Our study aimed to investigate the epidemiology of extrapulmonary tuberculosis (EPTB) and analyse the epidemiological characteristics of EPTB patients with or without pulmonary tuberculosis (PTB). EPTB cases admitted in our hospital from January 2015 to December 2020 were included. Uni- and multi-variable logistic regression analysis was carried out to identify risk factors and prognostic factors of concomitant EPTB and PTB or exclusively EPTB. A total of 3488 EPTB patients were reviewed, including 2086 patients with concurrent PTB and EPTB, and 1402 patients with exclusively EPTB. Logistic regression analysis showed that age >60 years (OR = 1.674, 95% CI = 1.438–1.949, P < 0.001) and female (OR = 1.325, 95% CI = 1.155–1.520, P < 0.001) were risk factors of exclusively EPTB, while co-morbidities (OR = 0.676, 95% CI = 0.492–0.929, P = 0.016) and severe symptoms (OR = 0.613, 95% CI = 0.405–0.929, P = 0.021) were risk factors for concurrence of EPTB and PTB. Age >60 years was an independent prognostic factor in EPTB patients with or without PTB (HR = 11.059, 95%CI = 5.097–23.999, P < 0.001; HR = 23.994, 95%CI = 3.093–186.151, P = 0.0020). Female gender was an independent prognostic factor in patients with concurrent PTB and EPTB (HR = 23.994, 95%CI = 3.093–186.151, P = 0.002). Our study disclosed the differential epidemiological characteristics of EPTB patients with or without PTB in China.

The prognostic factor for in-hospital mortality in tuberculosis (TB) patients requiring intensive care unit (ICU) care remains unclear. Therefore, a retrospective study was conducted aiming to estimate the in-hospital mortality rate and the risk factors for mortality in a high-burden setting. All patients with culture-confirmed TB that were admitted to the ICU of the hospital between March 2012 and April 2019 were identified retrospectively. Data, such as demographic characteristics, comorbidities, laboratory measures and mortality, were obtained from medical records. The Cox proportional hazards regression model was used to identify prognostic factors that influence in-hospital mortality. A total of 82 ICU patients with confirmed TB were included in the analysis, and 22 deaths were observed during the hospital stay, 21 patients died in the ICU. In the multivariable model adjusted for sex and age, the levels of serum albumin and white blood cell (WBC) count were significantly associated with mortality in TB patients requiring ICU care (all P < 0.01), the hazard ratios were 0.8 (95% confidence interval (CI): 0.7–0.9) per 1 g/l and 1.1 (95% CI: 1.0–1.2) per 1 × 109/l, respectively. In conclusion, in-hospital mortality remains high in TB patients requiring ICU care. Low serum albumin level and high WBC count significantly impact the risk of mortality in these TB patients in China.

Hispanic/Latino populations are disproportionately impacted by coronavirus disease 2019 (COVID-19) in the United States. The impact of state reopening on COVID-19 in this population after stay-at-home orders is unknown. We evaluated the incidence, prevalence and trends during reopening of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) at a major federally qualified health centre in Providence, Rhode Island. A total of 14 505 patients were tested for SARS-CoV-2 from 19 March to 18 August 2020, of which, data on 13 318 (91.8%) patients were available; 70.0% were Hispanic/Latino, and 2905 were positive for SARS-CoV-2 infection. The urban Hispanic/Latino population was almost five times more likely to test positive for SARS-CoV-2 (risk ratio 4.97, 95% CI 2.59–9.53, P < 0.001) compared to non-Hispanic White. The positivity rates among the urban Hispanic/Latino population remained >10% during all phases of reopening. The trends of the incidence rates showed similar associations to those we observed for positivity rates. Public health interventions to address SARS-CoV-2 in Hispanic/Latino communities are urgently needed, even in latter phases of state reopening.

Massive use of antibiotics has led to increased bacterial resistance to these drugs, making infections more difficult to treat. Few studies have assessed the overall antimicrobial resistance (AMR) burden, and there is a paucity of comprehensive data to inform health policies. This study aims to assess the overall annual incident number of hospitalised patients with AMR infection in France, using the National Hospital Discharge database. All incident hospitalisations with acute infections in 2016 were extracted. Infections which could be linked with an infecting microorganism were first analysed. Then, an extrapolation of bacterial species and resistance status was performed, according to age class, gender and infection site to estimate the total number of AMR cases. Resistant bacteria caused 139 105 (95% CI 127 920–150 289) infections, resulting in a 12.3% (95% CI 11.3–13.2) resistance rate. ESBL-producing Enterobacteriaceae and methicillin-resistant Staphylococcus aureus were the most common resistant bacteria (>50%), causing respectively 49 692 (95% CI 47 223–52 142) and 19 493 (95% CI 15 237–23 747) infections. Although assumptions are needed to provide national estimates, information from PMSI is comprehensive, covering all acute bacterial infections and a wide variety of microorganisms.

(1) A collection of S. typhi-murium strains, isolated during 11 months, in or near Manchester, was examined for the presence of symbiotic bacteriophage. In all, 177 strains derived from eighty-three incidents were investigated.

2. The different phages, or combinations of phage, allowed these strains to be divided into eleven varieties. Three hitherto undescribed types of phage were discovered.

3. With two minor exceptions, all groups of strains isolated from associated cases of infection carried the same type of phage, so that the ‘typing’ was in agreement with epidemiological expectations. In the two exceptions, the relationship of the cases was not intimate, and infection from different sources was an obvious possibility.

4. It is concluded that this is a reliable method of typing. It is probably applicable to other groups of bacteria. Its value would be enhanced by the discovery of a simpler method than filtration for sterilizing the lysato without damaging the phage.

We describe and analyse an outbreak of measles that affected Belgium early 2017. In total, 289 cases were reported, mostly (53%) in people 15 years or older. For 133 (46%) vaccination status was unknown and a further 117 (41%) were not vaccinated. According to national guidelines, 83 of the unvaccinated cases (29% of total cases) should have received minimum one dose of vaccine, but did not. One in five cases (21%) did not present with the classical triad of fever, rash and any of coryza, conjunctivitis or cough. Rash was the most sensitive symptom, being absent in only six cases. A large proportion of cases (125/289, 43%) required hospitalisation. In hospitalised patients, the most commonly observed complications were hepatic disorders (present in 58/125 hospitalised patients, 46%). Thirty-six of the cases (12%) were in healthcare workers and nosocomial spread contributed importantly to the outbreak. Older age at presentation, altered clinical presentations and presence of complications like hepatitis can delay the correct diagnosis of measles. Clinicians should maintain a high index of suspicion in any individual presenting with rash. If the elimination target is to be reached, catch-up vaccination campaigns should be intensified and target young adults and health care workers.

Neisseria meningitidis is the main cause of bacterial meningitis and sepsis in the UK, and can potentially be lethal or cause long-term sequelae. Bexsero® (4CMenB) is a new multi-component vaccine approved by the European Commission for use in individuals aged ⩾2 months. A theoretical transmission model was constructed to assess the long-term effectiveness of Bexsero compared to standard care. The model was populated with UK-specific demographic data and calibrated to ensure that the transmission dynamics of meningococcal disease in the UK were adequately simulated. The model showed the best strategy to be a routine vaccination programme at ages 2, 3, 4, 12 months and 14 years combined with a 5-year catch-up programme in toddlers aged 12–24 months and adolescents aged 15–18 years. This would lead to a 94% reduction in meningococcal cases or 150 000 cases and 15 000 deaths over a 100-year time-frame.

In May of 2018, PulseNet, the national molecular subtyping network for enteric pathogens, detected a multistate cluster of illnesses caused by an uncommon molecular subtype of Salmonella serovar Mbandaka. A case was defined as an illness in a person infected with the outbreak strain of Salmonella Mbandaka with illness onset on or after 3 March 2018 and before 1 September 2018. One-hundred thirty-six cases from 36 states were identified; 35 hospitalisations and no deaths were reported. Ill people ranged in age from <1 year to 95 years (median: 57 years). When standardised questionnaires did not generate a strong hypothesis, opened-ended interviews were performed. Sixty-three of 84 (75%) ultimately reported consuming or possibly consuming a specific sweetened puffed wheat cereal in the week before illness onset. Environmental sampling performed at the cereal manufacturing facility yielded the outbreak strain. The outbreak strain was also isolated from open cereal samples from ill people's homes and from a sealed retail sample. Due to these findings, the brand owner of the product issued a voluntary recall of the cereal on 14 June 2018. Additional investigation of the manufacturing facility identified persistent environmental contamination with Salmonella Mbandaka that was closely genetically related to other isolates in the outbreak. This investigation highlights the ability of Salmonella to survive in low-moisture environments, and the potential for prolonged outbreaks linked to products with long shelf lives and large distribution areas.

We evaluated the incidence of varicella-zoster virus (VZV) infections, including herpes zoster (HZ), and investigated the associated risk factors for HZ and compared lymphocyte subsets of these patients at 1, 3 and 6 months following haematopoietic stem cell transplantation (HSCT) in a case-control study in children and adolescents. The incidence of HZ infection at the first year after HSCT was 17/125 (13·6%). The cumulative incidence of HZ infection was 22/125 (17·6%). Sixteen (73%) cases with HZ and 11 (32%) cases in the control group had a diagnosis of malignant disorder. No significant difference was noted between the HZ group and the control group in absolute lymphocyte number and subsets (except WBC) at the pre-transplant evaluation. Pre-transplant WBC count was statistically lower in the HZ group (P<0·05). The CD4/CD8 ratios were lower in the HZ group during the first 6 months after HSCT, and the decrease was statistically significant at 6 months compared to the control group. In conclusion, patients undergoing HSCT for a malignant disorder had a significantly higher risk of VZV infection than those with non-malignant disorders and pretransplant donor characteristics were not helpful in predicting risk of post-transplant VZV infection.

It is shown that bits of allantois-on-shell cut from any one egg do not differ either in susceptibility to infection by influenza viruses or in yield of haemagglutinin. For this reason the dose-response curve within any egg is Poissonian.

Bits cut from different eggs vary both in susceptibility and in haemagglutinin yield. Unlike in whole eggs however, the scatter is so small that it can be demonstrated only by refined tests done on a large number of subjects. For practical purposes the dose-response curve may still be taken as Poissonian.

Susceptibility and yield vary independently of one another.

The data are used to define the accuracy of infectivity tests in bits of allantois-on-shell; the expected errors are given both for straight replication and for tests done with different reagents, by different operators, or at different times.

Longan County is considered a highly endemic area for hepatitis B virus (HBV). The plasma-derived vaccine has been used in newborns in this area since 1987. A cross-sectional survey was conducted to evaluate the long-term effectiveness of this vaccine. In total, 1634 participants born during 1987–1993 and who had received a series of plasma-derived HB vaccinations at ages 0, 1, and 6 months were enrolled. Serological HBV markers were detected and compared with previous survey data. Overall the prevalence of hepatitis B surface antigen (HBsAg) in all participants was 3·79%; 3·47% of subjects who had received the first dose within 24 h were HBsAg positive, and 8·41% of subjects who had received a delayed first dose were also HBsAg positive. There were 1527 subjects identified who had received the first dose within 24 h and whose HBsAg and anti-HBc prevalence increased yearly after immunization, while the anti-HBs-positive rate and vaccine effectiveness declined. The geometric mean concentration of antibody in the anti-HB-positive participants was 55·13 mIU/ml and this declined after immunization. Fewer than 2·0% of participants had anti-HB levels ⩾1000 mIU/ml. The data show that the protective efficacy of the plasma-derived vaccinations declined and administration of HB vaccine within 24 h of birth was very important. To reduce the risk of HBV infection in this highly endemic area, a booster dose might be necessary if anti-HBs levels fall below 10 mIU/ml after age 18 years. Furthermore, studies on the immune memory induced by plasma-derived HB vaccine are needed.

In a previous communication on the bacteriology of dehydrated fish (Shewan, 1945), data were presented concerning various aspects of the drying process, and their bearing upon commercial production was discussed. This communication reports further work, done mainly during the war, on the effect of storage conditions on the bacterial flora of various kinds of dehydrated fish products.

Early detection of highly pathogenic avian influenza (HPAI) in its natural reservoirs is a prerequisite for preventing disease spread to humans. The risk of introduction of H5N1 HPAI was assessed in order to design a risk-based surveillance system in Spain. Areas at highest risk for H5N1 HPAI followed a northeast–southwest direction, with two significant clusters located in the north and the southwest of the country. Most (83%) of the veterinary units (VUs) obtained fewer samples than would have been expected if samples had been collected using a risk-based design. In October 2009, a HPAI outbreak was reported for the first time in a Spanish layer farm located in a VU at high risk for HPAI, but no samples were collected. This risk-based surveillance approach will increase the cost-effectiveness of HPAI surveillance in Spain and can be easily extended to and adopted by other countries and regions throughout the world.

One contact plate and two homogenization methods have been compared for efficiency in assessing the bacterial contamination of fabrics with high or low, natural or artificial contamination. The contact plate method resulted in considerably lower counts than any of the homogenization methods, which closely resembled one another. One of these, utilizing a Stomacher 400®, was found to be more practical, and is therefore recommended for counting bacteria on fabrics.

Neutralization and complement-fixation tests to detect rubella antibody are described. Results of such tests show that between 80 and 95% of adults in England and Wales have neutralizing antibody. The presence of complement-fixing antibody indicates recent infection with rubella virus.

Results are presented showing the development of neutralizing and complement-fixing antibody after rubella.

Antibody tests on children with congenital rubella and their mothers are detailed. It is noted that higher neutralizing antibody titres are found in this group than in the general population.

Cytomegalovirus (CMV) enters latency after primary infection and can reactivate periodically with virus excreted in body fluids which can be called shedding. CMV shedding during the early stage of pregnancy is associated with adverse pregnancy outcome. The shedding pattern in healthy seropositive women who plan to have babies has not been well characterised. Vaginal swabs, urine and blood were collected from 1262 CMV IgG-positive women who intended to have babies and tested for CMV DNA by fluorogenic quantitative PCR method. Serum IgM was also detected. The association between sociodemographic characteristics and CMV shedding prevalence was analysed. Among 1262 seropositive women, 12.8% (161/1262) were detected CMV DNA positive in at least one body fluid. CMV DNA was more frequently detected in vaginal secretion (10.5%) than in urine (3.2%) and blood (0.6%) also with higher viral loads (P < 0.00). CMV shedding was more likely detected in IgM-positive women than IgM-negative women (29.5% (13/44) vs. 12.2% (148/1218); OR 3.03, 95% CI 1.55–5.93; P = 0.001). CMV shedding in vaginal secretion was highly correlated with shedding in urine, the immune state of IgM, the adverse pregnant history and younger age. CMV shedding was more commonly detected in vaginal secretion than in urine or blood with higher viral loads among healthy seropositive women of reproductive age. Further studies are needed to figure out whether the shedding is occasional or continuous and whether it is associated with adverse pregnancy outcomes.

Recovery from disseminated candidosis is associated with seroconversion to a 47 kDa breakdown product of the Heat Shock Protein (HSP) 90 of Candida albicans. Cloning, sequencing and epitope mapping has allowed the delineation of the immunodominant epitopes LKVIRKNIVKKMIE and STDEPAGESA. Monoclonal and polyclonal antibodies specific to these epitopes are used to show that all strains of C. albicans tested produce HSP 90 in both the yeast and mycelial phases. Homologous proteins are demonstrated in Saccharomyces cerevisiae, Candida parapsilosis and Corynebacterium jeikeium but not in Torulopsis glabrata. Evidence is presented for the existence of two distinct HSP 90s in C. albicans. The first of these is expressed constitutively whilst the second is produced on heat shocking the yeast from 23 to 37 °C.

Every bacteriologist is only too well aware of the many problems presented by the preparation of culture media for the growth of bacteria in vitro.

The Rideal-Walker and Chick-Martin tests depend on end-point methods for comparing bactericides. End-point methods have a number of disadvantages: (1) It is difficult, if not impossible, to estimate end-points accurately. (2) The nature of the test demands a standard time. The results at any standard time will be arbitrary. If the sensitivity of the organisms varies in the two solutions tested, the coefficients obtained will vary with the time chosen as standard. It is impossible to estimate the manner in which the survivor times of the organism are distributed, by end-point methods, and therefore the standard tests in current use do not ascertain whether the result is arbitrary or not. This can only be appreciated if the tests are repeated using different times.

Apart from the difficulties associated with end-points, the coefficients obtained in the present tests are calculated from one concentration of phenol and one concentration of test bactericide. This is also an arbitrary value, for the relative activity of two bactericides will depend on relative values of the concentration exponent, n, for each bactericide; if both phenol and the test bactericide have identical values of n the coefficients will be the same at all concentrations which are compared, but if values of n are different then different coefficients will be obtained for every different concentration compared. As a corollary, unless the value of n for the test bactericide is the same as that of phenol, it is illogical to transfer the phenol coefficient obtained at one concentration to the pure substance, for this procedure implies that the phenol coefficient applies to any concentration of the test bactericide. This is only true when the concentration coefficients of phenol and test bactericide are the same. The standard methods offer no value for n.

All these difficulties can be avoided if the rate of death is followed in both phenol and test bactericide, by viable counts. Two methods of interpreting the results are discussed:

(1) The comparison of reaction rates, calculated by the formula This method is complicated by the occurrence of lag period at the start of the reaction between organism and bactericide. This lag period varies in extent in different experiments (often extending up to 50% of the deaths) and makes the interpretation of the results difficult. The lag period has been shown to be a manifestation of, the distribution of logarithmic survival times (Withell, 1942), and is a function of the standard deviation of the logarithmic survivor times (λ). This fact is taken into account in method (2).

(2) The use of the time required for 50% response as a method of comparing bactericides. This time has been symbolized L.t. 50 and is analogous to the lethal dose for the 50% response (l.d. 50) widely used in biological assay. If a logarithmic time scale is used, the logarithmic survival times are found to be approximately normally distributed and consequently probit-logarithm of time lines are straight and in the case of phenol 0·5 % and para-chlor-meta-cresol 0·05% these lines are parallel. In this case a logarithmic time scale means that the comparative times for all percentage responses are equal. In cases where the probit-logarithm-of-time lines are not parallel this would indicate that the standard is unsuitable for the test, for any methods of assay based on a use of a standard to which the organism gives a different response-time relation from that which they give to the test substance or bactericide, are likely to give arbitrary results.

L.T. 50 has been chosen because of the simplicity of the idea underlying it, and because a similar function, L.D. 50, has been used with success in biological assay work. There is also a solid mathematical backing for the use of L.D. 50 in assays involving biological response.

It is suggested that by means of l.t. 50, phenol and the test bactericide can be compared in the following way:

(a) determine the relative speeds of action of the two solutions at any convenient concentrations;

(b) determine the concentration coefficient (ή) of both phenol and test bactericide by means of comparative l.t. 50 values;

(c) determine the temperature coefficient for each substance by similar methods.

From these observations the relative efficiency of the two bactericides can be calculated at any temperature and concentration. If two sets of figures are obtained, one with a vegetative organism, and the other with a sporing organism, a great deal of information can be summarized. It has been shown that an 0·05% solution of parachlor-meta-cresol is approximately one and a half times as efficient as an 0·5% phenol solution (against a Micrococcus). The comparative figure is about 1·0 when Bact. coli is used.

1. Observations on the sera of ponies, taken at frequent intervals for 321 days after oral administration of P. mallei, are described.

2. It was found that the conglutinating complement absorption test was more sensitive than the haemolytic complement fixation test as a means of diagnosis. It detected the antibodies earlier in the course of the disease and demonstrated their presence over a longer period of time.

3. The possibility of another practical use of this reaction as an adjunct to the allergic test is considered. Ten days after an intradermo-palpebral test a pony, which had been previously sensitized and whose serum antibody titre at that time was below 10, developed a serum titre of over 160 as demonstrated by the conglutinating complement absorption test. Under similar circumstances 11 unsensitized ponies developed no detectable serum antibodies.