- Email: [email protected]
Non-typable quinolone-resistant gonococci
604
systems). We have isolated similar strains from three patients in Glasgow. None was typable by the above panel but all reacted with monoclonal antibody Bjand they typed as serovar AvBx in the
Immunoblots of PBC
serum
(1
in
100) against:
(1 ) rat liver mitochondria, (2) rat brain mitochondria, (3) rat brain myelin, (4) bovineheartmitochondria, (5) bovinebraimitochondria, (6) bovine brain myelin. Myelin prepared according to procedure of Dodd et al.’ Same amount of protein was applied to each track. Escherichia coli, Proteus mirabilis, and Klebsiella pneumrnziae. Myelin is a target for autoimmune attack in multiple sclerosis, and infections, including those of the urinary tract, may be associated with exacerbation of that disease. Might an immunological cross-reaction between E2 antigens of infecting bacteria and homologous autoantigens present in myelin be involved in such exacerbation-or indeed in the pathogenesis of the disease? Division of Biomolecular Sciences, King’s College London, London W8 7AH, UK
H. BAUM F. DAFFERN G. S. HALL
Department of Neurology, King’s College Hospital,
K.
London
J. ZILKHA
Ghadiminejad I, Baum H. Evidence for the cell-surface localization of antigens cross-reacting with "mitochondrial antibodies" of primary biliary cirrhosis. Hepatology 1987; 7: 743-50. 2. Gerken G, Manns M, Ramadori G, et al. Correspondence. Hepatology 1988; 8: 1.
705-06. 3. Dodd PR, Manns M, Ramadori G, et al. A rapid method for preparing synaptosomes: comparison with alternative procedures. Brain Res 1981; 226: 107-18. 4. Ghadiminejad I, Baum H. Reaction pattern of mitochondrial antibodies of primary biliary cirrhosis (PBC) is species-specific but not organ-specific. J Bioeng Biomem 1987; 19: 245-59. 5. Fussey SPM, Guest JR, Bassendine MF, et al. Identification and analysis of the major M2 autoantigens in primary biliary cirrhosis. Proc Natl Acad Sci USA 1988; 85: 8654-58. 6. Danson MJ. Dihydrolipoamide dehydrogenase: a ’new’ function for an old enzyme? Biochem Soc Trans 1988; 16: 87-89. 7. Flannery GR, Burroughs AK, Butler P, et al. Antimitochondrial antibodies in primary biliary cirrhosis recognise both specific peptides and shared epitopes of the M2 family of antigens. Hepatology 1989; 10: 370-74. 8. Burroughs AK, Butler P, Brumfitt W, Baum H. Mitochondrial M2 autoantigens and primary biliary cirrhosis. Lancet 1989; i: 447-48.
Non-typable quinolone-resistant gonococci SIR,-Dr Jephcott and Dr Turner (Jan 20,
p 165) describe nine unusual type of penicillinase-producing Neisseria gonorrhoeae (PPNG) with diminished sensitivity to ciprofloxacin: these strains were contracted in the UK, Spain, or the Canary Isles, they carried 32 and 24MD plasmids, were of non-requiring auxotype, and were non-typable with the standard panel’ of six protein 1A and six 1B specific monoclonal antibodies (Genetic
isolates of
an
Pharmacia panel? The first isolate (October, 1989) was from a man infected after intercourse in Glasgow. One week after a single dose of 400 mg fleroxacin he was still culture positive. He denied intercourse during the intervening period. Pretreatment and post-treatment isolates were identical. He was treated successfully with spectinomycin and erythromycin. His partner was traced and an apparently identical strain was isolated from her urethra, cervix, and rectum. She was treated with spectinomycin and erythromycin, which proved successful on follow-up cultures. She had been infected in Benidorm, Spain, in the summer of 1989. The third patient was seen elsewhere in mid-October when she was found to be infected with a penicillin-resistant gonococcus. This isolate was not available for serotyping. She attended the department of genitourinary medicine 2 weeks later, when urethral culture yielded a scanty growth of PPNG Bj/AvBx; cervical and rectal cultures were negative. She was treated successfully with erythromycin. Despite the apparently identical strain she was not connected with the other two patients, but she had been infected after being raped by a Spanish man in Benidorm at the end of September. Our cases confirm the link of unusual PPNG isolates with Spain and support the view that quinolone therapy developed for the normal range of susceptibilities may fail in patients infected with strains of diminished sensitivity. Although the minimum inhibitory concentration (MIC) of fleroxacin was not determined for our isolates the MIC of ciprofloxacin was 0 06 mg/1. It is likely that the MIC of fleroxacin was greater than this since in one study,3 involving both PPNG and non-PPNG, the MIC offleroxacin was 006 mg/1 compared with 0 015 mg/1 for ciprofloxacin. These isolates also show that penicillinase plasmids can become established in rare strains of gonococci. Strains of serotype AvBx contain epitopes of both protein 1A and 1B, which are generally considered to be mutually exclusive forms of protein 1. P1A-P1B hybrids are rare in nature.2 The rarity of these strains may indicate a diminished capacity of hybrid strains to enter and maintain themselves in the gonococcal pool. If this is the case then the spread of this particular quinolone-resistant clone may be limited. STD
Diagnostic Laboratory, Department of Bacteriology, Edinburgh University Medical School, Edinburgh EH8 9AG, UK
H. YOUNG A. MOYES
Departments of Genitourinary Medicine and Bacteriology, Glasgow Royal Infirmary and Southern General Hospital, Glasgow
I. B. TAIT A. C. MCCARTNEY G. GALLACHER
JS, Tam MR, Nowinski RC, Holmes KK, Sandstrom EG. Serological classification of Neisseria gonorrhoeae with the use of monoclonal antibodies to gonococcal outer membrane protein 1. J Infect Dis 1984; 150: 44-48. 2. Bygdeman SM. Polyclonal and monoclonal antibodies applied to the epidemiology of gonococcal infection. In: Young H, McMillan A, eds. Immunological diagnosis of sexually transmitted diseases. New York: Marcel Dekker, 1988: 117-65. 3. Nye K, Shi YG, Andrews JM, Ashby JP, Wise R. The in-vitro activity, pharmacokinetics and tissue penetration of temafloxacin. J Antimicrob Chemother 1989; 24: 415-24 1. Knapp
Portable infusor for victims of
catastrophes
SiR,—Intravenous therapy is often needed for casualties of disasters, whether military or civilian.1 However, brackets for bottles (or packs) are not always available and it is often necessary for someone to keep the bottle in a raised position. We have devised a portable infusor that can be handled easily and attached without the use of a stand to a patient’s arm. This infusor consists of a sealed box containing a plastic bag, filled with 500 ml of the infusion solution (other sizes of plastic bags are available). Pressure is exerted on the bag by means of liquid gas which is fed into the box through a relief valve. A small gas cartridge is positioned on the outside of the box. The pressure is regulated to allow a mean rate of 500 ml in 60 min. This rate can be adjusted. A small ball flowmeter is incorporated in the tube (figure).
systems). We have isolated similar strains from three patients in Glasgow. None was typable by the above panel but all reacted with monoclonal antibody Bjand they typed as serovar AvBx in the
Immunoblots of PBC
serum
(1
in
100) against:
(1 ) rat liver mitochondria, (2) rat brain mitochondria, (3) rat brain myelin, (4) bovineheartmitochondria, (5) bovinebraimitochondria, (6) bovine brain myelin. Myelin prepared according to procedure of Dodd et al.’ Same amount of protein was applied to each track. Escherichia coli, Proteus mirabilis, and Klebsiella pneumrnziae. Myelin is a target for autoimmune attack in multiple sclerosis, and infections, including those of the urinary tract, may be associated with exacerbation of that disease. Might an immunological cross-reaction between E2 antigens of infecting bacteria and homologous autoantigens present in myelin be involved in such exacerbation-or indeed in the pathogenesis of the disease? Division of Biomolecular Sciences, King’s College London, London W8 7AH, UK
H. BAUM F. DAFFERN G. S. HALL
Department of Neurology, King’s College Hospital,
K.
London
J. ZILKHA
Ghadiminejad I, Baum H. Evidence for the cell-surface localization of antigens cross-reacting with "mitochondrial antibodies" of primary biliary cirrhosis. Hepatology 1987; 7: 743-50. 2. Gerken G, Manns M, Ramadori G, et al. Correspondence. Hepatology 1988; 8: 1.
705-06. 3. Dodd PR, Manns M, Ramadori G, et al. A rapid method for preparing synaptosomes: comparison with alternative procedures. Brain Res 1981; 226: 107-18. 4. Ghadiminejad I, Baum H. Reaction pattern of mitochondrial antibodies of primary biliary cirrhosis (PBC) is species-specific but not organ-specific. J Bioeng Biomem 1987; 19: 245-59. 5. Fussey SPM, Guest JR, Bassendine MF, et al. Identification and analysis of the major M2 autoantigens in primary biliary cirrhosis. Proc Natl Acad Sci USA 1988; 85: 8654-58. 6. Danson MJ. Dihydrolipoamide dehydrogenase: a ’new’ function for an old enzyme? Biochem Soc Trans 1988; 16: 87-89. 7. Flannery GR, Burroughs AK, Butler P, et al. Antimitochondrial antibodies in primary biliary cirrhosis recognise both specific peptides and shared epitopes of the M2 family of antigens. Hepatology 1989; 10: 370-74. 8. Burroughs AK, Butler P, Brumfitt W, Baum H. Mitochondrial M2 autoantigens and primary biliary cirrhosis. Lancet 1989; i: 447-48.
Non-typable quinolone-resistant gonococci SIR,-Dr Jephcott and Dr Turner (Jan 20,
p 165) describe nine unusual type of penicillinase-producing Neisseria gonorrhoeae (PPNG) with diminished sensitivity to ciprofloxacin: these strains were contracted in the UK, Spain, or the Canary Isles, they carried 32 and 24MD plasmids, were of non-requiring auxotype, and were non-typable with the standard panel’ of six protein 1A and six 1B specific monoclonal antibodies (Genetic
isolates of
an
Pharmacia panel? The first isolate (October, 1989) was from a man infected after intercourse in Glasgow. One week after a single dose of 400 mg fleroxacin he was still culture positive. He denied intercourse during the intervening period. Pretreatment and post-treatment isolates were identical. He was treated successfully with spectinomycin and erythromycin. His partner was traced and an apparently identical strain was isolated from her urethra, cervix, and rectum. She was treated with spectinomycin and erythromycin, which proved successful on follow-up cultures. She had been infected in Benidorm, Spain, in the summer of 1989. The third patient was seen elsewhere in mid-October when she was found to be infected with a penicillin-resistant gonococcus. This isolate was not available for serotyping. She attended the department of genitourinary medicine 2 weeks later, when urethral culture yielded a scanty growth of PPNG Bj/AvBx; cervical and rectal cultures were negative. She was treated successfully with erythromycin. Despite the apparently identical strain she was not connected with the other two patients, but she had been infected after being raped by a Spanish man in Benidorm at the end of September. Our cases confirm the link of unusual PPNG isolates with Spain and support the view that quinolone therapy developed for the normal range of susceptibilities may fail in patients infected with strains of diminished sensitivity. Although the minimum inhibitory concentration (MIC) of fleroxacin was not determined for our isolates the MIC of ciprofloxacin was 0 06 mg/1. It is likely that the MIC of fleroxacin was greater than this since in one study,3 involving both PPNG and non-PPNG, the MIC offleroxacin was 006 mg/1 compared with 0 015 mg/1 for ciprofloxacin. These isolates also show that penicillinase plasmids can become established in rare strains of gonococci. Strains of serotype AvBx contain epitopes of both protein 1A and 1B, which are generally considered to be mutually exclusive forms of protein 1. P1A-P1B hybrids are rare in nature.2 The rarity of these strains may indicate a diminished capacity of hybrid strains to enter and maintain themselves in the gonococcal pool. If this is the case then the spread of this particular quinolone-resistant clone may be limited. STD
Diagnostic Laboratory, Department of Bacteriology, Edinburgh University Medical School, Edinburgh EH8 9AG, UK
H. YOUNG A. MOYES
Departments of Genitourinary Medicine and Bacteriology, Glasgow Royal Infirmary and Southern General Hospital, Glasgow
I. B. TAIT A. C. MCCARTNEY G. GALLACHER
JS, Tam MR, Nowinski RC, Holmes KK, Sandstrom EG. Serological classification of Neisseria gonorrhoeae with the use of monoclonal antibodies to gonococcal outer membrane protein 1. J Infect Dis 1984; 150: 44-48. 2. Bygdeman SM. Polyclonal and monoclonal antibodies applied to the epidemiology of gonococcal infection. In: Young H, McMillan A, eds. Immunological diagnosis of sexually transmitted diseases. New York: Marcel Dekker, 1988: 117-65. 3. Nye K, Shi YG, Andrews JM, Ashby JP, Wise R. The in-vitro activity, pharmacokinetics and tissue penetration of temafloxacin. J Antimicrob Chemother 1989; 24: 415-24 1. Knapp
Portable infusor for victims of
catastrophes
SiR,—Intravenous therapy is often needed for casualties of disasters, whether military or civilian.1 However, brackets for bottles (or packs) are not always available and it is often necessary for someone to keep the bottle in a raised position. We have devised a portable infusor that can be handled easily and attached without the use of a stand to a patient’s arm. This infusor consists of a sealed box containing a plastic bag, filled with 500 ml of the infusion solution (other sizes of plastic bags are available). Pressure is exerted on the bag by means of liquid gas which is fed into the box through a relief valve. A small gas cartridge is positioned on the outside of the box. The pressure is regulated to allow a mean rate of 500 ml in 60 min. This rate can be adjusted. A small ball flowmeter is incorporated in the tube (figure).