Bench-to-bedside review: <Emphasis Type="Italic">Clostridium difficile</Emphasis> colitis

In recent years, the incidence and severity of Clostridium difficile-associated disease (CDAD) have increased dramatically. Beginning in 2000, widespread regional outbreaks associated with a previously uncommon hypervirulent strain of C. difficile have occurred in North America and Europe. Most likely because of increased toxin production as well as other virulence factors, this epidemic strain has caused more severe and refractory disease leading to complications, including intensive care unit admission, colectomies, and death. Worldwide increasing use of fluoroquinolones and cephalosporins has likely contributed to the proliferation of this epidemic strain, which is highly resistant to both. The elderly have been disproportionately affected by CDAD, but C. difficile has also recently emerged in populations previously considered to be at low risk, including healthy outpatients and peripartum women, although it is unknown if these cases are related to the epidemic strain. Nevertheless, transmission within hospitals is the major source of C. difficile acquisition, and previous or concurrent antimicrobial use is almost universal among cases. Applying current evidence-based strategies for management and prevention is critically important, and clinicians should maintain an awareness of the changing epidemiology of CDAD and take measures to reduce the risk of disease in patients.     

Not <Emphasis Type="Italic">if</Emphasis> but <Emphasis Type="Italic">when</Emphasis>; no longer <Emphasis Type="Italic">why</Emphasis> but <Emphasis Type="Italic">how</Emphasis>

There is accruing evidence that information technology can improve patient health care, with several trials of technology showing smaller numbers of medication errors, or can provide earlier detection of adverse events. Critics of this type of research point out that better resolution of events is of no value unless their direct management influences clinical outcome. Nevertheless, indirect evidence is available, such as reports indicating the importance of providing specialist neuro-critical care in the management of patients with traumatic brain injury. These studies do not indicate which aspects of critical care management are crucial, but management aimed at the earlier detection and treatment of adverse events must be partly responsible. We continue to hope for definitive controlled trial evidence that information technology-led management yields improved patient outcome, but our experience so far of funding and conducting such studies has been poor. There is no question that we need better monitoring and event detection technology for health care and that we need more research into optimising that technology, but should their adoption depend on large-scale clinical trials? Perhaps now the questions we need to focus upon are no longer if but when, and no longer why but how.     

Comparison of <Emphasis Type="Italic">albicans</Emphasis> vs. non-<Emphasis Type="Italic">albicans</Emphasis> candidemia in French intensive care units

Introduction  

Candidemia raises numerous therapeutic issues for intensive care physicians. Epidemiological data that could guide the choice of initial therapy are still required. This analysis sought to compare the characteristics of intensive care unit (ICU) patients with candidemia due to non- albicans Candida species with those of ICU patients with candidemia due to Candida albicans.     

<Emphasis Type="Italic">Saccharomyces boulardii</Emphasis>fungaemia in an intensive care unit patient treated with caspofungin

We describe a case of Saccharomyces boulardii fugaemia in a critically ill patient with septic shock treated with a probiotic agent containing this yeast. We attributed this fugaemia to gut translocation. Our use of caspofugin yielded excellent results.     

Multiresistant <Emphasis Type="Italic">Enterobacter cloacae</Emphasis> outbreak in an intensive care unit associated with therapeutic beds

We report a multiresistant Enterobacter cloacae outbreak in an intensive care unit, associated with mattresses and with antibacterial-treated and vapour-permeable polyurethane synthetic mattress covers of therapeutic beds.     

Multiresistant <Emphasis Type="Italic">Enterobacter cloacae</Emphasis> outbreak in an intensive care unit associated with therapeutic beds

We report a multiresistant Enterobacter cloacae outbreak in an intensive care unit, associated with mattresses and with antibacterial-treated and vapour-permeable polyurethane synthetic mattress covers of therapeutic beds.     

DNA Barcodes Distinguish <Emphasis Type="Italic">Withania somnifera</Emphasis> and <Emphasis Type="Italic">Withania ashwagandha</Emphasis>

On the basis of morphology, chemical profiling, crossing ability, amplified fragment length polymorphism and comparison of nucleotide sequences of nuclear ribosomal internal transcribed spacer (ITS), the cultivated form of Withania somnifera, a species of therapeutic value, has been circumscribed as a new species, Withania ashwagandha. The present study was undertaken to ascertain whether the two species can be distinguished on the basis of DNA barcoding. Six barcode loci, ITS, ITS2, matK (maturase K), rbcL (ribulose-bisphosphate carboxylase/oxygenase, large subunit), rpoC1 (RNA polymerase-β′ subunit, main catalytic subunit) and trnH-psbA spacer (transfer RNA for histidine-photosystem II protein D1 spacer) from W. somnifera, W. ashwagandha, their hybrid, and ‘ashwagandha’ market samples were amplified, sequenced, and compared. ITS, ITS2 and matK distinguished two species on the basis of phylogenetic tree method. Likewise, BLAST 1 analysis based on ITS, ITS2, matK, and rbcL individually discriminated two species. However, on the basis of Kimura 2 Parameter distances, two species could not be distinguished as the requirement of a distinct barcode gap—the highest intraspecific distance being lower than the lowest interspecific distance—was not met by any of the loci. If compared by character-based method, ITS, ITS2 and matK sequences of the two species had distinct diagnostic nucleotides (pure character attributes) at nine, four and one positions, respectively. Interestingly, all market samples co-segregated and shared character attributes with W. ashwagandha.     

Evaluation of Cultivated and Wild <Emphasis Type="Italic">Allium</Emphasis> Accessions for Resistance to <Emphasis Type="Italic">Fusarium oxysporum</Emphasis> f. sp. <Emphasis Type="Italic">cepae</Emphasis>

Fusarium basal rot (FBR) caused by Fusarium oxysporum f. sp. cepae (FOC) is a highly destructive soil borne disease incurring heavy damage in pre and post harvest onion and garlic crops worldwide. Only a few onion lines exhibit partial resistance against the pathogen and there is a need for identification of more effective resistance sources for use in breeding programmes. Selected sets of wild onion and garlic accession and seven related Allium species were screened for resistance to Fusarium basal rot using three FOC isolates. FOC infection revealed significant variation among the evaluated Allium species (at P = 0.001). A. sativum accession ‘CBT-As153’ showed high level of resistance to each isolate while A. cepa accession ‘CBT-Ac77’ exhibited intermediate resistance. Among related Allium species, A. fistulosum, A. roylei and A. schoenoprasum were highly resistant, A. tuberosum had mixed response while A. griffithianum was susceptible. Further, the root density of Allium species negatively correlated with disease incidence for different FOC isolates. Thus, the present study suggests that besides related Allium species, A. sativum ‘CBT-As153’ can be used as a potential donor of FBR resistance for genetic improvement of onion and garlic in India.     

Nutritional Requirements to Improve Delta-Endotoxins Production of <Emphasis Type="Italic">Bacillus</Emphasis><Emphasis Type="Italic">thuringiensis</Emphasis> var. <Emphasis Type="Italic">kurstaki</Emphasis> Using Mixed Designs Modelling

Bacillus thuringiensis kurstaki is a soil bacterium that produces insecticidal toxins called delta-endotoxins. In order to increase the toxic crystal concentrations in a low-cost culture medium and thus improve the biopesticide quality to control insect pests, the Plackett–Burman screening method was applied. It was shown a tool to evaluate the significance of the selected seven factors (KH₂PO₄, K₂HPO₄, MgSO₄, MnSO₄, FeSO₄, soybean meal, starch) which are necessary to the production of the delta-endotoxins. This was performed into two different shake flasks (250 and 500 ml). The main factors that affected the production of delta-endotoxins are shown to be soybean meal, starch, and FeSO₄ in 250 ml culture flasks. In 500 ml culture flasks, soybean meal and FeSO₄ are the principal factors influencing the delta-endotoxin production. The multiple linear regression, a method applied as the merging dataset of the two Plackett–Burman designs, established that soybean meal and starch are the factors positively affecting the production of delta-endotoxins, in contrast to FeSO₄. Furthermore, the available oxygen in culture flasks showed no significant negative effect on delta-endotoxin production. This study revealed that mixed method designs were useful to identify the significance and the effect of hidden culture parameters.     

Bioefficacy of <Emphasis Type="Italic">Beauveria bassiana</Emphasis> (Balsamo) Vuillemin and <Emphasis Type="Italic">Lecanicillium lecanii</Emphasis> Zimmerman against <Emphasis Type="Italic">Thrips tabaci</Emphasis> Lindeman

Bioefficacy of Beauveria bassiana (Balsamo) Vuillemin and Lecanicillium lecanii Zimmerman in comparison with their commercial formulations along with standard check insecticide, Fenvalerate 20 EC were evaluated against onion thrips, Thrips tabaci Lindeman under greenhouse as well as field conditions. The results revealed that the standard check fenvalerate 20 EC @ 0.0075 % showed significantly the highest cumulative corrected mortality of 97.84 % followed by commercial formulation of B. bassiana, Myco-Jaal @ 1 × 10⁸ spores/mL which showed 80.90 % mortality. The laboratory cultured B. bassiana showed percent mortalities of 74.11, 71.69 and 78.48 % for the concentrations of 1.23 × 10⁷, 1.23 × 10⁶ and 1.23 × 10⁸ spores/mL, respectively. However, these concentrations were statistically at par on all the days of observation. Thrips mortality gradually increased with the increase in concentrations of fungal preparations and days of observations. Similar trend was also observed in L. lecanii experiment. Under field conditions, Fenvalerate 20 EC @ 0.0075 % recorded highest mortality of T. tabaci (90.10 %) followed by commercial formulation of V. lecanii (Phule Bugicide @ 2 × 108 cfu/g) with 74.90 % mortality. All the concentrations of fungal concentrations gave low mortality ranging from 9.40 to 10.10 % and 7.10 to 7.40 % at 2 days after treatment (DAT) of B. bassiana and L. lecanii, respectively. The standard check of Fenvalerate 20 EC @ 0.0075 % was highly toxic and showed significantly maximum percent reduction (90.50 %) of T. tabaci population in both the experiments. The present study clearly shows that these entomopathogens may be integrated with existing integrated pest management (IPM) practices for management of T. tabaci.     

Larvicidal Activity of <Emphasis Type="Italic">Colocasia esculenta,Eclipta prostrata</Emphasis> and <Emphasis Type="Italic">Wrightia tinctoria</Emphasis> Leaf Extract Against <Emphasis Type="Italic">Culex quinquefasciatus</Emphasis>

Control of mosquitoes by using chemical insecticides creates several problems including development of resistance. This leads to find out alternative methods via plant products. Viewing this in mind, methanolic extracts of Colocasia esculenta, Eclipta prostrata and Wrightia tinctoria leaves were tested against II, III, IV instars and pupa of filarial vector Culex quinquefasciatus. The LC₅₀ value obtained for IV instar larvae of Cx. quinquefasciatus is 165.697 ppm for C. esculenta while it is 114.257 ppm for E. prostrata and 210.298 ppm for W. tinctoria. Of the three plants studied E. prostrata is most effective in controlling mosquito larvae than the others.     

Reduced activity of <Emphasis Type="Italic">Candida</Emphasis> detachment factors in the saliva of the elderly

Saliva in healthy human subjects contains protenaceous factors that detach Candida albicans cells from plastic plates. To investigate the physiological role of the detachment activity of human saliva, we compared the activity of salivary specimens collected from the elderly (who are at greater risk of oral candidiasis) to the activity of specimens collected from children and nonelderly adults. C. albicans cells were cultured and attached to the bottoms of the wells of a 96-well plate, and saliva preparations were then added to each well. After 3h of incubation, Candida cells attached to the bottoms of the wells were counted, using the crystal violet staining method. The results showed that the activity of salivary detachment factors was significantly lower among the elderly than among nonelderly adults and children. Furthermore, the activity of salivary detachment factors was reduced in 12 of the 43 elderly subjects (27.9%), a significantly higher proportion relative to that in the children and nonelderly adults. However, there was no significant difference in the level of salivary proteins between the samples collected from elderly subjects displaying low and high salivary detachment activity. These results suggest that the increased number of people with lower salivary detachment activity among the elderly may be one of the reasons that oral candidiasis is more common among the elderly than in nonelderly adults and children.     

Motion-Artifact-Free <Emphasis Type="Italic">In Vivo</Emphasis> Imaging Utilizing Narcotized Avian Embryos <Emphasis Type="Italic">In Ovo</Emphasis>

Purpose  

The chick embryo in ovo is a well-accessible and economical in vivo model, but its use in molecular imaging has been limited because of motion artifacts on resulting images. The purpose of this study was to develop a method using narcotics to inhibit motility and to perform motion-artifact-free imaging of living chick embryos in ovo.     

Isolation of <Emphasis Type="Italic">Mycoplasma hominis</Emphasis> in critically ill patients with pulmonary infections: clinical and microbiological analysis in an intensive care unit

Objective Mycoplasma hominis is a well recognized extragenital pathogen. However, it is an uncommon cause of respiratory infections in critically ill patients admitted to the intensive care unit (ICU). Design and setting Prospective clinical investigation in a 21-bed ICU in a university hospital. Patients Seven patients requiring intensive care who developed a ICU-acquired pneumonia in which M. hominis was recovered from bronchoalveolar lavage and pleural fluid cultures. Interventions M. hominis was isolated in all patients by use of conventional bacteriological cultures. All strains were identified by 16S rRNA gene sequencing analysis. Patients' charts were reviewed for each case of infection. Results Seven strains of M. hominis were isolated during a 4-year period. All of these isolates were recovered from adult men admitted to the ICU and all had clinical signs of pneumonia. In three patients treatment for M. hominis with quinolones was associated with a good clinical response. Conclusion Suspicion of M. hominis pneumonia must be heightened particularly in critically ill patients. Therefore an understanding of the microbiology of this organism is essential to successfully treat patients with these infections that are not ordinarily covered with standard antibiotic therapy.