A serological analysis of mycelial antigens of Thermoactinomyces vulgaris in immunodiffusion with human sera revealed five individual antigens. Three antigens were proteins, sensitive to pronase and soluble in phenol. Two were cationic polysaccharides, sensitive to sodium periodate, and containing glucosamine and muramic acid.

Latex coated with mycelial antigens was compared with precipitin tests in detecting antibodies to T. vulgaris; the number of positive results detected by each test differed slightly, and a combination of the two tests detected the highest number. Counterimmunoelectrophoresis (CIE) was shown to be a very sensitive method for detecting precipitins, but not for their measurement. A prospective evaluation of immunodiffusion, latex agglutination and CIE as potential serodiagnostic techniques for farmer's lung disease is suggested.

Retaining adolescents (aged 10–19 years), living with HIV (ALHIV) on antiretroviral therapy (ART) is challenging. In Myanmar, 1269 ALHIV were under an Integrated HIV Care (IHC) Programme by June 2017 and their attrition (death and lost to follow-up) rates were not assessed before. We undertook a cohort study using routinely collected data of ALHIV enrolled into HIV care from July 2005 to June 2017 and assessed their attrition rates in June 2018 by time-to-event analysis. Of 1269 enrolled, 197(16%) and of 1054 initiated ART, 224 (21%) had an attrition defining event. The pre-ART and ART attrition rates were 21.8 (95% CI 19.0–25.1) and 6.4 (95% CI 5.6–7.3) per 100 person-years follow-up, respectively. The factors ‘at enrolment’ that were associated with higher hazards of attrition were: (1) WHO stage 3 or 4; (2) haemoglobin <10 gm/dl; (3) no documented CD4 cell counts, hepatitis B and C test results; and (4) injection drug use. Baseline hazards were high during the initial 1–2 years and after 5–6 years. The pre-ART and ART attrition rates in ALHIV were lower than those in Africa but higher than the children under IHC. This warrants designing and implementing additional care tailored to the needs of ALHIV under IHC.

The incidence of positive toxoplasmin skin test among subnormals in hospital was compared with that in subnormals attending day training centres and among normal children taken into County Council children's homes. Twelve out of 120 subnormals below the age of 20 attending day training centres were positive to the test, and 23 were positive out of 233 subnormals of the same age tested in hospital.

There was only 1 positive out of 71 children under the age of 18 in the County Council children's homes, compared with 29 out of 296 subnormals of this age who were tested.

The incidence of positive skin test among 115 mongols under the age of 50 was about 11% in each age range, whereas that in 709 other subnormals rose from 5% in those below the age of 10 to 30% in those over the age of 30.

Although factors similar to those causing admission of normal children to County Council care often determine the admission of subnormals to hospital, the children in County Council homes did not share the high incidence of infection which was found in subnormals.

It is suggested that the majority of infections among subnormal children are postnatally acquired. Since the incidence was the same in subnormals living at home as among those in hospital it is suggested that some personal habit commoner among subnormal than among normal children exposes the subnormals to an increased risk of infection.

Plasmid profiles have been established for 68 isolates of Staphylococcus aureus from 13 episodes of epidemic spread in hospital wards between 1958 and 1962. Despite the original lack of care in preservation of strains the profiles give, in general, the same epidemiological patterns as were established originally on the basis of phage type, antibiotic sensitivity, ward and date of isolation.

In December 1917, Lieut.-Col. MacGilchrist of the Indian Medical Service published a paper on the necrosis produced by intra-muscular injections of strong solutions of quinine salts. It might be an advantage to quote the first few lines of this communication: “Advocates of intra-muscular injections of strong solutions of quinine salts for the treatment of malaria seldom omit to state that no local ill-effects are produced”. He records a case of tissue necrosis following on the intra-muscular injection of eleven grains of quinine bi-hydrochloride in thirty-four minims of water. Death supervened thirteen hours later. MacGilchrist especially noted, owing to rapid tissue necrosis, that the track of the needle remained patent. He regards as an established fact that most of the quinine injected is precipitated and probably chemically combined with serum proteins in the necrosed tissues and for this reason intramuscular injections of concentrated solutions of quinine salts are not to be recommended for cases of emergency. Very dilute solutions of quinine salts are, in his opinion, rapidly and completely absorbed whether employed subcutaneously or by the intra-muscular route. If the views which MacGilchrist puts forward in this and other communications are to be accepted without reserve then intra-muscular injections of strong solutions of quinine should no longer be employed. It was for this reason that Major-General Sir M. P. C. Holt, K.C.B., K.C.M.G., D.M.S., B.S.F., asked me to carry out an experimental enquiry on animals as to the effects produced by intra-muscular injections of strong solutions of quinine.

Presence of antimicrobial resistance (AMR) genes in Escherichia coli inhabiting anthropogenic rivers is an important public health concern because plasmid-mediated AMR genes can easily spread to other pathogens by horizontal gene transfer. Besides β-lactams, quinolones and aminoglycosides are the major antibiotics against E. coli. In the present study, we have investigated the presence of plasmid-mediated quinolone resistance (PMQR) and aminoglycoside resistance genes in E. coli isolated from a major river of northern India. Our results revealed that majority of the strains were phenotypically susceptible for fluoroquinolones and some aminoglycosides like amikacin, netilmicin, tobramycin and gentamicin. However, 16.39% of the strains were resistant for streptomycin, 8.19% for kanamycin and 3.30% for gentamicin. Of the various PMQR genes investigated, only qnrS1 was present in 24.59% of the strains along with ISEcl2. Aminoglycoside-resistance genes like strA-strB were found to be present in 16.39%, aphA1 in 8.19% and aacC2 in only 3.30% of the strains. Though, no co-relation was observed between phenotypic resistance for fluorquinolones and presence of PMQR genes, phenotypic resistance for streptomycin, kanamycin and gentamicin exactly co-related with the presence of the genes strA-strB, aphA1 and aacC2, respectively. Moreover, all the AMR genes discerned in aquatic E. coli were found to be situated on conjugative plasmids and, thus easily transferrable. Our study accentuates the importance of routine surveillance of urban rivers to curtail the spread of AMR genes in aquatic pathogens.

The object of this portion of the investigation was to determine

(a) Whether the amount of immune-body present in the sera of cases of pulmonary tuberculosis, bore any constant relation to the stage of the disease and the condition of the patient.

(b) Whether well-marked clinical phenomena, e.g. periods of fever, attacks of pleurisy etc., were associated in any definite manner with variations in the amount of immune-body in the serum.

(c) Whether gradual definite and sustained improvement or deterioration in a patient's condition was accompanied by increase or decrease of the specific immune-body in the serum.

Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA) have been considered prevalent pathogens in foot infections. However, whether empiric therapy directed against these organisms is necessary, and in whom to consider treatment, is rather unclear. The aim of this study was to develop predictive algorithms for forecasting the probability of isolating these organisms in the infected wounds of patients in a population where the prevalence of resistant pathogens is low. This was a retrospective study of regression model-based risk factor analysis that included 140 patients who presented with infected, culture positive foot ulcers to two urban hospitals. A total of 307 bacteria were identified, most frequently MRSA (11.1%). P. aeruginosa prevalence was 6.5%. In the multivariable analysis, amputation (odds ratio (OR) 5.75, 95% confidence interval (CI) 1.48–27.63), renal disease (OR 5.46, 95% CI 1.43–25.16) and gangrene (OR 2.78, 95% CI 0.82–9.59) were identified as risk factors associated with higher while diabetes (OR 0.07, 95% CI 0.01–0.34) and Infectious Diseases Society of America infection severity >3 (OR 0.18, 95% CI 0.03–0.65) were associated with lower odds of P. aeruginosa isolation (C statistic 0.81). Similar analysis for MRSA showed that amputation was associated with significantly lower (OR 0.29, 95% CI 0.09–0.79) risk, while history of MRSA infection (OR 5.63, 95% CI 1.56–20.63) and osteomyelitis (OR 2.523, 95% CI 1.00–6.79) was associated with higher odds of isolation (C statistic 0.69). We developed two predictive nomograms with reasonable to strong ability to discriminate between patients who were likely of being infected with P. aeruginosa or MRSA and those who were not. These analyses confirm the association of some, but also question the significance of other frequently described risk factors in predicting the isolation of these organisms.

We explored age-dependent patterns in haemagglutination inhibition (HI) titre to seasonal [1956 A(H1N1), 1977 A(H1N1), 2007 A(H1N1)] and pandemic [A(H1N1)pdm09] influenza strains using serological data collected from an adult French influenza cohort. Subjects were recruited by their general practitioners from 2008 to 2009 and followed until 2010. We explored age-related differences between strain-specific HI titres using 1053 serological samples collected over the study period from 398 unvaccinated subjects. HI titres against the tested seasonal and pandemic strains were determined using the HI technique. Geometric mean titres (GMTs) were estimated using regression models for interval-censored data. Generalized additive mixed models were fit to log-transformed HI estimates to study the relationship between HI titre and age (age at inclusion and/or age at initial strain circulation). GMT against one strain was consistently highest in the birth cohort exposed to that strain during childhood, with peak titres observed in subjects aged 7–8 years at the time of initial strain circulation. Our results complete previous findings on influenza A(H3N2) strains and identify a strain-dependent relationship between HI titre and age at initial strain circulation.

An enquiry (1) instituted in 1916 showed that from 1 to 2% of rail-borne milk was sour on arrival at its destination, with the result that in London alone there was a loss of some 90,000 gallons of milk annually. That this loss was not confined to the London milk was brought out by the fact that a similar loss was found to obtain in the north of England.

The aim of this study was to determine the most cost-effective strategy for the prevention and control of multidrug-resistant organisms (MDROs) in intensive care units (ICUs) in areas with limited health resources. The study was conducted in 12 ICUs of four hospitals. The total cost for the prevention of MDROs and the secondary attack rate (SAR) of MDROs for each strategy were collected retrospectively from 2046 subjects from January to December 2017. The average cost-effectiveness ratio (CER), incremental cost-effectiveness ratio (ICER) and cost-effectiveness acceptability curve were calculated. Hand hygiene (HH) had the lowest total cost (2149.6 RMB) and SAR of MDROs (8.8%) while single-room isolation showed the highest cost (33 700.2 RMB) and contact isolation had the highest SAR of MDROs (31.8%). The average cost per unit infection prevention was 24 427.8 RMB, with the HH strategy followed by the environment disinfection strategy (CER = 21 314.67). HH had the highest iterative cost effect under willingness to pay less than 2000 RMB. Due to the low cost for repeatability and obvious effectiveness, we conclude that HH is the optimal strategy for MDROs infections in ICUs in developing countries. The cost-effectiveness of the four prevention strategies provides some reference for developing countries but multiple strategies remain to be examined.

It does seem clear from the above series of results that of the factors examined in their relation to rickets, etc., the only one of substantial importance is differences in the manner of feeding. The absence of definite association with overcrowding is, certainly, surprising, in spite of the fact that we realise how crude is the measure of this factor which we have had to adopt. If, as we suggest, the personal factor is not a very serious one, the above findings afford at least prima facie evidence of the truth of the assertions made previously, and are certainly sufficient to warrant the prosecution of further field enquiries, on this line, but having greater regard to the obtaining of the necessary information in a form more suitable for detailed analysis.

In this section the influence of five possible factors on the weight of the child has been considered. No one of these can be shown to be of outstanding importance in this respect; but the efficiency of the mother shows the highest and most consistent relationship. Health of mother and those variations of feeding which are considered here as indiscretions have no appreciable influence on infant weight, but the remaining two variables, overcrowding and position of the infant in the family, seem to influence the weight of the child. In the case of overcrowding, the effect is small and only becomes substantial towards the end of the first year. Position of the infant in family, likewise, is of little moment; first and latest-born infants initially seem to have lower than average weights, but towards the end of the first year of life the weights of first-born infants tend to be over average, while those of infants born into already large families still show evidence of inferiority.

A total of 571 swine sera collected at an abattoir in the city of Obihiro, Hokkaido during the period February–November 1984 were tested for antibody against human (H1N1) influenza virus strains. A high prevalence of antibody was observed for only 3 months from April to June in that year, in 81/180 sera (45·0%) to A/USSR/92/77 strain and in 50/180 sera (27·8%) to a current epidemic strain (A/Hokkaido/1/84). Some cross-reactions were observed between the A/USSR/92/77 and A/Hokkaido/1/84 antibodies (r = 0·75). Only minor relationships were noted between the A/New Jersey/8/76 (swine type H1N1) and A/USSR/92/77 (r = 0·35) or A/Hokkaido/1/84 (r = 0·51) antibodies. Absorption of sera positive for antibody to the A/Hokkaido/1/84 strain with the homologous virus strain removed all detectable antibodies, while the absorption of the sera with the A/New Jersey/8/76 strain produced incomplete absorption in one half of the sera tested. These resultsstrongly suggest that the swine became infected with a human H1N1 virus as piglets during an epidemic of influenza which occurred in the human population during January and February 1984.

Between 19 May and 12 June 2020, employees of the UZ Brussel were recruited in this study aiming to document the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence, to investigate the potential work-related risk factors for SARS-CoV-2 infection and to estimate the proportion of asymptomatic infections. In total, 2662 participants were included of whom 7.4% had immunoglobulin G antibodies against SARS-CoV-2. Of the participants reporting a positive polymerase chain reaction for SARS-CoV-2, 89% had antibodies at the time of blood sampling. Eleven per cent of the antibody positive participants reported no recent symptoms suggestive of coronavirus disease 2019 (COVID-19). Participants reporting fever, chest pain and/or anosmia/ageusia were significantly more frequently associated with the presence of antibodies against SARS-CoV-2. The presence of antibodies was highest in the group that had had contact with COVID-19-infected individuals outside the hospital with or without using appropriate personnel protective equipment (PPE) (P < 0.001). Inside the hospital, a statistically significant difference was observed for the employees considered as low-risk exposure compared to the intermediate-risk exposure group (P = 0.005) as well as the high-risk exposure group compared to the intermediate exposure risk group (P < 0.001). These findings highlight the importance of using correct PPE.

This study aimed to evaluate risk factors associated with shedding of pathogenic Leptospira species in urine at animal and herd levels. In total, 200 dairy farms were randomly selected from the DairyNZ database. Urine samples were taken from 20 lactating, clinically normal cows in each herd between January and April 2016 and tested by real-time polymerase chain reaction (PCR) using gyrB as the target gene. Overall, 26.5% of 200 farms had at least one PCR positive cow and 2.4% of 4000 cows were shedding Leptospira in the urine. Using a questionnaire, information about risk factors at cow and farm level was collected via face-to-face interviews with farm owners and managers. Animals on all but one farm had been vaccinated against Hardjo and Pomona and cows on 54 of 200 (27%) farms had also been vaccinated against Copenhageni in at least one age group (calves, heifers and cows). Associations found to be statistically significant in univariate analysis (at P < 0.2) were assessed by multivariable logistic regression. Factors associated with shedding included cattle age (Odds ratio (OR) 0.82, 95% CI 0.71–0.95), keeping sheep (OR 5.57, 95% confidence interval (CI) 1.46–21.25) or dogs (OR 1.45, 95% CI 1.07–1.97) and managing milking cows in a single as opposed to multiple groups (OR 0.45, 95% CI 0.20–0.99). We conclude that younger cattle were more likely to be shedding Leptospira than older cattle and that the presence of sheep and dogs was associated with an increased risk of shedding in cows. Larger herds were at higher risk of having Leptospira shedders. However, none of the environmental risk factors that were assessed (e.g. access to standing water, drinking-water source), or wildlife abundance on-farm, or pasture were associated with shedding, possibly due to low statistical power, given the low overall shedding rate.

A review of the annual prevalence of Pseudomonas aeruginosa at a regional hospital in Taiwan revealed a significant increase in the incidence of extensive drug-resistant P. aeruginosa (XDRPA) from 2·1% in 2003 to 5·8% in 2007. The first XDRPA isolate was recovered in 2001 from the emergency ward. The widespread dissemination of XDRPA isolates to more than 10 other wards was discovered the following year. Six pulsotypes of 67 XDRPA isolates from 2006 onwards were identified and 91% were a single strain, suggesting the existence of a hidden outbreak. Prior to the recognition of the outbreak, the majority of cases were not considered to be healthcare-associated infections until molecular evidence was provided. A cohort measure was launched by the infection control practitioners that effectively controlled the outbreak. Patients with XDRPA were mostly referred from neighbouring long-term care facilities, which may have been the reservoir of the XDRPA clone.

Papillary variation includes all heritable changes of character which take place in the papillae of bacterial colonies and the corresponding variations in liquid media.

The following is a short summary of what is known about these variations. Papillary variation was first observed in B. coli-mutabile, and other coliform bacteria show the same variations. This race forms white colonies on lactose neutral-red plates. After 1–5 days’ incubation minute papillae, which become red and increase in size, appear on their surfaces. Subcultures from thesepapillae give colonies of two kinds, white and red. The white colonies continue to throw red, the reds breed true (Neisser, 1906; Massim, 1907). Similar variation to different sugars occurs in other related bacteria: B. dysentenae Sonne varies to lactose, B. dysentenae Mexner to maltose, B. paracolon to saccharose, B. coh-mutabile, B. acidi-lactici and B. typhosus to dulcite (Twort, 1907; Reiner Miiller, 1909; Burn, 1910; Stewart, 1926, 1927). Vacation takes place only on the sugar concerned, but, once it has taken place, the character remains fixed, even after long growth on other media. Variation is not determined by length of exposure to the sugar. It occurs at (or after) the end of the logarithmic phase. If this phase is kept going by daily subculture (in the appropriate sugar) the bacteria of the chain carried on from culture to culture do not vary, however long they are exposed (Stewart, 1927; Deere, Dulaney & Michelson, 1939). On the other hand, if the logarithmic phase is curtailed by heavy inoculation of a culture, variation occurs early (Stewart, 1927). If the bacterium is grown on a plate without sugar until the colonies are well formed and the sugar is then added, with care not to disturb the colonies, variants appear after very short exposure (Stewart, 1927, 1928). A variation 33–2 may be completed in, two distinct steps; thus a race of B. typhosus formed white colonies on dulcite with pink papillae, subcultures from which gave white and pink colonies; the pink colonies formed dark red papillae from which on subculture came pink and dark red colonies, the latter bred true.

Because of a lack of gold standard diagnostics, a combination of multiple diagnostic tests, or composite diagnostic standard, has been used to measure pneumococcal pneumonia (PP) in pneumococcal vaccine trials. We estimated the accuracy of composite diagnostic standards for PP used in previous randomised controlled trials by simple formulas. A systematic literature review identified five eligible trials and all trials had used different combinations of diagnostic tests for PP. The estimated values of sensitivity and minimum specificity of composite diagnostic standards varied substantially between trials: 48.4% to 98.1% and 71.0% to 97.3%, respectively. Without standardizing the outcome measurements, pneumococcal vaccine efficacy estimates against PP are not comparable between trials and their pooled estimates are biased.

In November 2017, eight confirmed measles cases were reported to Public Health England from a hospital in the West Midlands. A multidisciplinary Incident Management Team (IMT) was established to determine the extent of the problem and coordinate an outbreak response. Between 1 November 2017 and 4 June 2018, a total of 116 confirmed and 21 likely measles cases were linked to this outbreak; just under half (43%) were aged over 15 years of age. Fifty-five of the confirmed cases were hospitalised (48%) and no deaths were reported. At the start of the outbreak, cases were mostly individuals of Romanian origin; the outbreak subsequently spread to the wider population. Over the 8-month response, the IMT conducted the following control measures: extensive contact tracing, immediate provision of post-exposure prophylaxis, community engagement amongst specific high-risk groups, MMR awareness raising including catch-up campaigns and enhanced vaccination services at selected GP surgeries. Key challenges to the effective control measures included language difficulties limiting community engagement; delays in diagnosis, notification and appropriate isolation of cases; limited resources for contact tracing across multiple high-risk settings (including GPs and hospitals) and lack of timely data on vaccine coverage in sub-groups of the population to guide public health action.