A study of the structure and functions of the submandibular ganglion

This study examines the prevalence of coagulase-negative Staphylococcus species in normal and mildly inflamed conjunctiva, their sensitivity to antibiotics, and their relationship to the remaining flora. PATIENTS AND METHODS: In 99 patients including 9 HIV-positives in an early stage of the infection, 100 conjunctival swabs were taken and microbiologically investigated for bacteria and fungi. Thirty-four were from healthy eyes. 40 were from patients with chronic (n = 28) and unspecific (n = 12) conjunctivitis, 17 were from patients with a variety of outer inflammatory ocular conditions, and 9 were from the HIV group from uninfected (n = 6) and infected (n = 3) conjunctivae. Samples from each patient were collected with three moistened cotton swabs and directly inoculated onto five different agars, followed by immersion into three specific culture broths. Staphylococci were identified species-wise, the other microorganisms genus-wise. Sensitivity to a broad spectrum of antibiotics was determined by agar diffusion tests. OUTCOME: Staphylococci were found in 89%, which was the highest prevalence genus-wise. Of those, coagulase-negative species accounted for 86%, while coagulase-positive Staphylococcus aureus was isolated in 12% of all swabs. In the 86 smears positive for coagulase-negative staphylococci, 151 different strains were isolated. In these strains, resistance to the 13 tested antibiotics varied from 0% for vancomycin to 66% for penicillin. Strains which were isolated from patients with chronic conjunctivitis showed a greater range of resistance than those from normal flora, with significant levels for ciprofloxacin, gentamycin and kanamycin (Mann-Whitney) U-test: P < 0.05). All except six strains of staphylococci were identified strains represented ten species, of which Staphylococcus epidermidis was most prevalent (74%), but only made up 70% of all isolated strains of the coagulase-negative staphylococci. Staphylococcus aureus and gram-negative bacteria were found significantly more commonly in patients which chronic conjunctivitis than in healthy eyes, while coagulase-negative species of the Micrococcaceae family were significantly more prevalent in the healthy than in the chronically inflamed conjunctiva (chi-square: P < 0.05). CONCLUSION: The conjunctiva can simultaneously host several stems of coagulase-negative staphylococci, which differ in regard to species and resistance to antibiotics. This variety might indicate a microbiological balance of the conjunctiva and be reduced in chronic inflammatory conditions. In patients with chronic conjunctivitis the risk for multiresistant coagulase-negative staphylococci is increased.     

Reproducible model of a bacterial conjunctivitis

To test the efficiency of antimicrobial substances on bacterial conjunctivitis under standardized conditions a reproducible model is needed. As there are no data in the literature concerning this topic we have developed a model of bacterial conjunctivitis in the rabbit eye. Instillation of a suspension of Haemophilus influenzae, Staphylococcus epidermidis or Staphylococcus aureus into the cul-de-sac did not result in any effect. Thus, standardized techniques of conjunctival incision were used additionally. A follow-up was done for a period of 2 weeks (degree of conjunctival hyperemia, microbiology). Radial incision of the conjunctiva with injection of an S. aureus suspension (50 microliters of ATCC 29213; 1.35 x 10(8) cells) was done mimicking a branch injury. This resulted in a purulent conjunctivitis over a period of 1 week and disappeared within 14 days. The swabs were negative on day 7. This is the first model establishing a reproducible purulent conjunctivitis in the rabbit. Using this model antimicrobial substances may be tested under standardized conditions.     

Ocular manifestations of toxic epidermal necrolysis associated with allopurinol use

A 54-year-old man was receiving allopurinol therapy to treat hyperuricemia that followed an inferior wall, myocardial infarction. After three weeks of allopurinol therapy, the patient developed signs and symptoms of toxic epidermal necrolysis that included pseudomembranous conjunctivitis with ulcerative lesions on the lids and conjunctiva, and punctate corneal staining with subsequent corneal abrasions. Treatment with topical antibiotics and artificial tears relieved the symptoms somewhat, but punctate staining and dry eyes persisted after 14 months of follow-up. Bilateral corneal ulcers developed and necessitated conjunctival flaps in each eye. Visual acuity in each eye was 20/40.     

Use of enteric vaccines in protection against chlamydial infections of the genital tract and the eye of guinea pigs

Guinea pigs in a test group were fed living guinea pig inclusion conjunctivitis (GPIC) organisms classified as Chlamydia psittaci in 60% yolk-sac suspensions as enteric vaccines, while animals in a control group received uninfected yolk sac. Seven test animals and 14 control animals were challenged 11 or 22 days later with 1,000 50% infectious doses of GPIC organisms in either the conjunctiva or the vagina. Evidence of protection from mucosal infection in both sites was noted in test animals. Clinically, the disease was less severe, and microbiologically, lower percentages of mucosal cells were infected. The results suggest that enteric vaccination against mucosal infections of the eye and the genital tract with chlamydial agents is possible.     

Endosonography-guided celiac plexus neurolysis

This study was motivated by the sporadic observation of epiphora in two male rabbits. The epiphora was unilateral and not associated with conjunctivitis or Pasteurella infection. To characterize the cause of epiphora, we studied 15 specific-pathogen-free New Zealand White rabbits. This study group was composed of the two affected males, four unaffected males, and nine unaffected females. Clinical evaluation consisted of bacterial culture of conjunctival specimens, examination of conjunctival scrapings for chlamydial inclusions, culture and cytologic examination of specimens from the nasolacrimal duct, plain and contrast radiography, latex casting, histologic examination, and the Schirmer tear test. Important differences found in the rabbits with epiphora included an opalescent, gritty, nasolacrimal duct flush fluid and marked unilateral dilatation of the duct proximal to a dorsal flexure at the caudal limit of the incisor tooth root. The flush solution from one affected rabbit cleared with ether, suggesting the presence of triglycerides or cholesterol. The organisms most commonly isolated from the conjunctiva were Moraxella sp., Oligella urethralis, Staphylococcus aureus, coagulase-negative Staphylococcus sp., and Streptococcus viridans. The organisms most commonly isolated from the nasolacrimal duct flush fluid were Moraxella sp., S. viridans, and Neisseria sp. Culture of the nasolacrimal duct flush fluid yielded microorganisms more consistently than did culture of the conjunctival specimens. All microorganisms isolated from affected rabbits also were isolated from unaffected rabbits. There was no apparent contribution of microorganisms to the development of epiphora, and Schirmer tear test results for affected animals were within the range seen in unaffected animals. Occlusion of the nasolacrimal duct was presumed to be attributable to fat droplets. This study augments the existing literature and represents the first report of anomalous nasolacrimal duct anatomic features in the rabbit.     

Model for ocular tear film function

Blepharitis patients have a number of disturbances in their tear film associated with meibomian gland dysfunction that affect evaporation and tear osmolarity. We tested a series of 156 consecutive patients, with a presumed diagnosis of blepharitis, dry eye, or allergic disease, and a series of 72 normals. We compared their tear film characteristics using tear osmolarity, tear volume, tear production (fluorophotometric and Schirmer test), tear turnover (decay constant), tear evaporation, and meibomian gland function evaluated by gland drop-out, expressed lipid viscosity, and volume. Of the 156 patients tested, we found 37 had dry eye, 10 had only allergic disease, 73 had meibomian gland dysfunction and dry eye, and 36 had only meibomian gland dysfunction. We created a model of the relative influence some of these factors had on each other using their correlation coefficients. The highest correlations for osmolarity were Schirmer test (-0.44), lipid volume low (-0.44), lipid viscosity high (0.39), gland drop-out (0.39), and tear evaporation (0.36). With regression analysis we accounted for 47% of the total variation in osmolarity, but only 17% of the variation in tear evaporation. We also present our classification system for blepharitis and dry eye patients based on our measurable physiologic parameters.     

Epidermolysis bullosa acquisita diagnosed by direct immunoelectron microscopy of the conjunctiva

OBJECTIVE: To describe for the first time the direct immunoelectron microscopic pattern of immune deposits on the conjunctival basement membrane in epidermolysis bullosa acquisita (EBA). DESIGN: Case reports. PARTICIPANTS: Two patients. INTERVENTION: Epidermolysis bullosa acquisita associated with cicatrizing conjunctivitis. MAIN OUTCOME MEASURES: Direct immunofluorescence and direct immunoelectron microscopy without freezing on conjunctival and skin biopsy specimens, indirect immunofluorescence, Western immunoblot analysis. RESULTS: Results of direct immunoelectron microscopic examination of the conjunctiva showed the presence of immune deposits in the anchoring fibril zone, just beneath the lamina densa, in both patients. This finding was the same as the direct immunoelectron microscopic pattern shown in the skin of these patients, which is known to be very specific for EBA. Direct immunofluorescence was positive in the conjunctiva of only one patient. Indirect immunofluorescence and Western immunoblot analysis failed to detect circulating autoantibodies. CONCLUSIONS: Direct immunoelectron microscopy on the conjunctiva is a useful diagnostic tool to differentiate EBA from other related autoimmune mucocutaneous blistering diseases.     

Comparison of nested polymerase chain reaction, virus isolation, and fluorescent antibody testing for identifying feline herpesvirus in cats with conjunctivitis

OBJECTIVE: To compare nested polymerase chain reaction (PCR), virus isolation (VI), and fluorescent antibody (FA) testing to detect feline herpesvirus (FHV) in cats with naturally acquired conjunctivitis or respiratory tract disease, or both. SAMPLES: Swab and microbrush specimens from the conjunctiva and throat were taken from 46 cats, allotted to 3 groups (conjunctivitis only, respiratory tract disease and conjunctivitis, and clinically normal). PROCEDURE: Cells from microbrush specimens were digested and herpesvirus DNA was amplified, using a double round of PCR. Products were detected by use of agarose gel electrophoresis. The VI and FA tests were performed in routine manner. RESULTS: Of 16 cats with conjunctivitis only, conjunctival specimens from 8 and throat specimens from 8 were FHV positive by PCR. None had positive results of VI or FA testing. Of 15 cats with respiratory tract disease and conjunctivitis, conjunctival specimens from 13 and throat specimens from 12 were FHV positive by PCR. A conjunctival specimen from 1 cat and throat specimens from 3 cats were FHV positive by VI. A conjunctival specimen from 1 cat was FHV positive by FA testing. Of 15 clinically normal cats, conjunctival and throat specimens from 2 cats were FHV positive by PCR; neither conjunctival nor throat specimens from these cats were FHV positive by VI or FA testing. CONCLUSION: For cats with respiratory tract disease and conjunctivitis, or with conjunctivitis only, nested PCR was more sensitive at detecting FHV than was VI or FA testing. CLINICAL RELEVANCE: Nested PCR is a more sensitive test than the currently available VI and FA tests for identifying FHV in cats with conjunctivitis.     

Therapeutic and prophylactic effect of prepartum antibiotic infusion in heifers

Prepartum bacteriologic examination of secretions from 42 dairy heifers 12-14 weeks prepartum revealed a total of 24 Staphylococcus aureus infected quarters, 53 Staphylococcus species infected quarters, and 20 Streptococcus species infected quarters. Prepartum intramammary therapy of primigravid dairy heifers with two commercially available dry cow antibiotics (penicillin-novobiocin or cephapirin) resulted in cure rates of 94%, 97%, and 100% for S. aureus, Staphylococcus species, and Streptococcus species intramammary infections (IMI), respectively. No protective effect was observed for dry cow treatment of uninfected quarters of heifers for any of the antibiotic preparations. No antibiotic was detectable in heifer secretions collected at parturition indicating that antibiotic concentrations may have fallen below protective levels prior to parturition.     

A review of the causes and treatment of bacterial and allergic conjunctivitis

The most common causes of ocular inflammation are allergic or infectious in origin. A presumptive diagnosis can often be made through a comprehensive patient history and evaluation of presenting signs and symptoms, although the constellation and intensity of clinical findings may vary. Patients with allergic conjunctivitis often have itchy, red eyes, whereas patients with bacterial conjunctivitis often give a history of morning crusting and difficulty opening the eyelids. The treatment of patients with allergic conjunctivitis includes avoiding the offending allergen and applying topical antihistamines, mast cell stabilizers, or nonsteroidal anti-inflammatory agents. Streptococcus pneumoniae and Haemophilus influenzae are responsible for most cases of bacterial conjunctivitis in children. Staphylococcus species is the predominant organism in adults. Therefore, the treatment of patients with bacterial conjunctivitis consists of an antimicrobial agent with a broad spectrum of activity against most susceptible pathogens. Other causes of inflammation need to be considered in patients with atypical clinical signs and symptoms and in patients who do not respond to presumptive therapy.     

Corynebacterium macginleyi has to date been isolated exclusively from conjunctival swabs

Fifteen strains of Corynebacterium macginleyi were exclusively isolated from conjunctival swabs of patients with either conjunctivitis or corneal ulcers. Up to now, only three C. macginleyi strains had been described in the literature. The characteristics of the 15 patients from whom C. macginleyi was isolated are outlined, characteristics useful for the identification of C. macginleyi are described, and the antimicrobial susceptibility pattern of the species is provided. C. macginleyi is uniformly susceptible to penicillins, quinolones, and aminoglycosides. Although considered to be of rather low pathogenicity C. macginleyi seems to have the potential to cause superinfections in selected patients with ocular surface problems.     

Transient and persistent increases in protein phosphatase activity during long-term depression in the adult hippocampus in vivo

In a 34-month prospective study to determine the prevalence of Staphylococcus aureus small colony variants (SCVs) in cystic fibrosis (CF) patients, S. aureus SCVs or SCVs plus normal S. aureus were recovered from 26 of 78 patients; 27 patients harbored only normal S. aureus. By pulsed-field gel electrophoresis, clonal identity was demonstrated of SCV and normal strains isolated at the same time and of multiple S. aureus SCV and normal strains in consecutive specimens from individual patients. All S. aureus SCVs were resistant to antifolate antibiotics, while the corresponding parent strains were susceptible, and in 11 of 12 SCV/normal pairs, gentamicin was less active against S. aureus with the SCV phenotype than against the normal isolate. Analysis of the underlying auxotrophism of SCVs revealed hemin, thymidine, and/or menadione dependencies. Thus, S. aureus SCVs are highly prevalent in respiratory secretions of CF patients, persist over extended periods, and may contribute to S. aureus persistence in CF patients.     

Use of liposome-immunopotentiated exopolysaccharide as a component of an ovine mastitis staphylococcal vaccine

Experiments on the development of a vaccine against staphylococcal mastitis were carried out in ewes. The vaccine (Spanish patent no. 9200223) has the following components: (i) inactivated (formalinized) bacteria (Staphylococcus aureus and a coagulase-negative staphylococcal species. Staphylococcus simulans) and S. aureus toxoid in presence of an adjuvant (dextran sulfate, Mw 500,000); and (ii) S. aureus exopolysaccharide included within liposomes. High serum antibody titres were obtained against whole cells from Staphylococcus aureus, Staphylococcus simulans, Staphylococcus hyicus and Staphylococcus epidermidis strains. However, there was no response to cells from Staphylococcus warneri and Staphylococcus chromogenes strains. An immune response (serum IgG) against the inoculated exopolysaccharide was obtained when > or = 20 micrograms of exopolysaccharide were included in liposomes and when > or = 20 mg of exopolysaccharide were adjuvanted with dextran sulfate instead of liposomes. For experimental infection assays, ewes were vaccinated during pregnancy and challenged either with a low virulence S. simulans strain or with a highly virulent S. aureus strain. In these assays, the incidence of S. simulans subclinical mastitis and of S. aureus acute mastitis was significantly lower in vaccinated animals than in unvaccinated controls. Specifically, on challenge with S. simulans, two out of 14 glands became infected among the vaccinated animals and nine out of ten glands in the unvaccinated group (p < 0.001). On challenge with S. aureus, no protection was detected when component (ii) was omitted from the vaccine; nine out of ten animals developed mastitis (two mild, two moderate and five severe).(ABSTRACT TRUNCATED AT 250 WORDS)     

Persistence of Staphylococcus aureus strains among cystic fibrosis patients over extended periods of time

Pulsed-field gel electrophoresis (PFGE) of SmaI macrorestriction fragments of chromosomal DNA was used to confirm the persistence of methicillin-sensitive Staphylococcus aureus isolates in the sputum of 25 cystic fibrosis patients in five French hospitals. Three-to-eight consecutive isolates, with the same esterase electrophoretic type isolated from each patient over a period of 12-28 months, were analysed. Consecutive isolates with indistinguishable PFGE profiles were found in 12 patients (48%) and consecutive isolates with similar PFGE profiles showing minor differences of one-to-four fragments (similarity coefficient >/=84%) were found in 11 patients. Consecutive isolates with different PFGE profiles were obtained from only two patients, but the profiles found in each patient were more closely related to each other than to other profiles. The results were in agreement with esterase electrophoretic typing for 23 patients, and we considered that those patients were infected with a single persistent strain. For any given patient, variations in antibiotypes and phage types of consecutive isolates were not associated with major genotypic variations. PFGE is useful in confirming the persistence of S. aureus strains in cystic fibrosis patients over long periods.     

Clinical experience of orthotopic urinary reservoirs in male patients with bladder cancer

Demodex folliculorum has been demonstrated with an elevated frequency in patients with blepharitis, and is thought to cause therapy-resistant blepharitis. This paper presents the germ spectrum of patients with blepharitis and demodex and discusses the efficiency of a specific therapy. METHODS: In all, 3152 cilia from 139 patients with blepharitis (38% blepharitis, 44% blepharoconjunctivitis, others) and 108 persons with quiet eyes were examined for demodex. Smears n = 125, from the conjunctive of symptomatic patients were investigated for bacteria, 3 weeks of therapy with mercury ointment, 2%: Lindan, cortisone (prednisolone, dexamethasone, hydrocortisone, fluorometholone) or antibiotics after antibiogram (gentamicin, kanamicin, neomicin, erythromicin, ofloxacin, polymyxin-B, colistin) followed in all Demodex-positive blepharitis patients (n = 41). RESULTS: Demodex was found in 52% (62/139) of patients with chronic blepharitis, as against 20% (3/15) of those with acute blepharitis (statistically significant difference, chi 2-test, alpha = 2.5%) and in 29% of quiet eyes (statistically significantly less, alpha = 2.5%, chi 2-test). Gram-positive cocci were isolated from 79% of 57 Demodex-positive patients with blepharitis and 72% of 68 Demodex-negative patients anaerobes in 39% and 37%, gram-negative rods in 11% and 3% (statistically significant difference for gram-negative rods, alpha = 5%, chi 2-test). Of the patients with Demodex, 25% apparently had no more parasites after mercury ointment, 2% (n = 8) and lindan (n = 5) and 15% after cortisone and antibiotics (n = 13). (The best and statistically very significant results (alpha = 1%) were those obtained with mercury ointment, 2%, and lindan: t-test for connected spot checks). CONCLUSIONS: Gram-positive and gram-negative bacteria grew more often in patients with Demodex. Demodex seems to be a mediator of chronic blepharitis; we recommend that mites be sought in cilia of chronic blepharitis patients. Mercury ointment, 2% and lindan proved efficient for specific therapy, the main problem being the laborious application and toxicity.     

Study on 190 strains of "staphylococcus aureus" isolated in a department of ophthalmology (author's transl)

Biochemical features and sensitivity to chemotherapeutic agents of 190 strains of Staphylococcus isolated from pharinx and conjunctiva of ophtalmological patients and staff were studied. Each strain was investigated for: pigment, coagulase, hemolysis (alpha-toxin), phosphatase and penicillinase production and mannite fermentation. Twentyfour chemotherapeutic angents were used for sensitivity tests. The Authors emphasize that a positive coagulase test is the best laboratory evidence for pathogenicity of a given strain of Staphylococcus, and that the site of isolation of the examined strains is not related with their biochemical features and sensitivity to chemotherapeutic agents.     

Toxin involvement in staphylococcal scalded skin syndrome

The production of staphylococcal exfoliative toxin A (ETA) and toxin B (ETB), toxic shock syndrome toxin (TSST-1), and enterotoxins A-E was analyzed in 60 Staphylococcus aureus strains isolated from children with scalded skin syndrome (15 with generalized exfoliative syndrome, 28 with bullous impetigo, and 17 with staphylococcal scarlet fever). All strains isolated from patients with generalized exfoliative syndrome or bullous impetigo produced ETA and/or ETB and caused a Nikolsky's sign when injected subcutaneously into newborn mice. In contrast, exfoliative toxin was detected in an S. aureus strain from only one of 17 case of staphylococcal scarlet fever; the 16 other S. aureus strains produced TSST-1 and/or an enterotoxin. In conclusion, enterotoxins or TSST-1 are more frequently associated with staphylococcal scarlet fever than are exfoliative toxins. Hence staphylococcal scarlet fever may well represent an abortive form of toxic shock syndrome rather than a milder form of staphylococcal scalded skin syndrome.     

The lacrimal drainage system: pressure changes in the canaliculus

In order for tears to be removed from the eye, pressure gradients must be created in the ducts which lead to the nose. Blinking is only one of a number of mechanisms potentially capable of doing this. Pressure in the lacrimal canaliculus was recorded during voluntary blinks, tight squeezing of the lids, eye movements, and pressure changes in the nose. The results show that all of these produce pressure changes in the canaliculus.     

Aggravation of experimental allergic conjunctivitis by environmental chemical and physical factors

The effects of trichlorfon (DEP, Dipterex, anticholinesterase pesticide) and paraquat dichloride (Gramoxon, inhibitor of superoxide dismutase) on passive anaphylactic reaction in guinea pig conjunctiva using Japanese cedar pollen were quantitatively studied. For estimation of allergic conjunctivitis, Evans blue after i.v. injection was extracted from conjunctiva and measured spectrophotometrically. Allergic conjunctivitis was apparently aggravated by extremely low dosages of organophosphorus pesticide (10(-5) mg/kg) and organochlorine herbicide (10(-4) mg/kg). The aggravation of allergic conjunctivitis was also observed after exposure to cathode ray tubes used in commercial television, possibly due to electromagnetic waves. IgE-mediated allergic reaction could be non-specifically potentiated by such environmental factors.     

Heterogeneity of staphylococci and other bacteria isolated from six-week-old broiler chickens

In broiler operations, various health problems develop during the final 2 wk of the growing period, resulting in increased mortality and condemnation losses. At this stage, sickly birds were found to be systemically infected by various bacteria regardless of varied clinical signs, and the purpose of this study was to carry out thorough microbiological investigations on this problem. Thirty-one 6-wk-old broilers showing signs of illness were obtained from three farms, and bacterial isolations were carried out from the blood, liver, and hock joint. Bacteria were isolated from 87, 90, and 71% of the blood, liver, and hock joint samples, respectively. Mean bacterial counts in log10 of the blood (per milliliter) and liver (per gram) were 2.15 and 2.93, respectively. Among 132 bacterial isolates, major species were Staphylococcus (60%), Corynebacterium (18%), Escherichia coli (5%), and Stomatococcus (4%). Among 79 Staphylococcus isolates, 77 were coagulase-negative. Major species of staphylococci were S. lentus (19%), S. simulans (18%), S. cohnii (13%), S. gallinarum (10%), and S. captis (7%). In addition, six species of gram-positive and five species of gram-negative organisms were isolated. Thus, the apparent systemic infections were not caused by predominant pathogenic bacterial species, and adequately described as mixed infections. There were some significant relationships between isolated bacterial species and sampling sites, suggesting that certain organisms were abundant in the environment of a particular poultry house. These results indicate that systemic infections in market age broilers are caused by mixed bacterial species and suggest that they are caused by suppressed host antibacterial systems rather than pathogenic factors of microorganisms.