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Evidence from animal models demonstrate that intrauterine growth restriction (IUGR) alters airway structure and function which may affect susceptibility to disease. Airway inflammation and dysregulated epithelial barrier properties are features of asthma which have not been examined in the context of IUGR. This study used a maternal hypoxia-induced IUGR mouse model to assess lung-specific and systemic inflammation and airway epithelial tight junctions (TJs) protein expression. Pregnant BALB/c mice were housed under hypoxic conditions (10.5% O2) from gestational day (GD) 11 to 17.5 (IUGR group; term, GD 21). Following hypoxic exposure, mice were returned to a normoxic environment (21% O2). A Control group was housed under normoxic conditions throughout pregnancy. Offspring weights were recorded at 2 and 8 weeks of age and euthanized for bronchoalveolar lavage (BAL) and peritoneal cavity fluid collection for inflammatory cells counts. From a separate group of mice, right lungs were collected for Western blotting of TJs proteins. IUGR offspring had greater inflammatory cells in the BAL fluid but not in peritoneal fluid compared with Controls. At 8 weeks of age, interleukin (IL)-2, IL-13, and eotaxin concentrations were higher in male IUGR compared with male Control offspring but not in females. IUGR had no effect on TJs protein expression. Maternal hypoxia-induced IUGR increases inflammatory cells in the BAL fluid of IUGR offspring with no difference in TJs protein expression. Increased cytokine release, specific to the lungs of IUGR male offspring, indicates that both IUGR and sex can influence susceptibility to airway disease.
The transfer of gentamicin resistance between a coagulase-negative S. hominis strain and various coagulase-positive S. aureus strains on human and murine skin in the absence of a selective agent is described. Transfer occurs at higher frequency on skin than in broth. Skin transfer may account for the apparently explosive occurrence of gentamicin resistant staphylococci in hospitals.
Mycobacterium marinum, formerly known as ‘Mycobacterium balnei’, is a free-living organism which causes disease in fish and occasionally in man. When such infections occur in man they are usually associated with some aquatic activity, e.g. swimming, fishing, boating and keeping tropical fish. For this reason, the organism has been called a ‘leisure-time pathogen’ by Feldman, Long & David (1974) and the disease a ‘hobby hazard’ by Heineman, Spitzer & Pianphongsant (1972).
An isolation policy in a hospital for skin diseases is reported. Patients carrying penicillin- and tetracycline-resistant organisms were to be isolated in single rooms, though barrier nursing was not practised. The policy failed because the single beds rapidly became blocked with long-stay patients and because even in a single-bed unit patients acquired staphylococci within 3–7 days of admission. Patients with skin diseases often do not feel ‘ill’ and resent isolation.
Investigation of 39 JK-type coryneform isolates from patients at a single hospital revealed that 23 possessed plasmids, which formed six groups on restriction endonuclease analysis. Four of the groups were associated with production of similar bacteriocin-like substances, and shared a minimum of 6·4 kilobase pairs of DNA. These plasmids, found in isolates from different patients, provide strong direct evidence that person-to-person transmission of JK bacteria had occurred within the hospital.
Plasmid profiles have been established for 68 isolates of Staphylococcus aureus from 13 episodes of epidemic spread in hospital wards between 1958 and 1962. Despite the original lack of care in preservation of strains the profiles give, in general, the same epidemiological patterns as were established originally on the basis of phage type, antibiotic sensitivity, ward and date of isolation.
The genetics of gentamicin resistance in Staphylococcus aureus strains isolated during an outbreak of infection in a dermatology department have been studied. The predominant strain of S. aureus did not appear to possess a plasmid mediating gentamicin resistance though one isolate yielded a plasmid coding for penicillin and gentamicin. Three distinct plasmids were isolated from other phage types of S. aureus which appeared towards the end of the epidemic. There appeared to be a stepwise loss of gentamicin resistance in the predominant strain.
Nose, throat and finger carriage of Staphylococcus aureus was investigated in a series of random samples from a normal European population.
No evidence for a seasonal trend in carriage was found but the intersample variation between successive random samples was obtained. The mean nasal carrier rate was 29 % with a standard deviation of 7 %.
No association was found between nasal or throat carriage of staphylococci and stay in hospital or antibiotic therapy but respondents with penicillin-resistant staphylococci in the nose had skin infections more frequently than those with penicillin-sensitive strains.
Evidence was obtained for a family, perhaps genetic, ‘predisposition’ to carry staphylococci in the nose.
Studies on infections in a hospital for diseases of the skin are described. Patients were shown to acquire staphylococci in the groin and on the chest at about the same rate as in the nose. In contrast to surgical wards, many staphylococci were resistant to tetracycline but sensitive to penicillin. Nevertheless, much of the epidemic spread of staphylococci was with typical surgical-ward strains rather than with phage group II strains which might be thought typical of skin diseases.
William Norman Pickles (1885–1969) was, for most of his life, a general practitioner in the village of Aysgarth, Wensleydale in the North of England, a relatively remote area in the early part of this century with many of the doctors' visits made on horseback or on an ancient motorcycle. The story of Pickles' life, how he became, among other honours, the first President of the Royal College of General Practitioners, is told in Pemberton's book Will Pickles of Wensleydale. It may seem curious that Pickles, a country GP, should rank with other great men in epidemiology: Jenner who worked on smallpox, Budd on typhoid fever, Snow on cholera, yet it was the remoteness of his practice combined with his own acute observation and accurate recording that enabled him to contribute so significantly to epidemiology.
The form of the killing curve obtained by bombaring micro-organisms with high energy electrons enables an estimate to be made of the numbers of individual viable organisms present in the aggregates or clumps comprising the sample. Samples of Staph. aureus collected from the air of two hospital wards have been found to consist of aggregates containing, on the average, only about four viable cocci per air-borne particle. These samples were taken during quiet periods and during periods of active dispersion of the organism but there was no active spread of staphylococcal disease at any time.
The work on the linear accelerator was carried out with the aid of grants provided by the Treasurer and the Board of Governors from the Discretionary Fund of St Bartholomew's Hospital, to whom we wish to express our gratitude.
Endemic infection in male surgical wards has been studied during three periods. There was some infection due to gram-negative bacilli, though Staphylococcus aureus remained as the single most important pathogen even in the absence of epidemic spread. Beta haemolytic streptococci were isolated in large numbers from the lesions of four patients with deep wound infection. Changes introduced in the pattern of post-operative care reduced sepsis due to Staph. aureus, reduced the severity of wound infection and apparently decreased the need for antibiotic therapy. Patients who became infected were retained in hospital longer than those who escaped clinically apparent infection.
The epidemiology of bacterial infection is investigated by the use of identification procedures at a sub-species level by such techniques as serotyping, phage typing, various antigen recognition tests, plasmid profiling and DNA probes. Fungal epidemiology has tended to lag behind in the use of this technology, particularly with the filamentous fungi, though several techniques have been developed for yeasts and especially for Candida albicans. This review will briefly describe the application of these methods to outbreaks of C. albicans infection, describe the limited methods available for the investigation of filamentous fungal infection and indicate the necessity for increased research in this area.
Topical medicaments used by patients with diseases of the skin were examined for microbial contamination. Ps. aeruginosa was isolated from stock pots of a diluted emulsifying ointment used as a soap substitute in the bath. Cross-con tamination between patients and medicament was subsequently shown to have occurred.
Non-specific and specific mechanisms of adherence have been examined in two collections of methicillin–resistant Staphylococcus aureus (MRSA). Determination of hydrophobicity by salt aggregation, hydrophobicity indices and of adherence to the extra–cellular matrix proteins fibronectin, vitronectin, laminin and collagen type 1 have failed to reveal any correlation with phage-type, plasmid profile or antibiogram. Further, the strain collections, made over a period of years in two countries, differ markedly in their adherence characteristics; MRSA are heterogeneous in this respect. Such heterogeneity may explain the polarization of views on the epidemicity or ‘virulence’ of MRSA. With the exception of adherence to collagen a small group of methicillin sensitive S. aureus had characteristics intermediate between the two groups of MRSA.