- Email: [email protected]
PENICILLIN-INSENSITIVE NEISSERIA MENINGITIDIS
1167 child presented with shock and coma but had a macular rash only.6 However, as progression of the rash often coincides with clinical deterioration, treatment while the rash is at an early stage may improve the outcome. Unfortunately, some doctors who are the first to see febrile children with meningococcaemia are not aware of the significance of a discrete non-haemorrhagic rash, and this possibility is not mentioned in most standard British textbooks of general paediatrics, which describe either petechial or purpuric lesions. Besides the need to emphasise the significance of a haemorrhagic rash, more attention should be paid to the septicaemic form and to the early lesions that can occur. P. BAXTER B. PRIESTLEY
Children’s Hospital, Sheffield S10 2TH
1. Niklasson
P-M, Lundbergh P, Strandell T. Prognostic factors in meningococcal Scand J Infect Dis 1971; 3: 17-25. 2. Oakley JA, Stanton AN. Meningococcal infections during infancy, confidential inquines into ten deaths. Br Med J 1979; ii: 468-69. 3 Easton DM, Estcourt PG, Brimblecombe FSW, Burgess W, Hass L, Kurtz JB. Outbreak of meningococcal disease in Devon. Br Med J 1974; i: 507-09. 4. Toews WH, Bass JW. Skin manifestations of meningococcal infection. An immediate indicator of prognosis. Am J Dis Child 1974; 127: 173-76. 5 Sullivan TD, LaScolea LJ. Neisseria meningitidis bacteremia in children: quantitation disease.
of bacteremia and spontaneous clinical recovery without antibiotic therapy. Pediatrics 1987; 80: 63-67 6. Hamptom F, MacFadyen U, Field D. Prognosis of meningococcal septicaemia. Lancet
1987; ii:
395.
PENICILLIN-INSENSITIVE NEISSERIA MENINGITIDIS
SiR,—Mrs Sutcliffe and colleagues (March 19, p 657) report on increasing incidence of penicillin-insensitive meningococci in England and Wales. We have recently isolated Neisseria meningitidis serogroup B, type 15, sub-type PI’6 from the throat swab of a homosexual patient attending the department of genitourinary medicine, Newcastle upon Tyne. This strain is penicillininsensitive (minimum inhibitory concentration [MIC] 0-64 mg/1) and sulphonamide-resistant but sensitive to rifampicin, gentamicin, erythromycin, chloramphenicol, ciprofloxacin, and spectinomycin. However, unlike the reference centre isolates, this strain is tetracycline-resistant. Since it is not clinically relevant, meningococci are not routinely tested for tetracycline sensitivity and therefore the incidence of tetracycline-resistant meningococci in this country is unknown. Dr Round and Dr Hamilton (March 26, p 702) report a tetracycline-resistant meningococcus, although the degree of resistance was not recorded. Our isolate has been shown to have high-level resistance to tetracycline (giving no zone of inhibition to a 10 ug tetracycline disc and an MIC of 16 mg/1) and carries a 25-2 MD plasmid (plasmid analysis by Dr C. A. Ison, St Mary’s Hospital Medical School, London). Tetracycline-resistant N gonorrhoeae have been increasingly recognised in the USA,1 and have now been reported in the UK.2.3 In the gonococcus, plasmid-mediated resistance for tetracycline is due to the tet M determinant on a plasmid of 25-2 MD.’ Further the
studies
are
needed
to
determine the
nature
Public Health Service Laboratory, General Hospital, Newcastle upon Tyne NE4 6BE
1. Knapp
SIR,-Listen"a monocytogenes has lately received much attention in relation to foodborne infection. 1-3 The organism is a well known cause of severe illness in mother-infant pairs and immunocompromised patients. Although deaths attributable to L monocytogenes are rare, the case fatality rate can be as high as 30%.4 The organism is unusual in that it can multiply over a temperature range of 1-45OC. It has been associated with several major outbreaks of food-borne illness, being especially associated with the One consumption of milk products, particularly cheese.4-
KAREN SIZMUR C. W. WALKER
1. McLauchlin J, Saunders NA, Ridley AM, Taylor AG. Listeriosis and food-borne transmission. Lancet 1988; i: 177-78. 2. Gilbert RJ, Pmi PN Listeriosis and food-home transmission Lancet 1988; i: 472-73. 3. WHO Working Group recommendations. Food-borne listenosis. Wkly Epidem Rec 1988; 63: 62-3. 4. Flemming DW, Cochi SL, MacDonald KL, et al. Pasteunsed milk as a vehicle of infection in an outbreak of listenosis. N Engl J Med 1985; 312: 404-07. 5. James SM, Fannin SL, Agee BA, et al Listenosis outbreak associated with Mexican-style cheese—California MMWR 1985; 34: 357-59. 6. Bannister BA. Listeria monocytogenes meningitis associated with eating soft cheese. J Infect 1987; 15: 165-68. 7. Schlech WF, Lavigne PM, Bortolussi RA, et al. Epidemic listeriosis—evidence for transmission by food. N Engl JMed 1983; 308: 203-06.
of resistance in this
meningococcal isolate. We thank the Public Health for serotyping.
LISTERIA IN PREPACKED SALADS
TYRAMINE IN ALCOHOL-FREE BEER
Laboratory Reference Centre, Manchester, M. S. SPROTT A. M. KEARNS J. M. FIELD
JS, Zenliman JM, Biddle JW, et al. Frequency and distribution m the United States of strains of Neisseria gonorrhoeae with plasmid-mediated, high-level resistance to tetracycline. J Infect Dis 1987; 155: 819-22. 2 Ison CA, Terry P, Bindayna K, et al. Tetracycline-resistant gonococci in UK. Lancet 1988; i. 651-52. 3. Waugh MA, Lacey CJN, Hawkey PM, et al. Spread of Neisseria gonorrhoeae resistant to tetracycline outside the United States of America. Br Med J 1988; 296: 898 4 Morse SA, Johnson SR, Biddle JW, Roberts MC. High-level tetracycline resistance in Neisseria gonorrhoeae is due to the acquisition of the streptococcal tet M determinant. Antimicrob Agents Chemother 1986; 30: 664-70.
SIR,-Dr Hannah and colleagues (April 16, p 879) report the level of tyramine in certain alcohol beverages. We have seen a case of non-fatal acute cerebral haemorrhage in a patient taking a monoamine oxidase inhibitor (MAOI) who drank a dealcoholised Irish brewed beer. A 48-year-old man complained of acute onset of severe generalised headache followed by a right hemiplegia and expressive dysphasia. This happened 15 min after he had drunk 250 ml of alcohol-free beer. He had endogenous depression and was taking tranylcypromine 10 mg three times daily, lithium carbonate 200 mg twice daily, dothiepin 75 mg at night, and diazepam 10 mg three times daily. He had no history of hypertension. His blood pressure on admission was 140/80 mm Hg and he had expressive dysphasia and a dense right hemiplegia. Cranial computerised tomography revealed a left intracerebral bleed in the territory of the middle
Children’s Hospital, Sheffield S10 2TH
1. Niklasson
P-M, Lundbergh P, Strandell T. Prognostic factors in meningococcal Scand J Infect Dis 1971; 3: 17-25. 2. Oakley JA, Stanton AN. Meningococcal infections during infancy, confidential inquines into ten deaths. Br Med J 1979; ii: 468-69. 3 Easton DM, Estcourt PG, Brimblecombe FSW, Burgess W, Hass L, Kurtz JB. Outbreak of meningococcal disease in Devon. Br Med J 1974; i: 507-09. 4. Toews WH, Bass JW. Skin manifestations of meningococcal infection. An immediate indicator of prognosis. Am J Dis Child 1974; 127: 173-76. 5 Sullivan TD, LaScolea LJ. Neisseria meningitidis bacteremia in children: quantitation disease.
of bacteremia and spontaneous clinical recovery without antibiotic therapy. Pediatrics 1987; 80: 63-67 6. Hamptom F, MacFadyen U, Field D. Prognosis of meningococcal septicaemia. Lancet
1987; ii:
395.
PENICILLIN-INSENSITIVE NEISSERIA MENINGITIDIS
SiR,—Mrs Sutcliffe and colleagues (March 19, p 657) report on increasing incidence of penicillin-insensitive meningococci in England and Wales. We have recently isolated Neisseria meningitidis serogroup B, type 15, sub-type PI’6 from the throat swab of a homosexual patient attending the department of genitourinary medicine, Newcastle upon Tyne. This strain is penicillininsensitive (minimum inhibitory concentration [MIC] 0-64 mg/1) and sulphonamide-resistant but sensitive to rifampicin, gentamicin, erythromycin, chloramphenicol, ciprofloxacin, and spectinomycin. However, unlike the reference centre isolates, this strain is tetracycline-resistant. Since it is not clinically relevant, meningococci are not routinely tested for tetracycline sensitivity and therefore the incidence of tetracycline-resistant meningococci in this country is unknown. Dr Round and Dr Hamilton (March 26, p 702) report a tetracycline-resistant meningococcus, although the degree of resistance was not recorded. Our isolate has been shown to have high-level resistance to tetracycline (giving no zone of inhibition to a 10 ug tetracycline disc and an MIC of 16 mg/1) and carries a 25-2 MD plasmid (plasmid analysis by Dr C. A. Ison, St Mary’s Hospital Medical School, London). Tetracycline-resistant N gonorrhoeae have been increasingly recognised in the USA,1 and have now been reported in the UK.2.3 In the gonococcus, plasmid-mediated resistance for tetracycline is due to the tet M determinant on a plasmid of 25-2 MD.’ Further the
studies
are
needed
to
determine the
nature
Public Health Service Laboratory, General Hospital, Newcastle upon Tyne NE4 6BE
1. Knapp
SIR,-Listen"a monocytogenes has lately received much attention in relation to foodborne infection. 1-3 The organism is a well known cause of severe illness in mother-infant pairs and immunocompromised patients. Although deaths attributable to L monocytogenes are rare, the case fatality rate can be as high as 30%.4 The organism is unusual in that it can multiply over a temperature range of 1-45OC. It has been associated with several major outbreaks of food-borne illness, being especially associated with the One consumption of milk products, particularly cheese.4-
KAREN SIZMUR C. W. WALKER
1. McLauchlin J, Saunders NA, Ridley AM, Taylor AG. Listeriosis and food-borne transmission. Lancet 1988; i: 177-78. 2. Gilbert RJ, Pmi PN Listeriosis and food-home transmission Lancet 1988; i: 472-73. 3. WHO Working Group recommendations. Food-borne listenosis. Wkly Epidem Rec 1988; 63: 62-3. 4. Flemming DW, Cochi SL, MacDonald KL, et al. Pasteunsed milk as a vehicle of infection in an outbreak of listenosis. N Engl J Med 1985; 312: 404-07. 5. James SM, Fannin SL, Agee BA, et al Listenosis outbreak associated with Mexican-style cheese—California MMWR 1985; 34: 357-59. 6. Bannister BA. Listeria monocytogenes meningitis associated with eating soft cheese. J Infect 1987; 15: 165-68. 7. Schlech WF, Lavigne PM, Bortolussi RA, et al. Epidemic listeriosis—evidence for transmission by food. N Engl JMed 1983; 308: 203-06.
of resistance in this
meningococcal isolate. We thank the Public Health for serotyping.
LISTERIA IN PREPACKED SALADS
TYRAMINE IN ALCOHOL-FREE BEER
Laboratory Reference Centre, Manchester, M. S. SPROTT A. M. KEARNS J. M. FIELD
JS, Zenliman JM, Biddle JW, et al. Frequency and distribution m the United States of strains of Neisseria gonorrhoeae with plasmid-mediated, high-level resistance to tetracycline. J Infect Dis 1987; 155: 819-22. 2 Ison CA, Terry P, Bindayna K, et al. Tetracycline-resistant gonococci in UK. Lancet 1988; i. 651-52. 3. Waugh MA, Lacey CJN, Hawkey PM, et al. Spread of Neisseria gonorrhoeae resistant to tetracycline outside the United States of America. Br Med J 1988; 296: 898 4 Morse SA, Johnson SR, Biddle JW, Roberts MC. High-level tetracycline resistance in Neisseria gonorrhoeae is due to the acquisition of the streptococcal tet M determinant. Antimicrob Agents Chemother 1986; 30: 664-70.
SIR,-Dr Hannah and colleagues (April 16, p 879) report the level of tyramine in certain alcohol beverages. We have seen a case of non-fatal acute cerebral haemorrhage in a patient taking a monoamine oxidase inhibitor (MAOI) who drank a dealcoholised Irish brewed beer. A 48-year-old man complained of acute onset of severe generalised headache followed by a right hemiplegia and expressive dysphasia. This happened 15 min after he had drunk 250 ml of alcohol-free beer. He had endogenous depression and was taking tranylcypromine 10 mg three times daily, lithium carbonate 200 mg twice daily, dothiepin 75 mg at night, and diazepam 10 mg three times daily. He had no history of hypertension. His blood pressure on admission was 140/80 mm Hg and he had expressive dysphasia and a dense right hemiplegia. Cranial computerised tomography revealed a left intracerebral bleed in the territory of the middle