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Biomedical subjects

A E Jephcott

Publications and source records attributed to A E Jephcott.

At least 37 records · Page 2Linked to original sources

Health risks of snorkel swimming in untreated water.

There are certain health risks associated with recreational exposure to bacteriologically polluted water. In this study, 27% (21/77) of swimmers who took part in a snorkel swimming event, experienced gastrointestinal symptoms within 48 hours of entering the untreated water. The incidence of these symptoms was statistically significantly greater than the incidence of such symptoms reported by two control populations (p less than 0.001), but not significantly different to 25% of people who had experienced gastrointestinal symptoms in a previous snorkel event in the same water environment. As the water quality came within the confidence intervals of the EEC standards for bathing water the adequacy of these standards needs further appraisal.

Adolescent↗

In vitro activity of temocillin against Neisseria gonorrhoeae including penicillinase-producing strains.

169 penicillinase-producing strains of Neisseria gonorrhoeae (PPNG) isolated in the United Kingdom were examined for susceptibility to temocillin and spectinomycin. A further 25 PPNG strains and 214 non-penicillinase-producing strains were examined against temocillin, spectinomycin, amoxycillin, cefuroxime and penicillin. Minimum inhibitory temocillin concentrations ranged from 0.36 to 5.0 mg/L with a mode at 1.25 mg/L. The distributions of sensitivities to other agents were in keeping with those previously described.

Amoxicillin↗

Cryptosporidiosis in an urban community.

Over three months Cryptosporidium oocysts were identified in faecal samples from 43 (5%) of 867 patients presenting to their general practitioners with gastrointestinal symptoms. Cryptosporidium was the second most common enteric pathogen identified. Of the 867 patients, 329 were children aged under 5, of whom 24 (7%) excreted Cryptosporidium. A characteristic clinical presentation of infection with Cryptosporidium was recognised--namely, mild gastroenteritis with four to six watery, mucoid, and offensive motions a day, which lasted for one to two weeks. The source of infection was not identified, but direct contact with farm animals was not a feature and no association with a common water supply could be established.

Adolescent↗

Epidemiology of penicillinase-producing Neisseria gonorrhoeae in Liverpool from 1977 to 1982.

After the 1976 outbreak of penicillinase-producing Neisseria gonorrhoeae (PPNG) infections had been controlled, less than 1 per cent of cases of gonorrhoea in Liverpool in 1977 and 1978 were caused by PPNG. Thereafter the steady increase in PPNG infections to 5.6 per cent of all cases in 1982 was associated with marked changes in epidemiological pattern, plasmids and auxotypes. In 1976 nearly all PPNG infections were acquired by young black males living in the inner city from women frequenting clubs; the PPNG were all of the African 3.2 megadalton (MD) plasmid type and of arginine-requiring auxotype. Between 1977 and 1982 female patients were increasingly ship girl prostitutes associating with seamen who constituted more than 50 per cent of the male patients. These men and other travellers introduced PPNG into Liverpool from the Far East and West Africa. In 1978 PPNG of the Asian type with 4.4 MD plasmid with or without 24.5 MD transfer plasmids were isolated in Liverpool where in 1979 all PPNG carried 4.4 MD and 24.5 MD plasmids. In 1982 strains of the 'new' African type with 3.2 and 24.5 MD plasmids were isolated as were PPNG of the Asian type that had been acquired in West Africa. Auxotyping of the 1982 isolates showed that none were arginine-requiring but three other types were identified: proline-requiring: proline-arginine-requiring; non-requiring. For the control of PPNG, a strategy based on constant vigilance, appropriate diagnostic procedures, rapidly effective treatment and determined contact tracing is needed.

Adolescent↗

Immunisation of adults during an outbreak of diphtheria.

In an outbreak of infection due to Corynebacterium diphtheriae in a hospital for mentally subnormal adults sera from 211 members of staff were screened for diphtheria antitoxin titres. Of these, 79 (37%) required immunisation, and a low dose preparation (1 LfU of diphtheria and 10 LfU tetanus toxoids) was offered. Of the 64 subjects who accepted a single immunisation and were subsequently retested, seroconversion to diphtheria toxoid occurred in 45 (70%), the rate being highest in younger adults. Seroconversion to tetanus toxoid occurred in 59% of subjects. Local reactions to the single dose were reported by 29 (43%) subjects, and nine (13%) experienced moderately severe local reactions and systemic symptoms. We conclude that adults should not be vaccinated without previous screening for susceptibility to diphtheria; that neither previous immunisation nor age is reliable in predicting the need for vaccination; and that though a single booster dose of diphtheria toxoid is probably effective in adults under 45, two doses should be given to those in the older age group.

Adult↗

Person-to-person spread of Salmonella typhimurium phage type 10 after a common-source outbreak.

An outbreak of gastroenteritis caused by Salmonella typhimurium phage type 10 in a university hall of residence affected 66 students and one member of staff. Results of a questionnaire survey of students suggested that the main wave of (53) cases was due to consumption of contaminated cottage pie, but the remaining cases could best be explained by person-to-person spread of infection. Investigation of the outbreak was greatly assisted by rigorous case finding, the screening of those at risk for symptomless excretors, and the collection of food histories from those who remained well. The possibility of person-to-person spread of salmonella food-poisoning serotypes should be borne in mind when outbreaks are investigated in closed communities such as institutions, families, and ships.

Adolescent↗

Improved management in the diagnosis of gonorrhoea in women.

In this paper an evaluation is made of the endeavours to improve diagnosis in women named as contacts of gonorrhoea. The problem was approached in three ways. (a) The number of sites sampled was increased. (b) The results of microscopical examination of smears made by clinical staff were regularly evaluated. (c) Cultural examinations by the supporting laboratory were dealt with more efficiently and speedily. It is concluded that the number of tests currently used to establish or exclude a diagnosis of gonorrhoea in women can safely be reduced to two, and that the methods currently in use allow a more cost-effective management of an increasing case load.

Cells, Cultured↗

An unusual outbreak of food-poisoning associated with meals-on-wheels.

An outbreak of food-poisoning after a meals-on-wheels lunch affected 49 persons, 1 of whom died. Bacillus cereus serotype 10 and Bacillus licheniformis were isolated in large numbers from many of the patients including the deceased and from the remains of the meal. Clostridium perfringens (C. welchii) serotype 68, which was isolated from many of the patients and the deceased but not from the food, may also have been responsible. Food kept warm during distribution can produce an ideal environment for bacterial multiplication and similar outbreaks may occur again.

Aged↗

Reversion of Kellogg's colonial types of Neisseria gonorrhoeae in liquid medium.

Colonial type variation of gonococci is well known, but change from type 4 to type 4 to type 1 is rare except in vivo. By observing quantitatively subcultures from a new liquid medium it was possible to follow the day-to-day changes in the ratio of colonial types present. The results obtained showed that type 1 colonies could be derived from type 5 inocula even in unsupplemented media. In unsupplemented liquid medium, type 4 inocula did not revert to other types and indeed colonial type 4 appeared to be the final form of the organism before it died out. If, however, iron in the form of ferric citrate was added to the medium, reversion occurred and type 1 colonies rapidly came to predominate.

Culture Media↗

Perioperative antibiotic prophylaxis and prosthetic valve endocarditis.

A study of twenty-five cases of prosthetic valve endocarditis suggests that the antibiotics used for perioperative prophylaxis may alter the type and antibiotic sensitivity of organisms which subsequently infect the artificial valves. Based on the results of this study, the authors have been able to modify their prophylactic regime to encompass these organisms and to predict the antibiotics most likely to be effective in the treatment of prosthetic valve endocarditis in their unit. No single prophylactic or therapeutic regime will be equally effective in all centres, but by examining the different types and sensitivities of bacteria which cause prosthetic valve endocarditis in a locality, antibiotic regimes can be chosen which best suit the local situation.

Adult↗

Antibiotic-loaded acrylic cement.

Laboratory experiments and clinical investigations have confirmed the various claims made originally by Buchholz and Engelbrecht (1970) that antibiotic-loaded acrylic cement releases the antibiotic into the surroundings in useful concentrations. Palacos R cement released higher concentrations than CMW, Simplex and Sulfix brands of cement and over longer periods. Concentrations of gentamycin and fucidin were sufficient to penetrate dead cortical bone. These conclusions need to be assessed with animal studies, mechanical testing and clinical results before the ideal place of antibiotic-loaded acrylic cement is established.

Acrylic Resins↗

Bacterial infection and acrylic cement in the rat.

In thirty-one rat tibiae, plugs of plain acrylic cement were inoculated with Staphylococcus aureus; these all remained contaminated at the end of two weeks when the animals were killed. Inoculation with known strains of Pseudomonas, Proteus and Gp. G Streptococcus resulted in 70 to 93 per cent persisting contamination. Gentamicin, to which the organisms were fully sensitive, was efficacious in controlling the infection (90 per cent plugs proving sterile after two weeks). Fucidin was less successful against Staphylococcus aureus although effective in vitro. Intravenous inoculation with a suspension of Staphylococcus aureus succeeded in contaminanting 70 per cent of sixty plain cement plugs when injected into the tail vein half an hour after closure of the leg wounds. Only 11 per cent of sixty-four plugs were so contaminanted when the injection was delayed for two weeks. This animal model is submitted as a possible future means of testing different antibiotic-cement combinations against infection.

Animals↗

Improved transport and culture system for the rapid diagnosis of gonorrhoea.

The Jembec/Neigon transport-and-culture system for the rapid diagnosis of gonorrhoea has been assessed by 167 sets of investigations in 128 named female contacts of infected men. The system offers the same advantages of efficiency and speed as the Transgrow transport-and-culture system, but it is also more flexible and much less time-consuming.

Bacteriological Techniques↗

Penicillin sensitivity of gonococci. An evaluation of monitoring as an index of epidemiological control.

The penicillin sensitivities of 1,167 gonococci isolated during a 30-month period from male patients, and 794 gonococci isolated from female patients were analysed retrospectively. More strains from males were relatively resistant than those from females, and a higher proportion of relatively resistant organisms was isolated from each sex when the infection had been acquired outside the area served by the clinic. During the course of the study a fall in the number of relatively resistant strains was seen amongst the locally acquired organisms, whilst no such drop occurred in the strains acquired elswhere; it is postulated that improved contact tracing may have been responsible. Regular monitoring of the penicillin sensitivity of gonococci has been shown to be a sensitive index of gonorrhoea control.

Evaluation Studies as Topic↗