Cent Of Infections Research Articles

The Pathogenicity Test, Cultural and Morphological Characterization of Anthracnose (Colletotrichum lindemuthianum) of Green Gram (Vigna radiata L. Wilczek)

Aims: The objective of this study was to identify the appropriate anthracnose fungus of green gram using symptomatology, identification, pathogenicity test and characterization of samples.
 Study Design: Pathogenicity test, cultural and morphological characterization.
 Place and Duration of Study: The laboratory studies were conducted in the Department of Plant Pathology, N. M. College of Agriculture, Navsari Agricultural University, Navsari, Gujarat during rabi 2020-21.
 Methodology: The sample was collected and subjected to isolation, purification and identification of pathogen. Four different pathogenecity tests were conducted to verify the pathogen causing anthracnose of green gram. On the other hand, the cultural and morphological characteristics of pathogen were studied. 
 Results: The pathogenecity test confirmed that the pathogen as Colletotrichum lindemuthianum in all four tests. Spraying inoculum after needle pricking and carborandum powder producing 100% infection in inoculated plants while 96% in spraying spore suspension without any abrasion. The less per cent of infection was observed in seed inoculated plants. The cultural studies of C. lindemuthianium shown sub-aerial whitish-to-pink cottony growth and pinkish-to-brown pigmentation under the culture plate. The morphological study of C. lindemuthianium observed as single-celled, hyaline, cylindrical, and smooth with oil globules. The acervuli were blackish brown and measure 181.3 × 254.6 µm. The setae were visible through the conidial mass with 1-3 septations.
 Conclusion: A study on green gram anthracnose confirmed C. lindemuthianum as pathogen in all four pathogenicity test with needle pricking and carborandum powder producing 100% infection in inoculated plants while 96% in spraying spore suspension without any abrasion. Cultural studies revealed whitish-pink cottony growth and pinkish-brown pigmentation. C. lindemuthianium was morphologically observed as single-celled, hyaline, cylindrical, smooth, with oil globules, blackish brown acervuli, and visible setae through conidial mass with 1-3 septations. Therefore, these findings are important for identifying the anthracnose disease of green gram.

Clinical and microbiological features of bacteraemia with Gram-positive anaerobic cocci: a population-based retrospective study

ObjectivesGram-positive, anaerobic cocci (GPAC) can cause infections in humans. Only a few cases of bacteraemia with GPAC have been reported. We describe the clinical and microbiological characteristics of GPAC bacteraemia. MethodsA retrospective population-based study of GPAC bacteraemia 2012–2016 in southern Sweden was performed. GPAC were identified using matrix-associated laser desorption ionization time-of-flight mass spectrometry or 16S rRNA gene sequencing. Etests were used to determine antibiotic susceptibilities. Data on patient and infection characteristics, treatment, and outcome were collected from the medical records. ResultsA total of 226 episodes of GPAC bacteraemia in adults were studied; this corresponds to an annual incidence of 3.4 cases per 100,000 persons per year. The bacteria identified were Anaerococcus spp. (n = 43), Atopobium spp. (n = 7), Blautia spp. (n = 1), Finegoldia spp. (n = 15), Parvimonas spp. (n = 100), Peptoniphilus spp. (n = 52), Peptostreptococcus spp. (n = 2), and Ruminococcus spp. (n = 9) of which 200 isolates were identified to the species level. Resistance to imipenem and piperacillin was not identified, whereas resistance among the 229 isolates to penicillin was detected in four, to metronidazole in six, and clindamycin in 16 isolates. The median age of patients was 73 years (55–83, IQR), 57% were male and comorbidities were common. Fifty-one per cent of infections were polymicrobial. In 60% of cases a focus of infection was identified. Forty per cent of patients had either organ dysfunction or shock. The 30-day mortality was 11%, and nosocomial infections were over-represented among the deceased. ConclusionsGPAC bacteraemia is much more common than previously reported. GPAC-bacteraemia is a condition with significant mortality mainly affecting elderly persons with comorbidities.

Patient and Surgical Factors Contributing to Perioperative Infection in Complex Lower Extremity Trauma

Infections in the traumatized lower extremity are a significant source of morbidity and expense. Outcomes after vascularized soft tissue reconstruction were analyzed to determine impact on infection rates. A retrospective review of a prospectively maintained database was performed, including 114 trauma patients requiring soft tissue reconstruction of lower extremity injuries at an urban Level I tertiary referral center from 2008 to 2015. Patient characteristics and perioperative outcomes were analyzed. After trauma, 39 (34.2%) patients developed wound infections, of which 74.4 per cent of infections occurred before soft tissue coverage. Isolated lower extremity injury yielded a 4-fold increase in the incidence of infection. Infection rates doubled in patients who smoked, sustained a fall, had a proximal third of the lower leg wound, or underwent external fixation. Comorbid diabetes, underlying fracture, and wound size were not predictive of infection. Overall, there was a 97.4 per cent rate of limb salvage after soft tissue reconstruction. In patients with infection before soft tissue reconstruction, a salvage rate of 96.6 per cent was achieved. Soft tissue reconstruction in the traumatized and infected lower extremity resulted in high limb salvage success rates, demonstrating vascularized tissue transfer in lower extremity injuries is effective in treating lower extremity infection.

Study of Seed Borne Pathogens Associated with Rabi Sorghum (Sorghum Bicolor L. Moench) Genotypes

An experiment was conducted to study the seed borne pathogens associated with Rabi sorghum genotypes at Regional Agricultural Research Station, Bijapur Karnataka . Fungi associated with Rabi sorghum genotypes were detected by using blotter method and studied the fungal colony characters after isolation. About six different seed borne pathogens were identified in the order of infection were, Aspergillus Spp, Penicillium Spp, Fusarium Spp, Rhizopus Spp, Botrytis Spp, Curvularia Spp. Among these fungi the most predominant fungi were Aspergillus spp. (20%), Penicillium spp.(16%), Fusarium spp.(16%), Rhizopus spp.(12%) in terms of per cent of infection on the seeds.

Efficacy of hot water treatment to reduce the incidence of Fusarium circinatum on Pinus radiata seeds

Hot water treatments (HWTs) were evaluated for their ability to reduce the incidence of Fusarium circinatum on Pinus radiata seeds. The effect of HWTs on conidial germination and mycelial growth of F. circinatum isolates representative of both mating types (MAT-1 and MAT-2) was determined by incubating conidial suspensions and agar plugs with mycelium in a hot water bath. The percentages of conidial germination and mycelial growth relative to the non-treated control decreased with increasing temperature and time of HWTs. MAT-2 isolates were more sensitive to HWTs than those of MAT-1, and no germination or mycelial growth of MAT-2 isolates was observed for temperatures above 50°C. The effect of HWT on P. radiata seed germination was also evaluated. The decrease in the percentage of seed germination compared with the non-treated seeds was always below 30 per cent for treatment temperatures <53°C. In addition, two naturally infected seed lots of P. radiata were used to assess the effect of HWTs on naturally infected seeds and on 3-month-old seedlings obtained from treated seeds. There was no infection detected in most of the treatments evaluated for either seed lot. Only 1 per cent of infection was detected on seeds treated with 50°C for 30 min in seed lot 1 and on seeds treated with 50°C and 52°C for 45 min in seed lot 2. The results obtained in this study show that HWTs at 51–52°C for 30 min can be used to reduce F. circinatum contamination on P. radiata seed.

Good practice in antibiotic use: what about linezolid in a French university hospital?

Linezolid represents an important advance in the treatment of methicillinresistant staphylococci. Its effectiveness should be preserved by appropriate uses. The aims of this survey were to describe the use of linezolid in clinical practice and to assess its overall safety. This retrospective observational study included patients treated with linezolid in 2008 in all departments at the CHU Nantes. A data-collection card was completed using the patients' medical files. A total of 179 patients from 23 different departments were included. Fifty-four per cent of indications were outside the Marketing Authorization criteria, and were mainly osteoarticular infections and septicaemia (22% and 8% of total prescriptions, respectively). Inefficacy of first-line antibiotic treatment (23%) and alterations in renal function (23%) were the main reasons for using linezolid, which was prescribed as a first-line therapy in 28% of patients. Fifty-three per cent of infections were documented microbiologically, of which 58% were due to a methicillin-resistant Staphylococcus. Linezolid seems to be a possible therapeutic strategy in case of multiresistant bacteria and/or complex clinical situations. Because many prescriptions fall outside the Marketing Authorization criteria, this study highlights the need to have clinical data available for such situations.

Determination of teliospore concentration as surface contaminants in Karnal bunt-infected seed samples of wheat using indirect ELISA

The study describes the indirect ELISA method for the determination of teliospore concentration in infected seed lots employing anti-teliospore antiserum generated against intact teliospores of Tilletia indica – a quarantined pathogen. The detection limit is as small as 5–1000 teliospores. The teliospores were extracted by washing seed either one or three times using detergent to ensure complete removal of teliospores present as surface contaminants in wheat samples with varying per cent of Karnal bunt infection. To ensure the concentration of teliospores within the sensitivity range, optimal volume of different extracted samples was determined. The ELISA reactivity was used to extrapolate the number of teliospores present in wheat samples. Forty-nine wheat samples received for certification based on per cent of infection were also subjected to indirect ELISA to determine the sensitivity of the protocol. The samples having 0.05–26% infection were having teliospore concentration in the range of 7×102 to 6.6×104/1000 seeds.

Chronic osteoyelitis in patients with sickle cell disease

To determine the baseline pattern and audit management modalities of chronic osteomyelitis in patients with sickle cell disease. A retrospective study. Jos University Teaching Hospital, Jos, Nigeria from August 1993 to July 1997. Twenty four patients with concomitant chronic sickle cell disease. Fifteen patients had operations; eleven had sequestrectomy and curettage while four had incision and drainage. Eight patients were treated with antibiotics alone and one patient refused surgery. The demographic data of patients, aetiological agents, culture and sensitivity patterns, aetiopathogenesis, treatment modalities and outcome were analysed. Twenty four (36.9%) out of 65 patients who had chronic osteomyelitis also had sickle cell disease. Male:female ratio was 1.2:1. The peak age incidence (37.5%) was in the first decade of life. Seventy five per cent of infections were haematogenous. The most frequently isolated organism was Staphylococcus aureus (58.8%) while the rest were Gram negative organisms. There was no case of Salmonella osteomyelitis. The most sensitive antibiotics were gentamicin and the third generation cephalosporins. Twelve patients (50%) had good results while eight (33.3%) were still undergoing treatment. Complications recorded were persistent discharging sinuses in two cases, recurrence of symptoms in one and pathological fracture with non-union in one patient. Though the incidence of Gram negative organisms in causation of chronic osteomyelitis in patients who have sickle cell disease is high (41.2%), Salmonella osteomyelitis may be related to endemicity of the organism in a given locality.

Health Problems Associated with the Built Environment in Areas of Rapid Urbanization and Poverty

If UN projections are correct, global urban populations will grow to exceed 5 billion people by the year 2025, raising cities share of world inhabitants to more than 60 percent globally. Urbanization brings about fundamental changes in the way people live and work and has profound implications for the health of those who live in cities. Along with chronic and degenerative diseases in the developed nations, the expeditious spread of infectious diseases in the developing world threatens the very cohesion of society. In 2002, twenty six percent of all worldwide deaths were the result of communicable disease infection. Around 90 per cent of infections in developing countries are attributed to water borne diseases resulting from concentrated urbanization and industrialised agricultural practices. This paper will address health problems associated with the built environment in areas of rapid urbanization and poverty, and in particular the health impacts of marginalization, social exclusion, and inequity associated with built form and dispersed settlement patterns. It argues that the accelerated pace of urbanization requires that infectious disease is understood as a global challenge of improving public health, securing socio-economic well-being, and advancing sustainable development.

PSEUDOMONAS AERUGINOSA: EPIDEMIOLOGY OF BACTEREMIA AND ANTIMICROBIAL SUSCEPTIBILITY PATTERN IN A TEACHING HOSPITAL IN KUALA LUMPUR

A cross-sectional study of 109 patients with Pseudomonas aeruginosabacteremia from the University of Malaya Medical Centre (UMMC) in the years 2000 and 2001 was conducted to describe epidemiological features, underlying diseases, possible source of infection, early mortality among patients as well as the antibiotic susceptibility pattern of patients' isolates. Further analysis of the 87 patient records that were available revealed that the mean age was 48.5 years (SD ' 25.1). Fifty-two per cent of cases were male and 48% female. Seventy-nine per cent of infections were nosocomially acquired, 33% of bacteremias were polymicrobial, 47% of patients had a continuous bladder drainage catheter (CBD) in situ, 33% had a central venous catheter (CVL) present at the time of bacteremia and 30% were ventilated. Sixty-eight per cent of patients had an underlying immunosuppressed state and 26% had undergone surgery involving general anesthesia in the week prior to isolating P. aeruginosa. Among the 23 patients with early mortality, 61% were on inappropriate antimicrobials. Most of the patients' isolates were sensitive to imipenem (86%), ciprofloxacin (81%), ceftazidime (79%), gentamicin (78%) and cefoperazone (77%). Among the community acquired strains, however, there was 100% sensitivity to imipenem, ceftazidime, cefoperazone and ciprofloxacin.

Infection and the burn patient

Abstract : Burn patient survival has significantly increased during the past four decades as hypovolaemic shock, acute renal failure, invasive bacterial burn wound infection, Curling's ulcer, and metabolic wasting have been controlled by timely adequate resuscitation, topical chemotherapy, gastric acid control, and effective nutritional support. Even though infection of the burn wound is rare (only 8 per cent of infections in 1989), infection remains the major predator and most common cause of death in burn patients in whom the respiratory tract has now become the most frequent portal of infection. The success of current burn wound care is further indexed by the change in the predominant form of pneumonia, haematogenous pneumonia that commonly arose from an infected burn wound, having been supplanted by bronchopneumonia. Pneumonia and bronchitis comprised 53 per cent of all infections in burn patients treated at the US Army Institute of Surgical Research during 1989.

Transmission studies on an indian isolate of sugarcane mosaic potyvirus

An Indian isolate of sugarcane mosaic virus was found easily transmitted by mechanical sap inoculation to sugarcane and sorghum plants. Out of different methods tried for mechanical inoculation, Bain’s and Matz’s method gave maximum per cent of infection in inoculated sugarcane and three varieties ofSorghum vulgare (cv. M.P.cherry, CSH-5 and CSH-9). The virus was also found to be transmitted by four aphids, viz.Aphis gossypii, Longiunguis sacchari, Myzus persicae andRophalosiphum maidis. Since the virus could be transmitted most efficiently byR. maidis the detailed study was made with it to establish the virus-vector relationship.R. maidis could acquire virus without any pre-acquisition fasting, but fasting has beneficial effect up to 4h on the acquisition power. In case, fasting is increased beyond 4 h, the efficiency of transmission decreased. The aphid acquire the virus within 30 sec. However, optimum acquisition feeding was obtained in 2 min. but the maximum infection was obtained after 30 min infection feeding of test plants. Even a single viruliferous aphid was enough to initiate the infection. The transmission per cent decreased when the aphids were fasted after acquisition feeding of 2h from 60 to 13 per cent. In serial transfers, the aphids cease to be infective very soon while feeding on the test plants. Thus the virus under study was transmitted apparently by typically non-persistent manner and was stylet borne.

HIV/AIDS in India: Problem and Response

The current prevalence of HIV in India is estimated to be around 4. 6 million infections, 74.8 per cent of those infected being men and 85.3 per cent of infections occurring through the sexual route. Analysis of data from biological and behavioural surveillance from across the country brings out the fact that the epidemic is heterogeneously distributed and is spreading not onlygeographically, but also shows increasing rates in different risk groups, while continuing to affect the general population. The epidemic is in an advanced stage in Maharashtra, Tamil Nadu, Andhra Pradesh, Kar nataka, Manipur and Nagaland. Nationwide efforts have been initiatedduring the last decade through a comprehensive National AIDS Control Programme. The response has been participatory, multi-sectoral, evidence based and with a number ofsuccess stories. This gives us hope that a sustained high-quality response will contain and manage the epidemic and its consequences.

Prospective, multicentre audit of complex vascular wound and graft infections: the impact of methicillin-resistant Staphylococcus aureus

Abstract Background A number of studies have looked at the outcome of vascular graft infections, but these often include small numbers of patients collected over a prolonged period of changing practice. Many of these studies do not contain cases of methicillin-resistant Staphylococcus aureus (MRSA). Methods Between February 1998 and January 1999, a prospective, multicentre audit was performed in order to examine the outcome of complex wound and graft infections in vascular surgery, with particular reference to MRSA. Results Some 66 grade II or III Szilagyi wound infections occurred. Overall, 23 per cent of type II infections progressed to graft infection. Of those with type III infections, 83 per cent had an adverse outcome (death, major amputation or ongoing infection). No vein graft became infected, but 12 of 38 prosthetic grafts were affected. MRSA accounted for 42 per cent of infections and was present in 67 per cent of patients with an adverse outcome. Adverse events occurred in 32 per cent of MRSA cases and in 10 per cent of non-MRSA cases (P = 0·04). Wound infection proceeded to graft infection in 58 per cent of MRSA cases and in 32 per cent of non-MRSA cases (P = 0·08). Seven of eight patients with MRSA before operation developed postoperative MRSA infection. Median length of stay was 31 days for MRSA versus 18 days for non-MRSA infections (P = 0·001). Forty-three graft infections occurred; 12 were associated with a complex wound infection. Median time to presentation was 39 (range 2–2450) days. There were 16 deaths, nine major limb amputations and three ongoing infections among patients with a graft infection. The median length of stay was 36 days. MRSA was present in 36 per cent of all graft infections. Only one of these infections involved a vein graft (P = 0·001). MRSA infection occurred more frequently where the primary procedure had been urgent rather than elective (P = 0·03). MRSA graft infection accounted for seven of the nine major limb amputations. The median length of stay in patients with MRSA graft infection was 25 days longer (P = 0·001). Conclusion Complex wound and graft infections continue to be associated with postoperative deaths and amputations. MRSA infection is now the most common organism involved in complex infections following vascular procedures. It is associated with an increase in the number of adverse outcomes and a significant increase in length of stay.

The Demographic Impact of HIV/AIDS in Sub-Saharan Africa

Sub-Saharan Africa has more than two-thirds of the world's HIV/AIDS cases and these are concentrated more densely in an ‘AIDS Belt’ from southern Sudan through East Africa down to South Africa. Although the number of infections seems to have stabilised in East Africa, infection rates in southern Africa continue to soar. Over 80 per cent of the HIV/AIDS infections in sub-Saharan Africa are heterosexually transmitted and around 15 per cent of infections are caused by mother to child transmission. Increased mortality among prime age adults and infants has reduced life expectancy and altered population structure. Fertility has declined, not only through behavioural changes in response to the HIV epidemic but also due to biological changes caused by the HIV infection. The combination of increased mortality and reduced fertility will significantly slow population growth rates and may even cause population decline in the coming decades. Dependency ratios and the incidence of orphanhood are rising.

Malaria treatment in Queensland, 1992. The use of malaria treatment guidelines.

To investigate treatment patterns for malaria and the use of Australian guidelines which were then current for the treatment of malaria in Queensland in 1992. A review of patient treatment and demographic details, obtained from the treating doctor by questionnaire, for all cases of malaria in Queensland in 1992 which were reported to Queensland Health (316 people treated for 341 episodes of malaria). Plasmodium falciparum infections were treated according to the recommendations in the guidelines in 20% of cases. Thirty-five per cent of infections were treated with chloroquine, even though most of these were acquired in countries where chloroquine or chloroquine/antifolate-resistant P. falciparum malaria existed. Plasmodium vivax infections were treated with the recommended course of chloroquine in 58% of cases. Fifty per cent of patients with P. vivax infection were treated with primaquine, but only 57% of these received the dose recommended in the guidelines for the eradication of hypnozoites. Patterns of malaria treatment were basically similar in the malaria-receptive zone and elsewhere in Queensland, although P. falciparum infections in the receptive zone were treated according to the guidelines at a higher rate (32%) than in the rest of Queensland (13%). In 1992, many cases of malaria in Queensland were not treated according to the recommendations in the Australian malaria treatment guidelines. We suggest that improved distribution of simple but comprehensive guidelines for malaria treatment may assist medical practitioners in the provision of prompt, effective treatment, and help prevent the reestablishment of endemic malaria in Australia.

Infection and the burn patient

Abstract : Burn patient survival has significantly increased during the past four decades as hypovolaemic shock, acute renal failure, invasive bacterial burn wound infection, Curling's ulcer, and metabolic wasting have been controlled by timely adequate resuscitation, topical chemotherapy, gastric acid control, and effective nutritional support. Even though infection of the burn wound is rare (only 8 per cent of infections in 1989), infection remains the major predator and most common cause of death in burn patients in whom the respiratory tract has now become the most frequent portal of infection. The success of current burn wound care is further indexed by the change in the predominant form of pneumonia, haematogenous pneumonia that commonly arose from an infected burn wound, having been supplanted by bronchopneumonia. Pneumonia and bronchitis comprised 53 per cent of all infections in burn patients treated at the US Army Institute of Surgical Research during 1989.

Northwick Park Infection Consultation Service Part I. The aims and operation of the service and the general distribution of infection identified by the service between September 1987 and July 1990

The Northwick Park Infection Consultation Service (ICS) is a collaborative service operated by the departments of Medical Microbiology and Infectious Diseases where personnel and skills are combined. Its aim is to improve the availability and effectiveness of consultation for infection-related problems. This paper sets out the framework for establishing an ICS and also details the general distribution of infection identified by the Northwick Park ICS in a study carried out between September 1987 and July 1990. Part II assesses the contribution that the ICS made to the management of infection. One thousand and thirty-eight (1038) patients were seen on the ICS. Seventy-five per cent (776) were judged to be infected and in 691 this was a probable or certain diagnosis. Skin and subcutaneous tissue, respiratory tract, and genito-urinary tract infections accounted for 64% of the total. Eighty-seven per cent of infections required treatment with intravenous antibiotics, 22% were associated with concomitant bacteraemia, and 2.7% of patients died as a direct result of their infection. Sixty-four per cent of consultations were unsolicited and arose from laboratory results or the clinical information on the form accompanying the specimen: over one quarter were initiated before results were available. These infections were no different in either severity or nature from those identified by solicited requests to either department. Fifty-three per cent of consultations had a moderate to high clinical component. The results emphasise the importance of infection in hospitals and highlight the advantages of a collaborative approach from the departments of Medical Microbiology and Infectious Diseases.

Infections of Prosthetic Heart Valves and Cardiac Pacemakers

Prosthetic valve endocarditis may be considered present when two fo the following criteria are met: (1) two or more blood cultures are positive with the same organism in the absence of extracardiac infections, (2) evidence of bacterial endocarditis by histology or cultures is obtained from surgical or autopsy specimens, and/or (3) a clinical picture compatible with endocarditis (fever, new or changing regurgitant murmur, splenomegaly, hematuria, or evidence of peripheral emboli) is present. The overall incidence of PVE ranges from 0.98 to 4.4 per cent. Early and late PVE (that is endocarditis developing less than 60 and 60 or more days following valve implantation, respectively) accounts for 18 to 36 per cent and 64 to 82 per cent of infections, respectively. The overall mortality is 53 per cent and is higher in patients with early versus late PVE. Coagulase-negative staphylococci are responsible for a higher percentage of early (43 per cent) than late (28 per cent) infections. Streptococci are more common in late (27 per cent) than in early (3 per cent) PVE, while diphtheroids are most common in early PVE. The diagnosis of PVE may be difficult to establish, especially in patients with postoperative bacteremias who have other potential sources of extracardiac infections. Antimicrobial therapy is generally based on the susceptibility of the offending pathogen. With respect to the use of synergistic combinations, results are controversial, and most available data are derived from patients with native-valve endocarditis. Surgery remains an important aspect of treatment, and the mortality among patients who undergo early surgical intervention, particularly if their illness is complicated, is less than in those who are treated only with antibiotics. Indications for surgery include: (1) moderate-severe refractory congestive heart failure, (2) persistent bacteremia or fungemia, (3) multiple emboli, (4) myocardial abscesses, (5) relapsing PVE, and possibly (6) patients with clinical evidence of PVE and negative blood cultures and persistent fever despite 1 week or more of appropriate antibiotics. Pacemaker infections occur in less than 6 per cent of patients who undergo pacemaker insertion. These infections generally result from wound contamination at the time of surgery, and 75 per cent of infections are due to staphylococci. Staphylococcus aureus causes most infections occurring within 2 weeks after surgery, while S. epidermidis causes most later infections. The need to remove infected pacemakers is controversial.

&lt;italic&gt;Streptococcus pyogenes&lt;/italic&gt; Bacteraemia in Cambridge - A Review of 67 Episodes

Sixty-seven episodes of bacteraemia due to Lancefield Group A streptococci occurred in patients admitted to or autopsied at Addenbrooke's Hospital, Cambridge from July 1974 to June 1986. Ninety-two per cent of infections were acquired in the community and 71 per cent of patients were adults. The overall mortality rate was 48 per cent and 15 per cent of cases died at home shortly after the onset of illness. Thirty-eight per cent of the patients had underlying disease and sixty-one per cent of these died compared with 40 per cent of those without underlying disease. Presentation in shock was the major predictor of mortality (79 versus 16 per cent) and was commoner in adults. Clinical features were variable and led to incorrect initial diagnosis in some cases. A localized site of infection was not recognized initially in 37 per cent of cases but the commonest evident site of entry was the skin. Annual incidence varied with age from 0.71 to 4.16/100,000 population and cases were commonest in the young and those over 50. The fulminating onset of community-acquired streptococcal infection in some adults emphasizes the importance of early treatment of suspected cases with penicillins.