Severe human infections caused by Vibrio metschnikovii

Vibrio metschnikovii is largely distributed in the aquatic environment; human infections are rarely observed. A fatal case of septicemia in a patient with liver cirrhosis, renal insufficiency, and diabetes is described. A second case in a 82-year-old woman with septicemia, respiratory problems, and infected leg lesions is reported; she was successfully treated.

Identification of vancomycin-resistant lactic bacteria isolated from humans

By using cell morphology, arginine dihydrolase, and gas production in de Man, Sharp, Rogosa broth, 122 isolates of vancomycin-resistant lactic bacteria from humans were assigned to five profiles, allowing us to distinguish Pediococcus, homofermentative and heterofermentative Lactobacillus, and Leuconostoc species. The absence of L-(+)-lactic acid, as detected spectrophotometrically, was confirmatory for Leuconostoc species. API 50 CHL panels were useful for the identification of Lactobacillus species.

[Parasitological evaluation of the stool]

The parasitologic investigation performed without clinical orientation in a routine laboratory allowed to identify the most common parasites, often cysts of protozoa, using a minimal technique. A more accurate investigation (e.g.: concentration, extraction and flotation) was hampered by a too large number of systematic specimens. The use of an immersion objective improves the detection and identification of cysts of protozoa. There is still some controversy on the virulence of small amoebae, flagellates, Blastocysts and Entamoeba coli, the infection being often massive. AIDS should predispose to new parasitic diseases such as cryptosporidiosis and strongyloidosis. A careful examination of stools for parasites has become mandatory in view of the wide geographical origin of patients with a parasitic disease.

Three cases of opportunistic infection caused by propionic acid producing Corynebacterium minutissimum

Propionic acid producing strains of Corynebacterium minutissimum were isolated from three patients with opportunistic infections. One neutropenic patient was undergoing chemotherapy for prolymphocytic leukemia; the other two patients were undergoing hemodialysis and peritoneal dialysis respectively. An unusual feature of these three strains was their resistance to several antibiotics, which is seldom seen in diphtheroids other than Corynebacterium jeikeium and CDC group D2.

Isolation of Arcanobacterium haemolyticum from patients with pharyngitis in Belgium

During a 40 months period, 49 Arcanobacterium haemolyticum strains were isolated from 12,000 throat swabs of patients with pharyngitis originating from 5 belgian provinces. All strains were recovered on sheep blood Columbia agar plates, supplemented by nalidixic acid and colistin. In two thirds of the cases, pharyngitis was associated with a rash. Half of the cases occurred in the age group between 10 and 20 years and isolates were twice more frequent in females than in males. Streptococcus pyogenes was isolated 23.2 times more frequently than Arcanobacterium haemolyticum.

Causative role of Yersinia and other enteric pathogens in the appendicular syndrome

In 2,861 consecutive patients undergoing appendicectomy for clinically suspected appendicitis an enteric pathogen was isolated from the appendix in almost 7% using an optimal combination of culture media. The pathogenic Yersinia enterocolitica serotypes 03 and 09 predominated (3.6%), followed by Campylobacter and nontyphoid Salmonella. The same pathogen was isolated from the stool in 72.5% of patients with a culture-positive appendix and in 84.1% of those positive for a pathogenic Yersinia. Conversely, no pathogenic Yersinia were isolated in 326 gynaecologic control patients, in whom a normal appendix was removed. No frank appendicitis but mesenteric adenitis and/or terminal ileitis were found in 62.3% of 138 patients with a culture positive appendix, and in 74.6% of those positive for a pathogenic Yersinia. Histologic findings available in 135 patients showed acute suppurative appendicitis in only six (4.5%) patients, and in only one of 73 (1.4%) positive for a pathogenic Yersinia. In contrast, 46.8% of a group of 345 culture-negative appendices showed acute inflammation. A positive stool culture in a patient with suspected appendicitis, if consistent with sonographic and clinical findings, should be taken as strong evidence against the presence of true appendicitis.

Infections in patients in intensive care units: can the combination of a monobactam and a penicillin replace the classic combination of a beta-lactam agent and an aminoglycoside?

An open, comparative, randomized study was performed in two medical intensive care units to compare the efficacy of the combination of aztreonam and either cloxacillin or oxacillin [(cl)oxacillin] with that of the combination of tobramycin and a cephalosporin. Of the 92 patients who were included in the study, 76 were evaluable. All patients suffered from severe, mostly pulmonary, infections and received ventilatory support. The aztreonam combination yielded an 80% rate of clinical cure; mortality was 15%. Use of the aminoglycoside combination resulted in a 51% rate of clinical cure; mortality was 23%. The difference in cure rate between the two combinations was statistically significant. Adverse effects were negligible in patients who received the aztreonam combination, and superinfection was seen in only 2%. Of the patients who received the aminoglycoside combination, 20% developed a superinfection and 11% developed a new renal insufficiency. Therefore, the combination of aztreonam and (cl)oxacillin is a valuable alternative to the combination of an aminoglycoside and a cephalosporin.

Bone marrow scintigraphy in prostatic carcinomas

Bone marrow scintigrams (MS) were performed on 73 men with histologically proven prostatic carcinomas. Follow-up data were available in 24 cases. Thirty-six patients had skeletal metastases at the time of the first MS investigation. They were compared with conventional bone scintigrams (BS) as well as clinical, biological, radiological and other follow-up data obtained for the same patients. At the present stage of revision and of follow-up of our patients, MS appeared less sensitive than BS in diagnosing skeletal metastases (94% as against 100% if all abnormal MS and BS presentations are considered as diagnostic or 83% as against 86% if more restrictive analytic criteria were applied). On the other hand, MS showed slightly higher specificity (81% for MS as against 73% for BS) when all abnormal MS and BS presentations are considered as diagnostic. With more restrictive diagnostic criteria, BS remains more specific (100%) than MS (87%). Nevertheless, the likelihood of bone metastasis is low when a normal MS is found in case of dubious BS situations, but high when the MS is pathological. In 11 patients with skeletal metastasis for whom follow-up investigations were available, MS appeared better than (4 cases) or equivalent to (6 cases) BS for evaluating the responses and the ultimate evolution of the disease. Marrow scintigrams are thus a useful tool in cases of dubious BS and for evaluating the response of skeletal metastasis to treatment.

Fatal Capnocytophaga canimorsus septicemia in a previously healthy woman

A previously healthy 47-year-old woman presented to the emergency department with septic shock five days after a small dog bite on the dorsum of her hand. Capnocytophaga canimorsus was isolated from blood cultures. Despite intensive therapy, multiple organ failure developed, and the patient died 27 days after admission. Characteristics of Capnocytophaga (formerly CDC group Dysgonic Fermenter-2) infection are briefly discussed. This unusual outcome in a previously healthy patient and the need for careful management of dog bite wounds, even if initially very small, is emphasized.

Fatal septicemia with Capnocytophaga canimorsus in a compromised host. A case report with review of the literature

Capnocytophaga canimorsus (DF-2) is a newly described gram-negative bacterium that can produce serious infections following dog bites in the immunocompromised host. We are reporting a case of C. canimorsus infection in an elderly patient with a history of chronic respiratory disease and alcohol abuse. We also give a review of the clinical spectrum of the infection, discuss the difficulty in establishing the diagnosis and the preferential treatment.

Detection of pYV+ Yersinia enterocolitica isolates by P1 slide agglutination

Rabbit polyclonal antisera were raised against the pYV-encoded outer membrane protein P1 of five Yersinia enterocolitica strains belonging to serogroups O:3, O:5,27, O:8, and O:9. Analysis of these strains with the sera showed that P1 presented at least six different antigenic factors. Two of the serum specimens were chosen to test the P1 agglutinability of 797 strains isolated from various sources. This technique appeared to be more reliable than autoagglutination and Ca2+ dependency to monitor the presence of the pYV plasmid. Hence, we propose this P1-mediated agglutination as a new and easy virulence test.

Nucleotide sequence of yst, the Yersinia enterocolitica gene encoding the heat-stable enterotoxin, and prevalence of the gene among pathogenic and nonpathogenic yersiniae

The gene encoding the heat-stable enterotoxin (yst) was cloned from the chromosome of Yersinia enterocolitica W1024 (serotype O:9), and the nucleotide sequence was determined. The yst gene encodes a 71-amino-acid polypeptide. The C-terminal 30 amino acids of the predicted protein exactly correspond to the amino acid sequence of the toxin extracted from culture supernatants (T. Takao, N. Tominaga, and Y. Shimonishi, Biochem. Biophys. Res. Commun. 125:845-851, 1984). The N-terminal 18 amino acids have the properties of a signal sequence. The central 22 residues are removed during or after the secretion process. This organization in three domains (Pre, Pro, and mature Yst) resembles that of the enterotoxin STa of Escherichia coli. The degree of conservation between the E. coli and Y. enterocolitica toxins is much lower in the Pre and the Pro domains than in the mature proteins. The mature toxin of Y. enterocolitica is much larger than that of E. coli, but the active domain appears to be highly conserved. The yst gene of Y. enterocolitica introduced in E. coli K-12 directed the secretion of an active toxin. The cloned yst gene was used as an epidemiological probe among a collection of 174 strains representative of all Yersinia species except Yersinia pestis and numerous Y. enterocolitica subgroups. In Y. enterocolitica, there was a clear-cut difference between pathogenic and nonpathogenic strains: 89 of 89 pathogenic and none of 51 nonpathogenic strains contained yst-homologous DNA, suggesting that Yst is involved in pathogenesis. Among the other Yersinia species, only four strains of Yersinia kristensenii had DNA homologous to yst.

National study on the utilization of prophylactic antibiotics in surgery, Belgium, 1986

During the last week of May 1986, a 1-week prospective study on antibiotic utilization in surgical patients was held in 104 (42%) of the 247 Belgian acute care hospitals. All surgical patients with a post-operative stay of at least 3 days were studied, involving 3112 patients. Each patient was observed for 7 days, starting from the day before surgery. Antibiotics were administered to 71.9% of all patients; 21.9% received therapeutic antibiotics and 52.9% prophylactic antibiotics; 2.9% received both. Of the 1285 patients undergoing a surgical procedure with no indication for antimicrobial prophylaxis, 50.7% nevertheless received prophylaxis; 92.8% of patients with a generally recognized indication for prophylaxis received antibiotic prophylaxis. Less than one fifth (17.1%) of all prophylactic courses were stopped on the day of the intervention whilst 26.3% were continued up to the fifth post-operative day or beyond. The most frequently prescribed drugs for this indication included first and second generation cephalosporins and nitroimidazoles. The number of different generic drugs utilized per hospital ranged from 1 to 18 (mean: 7.7).

Identification of Campylobacter jejuni and C. coli by gel electrophoresis of the outer membrane proteins

Analysis of the electrophoretic profiles of the outer membrane proteins could be used to differentiate Campylobacter jejuni (16 strains) from Campylobacter coli (10 strains). This observation was confirmed by the study of DNA homology obtained by a quantitative filter hybridization method. The hippurate hydrolysis test gave a poor correlation with the results of differentiation obtained by DNA homology studies and outer membrane protein profile.

Corynebacterium jeikeium (group JK diphtheroids) endocarditis. A report of five cases

Corynebacterium jeikeium is the name recently given to a group of coryneform rods, formerly known as the JK group, and associated with a wide range of serious infections. We describe five patients with C. jeikeium endocarditis observed in two Belgian hospitals over a period of 5 years. In three cases, the infection occurred on prosthetic heart valves between 1.5 and 5 months after surgery. The two other patients, with known mitral insufficiency, presented with endocarditis on native valves. In four patients, bacteriologic and clinical cure followed treatment with vancomycin. The fifth patient died despite eradication of the coryneforms by combination antibiotic therapy. We know of no previous reports of C. jeikeium endocarditis on native heart valves.

Legionella spp. in a hospital hot water system: effect of control measures

Potential sources of Legionella spp. in a university hospital were investigated over 3 years in order to gain better understanding of the ecology and transmission of this organism to hospitalized patients. The survey highlighted the contamination of the hot water system with high concentrations of legionellas (up to 10(6) cfu 1(-1]. Legionella pneumophila serogroup 6 was predominant followed by L. pneumophila serogroup 10. Serogroup 1 and other species (L. longbeachae, L. micdadei) were rarely isolated. Serogroup 6 was also the predominant cause of nosocomial legionellosis in 15 sporadic cases in immunocompromised patients from 1981 to 1987. In light of this problem, several control measures were tried consecutively. A disinfection cycle with 6 ppm free chlorine failed to eradicate legionellas because of difficulties with the plumbing system. Raising the temperature in hot water tanks to 80 degrees C was effective locally, but mixer tanks where cold and hot water (60-65 degrees C) are mingled in order to achieve 45 degrees C became the principal reservoirs. Disconnecting the mixer tanks, maintaining a temperature of 60 degrees C in the heating tanks and accelerating the flow rate in the hot water system proved to be the most useful measures.

Imipenem/cilastatin versus piperacillin plus amikacin as empiric therapy in the treatment of febrile episodes in neutropenic patients with haematologic malignancies

Recently, new beta-lactam antibiotics, such as imipenem/cilastatin (IMP) with an unusually broad antibacterial spectrum and especially an adequate P. aeruginosa activity, have introduced the possibility of using prospective agent as empiric management of febrile granulocytopenic patients. We randomized 83 febrile neutropenic cancer patients for a prospective evaluation of two regimens: IMP versus piperacillin plus amikacin (PA). Both patients groups were similarly distributed with regard to age, sex, primary diagnosis and degree of granulocytopenia. More than 20% of the 74 evaluable patients had bacteraemia. The overall response rate for clinically or microbiologically documented infections was 90% in the IMP regimen versus 76% in the PA regimen, but statistical difference was not achieved. All bacteraemias in the IMP group but only 60% in the PA group were cured, however statistical difference was not achieved. IMP had to be discontinued in only one patient and the most common side effects were nausea and vomiting; no seizures were noted. Nephro- and ototoxicity, skin rash and bleeding have been the major side effects requiring drug discontinuation in 6 patients treated by PA. In conclusion, these data suggest that IMP used alone is safe and as effective as the combination of P plus A for the management of febrile granulocytopenic patients with haematologic malignancies. Further studies on a larger number of patients are needed to confirm these findings.