[Portal cavernoma at child about two observations]

We report two observations of portal cavernoma diagnosed successively in Bamako and Dakar. The first is a 6-year-old male admitted to the service for ascites and abdominal pain. At admission the clinical parameters (weight, height, temperature, cranial perimeter and temperature) were within the norms for age. The clinical examination noted a moderate skin-mucosal pallor, asthenia. The biological assessment returned to moderate normochrome anemia with impaired pancreatic function while renal and hepatic functions were maintained. The abdominal scan performed after two low-contribution abdominal ultrasounds, objected signs in favor of a portal cavernoma with perisplenic and gastric varicose veins. The second is an 8-year-old male child born from an unborn marriage and from a followed pregnancy with premature delivery. His pathological history includes a notion of prematurity that required a stay in neonatology with umbilical catheterization and repeated abdominal pain. He had an acute abdominal episode in March 2015 justifying a surgical hospitalization for suspicion of appendicitis. At admission the clinical parameters (weight, height, temperature, cranial perimeter and temperature) were within the norms for age. The abdominal ultrasound prescribed for this was suggestive of portal cavernoma, later confirmed by abdominal computed tomography.

Spreading of SARS-CoV-2 in West Africa and assessment of risk factors

Although the African continent is, for the moment, less impacted than the rest of the world, it still faces the risk of a spread of COVID-19. In this study, we have conducted a systematic review of the information available in the literature in order to provide an overview of the epidemiological and clinical features of COVID-19 pandemic in West Africa and of the impact of risk factors such as comorbidities, climatic conditions and demography on the pandemic. Burkina Faso is used as a case study to better describe the situation in West Africa. The epidemiological situation of COVID-19 in West Africa is marked by a continuous increase in the numbers of confirmed cases. This geographic area had on 29 July 2020, 131 049 confirmed cases by polymerase chain reaction, 88 305 recoveries and 2102 deaths. Several factors may influence the SARS-CoV-2 circulation in Africa: (i) comorbidities: diabetes mellitus and high blood pressure could lead to an increase in the number of severe cases of SARS-CoV-2; (ii) climatic factors: the high temperatures could be a factor contributing to slow the spread of the virus and (iii) demography: the West Africa population is very young and this could be a factor limiting the occurrence of severe forms of SARS-CoV-2 infection. Although the spread of the SARS-CoV-2 epidemic in West Africa is relatively slow compared to European countries, vigilance must remain. Difficulties in access to diagnostic tests, lack of hospital equipment, but also the large number of people working in the informal sector (such as trading, businesses, transport and restoration) makes it difficult to apply preventive measures, namely physical distancing and containment.

[Temporomandibular Joint Ankylosis: Focus On 17 Cases And A Review Of The Literature]

PURPOSE

The purpose of this report was to describe the epidemiology, clinical and curative treatment of a simple interrupter resection of the temporomandibular ankylosis.

MATERIALS AND METHODS

This is a retrospective descriptive study of patients who underwent surgical treatment for temporomandibular ankylosis at the university hospital of Bobo-Dioulasso. The treatment protocol comprised of a resection of the ankylosis followed by early functional rehabilitation.

RESULTS

17 patients were studied. The age of the patients at the beginning of the causal disease was between 3 and 50 years. 13 patients were younger than 15 years old. The sex ratio (men/women) was 1.4. The causes of ankylosis were dominated by noma and acute facial cellulite (76.5%), followed by facial trauma (23.5%). Transient facial paralysis, one anterior open bite and a recurrence of ankylosis were the main postoperative complications.

CONCLUSION

The temporomandibular ankylosis is a serious complication in maxillofacial pathology. Actions for the prevention and for a better curative treatment are recommended.

[Study of two cases of virological failure antiretrovirals in the Institute of Social Hygiene (ISH) of Dakar]

CONTEXT

The long term treatment of VIH/SIDA puts down majors risks among which the happening of virological failure or resistance to the anti-retroviral treatment at the patient.

OBJECTIVE

To study the cases of resistance to antiretroviral to a cohort of 70 patients of the social hygiene of Dakar.

METHOD

This is a retrospective study of the medical records of 70 patients followed in the social hygiene of Dakar during 24 mouths. Data were gathered with the help of form having following variables: The period of meadow inclusion; The period of inclusion; The period of rebound virological; The rate of CD4 count; The viral load and weight of patients.

RESULTS

Average of age in inclusion is of 47.5 years with a sex ratio of the women HIV 1 was dominant. Two cases of virological failure were found or (2.8%). The patient 1 was the stade II of the classification of the with as therapeutic class 2INTI + 2 INNTI. It was in stage asymptomatic with as therapeutic protocol DDI + 3TC + NVP. The patient 2 was at the stade III of the whom that is to say at the stade in AIDS with as therapeutic class: 2INTI + 1IP with the protocol of treatment DDI + 3TC +IND.

CONCLUSION

The virological failure to the newly infected persons noticed more and more in the world poses a problem of public health because it constitutes a threat for the success of the programs of treatment of the HIV/AIDS.

Detection of viral RNA by RT-PCR from serum for molecular diagnosis of measles

Measles continues to be a cause of morbidity and mortality in Côte d'Ivoire although the death rates are weak (2.4%). The monitoring and elimination programme of this disease require a laboratory confirmation testing by diverse methods of diagnosis needing diverse biological products. Serum is usually used for IgM detection. This study has therefore assessed the importance of the measles virus RNA detection from sera of measles suspected cases for confirmation of the case and determination of the genotype. A total of 45 sera tested were split into two groups according to the interval between the rash appearance and the day of blood collection: Group 1 (day 1 to day 3); group (2 day 4 to day 7). Four sera from Group 1 of the 45 (8.9 %) were positive by RT-PCR technique while 10 (22.2%) sera were positive for IgM anti- measles virus by ELISA test. RT-PCR and ELISA showed the same performance in group 1 with a positivity rate of 13.79 %. The B3 genotype was found. This result showed that the viral RNA can be detected in the serum but only from those sera collected the first 3 days after the rash appearance and could be used as palliative in case it is impossible to obtain other biological products.

The influence of pharmaceutical compounds on male fertility

1. Steroid hormones can affect spermatogenesis and thereby fertility directly and/or indirectly. All antigonadotropically active steroids inhibit spermatogenesis via inhibition of gonadotropin secretion, mainly that of H. Androgens and steroids occurring in the biosynthetic chain of testosterone synthesis have a direct promoting effect on spermatogenesis if applied in high doses. It has not been possible as yet to make clinical use of this positive effect since it is obviously not possible to achieve the necessary intratesticular androgen concentrations. 2. As concerns the different androgens and the steroids in the androgen biosynthetic chain, and also all synthetic anabolics, there is no parallelism between the direct spermatogenic activity, the androgenic activity and the antigonadotropic activity. 3. Estrogens and synthetic gestagens do not inhibit spermatogenesis directly at the testicular level. All effects of estrogens can be abolished experimentally by adequate substitution with gonadotropins or androgens, or a combination of androgens and gonadotropins. 4. Only those antiandrogens inhibit spermatogenesis with additional antigonadotropic properties (e.g. cyproterone acetate). Pure antiandrogens, like flutamide or cyproterone, have a slight and transient influence on spermatogenesis at the most. If at all, they merely cause transient subfertility. 5. Beside steroids and several centrally active pharmaceutics (e.g. psychotropic drugs and several antihypertensive compounds), only siloxanes and methallibur seem to affect spermatogenesis via inhibition of gonadotropin secretion. Other antispermatogenic agents act by inhibition of mitosis (Colchicine, alkylating agents) or presumably via damage of the Sertoli cells. 6. Based on present knowledge, contraception in men could be principally managed by administration of a) androgens alone, b) gestagen/androgen combinations, c) estrogen/androgen combinations, d) certain antiandrogens. 7. The difficulties of contraception in men by steroid hormones or steroid hormone combinations have been pointed out. As regards the usefulness of antiandrogens for contraception, no definite conclusions can be drawn at the moment. All non-steroidal inhibitors of spermatogenesis which have been found up to the present are not suitable because of toxic effects.

[Using CT to diagnose brain tumors at the Point G Hospital in Mali]

The authors report 27 cases of cerebral tumours in 22 men and 5 women age 1 to 81. Clinical symptoms were dominated by cranial hypertension (59.3%), focal motor impairment involving cranial nerves (51.9%.) and seizures due to epilepsy (44.4%). The main tumors detected with CT scan include glyoma (.5 cases), craniopharyngioma (3 cases), adenoma (3 cases), medulloblastoma (3 cases), and metastasis (3 cases). The supra tentoriel was predominant (76.9%). Neurosurgery was performed in 6 patients and 21 cases received medical treatment. We fund 13 cases of death. In conclasion, cerebral tumours are very severe pathologies because of the high mortality associated with. CT scan has contributed to diagnose the lesions, show their topography and to determinte the histological nature. Neurosurgery is necessary for the treatment of these lesions.

[Contribution of ultrasound in the diagnosis of the complications of intramuscular injection in children]

During a prospective study conducted at the rehabilitation Center of the physically handicapped persons and at the mother-child Hospital in Bamako, the authors report 50 cases of neuromuscular complications of the quinine intramuscular injection in the child. The scan revealed muscular calcifications in 37 cases (740%), abscesses, in 7 cases (14%) and muscular inflammations in 6 cases (12%). Xray of the affected limb was not systematic: it has been performed in four children in the case of a subjacent bone involment. It showed calcifications in two cases. If muscular abscess is easily diagnosed by clinical exam it is not the case for calcifications. The scan allows to set up a precise mapping of the muscular lesions, to determine their type and size. It also helps the clinicians in their therapeutic attitude. Medical treatment associated with rehabilitation has been carried out in 40 patients (80%) and surgery in 10 patients (20%).

[Epidemiological aspects of stroke in CT-scan department of the Point-G Hospital in Bamako, Mali]

The purpose of this prospective study conducted between January 2000 and December 2001 was to identify tomodensitometric aspects of stroke. The relationship between lesion type (hemorrhagic, ischemic, and transient ischemic) and prognosis was assessed. Axial sections were made through the posterior fossa (5 mm at 5mm intervals) and subtentorial region (10 mm at 10 mm intervals). The Virchow plan was used as the reference for sections. The chi square test was used to evaluate the correlation between lesion type and prognosis. A total of 159 stroke patients with a mean age of 44.5 years were enrolled during the study period. There were 90 men (56.6%) and 69 women (43.3%). In 118 patients (74.2%), CT scans showed cerebral abnormalities including ischemic lesions in 71 (44.6%) and hemorrhagic lesions in 47 (29.6%). Overall mortality was 45.7% (54/118). Hemorrhagic lesions were fatal in 51.1% (24/47) of cases and ischemic lesions in 35.2% (25/71). Transitory ischemic accidents were fatal in 0.12% of cases (5/41). This study demonstrates that CT scan is an important tool for stroke management by identifying the type and location of lesions.

[Value of computer tomography in the managment of brain injuries]

The purpose of this prospective study conducted from January 2001 to December 2001 was to ascertain the value of computer tomography for evaluation of brain injuries. Computer tomography was performed using a Toshiba X VID system with contiguous 5 mm axial sections through the posterior fossa and 10 mm contiguous axial sections through the subtentorial region without contrast injection. A total of 107 patients with brain injuries were enrolled over the one-year study period. These patients accounted for 0.8% of all admissions to surgical emergency unit of Gabriel Toure Hospital in Bamako, Mali. The predominant age group for brain injuries was the 20- to 29-year-old group (35 cases). The male-to-female sex ratio was 5:1. Vehicular accident was the most frequent cause of brain injury (76 cases). Trauma was severe in 48 patients with a Glasgow score less than 8. Coma occurred immediately after injury in 90 cases. Ventricular hemorrhage led to coma in 100% of cases whereas brain hemorrhage and hematoma led to coma in 93.3% and 83.3% of cases respectively. Treatment was medical in 99 cases and neurosurgical in 8. The mortality rate was 34% and the morbidity rate (permanent sequels) was 36%. Computer tomography is a valuable tool for therapeutic decision-making in medico-surgical emergencies involving brain injuries.

[Evaluation of the clinical classification of new cases of leprosy. Study conducted at the Marchoux Institute in Bamako, Mali]

INTRODUCTION

The difficulties related to the bacilloscopic diagnosis of leprosy, providing a more reliable classification of cases, in 1995 led the WHO to recommend the use of a new classification, in endemic countries, based on clinical criteria alone, in order to simplify the poly-chemotherapeutic regimens. According to our experience in the Marchoux Institute, this classification may lead to errors in diagnosis through overzealous or mis-interpretation of the two forms of leprosy. The aim of our study was to evaluate the concordance between this clinical classification and that based on a bacilloscopic examination.

PATIENTS AND METHODS

We conducted a descriptive study of new cases of leprosy seen at the Marchoux Institute, without distinction in gender or age, from January to December 2000. All the patients included underwent clinical examination and a bacilloscopic exploration to provide a double classification. The concordance between the two classifications was assessed using the Kappa test.

RESULTS

Two hundred new cases of leprosy were included. Out of 126 clinically multi-bacillary cases, 61 were confirmed bacteriologically, and 65 were false positives. Out of 74 clinical cases with few bacilli, 2 were bacteriologically multi-bacilli. The concordance between the two classifications was average (Kappa=0.40). There was a significant difference between the percentages of multi-bacilli observed in both classifications (p<10(-8)).

DISCUSSION

The clinical classification may well overestimate the multi-bacillary form. In the absence of a reliable bacilloscopic apparatus, a more detailed clinical classification of leprosy forms must be developed.

Effect of leachate recycling and inoculation on the biochemical characteristics of municipal refuse in landfill bioreactors

Activity development of key groups of enzymes involved in municipal refuse decomposition was measured in laboratory landfill bioreactors with and without leachate recycling and inoculation for about 210 days. The results showed that the enzymes (amylase, protease, cellulase, lipase and pectinase) were present in fresh refuse but at low values and positively affected by leachate recycling and refuse inoculation. The total average of cellulase activity in digesters D3 operated with leachate recycling but no inoculation, D4 and D5 operated with leachate recycling and inoculation was much higher than that in digesters D1 and D2 without leachate recycling and inoculation by 88%-127%, 117%-162% and 64%-98%. The total average of protease activity was higher in digester D4 than that in digesters D1, D2, D3 and D5 by 63%, 39%, 24% and 24%, respectively, and the positive effect of leachate recycling and inoculation on protease activity of landfilled refuse mainly was at the first two months. The total average of amylase activity was higher in digesters D3, D4 and D5 than that in digesters D1 and D2 by 83%-132%, 96%-148% and 81%-129%. During the early phase of incubation, the stimulatory effect of inoculation on lipase activity was measured, but refuse moisture was the main factor affecting lipase activity of landfilled refuse. The inoculation, initial and continuous inoculation of microorganisms existing in leachate, was the mainly stimulatory factor affecting pectinase activity of landfilled refuse.

Effect of leachate recycle and inoculation on microbial characteristics of municipal refuse in landfill bioreactors

Population development of key groups of anaerobic and aerobic bacteria involved in municipal refuse decomposition under laboratory landfill bioreactors with and without leachate recycle and inoculation was measured since modeling municipal refuse was landfilled in bioreactors for about 210 days. Hydrolytic fermentative bacteria (HFB), hydrogen-producing acetogenic bacteria (HPAB), methane-producing bacteria (MPB), sulfate-reducing bacteria (SRB), anaerobic and aerobic cellulolytic bacteria and denitrabacteria were enumerated by the most probable number technique. The results showed that the dominant microorganism groups were the methanogenic bacteria including hydrolytic fermentative, hydrogen-producing acetogenic and methane-producing bacteria. They were present in fresh refuse but at low values and positively affected by leachate recycle and refuse inoculation. The amounts of HFB or HPAB in digesters D4 and D5 operated with inoculation and leachate recycle reached their maximum values of 10(10)-10(12) cells/g dry refuse for HFB or 10(5)-10(6) cells/g dry refuse for HPAB on day 60, in digester D3 operated with leachate recycle on day 120 for HFB (10(9) cells/g dry refuse) or on day 90 for HPAB (10(5) cells/g dry refuse), and in digesters D1 and D2 on day 210 for HFB (10(9) cells/g dry refuse) or on day 90 for HPAB (10(4)-10(6) cells/g dry refuse). The population of methane-producing bacteria in digesters D4 and D5 sharply increased on days 60 and 90 respectively, however in digesters D1, D2 and D3 on day 120. Leachate recycle and inoculation changed the cellulolytic microorganisms composition of refuse ecosystem, the higher amounts of anaerobic cellulolytic bacteria were measured in digesters D4 and D5 (10(7) cells/g dry refuse), followed by digesters D3 (10(6) cells/g dry refuse), D2 or D1(10(4) cells/g dry refuse). However, the amounts of aerobic cellulolytic bacteria were much lower than that of anaerobic cellulolytic bacteria. And it was higher in digester D3 than those in digesters D1, D2, D4 and D5. The amounts of SRB and denitrabacteria were also higher in digester D5 than those in digesters D1, D2, D3 and D4. Refuse decomposition could be accelerated by leachate recycle and inoculation in the view of microorganism development.

High relapse rate among lepromatous leprosy patients treated with rifampin plus ofloxacin daily for 4 weeks

Fifty-one lepromatous leprosy patients, all of whom had relapsed after previous dapsone (DDS) monotherapy, were treated between 1990 and 1991 with 600 mg of rifampin (RMP) plus 400 mg of ofloxacin (OFLO) daily for 4 weeks, and the great majority of the patients were followed up at least once a year after completion of the treatment. After only 173 patient-years of follow-up, 5 relapses had been detected; the overall relapse rate was 10.0% (confidence limits, 1.7 and 18.3%), or 2.9 relapses (confidence limits, 0.4 and 5.4) per 100 patient-years. The unacceptably high relapse rate indicated that 4 weeks of treatment with daily RMP-OFLO was unable to reduce the number of viable Mycobacterium leprae organisms to a negligible level. In addition, the M. leprae from one of the relapses were proved to have multiple resistance to DDS, RMP, and OFLO. To avoid further relapses, the follow-up was terminated and the great majority of the patients were retreated with the standard 2-year multidrug therapy from 1994. No further relapse has been diagnosed since the beginning of retreatment.

Determination of the minimal effective dosages of ofloxacin and sparfloxacin against M. leprae in the mouse foot pad system

The minimal effective dosages (MEDs) of ofloxacin (OFLO) and sparfloxacin (SPFX) against 10 isolates of Mycobacterium leprae were measured in the mouse foot pad system. The drugs were administered either by gavage or by incorporation into the mouse diet in a range of concentrations. The results demonstrated that the MEDs of OFLO were 4 to 5 times higher than those of SPFX, thus confirming that, on a weight-to-weight basis, the anti-M. leprae activity of SPFX was significantly greater than that of OFLO. The MEDs of OFLO/SPFX measured by gavage were 20 times lower than those measured by incorporating the drug into the mouse diet.

Natural protection against HIV-1 infection provided by HIV-2

Significant differences have been observed in the rates of transmission and disease development in human immunodeficiency virus (HIV) types 1 and 2. Because many HIV-2-infected people remain asymptomatic for prolonged periods, the hypothesis that HIV-2 might protect against subsequent infection by HIV-1 was considered. During a 9-year period in Dakar, Senegal, the seroincidence of both HIV types was measured in a cohort of commercial sex workers. Despite a higher incidence of other sexually transmitted diseases (STDs), HIV-2-infected women had a lower incidence of HIV-1 than did HIV-seronegative women, with a relative risk of 0.32 (P = 0.008). An understanding of the cross-protective mechanisms involved may be directly relevant to HIV-1 vaccine development.

Reduced rate of disease development after HIV-2 infection as compared to HIV-1

Human immunodeficiency virus type-2 (HIV-2) is a close relative of the prototype acquired immunodeficiency syndrome (AIDS) virus, HIV-1. HIV-2 is biologically similar to HIV-1, but information is lacking concerning clinical outcomes of HIV-2-infected individuals. From 1985 to 1993, a prospective clinical study was conducted in women with HIV-2 and HIV-1 infection to determine and compare rates of disease development. HIV-1-infected women had a 67% probability of AIDS-free survival 5 years after seroconversion in contrast with 100% for HIV-2-infected women. In addition to having significantly less HIV-related disease outcome in HIV-2 enrollees compared to HIV-1 enrollees, the rate of developing abnormal CD4+ lymphocyte counts with HIV-2 infection was also significantly reduced. This natural history study demonstrates that HIV-2 has a reduced virulence compared to HIV-1.

Activity of two doses of rifampin against Mycobacterium leprae

In the course of a clinical trial designed to re-examine the bactericidal efficiency of 600-mg doses of rifampin (RMP) against Mycobacterium leprae, two doses of RMP, either 600 mg or 1200 mg, were administered 28 days apart to 29 previously untreated patients with lepromatous or borderline leprosy. Seven, 28, and 35 days after the start of the trial, skin biopsies were performed and immunologically normal mice were inoculated with 5 x 10(3) or 10(4) M. leprae in each hind foot pad. The patients assigned to the two regimens did not differ significantly in terms of sex, age, disease classification, bacterial index, or the concentration of M. leprae in the skin lesion biopsied for the inoculation of mice. The concentrations of organisms in the skin-biopsy specimens did not change significantly over the course of the trial among the patients, whether they were being treated by the first or the second regimen. The M. leprae recovered from specimens obtained from 21 of the patients, before beginning treatment, multiplied in a majority of the mice inoculated. The results of mouse inoculation confirmed the rapid bactericidal effects of RMP against M. leprae: a single dose of RMP rendered the organisms obtained from all but two of the patients incapable of multiplying in mice. No significant difference was demonstrated between the two regimens, nor was an additional effect of the second dose of RMP observed.

Relapses after a single dose of rifampin in skin-smear negative multibacillary patients after dapsone monotherapy

Between 1982 and 1985, a single 1500 mg dose of rifampin (RMP) was given to 136 multibacillary leprosy patients who had become clinically inactive and skin-smear negative after various durations of dapsone monotherapy, and then antileprosy chemotherapy was totally stopped. By the end of June 1992, 15 relapses were detected among these patients. The overall relapse rate was 11%; the relapse rate per 100 patient-years was 2.1%, which was the highest among those published to date; the cumulative risk of relapse at year 7 of follow up was 8.8%. All of these figures indicate that the relapse rate among this group was at least the same as in other studies where patients received dapsone monotherapy only. Therefore, the administration of a single large dose of RMP could neither prevent relapse nor reduce its rate among multibacillary patients who had already become clinically and skin-smear negative after dapsone monotherapy.

Short-term trial of clofazimine in previously untreated lepromatous leprosy

Forty-five previously untreated lepromatous leprosy patients were allocated randomly to three groups and treated, respectively, with Regimen A, standard dosage of clofazimine (CLO) in multidrug therapy (MDT) regimen; Regimen B, CLO 600 mg once every 4 weeks; and Regimen C, CLO 1200 mg once every 4 weeks. The duration of the trial was 24 weeks. By the end of the trial, although a few patients in each group did not improve at all clinically, the majority of patients showed clinical amelioration but the responses were slow. While the mean morphological index dropped to the baseline after 24 weeks of treatment, the mean bacterial index did not change significantly. About 80% of the patients in each group remained nasal-smear positive at the end of the trial, but the bacterial loads steadily declined. No significant difference has been detected in these parameters among the three groups. The patients tolerated the regimens very well and the side effects were mild. The results of serial mouse foot pad inoculation demonstrated that the positivity rates of multiplication of Mycobacterium leprae in mice and the proportions of viable organisms reduced gradually in all groups. Because the positivity rate at week 24 in Group C did not differ significantly from Group A, but was significantly smaller than that of Group B, we conclude that Regimen C was as active as Regimen A and could be applied for monthly supervised treatment along with rifampin; Regimen B is less effective and should not be used for the treatment of leprosy.

[Results of animal experimentation activities at the Institut Marchoux in Bamako (1982-1984)]

The Institut Marchoux animal research unit report of activities 1982-1984 shows increasing results in mouse-foods-pads inoculations. Among 17 multibacillary cases, 16 were clinically dapsone-resistant suspected. In 9 cases there was no multiplication; however in 4 cases, multiplication were observed in the untreated controled mice group but no multiplication in dapsone groups. Three cases were fully dapsone-resistant in all concentrations tested. In one case we have detected a partial DDS resistance. No multiplication in the mice group with 10(-2) dapsone dict, but multiplication in 10(-3) and 10(-4) dapsone dict.

Differential identification of Mycobacterium fortuitum and Mycobacterium chelonei

Mycobacterium fortuitum and Mycobacterium chelonei are distinguished unambiguously by the combined use of five test characters: nitrate reductase, beta-glucosidase, acid production from fructose, penicillinase, and trehalase. Typically, M. fortuitum was nitrate reductase positive, beta-glucosidase positive; M. chelonei was nitrate reductase negative, beta-glucosidase negative, penicillinase positive, and trehalase positive and did not produce acid from fructose.