial, 14 viral and 10 tuberculous meningitis); and twenty-five were of pleural or ascitic fluid (15 tuberculous exudates and 10 non-tuberculous samples). A statistically significant difference (p less than 0.01) was found between the tuberculous and control groups. The sensitivity and specificity of this test was almost 100%--no false negatives and only one false positive result occurred among the samples of CSF tested.
Antigens, Bacterial↗
Sensitivity and specificity of a latex agglutination test for detection of cryptococcal antigen in meningitis.
A cryptococcal latex agglutination test (Crypto-La; International Biological Laboratories, Canbury, New Jersey, USA) was evaluated for its ability to detect cryptococcal antigen in cerebrospinal fluid (CSF) specimens obtained from black patients with a clinical diagnosis of meningitis. Of the 445 Gram-stained and bacterial culture-negative CSF specimens routinely tested for cryptococcal antigen, 34 (7,6%) were positive. With the exception of 1 false-positive result, the remaining 33 specimens were obtained from 12 patients in whom the diagnosis of cryptococcal meningitis was confirmed by the isolation of Cryptococcus neoformans. The Crypto-La test gave false-positive results on 1% (4/384) of control CSF specimens tested. Nonspecific agglutination reactions were observed with 1,6% (13/829) of all CSF specimens and 22% (10) of sera tested. The ethylenediaminetetra-acetic heat-extraction method proved reliable in eliminating false-positives and nonspecific agglutination reactions in CSF and serum specimens.
Adult↗
Three latex agglutination tests compared with gram staining for the detection of bacteria in cerebrospinal fluid.
Three commercially available latex agglutination tests and the Gram stain were evaluated for their ability to detect Haemophilus influenzae, Streptococcus pneumoniae and Neisseria meningitidis in cerebrospinal fluid (CSF) specimens from 160 patients suspected of having meningitis. Bactigen detected 86% of all culture-positive CSF specimens, whereas Wellcogen detected 80%, Bio Merieux 59% and Gram stain 94%. Bactigen and Wellcogen detected 84% of cases of meningitis caused by H. influenzae, whereas Bio Merieux detected 53% and Gram stain 90%. Of the 27 cases of Strept. pneumoniae meningitis, all were detected by Gram stain, 96% by Bactigen, 89% by Wellcogen and 74% by Bio Merieux. For N. meningitidis, which included four isolates of group B and one group W135, detection was 80% with the Gram stain, 40% with Bactigen and 20% with Wellcogen. False-positive results were observed with Bactigen and Bio Merieux respectively on 5% of culture-positive CSF specimens for organisms other than the test organisms. With the exception of faulty batches of individual kits of Bactigen (H. influenzae B) and Wellcogen (Strept. pneumoniae) respectively, false-positives were not obtained on the 63 culture-negative CSF samples. Bactigen and Wellcogen were equally efficacious in detecting H. influenzae B. Bactigen was marginally superior to Wellcogen for the detection of Strept. pneumoniae. Bio Merieux was the least sensitive of the three latex agglutination kits tested. The Gram stain was found to be at least as sensitive or superior to latex agglutination for detecting H. influenzae B, Strept. pneumoniae and N. meningitidis in CSF specimens from patients with bacteriologically proven meningitis.
Cerebrospinal Fluid↗
Meningitis caused by vancomycin-resistant Leuconostoc sp.
A rare case of purulent meningitis caused by vancomycin-resistant Leuconostoc sp. is reported. The patient was treated successfully with penicillin G, and there were no neurological sequelae. We recommend that all gram-positive cocci isolated from cerebrospinal fluid and blood be fully identified so as not to confuse Leuconostoc spp. with more commonly isolated pathogens such as pneumococci and other alpha-hemolytic streptococci.
Adolescent↗
Chloramphenicol-resistant Salmonella typhi in Durban, South Africa.
A retrospective survey was undertaken to determine the incidence of chloramphenicol-resistant Salmonella typhi in Durban, South Africa. Of the 3313 strains tested over a 7 year period 20 (0.6%) showed intermediate resistance to chloramphenicol and 19 (0.6%) were fully resistant. Resistance to chloramphenicol was found to fluctuate over the period studied (0-2%). Resistance to ampicillin/amoxycillin was encountered less frequently (0-0.9%). For the present we would still recommend chloramphenicol or amoxycillin for the initial treatment of typhoid fever in this region.
Ampicillin↗
Meningitis due to beta-lactamase producing, chloramphenicol-resistant Haemophilus influenzae type b, in South Africa.
A case of meningitis and septicaemia due to Haemophilus influenzae type b resistant to both ampicillin and chloramphenicol is reported. After initial failure of chloramphenicol therapy, the patient responded to cefotaxime alone. To our knowledge, this represents the first such reported case in South Africa.
Ampicillin↗
Predictive value of C-reactive protein in neonatal septicaemia.
The following non-specific indices of infection were studied in septicaemic and non-septicaemic babies: haemoglobin, total white blood cell count, differential white count, ESR, platelet count, C-reactive protein (CRP), serum immunoglobulins, plasma C3 and haptoglobin. Forty-three low-birthweight (LBW) infants with clinical features suggesting septicaemia were investigated; blood cultures were positive in 19 and negative in 24. The mortality was 53% in the culture-positive and 13% in the culture negative group. Comparisons between the two groups of babies showed that the CRP titre (measured by Latex agglutination) was the only reliable non-specific indicator of infection. The titre was elevated more often in culture positive (16/19) than culture negative (7/17) babies (P less than 0.001). The CRP titre (Mean +/- 2 S.D.) was 15.75 +/- 12 in blood culture positive and 6.13 +/- 11.72 in culture negative neonates respectively (P less than 0.0004). Positive CRP titres were found in 5 of 20 healthy controls (4 +/- 8.4). Sequential CRP titres showed a gradual decline with clinical improvement in both groups of patients. The IgM was unhelpful as it was raised (greater than or equal to 40 mg%) in 37 of the patients.
C-Reactive Protein↗
Evaluation of adenosine deaminase activity and antibody to Mycobacterium tuberculosis antigen 5 in cerebrospinal fluid and the radioactive bromide partition test for the early diagnosis of tuberculosis meningitis.
A number of different biochemical and serological tests have been described recently for the early and accurate diagnosis of tuberculous meningitis. None of these tests has yet gained widespread acceptance in clinical medicine or in microbiology laboratories. To investigate this problem we evaluated adenosine deaminase activity (ADA), an enzyme linked immunosorbent assay (ELISA) that detects antibody to antigen 5 of Mycobacterium tuberculosis, and the radioactive bromide partition test (BPT) in the cerebrospinal fluid (CSF). Cerebrospinal fluid specimens from children with tuberculous, pyogenic, and viral meningitis as well as from patients with pulmonary tuberculosis without meningitis and from controls with normal CSFs were included inn the study. In addition, we estimated ADAs in serum samples from selected children in these groups. The sensitivity and specificity of the three tests evaluated in the CSF were: ADA assay 73% and 71%; BPT 92% and 92%; and ELISA for antibody to antigen 5, 53% and 90%, 40% and 94%, and 27% and 100%, respectively, at tires of more than or equal to 1:20, 1:40, and 1:80. The serum ADA was lower (11.0 +/- 6.15 IU/l) in children with tuberculous meningitis when compared with those with pulmonary tuberculosis alone (25.8 +/- 20.9 IU/l). The BPT was found to be the most reliable test in the early differentiation of tuberculous from other causes of meningitis and remained abnormal for a period of up to five months after the beginning of treatment. Accordingly, we believe that the BPT should be used in conjunction with bacterial and fungal antigen detection systems for the initial differentiation of clinically suspicious tuberculous meningitis from Gram or culture negative cases, or both, of bacterial and fungal meningitis.
Adenosine Deaminase↗
Comparison of passive haemagglutination test with Widal agglutination test for serological diagnosis of typhoid fever in an endemic area.
A passive haemagglutination test, using sheep red blood cells sensitised with Salmonella typhi lipopolysaccharide, was compared with the Widal test for the serological diagnosis of typhoid fever in an endemic area. The results obtained on sera from 152 patients with bacteriologically confirmed typhoid and 183 patients who did not have typhoid were analysed in terms of sensitivity, specificity, simplicity, and rapidity of the respective tests. The passive haemagglutination test was found to be more sensitive (80%) than the S typhi O antigen (71%) but marginally less sensitive than the H antigen (82%) of the Widal test. The false positive rate on control sera was 1.2% and 6.6%, respectively, for the Widal O and H antigens, and 1.6% for the passive haemagglutination test. Our findings indicate that the passive haemagglutination test is comparable with the Widal test for the serological diagnosis of typhoid fever in endemic areas, but is more simple, rapid, and economic. The passive haemagglutination test may be a useful alternative to the Widal test for the serological diagnosis of typhoid fever in busy microbiology laboratories in areas in which the disease is endemic.
Adolescent↗
Granuloma inguinale (donovanosis) of the oral cavity. A case report.
A case of granuloma inguinale of the oral cavity clinically resembling actinomycosis is reported. This condition should be considered in the differential diagnosis of chronic ulcerative lesions of the mouth, especially in patients with associated genital ulcers.
Actinomycosis↗
Evaluation of Bactigen latex agglutination and Phadebact coagglutination for detection of bacterial antigens in cerebrospinal fluid.
The Bactigen latex agglutination and Phadebact coagglutination tests were evaluated for their ability to detect bacterial antigens of Haemophilus influenzae type b, Streptococcus pneumoniae (83 serotypes) and Neisseria meningitidis groups A, B, C, and Y in 214 samples of cerebrospinal fluid (CSF). Bactigen latex agglutination was more sensitive than Phadebact coagglutination: it detected 87% (59/68) of culture positive CSF specimens, whereas Phadebact detected 72% (52/72). Bactigen detected all cases of meningitis caused by S pneumoniae and H influenzae. Of the 19 specimens that were positive for N meningitidis, 74% were detected by Phadebact and only 53% by Bactigen. Gram stain results were positive for 85% of all specimens positive on culture. Bactigen was slightly more specific (97%) than Phadebact (96%). Bactigen, however, showed less specificity (81%) than Phadebact (94%) on 31 CSF specimens that were culture positive for organisms other than the test organisms. These included two CSF specimens from patients with tuberculous meningitis which gave false positive results for S pneumoniae with the Bactigen reagents. No false positive results were obtained on 104 culture negative CSF samples. Bactigen latex agglutination was superior to Phadebact coagglutination and Gram stain for the detection of S pneumoniae and H influenzae in CSF specimens from patients with bacteriologically proved meningitis.
Agglutination Tests↗
The microbial aetiology of genital ulcers in black men in Durban, South Africa.
The microbial aetiology of genital ulcers was assessed in 100 black men attending a sexually transmitted disease (STD) clinic in Durban, South Africa. Forty patients harboured Haemophilus ducreyi, one hepes simplex virus, and one Neisseria gonorrhoeae. Syphilis was diagnosed in 44 patients on the basis of dark field microscopy or positive syphilis serology test results, or both. Of these 44 patients, eight also harboured N ducreyi, one herpes simplex virus. Lymphogranuloma venereum was diagnosed in one patient. No cause of ulceration could be found in the remaining 16 patients.
Adolescent↗
Neisseria flavescens septicaemia with meningitis. A case report.
A rare case of septicaemia with meningitis caused by Neisseria flavescens is reported. The clinical presentation and initial bacteriological findings were indistinguishable from those in meningococcal septicaemia with purpura. A review of the literature for N. flavescens infections revealed 15 other cases of meningitis and 1 of septicaemia. A plea is made for the full identification of all Neisseria isolated, especially those isolated from cerebrospinal fluid and blood cultures, so that closely related members of the family Neisseriaceae are not confused.
Child, Preschool↗