Xanthogranulomatous pyelonephritis complicated by psoas abscess

Xanthogranulomatous pyelonephritis is an unusual variant of chronic pyelonephritis. Xanthogranulomatous pyelonephritis is associated with urinary calculi, urinary tract obstruction, and invasion of the renal parenchyma. Pathologically, xanthogranulomatous pyelonephritis consists of a yellow (xantho) colored infiltrate in renal tissue with granulomatous formation. Xanthogranulomatous pyelonephritis may be distinguished from chronic pyelonephritis by renal size. Typically, the kidneys are enlarged in xanthogranulomatous pyelonephritis and are small/shrunken with chronic pyelonephritis. The diagnosis of xanthogranulomatous pyelonephritis is made by abdominal computed tomography scanning showing the characteristic "bear paw" sign, or findings typical for xanthogranulomatous pyelonephritis, eg, multiple hypo dense areas with ring-enhancing lesions. The definitive treatment for xanthogranulomatous pyelonephritis is antimicrobial therapy and nephrectomy. We present a case of xanthogranulomatous pyelonephritis complicated by psoas abscess.     

Xanthogranulomatous cystitis as a cause of elevated carcinoembryonic antigen mimicking recurrent colorectal cancer

We report a case of xanthogranulomatous cystitis that developed in a patient with a history of colon cancer. While undergoing adjuvant chemotherapy with fluorouracil and levamisole, rising carcinoembryonic antigen (CEA) levels and the appearance of a pelvic mass, suspicious for recurrent cancer, were identified. Exploratory laparotomy demonstrated the presence of a benign condition of the bladder, xanthogranulomatous cystitis, which was resected by partial cystectomy. CEA levels have normalized. This is the first reported case of xanthogranulomatous cystitis producing an elevated CEA level.     

An Escherichia coli strain with all chromosomal rRNA operons inactivated: complete exchange of rRNA genes between bacteria

Current global phylogenies are built predominantly on rRNA sequences. However, an experimental system for studying the evolution of rRNA is not readily available, mainly because the rRNA genes are highly repeated in most experimental organisms. We have constructed an Escherichia coli strain in which all seven chromosomal rRNA operons are inactivated by deletions spanning the 16S and 23S coding regions. A single E. coli rRNA operon carried by a multicopy plasmid supplies 16S and 23S rRNA to the cell. By using this strain we have succeeded in creating microorganisms that contain only a foreign rRNA operon derived from either Salmonella typhimurium or Proteus vulgaris, microorganisms that have diverged from E. coli about 120-350 million years ago. We also were able to replace the E. coli rRNA operon with an E. coli/yeast hybrid one in which the GTPase center of E. coli 23S rRNA had been substituted by the corresponding domain from Saccharomyces cerevisiae. These results suggest that, contrary to common belief, coevolution of rRNA with many other components in the translational machinery may not completely preclude the horizontal transfer of rRNA genes.     

Xanthogranulomatous pancreatic abscess secondary to acute pancreatitis: two case reports

Xanthogranuloma is a rare type of inflammation and very few cases have been reported in the pancreas. We report two cases with xanthogranulomatous pancreatic abscess that followed acute pancreatitis. In both cases, multiple pseudocysts in the pancreatic tail were infected with several species of bacteria and Candida albicans. In one case, abdominal angiography revealed a hypoperfused pancreatic tail due to prior atherosclerotic obliteration of the celiac and superior mesenteric arteries. In the other case, the splenic artery was completely occluded by a transarterial embolization performed to treat an aneurysm that appeared in the course of pancreatitis. In both cases, distal pancreatectomy was performed as inflammation of the pancreatic tail was resistant to conventional antibiotic therapy, and pathologic examination revealed xanthogranulomatous inflammation around the pancreatic tail and spleen. Although the underlying pathogenesis is unclear, the prolonged infection and/or relative hypoxia induced by hypoperfusion are likely causative factors for the xanthogranulomatous changes in these pancreatic abscesses.     

Bacille Calmette-Guerin (BCG) associated epididymitis: a case report and review

A case of Bacille Calmette-Guerin (BCG)-associated epididymitis that was non responsive to 6 months of antituberculous therapy, but stable after 2 years, is reported. We review the clinical and pathological features of previously reported cases of pathologically diagnosed BCG-associated epididymitis. Surgery has been the primary treatment for BCG-associated epididymitis in all previous cases.     

Escherichia coli expressing a Neisseria gonorrhoeae opacity-associated outer membrane protein invade human cervical and endometrial epithelial cell lines.

Members of the opacity-associated (Opa) outer membrane protein family of Neisseria gonorrhoeae have been proposed to mediate adherence to and invasion of cultured human epithelial cells. We transformed Escherichia coli with a plasmid containing a gonococcal opa gene fused in-frame to the leader sequence of the beta-lactamase gene as described by Palmer et al. [Palmer, L., Brooks, G. F. & Falkow, S. (1989) Mol. Microbiol. 3, 663-671]. These transformed E. coli [E. coli (opa)] expressed the heat-modifiable opa gene product (the Opa protein) in their outer membrane and adhered to and invaded ME-180 human endocervical epithelial cells. In a 2-h adherence assay, an average of 26.7 E. coli (opa) adhered per ME-180 cell, whereas the control E. coli carrying only the expression vector (pKT279) did not adhere at all (less than 0.15 bacterium per cell). We investigated the ability of the adherent E. coli (opa) to invade ME-180 epithelial cells by using a gentamicin selection assay. We recovered up to 1 x 10(6) gentamicin-resistant bacteria per monolayer when ME-180 cells were infected with E. coli (opa) compared to less than 10 bacteria when the epithelial cells were infected with the same number of control E. coli (pKT279). The kinetics and level of invasion by E. coli (opa) were similar to invasion by Opa+ N. gonorrhoeae. Maximum invasion occurred 4 h after infection with 4 x 10(7) bacteria. Transmission electron microscopy studies confirmed that E. coli (opa) invaded ME-180 cells. In comparative studies, the number of E. coli (opa) that invaded HEC-1-B human endometrial epithelial cells was about an order of magnitude less than the number that invaded ME-180 cells, and E. coli (opa) did not invade Chang human conjunctival epithelial cells at all. The observations that early (less than 4 h) invasion by E. coli (opa) was dramatically inhibited, in a dose-responsive manner, by the actin-disrupting reagent cytochalasin D but later invasion (8-24 h) was not suggest that invasion mediated by Opa proteins may occur by two mechanisms, only one of which is dependent upon microfilament function. Transmission electron microscopy also revealed that infected epithelial cells had a dramatically increased amount of cytoplasmic fibrillar material surrounding the nucleus. The function and genesis of this material remain unclear. These studies indicate that at least one gonococcal Opa protein is an invasin.     

PapG-dependent adherence breaks mucosal inertia and triggers the innate host response

Mucosal pathogens differ from normal flora constituents in that they provoke a host response that upsets mucosal integrity. We investigated whether the elaboration of discrete adherence factors is sufficient to break the inertia of the mucosal barrier. PapG-mediated adherence was selected as an example, because P fimbrial expression characterizes uropathogenic Escherichia coli and because adherence starts the attack on the mucosal barrier. Patients were inoculated intravesically with transformed nonvirulent E. coli strains expressing functional P fimbriae (E. coli pap(+)) or mutant fimbriae lacking the adhesin (E. coli Delta papG). E. coli pap(+) was shown to activate the innate host response, and adherent gfp(+) bacteria were observed on excreted uroepithelial cells. E. coli Delta papG failed to trigger a response and was nonadhesive. We conclude that PapG-mediated adherence breaks mucosal inertia in the human urinary tract by triggering innate immunity and propose that this activation step differentiates asymptomatic carriage from infection.     

Escherichia coli septic arthritis of a shoulder in a diabetic patient

Escherichia coli septic arthritis is rare and usually occurs in patients with underlying systemic disorders. Most commonly the hip joint is involved and the E. coli septic arthritis is caused by an intraabdominal source (e.g., an abscess communicating with the hip joint). We report the first case of E. coli septic arthritis involving the shoulder joint in a diabetic patient.     

A rare extrahepatic syndrome related to acute hepatitis type B: epididymitis in an adolescent

Hepatitis B is a common, vaccine-preventable infection with high mortality and morbidity rates worldwide. Numerous extrahepatic syndromes have been described in patients with either acute or chronic viral hepatitis B. But there is no previous report of co-existence of HBV infection and epididymitis in the English literature. We would like to present and discuss a 12-year-old male patient with epididymitis that might be relation exist with an underlying acute hepatitis B infection.     

The Yeast Phenylalanyl-Transfer RNA Synthetase Recognition Site: The Region Adjacent to the Dihydrouridine Loop

Purified yeast phenylalanyl-tRNA synthetase can aminoacylate (yeast) tRNA(Phe), (wheat) tRNA(Phe), and (Escherichia coli) tRNA(1) (Val) (1, 2). We now report that this synthetase can also aminoacylate (E. coli) tRNA(Phe) and (E. coli) tRNA(1) (Ala). Highly purified (E. coli) tRNA(Phe) is heterologously aminoacylated to approximately 90% of the extent achieved with the homologous enzyme (crude E. coli phenylalanyl-tRNA synthetase). Pure (E. coli) tRNA(1) (Ala) (the major species) is heterologously aminoacylated to 70% of the extent achieved with the homologous synthetase (crude E. coli alanyl-tRNA synthetase).(E. coli) tRNA(Phe) is the fourth purified transfer RNA of known sequence to be shown to be an acceptable substrate for purified yeast phenylalanyl-tRNA synthetase. A comparison of these sequences shows that only one region is extremely similar in all four tRNAs. This region is located adjacent to the dihydrouridine loop, and consists of the nucleotides [Formula: see text] We conclude that this is the synthetase recognition site for yeast phenylalanyl-tRNA synthetase.This conclusion is further supported by partial fragment analysis of (E. coli) tRNA(1) (Ala).     

Serious Complications of Tuberculous Epididymitis

Summary Tuberculous epididymitis is a rare entity associated with minor complications. We present two cases of tuberculous epididymitis associated with serious complications (bilateral psoas abscesses and Addison's disease with psoas abscess). A review of the literature disclosed six additional cases associated with serious complications (Addison's disease, inappropriate antidiuretic hormone secretion, central nervous system involvement) which are discussed and compared to these cases. We conclude that tuberculous epididymitis represents a grave sequela of genital tract involvement and may be associated with serious and even fatal complications. Received: October 20, 1999 · Revision accepted: February 23, 2000     

A human RNase E-like activity that cleaves RNA sequences involved in mRNA stability control.

We have detected an endoribonucleolytic activity in human cell extracts that processes the Escherichia coli 9S RNA and outer membrane protein A (ompA) mRNA with the same specificity as RNase E from E. coli. The human enzyme was partially purified by ion-exchange chromatography, and the active fractions contained a protein that was detected with antibodies shown to recognize E. coli RNase E. RNA containing four repeats of the destabilizing motif AUUUA and RNA from the 3' untranslated region of human c-myc mRNA were also found to be cleaved by E. coli RNase E and its human counterpart in a fashion that may suggest a role of this activity in mammalian mRNA decay. It was also found that RNA containing more than one AUUUA motif was cleaved more efficiently than RNA with only one or a mutated motif. This finding of a eukaryotic endoribonucleolytic activity corresponding to RNase E indicates an evolutionary conservation of the components of mRNA degradation systems.     

The pathogen-associated iroA gene cluster mediates bacterial evasion of lipocalin 2

Numerous bacteria cope with the scarcity of iron in their microenvironment by synthesizing small iron-scavenging molecules known as siderophores. Mammals have evolved countermeasures to block siderophore-mediated iron acquisition as part of their innate immune response. Secreted lipocalin 2 (Lcn2) sequesters the Escherichia coli siderophore enterobactin (Ent), preventing E. coli from acquiring iron and protecting mammals from infection by E. coli. Here, we show that the iroA gene cluster, found in many pathogenic strains of Gram-negative enteric bacteria, including E. coli, Salmonella spp., and Klebsiella pneumoniae, allows bacteria to evade sequestration of Ent by Lcn2. We demonstrate that C-glucosylated derivatives of Ent produced by iroA-encoded enzymes do not bind purified Lcn2, and an iroA-harboring strain of E. coli is insensitive to the growth inhibitory effects of Lcn2 in vitro. Furthermore, we show that mice rapidly succumb to infection by an iroA-harboring strain of E. coli but not its wild-type counterpart, and that this increased virulence depends on evasion of host Lcn2. Our findings indicate that the iroA gene cluster allows bacteria to evade this component of the innate immune system, rejuvenating their Ent-mediated iron-acquisition pathway and playing an important role in their virulence.     

Association between bacterial vaginosis and acute cystitis in women using diaphragms

We hypothesized that the increased vaginal fluid pH and altered vaginal microflora characteristic of bacterial vaginosis might predispose young women to introital colonization with Escherichia coli and to acute cystitis. To evaluate this hypothesis, we studied 291 women who presented with acute urinary symptoms for association of clinically defined bacterial vaginosis and vaginal conditions associated with this syndrome (increased vaginal fluid pH, absence of lactobacilli, and abnormal vaginal fluid gas-liquid chromatographic patterns) with E coli introital colonization and urinary tract infection. Escherichia coli introital colonization and urinary tract infection were both significantly more frequent among women with a high vaginal fluid pH, an absence of vaginal lactobacilli, or an abnormal vaginal fluid gas-liquid chromatographic pattern characteristic of bacterial vaginosis. Escherichia coli introital colonization was also more frequent in women with bacterial vaginosis. These associations and an association of bacterial vaginosis and E coli urinary tract infection were strong only among the 144 women who were diaphragm users. We conclude that bacterial vaginosis, or an altered vaginal microflora as reflected by an abnormal gas-liquid chromatographic pattern characteristic of bacterial vaginosis, is associated with E coli introital colonization and acute symptomatic urinary tract infection in women who use diaphragms.     

Whipple's disease with destructive arthritis,abdominal lymphadenopathy,and central nervous system involvement

We describe a patient with Whipple's disease who had an unusual erosive and destructive polyarthritis, massive abdominal lymphadenopathy, asymptomatic central nervous system involvement, and rare manifestations of orbital pseudotumor and orchitis with epididymitis. Taking oral therapy with trimethoprim-sulfamethoxazole he had recurrent flares of orbital pseudotumor, an episode of orchitis with epididymitis, and persistent polymerase chain reaction T. whipplei-positive cerebrospinal fluid. Resolution was achieved with a one month course of intravenous ceftriaxone and a 6 month course of azithromycin, and no relapse occurred during 24 months of followup.     

Sepsis caused by food-borne infection with Escherichia coli

We report a case of sepsis caused by Escherichia coli (E. coli) of serotype O-143. A 78-year-old man developed symptoms of gastroenteritis after ingesting raw meat on noodles. He rapidly developed respiratory failure. Blood culture grew E. coli. The sepsis seemed to have directly spread from a food-borne infection. The development of primary sepsis after ingesting E. coli is very rare. We suspect that bacterial translocation played a major role. Serotype O-143 is recognized in enteroinvasive E. coli (EIEC) as well as in Shigella dysenteriae. The pathogen in the present case is suspected of being EIEC although the isolated E. coli strain was negative for the inv and ipa genes.     

Changes of plasma gastrointestinal glucagon concentrations following lethal infusions of E. coli

We have determined the effect of lethal E. coli infusions in dogs on plasma concentrations of pancreatic and gastrointestinal-derived glucagon and have explored the contributions of each source of glucagon during the early and recovery phases of shock. We examined 18 adult dogs in three protocols: group I received LD100 E. coli alone, group II received LD100 E. coli + tobramycin (TOB), and group III received LD100 E. coli + TOB + methylprednisolone sodium succinate (MPSS). E. coli organisms were infused intravenously during a 1-hour period and each animal was monitored for 6 hours and observed for a 7-day recovery period. Plasma concentrations of pancreatic and gastrointestinal glucagon were determined by specific RIAs. The survival percentages (greater than 7 days) were 0% in group I, 17% in group II, and 83% in group III. Early progressive increases in plasma concentrations of pancreatic and gastrointestinal-derived glucagon, reaching statistical significance by 6 hours following the onset of E. coli administration, were seen in the three groups. The increase in gastrointestinal-derived glucagon was of a greater magnitude than that from the pancreas. Attenuation of the increase appeared to be achieved by corticosteroid infusion during its time of administration (6 hours). Recovery from shock was characterized by an exceptionally slow return (greater than or equal to 7 days) to control levels of glucagon in all recovering animals.     

多耐药大肠埃希菌NB8株全基因组耐药基因检测

目的检测1株多耐药大肠埃希菌NB8株的遗传学背景。方法病原分离自2012年4月宁波市第一医院住院患者尿液,作16S rDNA和gyrA基因测序、BLASTn比对确认为大肠埃希菌,采用Illumina HiSeq与Ion Torrent PGM两种大规模并行测序仪进行全基因组分析,再行人工测序。最后NB8株和9株已完成全基因组测序的大肠埃希菌耐药基因的比较基因组学研究。结果多耐药大肠埃希菌NB8株全基因组测序得到一条推定的染色体序列,长4 550 369 bp (内含14个缺口),得到一条推定的质粒序列,长635 377 bp(内含33个缺口)。从NB8株全基因组数据中挖掘出了β-内酰胺类、氨基糖苷类、喹诺酮类、大环内酯类、磺胺类、四环素类、多粘菌素的耐药基因,并挖掘出接合性质粒、转座子、插入序列、整合子的遗传标记,以及5大类外排泵基因。结论多耐药大肠埃希菌NB8株遗传学背景明确,主动外排机制增强也会导致或者增强NB8株的耐药性。质粒、转座子和整合子等可移动遗传元件可以使细菌的耐药性得以快速传播,使受体菌表现为多重耐药。     

A case of perforated xanthogranulomatous cholecystitis presenting as biloma

Xanthogranulomatous cholecystitis is an unusual inflammatory disease of the gallbladder characterized by severe proliferative fibrosis and the accumulation of lipid-laden macrophages in areas of destructive inflammation. Its macroscopic appearance may occasionally be confused with gallbladder carcinoma. We present a case of perforated xanthogranulomatous cholecystitis presenting as biloma. An 80-year-old woman was referred to our hospital with a 1-week history of abdominal pain and febrile sensation. Abdominal CT showed a biloma in the subhepatic area. The follow-up CT showed that the biloma increased in size. Therefore, ultrasonography-guided aspiration was performed. The aspirated fluid/serum bilirubin ratio was greater than 5, which was strongly suggestive of bile leakage complicated by perforated cholecystitis. She underwent a laparoscopic cholecystectomy with cyst aspiration and adhesiolysis. A histological diagnosis of perforated xanthogranulomatous cholecystitis was made.     

Burden of community-onset Escherichia coli bacteremia in seniors

BACKGROUND: Although Escherichia coli is a well-recognized cause of urinary tract infection in seniors, little is known about the burden of invasive E. coli infection in this population. METHODS: We conducted a population-based cohort study of 46,238 noninstitutionalized Group Health Cooperative members>or=65 years of age to ascertain incidences of community-onset E. coli bacteremia and, for comparison, pneumococcal bacteremia, and we then performed a case-control study to identify risk factors for community-onset E. coli bacteremia. RESULTS: The overall rate of community-onset E. coli bacteremia in the study cohort was 150 cases/100,000 person-years, which was approximately 3 times higher than the rate of pneumococcal bacteremia. In the case-control study, urinary catheterization and urinary incontinence were the only factors associated with an increased risk of E. coli bacteremia in men (62 cases), whereas cancer, renal failure, congestive heart failure, coronary artery disease, and urinary incontinence were associated with an increased risk of E. coli bacteremia in women (119 cases). CONCLUSIONS: E. coli appears to be the leading cause of community-onset bacteremia in seniors, and, on the basis of these rates, we estimate that 53,476 cases occur in noninstitutionalized seniors each year in the United States. Community-onset E. coli bacteremia in seniors is, therefore, an infection of public health importance.