IME does not permit for a review of the literature on the treatment T of viral and rickettsia1 infections with chemical and antibiotic substances. The results of such investigations have been reported recently by several groups of workers. In this preliminary report are presented some of the data obtained with the newly described antibiotic, Aureomycin, in experimental infections of embryonated eggs, mice, and guinea pigs with the agents of lymphogranuloma venereum, psittacosis, murine typhus, epidemic typhus, Rocky Mountain spotted fever, Q fever, rickettsialpox, and scrub typhus. Materials and Methods

Action of aureomycin against experimental rickettsial and viral infections

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Chloramphenicol (chloromycetin) in the treatment of tsutsugamushi disease (scrub typhus)

Colouterine fistula complicating diverticulitis is rare. Our experience with two patients, one with chronic vaginal discharge and the other with acute overwhelming sepsis, emphasizes the wide spectrum of clinical presentations that may accompany this entity. In patients with chronic symptoms, surgery is indicated to forestall further local infectious complications, and a single-stage sigmoid resection without hysterectomy may be adequate. If malignancy cannot be excluded, a single-stageen bloc resection of the uterus and colon is the procedure of choice. Hysterectomy may also be mandatory to extirpate a nidus of acute infection. When severe local inflammation or obstruction mandate urgent operation, a two-stage procedure involving resection and end colostomy, followed by reanastomosis at a later time, is safest and most effective.

Colouterine fistula secondary to diverticulitis.

Aureomycin is an antibiotic derived from a strain of Streptomyces aureofaciens). 1 It has been found to protect mice and guinea pigs infected with the rickettsia of Q fever, Rocky Mountain spotted fever, murine typhus and rickettsial pox. 2 The drug is readily absorbed after oral administration. Although quantitative assay in the body fluids has not been satisfactory, low levels (0.3 to 2.5 micrograms per millimeter) have been detected in the blood serum and levels up to 320 micrograms per milliliter 3 in the urine. Pharmacologic studies in animals have shown that the toxicity of the drug is low except after intravenous administration where hemoglobinuria and anemia have been noted. 4 In human beings, therapeutic doses up to 60.0 milligrams per kilogram of body weight per day given orally have not been associated with any toxic manifestations except for occasional nausea and vomiting. 5 The latter has been transient and

Aureomycin therapy of Rocky Mountain spotted fever.

Colouterine fistula complicating diverticulitis: a case report and review of the literature

Tsutsugamushi disease, or scrub typhus, is an acute infectious disease caused by Rickettsia orientalis and is transmitted to man by a larval trombiculid mite. This has been one of the severest diseases encountered by the troops in the Pacific and Asiatic theaters of the war. Figures for the case fatality rates according to the U. S. Army reports have varied from 1 to 28 per cent, but the majority ranged between 10 and 15 per cent, with an overall case fatality rate of about 5 to 7 per cent. While the average period of disability in these cases has been approximately three months, many of the patients have been unfit for duty for a much longer time. Many drugs have been tried on this disease, but until now no effective therapeutic agent has been found. The possible value of para-aminobenzoic acid as a therapeutic agent against a rickettsial disease was

Effect of para-aminobenzoic acid in tsutsugamushi disease

A sigmoidouterine fistula due to diverticulitis of the colon developed in one patient. This was treated by one-stage, en bloc resection of the uterus and sigmoid segment. Because of the difficulty of determining that a sigmoidouterine fistula is not due to cancer, which could be implanted in the operative field if the involved organs were separated during removal, en bloc resection when it is technically feasible seems to offer an improved chance of total recovery.

Nicholas A. Tierney

Papers

Effect of para-aminobenzoic acid in tsutsugamushi disease

One-stage, en bloc resection for colonic-uterine fistula caused by diverticulitis.