Gram-negative Intracellular Diplococci Research Articles

United Kingdom British association for sexual health and HIV national guideline for the management of epididymo-orchitis, 2020.

The British Association for Sexual Health and HIV (BASHH) UK guideline for the management of epididymo-orchitis has been updated in 2020. It offers advice on diagnostic tests, treatment and health promotion principles in the effective management of epididymo-orchitis. Empirical treatment should be started in patients with objective swelling and tenderness on testicular examination. First-line empirical treatment for sexually acquired epididymo-orchitis has changed to ceftriaxone 1g intramuscularly and doxycycline. Higher dose of ceftriaxone in line with the BASHH 2018 gonorrhoea guideline ensures effective treatment of strains with reduced susceptibility. Ofloxacin or doxycycline is recommended in patients with epididymo-orchitis probably due to non-gonococcal organisms (e.g. negative microscopy for gram-negative intracellular diplococci or no risk factors for gonorrhoea identified). Where Mycoplasma genitalium is tested and identified, treatment should include an appropriate antibiotic (e.g. moxifloxacin). If enteric pathogens are a likely cause (e.g. older patient, not sexually active, recent instrumentation, men who practice insertive anal intercourse, men with known abnormalities of the urinary tract or a positive urine dipstick for leucocytes and nitrites), ofloxacin and levofloxacin are recommended. A clinical care pathway has been produced to simplify the management of epididymo-orchitis. A patient information leaflet has been developed.

A Case Report of Cervicitis Gonorrhea

Background: Gonorrhea refers to a set of clinical conditions involving infection with the sexually acquired bacterial pathogen, Neisseria gonorrhoeae. One of the simplest gonococcal infections in women involves mucosal surfaces of the endocervix that cause cervicitis, a frequently asymptomatic inflammatory condition that results in an abnormal mucopurulent discharge and cervical friability. Purpose: To report a case of cervicitis gonorrhea in a female patient whose sexual partner had a hisstory of unprotected promiscuous intercource with multiple sex worker. Case: A 24-year-old female patient presented with increased vaginal discharge for 4 days. Her husband had a history of having sexual intercourse with a sex worker 8 days before. Physical examination revealed mucopurulent exudate in the genitalia and endocervical canal. The Gram staining showed numerous leucocytes and Gram-negative intracellular diplococci, while the result of polymerase chain reaction (PCR) examination for Chlamydia trachomatis was negative. The patient was treated with single-dose cefixime 400 mg orally and doxycycline 100 mg orally twice a day for 7 days. Discussion: The present case report showed cervicitis gonorrhea co-infected with a nonspecific genital infection that was felt asymptomatic and unintentionally found when the patient accompanied her husband to Sexually Transmitted Infection (STI) clinic. The presumptive treatment of cervicitis directed against N. gonorrhoeae and C. trachomatis in this patient leads to a complete cure of the disease. Conclusion: It is important to treat the sexual partner of a patient with urethritis gonorrhea. The empiric treatment of cervicitis that is directed against N. gonorrhoeae and also against C. trachomatis is mandatory in preventing further possible complications.

Development of a SimpleProbe real-Time PCR Assay for rapid detection and identification of the US novel urethrotropic clade of Neisseria meningitidis ST-11 (US_NmUC).

Urethritis, or inflammation of the urethra, is one of the most common reasons men seek clinical care. Sexually transmitted pathogens including Neisseria gonorrhoeae are responsible for over half of the symptomatic urethritis cases in U.S. men. Recently, clinics in Indianapolis, Columbus, Atlanta, and other U.S. cities began to note increasing numbers of men presenting with urethritis and Gram-negative intracellular diplococci in their urethral smears who test negative for N. gonorrhoeae. Many of these discordant cases, which have periodically reached highs of more than 25% of presumed gonococcal cases in some sexually transmitted infection clinics in the U.S. Midwest, are infected with strains in a novel urethrotropic clade of Neisseria meningitidis ST-11 (US_NmUC). However, no cultivation-independent tests are available for the US_NmUC strains, and prior studies relied on microbial culture and genome sequencing to identify them. Here, we describe a PCR test that can identify the US_NmUC strains and distinguish them from commensal and invasive N. meningitidis strains as well as N. gonorrhoeae. Our SimpleProbe®-based real-time PCR assay targets a conserved nucleotide substitution in a horizontally acquired region of US_NmUC strain genomes. We applied the assay to 241 urine specimens whose microbial compositions had previously been determined by deep shotgun metagenomic sequencing. The assay detected the single US_NmUC positive case in this cohort, with no false positives. Overall, our simple and readily adaptable assay could facilitate investigation of the pathogenesis and epidemiology of the US_NmUC clade.

The first year of the global Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) in Bangkok, Thailand, 2015-2016.

Antimicrobial-resistant Neisseria gonorrhoeae (NG) infection is a global public health threat, and there is a critical need to monitor patterns of resistance and risk factors. In collaboration with the World Health Organization (WHO), the U.S. Centers for Disease Control and Prevention (CDC), and the Thailand Department of Disease Control (DDC), Ministry of Public Health (MoPH) implemented the first Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) in November 2015. Men presenting with urethritis at two clinical settings in Bangkok, Thailand (Bangrak Hospital [BH] and Silom Community Clinic @TropMed [SCC @TropMed]) provided demographic and behavioral information and had a urethral swab for Gram’s stain and NG culture collected. The NG isolates were evaluated for antimicrobial susceptibility by the Epsilometer test (Etest) to determine minimum inhibitory concentrations (MICs) for cefixime (CFM), ceftriaxone (CRO), azithromycin (AZI), gentamicin (GEN), and ciprofloxacin (CIP). From November 2015 –October 2016, 1,102 specimens were collected from 1,026 symptomatic men; 861 (78.1%) specimens were from BH and 241 (21.9%) specimens were from SCC @TropMed. Among the 1,102 specimens, 582 (52.8%) had intracellular Gram-negative diplococci and 591 (53.6%) had NG growth (i.e., NG infection); antimicrobial susceptibility testing (AST) was performed on 590 (99.8%) NG isolates. Among all symptomatic men, 293 (28.6%) had sex with men only, 430 (41.9%) were ages 18–29 years, 349 (34.0%) had antibiotic use in the last 2 weeks, and 564 (55.0%) had NG infection. Among 23 men with repeat NG infection during this first year of surveillance, 20 (87.0%) were infected twice, 2 (8.7%) were infected three times, and 1 (4.3%) was infected more than four times. All NG isolates were susceptible to CFM and CRO, and had MICs below 2 μg/mL for AZI and below 16 μg/mL for GEN. Overall, 545 (92.4%) isolates were resistant to CIP. This surveillance activity assessed individual patients, and included demographic and behavioral data linked to laboratory data. The inclusion of both individual and laboratory information in EGASP could help identify possible persistent infection and NG treatment failures. Expansion of EGASP to additional global settings is critical to assess trends and risk factors for NG, and to monitor for the emergence of resistance.

Unusual Cause of a Wound Infection

A 21-year-old female with no previous medical history presents to an outpatient clinic with a bilateral nipple piercing infection. She had both nipples pierced about 7 months ago, and over the past week had noticed yellow-green crusty drainage. She tried using saline as a soaking solution, but no improvement was seen. Both nipples were tender to the touch, but she denied redness or fever, injury, or history of eczema. Given the depth of the piercing, topical antibiotic ointment was not thought to be adequate. She is allergic to penicillin, so clindamycin was prescribed for presumed Staphylococcus aureus (the most common cause of this type of infection) or other gram-positive organism. No specimens were sent for culture at this initial visit. One week later she returned to the clinic. Her infection had initially improved, but her symptoms then worsened, with soreness and small amounts of draining pus. The pus was sent for bacterial culture, and ciprofloxacin and topical mupirocin were added at this visit to cover for gram-negative organisms (ciprofloxacin) and S. aureus that may be resistant to clindamycin (mupirocin). A Gram stain of the specimen showed gram-positive cocci in clusters and gram-negative diplococci (GNDC)2, some of which were intracellular (Fig. 1A). Fig. 1. Gram stain of pus showing intracellular gram-negative diplococci (arrow) (A). Colonies on chocolate agar (Remel) after 3 days of growth (B). Two colony types of bacteria grew on trypticase …

Value of light microscopy to diagnose urogenital gonorrhoea: a diagnostic test study in Indonesian clinic-based and outreach sexually transmitted infections services

IntroductionGonorrhoea is a common sexually transmitted disease caused by Neisseria gonorrhoeae (Ng) infection. Light microscopy of urogenital smears is used as a simple tool to diagnose urogenital gonorrhoea in many...

Notes from the Field: Increase in Neisseria meningitidis-Associated Urethritis Among Men at Two Sentinel Clinics - Columbus, Ohio, and Oakland County, Michigan, 2015.

Neisseria meningitidis (Nm) urogenital infections, although less common than infections caused by Neisseria gonorrhoeae (Ng), have been associated with urethritis, cervicitis, proctitis, and pelvic inflammatory disease. Nm can appear similar to Ng on Gram stain analysis (gram-negative intracellular diplococci) (1-5). Because Nm colonizes the nasopharynx, men who receive oral sex (fellatio) can acquire urethral Nm infections (1,3,5). This report describes an increase in Nm-associated urethritis in men attending sexual health clinics in Columbus, Ohio, and Oakland County, Michigan.

Invasive meningococcal disease with pericarditis and pneumonia: A rare presentation in childhood

Previously healthy 2-year-old boy presented with a 3-day history of fever, irritability and vomiting. There was no cutaneous rash. Ceftriaxone (100 mg/kg/day) and Dexamethasone 5.5 mg 6/6 h (on the first 3 days) were started and lumbar puncture was performed. Cerebral spinal fluid (CSF) showed 3.696 WBCs/μL with 99% neutrophils, glucose 1 mg/dL and total protein 578.0 mg/dL. CSF Gram stain showed extracellular and intracellular Gram-negative diplococci. Latex agglutination was reactive for N. meningitidis group C. The CSF culture was negative. After 6-day of antibiotic treatment patient started with dyspnea, dry cough and hypotension. Cardiorespiratory examination revealed an elevated jugular venous pressure, normal heart sounds, with no pericardial rub, coarse sounds with crackles over left base were heard. New CSF analyses showed 336 WBCs/μL with 61% neutrophils, 39% lymphocytes, protein 99.5 g/L and glucose 26 mg/dL (serum glucose 75 mg/dL). The CSF and blood cultures were negative. Chest X-ray showed an enlarged cardiac silhouette, consolidation in the left lung and pleural effusion. The antimicrobial treatment was changed to meropenem. Computed tomography of the chest showed moderate pleural effusion, consolidation in the left lobe. The cardiac echography revealed a pericardial effusion. There was no sign of imminent cardiac tamponade. Pericardiocentesis was performed and a total of 115 ml hemorrhagic pericardial fluid was aspirated. The fluid analysis demonstrated 1.460 WBC/mm3, with 85% polymorphonuclear neutrophils and 15% lymphocytes, total proteins of 4.5 g/dL, 836 U/L LDH and glucose 60 mg/dL. No microorganism was observed by Gram and Ziehl-Nielsen stain. The pericardial fluid culture to aerobic and mycobacteria was negative. Methylprednisolone was administered for five days. Patient was discharged after 14 days of antibiotic therapy with full recovery. We present a case of meningococcal meningitis that developed two rare manifestations associated in children: pericarditis and pneumonia (Fig. 1, Fig. 2, Fig. 3). Occurrence of cardiac tamponade in reactive pericarditis is most often associated in serogroup C infections [1], [2], serogroup predominant in Amazon [3]. Meningococcal pneumonia is more associated with serogroup Y [4]. The forms of presentation of pericardial involvement include: disseminated meningococcal infection with pericardial, primary meningococcal pericarditis and reactive meningococcal pericarditis [1]. The hypersensitivity reaction type 3 tends to occur during the convalescent period (4–10 days after the start of antibiotic therapy) [5]. Thought to be due to a hypersensitivity reaction to previously damaged pericardial tissue, which acts as an antigen stimulus to antibody formation [5]. If the effusion is large treatment is done with high doses corticoids [1]. Fig. 1 Chest X-ray showed an enlarged cardiac silhouette, consolidation in the inferior lobe of left lung and pleural effusion. Fig. 2 Computed tomography of the chest (CTC) showed left lung atelectasis, moderate pleural effusion and consolidation in the left upper lobe. CTC mediastinal window shows moderate pericardial effusion. Fig. 3 The cardiac echography revealed a pericardial effusion. There was no sign of cardiac tamponade.

P116 An audit of gonorrhoea management in a UK sexual health clinic

<h3>Background/introduction</h3> Gonorrhoea (GC) is a prevalent sexually-transmitted infection in the UK. The British Society for Sexual Health and HIV (BASHH) published guidelines in 2011 for the management of GC. <h3>Aim(s)/objectives</h3> To audit the management of all patients who tested positive for GC at our centre between 1 May 2013 and 1 May 2014 against BASHH guidelines. <h3>Methods</h3> A proforma was developed and a retrospective notes review performed for all patients who tested positive for GC from 1 May 2013 to 1 May 2014. <h3>Results</h3> 115 patients tested positive for GC during the audit period. The prevalence of GC in this cohort was 0.9%. 46% of patients had symptom (s), 54% were truly asymptomatic, 18% of patients presented as contacts. Microscopy was performed on 80% of symptomatic patients and intracellular gram-negative diplococci were seen in 66% of these. 97% of patients were diagnosed by PCR testing and one by culture. 2 patients were diagnosed elsewhere with negative testing at our clinic. 83% had GC cultures prior to treatment. The sensitivity of culture compared to PCR testing was 59%. 93% of patients were treated as per BASHH guidelines. 65% were documented to have received written information about their diagnosis. All patients were offered test of cure, of which 61% attended within 2 weeks. 92% of patients saw health advisers for partner notification. <h3>Discussion/conclusion</h3> Management of GC was largely in line with BASHH guidance. However, this study highlighted a need to increase written information offer and to encourage attendance for test of cure.

Answer to December 2014 Photo Quiz

Answer: Neisseria meningitidis. The intracellular and extracellular Gram-negative diplococci were identified as beta-lactamase-negative Neisseria meningitidis by the API NH system (bioMerieux, Durham, NC) and further serotyped as group Y at the Illinois Department of Public Health. No organisms

Neisseria Gonorrhoeae Bacteraemia: An Antipodean Case Study

The objective of this case study was to highlight the role played by our regional laboratory in identifying N. gonorrhoeae bacteraemia infection in an otherwise un-suspecting patient who presented to Emergency department with fever. Using blood culture technique with BACTEC 9240, plate culture, catalase test, oxidase test and Gram’s stain, preliminary diagnosis was made at the regional laboratory. Blood culture became positive on day 3 and Gram’s stain from culture day 4 identified intracellular Gram-negative diplococci. The blood picture showed neutrophilia and a raised CRP indicating an underlying bacterial infection. This helped the physicians in starting prompt treatment with Ceftriaxone 500 mg and Azithromycin 1 g. The culture plates and blood culture bottles were then sent to the referral laboratory where confirmatory diagnosis was made using MALDI TOF (Matrix Assisted Laser Desorption Ionisation- Time of Flight), that gave a reading of 2.2 and a VITEK 2 system that gave a 99% probability. The timely detection of Neisseria by the regional laboratory helped the local health authorities to isolate the patient and treat him promptly, thereby preventing the spread of this infection to other parts of his body.

Gonococcal Infections

Gonococcal Infections

Gonococcal Infections

Gonococcal Infections

A case of urethritis due to Ureaplasma urealyticum associated with L�fgren?s syndrome

Lofgren’s syndrome is characterized by a clinical triad of associated erythema nodosum, bilateral hilar lymphadenopathy and arthritis. This syndrome has usually been considered a specific form of sarcoidosis. We recently observed a case of characteristic Lofgren’s syndrome in a patient who presented simultaneously with urethritis due to Ureaplasma urealyticum. To the best of our knowledge, this report represents the first case of Lofgren’s syndrome in association with U. urealyticum. A 32-year-old man, with no notable medical history, was admitted to hospital with a 10-day history of periarticular ankle inflammation associated with fever of 38°C and dysuria without urethral discharge of 2 days’ duration. On physical examination, the patient appeared well. His temperature was 37.7°C, pulse was 80 beats per minute, blood pressure was 130/80 mmHg and respiratory rate was 16 breaths per minute. No lymphadenopathy, parotid enlargement or anterior uveitis were noted. Lung, heart, abdomen and neurologic examinations were normal. Bilateral periarticular ankle inflammation (swelling of both ankles with acute inflammatory signs and preserved articular motion) and erythematous nodules and plaques involving the anterior part of the calf were observed on both legs. The hematocrit, leukocyte and platelet values were normal. The erythrocyte sedimentation rate was 88 mm/h. The aspartate aminotransferase (104 U/l), alanine aminotransferase (187 U/l) and alkaline phosphatase (373 U/l) levels were elevated. The levels of urea, creatinine, calcium, protein electrophoresis and all other routine blood chemical values were normal. Urinalysis was positive for leukocyte esterase, and multiple leukocytes were seen on microscopic examination of urine. Urine culture was negative. A Gram stain of the urethral smear showed polymorphonuclear neutrophils, but no typical intracellular gram-negative diplococci, while tissue culture grew U. urealyticum. A blood culture and a tuberculin skin test with 5 units of PPD were negative. Viral and bacterial serologic studies were negative for Brucella spp., Salmonella spp., Yersinia enterocolitica, hepatitis B surface antigen, hepatitis C, syphilis and HIV. Autoantibody screening was also negative for nuclear and DNA antibodies. Tests for rheumatoid factor and HLA-B27 antigen were negative, and complement levels were normal. The angiotensin-converting enzyme level was 46.8 U/l (normal range 7.8–51.6). A chest radiograph revealed bilateral hilar adenopathy without parenchymal infiltration. A thoracic computed tomography scan showed multiple mediastinal lymph nodes up to 1 cm and bilateral hilar lymphadenopathy. A gallium-67 lung scan showed a pattern of uptake enlarged nodes in the paratracheal and mediastinal regions. Pulmonary function tests showed evidence of minimal airflow limitation. A biopsy of skin nodules was indicative of erythema nodosum. The patient was treated successfully with doxycycline, 100 mg twice daily for 10 days, and both cutaneous and articular manifestations healed completely within 3 weeks. At 1-year follow-up the patient remained without symptoms, and repeat angiotensin-converting enzyme measurement, chest radiograph and thoracic computed tomography were normal. U. urealyticum is probably the most frequent cause of non-chlamydial non-gonococcal urethritis, although its role as a pathogen has been controversial. It clearly causes symptomatic urethral infection, but it has also been found to colonize as many as 60% of asymptomatic men attending sexually transmitted disease clinics [1]. With regard to extragenital infections, sexually acquired reacM. Lopez-Gomez (*) . M. A. Lopez-Ruz . J. Jimenez-Alonso Section of Infectious Diseases, Service of Internal Medicine, Hospital Universitario “Virgen de las Nieves”, Avenida Fuerzas Armadas 2, 18004 Granada, Spain e-mail: mlopezg@fundacionhvn.org Tel.: +34-95-8157687 Fax: +34-95-8020494

Screening of men for sexually transmitted infection and partner notification

There is a widely held public perception that sexually transmitted infections declare themselves by producing symptoms. If this were true, screening would not be necessary. In 1951, the US Commission on chronic illness defined screening as: The presumptive identification of unrecognized disease or defects by the application of tests, examinations or other procedures which can be applied rapidly. Screening tests sort out apparently well persons who probably have a disease from those who probably do not. A screening test is not intended to be diagnostic. Persons with positive or suspicious findings must be referred to their physicians for diagnosis and necessary treatment. Screening in the sphere of reproductive health has been directed predominantly at women, especially in relation to breast and cervical screening. The medical profession has a greater awareness of asymptomatic cervical infection in women. The paper by Scholes et al. (1996) on prevention of pelvic inflammatory disease by screening for cervical chlamydial infection was the first report that screening women for cervical chlamydial infection reduces the risk of developing pelvic infection considerably. This paper has highlighted the potential benefits of screening for sexually transmitted infection, although screening is only part of the management process. Accurate diagnosis, investigation for other pathogens, adequate treatment with an appropriate antibiotic and partner notification (also called contact tracing) are essential if prevalence of infection and complications are to be reduced. Secondary prevention by early detection of sub-clinical disease through screening or case finding is required to prevent lower genital tract infection from ascending to the upper genital tract in women. Once symptoms develop in pelvic infection, substantial damage to the Fallopian tubes has already occurred. Little can be gained by tertiary prevention of more effective antimicrobial therapies. The importance of partner notification in preventing exposure to organisms resulting in repeat episodes of pelvic infection through continuing stimulation of the immune system has been highlighted by Paavonen (1996). There is ample evidence showing that asymptomatic infection is also common in men, particularly with the organism Chlamydia trachomatis, the commonest bacterial sexually transmitted infection in the UK. Screening should be targeted at those groups in which there is likely to be a prevalence of infections such as gonorrhoea, chlamydial urethritis or non-specific urethritis, to prevent pelvic infection and its sequelae most cost effectively. What screening should be undertaken in men? In relation to fertility, screening should identify the organisms that can, if present in the genital tract of women, cause pelvic infection, with the possible sequelae of reduced fertility and ectopic pregnancy. These organisms usually cause urethritis in men. Urethritis may be caused by the organism Neisseria gonorrhoeae or by other organisms, in which case the condition is referred to as non-gonococcal urethritis (NGU). Gonorrhoea Gonorrhoea is diagnosed presumptively on taking a urethral swab and identifying Gram-negative intracellular diplococci in the polymorphonuclear cells (PMN) present on a Gram-stained slide. The diagnosis is made by the growth of N. gonorrhoeae on an appropriate medium and identification of the organism by confirmatory tests. Gonorrhoea usually causes symptoms of urethral discharge and mild dysuria in about 90% of men with urethral infection. However, infection in the oropharynx produces symptoms in only about 20% of cases and > 66% of men with anorectal gonorrhoea have no symptoms of infection. Gonorrhoea is considered of high infectivity, and risk of transmission for a female having intercourse with an infected male is higher than that for a male having intercourse with an infected female (Thelin et al., 1980).

Gonococcal pericarditis with tamponade in a patient with systemic lupus erythematosus

Pericarditis is one of the most frequent manifestations of systemic lupus erythematosus; however, purulent pericarditis and tamponade are rare. We describe a patient with systemic lupus erythematosus and culture-proven gonococcal arthritis who developed purulent pericarditis with intracellular gram-negative diplococci. Evidence of tamponade was seen on echocardiography. There has not been a reported case of Neisseria gonorrhoeae in pericardial fluid or tissue since the introduction of antibiotics.

Spectrum of diseases due to Branhamella Catarrhalis in children with particular reference to acute otitis media

For many years Branhamella catarrhalis was regarded as a non-pathogenic inhabitant of the respiratory tract. This article outlines the spectrum of B. catarrhalis disease in childhood and the extent of the evidence for a pathogenic role of the organism. B. catarrhalis is a rare etiologic agent in septicemia, meningitis, and other systemic illness in both apparently normal and immunocompromised infants and children. It is an unusual cause of ophthalmia neonatorum, but can be confused with Neisseria gonorrhoeae. Whether or not B. catarrhalis is acquired from the birth canal in these cases has not been established. B. catarrhalis is most common as a respiratory tract pathogen in children, including pneumonia, bacterial tracheitis, sinusitis, and otitis media. Since it is difficult to rigorously document pathogenicity of any bacterium in bronchopulmonary infections in children, it is probable that the spectrum of B. catarrhalis disease is wider than that reported to date. The evidence for pathogenicity in acute otitis media is more extensive than for other infections. Otitis media due to B. catarrhalis is clinically similar to that due to other pathogens. B. catarrhalis can be isolated in pure culture from the middle ear exudate and persists if there is no antibacterial treatment. Gram-negative intracellular and extracellular diplococci can be seen on smears of the inflammatory exudate. There is preliminary evidence that there is an antibody response in B. catarrhalis otitis media. B. catarrhalis has emerged as an important and common pathogen in neonates, infants, and children.

Neonatal ophthalmia in the developing world. Epidemiology, etiology, management and control.

In the 19th century, the incidence of neonatal conjunctivitis varied between 1 and 14% in Europe, and the disease was a main cause of blindness at that time. Since then the epidemiology of ophthalmia neonatorum (ON) has changed and Chlamydia trachomatis is more frequent than Neisseria gonorrhoeae. Both are still very common causes of ON in the developing world. ON can not be differentiated clinically as to the etiology, but Intracellular Gram Negative Diplococci (IGND) on a Gram stain of an eye smear has an excellent validity and further differentiation can be made using microbiological cultures. All cases of presumed gonococcal conjunctivitis must be treated with effective systemic antibiotics. Systemic treatment with penicillin can still be used in areas where the percentage of beta-lactamase producing strains of gonococci is very low. For other areas a single dose of ceftriaxone intramuscular combined with saline eye washes is the treatment of choice. Chlamydial ON necessitates also systemic treatment with erythromycin. Parents of infants with gonococcal or chlamydia ON also need to be examined and treated. Prevention of gonococcal and chlamydial disease can be done following 3 strategies: antenatal diagnosis and treatment of maternal infections or disinfection of the infants eyes at birth or adequate treatment of infants and parents as soon as a ON has been diagnosed. Crédé's eye prophylaxis with silver nitrate has become a controversial issue, because of concern about the occurrence of chemical conjunctivitis and its ineffectiveness against infections with C. trachomatis.(ABSTRACT TRUNCATED AT 250 WORDS)

Neisseria meningitidis Conjunctivitis in Children

We examined two children from the same family who had purulent conjunctivitis. Isolates of Neisseria species were obtained from eye cultures and Gram stain of conjunctival scrapings disclosed many gram-negative intracellular diplococci. Colony structure and growth characteristics of the organism with subsequent carbohydrate fermentation tests and serotyping were consistent with Neisseria meningitidis Group B. The patients had no neurologic signs or symptoms. Results of laboratory investigations and blood cultures were normal. Early diagnosis is mandatory and aggressive systemic therapy with appropriate antibiotics may prevent ocular, neurologic, or systemic complications.

CLINICAL AND MICROBIOLOGICAL FEATURES OF BRANHAMELLA CATARRHALIS BRONCHOPULMONARY INFECTIONS

Branhamella catarrhalis bronchopulmonary infection was diagnosed in 101 patients with clinical lower respiratory tract infections by the presence of gram-negative intracellular diplococci in sputum and growth of more than 20 colonies of B catarrhalis in quantitative culture at a 10-7 dilution. 94 patients had either chronic chest disease or were current or previous smokers, 59 had a cause of generalised immunosuppression, and 17 had a high risk of aspiration from the oropharynx. The pathogenicity of B catarrhalis was evident from purulence of sputum, fever, blood leucocytosis, and patchy pulmonary shadowing on chest radiographs. B catarrhalis infection contributed to 4 of 6 deaths. B catarrhalis was the only bacterial pathogen isolated from the sputum of 71 patients and it was isolated with other recognised bacterial pathogens from 30 patients. All 10 isolates of B catarrhalis tested were sensitive to oxytetracycline, all 82 tested were sensitive to cefuroxime, 93 of 96 were sensitive to erythromycin, and 85 of 95 to cotrimoxazole. Beta-lactamase was produced by 38 of 99 isolates of B catarrhalis.