Comparison of antigen detection and PCR assay using bronchoalveolar lavage fluid for diagnosing invasive pulmonary aspergillosis in patients receiving treatment for hematological malignancies.

The performance of a sandwich enzyme-linked immunosorbent assay (ELISA) which detects Aspergillus galactomannan (GM) was evaluated in bronchoalveolar lavage (BAL) fluid samples from 19 patients who were treated for hematological malignancies and who were suspected of having invasive pulmonary aspergillosis (IPA). All patients had fever and pulmonary infiltrates on the chest roentgenogram on the day that the BAL fluid was obtained. The ELISA results were compared with the results of culture and Aspergillus genus-specific PCR analysis of BAL fluid samples. ELISA was also performed with serum samples. Aspergillus species were detected by PCR or ELISA with BAL fluid samples from five of seven patients who had radiological evidence of IPA. Serum ELISA results were positive for all patients with ELISA-positive BAL fluid, and for four patients the serum ELISA was positive before the BAL fluid was obtained. PCR and ELISA were positive for 2 and 1 of 10 BAL fluid samples, respectively, obtained from patients without radiological evidence of IPA, and 5 and 2 of 35 BAL fluid samples, respectively, obtained from nonneutropenic patients. This preliminary investigation suggests that GM may be detected by ELISA in BAL fluid samples from patients at risk of IPA, but that monitoring of serum GM levels may allow for the earlier diagnosis of IPA. However, further evaluation in prospective studies is required.     

Ciprofloxacin vs. cefotaxime regimens for the treatment of intra-abdominal infections

Summary The efficacy of ciprofloxacin plus metronidazole was compared with that of cefotaxime plus gentamicin plus metronidazole in 79 patients with proven intra-abdominal infections. Patients were classified with the Peritonitis Index Altona-II (PIA-II) score for severity of disease, underlying conditions, prognosis and type of infection. Local peritonitis was diagnosed in 21 patients, generalized peritonitis in 25, intra-abdominal abscesses in 33; 35 patients had polymicrobial infections. Cure and improvement rates were: ciprofloxacin 77%, cefotaxime combination 56% (p<0.02). Failures were significantly associated with a low initial PIA-II score, the presence of generalized peritonitis or abscesses, persistence of pathogens and superinfection. Superinfection was observed in 49% of the cases under cefotaxime and in 30% under ciprofloxacin. Concentrations of ciprofloxacin in pus ranged 2.0–5.2 mg/l with simultaneous serum concentrations of 1.2–3.1 mg/l.

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Behandlung intraabdomineller Infektionen mit Ciprofloxacin im Vergleich zu einem Cefotaxim-haltigen Regime

Zusammenfassung Die Wirksamkeit der Kombination Ciprofloxacin-Metronidazol wurde mit der Kombination Cefotaxim plus Gentamicin plus Metronidazol bei 79 Patienten mit erwiesener intraabdomineller Infektion verglichen. Der Schweregrad der Erkrankung wurde nach dem Peritonitis-Index Altona-II (PIA-II)-Score klassifiziert, erfaßt wurden außerdem Grundkrankheiten, Prognose und Art der Infektion. Eine lokale Peritonitis lag bei 21 Patienten vor, eine generalisierte Peritonitis bei 25. In 33 Fällen fanden sich intraabdominelle Abszesse. In 35 Fällen handelte es sich um eine polymikrobielle Infektion. Die Rate an Heilungen und Besserungen betrug bei Patienten, die Ciprofloxacin erhalten hatten, 77%, bei Patienten, die mit der Cefotaxim-Kombination behandelt wurden, 56% (p<0,02). Eine signifikante Korrelation zu Therapieversagen bestand mit einem niedrigen initialen PIA-II-Score, dem Vorliegen einer generalisierten Peritonitis oder Abszessen, der Erregerpersistenz und einer Superinfektion. In 49% der mit Cefotaxim behandelten und bei 30% der mit Ciprofloxacin behandelten Fälle wurden Superinfektionen beobachtet. Die Konzentrationen von Ciprofloxacin im Eiter lagen in einem Bereich von 2,0–5,2 mg/l bei zeitgleichen Serumkonzentrationen von 1,2–3,1 mg/l.

     

Multiple brain abscesses and bacteremia in a child due toFusobacterium necrophorum

Summary A case ofFusobacterium necrophorum bacteremia and multiple brain abscesses in a 6-year-old child following aMycoplasma pneumoniae infection is described. Brain abscess due to this microorganism has only been described in three other cases since 1977. The clinical picture was consistent with postanginal septicemia, with septic metastatic complications normally only seen in teenagers and young adults. The patient was successfully treated with a 2-month course of parenteral penicillin G and metronidazole.

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Multiple Hirnabszesse und Bakteriämie durch Fusobacterium necrophorum bei einem Kind

Zusammenfassung Eine Bakteriämie, kompliziert durch multiple Hirnabszesse, trat bei einem sechs Jahre alten Kind nach einer Atemwegsinfektion durchMycoplasma pneumoniae auf. Seit 1977 wurden nur drei Fälle von Hirnabszeß durchF. necrophorum beschrieben. Das klinische Bild war vergleichbar mit einer postanginösen Bakteriämie mit septischer Komplikation, wie sie normalerweise bei jungen Erwachsenen gefunden wird. Die parenterale Behandlung mit Penicillin-G und Metronidazol für zwei Monate führte zur Heilung.

     

Treatment of chronic postsurgical osteomyelitis with ciprofloxacin

Sixteen patients (11F, 5M, age 18–83, mean 59.8 years) with chronic postsurgical osteomyelitis were treated with ciprofloxacin. The dosage was 500 or 750 mg twice daily orally during one to six months; four patients started with 300 mg twice daily intravenously and changed after 3–7 days to oral therapy. Twelve patients had implanted prostheses. The organisms involved wereEnterobacteriaceae (11),Pseudomonas aeruginosa (7),Staphylococcus aureus (5),Streptococcus faecalis (4) andBacteroides fragilis (1). Nine patients had pure cultures, seven mixed cultures.

Cure (disappearance of infection symptoms, return of normal function with negative cultures, without resurgery) was obtained in 11 patients, improvement (resurgery required to obtain complete cure) in two. Three patients with infections byStaphylococcus aureus (2) andPseudomonas aeruginosa (1) failed to respond after one and four months treatment respectively. No side effects were observed.

     

Comparative in vitro activity of moxifloxacin against Gram-positive clinical isolates

The in vitro activity of moxifloxacin was compared with that of 15 antibacterial agents against 513 Gram-positive microorganisms. The MIC(90) (mg/L) of moxifloxacin was 0.06 for quinolone-susceptible Staphylococcus aureus and Staphylococcus epidermidis, 0.12 for Streptococcus pyogenes and Streptococcus agalactiae; 0.25 for Streptococcus pneumoniae, Streptococcus mitis, Streptococcus bovis, Streptococcus anginosus and Actinomyces pyogenes; 0.5 for Streptococcus sanguis and Listeria monocytogenes, 2 for Corynebacterium jekeium and Bifidobacterium bivius. Over 50% of Enterococcus faecalis, Enterococcus faecium, quinolone-resistant staphylococci, Nocardia steroides and Clostridium difficile were susceptible to 2 mg/L moxifloxacin. Moxifloxacin and trovafloxacin demonstrated comparably high activity towards Gram-positive cocci; moxifloxacin and clinafloxacin were most active against Gram-positive bacilli.     

The Impact of Nontuberculous Myobacteria on Management of Presumed Pulmonary Tuberculosis

Background: The presence of nontuberculous mycobacteria (NTM) in sputum or bronchial washings may cause diagnostic problems which affect clinical management. Patients and Methods: In a retrospective analysis of 135 patients in a Dutch tuberculosis center, patients with NTM isolates were thoroughly investigated. Colonization or contamination by NTM was differentiated from true lung disease. Results: 25 HIV-seronegative and two HIV-seropositive patients with NTM were identified. NTM were a likely cause of disease in only 14 (52%) patients. In 15 (55%), their presence led to preliminary diagnosis and treatment of tuberculosis. Unnecessary or inappropriate treatment was instituted in 17 (63%) patients with NTM. In two patients, detection of NTM in sputum also led to delay in diagnosing malignant disease. Conclusion: In this series, NTM in sputum or bronchial washings poorly reflected disease and often led to diagnostic and therapeutic errors. Although it is common knowledge that the presence of NTM should be considered in smear-positive patients, this apparently is a diagnostic pitfall in clinical practice. Reliable DNA-based techniques and better communication between physicians and microbiologists may improve management of suspected mycobacterial infections. Received: July 20 · Revision accepted: December 21, 2000     

A primer on cytokines: sources, receptors, effects, and inducers.

Protection against pathogens is a prerequisite for survival of most organisms. To cope with this continuous challenge, complex defense mechanisms have evolved. The construction, adaptation, and maintenance of these mechanisms are under control of an extensive network of regulatory proteins called cytokines. A great number of cytokines have been described over the last 2 decades. This review consists of an overview of cytokines that are involved in immune responses and describes some historical and general aspects as well as prospective clinical applications. Major biological effects together with information on cytokine receptors, producers, inducers, and biochemical and molecular characteristics are listed in tables. In addition, some basic information is given on cytokine receptor signal transduction. Finally, the recent discoveries of cytokine receptors functioning as coreceptors in the pathogenesis of human immunodeficiency virus are summarized.     

Occurrence of yeast bloodstream infections between 1987 and 1995 in five Dutch university hospitals

The aim of this study was to identify retrospectively trends in fungal bloodstream infections in The Netherlands in the period from 1987 to 1995. Results of over 395,000 blood cultures from five Dutch university hospitals were evaluated. Overall, there were more than 12 million patient days of care during the nine-year study period. The rate of candidemia doubled in the study period, reaching an incidence of 0.71 episodes per 10,000 patient days in 1995. The general increase in candidemia was paralleled by an increase in non-Candida albicans bloodstream infections, mainly due toCandida glabrata. However, more than 60% of the infections were caused byCandida albicans. Fluconazoleresistant species such asCandida krusei did not emerge during the study period. The increasing rate of candidemia found in Dutch university hospitals is similar to the trend observed in the USA, but the rate is lower and the increase is less pronounced.For the Workgroup of Hospital infection Epidemiology of the Netherlands (WHEN), University Hospitals of Amsterdam, Nijmegen, Rotterdam, and Utrecht.     

Activity of cefotaxime and ceftriaxone alone and in combination with penicillin, ampicillin and piperacillin against neonatal meningitis pathogens

The activities of penicillin G, ampicillin, piperacillin, cefotaxime and ceftriaxone alone and in combination against 130 isolates of Escherichia coli, group B streptococci and Listeria monocytogenes from neonatal meningitis were assessed by using agar dilution, checkerboard and time-kill techniques. Cefotaxime and ceftriaxone were highly active against E. coli and group B streptococci (MIC90 0.05-0.1 mg/1) but not active against List. monocytogenes. Penicillin G was more active than ampicillin and piperacillin against group B streptococci (MIC90 0.1, 0.12 and 0.24 mg/l respectively) and ampicillin was the most active against List. monocytogenes (MIC90 0.6 mg/l). Every double beta-lactam combination was synergistic for 3-14% of E. coli, 8-26% of group B streptococci and 67-100% of List. monocytogenes in the checkerboard titration. The ceftriaxone combinations were less synergistic than the cefotaxime combinations. In time-kill evaluations using concentrations representative for cerebrospinal fluid, the killing kinetics of E. coli were not influenced by any combination. A significant delay in killing of group B streptococci was observed with penicillin G-cephalosporin and ampicillin-cephalosporin combinations. A significant increased killing of List. monocytogenes was observed with penicillin G-cephalosporin combinations. The other combinations did not alter the killing kinetics of group B streptococci and List. monocytogenes.     

Fatal infection withBorrelia burgdorferi by involvement of the cardiac conducting system

The cardiac conducting system of a patient with fatal cardiac involvement byB. burgdorferi showed necrosis of associated muscle fibers in the sinoatrial node with lymphoplasmacytic infiltrate and focal edema. Lymphocytic infiltrate was also found around the atrioventricular node and in the penetrating bundle and branching bundle. Fibrosis in the left bundle branch apparently resulted in nearly complete discontinuation of the fibers. Peripheral neural and muscular tissue also showed signs of inflammation. Spirochetes were demonstrated in the branching bundle and between the muscular fibers of the right atrium. Peripheral neural and muscular tissue showed signs of disseminated Lyme borreliosis.Presented at The 35th World Congress, International College of Angiology, Copenhagen, Denmark, July 1993