MALTA FEVER 6 1 



It has been stated that a point of difference between the phagocytosis with the 

 gonoccoci and the meningococci is that the meningococci invade and at times destroy 

 the nucleus of the polymorphonuclear, which is not true of gonococci. The appear- 

 ance of large phagocytic endothelial cells, often containing polymorphonuclears, in 

 the centrifuged cerebrospinal fluid is a favorable prognostic sign. At times there 

 does not appear to be any relation between the number of phagocytic polymorpho- 

 nuclears and the severity of the case. 



Vincent has recommended a precipitin test for epidemic cerebrospinal meningitis 

 which has the advantages of being simple and more immediate than cultures and of 

 particular value in those cases when meningococci cannot be found in the smears or 

 in cultures from the cerebrospinal fluid. It is performed by adding one or two drops 

 of antimeningococcic serum to a tube of fresh cerebrospinal fluid which has been 

 cleared by centrifugalization for 10 to 15 minutes. After adding the serum the tube 

 is placed in the incubator at 52 C. for two to five hours together with a control 

 tube. The formation of a precipitate (turbidity) shows a postive test. 



Micrococcus catarrhalis (Seifert, 1890). This organism has been 

 specially studied by Lord. It resembles the meningococcus strikingly 

 and can only be differentiated by cultural procedures. It grows on plain 

 agar and at room temperature, and does not produce acid in glucose 

 media. It not only occurs in the nasal secretions of healthy people, 

 but appears to be responsible for certain coryzas and bronchial affec- 

 tions, resembling influenza. It also is responsible for certain epidemics 

 of conjunctivitis. 



The original cultures may show only slight growth whereas the sub- 

 cultures prove luxuriant. 



The colonies are larger, more opaque, and have a more irregular 

 wavy border than the round colonies of the meningococcus. 



Micrococcus melitensis (Bruce, 1887). This is the organism of 

 Malta or Mediterranean fever, sometimes called undulant fever, on 

 account of successive waves 'of pyrexia running over several months. 

 The disease has a very slight mortality (2%), and the lesions are chiefly 

 of the spleen, which is large and diffluent. The organisms can best be 

 isolated from the spleen. 



M. melitensis is only about 0.3/1 in diameter. The characteristics are its very 

 small size and the dew-drop minute colonies on agar, which at incubator temperature 

 only show themselves about the third to the sixth day. It is nonmotile and Gram 

 negative. In bouillon there is a slight turbidity. 



Many laboratory infections have been recorded. 



The organism occurs in peripheral circulation, it having been cultivated from 

 blood very successfully by Eyre. He takes blood at the height of the fever, and in 

 the afternoon. Formerly it was customary to isolate by splenic puncture. 



Infection is chiefly by means of the milk of infected goats. The organisms are 



