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76 Str.pneumoniae strains isolated from different clinical disease forms were studied for the sensitivity to antimicrobial drugs using the diffusimetric method and the dilution in agar method (MIC to penicillin). The results revealed that 44.74% of pneumococci were sensitive to penicillin, the remaining pneumococci being resistant; 18.42% showed a high resistance (MIC > or = 2 micrograms/ml). A close relationship was seen between sensitivity to penicillin on the one hand and the Pneumococcus origin and serotype on the other. As concerning the multiresistance to antimicrobial drugs, 47.4% of the strains presented resistance to > or = antibiotics belonging to different classes, the most frequent resistance pattern being P, E, Te, SxT. The most active antimicrobial drugs were vancomycin, amoxiclave, rifampicin, followed by ceftriaxone and amoxicillin.

121 invasive pneumococci isolated from meningitis, septicemia, pneumopathies and other clinical infections (osteo-arthritis, peritonitis, sinusitis, otilis, conjunctivitis, plagues) were screened for susceptibility to penicillin G (P), erythromycim (E), chloramphenicol (Cl), tetracycline (T), ceftriaxone (Cro), and sulfametoxazole trimethoprim (SxT) by diffusimetric method, by MICs to P and Cro by agar dilutions and E-test. 48.8% were penicillin resistant (MICs > 0.12 microgram/ml), 22.7% being highly resistant (MICs 3-8 micrograms/ml). Any strain was resistant to P only, but patterns with P included were frequent (55.8%). Resistance to SxT was highest (monoresistance 25.6% as well as polyresistance 69.8%). 72.9% were resistant strains to > or = 1 antibiotic with 12 patterns of resistance (1-5 antibiotics). All of the strains were susceptible to Cro (MICs-0.003-0.5 microgram/ml). Resistance was closely correlated to serotypes 6,9,14,19,23 to site of isolation and diagnosis. Pneumococci from meningitis were 2-3 times more susceptible to P,E,Cl,T and SxT than the isolates from pneumopathies or other infections.

1496 Neisseria strains isolated from patients and carriers from 24 counties in Romania and Bucharest in 1971-1992 were studied. Serogroup A identified in 84.5% in 1987 shows a remarkable decrease in pre- and post-epidemic periods when serogroups B and C reach rates varying from 0 to 66.6% in 1975 for B and 38.8% in 1974 for C. Non-groupable strains were more frequently isolated in inter-epidemic periods, especially in carriers. Sensitivity to antibiotics of the meningococcal strains revealed a law rate of resistant strains, the most active antibiotics in decreasing order being: penicillin, chloramphenicol, tetracycline, ampicillin, rifampicin and erythromycin. Serogroup A was the most resistant to sulfamides as compared to the other serogroups, its resistance rate rising from 18.1% strains resistant to sulfathiazole in 1980-1985 to 60.7% in 1987 and to 83.3% in 1988.

The paper describes the endemic epidemic picture of meningococcal meningitis in Romania over 1971-1991 period. After the epidemic of 1970 with 1051 cases and a morbidity of 5.2 %000, the incidence of the disease suddenly decreased; thus in 1972-1984 the number of cases ranged from 191 to 534 per year, corresponding to a morbidity rate of 0.9 - 2.3 %000. Starting with the autumn of 1985 the incidence of meningococcal meningitis increased rapidly, reaching a maximum value in 1987 (2623 cases) and a morbidity rate of 11.4 %000. A spectacular decrease to 250-270 cases per year in 1990-1991 and a morbidity rate of 1.1 - 1.2 %000 were reported. Mortality followed closely the morbidity curve with a maximum in 1987 (0.4 %000). By contrast, lethality was higher in endemic periods with a maximum of 7.9% (1972), 8.9% (1975) and 6.3% (1990-1991), in the remaining years the lowest index being 1.4% (1980). The meningococcal meningitis epidemic of 1987 was due to group A Neisseria meningitidis identified in 84.5% of isolates from patients, the same serogroup decreasing in endemic periods to 0 (1991) or 5.5% (1974).

297 S. pneumoniae strains isolated from patients with different pneumococcal infections during 1990-1991 were tested for the sensitivity to antibiotics--by the diffusimetric method to 9 antibiotics (Penicillin (6 micrograms), Ampicillin (10 micrograms), Erythromycin (15 micrograms), Oxacyllin (5 micrograms), Streptomycin (50 micrograms), Tetracycline (50 micrograms), Chloramphenicol (50 micrograms), Rifampicin (6 micrograms), and Kanamycin (30 micrograms) and by MIC determination to Penicillin and Erythromycin. 30% of S. pneumoniae strains were resistant to Penicillin and Erythromycin corresponding to a MIC > or = 1 UP/ml or > or = 1 microgram E/ml. The most active antibiotics were Chloramphenicol and Rifampicin and the less active: Tetracycline, Kanamycin and Streptomycin. A relation between the origin and serotype of the strains and the sensitivity to antibiotics was revealed. The strains from the throat, conjunctive and otic secretions and belonging to serotypes 19, 6 and 14 showed the highest levels of resistance to all antibiotics. A good correlation between MIC and diffusion method results was observed to Erythromycin and no correlation to Penicillin. In this last case the results of MIC determination to Penicillin were better correlated with the results of inhibitions diameters to Oxacyllin, method which have to be recommended.

111 neonates with acute respiratory insufficiency and/or severe pneumopathy (pneumonia, bronchopneumonia) occurring in the first 10 hours after birth were investigated during January 1990-September 1991 for the group B streptococci presence. 430 samples from these neonate cases: throat and nose exudates, necroptic material from died neonates (pulmonary, blood, bronchial secretion) and their mothers (lochia, vaginal and uterine secretion) were examined. 33% of the neonates and their mothers were positive with the same GBS. 65.30% from the GBS strains belonged to serotype Ia and 34.70% to Ib. 24.48% from the GBS strains were resistant to Penicillin G by diffusimetric method with a corresponding MIC of 0.1 UP/ml (22.12%) and 0.5 UP/ml (2.65%).

In order to find methods for the prevention and control of streptococcal infections of 711 day schoolchildren and boarders, aged 7 to 14 years, were followed up during the 1969-1973 period. The clinical and epidemiologic investigations revealed a great number of acute infections with varied clinical manifestations and high proportions of the acute articular rheumatism (3.1%) in the boarding schools as compared to the day schools (0.5%). The bacteriologic examinations confirmed and established the etiology of the cases, revealing moreover the role of carriers in maintaining and spreading the infection. The ASLO test showed persistent and high gammaglobulin titers in the children of the boarding schools, pointing to a state of hypersensitivity consequent to repeated streptococcal infections.

Bacteriologic and virologic investigations carried out in a group of 85 patients with acute pneumonia have allowed the determination of the etiologic agent in 52.9% of the cases. Of these, 40% showed combined viral and bacterial infections. Mixovirus infections were frequently associated with staphylococcic ones (7 out of 8 cases) and adenovirus infections with the pneumococcic ones (6 out of 7 cases). The most severe and longdrawn clinical pictures with frequent pleuropulmonary complications (in 22.24% of the cases) had a biphasic evolution in only 6 of the 18 pneumonias of mixed etiology. For their high frequency and their clinical peculiarities, mixed etiology pneumonias might be considered as distinct clinical entities.

Thirty-five children between 6 and 17 years treated in the clinic for scarlet fever, rheumatic fever and other non-streptococcal infections as controls, were tested by lymphocyte transformation to four streptococcal antigens. In all cases of scarlet fever and especially of rheumatic fever the lymphocytes were better stimulated by streptococcal products than in the control group. The SO and the MAP fraction showed a good stimulating activity. The response in the rheumatic fever patients was not influenced by the steroid treatment, nor by the stage of the illness. A parallelism with high humoral and cellular responses to SO at the beginning of the acute rheumatic fever was observed, followed by a dissociation of both responses during the evolution with the maintenance of the cellular one and the decrease of the ASO titre.

The streptococcal infection cases from two outbreaks were serologically examined against two components of the streptococcal cellular wall; the M associated protein (MAP), by a latex agglutination test and the group A carbohydrate (A-CHO), by passive hemagglutination technique. Many positive cases with high levels of both antibodies were found, in rheumatic fever and glomerulo-nephritis, comparatively with the acute streptococcal infections. The differences were statistically significant. The results were correlated with the ASO titres and with the dermic cellular response.

It was tested the possibility to evidence the pneumococcal capsular antigen, by coagglutination, directly in CSF, using a specific coagglutinating reagent for all the 10 serological types of S. pneumoniae more frequently encountered in our country. Were investigated 134 CSF from purulent meningitis, out of which 37 were of probable pneumococcal etiology, on the basis of bacterioscopic examination, 26 of other etiology and 71 of unknown etiology. The results obtained showed 28 (75.7%) positive reactions in the fluids from probably pneumococcal meningitides on the basis of the positive bacterioscopic examination. The specificity of the reactions is demonstrated by the negative reactions with the fluids from meningitides of other etiology, as well as by the concordance between the antigen serotype from the liquid and that of the isolated S. pneumoniae strain. For a good test sensitivity could argue the positive reactions obtained with 6 CSF from meningitides of unknown etiology.

Immunodiagnosis is very useful especially in cases where bacteriological diagnosis cannot be made because of the high sensitivity of Neisseria meningitidis. A sensitive reaction is described for the detection of antimeningococcal antibodies using as antigen a latex suspension specifically sensitized with saline extracts from N. meningitidis groups A, B and C. The results prove the genus, species and serotype specificity of this reaction. The method is quick and easy to carry out, even in laboratories which do not possess elaborate equipment. The latex-antigen has the advantages of stability and possibility of standardization.

After taxonomic listing of group D streptococci, the authors discuss the methodology of the bacteriologic diagnosis of infections produced by these bacteria, showing the way in which the pathological products are collected, the strains isolated and seeded. The strains are identified in two stages: (1) group identification by group antigen identification, resistance to oxacillin, development at +45 degrees, development on bilaesculin media; (2) species and variety identification by biochemical, physiologic and metabolic tests, by lysotyping and enterocinotyping. A description is given of the testing of sensitivity of the strain to antibiotics by determination of the minimal inhibitory concentration. The formulas of the media used for culture and identification are given.