포도구균의 알파-용혈소와 그 항체에 관한 연구 알파-용혈소의 생활, 성질 및 항 알파-용혈소치의 임상적의의

Abstract

National Medical Center, Seoul, Korea The confirmation of deep-seated staphylococcal infections is one of the most difficult diagnostic problem. As with Anti-Streptolysin 0 " Titer, the same measure may be implied to the staphylococcal cases. Since 1935, many ~articles have' appeared on this problem but none of them has presented a critical value or standard as a diagnostic criterion. This paper presents more than 150 cases of staphylococcal infections , both superficial and deep-seated, with particular consideration for the applicability of anti-staphylolysin titer CASTA) in patient as one of the diagnostic measures. In order to secure the alpha-hemolysin of staphylococcus, Wood 46 strain and standard antitoxin of staphylococcus from the State Serum Institute of Denmark were used for the production of staphylolysin and identification. As a preliminary test, factors influencing alpha-hemolysin production in media were tested. A high titer alpha-hemolysin was produced after 5 days culture in brain heart infusion broth in an atmospheric condition of 8-10 % CO2 tension. The nature of alpha-hemolysin was tested on various erythrocytes, on influences by pH changes, and on heat resistance. Finally, the identity of the alpha-hemolysin produced was confirmed by a neutralization test with standard antitoxin. Anti-staphylolysin tests in vitro were performed on 552 sera, taken from apparently normal individuals, and on 235 sera from various patients including those infected by staphylococci. The results are summarized as follows: 1. During the production of a potent alpha-hemolysin in vitro, it seemed essential that the CO2 tension be kept at 8-10 %. 2. The hemolytic activities of alpha-hemolysin revealed various sensitivity on animal erythrocytes in decreasing order as follows: rabbit, swine, cattle, sheep , and rat. Human, horse or guinea pig erythrocytes were not hemolyzed. 3. Pseudomonas aeruginosa destroyed the alphahemolysin very rapidly when the organisms were cultivated in a culture filtrate containing alpha-hemolysin. 4. A storage test of the fluid alpha-hemolysin at 4a C showed practically no change in titer within one year. 5. For the application of ASTA, the following criteria are suggested. Insignificant or Normal: less than 2 u. Borderline group or inconclusive: 2-4 u. Significant or pathologic 4 u. or more. 6. Among spondylitis or osteomyelitis of unknown etiology, at least 20% were confirmed as being of staphylococcal origin, when judged by ASTA elevation or positive culture. The positive cultures in the cases of deep-seated staphylococcal infections were usually accompanied by high titers of ASTA. Three cases of septicemia showed marked elevation of ASTA. 7. In most of the superficial staphylococcal infections no elevation of ASTA was found , but in some cases of deep seated infections considerable elevations of ASTA were found even when the culture tests were negative.