[Pathology and bacteriology of so-called focal infection].
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Provided here are the descriptions of 18 patients with focal infections caused by Salmonella spp no-typhi occurring in a period of seven years at the Puerta de Hierro Clinic. In all cases, there was at least one local factor, treatment, or underlying illness associated with decreased resistance to infection. Antecedents of severe gastroenteritis were found in seven cases (38 percent). Eighty-three percent had previous or concomitant bacteremia caused by the same serotype of Salmonella isolated in the focal infection. S. enteritidis was the most prevalent serotype (66 percent). The most common localizations were plueropulmonary (5), osteoarticular (5), and intravascular (3). Relapsing infection was demonstrated in five cases. There was 28 percent mortality. Statistically, age greater than 65 years and the absence of surgical intervention were associated with a worse prognosis.
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The diagnosis of a focal infection in 13 patients (6 men and 7 women, aged 18 to 36) was based on the findings of chronic tonsillitis and general complaints interpreted as focal symptoms. The patients underwent symptom-limited maximal stress-testing before and after tonsillectomy to rule out any impairment of physical performance on the basis of computer-assisted processing of ergospirometric data. It can be concluded that the actual data of maximal oxygen uptake (aerobic power), the phenomenon of adaptation to increasing work loads (derived from rating of the increase in oxygen uptake during rectangular-triangular bicycle ergometry), the on-line processed index of anaerobic power and the anaerobic threshold, as well as heart rate and arterial blood pressure regulation did not differ in these patients from findings in healthy subjects. Nor were these parameters altered by tonsillectomy. Tonsillar focal infection is unlikely to cause any impairment of physical performance with respect to parameters of cardio-respiratory and metabolic function.
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This paper reviews the theory of focal infection that was widely held to explain the aetiology of inflammatory joint disease in the first three decades of this century. The theoretical basis for these beliefs and the practical consequences for physician and patient alike are examined, as are the results of such radical treatments as were applied.