The diagnostics and treatment of tropical diseasesStitt, E. R. (Edward Rhodes)
Science
The diagnostics and treatment of tropical diseases
Stitt, E. R. (Edward Rhodes)
Tropical medicine
Plague is practically the only bacterial disease where there
is likelihood of finding the causative organism in smears. In
septicaemic plague the blood culture is the proper procedure and
one should take 5 to 15 cc. of blood in 15 to 25 cc. of normal
saline containing 1% of sodium citrate. This prevents coagulation
and at one’s leisure 1 or 2 cc. can be added to tubes of melted
agar and plates poured or other portions added to bouillon or 3%
salt agar. This same blood emulsion can be used to infect guinea
pigs subcutaneously or to infect them cutaneously by rubbing on the
shaven surface.
In smears from material from buboes, from sputum, or in blood
smears, as well as from blood or spleen smears from experimental
animals, we obtain the typical morphology of a cocco-bacillus (1.5
× 0.5 microns) with very characteristic bipolar staining, there
being an intermediate, unstained area. Very characteristic also
is the appearance in these smears of degenerate types which stain
feebly and show coccoid and inflated oval types. The presence
of these involution forms associated with typical bacilli is
almost diagnostic for one with experience. Inoculating tubes of
plain agar and 3% salt agar with this same material, we obtain
in plain agar cultures organisms which are, typically, small,
fairly slender rods, which do not stain characteristically at
each end and are not oval. The smear obtained from the salt agar
presents most remarkable involution forms—coccoid, root-shaped,
sausage-shaped forms, ranging from three to twelve microns in
length, more resembling cultures of moulds than bacteria. Another
point is that on the inoculated plain agar we are in doubt at the
end of twenty-four hours whether the dew-drop colonies are really
bacterial colonies or only condensation particles. By the second
day, however, these colonies have an opaque grayish appearance,
so that now, instead of questioning the presence of a culture, we
consider the possibility of contamination.
Blood cultures in septicaemic plague may show from 5 to 500,000
bacilli per cc. Smears from the blood in such cases are positive in
only about 17%.
The plague bacillus grows well at room temperature—its optimum
temperature being 30° instead of 37°C., as is usual with pathogens.
Next to the salt agar culture, the most characteristic one is
the stalactite growth in bouillon containing oil drops on its
surface. The culture grows downward from the under surface of the
oil drops as a powdery thread. These are very fragile, and as the
slightest jar breaks them, it is difficult to obtain this cultural
characteristic.
Albrecht and Ghon have shown that by smearing material upon the
intact, shaven skin of a guinea pig, infection occurs. This is the
crucial test. Smear the material on a shaven surface about 1 inch
square.
Public-domain text, read in full here on John Shaqi.
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