Zentralblatt fur Bakteriologie, Parasitenkunde, Infektionskrankheiten und Hygiene. Erste Abteilung Originale. Reihe B: Hygiene, Betriebshygiene, praventive Medizin最新文献

In latent microbial hospitalism environmental checks of the patients, the staff and objects permit detection of pathogenic or potentially pathogenic bacteria which are silent epidemiologically. "One's own body" as a source of infection has not yet been sufficiently investigated in connection with auto-infections. Taking two staphylococcal epidemics as examples, reference is made to the monogenic and heterogenic forms of hospitalism as well as to the necessity of accurately identifying the strains for the purpose of localising the source of infection. In the monogenic form only one type of bacterial species is present (Table 2). In heterogenic hospitalism, infections are caused by various different species of bacteria or also by a single species. If this is the case, various biotypes, serotypes and phagotypes exist (Table 1). In addition, simple possibilities of biotyping the staphylococci are demonstrated. Defensive measures can be adopted selectively only when the epidemiology and the source of infection are known.

To receive objective informations about clinically supposed difference of bacteria spectrum in hospital infections within the last 20 years, we made statistical comparatively investigations between varying periods and in different fields. In the whole material of the Medical Department we found an increase of Proteus, Pseudomonas and Klebsiella (p = 0,01%) and an increase of Candida while Staphylococci, Streptococci, Pneumococci, Clostridium and Meningococci have clearly decreased. In the Department of Nephrology we found a significant increase of Proteus and Pseudomonas (in regard to the manifold findings also of Klebsiella) and a significant decrease of Enterococci (in regard to the manifold findings also of E. coli). In the Reanimation Department there were in opposite to a strong increase of Candida, followed by Pseudomonas, Klebsiella, Enterobacter and Pneumococci, a decrease of Staphylococcus aureus, Enterococci and Streptococci in the sputum findings. In the Urological Clinic while the period of report Pseudomonas and Enterobacter increased significantly, Staphlococcus aureus and Streptococci decreased significantly. In the Neurosurgical Clinic the part of the gramnegative germs of all germinal isolations increased from 8,3% to 51,5% at which especially E. coli, Enterobacter and Pseudomonas were more often found.

Veterinary medicine, dairying, and consumers are likewise interested in mastitis control. The veterinary point of view includes health and function of the udder as well as the production of milk of hygienic quality. Investigations in 6 dairy farms showed that a mastitis control program improved the udder health and resulted in economic benefits. Up to 67% of the subclinical infected udder quarters could be eliminated by prophylactical control measures, especially teat dipping and dry cow therapy. The frequency of clinical udder infections was reduced by about 50%. Furthermore in the first year 5.1% and 7.1% increase of milk and fat yield respectively could be noticed for cows being subject to the program for the whole time. These values could not be reached in the second year. In one herd the milk production increased by about 10% after a control period of two years. The owner of this herd (ca. 35 cows), who was very engaged in the program, obtained an economical benefit of ca. 3500 DM in the first and 7300 DM in the second year of the program. This realised a profit of1.85 DM in the first year and 3.85 DM in the second year per each DM cost in the control program. Mastitis as well as control measures do not implicate a special risk for the human health, because food and drug regulations enable the protection of the consumer in an optimal manner.

The danger to which man is exposed as a result of viruses contained in food differs basically from the risk to man caused by bacteria, fungi or their toxins. With respect to viral injuries it is not the specific diseases (e.g. hepatitis and polio) that are in the foreground but the much more dangerous noxious groups whose cause/effect relationships are rather complex. 1. the oncogenic risk, 2. synergistic interactions with opportunistic problem viruses, 3. slowly developing chronic diseases and persistent infections with their indirect injuries, 4. new infectious pathogens (viroids). Viral contamination of food can be exogenous or endogenous. Exogenous contamination is possible by: 1. specific human-pathogenic viruses, 2. polyphagous, human-pathogenic and animal-pathogenic viruses (zoonosis), 3. animal-pathogenic viruses only, 4. fish viruses, 6. bacteriophages, 7. fungal viruses. The viruses of group 1 and 2 are of practical importance, those of group 6 and 7 are it occasionally. Endogenous contamination is caused when an animal suffered from a viral infection at the time of slaughter or product extraction (e.g. milk, egg, fish) or when the animal has picked up a virus shortly beforhand. As far as endogenous contamination is concerned, a distinction must be made between 1. primarily biological and 2. primarily mechanical contamination. For the first, mainly the clinically inapparent especially persistent infections and viraemic stages at the end of incubation are dangerous. In both cases the animal is clinically healthy. In primarily biological contamination the zoonosis viruses predominate. In addition the bacteriophages must be taken into account. Primarily mechanical contamination is restricted to fish, molluscs, milk and eggs. The possibilities and consequences of exogenous and endogenous contamination are discussed. The risk of viral transmission by foodstuffs depends chiefly on the tenacity of the virus in the affected food, but also on its virulence and concentration. Basic considerations are discussed. Practically from any useful, healthy animal the most varied viruses can be isolated. In order to avoid destroying the confidence of the consumer, it is necessary to take stock of the following: 1. viral contamination in foodstuffs demonstrated so far 2. verified human diseases caused by the intake of virus-contaminated foodstuff and 3. speculations on imaginable consequential damage caused by the consumption of food containing virus. This is also dealt with in the paper. In a final, critical review the importance of virus contained in food is discussed comprehensively from a scientific, legal and practical point of view.

The causes of epidemics are plainly not the pathogens alone as was initially assumed by Koch's school, predisposition and constitution of the population proved to be equally important. Ever since ancient times problems linked with the "constitutio epidemica" have been topical; the "physis", the "natura hominis" and the invironment of man play an increasingly important role in the symptomatology of disease, as can be gathered from such early documents as the "Corpus hippocraticum". Fracastoro distinguished between contagious and non-contagious epidemics. The casual organisms were considered to be miasmas -- noxious emanations -- or "contagia" i.e. likewise toxic substances. Questions concerning the origin of these miasmas turned attention to the environment (air, soil, water) and even led to astrological medicine. Not until the Renaissance were attempts made to differentiate the usual global words for epidemic, such as "loimos", "lues" and "pestis" with the result that a symptom was used more and more to designate a disease. For example, the symptom fever led to the designation "three-day fever" or "four-day fever", "typhus fever". This terminology made a differential diagnosis difficult to establish, thwarted selection measures to check epidemics and the medical world was thus helpless in explaining the causal agents and the phenomena of epidemics. This is illustrated by some epidemiological examples (ergotism, scurvy, yellow fever, English sweat, diphtheria and malaria). In this connection the "morbus novus", the transformation of the pathogen and the change of the pathogen is discussed. Many questions still left unanswered regarding the seasonal incidence, the fluctuation and disappearance of epidemics over decades or even centuries lead more frequently to sociomedical considerations with respect to the victims of epidemics, their predisposition, constitution and environment exposure term "hospital gangrene" with the modern term "hospitalism", we are not dealing with a transformation but a change of the pathogen. The impressive effects produced by antibiotics resulted in carelessness and along with the unprecedented advances in medicine and engineering we forgot to bear in mind that almost all great steps forward have an adverse side. Hygiene and practical medicine have only made a modest beginning in establishing the contact which should indeed be a matter of course in the hospital.