YERSINIA-PESTIS INFECTION IN VIETNAM .2. QUANTITATIVE BLOOD CULTURES AND DETECTION OF ENDOTOXIN IN CEREBROSPINAL-FLUID OF PATIENTS WITH MENINGITIS

Quantitative blood cultures were obtained from 42 patients with acute Y. pestis infection to determine whether the concentration of bacteria in blood influenced the clinical severity and outcome of illness. In 17 bacteremic patients colony counts in blood cultures ranged from < 10-4 .times. 107/ml. Three of 5 patients with colony counts of > 102/ml died, and 2 patients survived episodes of hypotension. Results from plasma Limulus tests were positive at the time of admission in 3 of 10 patients tested; these 3 patients had bacteremia with colony counts of > 102/ml. Meningitis developed in 3 patients and pneumonia in 2 patients; these 5 patients all had buboes in the axillary region. Endotoxin was detected with the Limulus tests in the CSF in the 3 patients with meningitis. Ten patients randomly assigned to receive streptomycin or trimethoprim-sulfamethoxazole survived. Those treated with streptomycin had a shorter median duration of fever and a lower incidence of complications than did the patients treated with trimethoprim-sulfamethoxazole.