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Superficial cultures in neonatal sepsis evaluations. Impact on antibiotic decision making.
The authors performed a retrospective analysis of neonatal superficial cultures and their effect on antimicrobial decision making during a nine-month period at Nashville General Hospital.
They obtained and reviewed charts of infants (n = 66) having paired superficial (skin and/or gastric aspirate) and deep (blood and cerebrospinal fluid) cultures for the evaluation of early-onset sepsis.
Superficial cultures were positive for pathogens (any streptococcus or enteric gram-negative) in 15% (10/66) of cases.
Antimicrobial decision making was affected in only one of these cases, and in a seemingly inappropriate manner.
In summary, there was no evidence or review that superficial cultures used in sepsis evaluation influenced physician antimicrobial decision making; in one case they may have led to unnecessary antibiotic exposure.
| 0Bacterial Infections and Mycoses
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Catheter-related sepsis: prospective, randomized study of three methods of long-term catheter maintenance.
We studied the infectious risk of different methods of managing vascular catheters during long-term use.
Consecutive surgical ICU patients requiring triple lumen catheters, pulmonary artery catheters, or arterial catheters for greater than 7 days were prospectively randomized to one of three management groups: a) percutaneous (PERC) puncture with every 7-day catheter change at a new site, b) no weekly change (NWC) with a new site when changed, or c) guidewire exchange (GWX) with every 7-day catheter change at the same site.
In all groups, a catheter change was mandatory for a positive blood culture, skin site infection, or sepsis without a likely source.
Cultures were obtained when clinically indicated and at the time of every catheter change.
Catheter-related sepsis (CRS) was defined as a positive blood culture and catheter culture with the same organism.
A total of 112 patients met evaluation criteria.
There were no intergroup differences in age, primary diagnosis, severity of injury or illness, number of study days, number of protocol violations, route of catheterization, number of catheters present/patient day, catheter sepsis rate, or bacteremia rate.
The NWC group demonstrated an increased number of days/catheter, fewer catheter/subcutaneous tract segment cultures/patient, and a reduced incidence of catheter tip colonization.
These results occurred in a setting where the number of CRS episodes/patient was 0.17 for GWX, 0.22 for PERC, and 0.16 for NWC.
We conclude that there is no difference in infectious risk between these three methods of long-term catheter management.
The method with the least complications and expense should be used.
| 0Bacterial Infections and Mycoses
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Effect of blood transfusion on oxygen consumption in pediatric septic shock.
Treatment plans for pediatric septic shock advocate increasing oxygen consumption (VO2).
Recent studies in septic shock indicate that improving oxygen delivery (DO2) by increasing blood flow will increase VO2.
We prospectively examined the effect on VO2 of improving DO2 by increasing oxygen content (CO2) with blood transfusion in eight hemodynamically stable septic shock patients.
Transfusion consisted of 8 to 10 ml/kg of packed RBC over 1 to 2 h.
Hemodynamic and oxygen transport measurements were obtained before and after blood transfusion.
Transfusion significantly (p less than .05) increased Hgb and Hct from 10.2 +/- 0.8 g/dl and 30 +/- 2% to 13.2 +/- 1.4 g/dl and 39 +/- 4%, respectively (mean +/- SD).
DO2 significantly (p less than .05) increased after transfusion (599 +/- 65 to 818 +/- 189 ml/min.m2), but VO2 did not change (166 +/- 68 to 176 +/- 74 ml/min.m2; NS).
In pediatric septic shock patients, increasing CO2 by blood transfusion may not increase VO2.
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Effects of epinephrine on hemodynamics and oxygen metabolism in dopamine-resistant septic shock.
The hemodynamic effects of epinephrine were prospectively studied in 13 patients with septic shock who remained hypotensive after both fluid loading and dopamine.
Hemodynamic measurements were performed before and one hour after the start of epinephrine infusion.
Systolic, diastolic, and mean arterial pressure increased in all patients (p less than 0.01).
Cardiac index and systemic vascular resistance increased by 34 and 32 percent, respectively (p less than 0.05), but heart rate and pulmonary vascular resistance remained unchanged.
There was a concomitant increase in oxygen delivery (p less than 0.01) and oxygen consumption (p less than 0.05), the magnitude of the latter being related to baseline lactacidemia (p less than 0.01).
In view of the generally recognized physiologic goals of septic shock management, we conclude that epinephrine could be an appropriate alternative where fluid loading and dopamine have failed.
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Denatured muscle grafts for nerve repair. An experimental model of nerve damage in leprosy
About 20% of patients with leprosy develop localised granulomatous lesions in peripheral nerves.
We report experiments in guinea-pigs in which freeze-thawed autogenous muscle grafts were used for the treatment of such mycobacterial granulomas.
Granulomas were induced in guinea-pig tibial nerves and the animals were left for 7 to 100 days in order to assess maximal damage.
The local area of nerve damage was then excised and the gap filled with denatured muscle grafts.
Clinical assessment after periods up to 150 days showed good sensory and motor recovery which correlated well with the histological findings.
The muscle graft technique may be of value for the treatment of chronic nerve lesions in selected cases of leprosy.
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Selection of antibiotic coverage in vascular patients undergoing cystoscopy.
Bacteremic seeding of prosthetic vascular grafts represents a cause for graft infection; transurethral procedures account for one source of bacteremia.
Therefore, a prospective study of 200 patients undergoing cystoscopy was conducted to identify the incidence of bacteruria and factors associated with it, organisms involved and their antibiotic sensitivities.
Positive cultures were found in 21%.
The incidence was 64% in in-patients and 8% in out-patients.
Positive cultures were found in 12% of patients who received antibiotics and 29% who did not.
Four percent showed signs of bacteremia.
The cultures identified both Gram positive and negative organisms; multiple organisms grew in 22%.
Gram negative organisms were more common in in-patients.
Candida grew in 8%.
The Gram positive organisms were sensitive to ampicillin (92%), sulfatrimethoprim (75%) and cefazolin (60%); Gram negative to aminoglycosides (100%) and cefazolin (92%).
In view of the unpredictable and multiple organisms, it is recommended that pre-cystoscopy cultures be performed and specific antibiotic coverage be based on the sensitivities.
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Possible role of bacterial siderophores in inflammation. Iron bound to the Pseudomonas siderophore pyochelin can function as a hydroxyl radical catalyst.
Tissue injury has been linked to neutrophil associated hydroxyl radical (.OH) generation, a process that requires an exogenous transition metal catalyst such as iron.
In vivo most iron is bound in a noncatalytic form.
To obtain iron required for growth, many bacteria secrete iron chelators (siderophores).
Since Pseudomonas aeruginosa infections are associated with considerable tissue destruction, we examined whether iron bound to the Pseudomonas siderophores pyochelin (PCH) and pyoverdin (PVD) could act as .OH catalysts.
Purified PCH and PVD were iron loaded (Fe-PCH, Fe-PVD) and added to a hypoxanthine/xanthine oxidase superoxide- (.O2-) and hydrogen peroxide (H2O2)-generating system.
Evidence for .OH generation was then sought using two different spin-trapping agents (5.5 dimethyl-pyrroline-1-oxide or N-t-butyl-alpha-phenylnitrone), as well as the deoxyribose oxidation assay.
Regardless of methodology, .OH generation was detected in the presence of Fe-PCH but not Fe-PVD.
Inhibition of the process by catalase and/or SOD suggested .OH formation with Fe-PCH occurred via the Haber-Weiss reaction.
Similar results were obtained when stimulated neutrophils were used as the source of .O2- and H2O2.
Addition of Fe-PCH but not Fe-PVD to stimulated neutrophils yielded .OH as detected by the above assay systems.
Since PCH and PVD bind ferric (Fe3+) but not ferrous (Fe2+) iron, .OH catalysis with Fe-PCH would likely involve .O2(-)-mediated reduction of Fe3+ to Fe2+ with subsequent release of "free" Fe2+.
This was confirmed by measuring formation of the Fe2(+)-ferrozine complex after exposure of Fe-PCH, but not Fe-PVD, to enzymatically generated .O2-.
These data show that Fe-PCH, but not Fe-PVD, is capable of catalyzing generation of .OH.
Such a process could represent as yet another mechanism of tissue injury at sites of infection with P.
aeruginosa.
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Treatment of fungal skin infections: state of the art.
The number of cases of mycotic infections are increasing, presenting physicians today with an unprecedented challenge in handling the treatment and prophylactic control of these disorders.
The increase in mycotic disorders is due to many factors, such as longer life span, organ transplantation, and the acquired immunodeficiency syndrome.
The pharmaceutical industry is providing physicians with newer, more potent drugs to manage mycoses.
An overview of current practice in the use of topical and oral agents, especially ketoconazole, are given in the following specific mycoses: tinea capitis, pityriasis versicolor, seborrheic dermatitis, Trichophyton rubrum infections, vaginal candidiasis, and moist intertriginous tineas.
The efficacy of ketoconazole in various vehicles and dosage schedules and of traditional agents such as griseofulvin are discussed with relation to each of the mycoses.
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Itraconazole in tinea versicolor: a review.
Itraconazole, a new orally active triazole antifungal, has been tested in patients with pityriasis versicolor.
A number of studies have shown that itraconazole is effective for this mild fungal skin disease.
The total dose required for effective treatment is 1000 mg, and it has been given as 200 mg for 5 days or 7 days.
The organisms disappear slowly from the skin, even when dead, and the results should be assessed clinically and mycologically at around 3 to 4 weeks after treatment.
Numerous studies have shown that itraconazole is superior to placebo and as effective as selenium sulfide, clotrimazole, and ciclopirox olamine.
It is also better tolerated by patients than selenium sulfide.
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Itraconazole in common dermatophyte infections of the skin: fixed treatment schedules.
Itraconazole is an effective medication against the most common dermatophytoses.
It has been shown to be more active than griseofulvin and ketoconazole.
Ease of use, affinity for keratinized tissues, lack of toxicity, continued activity after discontinuation, and the possibility of using fixed schedules are advantages of itraconazole.
The fixed schedules indicated by pharmacokinetics and clinical studies are one 100 mg capsule daily for 15 days in cases of tinea corporis and tinea cruris and the same dosage for 30 days in cases of tinea pedis and tinea manuum.
These fixed treatments have some limitations, and they are not recommended for treating tinea capitis and tinea unguium.
The drug is well tolerated.
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Treatment of oral candidosis with itraconazole: a review.
Oral candidosis is a common infection in infants, elderly persons, patients receiving immunosuppressive therapy, and patients with acquired immunodeficiency syndrome (AIDS).
The orally active antifungal agent itraconazole has been evaluated in a number of different patient populations with oral and oropharyngeal candidosis.
Initial studies have shown that itraconazole, 100 or 200 mg/day for 14 days, is more active than placebo in treating oral candidosis.
A comparative study between itraconazole capsules (200 mg once daily) and clotrimazole troches (10 mg five times daily) showed equivalent results at the end of therapy but a significantly faster response to itraconazole and a faster relapse rate with clotrimazole.
A study in AIDS patients with oropharyngeal candidosis demonstrated that itraconazole, 200 mg/day, and ketoconazole, 400 mg day, for 4 weeks give equivalent clinical cure rates and similar relapse rates.
A pilot study with an oral solution of itraconazole has given an impressive 100% clinical and mycological response rate within 1 week of treatment.
In conclusion, itraconazole in capsule or in solution form may constitute a major addition to the armamentarium of drugs against oropharyngeal candidosis.
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Individualizing treatment of vaginal candidiasis.
Clinicians have a vast array of effective antimycotics for the treatment of vaginal candidiasis.
Multiple topical formulations are available, yet there is little evidence to suggest that formulation per se influences outcome.
A growing number of highly effective oral systemic antimycotic agents provide the practitioner with additional options.
Treatment regimens have also changed with the introduction of shorter, often single-day/single-dose courses of therapy.
Not all therapeutic agents have the same activity against vaginal fungal pathogens in that topical azoles tend to be more active than nystatin.
Differences in patient characteristics, however, are more important than the differences between antimycotic agents and therapeutic regimens in determining selection of the appropriate antimycotic.
Patients with vaginal candidiasis vary with regard to duration and severity of symptoms and past frequency of attacks, distribution of inflammation, and pregnancy status.
The clinician should consider all these variables both in selecting the appropriate antimycotic agent and the route of administration and in planning the duration of therapy.
Individualized therapy offers additional benefits to patients, who may then enjoy the maximum advantages of antimycotics now available.
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Itraconazole treatment of phaeohyphomycosis.
Nineteen patients with phaeohyphomycosis were treated with itraconazole.
Of these, 17 were assessable for clinical outcome.
Of these, two had received no prior therapy, five had failed amphotericin B therapy, four had failed ketoconazole or miconazole therapy, and five had failed both amphotericin B and azole therapy.
One patient had received only prior surgical intervention.
Fungi of seven different genera caused disease of the skin in nine patients, soft tissue in nine, sinuses in eight, bone in five, joints in two, and lungs in two.
Itraconazole was given in dosages ranging from 50 to 600 mg/day for 1 to 48 months.
Clinical improvement or remission occurred in nine patients.
Two patients have had stabilization of disease.
Six patients failed treatment, one had a relapse after initially successful treatment.
Itraconazole appears to be highly effective in some patients with phaeohyphomycosis, including patients refractory to other antifungal agents.
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Clostridium difficile invasion and toxin circulation in fatal pediatric pseudomembranous colitis.
The direct involvement of Clostridium difficile in the lesional tissue of pseudomembranous colitis has not been demonstrated; the organism's effects have been assumed to be strictly toxin mediated.
Because C.
difficile cytotoxin may be found incidentally in the intestinal lumina of asymptomatic infants, the role of the organism in a variety of pediatric intestinal diseases is uncertain.
The authors studied seven cases of fatal pediatric pseudomembranous colitis in which the presence of C.
difficile was uniformly demonstrable in lesional tissues with the use of both an intestinal spore stain and a specific immunostain.
The patients had either underlying Hirschsprung's disease or hematologic malignancy; the striking pathologic features peculiar to these patients were altered mucosal mucin and immunologic barriers in the former group and neutropenia in the latter.
Two patients had demonstrable circulating cytotoxin in serum or ascitic fluid, and C.
difficile was identified invading colonic mucosa or submucosa.
Such phenomena did not occur in control pediatric patients with multiple other intestinal lesions.
Altered host factors may be responsible for the intestinal invasion of C.
difficile and its systemic toxin circulation in cases of fatal pediatric pseudomembranous colitis.
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Cerebrospinal fluid changes after 48 hours of effective therapy for Hemophilus influenzae type B meningitis.
Interval cerebrospinal fluid (CSF) analysis is often performed to assess efficacy of treatment for bacterial meningitis.
The authors reviewed 101 cases of pediatric bacterial meningitis resulting from Hemophilus influenzae type b in which analysis of CSF occurred on admission and between 48 and 72 hours after initiation of parenteral antibiotic therapy; of these, only one patient had a positive repeat CSF culture.
Of the 100 cases with sterile CSF on repeat culture, there was no instance of recrudescence of infection during hospitalization.
The following characterized the interval changes in CSF profile of this group: 100 (100%) with persistence of pleocytosis; 14 (14%) with differential cell count conversion from polymorphonuclear neutrophil leukocyte (PMN) predominance to relative lymphocytosis; 96 of 98 (98%) with initial positive Gram-stained smear with negative results for organisms; 53 of 75 (71%) with normalization of initial hypoglycorrhachia; and 10 of 94 (11%) with normalization of initial abnormally elevated protein levels.
The differences in mean values of CSF total white blood cell counts, percentage PMNs, and glucose and protein concentrations on presentation and between 48-72 hours of therapy were highly significant (P less than 0.0001).
After 48 hours of effective antibiotic therapy for H.
influenzae type b meningitis, CSF pleocytosis and abnormally elevated protein concentration are usually preserved, whereas hypoglycorrhachia usually resolves; it is not uncommon for the differential cell count to convert from a PMN predominance to a relative lymphocytosis.
Significant alteration in all CSF parameters associated with H.
influenzae type b meningitis can occur after 48 hours of effective parenteral antibiotic therapy.
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Streptococcus mitis sepsis in bone marrow transplant patients receiving oral antimicrobial prophylaxis.
PURPOSE: Streptococcal infection has increasingly become a problem in neutropenic patients.
We report on an outbreak of Streptococcus mitis sepsis in six bone marrow transplant patients receiving oral antimicrobial prophylaxis.
PATIENTS AND METHODS: We performed an epidemiologic study of all patients in our bone marrow transplant program from 1986 to 1988.
The hospital and microbiology records for all patients were reviewed.
All bone marrow patients were treated according to specified protocols, including an oral prophylactic antimicrobial regimen that was changed in late 1987 from vancomycin/polymyxin/tobramycin to norfloxacin.
Identification, susceptibility testing, and whole cell protein analysis of streptococcal isolates were performed at the Reference and Antimicrobial Investigations Laboratories at the Centers for Disease Control.
RESULTS: We detected six cases of S.
mitis sepsis among 21 patients undergoing bone marrow transplantation.
No other concurrent pathogen was isolated from any patient at the time of the S.
mitis bacteremia.
Bacteremia developed within 72 hours of transplant in five of six patients and was associated with severe mucositis in four patients.
An environmental study failed to reveal any common source for the outbreak, and whole cell protein analysis of all six S.
mitis isolates revealed each to be distinct.
Of 12 patients receiving oral vancomycin/polymyxin/tobramycin, one developed S.
mitis bacteremia, versus five of nine patients receiving norfloxacin (p less than 0.03).
CONCLUSION: We believe S.
mitis bacteremia is a potential complication of bone marrow transplantation and is associated with antimicrobial prophylaxis with norfloxacin, especially in the setting of mucositis.
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Intraamniotic infection in the very early phase of the second trimester.
A total of 157 consecutive patients were studied in an effort to examine prospectively the incidence of asymptomatic intraamniotic infection in the early phase of the second trimester.
All patients were referred for amniotic fluid karyotyping.
In addition, the amniotic fluids were examined for Gram stain and were directly cultured on blood agar and MacConkey agar as well as in thioglycollate broth.
We found positive amniotic fluid cultures in eight cases (5.09%); however, results of Gram stain examinations were negative in all amniotic fluid samples.
The data indicate that there is no correlation between white blood cells in the amniotic fluid and positive amniotic fluid culture results.
Only one pregnancy with positive amniotic fluid culture resulted in a septic abortion.
Therefore we can suggest that intraamniotic infection can exist early in pregnancy, even with intact membranes, and in most cases without any clinical symptoms.
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hemofiltration reverses left ventricular dysfunction during sepsis in dogs.
Depressed left ventricular (LV) contractility in sepsis has been ascribed to the presence of circulating cardiodepressant substance (filterable cardiodepressant factor in sepsis [FCS]); however, this finding is controversial.
The authors hypothesized that if a decrease in LV contractility indeed occurred due to a circulating depressant substance, then removal of this substance by hemofiltration would reverse by dysfunction.
In this study, LV mechanics were examined before and after hemofiltration in anesthetized dogs during continuous intravenous infusion of live Escherichia coli.
Left ventricular anterior-posterior and apex-base dimensions were measured by subendocardial ultrasonic crystal transducers implanted 4 weeks before the experiments.
Left ventricular contractility was determined from the end-systolic pressure-dimension relationship.
The slope of this relationship (Emax) is an index of contractility.
After 4 h of sepsis, Emax was reduced by one half.
Hemofiltration resulted in a return of Emax to control values.
The FCS activity in the plasma was also assessed by the percent reduction in isometric contraction of electrically stimulated, isolated right ventricular trabeculae obtained from nonseptic dogs.
The FCS activity reached a peak 4 h after sepsis and was reduced after 2 h of hemofiltration.
The results show that during experimental sepsis, a circulating substance of less than 30,000 d produces a decrease in LV contractility and that this LV dysfunction may be improved by hemofiltration.
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Ceftazidime/clindamycin versus tobramycin/clindamycin in the treatment of intra-abdominal infections.
In order to assess the efficacy and toxicity of ceftazidime as a substitute for aminoglycosides in the treatment of intra-abdominal sepsis, a prospective randomized trial was conducted.
Ninety-four patients (49% trauma) were randomized to receive ceftazidime/clindamycin (CAZ/C) (n = 47) or tobramycin/clindamycin (T/C) (n = 47).
CAZ (2.0 gm) and C (0.9 gm) were administered intravenously every 8 hours while T dosage was adjusted to maintain peak (5-8 mg/L) and trough (less than 2 mg/L) concentrations.
Age, sex, baseline serum creatinine, and etiology of infection were comparable in the two groups.
Clinical cure was similar in culture-positive and culture-negative patients who received CAZ/C (94% vs 88%).
The clinical cure rate however was significantly lower in the T/C culture positive (73%) than in the culture negative patients (100%) (P = 0.016).
Pathogenic organisms were eradicated in 100% (30/30) and 76% (13/17) of CAZ/C and T/C patients, respectively (P = 0.0006).
Nephrotoxicity Nephrotoxicity or ototoxicity was observed in none of the CAZ/C patients and in one and two T/C patients, respectively.
CAZ/C more effectively eradicated the bacteria isolated from these patients and no significant difference in clinical response was observed in culture-positive patients.
These findings plus the lack of toxicity suggest that CAZ/C is an effective alternative for treatment of IAI.
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Effects of method of hemostasis on wound-infection rate.
Adequate hemostasis is important in preventing postoperative wound infection.
This study compared four methods of hemostasis: specific pinpoint vessel electrocautery (SPC), specific vessel ligation with 4-0 vicryl (SVL), nonspecific electrocautery of vessel plus excessive surrounding tissue (NSC), and nonspecific ligation of vessel and excessive surrounding tissue with 4-0 vicryl (NSL), on the rate of wound infection in rabbits that were contaminated with 10(6) Staphylococcus aureus.
There was no statistical significant increase in the rate of wound sepsis when electrocautery was used in a fashion producing minimal nonviable tissue compared to specific vessel ligation.
Electrocautery use for specific vessel hemostasis does not result in a higher wound infection rate in contaminated wounds.
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Congenital insensitivity to pain with neuroparalytic keratitis.
Congenital insensitivity to pain is a well-defined entity in the group of sensory deficiency syndromes.
To the best of our knowledge, unilateral neuroparalytic keratitis associated with congenital insensitivity to pain has not been reported.
We report such a case to alert clinicians to this potentially blinding problem.
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In vitro evaluation of nicotinamide riboside analogs against Haemophilus influenzae.
Exogenous NAD, nicotinamide mononucleotide, or nicotinamide riboside is required for the growth of Haemophilus influenzae.
These compounds have been defined as the V-factor growth requirement.
We have previously shown that the internalization of nicotinamide riboside is energy dependent and carrier mediated with saturation kinetics.
Thionicotinamide riboside, 3-pyridinealdehyde riboside, 3-acetylpyridine riboside, and 3-aminopyridine riboside were prepared from their corresponding NAD analogs.
These compounds and several other nicotinamide riboside analogs were evaluated for their ability to support the growth of H.
influenzae and for their ability to block the uptake of [carbonyl-14C]nicotinamide riboside by H.
influenzae.
3-Aminopyridine riboside blocked the uptake of [carbonyl-14C]nicotinamide riboside and inhibited the growth of H.
influenzae when NAD, nicotinamide mononucleotide, or nicotinamide riboside served as the V factor.
The antibacterial activity of 3-aminopyridine riboside was found to be specific for H.
influenzae but had no effect on the growth of Staphylococcus aureus or Escherichia coli.
In additional experiments by reversed-phase high-performance liquid chromatography, it was determined that whole cells of H.
influenzae degrade 3-aminopyridine adenine dinucleotide to 3-aminopyridine riboside, which is then internalized.
Inside the cell, 3-aminopyridine riboside has the ability to interfere with the growth of H.
influenzae by an undetermined mechanism.
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Beta-lactamase production and susceptibilities to amoxicillin, amoxicillin-clavulanate, ticarcillin, ticarcillin-clavulanate, cefoxitin, imipenem, and metronidazole of 320 non-Bacteroides fragilis Bacteroides isolates and 129 fusobacteria from 28 U.S. centers.
beta-Lactamase production (nitrocefin disk method) and agar dilution susceptibility of amoxicillin, amoxicillin-clavulanate, ticarcillin, ticarcillin-clavulanate, cefoxitin, imipenem, and metronidazole were determined for 320 Bacteroides species (not Bacteroides fragilis group) and 129 fusobacteria from 28 U.S.
centers.
Overall, 64.7% of Bacteroides species and 41.1% of fusobacteria were beta-lactamase positive.
Among the Bacteroides species, positivity rates were highest for B.
bivius (85.0%), followed by B.
splanchnicus (83.3%), B.
eggerthii (77.8%), and B.
oralis (77.1%); 54.5% of black-pigmented Bacteroides species were beta-lactamase positive.
Among the fusobacteria, Fusobacterium mortiferum showed the highest rate of beta-lactamase positivity (76.9%).
MICs of amoxicillin (128 micrograms/ml) and ticarcillin (64 micrograms/ml) for 90% of all beta-lactamase-positive strains were reduced to 4 and 2 micrograms/ml, respectively, with the addition of clavulanate.
MICs of amoxicillin and ticarcillin for 90% of all beta-lactamase-negative strains were 1 and 4 micrograms/ml, respectively, and greater than or equal to 98.4% of the strains were susceptible to the beta-lactams tested.
Of the beta-lactamase-producing strains, 45.9% were susceptible to amoxicillin at less than or equal to 4 micrograms/ml and 93.4% were susceptible to ticarcillin at less than or equal to 64 micrograms/ml; the addition of clavulanate raised the rates to 90.4 and 100%, respectively.
All strains were susceptible to cefoxitin, imipenem, and metronidazole.
The activity of amoxicillin against 29 beta-lactamase-producing strains (10 Bacteroides species and 19 fusobacteria) was not enhanced by the addition of clavulanate; however, 82.7% of these strains were susceptible to amoxicillin, and all were susceptible to ticarcillin.
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Activity of compound G2 isolated from alfalfa roots in experimental dermatophyte infection.
Compound G2 isolated from alfalfa roots was applied topically to skin lesions of guinea pigs experimentally infected with the dermatophyte Trichophyton mentagrophytes var.
granulare.
After 12 to 15 applications, 80% of the infected lesions were cured, as judged by clinical and microbial criteria, compared with 20% of the untreated lesions which healed spontaneously (P less than 0.01).
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In vitro susceptibility of Xanthomonas (Pseudomonas) maltophilia to newer antimicrobial agents.
The susceptibilities of 45 clinical and 3 environmental isolates of Xanthomonas maltophilia to 14 antimicrobial agents was determined by broth microdilution.
The newer quinolones PD117596, PD117558, PD127391, A-56620, amifloxacin, and fleroxacin were the most active agents tested, with 70 to 99% of isolates being susceptible to these agents.
All isolates were resistant to trospectomycin.
The new aminoglycosides SCH24120 and SCH22591 were active against 12 and 1% of isolates, respectively.
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Comparison of cilofungin and amphotericin B for therapy of murine candidiasis.
We compared the efficacies of cilofungin and amphotericin B treatment in a murine model of disseminated candidiasis.
Three different dosages of each drug plus controls were evaluated.
Statistically improved survival was noted only among mice treated with 1 mg of amphotericin B per kg of body weight (P less than 0.05).
While all amphotericin B regimens and the two lower-dosage cilofungin regimens significantly reduced yeast cell counts in kidneys compared with the controls, the amphotericin B-treated mice had a significantly higher percentage of sterile kidneys following therapy compared with those treated with cilofungin (P = 0.0001).
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Emergence of ciprofloxacin resistance in nosocomial methicillin-resistant Staphylococcus aureus isolates. Resistance during ciprofloxacin plus rifampin therapy for methicillin-resistant S aureus colonization.
We initiated a randomized, single-blinded trial of ciprofloxacin plus rifampin vs sulfamethoxazole and trimethoprim plus rifampin in the therapy for patients who underwent colonization with methicillin-resistant Staphylococcus aureus (MRSA).
Patients who were colonized with MRSA received 2 weeks of either regimen.
The study was terminated after the enrollment of 21 subjects due to the recognition of ciprofloxacin resistance in 10 of 21 new MRSA isolates during the last 2 months of the study.
Five of the 10 patients with ciprofloxacin-resistant MRSA isolates had never received ciprofloxacin.
Long-term (6-month) eradication had been achieved in only three of 11 ciprofloxacin plus rifampin and four of 10 sulfamethoxazole and trimethoprim plus rifampin recipients.
The use of this new fluoroquinolone for the eradication of MRSA colonization is usually not effective and may risk the development of ciprofloxacin resistance in MRSA within the hospital environment.
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Buccal cellulitis.
Buccal cellulitis (BC) is an innocuous appearing infection of the cheek that is found in children and has a high incidence of concomitant bacteremia.
Typically, the child is younger than 12 months and has a 2 to 8 hour prodrome of coryza and fever before developing the cellulitis on the cheek.
A purplish hue on the cellulitic region is highly suggestive of Hemophilus influenzae bacteremia.
The differential diagnosis is reviewed.
A complete blood count, blood culture, and cellulitis aspirate culture, should be obtained on all patients with BC.
Meningitis may be present despite the lack of meningeal signs.
A lumbar puncture should be performed on all children at risk for bacteremic BC.
The vast majority of these children are bacteremic and require parenteral antibiotics.
A typical case of BC is presented and its management is reviewed.
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Intraocular pressure changes and postural changes of intraocular pressure in experimentally induced Hansen's disease of rhesus, mangabey, and African green monkeys.
In our long term evaluation of patients with Hansen's disease we have frequently found reduction of their intraocular pressure.
Furthermore, we noted changes in their intraocular pressure on change of posture.
To determine if these changes have any significance we measured the intraocular pressures of 24 experimentally infected and 39 control monkeys in both sitting and reclining positions.
We found significant reduction of intraocular pressure in 66.7% compared with controls in the sitting position, and a significant increase in intraocular pressure in 79% when checked first in the sitting then in the reclining position.
We offer a possible pathophysiological explanation as to why the changes occur.
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Seven-day administration of recombinant human granulocyte colony-stimulating factor to newborn rats: modulation of neonatal neutrophilia, myelopoiesis, and group B Streptococcus sepsis.
Single-pulse administration of rhG-colony-stimulating factor (CSF) to neonatal rats was previously demonstrated to induce peripheral neutrophilia and modulate bone marrow (BM) neutrophil storage and proliferative pools (NSP + NPP).
In this study, we investigated the prolonged effects of 7 days of rhG-CSF therapy (5 micrograms/kg/per day).
Sprague-Dawley newborn rats (less than or equal to 24 hours) were injected intraperitoneally (IP) (daily for 7 days) with rhG-CSF or phosphate-buffered saline/human serum albumin (PBS/HSA).
RhG-CSF induced a significant early and late peripheral neutrophilia: 6,905 +/- 1,625 (day 1) and 9,223 +/- 515 microL (day 7) v 1,275 +/- 90/microL (P less than or equal to .0001).
In addition, 7 days of rhG-CSF resulted in a significant increase in the BM NSP: 3,247 +/- 190/microL v 1,677 +/- 339/microL (P less than or equal to .001).
There was, however, no depletion or significant change in the BM NPP.
Seven days of rhG-CSF also induced a mild increase in BM CFU-GM colony formation (P less than or equal to .01).
There was, however, no significant change in liver/spleen CFU-GM colonies or in the CFU-GM proliferative rate in either the BM or liver/spleen cultures.
Finally, 7 days of prophylactic rhG-CSF therapy resulted in a synergistic response with antibiotic therapy and significantly modulated the mortality rate during experimental group B streptococcal sepsis (GBS) (100% v 50%) (GvsC) (P less than or equal to .001).
Pulse rhG-CSF administered at 6 hours or 18 hours after GBS inoculation, however, failed to act synergistically with antibiotics to improve survival or prevent peripheral neutropenia.
This study suggests that 7 days of prophylactic rhG-CSF therapy induces peripheral neutrophilia, myeloid maturation, increases neutrophil BM reserves and also may provide immunologic enhancement of neonatal host defense during experimental GBS in term neonatal rats.
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Ringer's acetate and dextran-70 with or without hypertonic saline in endotoxin-induced shock in pigs.
The effects of Ringer's acetate, 6% dextran-70, 7.5% NaCl, and the combination of 7.5% NaCl and dextran-70 were tested in resuscitation from endotoxin shock induced by continuous iv infusion of Escherichia coli endotoxin in pigs.
After about 3 h, a reproducible shock state was achieved and treatment was started, governed by the left atrial pressure.
The hypertonic solutions (7.5% NaCl and 7.5% NaCl in dextran-70) did not show any overall advantages over the isotonic solutions (Ringer's acetate and dextran-70).
Only transient beneficial hemodynamic effects lasting less than 30 min after infusion were seen.
When dextran-70 was administered, cardiovascular function was markedly improved and oxygen delivery (DO2) and survival were significantly higher compared with the crystalloid groups (Ringer's acetate and 7.5% NaCl).
Administration of large amounts of Ringer's acetate resulted in an immediate deterioration of pulmonary function.
It was difficult to elevate left atrial pressure or even to keep it at baseline level, and cardiac index was only transiently increased.
The overall result was a deterioration of DO2 and poor survival compared with the dextran-70 treated pigs.
We conclude that dextran-70 is superior to Ringer's acetate in resuscitation from endotoxin-induced shock in pigs.
Furthermore, we found no role for the use of hypertonic saline, alone or in combination with dextran, in the treatment of this type of prolonged endotoxin shock.
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Infection control in the nursing home: the physician's role.
Infection control in the nursing home or long-term care facility is an increasingly complex activity.
The high rates (approximately 15%) and special risks (group activities, crowding) for nosocomial infection demand special attention by attending physicians.
Some specific responsibilities include: recognition of infection; knowledge and use of basic infection control principles; appropriate antibiotic use; review of immunizations; facilitation of communications among office, hospital, and long-term care facility; and involvement with infection control program(s).
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Use of latex agglutination technique for detecting Legionella pneumophila (serogroup 1) antibodies.
Following the outbreak of Legionnaires' disease in Stafford in 1985, 500 serum samples were submitted to the indirect immunofluorescence antibody test and a latex agglutination.
Latex agglutination using ultrasonically disrupted Legionella pneumophila antigens coupled to latex particles, proved a rapid, simple method for detecting circulating antibodies to L pneumophila in a one minute slide latex agglutination test.
There was good correlation with the indirect immunofluorescence antibody test (IFAT), and the specificity and sensitivity with respect to a diagnostic result were 98.3% and 97.6%, respectively, using a series of well characterised sera.
The latex agglutination test seems well suited as a screening test for presumptive cases of Legionnaires' disease; the latex reagent is easy to prepare and seems to remain stable at 4 degrees C for up to six months.
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History of antifungals.
Until two to three decades ago, only a few drugs were available for the treatment of fungal infections.
The status of antifungal therapy changed dramatically in the late 1960s with the introduction of newer broader spectrum agents, such as the iodinated trichlorophenols and the imidazoles, that acted by disruption of the fungal cell membrane.
Some of the more recently developed broad-spectrum antifungal drugs include the triazoles terconazole, itraconazole, and fluconazole and the dimethylmorpholine amorolfine.
The allylamines represent one of the newest classes of compounds shown to be effective in the management of fungal disorders.
The two members of this unique chemical class that have been studied clinically, naftifine and terbinafine, are effective against a wide spectrum of fungal organisms.
Terbinafine has the added advantage of both topical and oral activity.
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A clinical trial of topical terbinafine (a new allylamine antifungal) in the treatment of tinea pedis.
Twenty-three patients were enrolled in a randomized, double-blind trial of terbinafine 1% cream compared with placebo vehicle in the treatment of tinea pedis.
Of the 20 patients who were evaluated for efficacy, 10 received terbinafine and 10 received placebo.
Except for the terbinafine-treated patients being an average of 11 years older than the patients receiving placebo and the median duration of disease being 6 weeks longer in the placebo group, the two groups were demographically and clinically similar.
Results of mycologic tests and clinical findings showed terbinafine to be significantly more effective than placebo in the treatment of tinea pedis.
Significantly more terbinafine-treated patients than placebo-treated patients showed conversion to negative culture and microscopy at end of therapy and a significant reduction in scored signs and symptoms.
Overall efficacy at follow-up (combined mycologic and clinical findings) was also significantly greater in the terbinafine group (78%) than in the placebo group (zero) (p less than 0.001).
Unexplained elevation of liver function test results was noted in three placebo-treated patients and in one terbinafine-treated patient, but these changes were not considered clinically relevant or drug related.
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Efficacy and tolerability of topical terbinafine in the treatment of tinea cruris.
Thirty men with clinical and mycologic evidence of tinea cruris were enrolled in a controlled, randomized, double-blind trial comparing terbinafine 1% cream and its cream vehicle as placebo.
Patients applied the test medications to the affected area twice daily for 2 weeks.
Therapeutic response was evaluable in 18 patients after each week of treatment and at a follow-up visit 2 weeks after therapy ended.
At each visit, terbinafine was found to be more effective than the cream vehicle in the reduction of the signs and symptoms of infection and in the conversion of culture and microscopy findings to negative or normal.
At the end of treatment, therapy was effective in 67% of the nine terbinafine-treated patients compared with only 11% of the nine placebo-treated patients.
At the follow-up examination, efficacy rates were 78% in the terbinafine treatment group and 33% in the placebo group--a difference of borderline statistical significance (p = 0.077).
Possible reasons for this result may include the higher incidence of chronic disease in the terbinafine group and the large number of patients who were classified as delayed exclusions because of negative initial culture for dermatophytes.
No side effects or significant alterations in laboratory or hematologic tests were observed in either treatment group.
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Treatment of tinea cruris with topical terbinafine.
Twenty-three patients were enrolled in a randomized, double-blind trial of terbinafine 1% cream versus its vehicle (placebo) in the treatment of tinea cruris.
One patient had a negative initial culture and was excluded, and two patients were dropouts, one because of poor study compliance (terbinafine) and one because of an adverse event (placebo).
Twenty patients were examined for efficacy of treatment (9 terbinafine-treated, 11 placebo-treated).
Both groups were similar in age, sex, duration of disease, prior therapy, size and location of lesion, infecting organism, and predisposing factors.
Terbinafine 1% cream was more effective than vehicle cream in the reduction of the signs and symptoms of tinea cruris.
In addition, there was a higher conversion rate to negative culture and normal microscopy findings in the terbinafine-treated group.
Clinical results combined with evaluation of mycologic tests at end of therapy showed terbinafine to be a rapid and significantly more effective treatment for tinea cruris than placebo (78% vs 18% cure rate, respectively).
Follow-up cure rates confirmed these findings (89% and 18%, respectively).
No significant adverse events occurred during terbinafine treatment.
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Oral terbinafine versus griseofulvin in the treatment of moccasin-type tinea pedis.
The safety and effectiveness of oral terbinafine, 125 mg twice daily, and griseofulvin, 250 mg twice daily, in patients with moccasin-type tinea pedis were examined in a double-blind randomized trial.
At the end of the 6-week treatment period, both a clinical and mycologic cure or a mycologic cure with minimal signs of infection was noted in 12 (75%) of the 16 terbinafine-treated patients compared with only 3 (27%) of the 12 patients treated with griseofulvin.
The overall response rate 2 weeks after the completion of treatment was 88% in the terbinafine-treated group and 45% in the griseofulvin-treated group.
When contacted again 6 to 15 months after completion of the study, 94% of the terbinafine-treated patients reported sustained clearing of tinea pedis, and 88% of those with nail involvement at the time of treatment reported improvement.
In contrast, tinea pedis remained cured in only 30% of the patients who had received griseofulvin, and onychomycosis improved in only 14%.
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Leprotic involvement of peripheral nerves in the absence of skin lesions. Case report and literature review.
In the absence of clinically apparent cutaneous lesions, primarily neural leprosy is uncommon.
Primarily neural leprosy presents clinically as a peripheral neuropathy that most frequently affects motor nerves and that occasionally involves sensory nerves as well.
The long incubation period for leprosy and its occurrence outside endemic areas often lead to delayed diagnosis.
We present a case of glove and stocking hypoesthesia, weakness of the flexor muscle of the right great toe, palpable thickening of the right popliteal nerve, and hypoesthetic but normal-appearing areas on the back, which developed in a Trinidadian immigrant who lived in Canada for 16 years.
A skin biopsy specimen obtained from a visibly normal but hypoesthetic area on the back demonstrated a few acid-fast bacteria in small dermal nerves, in arrector pili smooth muscle, and in rare perivascular histiocytes, associated with a sparse mixed inflammatory cell infiltrate.
The patient responded well to therapy with dapsone, rifampin, and clofazamine.
A classification and review of primarily neural leprosy is presented.
Our patient represents the first reported case of primarily neural borderline lepromatous leprosy in Canada.
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Bioaerosols: prevalence and health effects in the indoor environment.
Assessing the role of bioaerosols in residence-related symptoms involves (1) determining that symptoms are related to the residence by medical examination and careful questioning, (2) connecting reported symptoms with known or hypothesized effects of bioaerosols, (3) examining the residence for bioaerosol risk factors such as overcrowding/poor ventilation, inappropriate outdoor air intrusion, and dampness/standing water, (4) and finally, if no obvious risk factors are present, air sampling.
Air sampling should always be a last resort and should use a reliable volumetric method.
Particulate samplers, such as the Burkard personal spore trap, are inexpensive alternatives to viable particle samplers and will provide data on most organisms implicated in hypersensitivity diseases.
Interpretation of residential bioaerosol sample data requires both qualitative and quantitative comparison with adjacent outdoor air and examination of aerosol changes related to domestic activities.
Recommendations that should lead to a decrease in indoor bioaerosols include the use of air conditioning to allow limitation of outdoor aerosols, prevention of dampness or moisture intrusion, and discouraging the use of humidifying devices other than steam.
Bioaerosol assessment in the workplace is often more complex than for residences.
Because the symptomatic subjects are not in charge of the environment, such situations often lead to difficult employee/management relations and occasionally to litigation.
It is essential that each step in workplace bioaerosol assessment be defensible and that the best possible methods are used.
The approach is similar to the approach used for residences, but on a larger scale.
Symptom assessment must include stress and ergonomic factors.
Air sampling, if this is necessary, must usually be extensive with controls for ventilation rates, occupancy, and spatial variation.
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Monoclonal antibody to mouse lipopolysaccharide receptor protects mice against the lethal effects of endotoxin.
Specific endotoxic lipopolysaccharide (LPS) binding sites on the cell membranes of murine lymphocytes and macrophages that may serve as functional receptors for LPS have recently been identified using photoactivatable cross-linking LPS derivatives.
A monoclonal antibody (Mab 5D3) with specificity for this 80-kDa protein has also been generated and characterized.
The capacity of MAb 5D3 to protect mice against the lethal effects of endotoxin was investigated.
Pretreatment of CF1 mice with as little as 15 micrograms of MAb 5D3 provided virtually complete protection against a dose of endotoxin 10-fold greater than that required to kill all mice in an untreated control group using the galactosamine sensitization model.
Significant protection was also afforded normal mice given MAb 5D3 relative to saline.
Several lines of evidence suggest that MAb 5D3-mediated protection is due to the agonist properties of this antibody rather than a receptor blockade mechanism.
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Platelet-activating factor or a platelet-activating factor antagonist decreases tumor necrosis factor-alpha in the plasma of mice treated with endotoxin.
When L-platelet-activating factor (PAF) or alprazolam (a PAF antagonist) was administered to lipopolysaccharide (LPS)-treated mice, the level of plasma tumor necrosis factor (TNF alpha) determined by either ELISA or a cytotoxic assay using WEHI cells was significantly lowered.
The inactive stereoisomer, D-PAF, was not effective in lowering plasma TNF alpha levels in LPS-treated mice.
The decrease in plasma TNF alpha induced by L-PAF or alprazolam was partly reversed by indomethacin.
Despite a decrease in plasma TNF alpha, L-PAF or alprazolam caused an increase in the amount of TNF alpha mRNA present in the kidneys and the livers of LPS-treated mice, suggesting that a posttranscriptional event leading to the synthesis or release of TNF alpha was inhibited by these agents.
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Protective effects of polyclonal sera and of monoclonal antibodies active to Salmonella minnesota Re595 lipopolysaccharide during experimental endotoxemia.
Mice were passively immunized with sera from blood donors active for rough lipopolysaccharides (LPS), the J5 (Rc chemotype) mutant of Escherichia coli O111:B4, and the Re595 (Re chemotype) mutant of Salmonella minnesota.
All protected the mice against lethal challenge with smooth E.
coli WF96 LPS, E.
coli and Salmonella rough mutant LPS, or free lipid A.
Epitopes recognized by monoclonal antibodies (MAbs) reacting with the LPS of S.
minnesota Re595 or lipid A were localized in the 2-keto-3-deoxy-D-manno-octulosonic acid (KDO) region and on lipid A.
Core-reactive MAbs reacted with their homologous Re LPS and with free lipid A.
One, GL11, cross-reacted with the KDO alone.
MAbs GL6, GL11, L.4, L.6, and L.8 protected the actinomycin D-sensitized mice against the lethal effects of LPS from E.
coli WF96, Salmonella enteritidis, E.
coli J5, S.
minnesota Re595, and free lipid A.
The GL11 antibody was also protective when injected after LPS challenge.
These results indicate that antibodies directed against the core glycolipid of S.
minnesota Re595 LPS may be useful as an additive form of therapy that may enable decreased mortality during gram-negative bacterial sepsis.
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Antimicrobial resistance of Shigella isolates in the USA: the importance of international travelers.
A nationwide sample of Shigella isolates was collected and tested for resistance to 12 antimicrobial agents to assess the prevalence and epidemiologic correlates of antimicrobial resistance in Shigella.
Of the isolates, 32% were resistant to ampicillin, 7% to trimethoprim-sulfamethoxazole, and 0.4% to nalidixic acid.
Fifty (20%) of 252 isolates were associated with foreign travel.
The best predictor of clinically important resistance was a history of foreign travel: 20% of isolates from foreign travelers showed trimethoprim-sulfamethoxazole resistance, compared with only 4% of isolates from those without such a history.
Quinolone resistance was not identified in travel-related isolates, and quinolones may be more appropriate for initial therapy of travel-related shigellosis than is trimethoprim-sulfamethoxazole.
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Cefuroxime treatment failure of nontypable Haemophilus influenzae meningitis associated with alteration of penicillin-binding proteins.
A 10-year-old boy presented with nuchal rigidity and cerebrospinal fluid (CSF) leukocytosis initially and again on day 6 of intravenous cefuroxime therapy (200 mg/kg/day).
Both CSF specimens yielded nontypable beta-lactamase-negative Haemophilus influenzae that were susceptible by disk tests but relatively resistant to cefuroxime (MIC, 8- to 16-fold greater than that of control isolates).
To define the mechanism of resistance, the cefuroxime resistance marker was transformed to a susceptible H.
influenzae recipient; inactivation and permeability of beta-lactam substrate were tested and the penicillin-binding protein (PBP) profiles were examined.
Inactivation of beta-lactam substrate was not detected and reduced permeability was not found.
However, reduced beta-lactam binding to PBPs 4 and 5 was observed; 18- to 27-fold more penicillin and 2.5-to 4-fold more cefuroxime was required to saturate or block 50% of the binding sites of these PBPs, respectively.
Thus, reduced affinity of PBPs 4 and 5 for beta-lactam substrate appears to be the mechanism of cefuroxime resistance in this strain.
The reduced affinity of these targets appears to have contributed to the bacteriologic and clinical failure in this patient.
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Restriction endonuclease analysis of total cellular DNA of Aspergillus fumigatus isolates of geographically and epidemiologically diverse origin.
No typing system exists for Aspergillus fumigatus, though isolates are distinguishable by phenotypic characteristics.
DNA was prepared by lysis of protoplasts, followed by deproteination, phenolchloroform extraction, and dialysis.
DNA prepared was of uniform size and exceeded 60 kb.
After digestion with SalI and XhoI endonucleases, DNA was electrophoresed, stained, and photographed.
Differences in the mobilities of 10- to 50-kb bands distinguished isolates.
Reproducibility was shown by repeated preparations and animal passage.
By use of a proposed notation system for describing restriction fragment length polymorphism patterns, 31 epidemiologically characterized isolates from three continents revealed 24 patterns (DNA types).
Three DNA types were represented by 3 isolates each and 1 DNA type by 2 isolates; 20 types were unique.
Two groups of 3 isolates of the same DNA type were from Stanford University Hospital.
One patient isolate from Stanford was the same DNA type as a sewage isolate from New Jersey.
Another Stanford isolate was the same as a German isolate.
These observations indicate widespread dispersal of some clones and restricted locales for others.
Paired isolates from airway fluids of three patients had two DNA types in each.
Restriction endonuclease typing shows promise for investigating the epidemiology and ecology of A.
fumigatus.
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Detection of interleukin-3 in the serum of mice infected with Mycobacterium lepraemurium.
Infection of mice by Mycobacterium lepraemurium is accompanied by ablation of erythropoiesis in the bone marrow and gross enlargement of the spleen.
This, together with increased monocytopoiesis and the earlier demonstration of macrophage colony-stimulating factor in the serum of infected mice, suggested the activity of additional cytokines.
Eight weeks after infection of mice by M.
lepraemurium, interleukin-3 (IL-3) activity was demonstrated in the serum (titer, 1:3200).
The serum titer of IL-3 activity was maximal after 13 weeks (greater than 1:6400) and was slightly reduced after 18 weeks (1:6400).
That the IL-3 activity detected in the serum of the M.
lepraemurium-infected mice reflected the presence of IL-3 itself was confirmed by a neutralization assay using anti-murine IL-3 antibodies; IL-3 activity in the serum of mice 13 weeks after infection was completely abolished by the anti-IL-3 antibodies.
Finally, a 1-kb signal of IL-3 RNA was detected in the spleens of M.
lepraemurium-infected mice 13 weeks after infection.
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A large outbreak of antibiotic-resistant shigellosis at a mass gathering.
In July 1987, a large outbreak of shigellosis occurred among attendees at a mass gathering in a national forest, the annual Rainbow Family Gathering.
Sanitation in the campsite was poor, allowing widespread transmission of disease, probably by food, water, and person-to-person spread.
The attack rate may have been greater than 50% among the estimated 12,700 attendees.
The outbreak was caused by Shigella sonnei, resistant to ampicillin, tetracycline, and trimethoprim-sulfamethoxazole; the organism was of colicin type 9 and contained a 90-kilobase plasmid not found in non-outbreak-related strains.
The dispersal of the group resulted in nationwide dissemination of the organism, and outbreaks in three states were linked to transmission from attendees at the Gathering.
This outbreak demonstrates the potential for rapid dissemination of disease in such a setting and the necessity for careful planning of mass gatherings.
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Prevalence and diagnosis of Legionella pneumonia: a 3-year prospective study with emphasis on application of urinary antigen detection.
During a 3-year period the frequency of legionellosis in hospitalized patients with community-acquired and nosocomial pneumonias was 3.4% (23/684 cases) and 5.9% (33/559), respectively.
Of the diagnostic tests evaluated, detection of Legionella pneumophila serogroup 1 antigen in urine had the highest sensitivity, with 86% of culture-proven cases being positive.
Sensitivities of serologic tests and examination of respiratory secretions (culture and direct immunofluorescence) were 36% and 26%, respectively.
The diagnostic value of serology and of examination of respiratory secretions can be low when specimens are obtained and processed under the typical conditions of hospitalization.
Urinary antigen detection represents an important diagnostic addition, and examination of postmortem lung tissue from fatal cases with pneumonia is an important adjunct for estimating the prevalence of legionellosis and for assessing the effectiveness of premortem diagnostic tests.
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Tumor necrosis factor-alpha plays a role in host defense against Histoplasma capsulatum.
Tumor necrosis factor-alpha was detected in supernatants collected from BALB/c mouse peritoneal macrophages incubated continuously with Histoplasma capsulatum.
The levels of TNF alpha measured by actinomycin D bioassay peaked within hours after exposure and then greatly declined by 24 h.
TNF alpha was also measured in bronchoalveolar lavage fluid from BALB/c mice challenged intranasally with H.
capsulatum.
Lavage fluid TNF alpha levels exhibited the same pattern as the in vitro supernatants; they peaked within hours after challenge and lower levels were detected at 24 h.
Treatment of mice with anti-TNF alpha antibody accelerated mortality in response to systemic infection and significantly increased tissue colony counts in the liver and spleen.
In the murine model, TNF alpha is produced in response to H.
capsulatum and appears to play some role in host defense to infection.
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Occurrence of secondary attenuating mutations in avirulent Salmonella typhimurium vaccine strains.
The attenuating delta aroA554 mutation in Salmonella typhimurium strain SL3261 was complemented in vitro by selecting for AroA+ recombinant DNA clones.
SL3261 containing cloned aroA+ genes did not require exogenous phenylalanine, tryptophan, tryosine, p-aminobenzoic acid, or dihydroxybenzoic acid for growth in defined media.
Cloned aroA+ genes did not restore wild-type virulence to SL3261, however, in a murine typhoid model.
The delta aroA554 mutation was transduced into S.
typhimurium strain SR-11, a mouse-virulent strain recently passaged in mice.
The SR-11 delta aroA554 mutant was highly attenuated for mice challenged parenterally.
The same cloned aroA+ genes isolated in SL3261 restored the virulence of the SR-11 delta aroA554 mutant to that of wild-type SR-11.
These results suggest that while the delta aroA554 allele remains effective in reducing S.
typhimurium virulence, laboratory passage of attenuated vaccine strains may lead to the accumulation of additional attenuating defects.
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Nasal carriage of Staphylococcus aureus: correlation with hormonal status in women.
In view of recent observations on hormone-microorganism interactions, a study of Staphylococcus aureus nasal carriage in relation to sex-hormone status was undertaken.
Prospectively in 479 women attending a colpocytologic clinic, hormonal status was assessed by determining the karyopyknotic index (KI) on smears stained by the Papanicolaou method.
Rates of S.
aureus nasal carriage were 29.3% in premenopausal women and 21.9% in postmenopausal women (P not significant).
Carriage rates were significantly higher (P = .026, chi 2 7.32) for women with high KIs (40.7%) than for those with intermediate and low KIs (27.03% and 25.1%, respectively).
S.
aureus nasal carriage also correlated independently and significantly with previous antibiotic use and the presence of insulin-treated diabetes mellitus.
This preliminary observation confirms an association between levels of sex hormones as reflected by the KI and S.
aureus nasal carriage rates.
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Positive Lyme serology in subacute bacterial endocarditis. A study of four patients.
Lyme borreliosis is a multisystem inflammatory disorder caused by the tick-borne spirochete Borrelia burgdorferi.
Clinical manifestations are protean, involving the skin, joints, peripheral and central nervous systems, and the heart.
However, the presentation of Lyme disease often overlaps with that of other conditions.
We describe four patients from a region endemic for Lyme disease who had elevated levels of antibodies reactive to B burgdorferi and whose signs and symptoms were initially attributed to Lyme borreliosis but whose subsequent blood cultures established a diagnosis of nonspirochetal subacute bacterial endocarditis.
Although immunoblots on serum samples from three of the four patients were consistent with prior infection from B burgdorferi, a positive immunoblot does not establish active infection.
Similarly, seropositivity to B burgdorferi only indicates possible exposure to this organism.
The occurrence of positive serologies to B burgdorferi in the presence of other diseases can lead to diagnostic confusion.
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Changing epidemiology of group A streptococcal infection in the USA.
To see whether changes in the epidemiology of group A streptococcal disease in the USA have been accompanied by a corresponding change in serotype distribution, epidemiological and M-typing and T-typing data for 5193 strains sent to the Centers for Disease Control, Atlanta, between 1972 and 1988 were analysed.
The proportions of M-types 1, 3, and 18 increased significantly during the study period.
These M-types were more likely to be invasive, to cause fatal infection, and to occur in a cluster of infections than were other types.
By contrast, the proportions of M-types 4 and 12 decreased; they were less invasive and were less likely to be found in clusters than were other types.
These data suggest that changes in the epidemiology of group A streptococcal disease may be related to changes in the distribution of M-types causing infection.
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A randomized, prospective field trial of a conjugate vaccine in the protection of infants and young children against invasive Haemophilus influenzae type b disease
BACKGROUND.
Haemophilus influenzae type b is the leading cause of invasive bacterial disease in young children.
The capsular polysaccharide vaccine does not protect children at greatest risk (those under the age of 18 months), but a polysaccharide-protein conjugate vaccine has proved to be more immunogenic in this age group.
METHODS.
We enrolled 114,000 infants in Finland in an open, prospective, randomized trial of a H.
influenzae type b capsular polysaccharide-diphtheria toxoid conjugate vaccine (polyribosylribitol phosphate-diphtheria toxoid [PRP-D]).
Children born on odd-numbered days were vaccinated at the ages of 3, 4, 6, and 14 to 18 months; those born on even-numbered days formed the control group and received the same vaccine at the age of 24 months.
RESULTS.
After three doses of the vaccine there were 4 cases of verified bacteremic H.
influenzae type b disease in the group receiving early vaccination, as compared with 64 cases in the control group, between the ages of approximately 7 and 24 months.
The protective efficacy of the vaccine was thus 94 percent (95 percent confidence interval, 83 to 98).
No serious adverse effects were reported.
The immune response to the conjugate vaccine was characteristic of a T-cell-dependent response when studied in a cohort of 120 infants.
The primary immunization series resulted in a geometric mean concentration of anticapsular antibody of 0.53 micrograms per milliliter at the age of seven months, and the fourth dose evoked an anamnestic response, with a mean antibody concentration of 45.22 micrograms per milliliter.
CONCLUSIONS.
A new conjugate vaccine consisting of the capsular polysaccharide of H.
influenzae type b covalently linked to a protein carrier (PRP-D), administered to infants beginning at the age of 3 months, is highly effective in protecting young Finnish children (7 to 24 months old) against invasive H.
influenzae type b infections.
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Limited efficacy of a Haemophilus influenzae type b conjugate vaccine in Alaska Native infants. The Alaska H. influenzae Vaccine Study Group
BACKGROUND.
The prevention of invasive Haemophilus influenzae type b disease requires a vaccine that is effective when administered during the first six months of life.
The infants of Alaska Natives are at particularly high risk of invasive H.
influenzae type b disease.
METHODS.
To evaluate the protective efficacy of a H.
influenzae type b polysaccharide-diphtheria toxoid conjugate vaccine (polyribosylribitol phosphate-diphtheria toxoid [PRP-D]), we enrolled 2102 Alaska Native infants in a randomized, double-blind, placebo-controlled trial in which either the vaccine or a saline placebo was administered at approximately two, four, and six months of age.
RESULTS.
After 3969 subject-years of follow-up and 32 episodes of H.
influenzae type b disease, the overall incidence of invasive disease was not reduced significantly in the vaccinated subjects (6.0 cases per 1000 patient-years), as compared with the placebo controls (9.6) or with other Alaska Native infants (6.0).
After one, two, or three doses there was no significant protective efficacy with the vaccine; after three doses the efficacy was only 35 percent (95 percent confidence interval, -57 to 73).
The lack of efficacy was not related to the age at onset of disease, age at immunization, type of disease, degree of Alaska Native heritage, time after immunization, or year of the study.
Levels of H.
influenzae type b anticapsular antibody in recipients of the vaccine became significantly higher than levels in those who received placebo only after the second and third doses.
Even after the third dose, only 48 percent of the vaccinated infants had antibody levels of more than 0.1 microgram per milliliter (geometric mean titer, 0.18).
Antibody responses did not vary with the level of maternally acquired antibody, degree of Alaska Native ancestry, or age at time of the first or second immunizations, but they increased with increasing age at time of the third dose (P less than 0.001).
CONCLUSIONS.
We found no evidence that the PRP-D vaccine provides significant protection, at least for Alaska Native infants, against invasive diseases caused by H.
influenzae type b.
The ineffectiveness of the vaccine paralleled its limited immunogenicity.
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The use of prophylactic furazolidone to control a nosocomial epidemic of multiply resistant Salmonella typhimurium in pediatric wards.
The nosocomial spread of enteric pathogens is often difficult to control in overcrowded pediatric wards.
During 1983 and 1984, despite cohorting of patients and enforced hand washing, more than 200 cases of nosocomial multiply resistant Salmonella typhimurium phage type R-9 were observed on two adjacent pediatric wards.
Most cases occurred during the summer months.
After 19 new cases were detected early in the summer of 1985, oral administration of furazolidone throughout their entire hospital stay (2.5 mg/kg twice daily) was recommended for all subsequently hospitalized infants.
Among the 114 (65%) infants who were appropriately treated, only one additional case (1%) was detected.
In contrast 11 (19%) cases occurred among the 59 infants who were inappropriately treated: 5 of 35 (14%) of those who were not treated and 6 of 24 (25%) in whom treatment with furazolidone was delayed greater than 24 hours (P less than 0.001 between the appropriately and inappropriately treated groups).
In pediatric wards where infection control measures cannot be optimally applied, prophylactic furazolidone administration may be helpful in preventing the spread of enteric pathogens.
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Safety evaluation of PRP-D Haemophilus influenzae type b conjugate vaccine in children immunized at 18 months of age and older: follow-up study of 30,000 children.
We evaluated the safety of the PRP-D conjugate Hib vaccine (ProHIBit, Connaught) in 29,309 children vaccinated at 18-60 months of age in the Southern California Kaiser Permanente medical clinics during the period April 1, 1988, to July 31, 1989.
Surveillance for potential reactions involved postcard questionnaires, telephone surveys, reports of Kaiser staff and review of hospitalizations and covered two periods following immunization: (1) the first 48 hours and (2) days 2 through 30.
Surveillance for invasive Hib disease involved the above methods in addition to systematic reviews of laboratory and hospital records through January 31, 1990.
Rates of local and systemic reactions within 48 hours of vaccination with PRP-D alone were low (less than or equal to 2% for fever greater than 102 degrees F, local redness or swelling) and similar to those previously reported after vaccination with PRP.
Hospitalization and seizures (0.15% and 0.09% of vaccinated children, respectively) occurring within 1 month of immunization appeared to be unrelated to vaccination.
One 29-month-old child had onset of a fatal episode of Hib sepsis/meningitis within 48 hours of vaccination.
Also, a 30-month-old child developed Hib meningitis 10 months after PRP-D vaccination.
We conclude that PRP-D is safe when given alone or in combination with other childhood vaccines between 18 and 60 months of age.
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Immunogenicity of Haemophilus b conjugate vaccine (meningococcal protein conjugate) in children with prior invasive Haemophilus influenzae type b disease.
Children younger than 2 years of age with previous invasive Haemophilus influenzae (Hib) type b disease may not develop protective antibodies to antigens of Hib and may be at risk of developing a second episode of Hib disease.
Twenty-three children with prior Hib disease were immunized with Haemophilus b conjugate vaccine (meningococcal protein conjugate).
Children 12 to 24 months of age were given one dose of vaccine and children younger than 12 months of age were given 2 doses 2 months apart.
Antibody to the polysaccharide capsule of Hib (PRP) was measured by radioimmunoassay.
Eighteen children had preimmunization serum antibody concentrations less than 0.150 micrograms/ml.
All 18 children responded with greater than 0.150 micrograms/ml of antibody after a single dose of vaccine.
Only 1 of the 23 children had a preimmunization serum antibody concentration greater than 1.000 micrograms/ml.
Seventeen children ultimately responded with greater than 1.000 micrograms/ml of antibody (P less than 0.0001), concentrations of antibody thought to correlate with protection.
Haemophilus b conjugate vaccine (meningococcal protein conjugate) is immunogenic in children with invasive Hib disease.
Children younger than 2 years of age with invasive Hib disease should be subsequently immunized with a Hib conjugate vaccine.
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Mycoplasmal pneumonia. Are you thinking of atypical presentations?
The presentations of mycoplasmal pneumonia can be varied and sometimes complicated.
The atypical nature of this illness, as opposed to the clear pattern of findings in classic bacterial pneumonias, leads the physician to the diagnosis.
Appropriate therapy then allows quick improvement as a rule, with few sequelae.
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Early postoperative care of the cardiac transplantation patient: routine considerations and immunosuppressive therapy.
The authors have attempted to outline the current state of the art with respect to the early postoperative management of the cardiac transplant recipient with special attention to immunosuppressive therapies.
The commonly used agents, as well as the most successful combination regimens, have been described along with the current levels of expectation regarding rates of rejection and infection.
Much has been learned regarding the management of these problems.
Much remains to be learned to further decrease the incidence of postoperative infection and rejection and, equally if not more importantly, studies to investigate the etiology of transplant coronary artery disease need to be undertaken such that measures to delay or prevent its occurrence and/or arrest its progression can be instituted.
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Comparison of species distribution and antimicrobial susceptibility of aerobic actinomycetes from clinical specimens.
To compare the species distribution and antimicrobial susceptibility of aerobic actinomycetes, we evaluated 366 isolates referred to the Centers for Disease Control from October 1985 through February 1988.
We used conventional biochemical tests to identify the various species.
Four species accounted for 191 (52%) of aerobic actinomycete isolates: Nocardia asteroides (98 isolates), Actinomadura madurae (42 isolates), Streptomyces griseus (28 isolates), and Nocardia brasiliensis (23 isolates).
Sputum and wounds were the most common sources.
No isolate was resistant to amikacin, no N.
brasiliensis isolate was resistant to sulfamethoxazole or trimethoprim-sulfamethoxazole, and no A.
madurae isolate was resistant to ceftriaxone or imipenem.
In summary, our findings show that unusual species of aerobic actinomycetes can cause infection, colonization, or both and that antimicrobial resistance varies markedly by species.
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Enterobacter bacteremia in pediatric patients.
Enterobacter has emerged as an important human pathogen, particularly in sick, hospitalized patients.
Previous reports of nonepidemic enterobacter bacteremia have focused on adult patients.
In this report, the epidemiologic factors, clinical characteristics, treatment, and outcome for 33 patients with enterobacter bacteremia in a large children's hospital during a 5-year period are reviewed.
The ratio of males to females was 1.2:1.
The patients' ages ranged from 2 days to 24 years, and 18 patients were less than 18 months old.
Twenty-two cases were nosocomially acquired; six were polymicrobial in nature.
Significantly underlying conditions were present in 32 patients.
The biliary tract and central venous catheters were the most common sources of bacteremia.
Two-thirds of patients had preceding antibiotic therapy.
The overall mortality was 24%; mortality attributable to enterobacter bacteremia was 18%.
Statistically significant differences in mortality were associated with an age less than 18 months (P = .031) or thrombocytopenia (P = .017); presence of fever was of borderline significance (P = .098).
Enterobacter bacteremia is an important cause of morbidity and mortality in pediatric patients.
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Quinolone antibiotics in the treatment of Salmonella infections
The 4-fluoroquinolones are a new class of antimicrobial agents that possess broad in vitro antibacterial activity, including efficacy against enteric pathogens such as Salmonella, Shigella, Campylobacter, Yersinia, and Vibrio species.
These drugs are clinically effective against both drug-sensitive and multiresistant strains of Salmonella typhi and Salmonella paratyphi that cause enteric fever.
In salmonella enterocolitis, the quinolones--unlike older antimicrobial agents that may have little impact on the duration of symptomatic illness and can in fact prolong fecal carriage of salmonellae--actually shorten the course of clinical disease and terminate excretion of these organisms in the stool.
Similarly, for chronic carriers of both typhoidal and nontyphoidal Salmonella strains, the quinolones are effective in eradicating biliary and fecal reservoirs of infection.
Immunosuppressed persons with salmonellosis, such as those with AIDS, may benefit from both short-term treatment and prolonged prophylaxis with a quinolone antibiotic.
The optimal agent, dose, and duration of quinolone therapy for all salmonella syndromes remain to be determined by larger controlled trials.
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Infectious diseases as a Canadian subspecialty, with projections to the year 2000.
Infectious diseases is a relatively new subspecialty in Canada.
During the past decade, however, important advances have been made.
These include the formation of the Canadian Infectious Diseases Society and the development of the first Royal College of Physicians and Surgeons examinations in the subspecialty of infectious diseases.
The majority of Canadians training for practice in the field of infectious diseases are now enrolled in programs in Canada.
Despite predictions in the United States of an excess of physicians who specialize in infectious diseases, such a situation has not occurred in Canada.
More physicians with training in infectious diseases will be required in Canada in the next decade to fill positions in patient care, microbiology (for individuals with both clinical and laboratory training), research, epidemiology and infection control, programs related to human immunodeficiency virus infections, geographic and international medicine, the pharmaceutical industry, and education and administration.
In Canada, the extent to which infectious diseases physicians are involved in these areas varies from that in the United States.
This review suggests a continued need for physicians with appropriate training in infectious diseases.
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Protection of mice against the Lyme disease agent by immunizing with recombinant OspA.
Lyme borreliosis is a tick-borne illness caused by Borrelia burgdorferi.
The gene for outer surface protein A (OspA) from B.
burgdorferi strain N40 was cloned into an expression vector and expressed in Escherichia coli.
C3H/HeJ mice actively immunized with live transformed E.
coli or purified recombinant OspA protein produced antibodies to OspA and were protected from challenge with several strains of B.
burgdorferi.
Recombinant OspA is a candidate for a vaccine for Lyme borreliosis.
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Giant basilar aneurysm in the course of subacute bacterial endocarditis.
We describe a man aged 42 years with mitral valve regurgitation who suffered from subacute bacterial endocarditis caused by Streptococcus morbillorum.
The clinical picture began with a toxic syndrome.
Five months later, the patient had an embolic episode and a right rostral pontine stroke, which was followed a few days later by an adversive focal seizure on the right.
Despite antibiotic treatment, he suffered complete third nerve palsy.
Arteriography, magnetic resonance imaging, and computed tomography of the brain showed a giant aneurysm in the rostral end of the basilar artery; the aneurysm was clipped.
We discuss the clinical features, radiology, and characteristics of this aneurysm as a unique case of a giant bacterial aneurysm in the vertebrobasilar system.
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Percutaneous central venous catheterization. Three years' experience in a neonatal intensive care unit.
Prolonged venous access is desirable in very-low-birth-weight infants and infants for whom feedings are contraindicated.
We prospectively evaluated 481 small-diameter venous catheters placed percutaneously in 317 patients over 3 years.
Of 478 catheters, 241 (50%) were placed in infants weighing 1 kg or less.
Mean catheter stay was 13 days (range, less than 1 to 77 days).
Almost half (49%) of the central and thoracic catheters (91% of placements) were removed nonelectively: 43% due to problems such as leaking or clotting and 6% to suspicion of sepsis or venous occlusion.
Of the 23 episodes of possible sepsis in the 478 catheter stays, six (1.3%) were confirmed catheter-related sepsis; 12 (2.5%) were confirmed alternate locus sepsis.
Three factors specific to percutaneous central venous catheter-related sepsis were prolonged catheter stay (3 to 5 weeks), Staphylococcus epidermidis, and weight less than or equal to 1 kg.
Four factors specific to alternate locus sepsis were presence of an alternate infection site, earlier infection (1 to 2 weeks), extremely low birth weight, and prolonged clinical instability.
Percutaneous central venous catheterizations reduced the need for the stress of repeated venipuncture, resulting in lower complication rates than those reported with surgically placed central venous catheters, and leading to identification of risk factors specific to catheter sepsis and alternate locus sepsis.
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Epidemiology of Lyme disease in Virginia.
Prior to January 1986, only one case of Lyme disease was reported from Virginia.
In 1986-87, however, the Virginia Department of Health observed an increase in reports of suspected Lyme disease by physicians, despite the fact that Ixodes dammini is not highly prevalent in the Virginia tick population.
Twenty-eight cases of Lyme disease were identified in Virginia, of which eight cases occurred in 1986 and 20 in 1987.
Lyme disease appears to be increasing in frequency in Virginia and moving southward along the Eastern Atlantic Seaboard.
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Epidemiologic differences between chlamydia and gonorrhea.
To assess the prevalence, demographics, and transmission patterns of genital chlamydia infection, we screened 3,078 patients, and compared identified cases (N = 511) to gonorrhea cases (N = 291) diagnosed in the same setting.
Chlamydia cases were younger and more likely to be White than their gonorrhea counterparts.
Chlamydia cases were distributed diffusely; geographic overlap between the two diseases was only about 40 percent.
Gonococcal coinfection was noted in less than 10 percent of patients with chlamydia.
Nearly half of men with chlamydia and four-fifths of women were asymptomatic and most cases were identified through screening or contact tracing.
Populations at high risk for chlamydia are seemingly different from those for gonorrhea.
Differences may be due to control interventions (active for gonorrhea, passive for chlamydia).
Chlamydia case reporting and control initiatives are recommended.
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Day care characteristics associated with Haemophilus influenzae disease. Haemophilus influenzae Study Group.
To identify characteristics of day care facilities associated with H.
influenzae disease, we compared 92 licensed facilities in which a case of H.
influenzae disease had occurred with randomly selected facilities at which no cases occurred.
Matched univariate analysis showed that personnel at facilities where H.
influenzae disease occurred were more likely than those at control facilities to use towels or handkerchiefs to wipe children's noses, admit children who were not toilet trained or had diarrhea ("liberal fecal policy"), had a narrower age range, were more likely than control facilities to be for-profit and less likely to use volunteers.
In a multivariate model that adjusted for age range, profit status and liberal fecal policy, towel or handkerchief use (OR 5.5, 95% CI: 1.1, 30) was the only variable independently associated with case facilities.
This is the first association of a specific day care practice with H.
influenzae disease.
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Evidence for gonococcal transmission within a correctional system.
In a study to examine sexually transmissible disease occurring within a large correctional system where sexual activity is prohibited, 27 male inmates acquired culture-proven gonorrhea from in-jail sexual activity during a three-month period.
These results provide evidence to encourage inmate education about the acquired immunodeficiency syndrome (AIDS) and to support condom distribution programs in correctional facilities.
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Recombinant capsular antigen (fraction 1) from Yersinia pestis induces a protective antibody response in BALB/c mice.
Yersinia pestis produces a glycoprotein capsule, the biosynthesis of which appears to be temperature dependent.
The fraction I (F1) component of this capsule is specific to Y.
pestis and the detection of F1 antibodies is the basis for several serological tests.
We report the cloning of the F1 gene and its expression in Escherichia coli using the phagemid vector lambda ZAPII and a F1-specific monoclonal antibody.
The recombinant F1 antigen had a molecular weight of 17 kDa, which proved to be identical to that of the F1 antigen produced by Y.
pestis.
The recombinant cells produced F1 antigen at 37 degrees C but only minimal amounts at 27 degrees C, suggesting that the genetic features affected by temperature in Y.
pestis may be operating in the E.
coli clone.
It is not known if their similar molecular weights reflect the glycosylated nature of both proteins.
F1 antigen purified from the E.
coli recombinant induced a protective immune response in BALB/c mice challenged with up to 10(5) virulent Y.
pestis.
The resistance of immunized mice to plague infection correlated with high titers of F1 antibody.
The cloned gene expresses an immunogenically competent F1 antigen suitable for use in plague serodiagnostics and vaccine development.
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Tetanus immunization status and immunologic response to a booster in an emergency department geriatric population.
STUDY OBJECTIVES: Although effective procedures for the prevention of tetanus have long been available, serosurveys done since 1977 demonstrate that 49% to 66% of the elderly population lacks a protective antitoxin level (more than 0.01 IU/mL).
This study was undertaken to assess the tetanus immunization status of patients presenting to an emergency department and to evaluate their immunologic response to a tetanus booster.
SETTING: The study was conducted in a tertiary care ED.
TYPE OF PARTICIPANTS: The patients enrolled were 65 or more years old and had breaks in their skin barriers.
DESIGN: At each patient's initial presentation, pertinent demographic data and tetanus immunization history were recorded.
The patient was then followed for 21 days.
INTERVENTIONS: Each patient's antitoxin titer was determined on a serum sample by ELISA, and, if required by the Advisory Committee on Immunization Practices criteria, a booster was administered at the first visit.
MEASUREMENTS AND MAIN RESULTS: Serum antitoxin assays were repeated on days 7, 14, and 21 after the initial visit until seroconversion (titer more than 0.01 IU/mL).
Forty-four patients (55%) had protective levels at initial presentation, and in 36 (45%) the levels were not protective.
Age and sex were not predictive of protection.
Past military service and a definite history of three or more previous immunizations were good predictors of protection.
Of 34 patients who were followed serially for inadequate initial titers, only 19 (56%) seroconverted by day 14.
Patients who did not seroconvert were more likely to be older (P less than .05).
CONCLUSIONS: This study demonstrated that a significant number of elderly patients lacked an initial protective level of tetanus antitoxin.
Of these, 44% failed to seroconvert within 14 days and carried a potential risk of developing tetanus.
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The inactivation of antithrombin III by serum elastase in patients with surgical infections.
The relationship between serum elastase and antithrombin III was determined in septic surgical patients as a possible mechanism for intravascular thrombosis and hypercoagulability during sepsis.
Eighteen patients with surgical infections and elevated white blood cell counts had their blood assayed daily for white blood cell count, serum elastase, and antithrombin III, until the patient's white blood cell count returned to normal.
Antithrombin III was significantly lower (0.87%) when elastase was above the normal range (greater than 14.2 micrograms/ml).
Elastase was significantly higher (30.6 micrograms/ml), when antithrombin III was less than normal.
These data indicate that elevated serum elastase is associated with a significant reduction in circulating antithrombin III.
Stimuli that increase serum elastase, i.e.
surgery, trauma, or sepsis may promote intravascular thrombosis by the inhibition of antithrombin III at the blood-endothelial cell interface.
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Air contamination in open heart surgery with disposable coveralls, gowns, and drapes.
The effect of a polypropylene coverall, replacing shirt and trousers, combined with sterile laminated gowns and drapes compared with an all-cotton system was studied in regard to the dispersion of bacteria and particles in a conventionally ventilated operating theater.
The operations carried out were open heart procedures in 30 adult patients.
Blood agar sedimentation plates were placed in the operative, anesthesia, and perfusion areas.
The mean sedimentation values during 1 hour after the start of operation were as follows in the laminate group: 63 colony-forming units (cfu)/m2 in the operative area; 77 cfu/m2 in the anesthesia area; and 143 cfu/m2 in the perfusion area.
The corresponding figures in the cotton group were 350 cfu/m2, 364 cfu/m2, and 437 cfu/m2, respectively (p less than 0.0002).
At the beginning of the operation, the mean values noted for colony-forming units in the air at the operative site were 8.0 cfu/m3 in the laminate group and 31 cfu/m3 in the cotton group.
One hour later, the values were 10 cfu/m3 and 22 cfu/m3, respectively (p less than 0.0002).
At the end of the operation, the number of particles 5 microns or larger in the air at the operative site was 278/m3 in the laminate group and 592/m3 in the cotton group.
It is concluded that the use of a polypropylene coverall and laminated gowns and drapes significantly reduces the particle and bacterial contamination of the air and the bacterial sedimentation during cardiac operations.
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Antimicrobial prophylaxis for open heart operations.
Between 1986 and 1988, 450 adults undergoing coronary artery bypass, cardiac valve replacement, or both were enrolled into a prospective, randomized, comparative trial of cephalothin versus cefamandole as perioperative prophylaxis.
They were assessed during their hospitalization and at 6 weeks and 6 months after discharge for postoperative infectious complications.
Eleven patients had major postoperative infections including 5 with sternal wound infections (three bacteremic), 6 with bacteremia, 1 with prosthetic valve endocarditis, and 3 with severe venous donor graft site infections.
Eight major infections occurred in patients receiving cephalothin prophylaxis and three in patients receiving cefamandole, with all five sternal wound infections occurring in the cephalothin group.
Postoperative pathogens responsible for the major infections included gram-negative aerobes in 5 patients, Staphylococcus aureus in 4, and Staphylococcus epidermidis in 2.
Preoperative colonizing staphylococcal isolates were not predictive of postoperative staphylococcal pathogens.
Although there was no statistically significant difference in rate of major postoperative infectious complications using either cephalothin or cefamandole prophylaxis, there was a trend in favor of cefamandole.
Gram-negative aerobes are becoming increasingly important pathogens in this setting.
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Seroprevalence of Helicobacter pylori in Seventh-Day Adventists and other groups in Maryland. Lack of association with diet.
To evaluate the possible role of diet in the transmission of Helicobacter pylori, we compared H pylori seroprevalence among Seventh-Day Adventists (who are vegetarian and abstain from alcohol, caffeine, and meat; n = 94) and two non-Seventh-Day Adventist control groups (n = 168).
With the use of an enzyme-linked immunosorbent assay H pylori antigen prepared in a French pressure cell, we found no difference in seroprevalence among these groups; however, seropositivity strongly correlated with age and black race.
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Does survival depend on the amount of autotransplanted splenic tissue?
Susceptibility to Streptococcus pneumoniae infection was studied in 11 groups of rats allocated to sham operation, splenectomy, or splenic autotransplantation of 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, or 90% of the removed spleen.
Three months later, all rats were exposed intravenously to type 1 Streptococcus pneumoniae (median lethal dose, LD50, for control group).
Survivors were killed 13 days after the bacterial challenge.
Autopsy showed that more splenic tissue was recovered in rats that received less than 50% splenic tissue compared with those that received 50% or more.
More survivors were found among sham-operated rats (47.5%; 95% confidence intervals, 32 to 68) and rats that had 40% splenic tissue implanted (35%; confidence interval, 20 to 54) or those that were found to have regenerated 40% splenic tissue.
We conclude that 40% of the spleen should be autotransplanted to protect the rat optimally against infection after splenectomy.
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Immunogenicity in animals of a polysaccharide-protein conjugate vaccine against type III group B Streptococcus.
The native capsular polysaccharide of type III group B Streptococcus elicits a specific antibody response in only 60% of nonimmune human subjects.
To enhance the immunogenicity of this polysaccharide, we coupled the type III polysaccharide to tetanus toxoid.
Prior to coupling, aldehyde groups were introduced on the polysaccharide by controlled periodate oxidation, resulting in the conversion of 25% of the sialic acid residues of the polysaccharide to residues of the 8-carbon analogue of sialic acid, 5-acetamido-3,5-dideoxy-D-galactosyloctulosonic acid.
Tetanus toxoid was conjugated to the polysaccharide by reductive amination, via the free aldehyde groups present on the partially oxidized sialic acid residues.
Rabbits vaccinated with the conjugate vaccine produced IgG antibodies that reacted with the native type III group B streptococcal polysaccharide (3/3 rabbits), while rabbits immunized with the unconjugated type III polysaccharide failed to respond (0/3 rabbits).
Sera from animals receiving conjugate vaccine opsonized type III group B streptococci for phagocytic killing by human peripheral blood leukocytes, and protected mice against lethal challenge with live type III group B streptococci.
The results suggest that this method of conjugation to a carrier protein may be a useful strategy to improve the immunogenicity of the type III group B Streptococcus polysaccharide in human subjects.
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The national immunization program of The Netherlands.
After a brief explanation of the immunization policy in the Netherlands, the national immunization program is described, with special attention given to coupling of the municipal population records with a computerized database of individual immunization records at the provincial level.
The Dutch program achieves coverage rates greater than 90% for all routine immunizations.
Participation in the program is free of charge to every child living in the country up to the age of 13 years, but there is no obligation or requirement to be immunized.
Financing of the program is also discussed.
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Postneonatal infectious disease mortality: the French situation.
Mortality caused by infectious and parasitic diseases represents a limited part of all postneonatal deaths in France, which have been stable for the past decade.
This component is worthy of careful analysis because it is at least partially preventable.
Statistics are presented and interpreted, with discussion on which disorders should be included in assessing the impact of infection on morbidity and mortality.
Figures and international rankings change according to the inclusiveness of the definition chosen.
There is need for epidemiologic and statistical research to make comparisons of mortality more clear.
Morbidity is also important because of high incidence, frequent hospitalization, and a heavy social cost.
Policy and services in France that relate to control and treatment of infection are described, as are shortcomings that call for further efforts.
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Postneonatal mortality in Norway: a study of recent trends and comparison with other mortality rates in Norwegian children.
Postneonatal mortality in Norway decreased rapidly from 1956 to 1980 but subsequently remained stable.
In recent years the postneonatal death rate appears to be increasing, primarily due to greater numbers of deaths attributed to the Sudden Infant Death Syndrome.
During the same period, mortality among older children has also decreased, with the decline evident in all leading causes.
Only among people aged 15 to 19 years have recent trends been less than encouraging, with the number of fatal traffic accidents in particular remaining stable or increasing.
Although there is room for continued improvement, the widely held belief that the health status of Norwegian children is good is supported by the trends in mortality.
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Botulism among Alaska Natives. The role of changing food preparation and consumption practices.
Alaska Natives have one of the highest rates of food-borne botulism worldwide.
All outbreaks have been associated with the consumption of native foods, but in recent years outbreaks have occurred in previously unaffected areas and have involved new food items.
Five botulism outbreaks occurred between 1975 and 1985 in an area of southwestern Alaska without previous confirmed outbreaks and among one ethnic group, the Yupik Eskimo.
Of the 5 outbreaks, 3 were associated with fermented beaver tail, a nontraditional native food recently introduced into the region.
Preparation techniques vary widely within villages and among ethnic groups.
Traditional fermentation techniques have changed over the past 50 years; current preparation methods used by some families and ethnic groups may be more favorable for Clostridium botulinum growth.
Prevention efforts should be targeted at high-risk subgroups of Alaska Natives who appear to have modified traditional practices and increased their risk of food-borne botulism.
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Impetigo. Current etiology and comparison of penicillin, erythromycin, and cephalexin therapies.
We attempted to determine the causative bacterial pathogens of impetigo in children in our area, to compare the effectiveness of three frequently used oral antimicrobial treatment regimens, and to correlate the antimicrobial sensitivity of the bacterial isolates with clinical responses to treatment.
Seventy-three children with impetigo were randomly assigned to receive penicillin V potassium or cephalexin monohydrate, both administered in dosages of 40 to 50 mg/kg per day, or erythromycin estolate administered in a dosage of 30 to 40 mg/kg per day.
All drugs were given in three divided doses for 10 days.
Treatment failure was defined as persistence of lesions 8 to 10 days after initiation of drug therapy as determined by examiners blinded to the treatment therapies.
Forty-five (62%) cultures showed Staphylococcus aureus only, 14 (19%) showed S aureus and group A beta-hemolytic streptococci, six (8%) showed group A beta-hemolytic streptococci only, and eight (11%) showed no growth or other organisms.
Treatment failure occurred in six (24%) of 25 patients treated with penicillin V, one (4%) of 25 patients treated with erythromycin estolate, and no patients treated with cephalexin.
We conclude that S aureus is the most common cause of impetigo in children in our study population, that cephalexin is the most effective treatment, that erythromycin estolate is nearly equally effective and may be preferred on a cost-effectiveness basis, and that penicillin V is inadequate for treatment of this infection.
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Lung function in children following empyema.
Spirometry was performed and response to exercise was measured in 15 children following recovery from empyema to evaluate the impact of pleural infection on subsequent lung function.
Seven children underwent chest tube drainage; eight did not.
The two groups were similar in age (mean +/- SD, 6 +/- 5 years), sex distribution, bacterial pathogen-producing empyema, and age at follow-up evaluation (12 +/- 5 years).
Only one child reported recurrent respiratory symptoms.
No child had restrictive spirometric changes (total lung capacity, less than 80%; vital capacity, less than 80% predicted) but seven of 15 had a reduced forced expiratory volume in 1 second (less than 80% predicted) or forced expiratory flow during the middle half of the vital capacity (less than 75% predicted), suggesting mild airway obstruction.
No child demonstrated reduced exercise tolerance due to restrictive ventilatory limitations.
Mild obstructive abnormalities in lung function were identified with equal frequency in children treated with and without chest tube drainage.
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Group B streptococcus endocarditis following second-trimester abortion.
An 18-year-old woman who underwent an elective second-trimester abortion developed Streptococcus agalactiae (group B streptococcus) endocarditis characterized by a large, pedunculated vegetation involving a previously normal tricuspid valve.
Polyarthritic symptoms, as well as multiple pulmonary emboli, were experienced, and cure followed a course of treatment using intravenous penicillin G potassium combined with gentamicin sulfate.
Endocarditis caused by this pathogen usually occurs among individuals compromised by underlying chronic disorders and, today, is a rare sequela of pregnancy and abortion.
When planning therapy, consideration should be given to the possibility of tolerance among clinical isolates and the need for operative intervention in selected patients.
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Initial evaluation of human monoclonal anti-lipid A antibody (HA-1A) in patients with sepsis syndrome.
HA-1A, a human monoclonal immunoglobulin M antibody that binds specifically to the lipid A domain of endotoxin, was administered to septic patients to evaluate the safety, pharmacokinetics, and immunogenicity of the antibody.
Thirty-four patients received a single infusion of either 25 mg, 100 mg, or 250 mg, and were followed clinically for 14 to 21 days after treatment.
HA-1A serum levels were measured before infusion and frequently after infusion with a radiometric assay.
A one-compartment pharmacokinetic model was fit to the measured serum levels, and accurately described the changes in HA-1A level over time in each dose group (r2 = .99).
The mean +/- SEM apparent volume of distribution of HA-1A was 48.5 +/- 4.5 ml/kg, and the mean serum clearance was 2.8 +/- 0.4 ml/kg.h.
The mean serum half-life of HA-1A was 15.9 +/- 1.5 h.
The mean serum level one hour after a 100-mg dose was 33.2 +/- 2.4 micrograms/ml, and the mean concentration 24 h later was 9.1 +/- 1.6 micrograms/ml.
The dose administered and presence of Gram-negative bacterial infection did not significantly influence the volume of distribution or serum clearance.
No adverse reactions to HA-1A were observed, and no antibodies against HA-1A were detected in any patient.
These data indicate that the pharmacokinetics of HA-1A are well described by a one-compartment pharmacokinetic model, and that HA-1A is safe and nonimmunogenic in patients with sepsis.
| 0Bacterial Infections and Mycoses
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Dependence of oxygen consumption on oxygen delivery in children with hyperdynamic septic shock and low oxygen extraction.
We studied the effect of increasing systemic oxygen delivery (DO2) by packed RBC (PRBC) transfusion on oxygen consumption (VO2) in children with hyperdynamic septic shock.
After routine resuscitation with volume loading and pharmacologic support, patients were studied if they had significant derangements of oxygen transport variables defined as: baseline VO2 less than 180 ml/min.m2 and oxygen extraction (O2 extr) less than 24%.
Eight studies were performed.
PRBC transfusion increased DO2 from 636 +/- 167 to 828 +/- 266 ml/min.m2 (p less than .01) without increasing cardiac index (5.2 +/- 1.3 vs.
5.0 +/- 1.4 L/min.m2).
VO2 increased from 112 +/- 36 to 157 +/- 60 ml/min.m2 (p less than .01) while O2 extr was unchanged (18 +/- 3% vs.
19 +/- 6%).
Despite initial low O2 extr, VO2 can be increased in pediatric septic shock by a further increase in DO2.
Since VO2 correlates with survival, one should consider enhancing DO2 further despite initial low O2 extr and high DO2.
Effects on morbidity and mortality require further study.
| 0Bacterial Infections and Mycoses
|
Accuracy in early prediction of prognosis of patients with septic shock by analysis of simple indices: prospective study.
In 26 consecutive septic shock patients, we analyzed the clinical, hemodynamic, and metabolic data before and during volume infusion to test their circulatory reserve in response to fluid repletion.
These patients were investigated to identify early variables that could predict outcome.
There were 15 survivors (group A) and 11 nonsurvivors (group B).
As a mean, group A patients were hemodynamically evaluated 2.3 h after onset of the sepsis syndrome, whereas group B patients underwent cardiac catheterization after a 12-h interval.
At the initial evaluation, both groups demonstrated similarly decreased mean arterial pressure, mean heart rate, and mean cardiac filling pressure.
Only group A patients evidenced elevated cardiac index (CI) (greater than 4 L/min.m2) associated with low systemic vascular resistance index (less than 7400 dyne.sec/cm5.m2), which is generally recognized as hyperdynamic cardiac state.
However, none of the initial cardiovascular variables could serve as a predictor for survival.
Fluid challenge increased left ventricular preload from 6 to 12.4 and from 7.8 to 12.7 mm Hg in group A and group B, respectively.
The increases were associated with significant increases in CI from 4.4 to 6.9 and from 3 to 3.8 L/min.m2.
However, at the end of fluid challenge, only group A patients exhibited normal cardiac response, as evidenced by the change in left ventricular stroke work index (LVSWI) for a given increase in the pulmonary capillary wedge pressure (WP) that was referred to as left cardiac preload.
| 0Bacterial Infections and Mycoses
|
Pseudomonas aeruginosa compared with Escherichia coli produces less endotoxemia but more cardiovascular dysfunction and mortality in a canine model of septic shock.
We investigated the effects of two different Gram-negative bacteria and radiation-induced leukopenia on endotoxemia, cardiovascular abnormalities, and mortality in a canine model of septic shock.
Serial hemodynamics were measured in conscious dogs using radionuclide heart scans and thermodilution cardiac output catheters.
Plasma endotoxin concentrations were determined with a chromogenic Limulus amebocyte lysate assay.
Viable Pseudomonas aeruginosa or Escherichia coli implanted intraperitoneally produced concordant hemodynamic patterns of septic shock (p less than 0.01).
Endotoxin concentrations were more than tenfold lower in dogs infected with P aeruginosa compared with E coli (p less than 0.0001).
Despite lower endotoxin levels, P aeruginosa-infected dogs had a higher mortality (p less than 0.01), more severe hypotension (p less than 0.05), and greater depression of the left ventricular ejection fraction (p less than 0.05) than dogs with E coli sepsis.
A nonlethal E coli challenge combined with leukopenia (induced by a nonlethal dose of radiation) resulted in a mortality of 60 percent (p less than 0.01) without greater cardiovascular dysfunction or higher endotoxin concentrations.
These findings suggest that bacterial products other than endotoxin and host-related factors may be important contributors to the toxicity, cardiovascular instability, and mortality of Gram-negative septic shock.
Quantitative determinations of plasma endotoxin are unlikely to correlate with the clinical severity of septicemia in heterogeneous patient populations infected with different Gram-negative organisms.
| 0Bacterial Infections and Mycoses
|
Reduction of contamination at total hip replacement by special working clothes.
We assessed wound, air and operative field contamination at 50 total hip operations, performed in a zonal ventilation system.
Theatre staff wore either a specially designed polypropylene non-woven coverall or conventional cotton shirt and trousers.
The surgeons wore partially impermeable operating gowns.
The polypropylene coverall was associated with significantly lower air and wound counts.
The coverall was warmer than cotton but judged to be acceptable.
The combined use of zonal ventilation and the coverall achieved ultra-clean air conditions.
| 0Bacterial Infections and Mycoses
|
Lack of association between medication use and the presence or absence of bacteriuria in elderly women.
This study was undertaken to determine if there is an association between medication use and the presence or absence of bacteriuria in elderly ambulatory women.
Of 198 women who participated in three urine culture surveys (every 6 months) during the 18-month study period, 66 (34.4%) had bacteriuria on at least one survey.
Both univariate and multivariate analyses for the demographics, age, place of residence, and medication use (by drug class) revealed that only place of residence had a significant association with the presence or absence of bacteriuria.
In this regard, bacteriuric subjects more commonly resided in the nursing home and less commonly lived in the apartment-house complex compared with nonbacteriuric subjects (P less than .05).
Therefore, this study demonstrates that in elderly ambulatory women, medication use does not appear to be associated with the presence or absence of bacteriuria.
| 0Bacterial Infections and Mycoses
|
Absence of significant bacteremia during urinary catheter manipulation in patients with chronic indwelling catheters.
The objective of this study was to quantify the microorganisms present in blood at urinary catheter removal and at reinsertion in patients with chronic indwelling urinary catheters.
This was a prospective study during a 4-month period at a university-affiliated geriatric medical center.
Our subjects were 33 patients with chronic indwelling urinary catheters and positive urinary cultures; the urinary catheter was usually changed once a month.
A peripheral vein line was used for blood withdrawal and urinary cultures and quantitative blood cultures (Isolator) were performed during and shortly after urinary catheter removal and insertion.
All patients had significant bacteriuria (greater than 10(5) cfu/mL) with an average of 2.3 microorganisms.
Among the 46 sequential quantitative blood cultures performed, only two patients had bacteremia from the urinary source and at a very low concentration; one patient had 0.13 cfu/mL Str.
faecalis in blood 5 minutes after removal of the urinary catheter, and the other 0.1 cfu/mL Proteus mirabilis 5 minutes after reinsertion of a new urinary catheter.
None of the patients had any subjective or objective clinical problem during the 36 hours after the urinary manipulation.
Clinical symptoms and bacteremia are rare events, and prophylactic antibiotics do not appear necessary during urinary catheter removal and reinsertion in elderly institutionalized patients.
Further studies are necessary to identify risk factors in the rare instances of patients with bacteremia.
| 0Bacterial Infections and Mycoses
|
Mycobacterium leprae-specific T cells from a tuberculoid leprosy patient suppress HLA-DR3-restricted T cell responses to an immunodominant epitope on 65-kDa hsp of mycobacteria.
The polar tuberculoid type (TT) of leprosy, characterized by high T cell reactivity to Mycobacterium leprae, is associated with HLA-DR3.
Surprisingly, DR3-restricted low T cell responsiveness to M.
leprae was found in HLA-DR3-positive TT leprosy patients.
This low responsiveness was specifically induced by M.
leprae but not by M.
tuberculosis and was seen only in patients and not in healthy controls.
We studied this patient-specific, M.
leprae-induced, DR3-restricted low T cell responsiveness in depth in one representative HLA-DR3-positive TT leprosy patient by using T cell clones.
From this patient two types of T cell clones were obtained: one type was cross-reactive with M.
tuberculosis and recognized an immunodominant epitope (amino acids 3 to 13) on the 65-kDa heat shock protein (hsp) the other type was M.
leprae specific and reacted to a protein other than the 65-kDa one.
To examine whether these M.
leprae-specific T cell clones were responsible for the DR3-restricted low responsiveness to M.
leprae, we tested them for the ability to suppress the proliferation of the DR3-restricted, 65-kDa, hsp-reactive clones.
The DR3-restricted, M.
leprae-specific T cells completely suppressed the proliferative responses of DR3-restricted, cross-reactive T cell clones to the 65-kDa hsp from the same patient as well as from other individuals.
Also, DR3-restricted responses to an irrelevant Ag were suppressed by the M.
leprae-specific T cell clones.
However, no suppression of non-DR3-restricted T cell responses was seen.
Although the mechanism must still be elucidated, this M.
leprae-induced, DR3-restricted immunosuppression may at least partly explain the observed DR3-associated low T cell responsiveness in TT leprosy patients.
| 0Bacterial Infections and Mycoses
|
A general model of sexually transmitted disease epidemiology and its implications for control.
Achieving control of STDs may be possible by integrating the activities discussed previously with further research to provide additional empiric data on sex behavior, to develop innovative strategies to access and communicate with those most at risk of STD (i.e., core-group members), and to foster biologic study of STD pathogens with the goal of vaccine development.
New strategies to identify core-group members aside from the currently used STD-repeater status would be of immense help in targeting educational efforts, laboratory screening, and vaccines.
Achieving more complete control of STDs may be possible if recent advances in our understanding of their epidemiology and transmission dynamics can be translated into effective new interventional strategies.
| 0Bacterial Infections and Mycoses
|
Syphilis in adults.
This article reviews the clinical manifestations of syphilis, diagnostic tests that might help to diagnose accurately the disease, and current recommendations for therapy.
The association of syphilis and human immunodeficiency virus infection raises additional questions related to transmission, diagnosis, and therapy of both diseases.
| 0Bacterial Infections and Mycoses
|
Amoxycillin plus probenecid versus doxycycline for treatment of erythema migrans borreliosis.
72 adults with erythema migrans (early Lyme borreliosis) were enrolled in a randomised prospective trial comparing amoxycillin 500 mg plus probenecid 500 mg three times a day with doxycycline 100 mg twice a day for 21 days.
These antibiotic regimens were chosen because of the known in-vitro sensitivity of Borrelia burgdorferi, the antibiotic tissue penetration, the pharmacokinetics of the drugs, and because the organism can disseminate early in the course of infection.
72 patients were evaluable (35 in the doxycycline group and 37 in the amoxycillin/probenecid group).
The two regimens were equally effective for treatment of erythema migrans.
Mild fatigue or arthralgia were the only post-treatment complaints, which resolved within 6 months.
None of the patients needed further antibiotic treatment for Lyme borreliosis.
| 0Bacterial Infections and Mycoses
|
Bird attack on milk bottles: possible mode of transmission of Campylobacter jejuni to man
A case-control study was carried out to test the hypothesis that the rise in the rate of Campylobacter jejuni infection in the Brigend area of South Wales during May was due to the consumption or handling of milk from bottles that had been attacked by birds.
32 of 36 cases meeting the case definition were interviewed, along with 2 controls per case, matched for age, sex, and area of residence.
There were strong associations between campylobacter infection and doorstep delivery of milk bottles, a history of milk bottle attack by birds, milk bottle attack by birds during the week before illness, and consumption of milk from attacked bottles during the week before illness.
There was a very strong dose-response relation between frequency of bird attack and illness.
Controls with a history of milk bottle attack by birds were more likely than cases to have taken preventive measures against bird attack and consumption of contaminated milk.
Although few people witnessed the attacks, the likely culprits are magpies (Pica pica) and jackdaws (Corvus monedula).
| 0Bacterial Infections and Mycoses
|
Interleukin-1 receptor antagonist reduces mortality from endotoxin shock.
About five out of 1,000 patients admitted to hospital develop bacterial sepsis leading to shock, the mortality rate for which is high despite antibiotic therapy.
The infection results in hypotension and poor tissue perfusion, and eventually leads to the failure of several organ systems.
Bacterial endotoxin is thought to be the direct cause of shock in Gram-negative sepsis, because it can cause shock in animals, and antibodies against endotoxin prevent Gram-negative shock in animals and in humans.
But, the symptoms of septic shock are the result of the actions of host cytokines induced by the endotoxin.
The cytokine interleukin-1 has been implicated as an important mediator of septic shock because it can induce tachycardia and hypotension and act synergistically with tumour necrosis factor to cause tissue damage and death.
We now report that a specific interleukin-1 receptor antagonist reduces the lethality of endotoxin-induced shock in rabbits, indicating that interleukin-1 does indeed play an important part in endotoxin shock.
| 0Bacterial Infections and Mycoses
|
End of preview. Expand
in Data Studio
This dataset is an adaptation of the Ohsumed dataset made available in https://github.com/yao8839836/text_gcn, wich removes records from the original Ohsumed corpus belonging to more than one desease category. The dataset is divided into the same train and test splits defined in the original repository.
Numerical labels were converted to ClassLabels using string descriptors as names, based on the following relation (adapted from this repo):
| Label | Original Category | Name |
|---|---|---|
| 0 | C01 | Bacterial Infections and Mycoses |
| 1 | C02 | Virus Diseases |
| 2 | C03 | Parasitic Diseases |
| 3 | C04 | Neoplasms |
| 4 | C05 | Musculoskeletal Diseases |
| 5 | C06 | Digestive System Diseases |
| 6 | C07 | Stomatognathic Diseases |
| 7 | C08 | Respiratory Tract Diseases |
| 8 | C09 | Otorhinolaryngologic Diseases |
| 9 | C10 | Nervous System Diseases |
| 10 | C11 | Eye Diseases |
| 11 | C12 | Urologic and Male Genital Diseases |
| 12 | C13 | Female Genital Diseases and Pregnancy Complications |
| 13 | C14 | Cardiovascular Diseases |
| 14 | C15 | Hemic and Lymphatic Diseases |
| 15 | C16 | Neonatal Diseases and Abnormalities |
| 16 | C17 | Skin and Connective Tissue Diseases |
| 17 | C18 | Nutritional and Metabolic Diseases |
| 18 | C19 | Endocrine Diseases |
| 19 | C20 | Immunologic Diseases |
| 20 | C21 | Disorders of Environmental Origin |
| 21 | C22 | Animal Diseases |
| 22 | C23 | Pathological Conditions, Signs and Symptoms |
To cite the original work:
@InProceedings{10.1007/BFb0026683,
author="Joachims, Thorsten",
editor="N{\'e}dellec, Claire
and Rouveirol, C{\'e}line",
title="Text categorization with Support Vector Machines: Learning with many relevant features",
booktitle="Machine Learning: ECML-98",
year="1998",
publisher="Springer Berlin Heidelberg",
address="Berlin, Heidelberg",
pages="137--142",
abstract="This paper explores the use of Support Vector Machines (SVMs) for learning text classifiers from examples. It analyzes the particular properties of learning with text data and identifies why SVMs are appropriate for this task. Empirical results support the theoretical findings. SVMs achieve substantial improvements over the currently best performing methods and behave robustly over a variety of different learning tasks. Furthermore they are fully automatic, eliminating the need for manual parameter tuning.",
isbn="978-3-540-69781-7"
}
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