Showing papers in "Infection in 1990"

A new plasmidic cefotaximase in a clinical isolate of Escherichia coli.

Abstract: Escherichia coli GRI was isolated from an ear exudate of a newborn. The strain was highly resistant to cefotaxime (MIC 128 mg/l). Resistance to cefotaxime and the majority of beta-lactam antibiotics was readily transferred to an Escherichia coli recipient strain. Both the wild type and the transconjugant strains are different in their resistance phenotype from TEM-3 beta-cefotaximase producers by higher MICs to the majority of beta-lactams and lower MICs to ceftazidime. The isoelectric point of the cefotaximase of E. coli GRI was 8.9 in comparison with 6.3 for TEM-3. Thus, the enzyme produced by E. coli GRI represents a new plasmidic (plasmid pMVP-3) broad spectrum beta-lactamase (CTX-M) which may not be closely related to either the TEM- oder SHV-family of extended broad spectrum beta-lactamases.

Streptococcal bacteremia in adult patients with leukemia undergoing aggressive chemotherapy. A review of 55 cases.

Abstract: We reviewed 55 cases of streptococcal bacteremia in adult patients who received cytotoxic chemotherapy for treatment of acute leukemia. Viridans group streptococci were the most frequent species isolated (45 isolates). Hemolytic streptococci (four isolates), pneumococci (three isolates), and enterococci (three isolates) were infrequent. Clinical features of streptococcal bacteremia included fever, upper and lower respiratory infection, respiratory distress syndrome, soft tissue infection, and septic shock. Forty patients who had only streptococci, but no other organisms isolated from their blood, were compared with 36 cases of gram-negative bacillary bacteremia that occurred during the same study period within the same population at risk. The comparison showed that patients with streptococcal bacteremia had more often received high dose cytosine arabinoside as part of their chemotherapy (17 vs. five), had a longer mean duration of fever (11 vs. seven days, p<0.01) needed slightly more days of antibacterial therapy (15 vs. 12 days, p=0.07, not significant), and were more likely to have been treated with newer quinolones for infection prevention (30 vs. eight). No differences between both groups were found for age, underlying disease, remission status, duration of severe granulocytopenia, and number of superinfections. The overall mortality was 18% in streptococcal bacteremia and 17% in gram-negative bacillary bacteremia. Streptococci, especially viridans group streptococci, should now be regarded as frequent causes of serious life-threatening infections following aggressive chemotherapy in patients with hematologic malignancies.

A randomized trial of ceftriaxone versus oral penicillin for the treatment of early european lyme borreliosis

Abstract: In a prospective randomized multicenter trial for the therapy of erythema migrans, 40 patients received ceftriaxone 1 g daily for 5 days and 33 patients obtained phenoxymethylpenicillin, 1 million units 3 times daily, for 12 days. Follow-up was for a mean of 10±5 months. Eight oral penicillin recipients (24%) and six ceftriaxone recipients (15%) developed minor consecutive manifestations. Two ceftriaxone and one penicillin recipient(s) still had elevated IgG antibody titers 10 to 20 months after therapy.Borrelia burgdorferi could be isolated from the erythema migrans in 29 out of 56 patients (52%) before therapy and in one oral penicillin recipient but none of 24 other patients after therapy. Ceftriaxone was superior to oral penicillin in a subgroup of patients with more than one symptom prior to therapy (p<0.01), but not in the overall evaluation of clinical, serological and bacteriological outcome data. Ceftriaxone ought to be preferred to oral penicillin in patients with more severe early Lyme borreliosis.

Cefotaxime versus penicillin in the late stage of Lyme disease--prospective, randomized therapeutic study.

Abstract: The low responsiveness of Lyme arthritis to high dose intravenous penicillin G therapy has evoked the demand for new drugs for the treatment of late stage borreliosis. As can be deduced from in vitro susceptibility data, third generation cephalosporins are far more effective on Borrelia burgdorferi spirochetes than penicillin G. The study presented here was designed to compare cefotaxime at a dosage of 2 x 3 g/day with penicillin G at a dosage of 2 x 10 megaunits/day, for ten days in a prospective randomized trial. A total of 135 patients were included in the study. They were diagnosed to suffer from late stage Lyme borreliosis on the basis of defined clinical symptoms compatible with stage three borreliosis manifestations of at least six months' duration and positive antibody titers against B. burgdorferi. Final outcomes were recorded after a 24 month post-treatment observation period with re-examination at three-month-intervals. Cefotaxime proved to be significantly superior to penicillin G with 87.9% versus 61.3% of treatments resulting in full or incomplete remission of symptoms (p = 0.002). Clinical remission was accompanied by declining antibody titers. Herxheimer-like reactions were observed in 20% of the patients of the penicillin group and in 40.5% of the patients of the cefotaxime group and may be interpreted as an indication of a response to therapy.

Persistence of borrelia burgdorferi and histopathological alterations in experimentally infected animals. a comparison with histopathological findings in human lyme disease

Abstract: Gerbils appear to be susceptible to infection by human isolates of Borrelia burgdorferi; we obtained 100% infection. Isolation of the B. burgdorferi from different organs six months post infection causes a generalized infection thus demonstrating that borreliae persist in these animals for a long period. Spirochetemia was present for 14 days, apparently in two intervals. The Borrelia burgdorferi specific antibody titers increased with time after infection thus indicating the persistence of spirochetes. The intraperitoneal inoculation of the B. burgdorferi to six gerbils of groups A and B induced significant histopathologic changes in most of the major organ systems and their surrounding adipose and fibrous connective tissues. The infiltrates consisted mainly of lymphocytes and histiocytes. Various numbers of plasma cells, eosinophils and high numbers of mast cells were also present. Three further animals which served as controls displayed no histological signs of inflammation in any organ system. No significant differences were noted between the histopathological findings seen in the animals of groups A and B (infected with cells from subcultures no. 25 and with no. 5, respectively). The persistence of B. burgdorferi and the high number of organs involved with slight to severe signs of inflammation in this series can be compared to persistence and to the multiorgan involvement seen in human Lyme disease. Thus gerbils can serve as suitable experimental animals to study the pathogenesis of Lyme disease and the extent of organ damage caused by B. burgdorferi.

Degree of absorption, pharmacokinetics of fosfomycin trometamol and duration of urinary antibacterial activity.

Abstract: The pharmacokinetics and in particular bioavailability of fosfomycin trometamol was studied and compared to the earlier emerging calcium salt formulation by administration of 50 mg/kg body weight orally of the two and an identical dose intravenously to all of eight healthy male volunteers. The serum and urine samples collected over 12 and 48 hours, respectively, were assayed microbiologically. The serum peak concentrations were 26.2 mg/l after trometamol and 6.5 mg/l after the calcium salt. Based on total area under the serum curves, the bioavailability of fosfomycin from the trometamol formulation was 42.3% compared to a mere 12% of the calcium salt. Urinary recovery was nearly completed within 12 hours, and the amounts eliminated in percentage of the doses were 87, 43, and 18% after the intravenous, the oral dose of trometamol and oral calcium salt, respectively. The serum half-life was 3.4 hours after intravenous administration, which demonstrates the inherent rate of elimination of fosfomycin. In comparison the half-life values were 3.6 hours after the trometamol dose, and 5.6 hours after the calcium salt. The longer elimination of the latter is explainable by the less complete absorption and consequent delayed absorption of fosfomycin from the calcium salt formulation. The antibacterial activity in urine upon administration of 50 mg/kg was prolonged to 48 hours in nearly all cases of trometamol orally and more than after the calcium salt orally or the sodium salt intravenously. A dose of 3 g for adults - or 50 mg/kg - is consistent with the findings in this study.

A study on delta virus infection and its clinical impact in Iran

Abstract: During the period 1986-1988, the expression of anti-HDV in different high-risk groups and its clinical impact on patients with HBV-related chronic liver disease and hepatocellular carcinoma was investigated in Iran. Using the ELISA technique, we observed a 2.5% anti-HDV positivity in asymptomatic chronic HBsAg carriers (3 of 120); in hemophiliacs, two of six HBsAg carriers were positive for anti-HDV and zero of 50 anti-HBs positives. Anti-HBs positive dialysis patients were positive for anti-HDV in 2.0% of the cases (1 of 50), whereas the rate of anti-HDV positivity was 44.5% in hemodialysis patients positive for HBsAg (16 of 36). The figures were comparable in HBsAg positive patients with chronic active hepatitis and cirrhosis (49.2%; 31 of 63). Moreover, anti-HDV was detected in five of eight patients with hepatocellular carcinoma. These data indicate the endemicity of delta infection in Iran. The increased incidence among hepatocellular carcinoma patients is an interesting finding to be further investigated with larger groups of patients in this region.

Prevalence of antibodies to human herpesvirus 6 in different age groups, in children with exanthema subitum, other acute exanthematous childhood diseases, Kawasaki syndrome, and acute infections with other herpesviruses and HIV.

Abstract: We determined IgG antibodies against Human Herpesvirus-6 (strain Uganda 1102, M. D. Griffin, London) in the indirect immunofluorescence test in sera from 1105 persons of various age groups. Of these sera 570 were retested using HHV-6 strain St. W. (Prof. Schneweis, Bonn). We could confirm that maternal antibodies decrease between birth and six months of age and the seropositive rate rises rapidly between seven months and five years of age up to 79.5%. Between six and ten years and up to 40 years, the antibody-positive rate lies around 81.3% and 66%, respectively. To confirm the causal nature of human herpes virus type 6 (HHV-6) for exanthema subitum we could demonstrate eight seroconversions testing sera from 14 patients with roseola infantum. In addition, the virus was isolated from peripheral blood lymphocytes of children during the acute fever phase in four cases in tissue culture and in six cases the virus was detected by positive hybridization. In single and some paired sera from patients with acute exanthematous diseases, rubella (n = 28), parvovirus B 19 (n = 24), measles (n = 17), mumps (n = 27), adenovirus (n = 27) and parinfluenza virus type 3 (n = 28) and in sera from patients with Kawasaki syndrome (n = 20), acute varicella-zoster- (n = 27), acute herpes simplex- (n = 18) and HIV-1 infection (n = 50), we found no HHV-6 IgM antibodies and no HHV-6 IgG antibody rises. We could only demonstrate an HHV-6 seropositive rate according to our age-prevalence study.(ABSTRACT TRUNCATED AT 250 WORDS)

The epidemiology of urinary tract infection and the concept of significant bacteriuria.

Abstract: Urinary tract infections (UTI) are among the most common infections afflicting man. Urinary tract infections in young adult women are usually uncomplicated, but are often recurrent and cause considerable morbidity. Urinary tract infections in pregnant women, elderly patients, and catheterized patients warrant special attention because of their association with increased morbidity and possibly with increased mortality. Diagnosis of UTI is usually based on quantitation of uropathogens in voided urine. The traditional criteria for significant bacteriuria, greater than or equal to 10(5) uropathogens per ml of voided urine, is insensitive for detecting acute symptomatic cystitis in men and women and should be replaced with a lower colony count threshold.

Fosfomycin trometamol in a single dose versus norfloxacin for seven days in the treatment of uncomplicated urinary infections in general practice.

Abstract: The efficacy and tolerability of fosfomycin trometamol in a single dose of 3 g was compared with norfloxacin 400 mg b.i.d. for seven days in the treatment of adult female patients with uncomplicated urinary infections. 158 female patients with a mean age of 30 years who presented symptoms of dysuria and frequency with documented pyuria and bacteriuria on urinalysis (≥ 105 cfu/ml of urine) were initially included in the study. The total number of clinically and bacteriologically evaluable patients was 111, of which 61 received fosfomycin trometamol and 50 norfloxacin. One to two days after the double blind medication schedule for seven days, 55 of 60 patients (92%) in the fosfomycin trometamol group and 48 of 50 patients (96%) in the norfloxacin group were clinically cured. 37 patients without significant bacteriuria showed a clinical cure rate of over 90% in both therapy groups. Two to three days after the single dose treatment with fosfomycin trometamol the initial infecting pathogen was eradicated in 60 of the 61 patients (98%). One to two days after a seven day treatment with norfloxacin 48 of 50 patients (96%) showed an eradication of the initial infecting pathogen. Six weeks after the start of therapy 39/60 patients (65%) and 32/49 (65%) in the fosfomycin trometamol and norfloxacin groups respectively, remained free from urinary infection. The reinfection rate in both treatment groups was approximately 25%. The relapse rate in the post treatment evaluation period of four weeks was relatively low in both therapy groups, 5/49 patients (10%) in the norfloxacin group and 3/55 patients (6%) in the fosfomycin trometamol group, respectively. Adverse effects, which were classified as ‘probably’ drug related, were mentioned by 10/79 of the patients (13%) and by 2/79 of the patients (3%) in the fosfomycin trometamol and norfloxacin groups, respectively. In 3/79 (3%) of the patients in the fosfomycin trometamol group the side effects were reported on the actual day of (single dose) treatment. Fosfomycin trometamol in a single dose of 3 g is as effective as norfloxacin 400 mg b.i.d. for seven days in the treatment of adult female patients with uncomplicated urinary infections.

Clinical significance of Staphylococcus aureus in cystic fibrosis.

Abstract: Staphylococcus aureus is usually the first bacterial pathogen detected in the respiratory secretions of patients with cystic fibrosis. This review briefly examines the characteristics of this host-parasite relationship in terms of current knowledge about the toxicity of the organism, mechanisms of respiratory tract injury, therapy and prevention. Recent evidence indicates that viral infection plays a role in the initial damage of the respiratory epithelial cells and staphylococcal colonization ensues. Affinity of staphylococcus for cystic fibrosis mucus, mucociliary abnormalities and unknown factors contribute to persistent colonization with this organism causing progressive pulmonary damage and possibly influencing Pseudomonas infection. Most of the evidence today indicates that aggressive antibiotic management directed against S. aureus is warranted in all stages of bronchopulmonary infection in cystic fibrosis. Future efforts to prevent colonization and the toxic and immunopathic consequences of staphylococcal infection are also important. One study is in progress that examines antibiotic prevention in the early stages of cystic fibrosis. Future investigations need to address other strategies including vaccines, antitoxins, anti-inflammatory agents, immunomodulators, and antibiotic regimens.

Fosfomycin trometamol versus ofloxacin/co-trimoxazole as single dose therapy of acute uncomplicated urinary tract infection in females: a multicentre study.

Abstract: 20 urologists took part in a single blind, randomized study. Female patients with acute uncomplicated UTI were recruited. The patients received either a single dose of 3 g fosfomycin trometamol versus 200 mg ofloxacin or 1.92 g co-trimoxazole. Follow-up examinations were carried out after one and four weeks. Of 562 patients 446 could be evaluated for efficacy and 496 for tolerance. Patients were analysed according to the amount of bacteriuria: "significant" (greater than or equal to 10(5)/ml), "low count" (10(2) - 10(4) ml) and "no bacteriuria" (less than or equal to 10(1)/ml), as well as according to the sensitivity of the infecting organisms: sensitive (resistant): fosfomycin trometamol less than or equal to 16 mg/l (greater than or equal to 128 mg/l), ofloxacin less than or equal to 1 mg/l (greater than or equal to 8 mg/l), co-trimoxazole less than or equal to 2/38 mg/l (greater than or equal to 16/304 mg/l). Up to one week the following results could be achieved: clinical improvement was attained in patients with "significant" bacteriuria (fosfomycin trometamol-150, ofloxacin-89, co-trimoxazole-69) in 94.7% for fosfomycin trometamol, in 95.4% for ofloxacin, and in 94% for co-trimoxazole; in patients with "low count" bacteriuria (fosfomycin trometamol-44, ofloxacin-18, co-trimoxazole-30) in 95.2% for fosfomycin trometamol, in 93.7% for ofloxacin, and in 96.4% for co-trimoxazole; and in patients with no bacteriuria (fosfomycin trometamol-11, ofloxacin-6, co-trimoxazole-4) in 81.8% for fosfomycin trometamol, in 100% for ofloxacin and in 100% for co-trimoxazole.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiovascular parameters and scoring systems in the evaluation of response to therapy in sepsis and septic shock.

Abstract: In 47 medical and postoperative ICU patients with 57 episodes of sepsis and septic shock, cardiovascular parameters including systemic vascular resistance (SVR), cardiac index (CI), stroke volume index (SVI), left ventricular stroke work index (LVSWI) as well as six scoring systems (APACHE II, Elebute, Goris, HIS, SAPS and SSS) were studied regarding their usefulness in the assessment of disease progression and evaluation of response to supplemental sepsis therapy (immunoglobulins, plasmapheresis). Among the hemodynamic parameters, only a prompt SVR improvement significantly discriminated between ultimate survivors and nonsurvivors. Thus, an increase in SVR (greater than 160 dyn*cm-5*sec, within days 0 to 4, persisting for greater than 24 hours) can serve as a prognostically validated "response" criterion (responders/non-responders: 26/31; mortality: 27% vs. 77%). Non-invasively, the APACHE II score was best suited (specificity: 88%, sensitivity: 67%) to classify hemodynamically defined responders to supplemental sepsis treatment (score-reduction greater than or equal to 4 on day 4 after onset of therapy).

Short course single daily ceftriaxone monotherapy for acute bacterial meningitis in children: results of a Swiss multicenter study. Part II: Bacteriological results.

Abstract: Thein vitro activity of ceftriaxone, ampicillin and chloramphenicol was studied at a reference laboratory against the isolates of the first 33 patients enrolled in a pediatric Swiss Multicenter Meningitis Study The predictive value of the MIC data of 31 of the strains was further corroborated by two sets of bacterial killing curves in broth supplemented with 2 g/l of albumin Ceftriaxone had the lowest geometric mean MIC values against all groups of isolates except for ampicillin againstStreptococcus agalactiae The bactericidal activity of ceftriaxone and that of ampicillin, alone and in combination with chloramphenicol, was compared at six times the respective MICs and at pharmacologically readily achievable concentrations in cerebrospinal fluid The bactericidal power of ceftriaxone at six times the MIC was as good or better than that of ampicillin alone or in combination againstNeisseria meningitidis andStreptococcus pneumoniae despite the very low drug concentrations of ceftriaxone compared to that of the competitors; and it was barely lower at six times the MIC and at 1 mg/l (a level that is readily surpassed in CSF at the 24 h trough level after a single daily dose of ceftriaxone of 100 mg/kg (neonates 50 mg/kg) than that of ampicillin and chloramphenicol at much higher concentrations againstHaemophilus influenzae type b

Respiratory failure elicited by streptococcal septicaemia in patients treated with cytosine arabinoside, and its prevention by penicillin.

Abstract: In order to prevent septicaemia with streptococci, 20 consecutive selectively decontaminated patients on intermediate high-dose Ara-C treatment for malignant haematological disease were given pencillin G. The incidence of infection with streptococci decreased from 0.76 per episode (14 patients, 17 episodes) for controls who did not receive penicillin G to 0.11 per episode in the prophylaxis group (20 patients, 26 episodes). Simultaneously, a decrease in the incidence of respiratory failure was observed, i. e. 0.52 per episode for controls and 0.19 per episode for patients on penicillin G. The results suggest that septicaemia with streptococci triggers the development of noncardiogenic pulmonary oedema in patients with pre-existing damage of the lung due to aggressive cytotoxic treatment. This suggestion is supported by the sequence of events, regarding the occurrence of infection and respiratory failure and the results of measurements of antileukoprotease serum concentrations, a paramenter for pulmonary capillary leakage. Taking into account the data in the literature and the results of the present study, the conclusion is drawn that in patients treated with (intermediate) high dose Ara-C, prevention of streptococcal septicaemia is associated with a decrease in the incidence of respiratory failure.

The incidence of gram-negative bacterial and fungal infections in liver transplant patients treated with selective decontamination.

Abstract: We have used selective bowel decontamination in 145 consecutive patients undergoing liver transplantation. In these 145 patients undergoing initial transplantation, we have experienced 42 major bacterial infections in 37 patients. Only five patients have experienced a gram-negative infection and only 2 of 26 documented bacteremias were associated with gram-negative organisms. To date, we have experienced only one systemic Candida infection. These results suggest that selective bowel decontamination may play a major role in reducing the previously reported high incidence of gram-negative and Candida sepsis following liver transplantation.

Single dose and conventional treatment for acute bacterial and non-bacterial dysuria and frequency in general practice.

Abstract: A five day course of clavulanate-potentiated amoxicillin (Augmentin) has been compared with a single oral dose of fosfomycin trometamol in the treatment of patients complaining of symptoms suggesting urinary tract infection. The study took place in a single urban general practice of 15,000 patients in Cheshire. The microbiology was performed at a London Teaching Hospital. 141 patients entered the trial. 65 had a significant bacteriuria, 62 of which were assessable for the ability of the trial drugs to eradicate bacteriuria: 29 patients received clavulanate-potentiated amoxicillin and 33 fosfomycin trometamol. The cure rates, assessed at five to ten days and at four to six weeks post treatment, were 72% and 65%, respectively for clavulanate-potentiated amoxicillin and 85% and 81%, respectively for fosfomycin trometamol. Side effects, assessed in all 141 patients, occurred in 11.6% receiving clavulanate-potentiated amoxicillin and in 8.3% receiving fosfomycin. Statistically there is no difference between any of these findings and the effect of sample size is discussed. 69 patients were symptomatic but did not have a significant bacteriuria ("urethral syndrome"). These patients were assessed for the effect of treatment in relieving symptoms: 33 received fosfomycin trometamol and 36 clavulanate-potentiated amoxicillin. The success and speed of relieving the symptoms were very similar in the two groups. The finding that both groups responded equally well appears to refute an aetiological role for lactobacilli and diphtheroids in the "urethral syndrome", since these organisms are resistant to fosfomycin but sensitive to clavulanate-potentiated amoxicillin.

Listeria isolations from feces of patients with diarrhea and from healthy food handlers.

Abstract: A study was undertaken on the presence and frequency ofListeria sp. in feces from 1,000 patients suffering from diarrheal diseases and from 2,000 healthy persons. Furthermore, the feces of patients were examined for other well-documented enteropathogens such asCampylobacter, Salmonella, Shigella, Staphylococcus aureus, Yersinia enterocolitica, protozoa and rotavirus as well as for organisms of questionable enteropathogenic potency such as fungi, i.e. Candida. Finally, in continuation of previously described investigations of the enteropathogenic role ofProteus mirabilis but not ofProteus vulgaris, both these species were studied too. OnlyListeria innocua andListeria monocytogenes could be detected in the investigated fecal specimens. There were no differences of the frequencies ofL. innocua, andL. monocytogenes between patients and healthy persons. 17 strains (= 1.7%) ofL. innocua and six strains (= 0.6%) ofL. monocytogenes were isolated from 1,000 samples of patients. As a comparison 2,000 fecal samples from healthy people contained 40 strains (= 2.0%) ofL. innocua and 16 strains (= 0.8%) ofL. monocytogenes. A coincidence study showed that there were no statistically significant correlations between well-known enteropathogens andListeria sp.,Proteus sp. or any of the other isolates. Significant correlations were found only between harmless species such asL. innocua andP. vulgaris.

Clearance of Candida colonizing the urinary bladder by a two-day amphotericin B irrigation.

Abstract: The minimum duration of continuous amphotericin B irrigation (50 mg/liter/day) required to clear the candida colonizing the urinary bladder was investigated. Eleven in vitro experiments revealed a consistent candidicidal effect within 48 hours with 25 and 5 mg/l of amphotericin B concentrations attainable in the bladder. Hospitalized nursing home patients with candiduria were treated with two-day irrigation according to the protocol. The protocol consists of the use of a newly inserted catheter for the irrigation, subsequent washout of the residual drug, and immediate sampling of urine for microscopic examination and culture after the procedure. In 47 of 65 (72.3%) cases yeast was cleared. In the remaining 18 the candida persisted. Of the latter, ten received additional irrigation for an average of 7.3 days (range: 4-12 days). In all ten cases funguria continued. Two-day irrigation saves time and expense, and is as effective as the five-day procedure in eradicating the yeast on bladder mucosa. Because of the relatively short irrigation time, the protocol may be useful in clinical evaluation of the site of urinary candidiasis.

Staphylococcus aureus in patients with cystic fibrosis: an epidemiological analysis using a combination of traditional and molecular methods.

Abstract: An epidemiological analysis of Staphylococcus aureus was conducted in a study group of 157 cystic fibrosis patients cultured over a 30-month period. The resulting S. aureus isolates were categorized by bacteriophage type, plasmid profile, and (in some instances) chromosomal restriction fragment pattern of the culture-positive patients with S. aureus (34 of 157) 44% only were sporadically infected while 68% shared identical strains with one or more other patients. Six patients exhibited persistent infection (for up to ten months) which, in three individuals, occurred as cycles of carriage and reappearance. By contributing toward our understanding of the persistence and spread of S. aureus in cystic fibrosis patients these data should aid in clarifying the role this organism may play in the course of the disease.

Intestinal Cryptosporidiosis Acquired From A Cat

Abstract: A case of intestinal cryptosporidiosis in an eight-year-old boy is presented The patient became ill during a visit to a farm where diarrhoea in newborn calves is a recurrent problem Furthermore, on that farm kittens periodically suffer from diarrhoea and failure to thrive Oocysts ofCryptosporidium sp were identified in the stool of the patient, and in the stool of the cat he had contact with At that time the calves were not infected The patient's gastrointestinal symptomatology consisted of severe diarrhoea, vomiting, colics and moderate dehydration, and was preceded by coughing

A general practitioner multicenter study: fosfomycin trometamol single dose versus pipemidic acid multiple dose.

Abstract: In order to evaluate the efficacy and safety of fosfomycin trometamol as single dose oral treatment for acute cystitis in women, an open, multicenter comparative study was carried out in general practices in France, 386 women, aged 16 to 75 years, with clinical symptoms of acute cystitis were enrolled in the study to receive either a single 3 g oral dose of fosfomycin trometamol or a five-day course of 400 mg pipemidic acid twice daily. The diagnosis of cystitis was based on clinical symptoms and significant bacteriuria (greater than or equal to 10(5) cfu/ml midstream urine). Follow-up examinations were carried out five to ten and 28 days after the end of treatment, 289 and 244 patients, respectively, were available for clinical and bacteriological evaluation at short-term (five to ten days) and medium-term (28 days) post-treatment follow-up. Both regimens were comparable for clinical and bacteriological efficacy with short-term eradication rates of 122/146 in the fosfomycin trometamol group and 130/143 in the pipemidic acid group. The results of medium-term follow-up were 113/122 and 114/122 for the eradication rates of the respective groups. Both drugs were well tolerated. Side effects were mild and of significantly shorter duration in the fosfomycin trometamol group.

An outbreak of Acinetobacter calcoaceticus infection in a neonatal care unit

Abstract: Between January and December 1988, 383 neonates were admitted to our neonatal intensive care unit 1,991 swabs and blood cultures were tested bacteriologically Among them 90 specimens obtained from 41 patients were positive for Acinetobacter calcoaceticus During this period we discovered and treated three cases with A calcoaceticus sepsis Three additional cases had blood cultures positive for this bacterium without demonstrating any clinical signs of infection There is good evidence that contaminated warm air humidifiers were the source of infection A review of microbiological data for several months preceding the outbreak showed a definite increase in the presence of A calcoaceticus The affected neonates required specific antibiotic therapy and intensive care All of them survived Conditions favoring the spread of these generally non-pathogenic bacteria and modes of preventive measures are discussed The necessity of continuous bacteriological surveillance and careful disinfection of intensive care equipment is emphasized

Nasopharyngeal culture in the pneumonia diagnosis.

Abstract: The diagnostic value of bacterial cultures from nasopharynx (NPH) was prospectively studied in 261 patients with community-acquired pneumonia requiring hospitalization. NPH culture results were compared with those of other diagnostic methods: Culture from blood and sputum, pneumococcal antigen detection, enzyme immuno assay (EIA) for detection of antibodies against pneumococcal hemolysin and in selected cases bronchoscopy. Pneumococcal pneumonia was diagnosed by these other methods in 121 patients.Streptococcus pneumoniae was detected in NPH in 33 of these patients (27%, or 36% if only cultures obtained before start of antibiotics are considered), but in only four of the other 140 patients. For other species the relevance of NPH culture was uncertain. Because of its simplicity and high specificity NPH culture can be a valuable supplement to other diagnostic methods, particularly when sputum samples are difficult to obtain.

Low risk of health care workers for infection with hepatitis C virus.

Abstract: 294 health care workers from 21 different departments were tested for hepatitis C antibodies by means of the Ortho ELISA test. Only six (2%) were found positive. Health care workers having direct contact with the patient, such as doctors and nurses, seem to be at a higher risk of infection than those with only indirect contact, such as laboratory technicians and cleaning personnel. In the geriatric ward the risk is possibly slightly higher than in other departments. However, in general risk of infection with HCV for health care workers seems to be low.

Cerebrospinal fluid and serum neopterin levels in patients with Lyme neuroborreliosis.

Abstract: Elevated (greater than 3.0 nmol/l) cerebrospinal fluid neopterin concentrations were observed in 20 of 21 patients with Lyme neuroborreliosis compared with three of 11 control patients with headache, back pain or psychoneurotic disorders. Neopterin concentrations were correlated to mononuclear cell counts and protein concentrations in the cerebrospinal fluid (CSF). Following antibiotic treatment, CSF neopterin levels decreased. Serum neopterin levels were not significantly raised in patients with neuroborreliosis when compared to control subjects. Neopterin levels as well as cell count and protein concentration in the CSF are valuable inflammation markers of disease activity in Lyme neuroborreliosis.

Serology, clinical manifestations and treatment of brucellosis in different age groups.

Abstract: We prospectively studied 339 patients diagnosed of brucellosis over a six year period in order to evaluate the clinical and serological characteristics of brucellosis in the elderly. 319 patients (94.1%) were under 65 years of age (group A), and 20 patients (5.9%) were older than 65 (group B). No patient in group B developed splenomegaly as opposed to 69 (21.6%) in group A (p<0.05). The percentage of positive blood cultures (Brucella melitensis isolated in all cases) was 72.1% in group A and 60% in group B. The mean titer of IgM antibodies measured by indirect immunofluorescence test was significantly lower in the elderly patients, with no other differences in serologic response between the two groups. 103 patients (32.2%) in group A and seven patients (35%) in group B developed some complications; spondylitis was more common and severe among group B patients. There was no therapeutic failure or relapse among patients over 65. We conclude that clinical, bacteriological and serological characteristics and the outcome of brucellosis in the elderly are similar to those seen in younger patients.

Review of published studies on single dose therapy of urinary tract infections.

Abstract: The published studies of the use of single dose antimicrobial therapy for the treatment of urinary tract infection have been reviewed. In women and children a single dose of any of several antimicrobial agents was as effective as a course of treatment for uncomplicated urinary tract infections caused byEscherichia coli. Trimethoprim or co-trimoxazole are currently the preferred agents for single dose therapy. Failure of single dose therapy may prove to be a simple guide as to the need for further urinary tract investigation or more intensive therapy. Single dose antimicrobial therapy is now the treatment of choice for uncomplicated urinary tract infections.

Single dose fosfomycin trometamol versus multiple dose norfloxacin over three days for uncomplicated UTI in general practice.

Abstract: The aim of this study was to carry out a small-scale bacteriological comparison between a standard therapy with norfloxacin 400 mg twice daily, and fosfomycin trometamol (3 g) in single dose in uncomplicated urinary tract infections (UTI) in women. Only patients with UTI with cultures showing a bacterial count of 105 or more bacteria/ml were included in the study (n=32; ages 16–75 years). After one week sterile cultures were obtained in 14 of 16 cases in the fosfomycin trometamol group, and in 14 of 16 cases in the norfloxacin group. After one month eradication was confirmed in 13 of 16 patients in the fosfomycin trometamol group, and in nine of 16 patients in the norfloxacin group. Recurrence was seen in one case in the fosfomycin trometamol group, and in five cases in the norfloxacin group. The reinfection and persistence rates were identical (1/16) in both groups. The main clinical symptoms disappeared very rapidly after initiating treatment, and the correlation with the bacteriological data after one week was excellent. Both drugs were well tolerated and the compliance for fosfomycin trometamol was 100%.