Diphtheria Patients Research Articles

To the assessment of bacteriological diagnosis of diphtheria by the Folger-Zole method

Back in 1902, in the society of doctors of Carinthia, Folger made a report on the method he proposed for the accelerated cultivation of a diphtheria bacillus. But this method later remained untested and completely unknown for the majority. It was only in 1934 that the work of Alphons Sоle (Vienna) appeared, who checked this accelerated Folger's diagnosis on 200 cases of diphtheria patients and was convinced of the great value of this method.

Postoperative lung abscess

1. 1. A discussion of the aspiration and embolic theories of lung abscess is presented. 2. 2. Case histories are cited to substantiate conclusions that pulmonary embolism is frequently followed by typical lung abscess. 3. 3. In a study of 100 diphtheria death protocols, false membrane, with its contaminating mouth organisms, was found in the minute arborizations of the bronchial tree, but no lung abscess complication was found. 4. 4. When operation (tracheotomy) was performed on bronchial diphtheria patients, abscess was found in 3.5 per cent of the cases. 5. 5. Many preventive measures have been devised and are used to prevent aspiration during tonsillectomy, yet far too many patients develop lung abscess. Unquestionably, lung abscess is a more frequent complication of modern tonsillectomy than the older operation of tonsillotomy. 6. 6. Earlier surgical drainage is urged in fulminating lung abscess. 7. 7. The use of drugs and vaccines is of no value in the treatment of lung abscess. 8. 8. Pneumothorax should not be used as a treatment of lung abscess. It may be used as a localizing diagnostic measure. 9. 9. Postural drainage must be used cautiously in acutely ill patients. 10. 10. If surgical treatment is postponed until a chronic stage has been reached, more radical surgery, with its higher mortality, is required to effect a cure.

Diphtheritic myocarditis: A review of 496 cases

Summary 1. In 496 cases of myocarditis which developed in 4,671 diphtheria patients, there was a fatality rate of 62 per cent. 2. The fatality rate was 75 per cent during the age period from one to five years; 54 per cent, from six to ten years; 50 per cent, from eleven to fifteen years; and 43 per cent, over fifteen years of age. 3. The mortality was highest (70 per cent) in cases in which there was nasal involvement and lowest (11 per cent) in simple tonsillar diphtheria. 4. Seventy-nine per cent of all deaths from diphtheritic myocarditis occurred during the first fourteen days of the disease, the average day on which death occurred being the tenth. 5. Abdominal pain and vomiting with falling pulse rate and blood pressure were signs of grave prognostic importance. 6. “Malignant diphtheria” was an important factor in accounting for the high mortality rate. 7. The most important pathologic findings in 126 autopsies was extensive toxic myocardial degeneration. 8. Epinephrine and caffeine were of no value as permanent circulatory stimulants. 9. Parenterally injected glucose solution seemed to be a life-saving measure in some cases of severe diphtheritic myocarditis. 10. A series of blood sugar determinations before and at varying intervals after glucose administration are presented.

Scarlet fever and Diphtheria in Tonsillectomized Children.

SummaryIn the Stockholm Hospital for Infectious Diseases the scarlet fever and diphtheria cases over a six year period have been studied with reference to the course of these diseases in tonsillectomized patients. 104 cases of scarlet fever and 71 cases of diphtheria all of whom had had previous tonsillectomies were compared with a suitable series of controls consisting of 3 times as many patients. The results in regard to the scarlet fever cases are as follows:1. There probably exists no difference in regard to the severity of onset as estimated by the angina and eruption in tonsillectomized and non‐tonsillectomized individuals.2. The number of cases with complications as well as the different complications occur on the whole in the same frequency in the two groups (No statistically determinable difference).3. Tonsillectomized patients cause just as many infections as do the non‐tonsillectomized after they return to their homes, thus indicating that the contagiousness at the later stage of the disease is not dependent on the presence or absence of the tonsils.4. Hemolytic streptococci can be demonstrated later in the convalescent period in non‐tonsillectomized than in tonsillectomized individuals.The results in regard to the diphtheria cases are as follows:1. Diphtheria of the pharynx is much more frequent among diphtheria patients with tonsils than among those who have had a tonsillectomy. Nasal diphtheria is common among the latter.2. Malignant diphtheria occurs considerably oftener among non‐tonsillectomized than among tonsillectomized patients.3. The frequency of complications is less among tonsillectomized than among non‐tonsillectomized patients.

THE PATHOGENICITY OF THE FUSIFORM BACILLUS AND SPIRILLUM OF PLAUT-VINCENT

It has been quite generally accepted that the Plaut-Vincent organisms have a pathogenic relationship to a variety of clinical entities. Unexceptionable proof of such relationship is wanting. The purpose of this report is to record clinical and experimental observations bearing on this subject. This study was undertaken at the suggestion of Dr. Joseph Brennemann. In the course of a study of a large series of diphtheria patients Plaut, 1 in 1894, came on five cases of non-diphtheritic membranous angina, at first taken for diphtheria, in which fusiform bacilli and spirochetes were found. Plaut called these Miller's organisms, since these had been described in 1883 by an American dentist, Willoughby D. Miller, who stated that pathogenic properties had already been ascribed to these organisms by Verneuil and Clado, who had found them in abscesses of the sublingual salivary gland, in submaxillary adenitis and in an abscess of a finger due to

On the Bacterial Flora of Diphtheria Carriers, Diphtheria Patients, and Normal School Children

During a recent investigation on the carrier problem as it occurs in diphtheria, which was carried out (under the auspices of the Scientific Advisory Committee of the Metropolitan Asylums Board) at the Northern Group Laboratory, North-Eastern Hospital, one of the first subjects considered was that of the bacterial flora of the carriers under examination, and of an adequate series of controls. It was suggested that possibly the flora of the carriers might differ (apart altogether from the presence of the Klebs-Loeffler bacillus) from that found in non-carrier persons of the same age. It was thought that some pathogenic organism might be found to be constantly present in the nose or throat flora of carriers and not in controls, and that this might be exerting an influence on the Klebs-Loeffler bacillus by allowing it to survive in the infected region for prolonged periods. If such were the case it was hoped that an elimination of the organism or organisms concerned would go a long way towards clearing up the carrier condition.

Some Observations on Diphtheria Carriers

The results of the clinical examination of 288 diphtheria carriers, 300 diphtheria patients, and 100 diphtheria convalescents ready for discharge are given. It is shown that the proportion of abnormal conditions in the nose and throat of the carriers (94.1 per cent.) is higher than in the diphtheria patient group (73 per cent.), and considerably higher than in the recovered convalescent cases (52 per cent.). This is particularly noticeable when the proportion of cases with nasal abnormalities is considered in the three groups, namely, in carriers 72.2 per cent.; in diphtheria patients 42.6 per cent.; while in negative convalescent cases the figure is only 7 per cent. Further, the departures from normal in the recovered convalescents are generally enlarged but healthy looking tonsils which do not appear to interfere with the natural elimination of diphtheria bacilli during convalescence.The greatest proportion of carriers is in the age group 1 to 5 years, and owing to the small size and anatomical complexities of the nasal passages, the pathological conditions tend to persist and make examination and treatment difficult. The figures indicate that the presence of pathological conditions in the nose and throat of diphtheria patients is conducive to the establishment of the carrier state.It has been shown during the investigation that the presence of diphtheria bacilli in carriers is intermittent, and that there may be failure to isolate the organisms over long periods of time although the patient may still be infective.It is emphasized that even three negative culture results are not sufficient to establish that a carrier is completely free from infection.

The Incidence of Scarlet Fever Streptococci in Throats of Diphtheria Patients.

The Incidence of Scarlet Fever Streptococci in Throats of Diphtheria Patients.

The Incidence of Scarlet Fever Streptococci in Throats of Diphtheria Patients

Journal Article The Incidence of Scarlet Fever Streptococci in Throats of Diphtheria Patients Get access Paul S. Rhoads Paul S. Rhoads From the Scarlet Fever Committee and the John McCormick Institute for Infectious Diseases, Chicago Search for other works by this author on: Oxford Academic PubMed Google Scholar The Journal of Infectious Diseases, Volume 41, Issue 5, October 1927, Pages 377–382, https://doi.org/10.1093/infdis/41.5.377 Published: 01 October 1927 Article history Received: 30 July 1927 Published: 01 October 1927

Observations on the Mechanism of Circulatory Failure in Diphtheria.

This report consists of study by means of the string galvanometer of the effects of diphtheria toxin upon the heart. It has long been known that a circulatory collapse may occur in diphtheria, which frequently results in death. There is still considerable uncertainty, however, as to whether it is the heart or the vasomotor apparatus which is primarily effected.In the present study electrocardiographic observations were carried out (1) on a series of diphtheria patients (2) on animals injected with diphtheria toxin.Previous observers1, 2, 3, 4 have noted electrocardiographic changes indicating myocardial injury during the acute stage of diphtheria. The present investigation was made during the convalescent or late stage of the disease, since circulatory failure may occur during this period also.Readings were taken of 15 diphtheria patients during the period of convalescence, beginning usually in the 3rd or 4th week of their illness. In all cases, the local throat condition had entirely cleared up, and the ...

The effect of the diphtheria toxin on the blood and hemopoietic organs of rabbits

Bouchut and Dubrisay1 noted leukocytosis as usual in diphtheria, and later the former2 found that the number of leukocytes increases with the severity of the disease and decreases on improvement. After a careful study of leukocytic reaction in animals and in clinical cases, Gabritchewsky3 concluded that a progressive leukocytosis signifies a bad prognosis in diphtheria, and this is in accord with the results of Nicolas and Courmont,* Schlesinger,5 and Morse,0 but contrary to those of Besredka,7 who observed that leukocytosis has no relation to the severity of the disease, but that a decrease in the number of polymorphonuclear leukocytes, together with the presence of intermediate cells,,, means an unfavorable prognosis. Furthermore, his results showed that in the animals inoculated with a massive dose of diphtheria toxin the number of leukocytes after reaching its maximum gradually declined till the death of the animal. Ewing8 stated that in fatal cases the number of leukocytes may be steadily increased or decreased, or there may be no leukocytosis. Arneth 9 found leukopenia in one fatal case, and also recorded the occurrence of myelocytes in two fatal cases. As to the presence of myelocytes in the blood of diphtheria patients, Engel10 was the first to call attention to the fact that the number of myelocytes increases as the disease advances. He found from 3 to 11 7o of myelocytes in the fatal cases.

The Virulence of Diphtheria Bacilli from Diphtheria Patients and Diphtheria-carriers

The Virulence of Diphtheria Bacilli from Diphtheria Patients and Diphtheria-carriers

The Virulence of Diphtheria Bacilli from Diphtheria Patients and Diphtheria Carriers

Journal Article The Virulence of Diphtheria Bacilli from Diphtheria Patients and Diphtheria Carriers Get access George H. Weaver George H. Weaver Memorial Institute for Infectious Diseases, Chicago Search for other works by this author on: Oxford Academic PubMed Google Scholar The Journal of Infectious Diseases, Volume 20, Issue 2, February 1917, Pages 125–130, https://doi.org/10.1093/infdis/20.2.125 Published: 01 February 1917 Article history Received: 08 November 1916 Published: 01 February 1917

DIPHTHERIA IN THE FIRST YEAR OF LIFE

Though the occurrence of diphtheria in the first year of life was noted by Bretonneau, 1 who first gave the name to the disease, all authorities are agreed as to its rarity at this period. During the last fifteen years the percentage of diphtheria patients under one year admitted to the Metropolitan Asylums Board's Hospitals 2 has remained fairly constant, varying between 1.5 and 2.8 per cent. annually of the total cases admitted. The figures given by some continental observers are slightly higher. Thus Flugge 3 states that among 6,394 cases of diphtheria in Breslau in the period 1886 to 1890, 160 patients, or 2.5 per cent., were under 1 year. According to Filatow 4 the morbidity in southern Russia among children below 12 months was 4 per cent. of the total. In the Children's Hospital directed by Baginsky 5 in Berlin infants under 1 year formed 5.5 per cent.

THE USE OF KAOLIN TO REMOVE DIPHTHERIA BACILLI FROM THE NOSE AND THROAT

In a preliminary note, 1 the use of kaolin to remove bacteria from the nose and throat was suggested on the basis that kaolin by means of its adsorptive property would carry with it bacteria with which it came in contact. Since this report, a study has been made of this method in 100 unselected cases, ninety-six being diphtheria patients and four diphtheria carriers. By pure diphtheria carriers is meant a person with diphtheria bacilli in the nose or throat, who yields no history of sore throat or other symptom of diphtheria, and who gives a negative Schick test. The method of the application of kaolin is as follows: As crude kaolin, which is moist and lumpy, has not the adsorptive power of the thoroughly dried and finely powdered product, the crude material is first thoroughly dried for several days in a bacteriologic incubator. The lumps are then broken

IS DIPHTHERIA FREQUENTLY A BACTEREMIA?

In August last, Conradi and Bierast 1 of the Hygienic Institute of the University of Halle reported the results of an extensive examination of the urine of diphtheria patients. They call attention to the fact, that, while diphtheria has been regarded as essentially a local disease, yet the Loeffler bacillus has frequently been isolated from the blood and organs after death, and occasionally from the blood during life, usually, however, in the agonal stage of the disease. On account of the technical and other difficulties of obtaining a sufficiently large quantity of blood from diphtheria patients, they sought to solve the question of diphtheria bacteremia by an indirect method, namely, an examination of the urine of those actively ill, and of convalescents. In all, 155 patients were examined, of whom fifty-four showed a positive urine. In six cases only, however, were virulence tests made, all of which proved positive. As

The Opsonic Index in Diphtheria

According to Wright1 diphtheria bacilli are insensible to the opsonic action of blood fluids. This conclusion is based upon experiments showing that there is as much (or, in one case, more) phagocytosis in the presence of normal human serum heated at 600 C. as in unheated. In order to study this question four strains of typical diphtheria bacilli furnished me by Dr. Hamilton were tested. With all of these strains there was no opsonin demonstrable in normal human serum after heating the serum 30 minutes at 500 C. This was found to be true also of serum from diphtheria patients when tested with strain N, the organism employed in the subsequent experiments. Re que2 also found that when washed leucocytes are mixed with normal human or dog serum heated to 58-600 for 15-30 minutes, there 1s practically no phagocytosis with diphtheria bacilli. It is possible that the strain which Wright used was subject to the spontaneous phagocytosis which has been observed to occur with occasional strains of diphtheria bacilli. As the course of the specific opsonic index in certain acute infections has been found to possess characteristic features that harmonize well with the general clinical picture, rising above normal as the symptoms decline, it was thought it would be of interest to determine if this were also true in regard to diphtheria. Both the diphtheriaand the streptococco-opsonic indices were estimated on account of the close association of streptococci with tonsilar infections. The Wright method of estimating the opsonic index has been employed for the most part. The suspensions are made from 24,

ANTITOXIN AND INTUBATION WITH A REPORT OF 100 OPERATIONS.

The results of progress in scientific therapeutics can be most thoroughly demonstrated in the treatment of laryngeal diphtheria. The uncertain pathology of this disease has assumed a clear and definite position under the light of modern bacteriologic research. Arguments on the nature of the causative microbe are past, and the claims of the Klebs-Loeffler bacillus are established. The question has been decided, and the presence of the Klebs-Loeffler bacillus is demonstrated in primary pseudomembranous laryngitis almost without exception. A careful investigation of the management of diphtheria patients, and a study of the development of new cases from day to day leads to the conclusion that the great mortality can be reduced one-half by early treatment. The great importance of more care in recognizing the causes and enforcing the means of preventing diphtheria are obvious. The causes of the rise and fall in the number of cases in our city require

Letter from Vienna.

Vienna, Nov. 18, 1894. To the Editor: —As the Behring remedy for diphtheria is causing a great commotion in medical circles throughout Europe, and probably also in the United States, it may be of interest to inform your readers of the status of the remedy on this side of the Atlantic, in so far as it is possible to get at the facts. I made daily visits until a few days ago, for three weeks at Professor Koch's barracks in Berlin where Dr. Kossel is conducting the treatment of diphtheria patients with Behring's blood serum, and am happy to be able to say that, in the main, the treatment of his cases has been followed by satisfactory results while the work there has aroused the interest of European physicians. Every day a number of different foreign physicians are to be met there who have come to investigate the progress of