Representatives of the following species or 
groups of bacteria are most often involved in 
meningitis: 1) Neisseria meningitidis, 2) 
Haemophilus influenzae, 3) Diplococcus pneu- 
moniae, 4) Streptococcus pyogenes, 5) Staphyl- 
ococcus aureus, 6) Proteus species, 7) Pseudo- 
monas species, 8) Escherichia coli, 9) Myco- 
bacterium tuberculosis, 10) Listeria monocyto- 
genes, 11) Mimeae, and 12) Flavobacterium 
meningosepticum. Meningitis may also be caused 
by viruses, fungi, spirochetes, or protozoa. 
Specimens for the isolation of the infectious 
agent 
Spinal fluid, blood, nasopharyngeal swabs, 
petechial scrapings, and less frequently ventric- 
ular, cisternal, or subdural fluid, are usually 
submitted for laboratory examination. The time 
in the course of the infection at which the speci- 
men is taken, the temperature at which it is held, 
and the amount of the inoculum used for 
cultures are all important. Spinal fluid should be 
taken as soon as meningeal symptoms appear; 
blood for cultures, as soon as infection is sus- 
pected; petechial scrapings for culture, in either 
doubtful or postmortem cases. Nasopharyngeal 
swabs are cultured for carrier detection. All 
specimens for isolation of the meningococcus 
should be transmitted to the laboratory with a 
minimum of delay. If nasopharyngeal swabs are 
not planted on plating media immediately, they 
may be transported in a tube containing 0.5 ml. 
heart infusion broth. Blood for culture may be 
drawn directly into a vacuum bottle containing 
appropriate medium and taken to the laboratory 
for incubation. 
1 1 . Plague. From time to time epidemics of plague 
have swept over large areas of the world, 
temporarily paralyzing all forms of human 
activity. Plague is primarily a disease of rats and 
wild rodents. It is transmitted from animal to 
animal by the bites of infected fleas. Man serves 
only as an accidental host. The pneumonic type 
of the disease can, however, be spread from man 
to man by droplet infection without the inter- 
vention of an insect vector, 
a. Specimens to be collected for isolation of the 
agent 
Bubo fluid, portions of bubo, spleen, bone 
marrow, sputum, blood, or ectoparasites may 
be submitted for cultures in cystine broth or 
on blood agar slants or plates. Do not ship 
plates. Original specimens should be shipped 
in double containers with screw tops. The 
disease may be identified in decayed or 
mummified carcasses by precipitin tests or 
the fluorescent antibody technic, 
b. Diagnosis of plague by FA technic 
This procedure appears to be reliable and 
rapid yielding results in one hour, in the 
examination of bubo exudate, blood from 
human cases, tissue impression smears, or 
cultured organisms. However, if clinical 
material is injected into laboratory animals, 
about two days must be allowed for the 
development of organisms within the animal 
before the FA test may be made or isolation 
by culture begun. 
Plague bacteriophage may be used to differ- 
entiate between plague and pseudotubercu- 
losis organisms. 
12. Syphilis. 
a. Guide for submitting blood specimens for 
the Treponema Pallidum Immobilization 
(TPI) test 
( 1 ) Criteria for requesting the TPI test 
This test should be requested only on 
specimens from patients who are diag- 
nostic problem cases: (a) with reac- 
tive nontreponemal tests and no history 
or clinical evidence of syphilis; or (b) 
with nonreactive nontreponemal tests 
and suggestive evidence of syphilitic 
infection. 
(IF THE PATIENT HAS RECEIVED 
ANY INJECTED ANTIBIOTICS WITHIN 
ONE MONTH OR ORAL ANTIBIOTICS 
WITHIN ONE WEEK OF THE DRAW- 
ING OF THE BLOOD SPECIMEN, AN 
INVALID OR INCONCLUSIVE FIND- 
ING IN THE TPI TEST MAY RESULT.) 
(2) Collection of the blood specimen 
(a) Collect at least 5 ml. of blood with 
a sterile syringe and needle. 
(b) Transfer the blood to a sterile test 
tube and stopper with a paraffin- 
coated cork. Uncoated corks or 
rubber stoppers are unsatisfactory. 
NOTES: 
Unless a vacuum tube with a nontoxic 
rubber stopper is used, the rubber 
stopper should be replaced immedi- 
ately after collection of the specimen. 
Vacutamer tubes with nontoxic rubber 
stoppers are available from Becton- 
Dickinson (Catalog #-4719, descrip- 
tion #3200 NT.) 
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