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This investigation is the first nationwide survey on the circulation of leptospira infections in human beings in Italy. In nine out of twenty Italian regions, representative samples of the population were investigated for the presence of leptospira infections. Unexpectedly, leptospira infections were found to be widespread, the number of cases being much higher than the diagnosed clinical cases. There were found to be high, medium, and low risk areas. On the whole, the risk for the rural population was no higher than the risk for urban dwellers; leisure activities, contact with animals and residence on the plain versus residence in the hills were important risk factors. There was an unidentified risk factor in urbanites which was absent in the rural population. A changing pattern in infecting serovars was observed, with infections from serogroups Sejroe, Javanica and Australis prevailing over infections from the Icterohaemorrhagiae and Bataviae serogroups, which were the main agents of human leptospirosis during the 1950s. The mechanisms of these changes, the need for epidemiological surveys and improved diagnostic methods of screening are discussed.

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The Microbiological Laboratory of Verona Hospital is the leptospirosis reference Centre since 1980. It uses routinely the lysis/agglutination test with leptospires strains in order to confirm the clinical diagnosis and to define the typing of strains. Although this Centre is not yet officially recognized, it is in fact, at the service of the Veneto region and greater part of the Trentino Alto Adige. It examines 600 samples a year (about 3000 determinations) from these two regions, therefore it can construct a biregional epidemiology although the data is neither referred to superior Committees nor, perhaps, utilized in the requesting territory. The aspects of this service to be improved are the incompleteness of data with samples and their not perfect condition on arrival for testing. The most interesting point is that the epidemiology in the Veneto region has not changed since 1980: the prevailing leptospira is the icterohaemorrhagiae and then the canicola and pomona.

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We have investigated the effectiveness of seven new beta-lactam antibiotics, azlocillin, piperacillin, ceftazidime, cefsulodin, cefoperazone, latamoxef (moxalactam), and cefotaxime, against acute pulmonary exacerbations caused by Pseudomonas aeruginosa in cystic fibrosis. Three hundred and fifty-five strains of Ps aeruginosa isolated from 310 sputum cultures (190 cystic fibrosis patients) were tested for susceptibility to the drugs by determination of minimal inhibitory concentrations (MIC). The highest activity was shown by ceftazidime (6% resistant strains) followed by cefsulodin and piperacillin (15 and 16% resistant strains); very low activity was found for cefotaxime and latamoxef (moxalactam). Ceftazidime was the most active drug against 32 pseudomonas isolates that were resistant to both carbenicillin and aminoglycosides (78% susceptible). A randomized, double-blind trial of azlocillin, piperacillin, ceftazidime, cefsulodin or cefoperazone was performed in 111 cystic fibrosis patients with predominant and susceptible pseudomonas in their sputum. Results were evaluated by a clinical, radiological and bacteriological scoring system: the best results were obtained with ceftazidime, followed by cefsulodin and piperacillin. However, pseudomonas was eradicated in only 22 (23%) of the cases with the most active drugs and persisted or reappeared in all the cases 1 to 3 months later. Ceftazidime always eradicated Staph. aureus and Haemophilus influenzae associated with pseudomonas. Similar eradication occurred nearly always with cefsulodin but rarely with the other drugs. No serious drug reaction occurred but a later fever and rash with piperacillin, transient diarrhoea with cefoperazone, vomiting with cefsulodin, and very frequent eosinophilia with ceftazidime should be mentioned. These five drugs offer, in varying degree, alternatives to traditional anti pseudomonas antibiotics in cystic fibrosis pulmonary infections, but they should be used only against well-proven resistant strains. Ceftazidime is best and cefotaxime and latamoxef (moxalactam) least useful.

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Urinary tract infections due to low-grade pathogenic Gram-negative bacteria show an increasing prevalence. The frequency of isolation from urinary samples of some of these pathogens (Alcaligenes, Citrobacter, Acinetobacter, Providencia, Serratia) was detected in a group of adult patients. The role of local and systemic predisposing factors was investigated. These bacterial agents accounted for 21% of 1,354 isolated strains. Systemic predisposing factors were found in most patients. Moreover, a high proportion of the isolates was found in the urinary samples of patients receiving prolonged antibacterial therapy. Sensitivity to several antibacterial drugs was examined for each strain. A high degree of drug resistance was commonly found.

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The institution is proposed of a expert committee to study and introduce new methods to allow a better diffusion of numerical taxonomy among clinical bacteriologists. Computers are nowadays rather diffuse devices that can contribute to bring order in the field of the classification of microorganisms and to introduce new keys for the identification of isolates from pathological materials.

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The finding is described of a Gram-negative bacterium in cerebrospinal fluid of a patient suffering from internal hydrocephalus and taken in the hospital of Udine with symptoms of meningitis. The isolated bacterium belongs to the genus Bacteroides. The cases of meningitis are indicated in which the bacteriological examination of the cerebrospinal fluid for anaerobes is recommended.

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The general outlines for the isolation of viruses from the cerebro-spinal fluid are described. It is suggested to associate to the virus cultivation of the cerebrospinal fluid even the cultivation from other pathological materials as faringeal swabs and stools and the search for antibodies in the blood serum. Researches of viruses in cerebro-spinal fluid done by the Service of Microbiology of the Hospital of Verona have given in 55 cases examined during the year 1976 2 positive isolates; in both mumps virus has been isolated.

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The Authors describe a technique suitable for isolating fungus from haemocultures. Although it is not frequent to find a description of septicaemia caused by fungus in hospital practice besides the Candida type, many kinds of yeasts and filamentous fungus have been occasionally isolated from the blood. It is the Author's opinion that if suitable techniques were always used, the evidence of fungus in haemocultures would be more frequent and above all one could also isolate filamentous fungus.

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Epidemiological features of pathogenic mycetes have been investigated with regard to their relationship with bacterial flora in patients with acute and chronic bronchopulmonary diseases and in immunosuppressed patients. Opportunistic mycetes (Candida and Aspergillus) have been found frequently associated with Gram-negative pathogenic bacteria. In immunosuppressed patients, the plenty of mycetic flora is related to the degree of immunoglobulin deficiency especially to the IgG and IgA levels.

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An antigenic extract from broth culture of Aspergillus fumigatus has been analyzed by bidimensional immunoelectrophoresis of Clark and Freeman against rabbit antiserum. The analysis has show the extract to be constituted by seven different antigens.

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The general outlines for the microbiological study of respiratory tract anaerobic flora are indicated. To day research tend to assign to these bacteria a significant role in sustaining some diseases of lungs pleural space and upper respiratory tract; anaerobes are therefore a subject of outstanding interest for clinical microbiologists. Difficult arise in isolation and identification of respiratory tract anaerobes owing to normal presence of anaerobic flora in the mouth; the difficult can be overcomed by avoiding contamination with normal flora (lung puncture for instance) or by quantitative evaluations of bacteria in sputum.

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