Ampicillin-insensitive Haemophilus influenzae type B causing acute epiglottitis.
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Biomedical subjects
Publications and source records attributed to D Hansman.
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Two cases of pneumococcal peritonitis, which occurred after puberty in previously healthy adolescent girls, are described. In each case, the infection was caused by a Type 1 tetracycline-resistant pneumococcus.
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We report what we believe to be the first case of coccidioidomycosis to be diagnosed within Australia, and emphasize the dangers of handling Coccidioides immitis in the laboratory.
Three cases of infection, including two fatal ones, caused by pneumococci relatively resistant to penicillin are reported. The patients were a 19-year-old New Guinean with fatal multisegmental pneumonia, a 10-week-old Caucasian infant who died suddenly from purulent meningitis, and an Australian Aboriginal child aged two years with bronchiectasis complicated by pneumococcal bacteraemia. The pneumococci isolated (serotypes 6, 16 and 19) showed minimal inhibitory concentrations of penicillin G ranging from 0-1 microgram/ml to 1-0 microgram/ml (resistance ratios five to 50) and were also relatively resistant to penicillin V, methicillin, cloxacillin and cephalosporins.
A five-year-old boy developed primary tuberculosis of the conjunctiva which spread to the preauricular and cervical lymph nodes, producing caseous lymphadenitis. Because conjunctival tuberculosis is rare, the correct diagnosis may be easily missed. When unilateral conjunctivitis is accompanied by lymph node enlargement and persists or progresses, tuberculosis should be suspected.
During a five-year period, 1965 to 1969 inclusive, pneumococci from 294 patients with acute pneumococcal infections were serotyped. Pneumococci of 33 serotypes were encountered, of which types 3 and 19 were most frequent. The spectrum of infections included pneumonia, meningitis, peritonitis, otitis media and mastoiditis, wound infection and conjuctivitis. At least 17 infections were fatal, all of which, with one exception, occurred either in infants or in adults over 50 years of age. In pneumonia, type 3 pneumococcus was predominant, being isolated from 21 of 101 patients. In 67 cases of pneumococcal meningitis, most of which were in children, the commonest type was 14. If a pneumococcal vaccine is produced for use in Australia, inclusion of serotypes 1, 3, 4, 6, 9, 14, 19 and 23 should be considered. These eight types caused 52% of the cases of pneumonia and 67% of the cases of meningitis in this study.
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During a three-year-period, 1971-73 inclusive, haemophili isolated from 96 children with severe infections, of whom 73 had meningitis and 19 acute epiglottitis, were serotyped and tested for sensitivity to antibacterial drugs. All strains were identified as Haemophilus influezae type b, and were sensitive to ampicillin, chloramphenicol, and trimethoprim. However, 3 isolates--from a boy aged 11 months and a girl aged 1 year with meningitis, and a girl aged 2 years with epiglottitis--were highly resistant to tetracycline, with a median minimal inhibitory concentration of 50 mug tetracycline hydrochloride per ml (resistance ratio greater than or equal to 50). Resistance was also demonstrated to doxycycline, oxytetracycline, and rolitetracycline and, in one strain, to minocycline. No evidence was obtained that the resistant organisms were capable of inactivating tetracyclines.
Penicillin-insensitive pneumococci, of 10 serotypes, which had been isolated in Australia and New Guinea from healthy carriers and patients with pneumococcal infections, were shown to be relatively resistant to penicillin G, penicillin V, methicillin, cloxacillin, cephaloridine and cephalothin, compared with pneumococci fully sensitive to penicillin G. Most penicillin-insensitive pneumococci either were fully sensitive to ampicillin or showed a slight decrease in sensitivity. The size of inoculum, measured in viable units, had little effect on the minimal inhibitory concentration of penicillin G; this applied to both penicillin-insensitive and penicillin-sensitive pneumococci. In bacterial tests, the minimal bactericidal concentration of penicillin G either equalled or exceeded the minimal inhibitory concentration.
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