PARA-UNDULANT FEVER 



1447 



infection caused by human carriers and ambulant cases, and disin- 

 fection of excreta, etc., should be carefully carried out. 



Vaccination. — The use of a preventive vaccine prepared with M. melitensis 

 has not yet become general. It should contain both M. melitensis and 

 M. paramelilensis. For a number of years Castellani has prepared and used 

 polyvaccines containing M. melitensis — e.g., a double vaccine, Malta fever and 

 typhoid ; a quadruple vaccine, Malta fever, typhoid, para A and B ; a, quintuple 

 vaccine, Malta fever, typhoid, para A and B, and cholera; a sextuple vaccine, 

 Malta fever, typhoid, para A and B, cholera, and plague. Recently Lurie and 

 others have used the quadruple and quintuple vaccines with good results. 

 The former contains in i cubic centimetre, M. melitensis 4,000 millions (or 

 M. melitensis 2,000 millions, and M .paramelilensis 2,000 m.i\\ions),B. typhosus 

 500 millions, B. paratyphosus A 250 millions, B.paratyphosus B 250 millions; 

 but care should be taken, in preparing this vaccine, to select strains of 

 M. melitensis rich in antigen. The dose is ^ cubic centimetre for the first and 

 I cubic centimetre for the second injection, which is given one week later. 



A general vaccination of goats has been suggested by Vincent and other 

 authorities. 



The prophylactic measures may be summarized as follows: — 



A. General Measures. 



(1) Notification. 



(2) Isolation. 



(3) Disinfection. 



(4) Sterilization of milk and water. > 



(5) Good hygiene. 



B. Personal Measures. ' 



(1) Personal cleanliness. 



(2) Prevention of infection from mother to child. 



(3) Vaccination. 



C. Veterinary Measures. 



(1) Investigation of goats by seram and Zammit's lacto-reaction. 



(2) Slaughter of infected goats. 



(3) General immunization of the goats by vaccines. 



(4) Prevention of importation of infected animals, 



(5) Inspection of stables, etc. 



PARA-UNDULANT FEVER. 



Definition. — Para-undulant fever is clinically similar to or iden- 

 tical with undulant fever, but is caused by organisms which differ 

 biologically from the typical Micrococcus melitensis. 



Historical. — In 1912 Negre and Raynaud described an organism 

 which they called Micrococcus paramelilensis, but previously Sergent 

 and Zammit had found a M. pseudomelilensis. Later Bassett-Smith 

 fully confirmed these findings, and described a case of para-undulant 

 fever contracted in the South of France. M. paramelilensis has been 

 found in man and goats. 



Geography. — Cases have been described from Africa and Europe. 



.ffitiology . — ^The germs mentioned above are the causal agent of the 

 disease, and differ from M. melitensis both in agglutinative and 

 absorptive tests. 



Symptomatology. — ^From the cases so far reported it is not possible 

 to distinguish clinically between the typical undulant fever and its 

 para variety. 



Diagnosis. — This is based upon serological tests. 



Prognosis and Treatment. — As for undulant fever. 



