During the period January 1985-July 1988, 532 purulent CSF taken from patients with meningitis, aged between 3 weeks and 91 years, were studied by microscopic examination, cultivation and for H. influenzae type B (HITB) also by coagglutination (COA), counterimmunoelectrophoresis (CIE) and double immunodiffusion (DID) in agarose gel. Positive CSFs were taken from the patients aged 1 month-24 years old, of which 76% from children under 5 years old, and 42% from children under one year. 65.9% of the patients were males; the disease was more frequent in the first and last 4 months of the year, with the highest incidence in April. 12 bacterial spectra were found: N. meningitidis--62.97%, Str. pneumoniae--9.77%, H. influenzae type B--8.27%, and also Salmonella, E. coli, Staphylococcus, Klebsiella, Acinetobacter, beta-hemolytic Streptococcus, Alcaligenes, Proteus and Enterobacter in 4.70; the rest of 14.28% had indefinite etiology. H. influenzae was evidenced in CSF by microscopic examination in 3.38%, by cultivation in 3.94%, and the soluble antigen of HITB by COA in 8.27%, by CIE in 8.08% and by DID in 7.33%. The sensibility order of the tests was: COA, CIE, DID, cultivation and microscopic examination. The COA and CIE techniques are recommended for the current use in examination of the purulent CSF due to their simplicity, rapidity, sensibility, specificity and possibility of establishing the diagnosis when the bacteriologic techniques are negative.
Numerous cytokines are present within inflammatory foci. Interleukin-1 (IL-1) and tumour necrosis factor (TNF) play a major role in coordinating mechanisms which command inflammation. Upon their action, many different cells produce lipidic mediators, proteolytic enzymes, and free radicals, all directly responsible for the noxious effects observed. IL-1 and TNF exert cytotoxic effects on vascular endothelium, cartilage, bone and muscle. Such cytokines as interferon-gamma, IL-3 or granulocyte-macrophage colony stimulating factor amplify the inflammatory response by increasing the production of IL-1 and TNF. The latest trigger the release of chemokines such as IL-8 and macrophage chemoattractant protein-1, the chemotactic activity of which participates in the recruitment of leukocytes within the foci of inflammation. IL-6, abounds in inflammatory processes and induces the production by hepatocytes of acute phase proteins. The same applies to IL-1, TNF, IL-11, the leucocyte inhibitory factor, and the transforming growth factor-beta. The later also processes a number of anti-inflammatory activities and, like IL-4, IL-10 and IL-13, can inhibit IL-1 and TNF production. Such property has also been mentioned for interferon-alpha. These anti-inflammatory cytokines can also counteract some of the IL-1 and TNF activities such as those reported during the coagulation process. Furthermore, these anti-inflammatory cytokines can induce the production of the IL-1 receptor antagonist which prevents the activities initiated by IL-1. Soluble TNF receptors, released during inflammation, are the direct inhibitors for TNF. Glucocorticoids, produced following a cascade of events initiated by IL-1, TNF and IL-6, involving the neuroendocrine axis, also inhibit proinflammatory cytokine productions. The concept of "cytokine network" therefore, perfectly illustrates the participation of these mediators in inflammation mechanisms.
The development of the methyl red reaction (MR) in Klebsielleae, analyzed during a 4-day thermostatting, showed important pH-variations. Two steps are distinguished during the reaction dynamics: the former of acidification, common to all Enterobacteriaceae and the latter of alkaline reversion, specific to Enterobacter, Klebsiella, Serratia and other MR germs. The processes determining the alkaline reversion are conditioned by the presence of large amounts of air/oxygen (aerobic processes). In this situation, the lack of oxygen and maintenance of a relative degree of anaerobiosis block realkalinization (media covered with paraffin oil) whereas the large aeration stimulates it (optimum ratio between the large contact surface and a small volume of medium). Alkaline reversion cannot be explained by the more or less intense process of glucose fermentation but by degradations of nitrogenized substances with formation of amines, ammonia, and other basic compounds. That is why the analysis of the reaction mechanism of methyl red has to consider the characteristics of the catabolism of the nitrogenized substances and the intense realkalinization capacity of the culture medium proper to Klebsielleae but poorly expressed and non efficient in Enterobacteriaceae.
A study of the vaccinal antecedents on a representative group of children between 12 and 45 months in the district 3 of Bucharest showed that there exists a certain and direct correlation between the number of simultaneous DTP/VPOT administrations programmed in the immunization scheme and the vaccinal coverage with I DTP revaccination at the minimum age recommended. Administration of VPOT at the ages of 3, 5 and 11 months, simultaneously with the corresponding doses of DTP is the most efficient immunization scheme with these vaccines, in order to proceed to steady rate of antipoliomyelitis vaccination.
The present paper reports data referring to the mechanism of the CNS degenerating process of prion origin, the role of the biological timing in prion diseases, the interrelations between the prion diseases and Alzheimer's disease, new data on the normal cell protein PrPc and prion protein in the PrPsc scrapie, the physico-chemical properties of the prion PrP-RN Am properties the presence of the nucleic acid in the structure of prion, interrelations between prion and AIDS/VISNA retroviruses. The paper underlines the importance, for the next decade of the molecular biology studies for clearing up: the complete structure of prion, the prion multiplication, the role of nucleic acid for the infectivity, at the molecular level, and molecular epidemiology of these cases.
The paper reports on the biochemical characteristics and the antibiotic resistant phenotypes in 18 strains of H. influenza (17 b serotype and a strain of c serotype) isolated from the CSF of the patients with purulent meningitis. The following were found: --all the 16 viable strains have homogeneous biochemical characteristics, typical for H. influenza; --the viable strains were: 7 biotype, 4 biotype II, 1 biotype III, 3 biotype IV and 1 biotype VII; --68.8% of the strains had the following antibiotic resistant phenotypes: Ap, Km, Rf, ApKm, ApRf, ApKmTc, ApKmRfT and ApCmFrKmRfTc; --the strains of the biotypes II and IV have the highest resistance to antibiotics, as concerns frequency and phenotype; --the frequency of the resistant strains is of 56.2% for ampicilline, 18.7% for tetracycline, 31.2% for rifampicine and 6.2% for cholarmphenicol.
The efficiency was studied, in experimental and practical conditions, of media for the isolation of C. pylori, as well as criteria for diagnosis and identification. The highest sensitivity was obtained with Columbia gelose, and a lower sensitivity was achieved with Campy I. C. gelose, and with heart-brain gelose, prepared as chocolate gelose, and Columbia gelose with integral blood. Both variants of the Mueller-Hinton gelose, even in the chocolate formula, gave negative results. Of the fluid media, supplemented with blood or with serum, only broth for I. C. blood cultures, and the heart-brain broth permitted the development of small cultures, while the soya-tripticase broth and the Mueller-Hinton broth remained sterile. None of the media, either solid or fluid, as such or supplemented with factors X, V, or X + V, did allow the development of C. pylori. In natural conditions, by inoculating 92 samples of gastric mucosa from patients with gastritis, with or without ulcers, confirmed histologically on Columbia chocolate gelose as such, or in a selective variant, 50 positive results were obtained with both variants, 9 positive results on the selective variant, and one positive result on the nonselective variant. The direct microscopic examination of samples from the mucosa disclosed the presence of C. pylori in all 60 samples that had also been confirmed by culture, as well as in another 21 samples from a total of 32 samples with negative cultures (88%). The direct urease test performed directly from the sample was done in 90 cases and was positive in 64 out of 79 samples that had been confirmed bacteriologically (77.2%), but in none of the 11 negative samples. The positive prediction index is thus of 100%, and the negative index is of 37.9%. Procedures for identification consisted in a definition of morphological characteristics, and in the cultivation, and biochemical features (including catalase and oxydase determination), which can define the Campylobacter genus, and the urease test, the sensitivity to cephalotine and the resistance to nalidixic acid for the differential species diagnosis. In conclusion cultivation of C. pylori presumes the use of media with superior quality peptones, supplemented with blood lactate in the gelose chocolate formula. The direct urease test is very useful as a procedure for diagnosis, and this can be done in the departments of gastroenterology.
Among the strains of Escherichia coli involved in the etiology of the diarrheal syndrome, several etiopathogenic entities were described. Of them, the strains of enteroadherent E. coli (EAEC) were isolated from about 25% of the patients suffering from an acute diarrheal disease, in which no other etiologies could be established. The present paper synthesizes data from the literature on: the importance of EAEC in the etiology of the acute diarrheal disease; the biotype-serotype-pathogenicity interrelationship; "pathogenicity mechanisms" in EAEC; methods of identifying the EAEC strains.
The authors describe the evidencing of the O157H7 E. coli serotype--an enterohaemorrhagic strain of E. coli--for the first time in our country. This germ is incriminated in haemorrhagic enteritis of children and adults, accompanied or not by an uremic haemolytic syndrome. A total of 717 strains were investigated, obtained from cases of haemorrhagic enteritis (283), nonhemorrhagic enteritis (174), food poisoning (27), and a control lot of subjects without signs of enteritis (233). Identification of the strains was done with a screening method (McConkey) with D-sorbitol in place of lactose, and with anti-O157, and anti-H7 sera. The results obtained have indicated a total of 37 positive strains in haemorrhagic enteritis (69.8%), 12 strains in nonhemorrhagic enteritis (22.65%), and 4 strains in food poisoning (7.55%). No strain was isolated from the control group. The percentage of isolated O157H7 E. coli strains in our county is of 7.55% and this contributes to additional knowledge in the definition of the still unknown etiology of diarrhoeic disease in our country.
The authors of the present paper consider that 82.3% of all cases of viral hepatitis in a Bucharest district were transmitted nonparenterally and only 17.7% were transmitted parenterally. They used the information on the way and mode of transmission, recorded in the epidemiologic investigations, of the cases of viral hepatitis without HBsAg in 1987 and of those with HBsAg in 1983-1987, respectively. The highest values of the risk of catching the disease were calculated for the infective social contact in family, in the viral hepatitis with HBsAg (60.9%), and for the infective social contact in collectivities (46.4%) in the viral hepatitis without HBsAg. These data have to be checked up by prospective epidemiologic studies, randomized and controlled.
The determination of the activity of the product nitrofurantoin (10 and 100 mcg) versus 324 strains of Gram-negative bacteria showed that the diameter of the inhibition zones and the MIC values on a medium with a definite composition (7SG) are considerably larger than on the Mueller-Hinton (MH) medium, in the bacto-tryptose (BT) medium. An increase with 8-12 mm phi or with 2-4 binary dilutions changes the interpretation from resistant, on the MH and BT media into sensitive on the 7SG medium. The low results recorded on the conventional media reveal the existence of an antagonism between peptone and nitrofurantoin, similar to that known for sulfamides. The authors believe that the peptone antagonism has hindered the knowledge of the activity of the nitrofurfural derivatives and the correct assessment of the bacteria sensitivity. They also consider questionable the elimination tendency of the small dosage of microtablets of nitrofurantoin (10 mcg) and sulfamide (30 mcg), since their apparent insufficiency might be due less to the inadequate contraction of substances and more to the inadequate testing media. The results plead for the use of the media with definite chemical composition sulfamide and nitrofuran antagonists free and for reconsideration of several methodologic problems: use of the media with definite chemical composition; introduction of an intermediary dosage of maximum 100 mcg/microtablet; reassessment of the sensitivity categories for sulphafurazole and nitrofurantoin.
The present paper reports on the incidence of the Hymenolepis nana cestode in the Dolj County, in 45,725 cases, in the polyclinic and hospital, between 1985 and 1987, with several variation, on age-groups and as a function of sex. Our remarks, made during this period and on the whole group of the subjects investigated in the polyclinic and hospital show the low incidence, of 2.34% of Hymenolepis nana, versus 97.16%, a value found for the following parasites investigated: Giardia lamblia, Entamoeba coli, Enterobius vermicularis, Ascaris lumbricoides and Trichuris trichiura. Mention should be made that this incidence has been increasing since 1985, when it recorded 28.21%. In 1986 this value reached 36.63%, and in 1987 it remained almost the same, 35.25%. Analysis of the seasonal evolution of hymenolepiasis shows a maximum during autumn and a minimum during winter in the polyclinic, and also during spring in the hospital. Increase or diminution of the incidence of this parasitosis, irrespective of season, is a function of the age group and of the children's sex: the male sex was is prevalent in the hospital and the female sex in the polyclinic (in 1987). The greater incidence of Hymenolepis nana in the adult requires the investigation of his immunity state.
