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Abstract4 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.

Abstract22 patients with various gram-negative infections were treated with tobramycin at a dose of approximately 3 mgkg body weight24 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 or clinical improvement were achieved. Two patients did not improve. In another 4 patients the effect of tobramycin therapy could not 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.

20 patients with chronic staphylococcal osteomyelitis were tested for 6 acute phase reactants: alfa,-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.

Abstract41 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 andor locally with antibiotics during LTT. Especially sequestrectomy appeared to improve the prognosis.

AbstractDuring 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 andor 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.

AbstractThe therapeutic efficacy of dicloxacillin 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 flucloxacillin in serum exceeded MIC values of methicillin-susceptible Staphylococcus aureus during 11 of 24 h. Pharmacokinetic data on flucloxacillin with and without probenecid are given.

Abstract61 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. 1315 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 osteomyelitic strains tested were protein A-positive. The incidence of α-toxin production in osteomyelitic strains did not differ from that in the control strains.