IgG antibody response to ES or somatic antigens of Dicrocoelium dendriticum (Trematoda) in experimentally infected sheep

The ELISA technique was used to study the kinetics of IgG antibodies against excretory–secretory (ES) and somatic (So) antigens of Dicrocoelium dendriticum in the sera of 32 lambs: 12 experimentally infected with 1,000 metacercariae, 12 with 3,000 and 8 controls. Both antigen types were used at a 2 μg/ml concentration. Dilutions of sera and the anti-sheep IgG peroxidase conjugate were: 1:200 and 1:6,000, respectively. Optical density values for each type of antigen in the two infected groups were higher than the cut-off point from day 30 post infection (p.i.), showing positive infection. Maximum antibody levels were observed 60 days p.i. and remained high until the experiment ended 180 days p.i. This pattern was similar for both ES and So antigens, although with slightly lower figures in the latter. Antibody kinetics were very similar for each of the two doses, except on day 30 p.i. No correlation between the antibody level and parasite burden could be established. Received: 23 November 1999 / Accepted: 9 December 1999     

Effect of mefloquine administered orally at single, multiple, or combined with artemether, artesunate, or praziquantel in treatment of mice infected with Schistosoma japonicum

The purpose of the study is to better understand the antischistosomal properties of artemether, praziquantel, and ozonide (OZ) compounds (synthetic trioxolanes, secondary ozonides) in hamster (Mesocricetus auratus) model. A total of 230 male hamsters infected each with 100 Schistosoma japonicum cercariae were used in the study. Groups of five to ten hamsters were treated orally with artemether, praziquantel, and OZ78 or OZ277 7–35 days post-infection at single doses of 50, 100, 150, or 200 mg/kg. Untreated but infected hamsters in each batch of test served as the control. All treated hamsters were sacrificed 4 weeks post-treatment for collection of residual worms using perfusion technique. Nonparametric method (Mann–Whitney test) was used to analyze the data. In groups of five hamsters treated with artemether 7, 14, 21, 28, and 35 days post-infection at single doses of 150 and 200 mg/kg, the difference of mean worm burden between each treated group and control group was statistically significant (P < 0.01). Apart from individual group, no difference in mean worm burden between each two groups of them was seen (P > 0.05). Further test with various single doses of 50–200 mg/kg confirmed the similar susceptibility of 7-day-old juvenile and 35-day-old adult schistosomes to artemether. After administration of praziquantel 100 mg/kg to groups of five hamsters 7, 21, and 35 days post-infection, higher worm burden reduction of 95.5% was seen in the group with 35-day-old adult schistosomes while in the groups with 7- and 21-day-old juvenile schistosomes, poor efficacy was seen with mean worm burden reductions of 36.6% and 35.6%. In the same batch of hamster treated with praziquantel 200 mg/kg, the moderate effect of the drug against 7- and 21-day-old worms was seen, but their mean worm burden was significantly higher than that of the group with adult schistosomes. In comparison of artemether and praziquantel against various stages of schistosomes, the results further demonstrated that artemether possessed similar effect against juvenile and adult schistosomes in hamsters, while praziquantel was more effective against adult schistosomes than the juvenile ones in the same host. Finally, after administration of OZ78 and OZ277 to the groups of four to six hamsters with 14- and 35-day-old schistosomes at a single dose of 200 mg/kg, promising effect against juvenile and adult schistosome was observed with the mean worm burden and female worm burden reductions of 69.6–94.2% and 64.2–100% as well as 73.3–80.7% and 68.3–81.1%, respectively. The results indicate that in hamster model, praziquantel exhibits higher effect against adult schistosomes than the juvenile ones, while artemether and OZ compound display similar effect against both juvenile and adult schistosomes.     

Reinfections and <Emphasis Type="Italic">Trypanosoma cruzi</Emphasis> strains can determine the prognosis of the chronic chagasic cardiopathy in mice

Chronic Chagas’ disease represents the result of the interaction between the host and the parasite, producing different clinical features: from a mild disease to a severe heart failure. In the present investigation, we analyzed whether Trypanosoma cruzi strain and/or reinfections in the acute stage, determine changes in the chronic phase (135 days postinfection, d.p.i) that could explain the diverse evolution of cardiac lesions. After infection of albino Swiss mice (n = 170) with 50 blood trypomastigote of the T. cruzi, strain Tulahuen (n = 80) and the isolate SGO-Z12 (n = 90), respectively, and reinfections at 10 and 20 d.p.i. Parasitemia, survival, electrocardiography, affinity and density of cardiac β-receptors and histopathology of the heart were studied. Parasitemias in reinfected mice were significantly higher than those in single-infected mice. Survival of SGO-Z12-infected group was significantly higher than the other groups (p < 0.01). All Tulahuen-reinfected mice and 55–67% of the infected and SGO-Z12-reinfected groups presented some electrocardiographic abnormality (p < 0.01). Hearts from single-infected mice presented fibber disorganization and necrosis; reinfected groups also exhibited fibber fragmentation and a diminished affinity and a higher beta-adrenergic receptors’ density than the other groups (p < 0.05). Therefore, parasite strain and reinfections determine different cardiac damage, and either (or both) of these factors are involved in the severity of the clinical picture and the prognosis of the chronic cardiac disease.     

Immunomodulatory effects in Litomosoides sigmodontis-infected Mastomys coucha

The levels of parasite-specific IgG₁ and IgG₂ antibodies and mitogen-induced and parasite-specific proliferative T-cell responses were determined in Litomosoides sigmodontis-infected Mastomys coucha throughout an observation period of 400 days post infection (p.i.). These were compared with the respective reactions in animals that had been immunized with intrauterine stages/microfilariae of the parasite and in animals that had been challenged after immunization as determined at up to 60 days after challenge. IgG₁ antibodies to adult antigen developed early and reached a plateau at 120 days p.i., whereas IgG₂ antibodies were not found before day 60 p.i., increased with rising parasitemia, reached a plateau at 200 days p.i., and, in some animals, even became the predominant IgG subclass. Proliferative responses of spleen lymphocytes to concanavalin A (Con A) and lipopolysaccharides (LPS), but not Con-A-induced interleukin 2 (IL-2) production, were found to be suppressed in infected animals during patency as compared with uninfected controls. Spleen cells of infected animals showed a weak proliferative reaction to male antigen but were unresponsive to female and microfilarial antigen during prepatency and early patency. Subsequently, when microfilaremia decreased (200 days p.i.), continuously increasing responses to all antigens were observed. Immunized M. coucha developed specific IgG₁ and IgG₂ antibodies, and their spleen cells showed strong proliferative responses to the three L. sigmodontis antigens. Challenge infections down-regulated the proliferative responses of spleen cells to filarial antigens as early as during the prepatent phase of the challenge infection but supported existing IgG₁ and IgG₂ responses. Received: 1 September 1999 / Accepted: 24 September 1999     

Allopurinol is effective to modify the evolution of <Emphasis Type="Italic">Trypanosoma cruzi</Emphasis> infection in mice

There is a real need for new and less toxic drugs for the treatment of Chagas disease, as nifurtimox and benznidazole are effective but toxic and provoke unpleasant side effects, especially in adult patients. Allopurinol, commonly used to treat the hiperuricemia, is also used by the Trypanosoma cruzi’s hypoxantine guanine fosforyltransferase as an alternative substrate incorporating it into the parasite’s ribonucleic acid, provoking the death of the parasite. However, the results of using allopurinol as chemotherapy for Chagas disease are not clear. For that, we investigated the evolution of the T. cruzi infection in mice treated with allopurinol (5, 10 or 15 mg/kg for 90 days) obtaining a reduction in the parasitaemia (p < 0.05), no electrocardiographic alterations (p < 0.05) and a conserved myocardial and cardiac β-receptors’ affinity values with the highest dose of the drug, compared to those of the uninfected mice. Cruzipain immunoglobulin G levels remained high in all the groups as well as the survival (70%, 90 days post-infection). Allopurinol prevented the acute phase evolving into the chronic cardiac disease.     

Improved efficacy of tetracycline by acaciasides on <Emphasis Type="Italic">Dirofilaria immitis</Emphasis>

The discovery of Wolbachia, a bacterial endosymbiont that occurs in the filarial parasite and its sensitivity to tetracycline, has fostered a new initiative in the development of suitable antifilarial drugs. The present study is an attempt to investigate whether adding acaciasides (saponins from Acacia auriculiformis) to the standard dose of tetracycline would further improve the efficacy of tetracycline treatment against Dirofilaria immitis microfilariae in vivo. Treatment of microfilaremic adult dogs (body weight range 8–12 kg) with tetracycline at 10 mg/kg/day for 40 days resulted in 72% and 83% reduction in mf count on days 15 and 30, respectively, and the maximum reduction in mf count (91%) was achieved on day 75 post-treatment. However, treatment with tetracycline (10 mg/kg/day for 40 days) followed by acaciasides (10 mg/kg/day for 7 days) resulted in almost 100% clearance of mf at a faster rate on day 45 post-treatment and ensured long-term (until 4 months post-treatment) protection against microfilaremia. Data from polymerase chain reaction analysis reveals that compared to untreated dogs, in treated dogs, there was marked reduction in Wolbachia specific wsp markers in fast depleting mf population. The present data indicate that prior tetracycline treatment enhances microfilaricidal activity of saponins. This effect may be additive or synergistic as the worms are weakened by Wolbachia depletion, and these weakened microfilariae are possibly killed by the saponins. S. Datta and S. Maitra have contributed equally in this paper.     

Drug-abbreviated infections of <Emphasis Type="Italic">Trichostrongylus colubriformis</Emphasis> and development of immunity in jirds (<Emphasis Type="Italic">Meriones unguiculatus</Emphasis>)

The objective of this study was to examine the development and the duration of immunity achieved with drug-abbreviated infections of Trichostrongylus colubriformis in jirds (Meriones unguiculatus). Jirds were primarily infected either by trickle infection with 6 × 100 infective larvae (L₃) of T. colubriformis at 3-day intervals or by a single infection with 600 L₃. On day 35 post-infection, one batch of jirds from each group was autopsied; the others were treated with oxfendazole at a dose of 5 mg/kg and were challenged with 1,000 L₃ on either day 7 or day 42 post-treatment. All jirds were autopsied at 17 days post-challenge. Trickle infection resulted in lower levels of egg production during the primary infection period. The systemic IgM and IgG antibody response was significantly stronger in trickle- and single-infected groups as compared with the negative control group (P < 0.01–P < 0.05). Significantly higher levels of intestinal IgA were demonstrated in trickle- and single-infected groups than in the negative control group (P < 0.01). Numbers of mucosal mast cells increased following infection, but this was not dependent on the type of immunisation. After challenge the extent of worm reduction was greater in trickle-infected than in single-infected subgroups. The IgM and IgG response was significantly stronger in challenged subgroups as compared with negative control subgroups (P < 0.01). However, the IgG response was weaker in control challenged subgroups than in challenged subgroups (P < 0.01). There was a negative correlation between the IgG response and the worm burden after the second challenge (r=−0.73). The acquired immunity to T. colubriformis infection in jirds developed within 5 weeks of primary infection. The level of immunity was higher after trickle infection than after single infection. Furthermore, the immunity persisted for at least 6 weeks after oxfendazole treatment in the absence of a worm burden and larval intake, which is very similar to the situation in domestic ruminant hosts. Received: 25 October1999 / Accepted: 23 December 1999     

Experimental Angiostrongylus costaricensis infection in mice: immunoglobulin isotype responses and parasite-specific antigen recognition after primary low-dose infection

Immunoglobulin isotype responses and parasite-specific antigen recognition were investigated in experimental Angiostrongylus costaricensis infection in two different mouse strains. Even in a low-dose infection with third-stage larvae (L3), BALB/c mice showed high mortality until 28 days postinfection (p.i.) in association with a low patency rate in surviving animals. On the other hand, low mortality and a high rate of patent infection was observed in C57BL/10 mice. Parasite-specific IgM, total IgG, and IgG subclasses against crude adult-worm antigen (AcAg) rose in both groups of mice from day 14 onward, with IgG and IgG1 being significantly elevated in BALB/c mice at 21 and 28 days p.i., respectively. For total IgE, significantly elevated concentrations were detected at 14 days p.i. in BALB/c mice as compared with C57BL/10 mice. A. costaricensis-specific antigen recognition by total IgG, IgG1, or IgG2a was similar in both mouse strains, intensifying from 3 to 4 weeks p.i., with recognition of immunodominant AcAg ranging between 80 and 210 kDa. This study provides evidence that in BALB/c and C57BL/10 mice, immunoglobulins, with the possible exception of IgE and IgG1, do not decisively contribute to the outcome of a primary A. costaricensis infection with respect to immunopathogenesis or parasite permissiveness. Received: 20 May 1998 / Accepted: 10 September 1998     

Mycobacterial infections in adult patients with hematological malignancy

We retrospectively analyzed the clinical and microbiological characteristics of adult patients with hematological malignancy and nontuberculous mycobacteria (NTM) infections from 2001 to 2010. During the study period, 50 patients with hematological malignancy and tuberculosis (TB) were also evaluated. Among 2,846 patients with hematological malignancy, 34 (1.2%) patients had NTM infections. Mycobacterium avium-intracellulare complex (13 patients, 38%) was the most commonly isolated species, followed by M. abscessus (21%), M. fortuitum (18%), and M. kansasii (18%). Twenty-six patients had pulmonary NTM infection and eight patients had disseminated disease. Neutropenia was more frequently encountered among patients with disseminated NTM disease (p = 0.007) at diagnosis than among patients with pulmonary disease only. Twenty-five (74%) patients received adequate initial antibiotic treatment. Five of the 34 patients died within 30 days after diagnosis. Cox regression multivariate analysis showed that chronic kidney disease (p = 0.017) and neutropenia at diagnosis (p = 0.032) were independent prognostic factors of NTM infection in patients with hematological malignancy. Patients with NTM infection had higher absolute neutrophil counts at diagnosis (p = 0.003) and a higher 30-day mortality rate (15% vs. 2%, p = 0.025) than TB patients. Hematological patients with chronic kidney disease and febrile neutropenia who developed NTM infection had significant worse prognosis than patients with TB infection.     

Applicability of the use of charcoal for the evaluation of intestinal motility in a murine model of <Emphasis Type="Italic">Trypanosoma cruzi</Emphasis> infection

Chagas disease, caused by the protozoan Trypanosoma cruzi, remains a serious public health problem in Latin America. In relation to digestive problems, 4.5% of patients show mega syndromes (megacolon) in the chronic phase. In this article, we evaluated intestinal motility at the acute phase of T. cruzi infection through charcoal ingestion in adult mice. After infection, Swiss mice were administered an aqueous suspension of charcoal in water by gavage. Decrease in intestinal motility was determined by increased time of appearance of charcoal in the feces. The uninfected group showed a mean time of charcoal elimination of 109.0 ± 14.6 min throughout the assay. On the other hand, infected mice presented a significant increase in charcoal defecation time during infection. At 15 days postinfection, infected mice showed a significant increase in charcoal defecation time, 310.2 ± 67.4 min when compared to the uninfected group, which presented 97.8 ± 31.8 min, indicating that the T. cruzi infection interferes with intestinal motility. Our results demonstrate that the use of charcoal is an ethical and efficient procedure to evaluate the intestinal motility in the murine model of T. cruzi infection.     

Effects of artemether, artesunate and dihydroartemisinin administered orally at multiple doses or combination in treatment of mice infected with Schistosoma japonicum

Artemether and artesunate, derivatives of the antimalarial artemisinin, as well as their main metabolite, dihydroartemisinin, all exhibit antischistosomal activities. The purpose of the current study was to compare the effects of artemether, artesunate and dihydroartemisinin administered orally at multiple doses or combination in treatment of mice infected with Schistosoma japonicum. We carried out experiments with mice, infected with 40 cercariae of S. japonicum, and treated with artemether, aretesunate and dihydroartemisinin (all at a single dose of 300 mg/kg, and the dose of the mixed three drugs is also 300 mg/kg) at multiple doses or combination therapy on days 6–8 or 34–36 post-infection. Administration with artemether, artesunate or dihydroartemisinin for 3 successive days reduced total worm burdens by 79.5−86% (30.86 ± 4.98 of mean total worm burden in control), female worm burdens by 79.4−86.7% (11.29 ± 2.63 of mean female worm burden in control) (all P values <0.01 vs. control), depending on different treatment protocols given on days 6–8 post-infection. However, no differences were seen between each treatment group (all P > 0.05). While the same treatment was given on days 34–36 post-infection, total worm burden reductions of 73.8−75.8% were achieved (29.44 ± 3.36 of mean total worm burden in control), which were significant when compared with the untreated control group (all P values <0.01). In all different treatment groups, female worm reductions (ranging from 88.7% to 93.1%, while the mean female worm burden in control is 10.33 ± 1.80) were consistently higher than the total worm reductions, resulting always in significantly lower female worm burdens when compared to the corresponding control (all P values < 0.01). However, there were no significant differences found between each treatment group (all P values >0.05). It is concluded that artemether, artesunate and dihydroartemisinin can be used to control schistosomiasis japonica, as a strategy to prevent S. japonicum infection. Administration with artemether, artesunate and dihydroartemisinin at multiple doses or in combined treatment damages both juvenile and adult S. japonicum, without statistically significant differences among the three drugs at the same dose.     

Epidemiology of fasciolosis affecting Iberian ibex (<Emphasis Type="Italic">Capra pyrenaica</Emphasis>) in southern Spain

Between 1995 and 2006, we surveyed the presence of Fasciola hepatica in Iberian ibex (Capra pyrenaica) from Andalucía (southern Spain) by both necropsy (n = 2,096) and coprological approaches (n = 380). Most of the samples came from the Sierra Nevada mountain range (n = 1,884 and 267, respectively), and all positive cases involved animals from this location. The prevalence reached 0.53% by necropsy and 1.87% by faecal examination. Taking into account both diagnostic methodologies and the total number of animals affected (n = 14), we obtained a yearly prevalence of 0.7 ± 0.3%. The infection with F. hepatica was found not to be related to host sex, climatology or to co-infection with Sarcoptes scabiei (the most important parasite affecting Iberian ibex, with a prevalence of 49.27 ± 7.90% in the examined animals). The prevalence of fasciolosis decreased significantly during the period under study and this would be explained by an increase of ibex resistance to this fluke as a result of a reduction of the parasite abundance in the area and/or a reduction of the host infection rate. There was no statistical difference between the two diagnostic methods for the examination of fasciolosis during the period in which both methods were used. Therefore, examination of faecal samples as a non-invasive procedure may provide a useful approach for monitoring fasciolosis in wild ungulate populations. The results of the present study provided foundation for the effective control of F. hepatica infection in Iberian ibex.     

Serological detection of <Emphasis Type="Italic">Trichinella spiralis</Emphasis> in swine by ELISA (enzyme-linked immunosorbent assay) using an excretory–secretory (E/S) antigen

The enzyme-linked immunosorbent assay (ELISA) method is recommended for farm surveillance programs and may be useful for epidemiological studies in wildlife or for establishing Trichinella-free areas. In this study, our interest was to compare the specificity and the time of seroconversion of excretory–secretory (E/S) antigens prepared from Trichinella spiralis. A group of eight pigs was inoculated with 500 T. spiralis larvae per animal, and blood sampling was performed at 3 and 4-day intervals during all experiments. The numbers of muscle larvae were determined in four different muscles groups. The larvae per gram burden shows that the most heavily parasitized muscles were the diaphragm [mean = 43.7 larvae per gram (lpg)] and the tongue (mean = 16.9 lpg). Antibody responses were detected by any of eight infected pigs of T. spiralis. Using the ELISA method with E/S antigen, antibodies to T. spiralis were first found on the day 21st p.i. The initial detection of antibodies varied from 21st to 31st day p.i., and the peak was reported 42nd day p.i. Dynamic of antibodies was stable or increased slightly throughout the experimental period (60 days post-inoculation). Our results represent important data for validation of a serological test, especially if blood samples are taken during early stages of infection.     

In vitro and in vivo antileishmanial efficacy of nitazoxanide against Leishmania donovani

Control of Leishmania infection relies primarily on chemotherapy, and the current drug available for treating leishmaniasis is limited. Nitazoxanide (NTZ) is a broad spectrum antiparasitic agent with activity against protozoa, nematodes, cestodes, and trematodes. In the present study, the in vitro antileishmanial efficacy of NTZ was evaluated by incubation of Leishmania donovani promastigotes with NTZ, indicating that NTZ can affect the ultrastructure of parasite promastigote and efficiently inhibit the parasite growth. Moreover, 200 μg/ml NTZ inhibited >90% of promastigotes growth, showing similar activity of the reference drug amphotericin B (P > 0.05). Therapeutic efficacy of NTZ against L. donovani-infected BALB/c mice demonstrated that oral NTZ produced a significant reduction of parasite burden in spleen and liver from L. donovani-infected mice, compared with the untreated mice (P < 0.05). These results indicated NTZ may be a novel therapeutic drug for leishmaniasis.     

The effect of intestinal trichinellosis on oral bioavailability of albendazole in mice

The effect of Trichinella spiralis infection on the pharmacokinetic profile of orally administered albendazol has been investigated in mice during the intestinal phase of the disease. Swiss CD-1 mice were orally infected with 300 ± 50 muscle larvae of T. spiralis and then treated with albendazole (ABZ) formulated in hydroxy-propyl-beta-cyclodextrins at the dose of 10 mg/kg given orally on days 0, 5, 10 and 22 post-infection (p.i.). Blood samples were taken at 0.25, 0.5, 0.75, 1, 5, 6 and 24 h post-treatment (p.t.). Adult worm establishment as well as the histopathological alterations induced in the small intestine was assessed on days 0, 5, 10 and 22 p.i. The area under the blood concentrations to time curve (AUC) for ABZ sulphoxide was not significantly higher in infected mice than in control during the first step of intestinal infection (day 5 p.i.), whereas in the late step (day 10 p.i.), it was significantly lower. On day 22 p.i., the AUC showed similar values in both groups. The histopathological analysis showed a transient acute inflammatory reaction that varied from moderate to severe as the infection progressed from the early to the late intestinal stage. After intestinal infection, the inflammation was mild or absent with no signs of chronic effects. The histopathological studies correlated with the pharmacokinetics of ABZ and show that after transient inflammation induced by intestinal T. spiralis infection, the mucosa is restored to allow absorption of ABZ up to levels comparable to those observed in non-infected controls.     

Partial characterization of serine proteinases secreted by adult <Emphasis Type="Italic">Trichinella spiralis</Emphasis>

Serine proteinases secreted by adult Trichinella spiralis were isolated from excretory/secretory products (ES) of in-vitro-cultured parasites by affinity chromatography with p-benzamidine-celite. The purified enzymes had molecular weights of approximately 18, 40, and 50 kDa and displayed enzyme activity against a range of low-molecular-weight substrates, gelatin, and azocasein. The antigenicity of these parasite proteinases was demonstrated by the inhibition of enzymatic activity with IgG purified from infected hosts. The inactivation of major secreted proteinases of adult T. spiralis by immune antibody could presumably contribute to impairment of the survival of the parasite in sensitized hosts. Received: 29 January 2000 / Accepted: 8 February 2000     

Effects of acute <Emphasis Type="Italic">Plasmodium falciparum</Emphasis> malaria on body weight in children in an endemic area

The impacts of acute falciparum malaria on body weight and the host and parasite factors predictive of change in body weight were characterized in 465 prospectively studied children in an endemic area of southwest Nigeria. Pre-treatment weights were significantly lower than the 14 to 28-day post-treatment weights (P = 0.0001). In 187 children, fractional fall in body weight (FFBW) exceeded 4.9%. FFBW correlated negatively with age and body weight (P = 0.014 and 0.0001, respectively), but not with enrolment parasitaemia. In a multiple regression model, an age ≤5 years (AOR = 2.03, 95% CI 1.2–3.2, P = 0.003), a hematocrit ≤29% (AOR = 1.6, 95% CI 1.0–2.3, P = 0.037), and a body weight ≤9.6 kg (AOR = 5.4, 95% CI 1.7–20, P = 0.003) were independent predictors of FFBW ≥5% at presentation. Children who, after initial clearance, had recurrence of their parasitaemia within 28 days had a significantly higher propensity not to gain weight than children who were aparasitaemic after treatment (log-rank statistic 6.76, df = 1, P = 0.009). These results indicate that acute malaria contribute to sub-optimal growth in young children and may have implications for malaria control efforts in sub-Saharan Africa.     

<Emphasis Type="Italic">Stenotrophomonas maltophilia</Emphasis> pneumonia in cancer patients without traditional risk factors for infection, 1997–2004

In order to elucidate the spectrum of Stenotrophomonas maltophilia pneumonia in cancer patients without traditional risk factors, 44 cancer patients (cases) with S. maltophilia pneumonia in whom S. maltophilia pneumonia risk factors were not present were compared with two S. maltophilia pneumonia risk groups (controls) including 43 neutropenic non-intensive care unit (ICU) and 21 non-neutropenic ICU patients. The case and control patients had similar demographic and underlying clinical characteristics. Compared with case patients with S. maltophilia pneumonia, neutropenic patients had higher exposure to carbapenem antibiotics (58 vs. 41%; p < 0.03), more frequent hematologic malignancy (95 vs. 64%; p < 0.0003), and they presented with concurrent bacteremia more often (23 vs. 0%; p < 0.0005). Patients with S. maltophilia pneumonia in the ICU needed vasopressor therapy more frequently than cases (62 vs. 5%; p < 0.0001). Hospital-acquired S. maltophilia pneumonia was more common among controls than cases (98 vs. 61%; p < 0.000002). Among the cases, 15 (34%) received outpatient oral antimicrobial therapy, while 29 were hospitalized and eight (28%) were subsequently admitted to the ICU. The mean duration of ICU stay, even among these eight patients (19 ± 40 days), was comparable to that of patients with neutropenia (23 ± 26 days) and those who developed S. maltophilia pneumonia during their ICU stay (34 ± 22 days; p = 0.46). The overall infection-associated mortality in the 108 patients with S. maltophilia pneumonia was 25%. Twenty percent of patients without traditional risk factors for S. maltophilia pneumonia died due to progressive infection. In a multivariate logistic regression analysis, only admission to the ICU predicted death (odds ratio 33; 95% confidence interval, 4.51–241.2; p < 0.0006). The results of this study indicate S. maltophilia pneumonia is a serious infection even in non-neutropenic, non-ICU patients with cancer. This work was presented in part at the 15th European Congress of Clinical Microbiology and Infectious Diseases, Copenhagen, Denmark, April 2–5, 2005 (abstract no P1374) and at the 45th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy, Washington D.C., December 16–19, 2005 (abstract no K-1535).     

Differentiation of <Emphasis Type="Italic">Mycobacterium kansasii</Emphasis> infection from <Emphasis Type="Italic">Mycobacterium tuberculosis</Emphasis> infection: comparison of clinical features,radiological appearance,and outcome

This retrospective study sought to systematically identify clinical and radiological features differentiating Mycobacterium kansasii from Mycobacterium tuberculosis infection. The sample included matched patients with a culture-positive diagnosis of M. tuberculosis infection (n = 121) or M. kansasii infection (n = 62) derived from the databases of two tuberculosis centers. Data on patient background and clinical features were collected, and chest radiographs were analyzed. Sixty percent of the M. kansasii group were native Israelis compared to 15% of the M. tuberculosis group (p = 0.0001). M. tuberculosis infection was associated with a higher rate of human immunodeficiency virus (HIV) infection (p = 0.03) and M. kansasii infection with a higher rate of lung disease (p = 0.0001). M. tuberculosis infection was characterized by a higher likelihood of bilateral disease (p = 0.005), pleural effusions, and lymphadenopathy (p = 0.006 and p = 0.001, respectively). There were ten deaths, all in the M. tuberculosis group. On multivariate logistic regression, the presence of chronic obstructive pulmonary disease and associated lung disease were significant predictors of M. kansasii infection. The findings show that there are group differences between the clinical features of the two infections. In the setting of pulmonary mycobacterial infection, the presence of coinfection with HIV, bilateral disease, pleural effusion, and lymphadenopathy make M. kansasii infection very unlikely.     

Effect of xylazine–ketamine–diazepam anesthesia on certain clinical and arterial blood gas parameters in sheep and goats

This study was conducted to evaluate the effect of xylazine–ketamine–diazepam anesthesia on heart rate, respiration rate, rectal temperature, rumen motility, peripheral blood pH, PaO2, and PaCO2 in adult female nonpregnant Awassi sheep and adult female nonpregnant Damascus goats. Anesthesia was induced using 0.1 mg/kg, 5 mg/kg, and 0.25 mg/kg xylazine, ketamine, and diazepam respectively as a single intravenous injection. The heart rate, respiration rate, rectal temperature, rumen motility, peripheral arterial blood pH, PaO2, and PaCO2 were evaluated 15 min before and at 15, 30, and 60 min during anesthesia. In sheep, the heart rate, rumen motility, and PaO2 were decreased significantly (P < 0.05) at 15, 30, and 60 min following anesthesia. The respiration rate and rectal temperature and blood pH were decreased significantly (P < 0.05) at 30 and 60 min. The peripheral PaCO2 was increased significantly (P < 0.05) at 15 and 30 min. In goats, the heart rate and rumen motility were decreased significantly (P < 0.05) at 15, 30, and 60 min while the respiration rate was decreased only significantly (P < 0.05) at 60 min. Rectal temperature was decreased significantly (P < 0.05) at 30 and 60 min. The blood pH was decreased significantly (P < 0.05) at 15 and 30 min. PaO2 was only significantly (P < 0.05) decreased at 15 min while PaCO2 was increased significantly (P < 0.05) at 15 and 30 min.