DIVERTING ANTIBIOTICS ONTO THE BLACK MARKET
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700 APPEARANCE IN CANADA OF NEISSERIA GONORRHOEAE STRAINS WITH A 3·2 MEGADALTON PENICILLINASE-PRODUCING PLASMID AND A 24·5 MEGADALTON TRANSFER PLASMID SIR,-In April van Embden et al. described the emergence, in the Netherlands, of penicillinase-producing Neisseria gonorrhoeae (PPNG) carrying both the 3-2 megadalton penicillinase plasmid and the 24 - 5 megadalton transfer plasmid. About 80% of all PPNG isolated in the Netherlands now carry these plasmids.z 2 Surveillance of PPNG isolates began in Canada in late 1976. All isolates are sent to us for central documenting and genetic and biological characterisation. Before June of this year, only 11 % (9/80) of the PPNG submitted carried a 3 - 2 megadalton penicillinase plasmid (all the other PPNG harboured a 4-5 5 megadalton penicillinase plasmid). None of the isolates with the smaller penicillinase plasmid carried the 24 - 5 megadalton transfer plasmid; except for a single ornithine-requiring strain, they could all be typed auxonographically as either proline requiring or wild-type (non- requiring).3 This auxotype result contrasted with early reports4,5 in which isolates harbouring the 3’ 2 megadalton plasmid-generally categorised as "African" in origin-were uniformally ornithine (i.e., arginine) requiring. Since June, 5 (56%) of the 9 PPNG isolated in Canada have carried both 3 - 2 and 24 - 5 megadalton plasmids. 4 cases originated in the same city. 1 male identified a west coast prostitute as his contact; a second male, who subsequently infected his wife, was associated with a second prostitute (who could not be traced) from the same area. The strains isolated from these four cases all carried 3’ 2 and 24 - 5 megadalton plasmids; they also exhibited identical auxotypes (wild type) and minimum inhibitory concentrations. The fifth case was a 29-year-old male who presumably acquired his infection from a contact who had returned to Barbados. The PPNG isolated from this case was ornithine requiring. The presence of a 24’5 5 megadalton plasmid in ornithine-requiring strains is unusual. We have screened 66 strains of N. gonorrhoeae harbouring the 24 - 5 megadalton plasmid (including non-PPNG) and have found this plasmid only in proline requiring (52%) or wild type (48%) isolates. Therefore the spread of this larger plasmid into an ornithine-requiring strain may be epidemiologically significant. In conclusion, therefore, Canada, on a smaller scale, mimics the situation in the Netherlands with respect to the discovery of PPNG strains carrying both 3-2 2 and 24-5 5 megadalton plasmids. Antimicrobials and Molecular Biology Unit, Bureau of Microbiology, Laboratory Centre for Disease Control, Ottawa, Ontario, Canada K1A 0L2 J. R. DILLON M. PAUZÉ DIVERTING ANTIBIOTICS ONTO THE BLACK MARKET SIR,-Your Aug. 8 issue (p. 299) draws attention to a statement on antibiotic misuse, much of it at the hands of physicians. An additional avenue of diversion of antimicrobials from legitimate usage has come to my attention. Vietnamese physicians in the U.S. often include large numbers of antibiotic capsules in their parcels shipped back home to families. The contents of these packets are determined by black market forces in South East Asia: certain 1. van Embden JDA, van Klingeren B, Dessens-Kroon H, van Wijngaarden LJ. Emergence in the Netherlands of penicillinase-producing gonococci carrying "African" plasmid in combination with transfer plasmid. Lancet 1981; i 938 2 Anon Surveillance of &bgr;-lactamase producing PPNG Neisseria gonorrhoeae: Emergence of strains with a new plasmid combination. Wkly Epidem Rec 1981; 28: 221. 3 Dillon JR, Duck P, Thomas DY. Molecular and phenotypic characterization of penicillinase-producing Neisseria gonorrhoeae from Canadian sources. Antimicrob Ag Chemother 1981; 19: 952-57. 4. Perine PL, Schalla W, Siegel MS, Thornsberry C, Biddle J, Wong K-H, Thompson SE Evidence for two distinct types of penicillinase-producing Neisseria gonorrhoeae. Lancet 1977; ii: 993-95 5 Siegel MS, Perine PL, Westbrook WG, Jesus I de. Epidemiology of penicillin- producing Neisseria gonorrhoeae In Brooks GF, Gotschlich EC, Holmes KK, Sawyer WD, Young FE (eds). Immunobiology of Neisseria gonorrhoeae. American Society for Microbiology, Washington DC. 1978 75-79. western products, including antibiotics, demand high prices. South East Asia is not unfamiliar with antibiotic resistance in bacteria. Doctors should cease this counterproductive activity. Schools of Basic Medical Sciences and Clinical Medicine, University of Illinois College of Medicine, Urbana, Illinois 61801, U.S.A. THOMAS W. FILARDO CEREBELLAR VERMIS IN SCHIZOPHRENIA SIR,-Coffman et al.l found no difference in the cross-sectional areas of cerebellar vermis and brain or in areal ratio of vermis to brain in computerised tomographic (CT) scans of young and middle aged chronic schizophrenics and those of control patients of unspecified ages. Their findings differed from other CT scan studies where subjective estimates have revealed atrophy of cerebellar vermis in chronic schizophrenics.2,3 Coffman et al. suggested that differences in ages or, possibly, in diagnostic selection may explain the discrepancies of results of these CT studies. However, a necropsy study of the anterior vermis of the cerebellum has already shown significant atrophy in chronic schizophrenics compared to non-schizophrenic patients.4 Our stereological light microscopic analysis of paraffin-embedded sections of cerebellar vermis of 8 chronic schizophrenics who died in State hospitals and 12 age-matched control patients without clinical or pathological findings of cerebellar disease may be able to reconcile Coffman’s findings with other published CT scan and necropsy findings. We found (table) the number ofPurkinje cells per unit line length of Purkinje cell layer (numerical linear density) to be significantly MEAN -them (MEDIAN AND RANGE) OF STEREOLOGIC ESTIMATES OF PURKINJE CELLS OF CEREBELLAR VERMIS SCHIZOPHRENIC AND CONTROL PATIENTS *p <0-O5. less in the chronic schizophrenics, although the number ofPurkinje cells per unit area of cortex (numerical areal density) did not differ in the two groups. This difference in numerical densities of Purkinje cells correlated with our finding that the surface area of the Purkinje cell layer per unit volume of cortex (surface density) was greater in the schizophrenics. Again, the volume of the Purkinje cell layer per unit volume of cortex (volume density) did not differ in the two groups of patients. The greater surface density of the Purkinje cell layer in our schizophrenic patients is consistent with an overdevelopment of that layer in the cerebellar vermis. Such an interpretation would be consistent with Coffman’s CT scan find- ings. On the other hand, loss of Purkinje cell bodies can explain the 1. Coffman JA, Mefferd J, Golden CJ, Block S, Graber B. Cerebellar atrophy in chronic schizophrenia. Lancet 1981, i: 666. 2. Heath RG, Franklin DE, Shrabers D. Gross pathology of the cerebellum in patients diagnosed and treated as functional psychiatric disorders. J Nerv Ment Dis 1979. 167: 585-92. 3. Weinberger DR, Torrey EF, Wyatt RJ Cerebellar atrophy in chronic schizophrenia Lancet 1979; i: 718-19. 4. Weinberger DR, Kleinman JE, Luchins DJ, Bigelow LB, Wyatt RJ Cerebellar pathology in schizophrenia: A controlled postmortem study Am J Psychiat 1980. 137: 359-61
Transcript of DIVERTING ANTIBIOTICS ONTO THE BLACK MARKET
700
APPEARANCE IN CANADA OF NEISSERIAGONORRHOEAE STRAINS WITH A 3·2 MEGADALTONPENICILLINASE-PRODUCING PLASMID AND A 24·5
MEGADALTON TRANSFER PLASMID
SIR,-In April van Embden et al. described the emergence, in theNetherlands, of penicillinase-producing Neisseria gonorrhoeae(PPNG) carrying both the 3-2 megadalton penicillinase plasmidand the 24 - 5 megadalton transfer plasmid. About 80% of all PPNGisolated in the Netherlands now carry these plasmids.z 2
Surveillance of PPNG isolates began in Canada in late 1976. Allisolates are sent to us for central documenting and genetic andbiological characterisation. Before June of this year, only 11 % (9/80)of the PPNG submitted carried a 3 - 2 megadalton penicillinaseplasmid (all the other PPNG harboured a 4-5 5 megadaltonpenicillinase plasmid). None of the isolates with the smaller
penicillinase plasmid carried the 24 - 5 megadalton transfer plasmid;except for a single ornithine-requiring strain, they could all be typedauxonographically as either proline requiring or wild-type (non-
requiring).3 This auxotype result contrasted with early reports4,5 inwhich isolates harbouring the 3’ 2 megadalton plasmid-generallycategorised as "African" in origin-were uniformally ornithine(i.e., arginine) requiring.
Since June, 5 (56%) of the 9 PPNG isolated in Canada havecarried both 3 - 2 and 24 - 5 megadalton plasmids. 4 cases originatedin the same city. 1 male identified a west coast prostitute as hiscontact; a second male, who subsequently infected his wife, wasassociated with a second prostitute (who could not be traced) fromthe same area. The strains isolated from these four cases all carried3’ 2 and 24 - 5 megadalton plasmids; they also exhibited identicalauxotypes (wild type) and minimum inhibitory concentrations.The fifth case was a 29-year-old male who presumably acquired
his infection from a contact who had returned to Barbados. ThePPNG isolated from this case was ornithine requiring. Thepresence of a 24’5 5 megadalton plasmid in ornithine-requiringstrains is unusual. We have screened 66 strains of N. gonorrhoeaeharbouring the 24 - 5 megadalton plasmid (including non-PPNG)and have found this plasmid only in proline requiring (52%) or wildtype (48%) isolates. Therefore the spread of this larger plasmid intoan ornithine-requiring strain may be epidemiologically significant.In conclusion, therefore, Canada, on a smaller scale, mimics the
situation in the Netherlands with respect to the discovery of PPNGstrains carrying both 3-2 2 and 24-5 5 megadalton plasmids.Antimicrobials and Molecular
Biology Unit,Bureau of Microbiology,Laboratory Centre for Disease Control,Ottawa, Ontario, Canada K1A 0L2
J. R. DILLONM. PAUZÉ
DIVERTING ANTIBIOTICS ONTO THE BLACK MARKET
SIR,-Your Aug. 8 issue (p. 299) draws attention to a statement onantibiotic misuse, much of it at the hands of physicians. Anadditional avenue of diversion of antimicrobials from legitimateusage has come to my attention. Vietnamese physicians in the U.S.often include large numbers of antibiotic capsules in their parcelsshipped back home to families. The contents of these packets aredetermined by black market forces in South East Asia: certain
1. van Embden JDA, van Klingeren B, Dessens-Kroon H, van Wijngaarden LJ.Emergence in the Netherlands of penicillinase-producing gonococci carrying"African" plasmid in combination with transfer plasmid. Lancet 1981; i 938
2 Anon Surveillance of &bgr;-lactamase producing PPNG Neisseria gonorrhoeae: Emergenceof strains with a new plasmid combination. Wkly Epidem Rec 1981; 28: 221.
3 Dillon JR, Duck P, Thomas DY. Molecular and phenotypic characterization ofpenicillinase-producing Neisseria gonorrhoeae from Canadian sources. AntimicrobAg Chemother 1981; 19: 952-57.
4. Perine PL, Schalla W, Siegel MS, Thornsberry C, Biddle J, Wong K-H, ThompsonSE Evidence for two distinct types of penicillinase-producing Neisseria gonorrhoeae.Lancet 1977; ii: 993-95
5 Siegel MS, Perine PL, Westbrook WG, Jesus I de. Epidemiology of penicillin-producing Neisseria gonorrhoeae In Brooks GF, Gotschlich EC, Holmes KK,Sawyer WD, Young FE (eds). Immunobiology of Neisseria gonorrhoeae. AmericanSociety for Microbiology, Washington DC. 1978 75-79.
western products, including antibiotics, demand high prices. SouthEast Asia is not unfamiliar with antibiotic resistance in bacteria.Doctors should cease this counterproductive activity.Schools of Basic Medical Sciencesand Clinical Medicine,
University of Illinois College of Medicine,Urbana, Illinois 61801, U.S.A. THOMAS W. FILARDO
CEREBELLAR VERMIS IN SCHIZOPHRENIA
SIR,-Coffman et al.l found no difference in the cross-sectionalareas of cerebellar vermis and brain or in areal ratio of vermis tobrain in computerised tomographic (CT) scans of young and middleaged chronic schizophrenics and those of control patients ofunspecified ages. Their findings differed from other CT scanstudies where subjective estimates have revealed atrophy ofcerebellar vermis in chronic schizophrenics.2,3 Coffman et al.
suggested that differences in ages or, possibly, in diagnosticselection may explain the discrepancies of results of these CTstudies. However, a necropsy study of the anterior vermis of thecerebellum has already shown significant atrophy in chronic
schizophrenics compared to non-schizophrenic patients.4 Ourstereological light microscopic analysis of paraffin-embeddedsections of cerebellar vermis of 8 chronic schizophrenics who diedin State hospitals and 12 age-matched control patients withoutclinical or pathological findings of cerebellar disease may be able toreconcile Coffman’s findings with other published CT scan andnecropsy findings.We found (table) the number ofPurkinje cells per unit line length
of Purkinje cell layer (numerical linear density) to be significantly
MEAN -them (MEDIAN AND RANGE) OF STEREOLOGIC ESTIMATES OF
PURKINJE CELLS OF CEREBELLAR VERMIS SCHIZOPHRENIC AND
CONTROL PATIENTS
*p <0-O5.
less in the chronic schizophrenics, although the number ofPurkinjecells per unit area of cortex (numerical areal density) did not differ inthe two groups. This difference in numerical densities of Purkinjecells correlated with our finding that the surface area of the Purkinjecell layer per unit volume of cortex (surface density) was greater inthe schizophrenics. Again, the volume of the Purkinje cell layer perunit volume of cortex (volume density) did not differ in the twogroups of patients. The greater surface density of the Purkinje celllayer in our schizophrenic patients is consistent with an
overdevelopment of that layer in the cerebellar vermis. Such aninterpretation would be consistent with Coffman’s CT scan find-ings. On the other hand, loss of Purkinje cell bodies can explain the
1. Coffman JA, Mefferd J, Golden CJ, Block S, Graber B. Cerebellar atrophy in chronicschizophrenia. Lancet 1981, i: 666.
2. Heath RG, Franklin DE, Shrabers D. Gross pathology of the cerebellum in patientsdiagnosed and treated as functional psychiatric disorders. J Nerv Ment Dis 1979.167: 585-92.
3. Weinberger DR, Torrey EF, Wyatt RJ Cerebellar atrophy in chronic schizophreniaLancet 1979; i: 718-19.
4. Weinberger DR, Kleinman JE, Luchins DJ, Bigelow LB, Wyatt RJ Cerebellar
pathology in schizophrenia: A controlled postmortem study Am J Psychiat 1980.137: 359-61
