Multiple introductions of methicillin-resistant Staphylococcus aureus (MRSA) strains occurred to a new hospital in Hong Kong. Two years of clinical microbiological surveillance of the resulting outbreaks was combined with laboratory investigation by phage and antibiogram typing, and plasmid profiling. The outbreaks on the special care baby (SCBU) and burns (BU) units were studied in detail, and colonization of staff and contamination of the environment were investigated. MRSA were spread by the hands of staff on the SCBU, where long-term colonization of dermatitis was important, but were probably transmitted on the BU by a combination of the airborne, transient hand-borne and environmental routes. Simple control measures to restrict hand-borne spread on the SCBU were highly effective, but control was not successful on the BU.

Corynebacterium jeikeium causes septicaemia in neutropenic patients usually after colonizing intravenous lines. This paper reports the results of immunoblotting sera from 14 patients with a C. jeikeium septicaemia. Recovery from the septicaemia was associated with production of both IgM and IgG against antigenic bands of 50, 52 and 110 kDa. Antibody against the 110 kDa band was present in controls but the antibody against the 50 and 52 kDa was specific to those patients who had on-going or previous C. jeikeium infection. A case of C. jeikeium endocarditis is also presented and here recovery was associated with seroconversion to the 50 and 52 kDa bands.

The present study has attempted to determine the colonization resistance (CR) of the digestive tract by biotyping Enterobacteriaceae in four faecal samples per subject of five different animal species as well as man. The results indicate that the degree of bacterial contamination with Enterobacteriaceae from the environment may strongly influence the outcome. Both conventionally living chicken and man, showed a much wider range of the ‘confidence limits of the mean’ of the mean number of biotypes per faecal sample between individual subjects, than was found between subjects maintained under laboratory circumstances. Yet there appeared a statistically significant difference in CR between some of the animal species as a group. Man did not differ from monkeys, however, both differed from the rodents species studied. Monkeys differed also from dogs and the latter from rodents. It is concluded that the CR measured by determining the mean number of biotypes of Enterobacteriaceae can only be used for accurate comparison of the CR between subjects, if the ‘bacteriological environment’ is known; i.e. the sources of contamination.

Ninety-six isolates of presumptive or confirmed Listeria monocytogenes were obtained from local clinical (30 isolates) or food laboratories (66 isolates). Minimal biochemical analysis identified only 80% of these isolates as L. monocytogenes the remaining included L. seeligeri, 1%, or the non-haemolytic L. innocua, 19%. The 27 clinical and 50 food isolates, mainly from meat products, frozen confectionaries, and cheeses, confirmed as L. monocytogenes were compared biochemically and serologically. Twenty-one isolates, including some strains of L. innocua and L. seeligeri, were examined for pathogenicity in immunocompromized mice and 44 typed using bacterial restriction endonuclease DNA analysis (BRENDA). Only isolates of L. monocytogenes were found to be pathogenic. Biovar-typing of the isolates was unreliable and provided poor discrimination. Serogroups 1/2 and 4 predominated among clinical and food isolates and BRENDA provided better discrimination among isolates. Ten stable and reproducible restriction patterns were observed among the Listeria sp. isolates studied. Overall, a combination of techniques gave the best discrimination and indicated their potential for use as epidemiological tools.

Cell surface hydrophobicity, haemagglutination pattern and adherence to HeLa cells were examined in 230 strains of Escherichia coli collected from women (n = 61 strains) and children (n = 65 strains) with non-obstructive acute pyelonephritis and in 104 faecal control strains of E. coli from healthy adults (n = 71 strains) and children (n = 33 strains). Pyelonephritogenic E. coli strains showed a significantly increased incidence of hydrophobic properties (90%) and mannose resistant haemagglutination (MRHA) of human erythrocytes (83%) than faecal control strains (64 and 23% respectively, P < 0·001 in both cases). Mannose sensitive haemagglutination (MSHA) was observed in 48% of the pyelonephritogenic E. coli strains and in 50% of the faecal control strains (NS). The incidence of adherence to HeLa cells was low both in pyelonephritogenic and faecal control strains, 6 and 7% respectively (NS). The bacterial phenotypes MRHA + MSHA + and MRHA + MSHA− appeared significantly more often in pyelonephritogenic E. coli strains (35 and 48% respectively) than in faecal control strains (5 and 17% respectively, P < 0·001 in both cases). The phenotype MRHA − MSHA + occurred significantly more often in control strains (45%) than in pyelonephritogenic strains (13%, P < 0·001). Eighty-three per cent of the pyelonephritogenic E. coli strains expressing hydrophobic properties showed MRHA and 50% of the hydrophobic strains showed MSHA. There were no significant correlations between cell surface hydrophobic properties and haemagglutination pattern or adherence to HeLa cells in pyelonephritogenic E. coli strains nor in faecal control strains.

DNA restriction endonuclease (Hae III and Hind III) total digest and 16S and 23S ribosomal (r)RNA gene patterns (ribopatterns) were determined for 18 isolates of Campylobacter jejuni from three separate outbreaks of diarrhoea in the north of England. Strains were also characterized by biotyping, serotyping and phage typing. Comparisons of the DNA patterns by visual and numerical methods revealed five distinct strain groupings with clear differences between isolates from different outbreaks as well as some heterogeneity between strains within the community outbreak and one of the school outbreaks. An excellent correlation was observed between the genomic DNA fingerprints data and the Preston bacteriophage group, both of which gave better discrimination than biotyping and serotyping alone or in combination. Only one phage group (PG 37) was not confirmed by the DNA data. DNA fingerprints therefore provide additional information of value in studying the epidemiology of outbreaks of C. jejuni.

Sixty-one isolates of Aeromonas spp. from the faeces of pigs, cows and a variety of associated environmental sources were examined for the characteristics that are reputed to have roles in pathogenicity. Most isolates of Aeromonas hydrophila were cytotoxic (96·4%) and were capable of producing cell elongation factor (75%) and haemagglutinins (67·9%). In contrast few of the Aeromonas caviae isolates produced these three markers (13·6 %, 27·3% and 36·4% respectively). In general, Aeromonas sobria occupied an intermediate position (36·4%, 27·3% and 54·5%), but they did produce the highest mean invasion index for HEp-2 cells. Statistical analysis revealed significant associations between the carriage of these factors and it was clear that many isolates of aeromonads from water and animals possessed the full battery of putative virulence factors.

Salmonellas were detected in the environment of 10 of the 12 calf dealers' premises studied. The cleaning and disinfection routines were often ineffective and salmonellas were isolated from 7·6 % and 5·3 % of the wall and floor samples before disinfection and 6·8% and 7·6% afterwards. Eight different salmonella serotypes were detected, of which the commonest were Salmonella typhimurium, predominantly phage type DT204C, and S. dublin. Plasmid profiles were used to fingerprint S. typhimurium DT204C and the results indicated that with the exception of one of the premises, prolonged salmonella-persistence in the environment was not occurring.

Three separate epidemics of salmonellosis in calves were studied by use of plasmid profile analysis. The results illustrated the role of dealers, and their subcontractors, in the dissemination of salmonellas. The study concludes with suggestions for methods to reduce the spread of salmonellas in the calf marketing chain.

An epidemiological survey was conducted on two commercial turtle farms in southern Louisiana to determine the reason for an apparent increase in the prevalence of Salmonella spp. in turtle hatchlings at the time of pre-export certification examination.

Pond water was consistently found to be contaminated (6/36 samples) with either Salmonella newport, S. arizonae, or S. poona. Environmental specimens obtained from eggs and turtle hatcheries (204 specimens) failed to yield Salmonella spp. A sample comprising 197 hatchlings, derived from a batch previously demonstrated to be contaminated, showed a salmonella prevalence of 12%, with S. arizonae and S. poona the only serotypes isolated. Four serotypes of Salmonella sp. isolated by a certifying laboratory in 1988, and 20 salmonella isolates obtained from hatchling turtles, were all resistant to gentamicin. The emergence of gentamicin resistance in Salmonella spp. isolated from turtles will reduce the effectiveness of preventive measures in use in Louisiana since 1984.

Thirty-eight Salmonella typhimurium strains isolated from December 1987 to March 1988 in Isernia, Central Italy, were characterized on the basis of their phage type, resistance to antimicrobials and plasmid profiles. According to their phage types, the isolates could be assigned to one of six groups, the prevalent one being PT 195 which accounted for 73·6% of isolates.

On the basis of their plasmid content, the isolates could be assigned to one of ten groups. The prevalent plasmid profile (60·0; 6·0; 4·3; 4·0; 3·2 megadaltons) was found in 60·4% of isolates.

All the isolates from a particular food (salsicce), and as most of isolates from humans who had consumed this food belonged to phage type 195 and were of the same plasmid profile.

The combined use of phage typing and DNA plasmid analysis proved to be a useful tool in identifying epidemiologically related isolates in this investigation.

Infection with potential bacterial enteropathogens was studied prospectively in 94 Swedish travellers. Three faecal samples were collected, regardless of diarrhoeal symptoms, after each of three 1-week stays in Singapore, Hong Kong and Japan. The specimens were analysed for salmonella, shigella, yersinia, campylobacter and different enterotoxin-producing bacteria. A potential enteropathogen was identified in 30% (28/94) of the participants, i.e. in 26% of the healthy and in 39% of the travellers with diarrhoea. The most common isolates were enterotoxigenic bacteria of different species (14%), salmonella (11%) and campylobacter (7%). By performing enterotoxin-tests on six different colonies from the primary culture of each specimen enterotoxigenic Escherichia coli (ETEC) as well as enterotoxin-producing Klebsiella sp., Citrobacter sp. and Morganella morganii were identified. The latter strains were as prevalent as ETEC. In the 33 participants with diarrhoea enterotoxigenic bacteria (18%) and campylobacter (18%) were the most common isolates. Campylobacter-infected travellers developed symptomatic disease (6/7) significantly (P>0·02) more often than those infected with salmonella (3/10) or enterotoxigenic bacteria (6/13; 2 ETEC, 4 other species).

This paper reviews epidemiological data to see if there are sex differentials in prevalence, density and clinical pathology due to lymphatic filariasis. Of 53 studies from Africa, South East Asia, the Indian Subcontinent and The Americas, 43 showed a lower mean prevalence of infection in females than in males. Prevalence is consistently lower in women of reproductive age and this is statistically significant in 16 of 32 studies classified by age and sex. Density of infection is also lower in the reproductive age but may be higher in children and in older women. Clinical disease is also lower in women and pathology has a later age of onset and rise to peak prevalence than in males. The paper assesses the evidence that lower rates of infection and clinical pathology are due to less exposure of females to infective vectors. It seems unlikely that exposure alone could account for these differences which are observed for both bancroftian and brugian filariasis, irrespective of periodicity. Several investigators have suggested that females have increased resistance to infection and this is supported by serological studies showing high antibody positivity to adult worm antigens in females. The review concludes that the association with the reproductive years suggests a pregnancy-associated mechanism. This has important implications for maternal – fetal interactions and maternal filarial infection may influence the development of immunity in children.

In studies concerning the effect of antibiotics on faecal microflora, Colonization Resistance is an important parameter. Colonization Resistance correlates inversely with the number of different biotypes of Enterobacteriaceae isolated from faecal samples. Nine healthy volunteers were studied during 6 weeks, in order to determine the natural variation in the number of different biotypes of Enterobacteriaceae per faecal sample. The numbers of biotypes ranged from 1–15 per faecal sample, the mean number of biotypes varied between 2·6 and 7·3 different biotypes per faecal sample per healthy volunteer. Inter-individual variations of five biotypes in the mean number of biotypes per faecal sample are normal. We assessed the minimal number of faecal samples that should be taken for comprehensive biotyping so as to determine reliably the mean number of different biotypes representative for the Colonization Resistance of an individual. It was found that a minimum of four faecal samples was required.

Most villagers in north-east Thailand carry water to their homes and store it in separate containers depending on its subsequent use. In one village, information on water use was collated with the bacteriological quality of stored water, water sources and fingertip-rinses. Stored water quality was a function of water-related activities rather than quality at source (P<0·0001). Specifically water used for toilet, washing dishes and cooking-related activities was much more contaminated with faecal bacteria than that used for drinking and cooking. Salmonella spp. was significantly more common in water used for washing dishes than drinking (P<0·05). Escherichia coli contamination of fingertip-rinses was strongly associated with the individual's activity prior to testing (P<0·0001); child care, food and water-related activities produced much higher levels of fingertip contamination than others. Dirty utensils used for cooking and eating were usually left to soak and faecal bacterial growth occurred in this grossly contaminated soak-water. Cross-contamination via water handling was the main mechanism of stored water pollution. These results were used to develop a hygiene intervention study presented in a companion paper.

An intervention study was developed from risk-factors associated with faecooral transmission, based on the levels of contamination in stored water and fingertip-rinses from households in rural north-east Thailand. This was designed to improve: (a) handwashing, particularly before cooking/eating and after defecation; (b) washing dishes immediately after use. Verbal messages were administered to two intervention groups, one also received a plastic container with a tap to assist these activities. Indicators of compliance were the direct observation of soaking dishes and the presence of faecal streptococci from fingertip-rinses; the main outcome indicator was Escherichia coli contamination of stored water. The intervention group receiving the container was significantly better than the control for indicators of compliance (P < 0·001 and P < 0·01) and its stored water was significantly less contaminated (P < 0·001). There was no significant improvement to the other intervention group, although some features of the intervention had clearly been made available to the control group. Humidity was significantly correlated with fingertip contamination (r = 0·2; P < 0·001) and with the peak of reported diarrhoea around the beginning of the rainy season.

Between 1972 and 1988 we have serologically confirmed 103 Coxiella burnetii infections: 46 were acute, 5 were chronic, 52 represented past infections. Details of 61 cases are presented.

Of acute cases 80 % had respiratory involvement; at least 63 % had pneumonias. The incidence (22%) of neurological complications was of particular interest; 40% of these patients had prolonged sequelae. One acutely ill patient died of fulminating hepatitis. Patients with pre-existing pathology or immunosuppression were especially susceptible to C. burnetii.

In the absence of acute sera, the complement fixation test alone provided inadequate differentiation between recent and past Q fever: phase II titres persisted at ⋝ 80 for more than 1 year after the acute infection in 15 cases; maximum duration of persistence was 14 years. Three patients acquired high phase I titres.

Only 5% of cases had chronic Q fever, but in view of the diverse sequelae observed in this series, we suggest that long-term serological and clinical follow-up of all cases of Q fever is fully justified.

Recent publicity concerning congenital toxoplasmosis has generated a demand for serological assessment of pregnant women. Many laboratories are requested to undertake primary screening in these cases. We assessed the latex agglutination test (LAT) findings in 158 specimens with detectable toxoplasma specific IgM derived from pregnant women. The LAT titres ranged from 16 to ≥ 4000 reflecting the variable antibody response observed in acute toxoplasmosis. We recommend that non-reference laboratories test specimens from pregnant women using the LAT at a screening dilution of 1:16 and select all reactive samples for detailed investigation.

Asymptomatic individuals seropositive for antibody to human immunodeficiency virus (HIV) were investigated for the presence of toxoplasma specific antibody. Serological examination was performed using multiple assays. Of 500 patients studied 133 had serological evidence of previous exposure to Toxoplasma gondii. Specific IgM was detected in 7 patients using ISAGA and 2 patients by DS-ELISA. The immunoglobulin-G annual seroconversion rate was calculated to be 0·75 %. The results of this study indicate 27 % of HIV positive patients in the UK are at risk of developing life-threatening secondary reactivation of cerebral toxoplasmosis in association with AIDS. A further 0·5–1 % per year may suffer primary toxoplasmosis.

In this review of 66 outbreaks of infectious disease in schools in England and Wales between 1979–88, 27 were reported from independent and 39 from maintained schools. Altogether, over 8000 children and nearly 500 adults were affected. Most of the outbreaks investigated were due to gastrointestinal infections which affected about 5000 children; respiratory infections affected a further 2000 children. Fifty-two children and seven adults were admitted to hospital and one child with measles died. Vaccination policies and use of immunoglobulin for control and prevention of outbreaks in schools have been discussed.

After preliminary trials, the detailed changes in the concentration of specific circulating and local antibodies were followed in 15 volunteers inoculated with coronavirus 229E. Ten of them, who had significantly lower concentrations of pre-existing antibody than the rest, became infected and eight of these developed colds. A limited investigation of circulating lymphocyte populations showed some lymphocytopenia in infected volunteers. In this group, antibody concentrations started to increase 1 week after inoculation and reached a maximum about 1 week later. Thereafter antibody titres slowly declined. Although concentrations were still slightly raised 1 year later, this did not always prevent reinfection when volunteers were then challenged with the homologous virus. However, the period of virus shedding was shorter than before and none developed a cold. All of the uninfected group were infected on re-challenge although they also appeared to show some resistance to disease and in the extent of infection. These results are discussed with reference to natural infections with coronavirus and with other infections, such as rhinovirus infections.