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Over a period of 19 months, Bacillus species, most frequently B. cereus, were isolated from postoperative and post-traumatic wounds in 24 patients on orthopaedic wards in a Swedish hospital. Clinical signs of infection were found in all but 3 patients: in 9 patients, mild signs with increased secretion from the wounds; in 10 patients, moderate signs with fever and/or significant local reaction around the wounds; and in 2 patients, severe signs with necrotic infections. Bacillus spp. were isolated from one-fourth of all patients with wound complications following total hip arthroplasty. Their hospitalization was significantly prolonged, compared with a control group (p = 0.0042). Isolates of B. cereus from wounds should not be dismissed as contaminants or as non-pathogenic, but must be assessed in the light of the clinical situation.

30/60 patients electively reconstructed with synthetic arterial grafts were randomly treated with dicloxacillin per- and postoperatively for 6 days. Wound infections occurred in 10 of the non-treated patients. 1 of whom had a graft infection. In the dicloxacillin group no wound infection was recorded. Overgrowth with bacteria resistant to isoxazolylpenicillin was not noticed during treatment. No late infections occurred. In comparison with previous results, improved hygienic routines before, during and after operation reduced the incidence of postoperative graft infections from 15 to 3%. As postoperative infections after synthetic arterial graft implantation are serious complications, per- and postoperative antibiotic treatment seems justified as a complement to a rigorous hygienic routine.

Various therapeutic and preventive methods were evaluated in 80 patients with recurrent staphylococcal furunculosis. The most appropriate treatment was peroral antibiotics for 10-14 days, mainly flucloxacillin twice daily. Fusidic acid ointment was used for prevention of relapses. Patients and healthy family members who carried the patient strain applied the ointment in nares twice daily every 4th week during 4-15 months. The method had a permanent effect in 80%. Implantation of strain 502 A was less effective when evaluated during a 2-3 yr period. 40-80 patients were checked up to 8 yr after their last furuncle. Three still had furuncles, in 2 of these cases the original strain was found in nares. 37 patients, now healthy after a mean observation time of 4.5 yr, showed either new nasal strains or negative cultures. A significantly lower frequency of phage group II strains in nares was noted in comparison to the previous findings during active furunculosis.

Cefuroxime was used in 17 patients with clinical, bacteriological and/or laboratory signs of acute septic arthritis in comparison with 10 patients given cloxacillin and ampicillin alone, or in combination. 14 patients in the study group had positive cultures (Staphylococcus aureus, 10, S. epidermidis, 1, Streptococcus pyogenes group G, 2 and Acinetobacter, 1). Three more patients with non-bacterial arthritis were included in an antibiotic penetration study. In 6 patients serum and joint fluid concentrations of cefuroxime were repeatedly determined by an assay using high pressure liquid chromatography. After 1.5 g intravenous cefuroxime the joint fluid concentrations were 16-80 and 5-40 mg/l at 2 and 8 h, respectively, exceeding the serum concentrations during that period of time. From the clinical and pharmacokinetic data a dosage of 1.5 g cefuroxime intravenously t.i.d. is recommended to the adult patient. This high dosage resulted in primary healing in 11 patients with one relapse one year later in a patient with a knee arthroplasty. Half the dosage intramuscularly in 6 patients failed in 2. No side effects were seen during cefuroxime therapy.

The therapeutic efficacy of decloxacillin or flucloxacillin, 1--2 g orally with probenecid twice daily was evaluated in staphylococcal infections. Excellent results were obtained with this as long-term maintenance therapy in 4 patients with relapsing chronic osteomyelitis and in 6 patients with postoperative infections. No side effects were observed in these patients. In 35 patients with furunculosis twice daily administration of dicloxacillin was used as a primary therapeutic regimen. All healed, but 4 recurrencies occurred during a 3-month observation period after therapy. In 5 patients allergic reactions were noted. The unbound fraction of flucloxallin in serum exceeded MIC values of methicillin-susceptible Staphylococcus aureus during 11 of 24 h. Pharmacokinetic data on flucloxallin with and without probenecid are given.

Metronidazole (600-1 200 mg daily) and phenoxymethyl penicillin (1.6 g daily) were administered to 21 patients with anginose type of infectious mononucleosis. A control group with 19 other patients received only phenoxymethyl penicillin in the same dosage. The patients were randomly allocated to metronidazole treatment and were stratified into 2 further groups according to the duration of tonsillitis (less than or equal to 5 anddays, respectively) before instituted therapy. Changes in the state of the tonsillitis, body temperature reaction and acute phase reactants (alfa1-antitrypsin, antichymotrypsin, C-reactive protein, haptoglobin and orosomucoid) were parameters for evaluation of the effect. Metronidazole treatment resulted in a more rapid regression of tonsillitis note on the 4th day in both treated groups and a faster defervescence noted on the 3rd day compared to controls. The effect was most pronounced in patients with a duration of tonsillitis for5 days at admission. At 2 weeks after start of treatment a more rapid normalization of acute phase reactants was seen in the metronidazole groups. Especially in patients with tonsillitis for5 days before treatment the decrease of the C-reactive protein level was rapid during the 1st week.

20 patients with chronic staphylococcal osteomyelitis were tested for 6 acute phase reactants: alpha 1-antitrypsin, orosomucoid, haptoglobin, ceruloplasmin, C-reactive protein (CRP) and antichymotrypsin during different phases of the disease. CRP was best correlated to clinical activity and in 3 cases CRP and ceruloplasmin increased a few weeks before a clinically apparent exacerbation of the osteomyelitis took place. A Latex-CRP slide method showed fairly good agreement with CRP assessed by immunoassay. Determination of CRP is a suitable test for following the activity of chronic osteomyelitis.

(1983). Symposium on Staphylococcal Septicaemia and Endocarditis. Lund, Sweden, March 17–18, 1983. Scandinavian Journal of Infectious Diseases: Vol. 15, No. sup41, pp. 1-195.

4 patients with a history of initial fever 2--4 weeks passing on to fever peaks every 3rd to 6th day with afebrile intervals repeating for months are presented. Three of them had dental infectious foci mainly in maxillar teeth and 1 patient was treated by a dentist 1 month before onset. None showed meningism or clinical signs of encephalitis. Extensive investigations resulted only in findings from the central nervous system. The EEG was slightly pathological in all cases and papilloedema was found in 2 cases. In the cerebrospinal fluid (CSF) a pleocytosis extending over months, transient presence of plasma cells and increased proteins in the gamma region on agar electrophoresis was found. In 1 case antigen from Streptococcus milleri, a commensal of the mouth flora at times isolated from infectious dental foci, was detected in CSF by counterimmunoelectrophoresis 6 weeks after onset of the disease. Treatment with penicillin had no effect on the fever. Three patients received antiphlogistic drugs with benefit and their dental foci were treated by a dentist.

A study of 36 chronic osteomyelitis patients is presented, with an account of, inter alia, symptoms, pathogenesis, bacteriology, serology, and other laboratory data. Almost throughout, the infective agent was Staphylococcus aureus and the treatment cloxacillin (0.5–1 g 5–6 times a day perorally). Antibiotics in dextran emulsion were injected into fistulas twice daily. Osteosynthesis material prolonged definitive healing. After antibiotic treatment for less than 6 months, the tendency to recurrence was considerably higher than after treatment for more than 6 months. Traumatic pathogenesis, ESR above 70 mm/1 h, and raised antistaphylolysin titre were prognostically unfavourable factors. The treatment resulted in healing in 90% of staphylococcal osteomyelitis cases. The observation period was 4–33 months after termination of treatment in 16 patients.

Seroconversion rates and antibody titre rises after vaccination of 872 ***newly delivered mothers with HPV-77 DE-5 (Meruvax), Cendehill (Cendevax) and RA 27/3 (Almevax) rubella vaccines were studied. Seroconversion was observed in non-immune women in 92, 91 and 96% for the 3 vaccines, respectively. In individuals with pre-immunization hemagglutination-inhibiting antibody titres of 20 or more significant titre rises occurred in 5, 2 and 9%, respectively. No evidence for transmission of vaccine virus from non-immune mothers to 63 breast-fed children was observed. The occurrence of side-effects was studied in 949 mothers. One of the vaccines (Almevax) caused more local reactions at the site of the vaccination than the other two. Vaccination with Meruvax was associated with significantly more joint pains and rash, the side-effects found most troublesome by the vaccinees.

61 patients with chronic osteomyelitis were admitted to the University Hospital of Lund during a 7-year period. Positive cultures were obtained from 59 cases, all of them showing growth of Staphylococcus aureus. 50 strains were phage-typed, 40 strains tested for lipase activity, and 16 strains investigated on protein A content and α-toxin production. The osteomyelitic strains were compared in these respects and regarding antibiotic resistance patterns with other staphylococcal strains from routine diagnostic work. 13/15 strains from cases of hematogenous osteomyelitis belonged to phage groups I and II; none belonged to group III. This distribution differed significantly from posttraumatic osteomyelitic strains and from strains isolated from cases of septicemia. 90% of the osteomyelitic strains were lipase-positive and did not differ from unselected strains. Among the unselected control strains lipase activity in phage group III was significantly less frequent than in phage groups I and II. All 16 ...

12 patients with chronic staphylococcal osteomyelitis were treated with cloxacillin (6 patients) and dicloxacillin (6 patients) in a prospective, comparative study. The drugs were given perorally in the dose 1 g every 4th hour and serum concentrations were followed. 0.5, 1 and 2 hours after administration the serum level of dicloxacillin was about double that of cloxacillin. The lowest serum level of dicloxacillin at the time of administration of the drugs was nearly 3 times as high as the level of cloxacillin. An evaluation of clinical benefit and side-effects revealed no differences between the drugs. The prolonged serum level of dicloxacillin may permit a longer interval between doses than the administration of cloxacillin.

16 patients with the anginose type of infectious mononucleosis were treated with metronidazole, and another 3 patients were given clindamycin. Most of the patients had been given penicillin or erythromycin before admittance to hospital. Treatment with metronidazole had a favourable effect on the course of the disease; the body temperature was normalized, signs of tonsillitis disappeared and cervical lymph nodes decreased in size within 3 days in 10 patients and in the remaining 6 within 4 or 5 days. Difficulty in mastication and swallowing was usually relieved within 1 to 2 days of treatment. The period before normalization was significantly shorter than in 10 controls. Two of the 3 patients who were given clindamycin developed exanthems, but otherwise a similar favourable effect as in the metronidazole-treated patients was observed.

During about 3 years 100 cases of recurrent staphylococcal furunculosis were studied with reference to phage-types of strains from lesions, nares, perineum and groins in relation to possible contamination sources. Phage group II staphylococci were found in 58% of the cases. In about half of the patients the same phage type was found in the nares as in the lesion but in the perineum and/or groins in only 14%. In two thirds of these cases the strains belonged to phage group II. Phage group II strains were isolated mainly from patients after supposed contamination outside hospital, while these strains were not dominating in patients probably infected in hospital. An epidemiological study revealed that recurrent furunculosis mostly has its origin outside hospital. Phage typing of lesion and nares strains is essential for the epidemiological analysis of recurrent furunculosis.

20 adult patients (17 women) presented axillary, gluteal, external genital, breast and groin abscesses. Anaerobic bacteria were isolated in 10 cases; Peptococcus magnus in 8. Staphylococcus aureus was the sole organism in 2 cases, skin flora (Staphylococcus epidermidis) in 6. No bacteria were isolated from 2 patients. The Staph, aureus were mainly phage group III strains or nontypable. It is apparent that these kinds of skin infections comprise a special group with regard to epidemiology and etiology.

Reports in the literature of acute pancreatitis concomitant with infectious mononucleosis are rare. Two new cases (man, 24, and girl, 12 years) are described. Pancreatitis is of interest mainly in the differential diagnosis versus rupture of the spleen. Abdominal pain in infectious mononucleosis should lead to investigation of amylases in serum and urine.

This study was focused on cerebrospinal fluid (CSF) manifestations in experimental Streptococcus pneumoniae and Escherichia coli meningitis in rabbits. An increased (p less than 0.001) CSF lactate concentration was found in infected animals, mostly not accompanied by a decrease in CSF glucose concentrations. Despite a marked difference in CSF cellular response between the 2 etiological groups no significant difference in CSF lactate levels was found. Neither did CSF lactate levels correlate to CSF polymorphonuclear cell counts. CSF concentrations of albumin were with large variations above control levels in all infected animals. Also a small or moderate increase in CSF albumin levels was generally associated with a marked increase in CSF lactate concentration. The concentration of total amino acids in the CSF was above control values (mean + 2 SD) in 9/21 infected animals. Halothane/N2O anesthesia for 25 min increased (p less than 0.05) CSF levels of glucose, partly independent of alterations in plasma glucose concentrations, in both infected rabbits and in controls.

Antibody responses against teichoic acids and other antigens from Staphylococcus aureus in 23 patients with septicemia and 8 patients with endocarditis caused by S. aureus were investigated. Both methods used—solid-phase radioimmunoassay (SPRIA) and crossed ***immunoelectrophoresis (CIE)—detected significantly higher titres in the endocarditis group. The SPRIA method utilized a sonicated extract of S. aureus, strain Wood 46 for the quantitation of antibodies. In CIE precipitating anti-teichoic acid antibodies were measured. There was no absolute correlation between the two assays, indicating that the antibodies measured were directed at partly different antigens. The two tests might be complementary to each other when used in combination.

19 patients with recurrent staphylococcal furunculosis have been investigated as to granulocyte gross counts, plasma levels of IgG, IgA, IgM and IgE, complement factors C3 and C4 as well as lymphocyte populations characterized by receptors for sheep erythrocytes and Fc of IgG (Fcγ). Patients with severe furunculosis had on average low proportions of Fc-γ-receptor bearing lymphocytes. Two patients with hyperimmunoglobulinemia E were recorded. Other investigated parameters were normal.

The serum antibody response against staphylococcal antigens was investigated by crossed immunoelectrophoresis in 79 patients with recurrent staphylococcal furunculosis. The levels of precipitating antibodies were significantly higher than in normal controls. Patients increased their antibody levels during an acute exacerbation. It was not possible to differentiate between a severe and a mild infection by means of antibody level.

In a retrospective study the etiology was verified in 35/52 patients with suspected septic prepatellar or olecranon bursitis. Staphylococcus aureus was the most common pathogen and 86% of them were penicillinase-producing. Other strains were streptococci. Mean age was 47 (18-83) years and males predominated (91%). Predisposing factors were seen in most cases. Preceding trauma was found in 27 and/or associated diseases (e.g. diabetes mellitus) in 11 patients. Hyperglycemia was found in 38% of the patients. Treatment with antimicrobial agents, mostly penicillins, and bursal drainage were successful in 32 cases. Two patients had local spread of the infection and 1 patient chronic bursitis.

22 patients with various gram-negative infections were treated with tobramycin at a dose of approximately 3 mh/kg body weight/24 h for 7 to 53 (mean 16) days. Therapy was monitored with determinations of drug serum concentrations and renal and audio-vestibular function tests. In 16 patients either cure of clinical improvement were achieved. Two patients did not improve. In another 4 patients the effect of tobramycin therapy could nto be evaluated. One patient exhibited a subclinical vestibular dysfunction and one patient experienced transient tinnitus. In one patient, slight but clinically significant renal impairment occurred.

Metronidazole (Flagl), a compound widely used in man with minimal side-effects, has been used in the treatment of anaerobic infections caused by Bacteroides fragilis and other Bacteroides species. Seven patients were treated and all were restored to full health. Four of them did not respond to lincomycin or clindamycin which so far have been the drugs of choice against anaerobic infections. The reasons for the good results during metronidazole therapy such as the good penetration through the blood/brain barrier and into abscess cavities are discussed.

41 patients with chronic staphylococcal osteomyelitis received antibiotic therapy for at least 6 months. They were observed for 1–5.5 years after the end of treatment. The frequency of recurrences after such long-term treatment (LTT) was significantly lower than before. Despite this improvement, 21 recurrences were diagnosed in 12 patients (29%) during the observation period. The recurrences did not appear to be associated with any particular characteristic of the patients. 16 of the recurrences were seen in 8 patients infected with staphylococci belonging to phage group I. Various aspects of the virulence of staphylococci were considered, but no particular factor could be regarded as decisive for the recurrence tendency. Half of the patients were treated surgically and/or locally with antibiotics during LTT. Especially sequestrectomy appeared to improve the prognosis.