125
twice for a meningioma, and with inoperable disease associated with severe involvement of visual fields and acuity. Both patients had general complaints, such as fatigue and headache. Mifepristone was given orally at a dose of 200 mg per day for 6 months followed by 400 mg daily for a further 6 months (patient 1) or 8 months (patient 2). The two patients also received dexamethasone 1-5 mg daily because of the known glucocorticoid receptor blocking activity of mifepristone. Computerised tomographic scans indicated a decrease in tumour growth in patient 1, no change in tumour size being noted in patient 2. Visual deterioration did not progress for the duration of treatment. Wellbeing improved in patient 1 and remained unchanged in patient 2. Treatment was well tolerated and no side-effects were observed. Withdrawal of mifepristone (with the patients still on dexamethasone) was followed by rapidly progressive visual deterioration in both patients, blindness being a threat. Scans in patient 1 indicated an increase in tumour size. The patients’ general complaints returned. Mifepristone therapy was restarted and a significant regression of symptoms was observed in both. women,
operated
SUSCEPTIBILITY (Ilg/ml) OF SALMONELLA AT 10. CFU TO SELECTED ANTIMICROBIAL AGENTS
progressive
These
cases were
reported in abstract in Eur J Cancer 1990; 26: 172 (abstr
104).
Departments of Endocrinology, Ophthalmology, Neurosurgery, and
Radiology,
University Hospital, 2300RC Leiden, Netherlands
H. R. HAAK R. J. W. DE KEIZER J. C. W. HAGENOUW-TAAL A. P. VAN SETERS G. J. VIELVOYE H. VAN DULKEN
Nal=nalidixic acid;
Enr=enrofloxacin ; Cip=ciprofloxacin; Nor=norfloxacin;
CFU =colony forming
units.
*West German isolates
The isolation of nalR Salmonella spp with decreased susceptibility the newer quinolones used to treat salmonellosis in man is worrying. Thought needs to be given as to whether quinolones, such as enrofloxacin, should be given to animals. to
Department of Medical Microbiology, Birmingham University, Birmingham B15 2TJ, UK Central Veterinary Laboratory, Ministry of Agriculture, Fisheries and Food,
L.
J. V. PIDDOCK
Weybridge
C. WRAY I. MCCLAREN
Department of Medical Microbiology, Dudley Road Hospital, Birmingham
RICHARD WISE
1. Blankenstein
MA, Blaauw G, Lamberts SWJ, Mulder E. Presence of progesterone receptors and absence of oestrogen receptors m human intracranial meningioma cytosols. Eur J Cancer Clin Oncol 1983; 19: 365-370. 2. Olsen JJ, Beck DW, Schlechte J, Loh PM. Hormonal manipulation of meningiomas m vitro. J Neurosurg 1986; 65: 99-107. 3. Jaaskelainen J, Laasonen E, Karkkainen J, Haltia M, Troupp H. Hormone treatment of meningiomas: lack of response to medroxyprogesterone acetate (MPA). Acta Neurochir 1986; 80: 35-41. 4. van Seters AP, van Dulken H, de Keizer RJW, Vielvoye GJ. Symptomatic relief of meningioma by buserelin maintenance therapy. Lancet 1989; i: 564-65. 5. Baulieu EE. RU-486 as an antiprogesterone steroid. JAMA 1989; 262: 1808-14.
LJV, Whale K, Wise R. Quinolone resistance m salmonella: clinical experience. Lancet 1990; 335: 1459. 2. Piddock LJV, Wise R. Mechanisms of resistance to quinolones and clinical perspectives. J Antimicrob Chemother 1989; 23: 475-83. 3. Wray C, McLaren I, Wise R, Piddock LJV. Nalidixic acid-resistant salmonellae. Vet Rec 1989; May 12: 489. 4. British Society for Antimicrobial Chemotherapy, Working Party Report. Breakpoints in in-vitro antibiotic sensitivity testing. J Antimicrob Chemother 1988; 21: 701-10.
Quinolone resistance in Salmonella spp:
Borrelia burgdorferi ELISA titres in children with recent mumps meningitis
veterinary pointers SIR,-Until recently, quinolone-resistant (quinR) bacteria had been reported from human, but not from veterinary, sources in the UK.l,2 Dr Endtz and colleagues from the Netherlands (March 31, p 787) report quinR Campylobacter spp isolated from human sources and poultry. Recently we described the isolation of 17 nalidixic acid-resistant (nalR) salmonella serotypes (representing 0-0031 % of total Salmonella isolates) from poultry,3 some of which were imported and in quarantine in the UK. These strains were also resistant to the newer quinolones used clinically (eg, ciprofloxacin). The quinolone-susceptibility data for 6 of the typical British isolates and 3 West German isolates are shown in the table. A further 5 S newport, 4 S virchow, I S newington, and 1 S enteritidis, similar to those shown, were also isolated. All strains showed a 250-fold decrease in susceptibility to nalidixic acid when compared with reference S typhimurium NCTC 74 (L19), and a 100-fold decrease when compared with reference Escherichia coli NCTC 10418. S typhimurium (L22), S enteritidis (L34), and S bredeney (L25) had minimum inhibitory concentrations (MICs) of ciprofloxacin similar to the recommended breakpoint concentration for man, 2 /lgjml.4 All strains except the S seftenberg and S virchow had MICs above the recommended breakpoint to the new veterinary quinolone enrofloxacin. Typical wild type susceptibilities to gentamicin, trimethoprim and ceftazidime were observed for all strains (data not shown), with no apparent cross-resistance to chemically unrelated agents. High MICs are indicative of a target site alteration causing DNA gyrase to have decreased affinity for quinolones ;2 however, further studies of the precise mechanism of quinolone resistance are under way in our laboratory.
1. Piddock
SIR,-Since the detection of the causative agent of Lyme disease (Borrelia burgdorfere) serological methods have been developed for confirmation of the clinically suspected disease. However, there have been reports of both healthy seropositive and affected seronegative individuals.1-3 It is not yet clear what, after infection, is responsible for a transient (eg, erythema chronicum migrans), or a chronic progressive course of the disease, and for the wide variety of clinical conditions which may manifest in one individual. We have made the puzzling observation of 2 children presenting with aseptic meningitis (one of them without parotitis), and with serological evidence for both recent mumps and B burgdorferi infection. Neither child had a tick bite. This made us consider the possibility of false-positive B burgdorferi serology in cases of recent mumps meningitis. We studied 15 children with aseptic mumps meningitis (mean age 11years, mean disease duration 15 days), having first excluded those with a tick bite, antibodies to Epstein-Barr virus (IgM), or a high risk of acquiring meningitis (eg, immunodendent/ immunosuppressed, hydrocephalus shunt, &c). The control group comprised 14 children with aseptic non-mumps meningitis (mean age 9 years, mean disease duration 15 days), who were compatible with the exclusion criteria given above. Serum antibodies to B burgdorferi were determined with an ELISA method. Results were considered positive if a 1 in 1000 serum dilution gave an absorbance exceeding 0-45 at a wavelength of 492 nm. The significance of the anti-B burgdorferi antibody ELISA results in the test and control groups was assessed with a standard statistical method.4 7 of 15 children in the mumps group were seropositive for B burgdorferi while none of the 14 controls were seropositive; a
twice for a meningioma, and with inoperable disease associated with severe involvement of visual fields and acuity. Both patients had general complaints, such as fatigue and headache. Mifepristone was given orally at a dose of 200 mg per day for 6 months followed by 400 mg daily for a further 6 months (patient 1) or 8 months (patient 2). The two patients also received dexamethasone 1-5 mg daily because of the known glucocorticoid receptor blocking activity of mifepristone. Computerised tomographic scans indicated a decrease in tumour growth in patient 1, no change in tumour size being noted in patient 2. Visual deterioration did not progress for the duration of treatment. Wellbeing improved in patient 1 and remained unchanged in patient 2. Treatment was well tolerated and no side-effects were observed. Withdrawal of mifepristone (with the patients still on dexamethasone) was followed by rapidly progressive visual deterioration in both patients, blindness being a threat. Scans in patient 1 indicated an increase in tumour size. The patients’ general complaints returned. Mifepristone therapy was restarted and a significant regression of symptoms was observed in both. women,
operated
SUSCEPTIBILITY (Ilg/ml) OF SALMONELLA AT 10. CFU TO SELECTED ANTIMICROBIAL AGENTS
progressive
These
cases were
reported in abstract in Eur J Cancer 1990; 26: 172 (abstr
104).
Departments of Endocrinology, Ophthalmology, Neurosurgery, and
Radiology,
University Hospital, 2300RC Leiden, Netherlands
H. R. HAAK R. J. W. DE KEIZER J. C. W. HAGENOUW-TAAL A. P. VAN SETERS G. J. VIELVOYE H. VAN DULKEN
Nal=nalidixic acid;
Enr=enrofloxacin ; Cip=ciprofloxacin; Nor=norfloxacin;
CFU =colony forming
units.
*West German isolates
The isolation of nalR Salmonella spp with decreased susceptibility the newer quinolones used to treat salmonellosis in man is worrying. Thought needs to be given as to whether quinolones, such as enrofloxacin, should be given to animals. to
Department of Medical Microbiology, Birmingham University, Birmingham B15 2TJ, UK Central Veterinary Laboratory, Ministry of Agriculture, Fisheries and Food,
L.
J. V. PIDDOCK
Weybridge
C. WRAY I. MCCLAREN
Department of Medical Microbiology, Dudley Road Hospital, Birmingham
RICHARD WISE
1. Blankenstein
MA, Blaauw G, Lamberts SWJ, Mulder E. Presence of progesterone receptors and absence of oestrogen receptors m human intracranial meningioma cytosols. Eur J Cancer Clin Oncol 1983; 19: 365-370. 2. Olsen JJ, Beck DW, Schlechte J, Loh PM. Hormonal manipulation of meningiomas m vitro. J Neurosurg 1986; 65: 99-107. 3. Jaaskelainen J, Laasonen E, Karkkainen J, Haltia M, Troupp H. Hormone treatment of meningiomas: lack of response to medroxyprogesterone acetate (MPA). Acta Neurochir 1986; 80: 35-41. 4. van Seters AP, van Dulken H, de Keizer RJW, Vielvoye GJ. Symptomatic relief of meningioma by buserelin maintenance therapy. Lancet 1989; i: 564-65. 5. Baulieu EE. RU-486 as an antiprogesterone steroid. JAMA 1989; 262: 1808-14.
LJV, Whale K, Wise R. Quinolone resistance m salmonella: clinical experience. Lancet 1990; 335: 1459. 2. Piddock LJV, Wise R. Mechanisms of resistance to quinolones and clinical perspectives. J Antimicrob Chemother 1989; 23: 475-83. 3. Wray C, McLaren I, Wise R, Piddock LJV. Nalidixic acid-resistant salmonellae. Vet Rec 1989; May 12: 489. 4. British Society for Antimicrobial Chemotherapy, Working Party Report. Breakpoints in in-vitro antibiotic sensitivity testing. J Antimicrob Chemother 1988; 21: 701-10.
Quinolone resistance in Salmonella spp:
Borrelia burgdorferi ELISA titres in children with recent mumps meningitis
veterinary pointers SIR,-Until recently, quinolone-resistant (quinR) bacteria had been reported from human, but not from veterinary, sources in the UK.l,2 Dr Endtz and colleagues from the Netherlands (March 31, p 787) report quinR Campylobacter spp isolated from human sources and poultry. Recently we described the isolation of 17 nalidixic acid-resistant (nalR) salmonella serotypes (representing 0-0031 % of total Salmonella isolates) from poultry,3 some of which were imported and in quarantine in the UK. These strains were also resistant to the newer quinolones used clinically (eg, ciprofloxacin). The quinolone-susceptibility data for 6 of the typical British isolates and 3 West German isolates are shown in the table. A further 5 S newport, 4 S virchow, I S newington, and 1 S enteritidis, similar to those shown, were also isolated. All strains showed a 250-fold decrease in susceptibility to nalidixic acid when compared with reference S typhimurium NCTC 74 (L19), and a 100-fold decrease when compared with reference Escherichia coli NCTC 10418. S typhimurium (L22), S enteritidis (L34), and S bredeney (L25) had minimum inhibitory concentrations (MICs) of ciprofloxacin similar to the recommended breakpoint concentration for man, 2 /lgjml.4 All strains except the S seftenberg and S virchow had MICs above the recommended breakpoint to the new veterinary quinolone enrofloxacin. Typical wild type susceptibilities to gentamicin, trimethoprim and ceftazidime were observed for all strains (data not shown), with no apparent cross-resistance to chemically unrelated agents. High MICs are indicative of a target site alteration causing DNA gyrase to have decreased affinity for quinolones ;2 however, further studies of the precise mechanism of quinolone resistance are under way in our laboratory.
1. Piddock
SIR,-Since the detection of the causative agent of Lyme disease (Borrelia burgdorfere) serological methods have been developed for confirmation of the clinically suspected disease. However, there have been reports of both healthy seropositive and affected seronegative individuals.1-3 It is not yet clear what, after infection, is responsible for a transient (eg, erythema chronicum migrans), or a chronic progressive course of the disease, and for the wide variety of clinical conditions which may manifest in one individual. We have made the puzzling observation of 2 children presenting with aseptic meningitis (one of them without parotitis), and with serological evidence for both recent mumps and B burgdorferi infection. Neither child had a tick bite. This made us consider the possibility of false-positive B burgdorferi serology in cases of recent mumps meningitis. We studied 15 children with aseptic mumps meningitis (mean age 11years, mean disease duration 15 days), having first excluded those with a tick bite, antibodies to Epstein-Barr virus (IgM), or a high risk of acquiring meningitis (eg, immunodendent/ immunosuppressed, hydrocephalus shunt, &c). The control group comprised 14 children with aseptic non-mumps meningitis (mean age 9 years, mean disease duration 15 days), who were compatible with the exclusion criteria given above. Serum antibodies to B burgdorferi were determined with an ELISA method. Results were considered positive if a 1 in 1000 serum dilution gave an absorbance exceeding 0-45 at a wavelength of 492 nm. The significance of the anti-B burgdorferi antibody ELISA results in the test and control groups was assessed with a standard statistical method.4 7 of 15 children in the mumps group were seropositive for B burgdorferi while none of the 14 controls were seropositive; a
