VARIOUS hzemophilic bacilli have been described as responsible for fatal endocarditis in the human subject (Miles and Gray, 1938). The case described below is apparently the first on record due to a hsmophilic bacillus that has the X and V requirements of H . canis, i.e. is capable of synthesising V but not X factor. DESCRIPTION OF CASEThe patient, a female aged 28, was admitted to University College Hospital on 30.7.38 under Dr Kenneth Harris with a history of fever (up to 104' F.), generalised muscular pains, headache and vomiting fm ten days and of " red " urine for five days. On the 11th day faint presystolic and blowing systolic murmurs ; blood and albumen in urine : anzmia, which persisted till death; no leucocytosis. A haemophilic bacillus was isolated from the blood. The patient remained in statu quo, with continued pyrexia and bacteriemia, and was discharged a t her own request on the 91st day. She was readmitted in a semi-comatose condition on the 161st day. Two days later bronchopneumonia became manifest and muco-purulent oropharyngitis due to Staph. aurew.For two periods chemotherapy was attempted, first with a total of 26-7 g. of sulphanilamide, and later with a total of 96 g. of 2-sulphanilyl-aminopyridine. Both drugs reduced the pyrexia during the period of administration, but the degree of bacteriaemia (20-100 organisms per c.c.) was unaffected.On four occasions during life the haemophilic bacillus was isolated from the blood. Growth occurred in fluid media incubated in air and in air containing 5 per cent. CO,, but subculture on to solid media was successful only when the plates were incubated in air + 5 per cent. CO,. All four strains were alike morphologically and biochemically. The last two were agglutinated to the same titre by an antiserum prepared against one of them (the first two strains died before the serological tests were made).Death occurred on the 165th day. Post-mortem $ n d i n p ( 8 hours after death) S k i n : numerous peteohie on abdomen and chest. Heart: 360 g. Mitral valve showed subacute * This work formed part of a thesis for the Ph.D. degree of tlie University f With a grant from Fouad I University, Cairo. JOURN. OF PATE.-YOL. L 487The American illustratod medical dictionary, 18th ed., Philadelphia and London, 1938.

SYNOPSIS IN INTERLINGUA LE NON-AEROBIOS DE BACTERIEMIA POST EXTRACTION.-Con le objective de investigar le rolo de anaerobios in bacteriemia post chirurgia, culturationes sanguinee de ante e post extraction esseva effectuate in 100 patientes. Le culturationes de ante le extraction se provava sterile, sed in 64 casos illos de post le extraction esseva positive. Le lineas isolate esseva 67 lineas aerobie e 88 non-aerobies. Le lineas non-aerobie include 5organismos strictemente dependent de C02, 46 anaerobios obligatori, e 37 crescent tanto anaerobiemente como etiam in aere con un contento de 5 pro cento de CO2. Tres aliquots de omne specimen individual esseva incubate in tres different atmospheres gasose. Le precision del studios esseva promovite additionalmente per le meticulose uso de bottilias anaerobic con bouillon "Liquoid."

No abstract

SYNOPSIS Pre-and post-extraction blood cultures were taken from 242 patients. The post-extraction ones were taken from 100 unpremedicated patients, from 42 with an erythromycin estolate cover, and from 100 patients after protection with pyrrolidino methyl tetracycline. The 100 post-extraction blood cultures from unpremedicated patienits gave 64 positive results which yielded 155 strains, 88 of which were not aerobes.One hundred and fifteen representative strains were tested for sensitivity to 22 antibiotics. Of the 42 patients who received the erythromycin orally, 16 yielded positive blood cultures of mixtures of aerobes and anaerobes and of the 100 given one intravenous injection of the tetracycline three only developed a bacteraemia of a single type of aerobe. The serum concentrations obtained with the tetracycline given intravenously were 15 to 20 times higher than the serum levels obtained with the erythromycin given orally.There is a strong indication for using this kind of efficient antibiotic cover for dental extractions and other operative procedures known to be followed by a bacteraemia.Bacterial endocarditis is in many cases the result of bacteraemia produced by operative procedures, among which is tooth extraction. It is stated that 25 to 50% of endocarditis patients had one or more teeth extracted some two months before the onset of the valvular ailment (Cates and Christie, 1951). Northrop and Crowley (1943) reported 23 such cases, and 94 other cases are on record by various other authors.The bacteraemia of tooth extraction is transient, lasts about 10 minutes (Northrop and Crowley, 1943; Okell and Elliott, 1935), and the bacteria are most numerous in the blood stream within the first two minutes of their introduction into the circulation (Reichel, 1939). In persons with heart valves damaged by rheumatic fever, syphilis, or a congenital defect, the platelet-and-fibrin thrombi on the surface of the diseased valves trap some of the bacteraemic organisms, which then multiply and start an endocardial vegetation. The circulation time from the site of a tooth socket to an elbow vein is less than 18 seconds (Koch, 1922 56For an antibiotic cover during dental extraction various investigators tried sulphonamide compounds, penicillin, and other antibiotics, but all except one failed to isolate one single anaerobe in their unpremedicated post-extraction control blood cultures. Using sulphanilamide, Pressman and Bender (1944) obtained 7 % reduction (from 83 % to 76%) and Northrop and Crowley (1943) 5*4% reduction (from 15% to 9 6%). With penicillin the reductions varied from 9 % (Hirsch, Viveno, Merril, and Dowling, 1948) to 42 % (Schirger, Martin, Royer, and Needham, 1960). With antibiotics other than penicillin the reductions were 61 % (Khairat: the present work, the highest reduction ever obtained, in a series of 100 patients with 88 anaerobes isolated), 44 % (Roth, Cavallaro, Parrott, and Celentano, 1950) with aureomycin orally, 280% (Bender, Pressman, and Tashman, 1958) using streptomycin sulphate intra...

No abstract