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Objectives of this study were twofold: (i) to assess the association between polymorphonuclear (PMN) counts and chronic alterations within the bovine endometrium and (ii) to determine the distribution of inflammation throughout the endometrium of clinically healthy dairy cows. Holstein-Friesian cows (n = 32) from a single dairy farm were selected for this experiment. Before slaughtering, a complete reproductive examination was performed to discard any type of clinical disease. After slaughtering, reproductive tracts were collected, and the endometrium was sampled at 8 pre-defined locations. At each location, endometrial biopsies (EBs) and cytology (CY) samples were harvested. Histopathology samples were stained with haematoxylin-eosin (EB-HE) and naphthol-AS-D-chloroacetate-esterase (EB-naphthol), while CY samples were stained with Wright-Giemsa. In the EB-HE samples, parameters assessed were epithelium height, mononuclear cells infiltration, lymphocytic aggregates, periglandular fibrosis, angiosclerosis and haemorrhage. In EB-naphthol and CY slides, PMNs counts were evaluated. Binomial logistic regression was used to assess the association between the number of PMNs present in both the EB-naphthol and CY samples and alterations identified in the EB-HE samples and to analyse the distribution of the histopathological alterations (EB-HE). A Poisson mixed-effect model was used to analyse the distribution of PMNs within the endometrium. A significant positive association was found between the PMN counts and the mononuclear cells infiltration. The presence of erythrocytes was associated with higher odds to detect PMNs in the stratum compactum. Significantly, higher infiltration of PMNs and mononuclear cells were detected in the uterine body and the right horn region. Concluding, CY is a technique that allows the evaluation of PMN counts and therefore only evaluates active inflammation. A complete assessment of endometrial health can only be obtained using EB. To optimize the sensitivity to diagnose endometrial inflammation in cows, adjacencies of the corpus uteri should be considered as the preferred region to harvest samples.

Streptococcus pneumoniae is a leading cause of fatal bacterial pneumonia in young children. Pneumococcal polysaccharide vaccines have not been promoted for use in young children because many constituent serotypes are not immunogenic in children < 2 years old. Conjugating pneumococcal polysaccharide epitopes to a protein carrier would likely increase vaccine immunogenicity in children. We reviewed published and unpublished pneumococcal serotype and serogroup data from 16 countries on 6 continents to determine geographic and temporal differences in serotype and serogroup distribution of sterile site pneumococcal isolates among children and to estimate coverage of proposed and potential pneumococcal conjugate vaccine formulas. The most common pneumococcal serotypes or groups from developed countries were, in descending order, 14, 6, 19, 18, 9, 23, 7, 4, 1 and 15. In developing countries the order was 6, 14, 8, 5, 1, 19, 9, 23, 18, 15 and 7. Development of customized heptavalent vaccine formulas, one for use in all developed countries and one for use in all developing countries, would not provide substantially better coverage against invasive pneumococcal disease than two currently proposed heptavalent formulas. An optimal nanovalent vaccine for global use would include serotypes 1, 5, 6B, 7F, 9V, 14, 18C, 19F and 23F. Geographic and temporal variation in pneumococcal serotypes demonstrates the need for a species-wide pneumococcal vaccine.

A prospective randomized controlled double-blind study was performed on 61 patients undergoing transurethral resection of the prostate. The first group of 31 patients received 3 g fosfomycin trometamol p.o. each on the evening before and after the operation; the second group of 30 patients received a placebo. Urine samples were taken by catheter puncture 24 and 48 h postoperative. After removal of the catheter (day 5) the first midstream urine was collected for culture, and from that moment on all patients were treated with a nitrofurantoin derivative for two weeks. Although the same strict antiseptic measures were standard practice for both groups, the incidence of early postoperative urinary tract infections was significantly lower for the fosfomycin trometamol group (0/31 versus 6/30 in placebo recipients). None of the patients suffered from a major symptomatic or complicated infection. There were no side effects registered.

A total of 383 clinical isolates of Streptococcus pneumoniae, obtained from an equal number of patients in Kigali, Rwanda, was tested for resistance to penicillin G with a 1 microgram oxacillin disc. Of these isolates, 99 (25.8%) showed reduced zones of inhibition. By means of an agar dilution method, 21% all isolates were confirmed as relatively resistant (MICor = 0.12-or = 1.0 mg/l) strains of Streptococcus pneumoniae (RRSP). A high degree of resistance to penicillin G (MICor = 2 mg/l) was not observed. Resistance to chloramphenicol (MICor = 8 mg/l) was found in 31% RRSP and in 6% penicillin susceptible strains (PSSP). Doxycycline resistance was common in both RRSP and PSSP strains. All isolates remained fully susceptible to erythromycin. Children more often harboured a strain giving a reduced inhibition zone than did adults (74/230 versus 25/153; P = 0.0005). A total of 32 serotypes or serogroups were identified, seven of them relating to 64.8% all isolates typed. Of all the isolates 84% belonged to a serotype represented in the 23-valent vaccine or to a cross-reacting serotype. Serotype 25, not included in the vaccine, accounted for 10.7% typed isolates from adults but only for 2.0% typed isolates from children. Results of susceptibility testing and clinical experience suggest that penicillin G, ampicillin and chloramphenicol should not be used alone as empirical treatment for pneumococcal meningitis in patients in Rwanda.

The cloning of glycosyltransferases is a major breakthrough in the study of glycosylation in normal an malignant tissue. In bladder tumours we need a molecular explanation for the changes observed in especially Gal alpha 1-3 and GalNac alpha 1-3 transferase activity. Studies of the events (transcription/translation) taking place in the different cell layers would also be of importance, especially if the cells could be sorted layer by layer. The urine is a source of malignant cells, and could be a target for diagnosis as well as monitoring. Studies of urinary tumour-associated glycoconjugates or tumour-associated rearrangements in glycosyltransferase genes in exfoliated cells would be of great interest.

Nine doses of oral spiramycin were administered to 59 adult healthy nasopharyngeal carriers of meningococci: a 2-gram loading dose followed by 1 g every 12 h for 4 days. There was a reduction in carriage of 85 and 59%, respectively, on the 2nd and 12th post-treatment day. There was no difference in vitro sensitivity to spiramycin and erythromycin of the meningococci isolated before and after treatment. Spiramycin may be advocated as an effective and safe alternative drug for the chemoprophylaxis of secondary meningococcal disease when sulphonamide resistance is suspected.

The susceptibility of 83 non-pigmented Serratia marcescens strains was determined by an agar dilution technique. They originated from miscellaneous pathological specimens submitted

During a 21-month period, we observed an outbreak of severe systemic infections due to multiresistant Salmonella typhimurium among 66 children in the in-patient Department of Paediatrics of Kigali, Rwanda. These infections were more likely to occur in subjects who had stayed for a long time in the hospital for severe illness and/or malnutrition. The children usually presented first with mild to moderate diarrhoea and fever. Later, sever pulmonary involvement was often noted (rales: 58%; respiratory distress: 42%). Moreover, there were four cases of abscess, three arthritis and one meningitis. Of the 66 children, 48 were treated with cefotaxime. The fatality-rate among this group was 10.4%. The fatality-rate among the 18 other untreated patients was 77.9%, suggesting a high efficiency of cefotaxime against these strains of multiresistant Salm. typhimurium.

SummaryIn April 1972, the (Belgian) Association for the Quality in clinical Biology has launched a proficiency testing program in the area of microbiology. At present 105 laboratories adhere to this program, and 88% of them participate actively at the different trials. The trials are organised at trimestrial intervals and each comprises the identification of three pure cultures and the determination of their susceptibility to 10 antibiotics. After each survey a detailed report is sent to the participants, giving the results of the identifications and the antibiotic susceptibility tests (performed according to Bauer-Kirby) together with a statistical and anonymous assessment of the overall performance of the participating laboratories. The report also contains recommendations on suitable identification techniques.The results of the 9 trials carried out during a period of 24 months, are represented in a series of tables. The choice of the cultures, submitted for identification, is briefly discussed. Importa...

In an open prospective study, single oral doses of norfloxacin (800 mg) and thiamphenicol (2.5 g) were used to treat, respectively, 122 and 46 consecutive patients with uncomplicated gonorrhea. Neisseria gonorrhoeae was eradicated from 119 (97.5%) patients treated with norfloxacin and from 35 (76.0%) patients treated with thiamphenicol. Norfloxacin treatment failure was not related to drug resistance or to insufficient absorption of the drug. Thiamphenicol failure correlated with low in vitro susceptibility of the infecting strain. In a single oral dose of 800 mg, norfloxacin appeared to be an excellent alternative treatment regimen for uncomplicated gonorrhea in an area with a high prevalence of penicillin-resistant gonococci.

A case of subacute bacterial endocarditis due to Actinobacillus actinomycetemcomitans is reported. The patient was successfully treated first by a combination of gentamicin and ampicillin and then, because of severe allergic reactions, ampicillin was replaced by co-trimoxazole; symptoms did not recur and blood cultures remained sterile. A synoptic table is presented of 19 reported cases of infection caused by A. actinomycetemcomitans not connected with actinomycosis, with particular regard to their clinical features, treatment, and outcome.

Resume Par leurs proprietes pharmacologiques et leur spectre antibacterien in vitro, les 4-fluoroquinolones apparentees a l'acide nalidixique, sont appelees a prendre une place importante dans le traitement des diarrhees aigues d'origine bacterienne. Les auteurs passent en revue les resultats cliniques et bacteriologiques, parfois preliminaires, obtenus dans le traitement de la shigellose, la fievre typhoide, les salmonelloses non-typhoidiques, les diarrhees a Campylobacter et a vibrionacees, et les diarrhees du voyageur. Dans l'ensemble les resultats sont superieurs ou au moins comparables a ceux obtenus avec les antibiotiques classiques, meme avec des traitements de plus courte duree. Pour la premiere fois, il semble possible d'obtenir une guerison bacteriologique de la diarrhee a Salmonella et d'eradiquer le portage de ce germe. La tolerance des fluoroquinolones est excellente du moins chez l'adulte. Leur toxicite pour le cartilage chez les jeunes animaux d'experience a empeche jusqu'a present leur essai en milieu pediatrique. Il serait regrettable que l'emergence de souches resistantes compromette l'avenir brillant de cette nouvelle classe de produits antibacteriens. Beaucoup dependra de l'usage judicieux qu'on en fera et d'une bonne surveillance bacteriologique.

Summary Details are given on the epidemiology of human Yersinia enterocolitica infections in Belgium, based on 3167 isolations from 1963 to 1978. A continuing increase of the number of isolations is noted, with 1386 isolations in the last three years covered, excluding repeated isolations from the same patient. Serotype 3 remains predominant accounting for 84 per cent of all isolations. However, a changing pattern of serotypes distribution has been observed in recent years, with an increasing proportion of serotype 9 and serotypes other than 3 or 9. Most isolations are from faeces. From blood and deep abscesses only serotypes 3 and 9 were recovered. In Belgium only the latter serotypes are clearly associated with human disease, such as enteritis, pseudo-appendicular syndrome and septicaemia. The pseudo-appendicular syndrome is seen at an older age than is enteritis, and is relatively more frequent in serotype 9 infections. In contrast, serotypes other than 3 or 9 are relatively more common in persons without any illness or with atypical symptoms. There is evidence that they are non-pathogenic.

In this clinical trial, amoxycillin, a new semi-synthetic penicillin, was administered to gynaecologial and obstetric patients suffering mostly from asymptomatic bacteriuria. The incidence of bacterio

SummaryThe clinical features of a case of bacterial endocarditis superimposed on a congenital ventricular septum defect in a 54 year old man are presented. Aclinobacillus actinomycetemcomitans was repeatedly isolated from the blood and the patient was successfully treated with penicillin and streptomycin. Our observation is the second such infection reported in detail from the European continent.Other published observations of endocarditis due to this organism, together with the bacteriologic characteristics of the bacterium are biefly discussed.

SummaryThe basic concepts governing the disc diffusion sensitivity method are reviewed with particular reference to the present attempts of adopting an international reference method. Real progress in this field has chiefly been hampered by the impossibility of reaching an agreement on the values of the critical serum levels obtained in vivo. Four sensivity testing systems, using commercial discs, are commented in the light of the above principles. Some final comments are devoted to the difficulties inherent in testing the activity of antibiotic combinations by the disc diffusion technique.

All of 37 recent human isolates of Edwardsiella tarda were resistant to colistin. All strains were resistant to 6.3 μg of sodium colistimethate per ml; 82% of them were resistant to 100 μg/ml. With 34 Salmonella strains, the average minimal inhibitory concentration (MIC) was 1.6 μg of sodium colistimethate per ml. There was virtually no overlapping of MIC values between both groups of bacteria. Using the Kirby-Bauer method and 10-μg colistin disks, inhibition zone diameters were less than 11 mm for all Edwardsiella strains, and larger for all Salmonella strains. An atypical, mannitol-fermenting strain of E. tarda was resistant to colistin. It is concluded that E. tarda is naturally resistant to colistin, that this property may be helpful in differentiation, and that colistin should be tried in enrichment and selective media for the isolation of E. tarda . It was also observed that, under conditions as described, all strains of E. tarda were susceptible to streptomycin and to novobiocin, whereas all strains of Salmonella were resistant.

Cryptosporidium oocysts were present in 20 (10.4%) of 193 Rwandese children and in 3 (3.0%) of 100 adults with diarrhea. In four of the children and in one adult, Cryptosporidium was associated with other enteric pathogens. The higher incidence of Cryptosporidium in diarrheic children was statistically significant. The parasite was not found in 94 formed stools submitted for parasitological examination. The mean age of the Cryptosporidium-positive children was 13.3 months. In four children, Cryptosporidium was associated with severe malnutrition. All of those required rehydration, and one child died as a direct consequence of severe diarrhea. The three adult patients showed no recognizable immunodeficiency, and their diarrhea resolved spontaneously. Staining with 1% safranin was not only more simple and rapid but also more sensitive than the modified Ziehl-Neelsen technique.

Trimethoprim (300 mg twice daily for five days) and co-trimoxazole (two tablets twice daily for five days) were compared as treatment for adult patients with severe shigellosis in Rwanda. Excellent bacteriological and clinical results were obtained with both regimens, with the exception of patients infected with a trimethoprim-resistant strain of Shigella dysenteriae type 1. Since only 20 patients were investigated, the conclusions of our study do not reach statistical significance. Before recommending trimethoprim as standard therapy for shigellosis, the validity of our results should be tested in a larger trial and the long-term ecological consequences of monotherapy carefully monitored.

Pseudomonas putrefaciens has been presented as an opportunistic pathogen in a few isolations from humans. This is the first documented report of a local infection of P. putrefaciens complicated by invasion of the blood stream. The organism was twice isolated from the blood culture and once from the wound exudate of a 73-year-old woman hospitalized for extensive ulcerations on the legs. Parenteral ampicillin and gentamicin together with local antiseptic treatment led to an uneventful recovery.

Protracted diarrhea in a 2-month-old Belgian infant was associated with Edwardsiella tarda as the only potential pathogen. The same organism was isolated from a tropical aquarium fish in the home of the patient. The enteropathogenic role of E. tarda and the role of fish as a reservoir of infection are reviewed. Additional observations, volunteer studies, and careful prospective surveys in tropical countries will be needed to produce firm evidence of the enteropathogenic potential of E. tarda.

The in vitro sensitivity of 104 isolates of Neisseria gonorrhoeae to six antimicrobial agents was tested. More than 50% of the isolates produced penicillinase. Of those that did not produce penicillinase, 26% were resistant (minimum inhibitory concentration (MIC)) greater than or equal to 0.5 mg/l), and 68% showed a decreased sensitivity for penicillin G (0.06 less than or equal to MIC less than or equal to 0.25 mg/l). Twenty six per cent and 50% of the strains, respectively, showed a decreased sensitivity to thiamphenicol (MIC greater than or equal to 1 mg/l) and tetracycline (MIC greater than or equal to 2 mg/l). All isolates were sensitive to spectinomycin, kanamycin, and norfloxacin. Of 20 penicillinase producing N gonorrhoeae (PPNG) isolates examined, seven contained the 3.4 megadalton R-plasmid, another seven contained both the 3.4 megadalton and 22.5 megadalton plasmids, five the 4.3 megadalton and 22.5 megadalton plasmids, and one isolate harboured both the 3.4 and 4.3 R-plasmids, together with the 22.5 megadalton plasmid. A disturbing increase in resistance to penicillin has been observed since the publication of earlier surveys, and the clinical implications of these findings are discussed.

The intestinal contents of 59 Zairese freshwater fish were examined for the presence of potential human enteric pathogens. Edwardsiella tarda and Plesiomonas shigelloides were isolated from 57 and 59% of them, respectively. For both microorganisms there was a significant difference between the isolation rates from lake and river fish: whereas E. tarda was much more frequently isolated from lake fish than was P. shigelloides, the reverse was observed for river fish. The authors hypothesize that sporadic cases of tropical diarrhea with E. tarda or P. shigelloides can be traced to contact with or consumption of freshwater fish.

SummaryOut of ten patients with brain abscess, observed over a period of fifteen months, eight were associa ted with Streptococcus milleri, either in pure culture or as part of a mixed flora with strict anaerobes. Inspite of surgery and chemotherapy, two patients died and one survived with severe sequelae.The taxonomic position, the ecology, the pathogenic spectrum, and the bacteriologic diagnosis of S. milleri are reviewed.

SummaryThe clinical and bacteriological observation of a 23-year old male student with gonococcal endocarditis is presented. In spite of antibiotic treatment and of four successive surgical interventions with insertion of artificial aortic and mitral valves, the patient expired as a consequence of haemodynamic problems.The pathogenesis of disseminated gonococcal in fection and the problems involved in bacteriological diagnosis are discussed.

238 patients undergoing primary total hip replacement had on a routine basis both "clean air system" prophylactic conditions and a one day lasting prophylactic Cefamandole treatment on the day of surgery. All patients had a follow-up during at least one year; the follow-up in some patients was up to 25 months. Deep infections were not seen in any of the patients and E.S.R. returned to normal values one year after the intervention in all patients. Superficial wound infections were seen in 2% of the patients. One fifth of the patients had significant bacteriuria on the day of the intervention. This did not seem to have any implication. In our series both laminar air flow and prophylactic administration of Cefamandole on the day of intervention give an adequate prophylactic coverage to prevent the dangerous deep infection as a complication in total hip surgery.

Summary Cases of multiple cutaneous abscesses due to Mycobacterium borstelense and M. abscessus are described. One occurred in Belgium after insulin injections and the other as a result of a wound infection sustained in Central Africa. The differentiation of M. borstelense from M. abscessus, M. fortuitum and M. peregrinum is discussed.

Yarwood and Elmes1 observed a cyst in the retroauricular region of a native in Nigeria, containing operculated eggs having the same form as the eggs of Paragonimus. Recently, one of us discovered, in natives of the Kasai Province, four cases of cysts or abscesses, similarly situated and containing eggs resembling those of Paragonimus westermani but slightly smaller in size2. Examination of an adult worm extracted from one of these cysts showed that it did not belong to the Troglotrematidae (although it had some of the characteristics of this family) but to the Achillurbainiidae Dollfus3. At the present time this family is represented by only one genus containing one species Achillurbainia nouveli Dollfus, which was discovered in an abscess of the upper eyelid in a Malayan leopard. Our specimen has certain differences from the genus Achillurbainia and we propose to place it in a new genus and in a new species: Poikilorchis congolensis n.g., n.sp.