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Ann N Y Acad Sci, 1975 Jun 30, 254, 334 - 49 Diagnosis of Neisseria infections by defined immunofluorescence . Methodologic aspects and applications; Danielsson D et al.; Defined IF techniques have been used in our laboratories for the past 15 years for diagnosing meningococcal and gonococcal infections . Conjugates against these bacteria give desired specific staining (DSS) but also undersired specific staining (USS) due to cross-reacting antigens . USS is controlled by absorption . Nonspecific staining (NSS) of protein A-containing S . aureus caused by the reaction with the Fc part of the IgG molecule is blocked by adding RB 200-labeled antiS . aureus globulins to diluted FITC conjugates against gonococci or menigococci . Nss is also avoided by using FITC-labeled F(ab')2 fragments of IgG . By optimal labeling and separation of unlabeled FITC and heavily labeled molecules on Sephadex G-25 at low ionic strength and low pH, nonspecific reactions with tissues are reduced to a minimum . Defined IF can be utilized for diagnosing pathogenic Neisseria by examination of smears prepared from clinical specimens, as confirmative tests of oxidase-positive colonies, and for demonstrating these bacteria in tissue efflorescences and tissue biopsies . It is stressed that this technique should always be used in conjunction with conventional methods. Am J Med, 1975 Jun, 58(6), 823 - 8 Meningococcal antigen in diagnosis and treatment of group A meningococcal infections; Whittle HC et al.; Meningococcal antigen was measured by countercurrent immunoelectrophoresis in the blood and cerebrospinal fluid of 200 patients with group A meningococcal meningitis . Antigen was detected in the blood of 27 (13.5 per cent) patients . These patients had a worse prognosis and a higher incidence of allergic complications, such as arthritis and vasculitis, about 5 days after the start of antibiotic treatment . Antigen was found in the CSF of 129 (67.5 per cent) patients); antigen often persisted in the cerebrospinal fluid despite antibiotic treatment before admission . A combination of immunoelectrophoresis and routine bacteriologic study was used in the diagnosis of 162 (84.8 per cent) patients with meningococcal meningitis . High levels of antigen and a slow antigen disappearance were associated with neurologic damage . The antigen is stable and may be detected from specimens of cerebrospinal fluid dried on filter paper. Zh Mikrobiol Epidemiol Immunobiol, 1975 Jun, (6), 85 - 9 {Toxicity and virulence of different strains of meningococcus}; Kasatskaia LK; With the aid of a modified Dubos and Schaedleder's method a determination was made on albino mice of the toxicity of 49 strains of meningococcus . The greatest toxicity was possessed by strains isolated from the cerebrospinal fluid of patients with cerebrospinal meningitis; standard strains were less toxic and strains isolated from healthy carriers were nontoxic . The living and the heated cultures of meningococci produced the same toxic action which was apparently associated with the thermostable antigens of the cell . The virulence studied in 24 strains of meningococcus on a model of 9-day chick embryos failed to correlate with the toxic properties of the strains. J Immunol, 1975 Jun, 114(6), 1779 - 84 Bactericidal activity of meningococcal antisera . Blocking by IgA of lytic antibody in human convalescent sera; Griffiss JM; Humoral IgA, separated and purified from human sera drawn 12, 27, and 33 days after infection with serogroups B, Y, and C meningococci, respectively, has been shown to inhibit complement-mediated bacteriolysis by IgG and IgM purified from the same sera . Inhibition was dependent on the ratio of lytic to blocking antibody, was strain specific, and was greater for IgG than IgM . IgM was found to be more active than IgG in a bactericidal test . Activity of IgA appeared unrelated to the presence of a prozone in the whole serum . Similar inhibition was noted for IgA separated from rabbit sera. Zh Mikrobiol Epidemiol Immunobiol, 1975 Jun, (6), 15 - 8 {Results of a controlled epidemiological trial of the application of placental gamma globulin in foci of meningococcal infection}; Favorova LA et al.; Controlled epidemiological trial was applied to the study of the use of placental gamma-globulin for prophylaxis of generalized forms of meningococcus infection in the foci (creches and kindergartens) . A group of the vaccinated children (16 140) and control group (16 080) were the same age and sex . Gamma-globulin was administered in a dose of 3 ml to every other child attending creches and kindergartens not later than the 10th day after the patient's isolation . It was shown that the efficacy coefficient of gamma-globulin in the foci of meningococcus infection constituted 68% (the efficacy index was 3.2) for one month after the administration. South Med J, 1975 May, 68(5), 636 - 8 Meningococcal arthritis simulating gonococcemia; Young EJ et al.; A 19-year-old man was admitted to the hospital with acute onset of fever, sore thoart, and leg pain . He gave a history of recent sexual activity and was found to have an exudative pharyngitis, two pustular skin lesions, and a hot, swollen left knee . Laboratory studies were consistent with an acute septic arthritis and the diagnosis of the gonococcal arthritis-dermatitis syndrome was entertained . He responded to high doses of penicillin, and Neisseria meningitidis, group B, subsequently was cultured from the blood and pharynx . The same organism was isolated from the throats of three of 11 asymptomatic contacts. Chest, 1975 May, 67(5), 611 - 2 Primary meningococcal pericarditis presenting with tamponade; Chow AW et al.; An unusual case of a patient with primary meningococcal pericarditis presenting with tamponade is reported . tdespite repeated aspiration and appropriate antibiotic therapy with eradication of group C Neisseria meningitidis, pericardial effusion continued to reaccumulate . Institution of high-dosage corticosteroid therapy resulted in rapid resolution of the effusion . Only six other cases of primary meningococcal pericarditis have been reported in the English literature . Early manifestations of this disease are due to bacterial invasion of the pericardium . The later phase of intensive reaccumulation of sterile pericardial fluid may conceivably be related to meningococcal endotoxin and appears to be responsive to corticosteroid or salicylate therapy . Recognition of this phenomenon may obviate the necessity for a pericardiectomy. J Immunol, 1975 May, 114(5), 1497 - 505 Fractionation and characterization of surface antigens from group A Neisseria meningitidis; Cheng WC et al.; Group A meningococcal surface components were first subjected to fractionation with a mixture of chloroform-methanol . Sodium dodecyl sulfate-acrylamide gel electrophoresis of the aqueous phase containing 30 to 40% of the original material revealed only two polypeptide components and a slowly migrating carbohydrate component . The soluble fraction of the interphase was found to contain most of the bacterial surface proteins and the chloroform-methanol phase essentially all of the lipid components . The components of the aqueous phase were further fractionated by use of the hydrophobic affinity column, 4-phenylbutylamino-Sepharose and gradient elution with NaCl to yield fractions I and II . Fraction II was further separated into a minor and a major component (IIb) with Sepharose G-200 . Fraction I contained the group A polysaccharide in ionic linkages with a minor polypeptide component (6%) . It elicited bactericidal antibodies in rabbits and protected mice against homologous challenge, whereas the polysaccharide alone was non-immunogenic in these animals . Fraction IIb was a polysaccharide-polypeptide complex with unknown linkages; it induced a low concentration of rabbit antibodies that were bactericidal to group A and C meningococci . Mice vaccinated with fraction IIb were most resistant to homologous challenge and the resistance was also extended to challenges with group B and C cells . Fractions I and IIb appeared to be useful alternatives to the currently employed group-specific polysaccharide vaccines for the protection against drug-resistant meningococci . A simplified procedure for the preparation of group-specific polysaccharide was presented. Ann Intern Med, 1975 May, 82(5), 689 - 93 Cephalothin and cephaloridine therapy for bacterial meningitis; Fisher LS et al.; The efficacy of cephalothin and cephaloridine in the treatment of bacterial meningitis was evaluated from a review of 106 cases reported in the literature . Fifty-nine percent of 34 patients treated with intravenous cephalothin responded suboptimally; those receiving daily doses of 12 g or more fared significantly better (P less than 0.025) . In contrast, 74% of 72 patients treated with cephaloridine responded favorably; those who received concomitant intrathecal cephaloridine responded significantly better (P less than 0.005) . These findings indicate that cephalosporin therapy for bacterial meningitis, without concomitant intrathecal medication, is unreliable and that this is probably due to inadequate penetration of the antibiotics into cerebrospinal fluid . In penicillin-allergic patients with pneumococcal, meningococcal, and hemophilus meningitis, chloramphenicol is the agent of choice . For staphylococcal meningitis, intravenous cephalothin at doses of 12 g/day with additional intrathecal cephaloridine at doses of 12.5 to 50 mg/day should be administered concomitantly. J Clin Pathol, 1975 Apr, 28(4), 274 - 8 Reevaluation of bacteriocinogeny in Neisseria gonorrhoeae; Knapp JS et al.; Bacteriocin typing has been described previously and proposed for typing gonococci . A survey has been made of 150 strains of N . gonorrhoeae from various places to determine the feasibility of a gonocin typing system . All strains were found to produce an inhibitory substance which inhibited all strains of gonococci tested, one strain of Neisseria flavescens, two strains of Neisseria meningitidis, as well as the producing strain itself . The inhibitory activity was enhanced by supplementary glucose, reduced by supplementary serum, and unaffected by the addition of HEPES buffer, by the temperature of incubation, or by the exposure of potential producer strains to sublethal concentrations of mitomycin C . This nonspecific inhibitory activity differed from that of a putative bacteriocin produced by a strain of N . meningitidis, in that the latter inhibited most other meningococci but not the producer strain itself . Bacteriocinogeny has not yet been convincingly demonstrated in N . gonorrhoeae, and gonocin typing has not yet been shown to be feasible . Production of the nonspecific inhibitor may have obscured past attempts to demonstrate type-specific gonococcal bacteriocin. Ann Intern Med, 1975 Apr, 82(4), 493 - 8 Primary meningococcal pneumonia; Irwin RS et al.; Three cases of pneumonia caused by Neisseria meningitidis group Y are reported . From the results of these cases, the following conclusions were made . N . meningitidis probably can cause serious infection without preceding blood stream invasion . Primary meningococcal pneumonia is not rare; it has no distinctive clinical presentation; and it may not be recognized by routine expectorated sputum cultures . In addition, it may be associated with recent influenzal and adenoviral infections . Lastly, meningococci of the serogroup Y are capable of causing serious disease . Antimicrobial susceptibility studies showed that all three group Y isolates were sensitive to sulfadiazine and rifampin as well as to penicillin, ampicillin, erythromycin, and chloramphenicol. J Biol Chem, 1975 Mar 10, 250(5), 1926 - 32 Structural determination of the sialic acid polysaccharide antigens of Neisseria meningitidis serogroups B and C with carbon 13 nuclear magnetic resonance; Bhattacharjee AK et al.; The application of 13-C nuclear magnetic resonance to the analysis of some sialic acid-containing meningococcal polysaccharide antigens is described . Complete assignments of the spectra of both the native serogroup B and the de-O-acetylated serogroup C polysaccharides have been made . These assignments were based on the corresponding data for some related monomers (sialic acid and its alpha-and beta-methylglycosides) and on supportive chemical evidence . The data indicate that the serogroup B polysaccharide is a 2 yields 8-alpha-linked homopolymer of sialic acid, identical in structure with colominic acid from Escherichia coli, whereas the de-O-acetylated serogroup C polysaccharide is a 2 yield 9-alpha-linked homopolymer . The native serogroup C polysaccharide is O-acetylated (1.16 mol of O-acetyl per sialic acid residue), all the O-acetyl substituents being located only at C-7 and C-8 of the sialic acid residues, and in addition contains unacetylated residues (24%) . The polysaccharide contains di-O-acetylated residues (O-acetyl on C-7 and C-8), and at least one of the possible monoacetylated residues at C-7 or C-8. Am J Med Sci, 1975 Mar-Apr, 269(2), 247 - 50 Meningococcal pneumonia; Galpin JE et al.; A patient with meningococcal pneumonia which developed following therapy for an earlier episode of pneumococcal pneumonia is presented . This entity is most frequently associated with an antecedent viral respiratory illness and/or a concurrent infection with Hemophilus influenzae or diplococcus pneumoniae . The characteristics of this disease are discussed and the possible pathogenetic mechanisms reviewed. Am J Med Sci, 1975 Mar-Apr, 269(2), 243 - 6 A case of chronic meningococcemia with unusual features; Angoff GH et al.; A patient with chronic meningococcemia with the unusual features of subungual splinter hemorrhages, a pericardial friction rub, and a culture positive skin lesion is presented . Group specific and homologous antibody responses were absent and the nitroblue tetrazolium test for infection was negative . The clinical features and the difficulty in explaining the mechanism of the relatively benign course that characterizes this disease are discussed. Pediatrics, 1975 Mar, 55(3), 348 - 53 Measles immunization status in 1972 among first- and second-grade school children in Danbury, Connecticut; Lepow ML et al.; An increased incidence of rubeola among first-grade Danbury school children in 1973 led to a study of seroimmunity to rubeola in a random sample of 60% of the first- and second-grade school children (299) from whom blood samples had been obtained in October 1972 during a voluntary meningococcal vaccination program . Immunization histories derived from physicians' statements on school entry were obtained from school health department records and included date of immunization . Seventy-five percent of the study group had received measles vaccine . Of those immunized prior to 11 months of age only half had an hemagglutinating inhibiting titer (HAI) of greater than or equal to 5 five to seven years later . This antibody level correlates with immunity . Eighty-five to ninety percent of those immunized during or after the 11th month had an antibody titer of greater than or equal to 5 . Seventy-one percent of those never immunized also had an HAI titer of greater than or equal to 5 indicating natural infection had occurred . As a result of this investigation, a community-wide program was initiated to vaccinate those who were more than 1 year old as well as reimmunize those who had been vaccinated before the 11th month in accord with current U.S . Public Health Service recommendations for measles immunization.
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