Rapid diagnosis of anaerobic infections by gas-liquid chromatography of clinical material

Quantification of the antibody response to Propionibacterium acnes in a patient with prosthetic valve endocarditis: - a case report

Background

The isolation of Propionibacterium acnes in blood cultures is often considered a contaminant. On rare occasions, P. acnes can cause severe infections, including endocarditis and intravascular prosthesis-associated infections. To evaluate the discrimination between a contaminant and a clinically relevant infection we used an Ouchterlony test system to quantify the antibody response to P. acnes in a patient with a proven P. acnes endocarditis.

Case presentation

We report on a 64-year-old Caucasian man who developed P. acnes endocarditis four years following a composite valve-graft conduit replacement of the aortic root. Bacterial growth in blood cultures was detected after an incubation period of 6 days. However, the antibody titer to P. acnes was 1:8 at the time of diagnosis and declined slowly thereafter over 2½ years. The patient’s response to the antibiotic treatment was excellent, and no surgical re-intervention was necessary.

Conclusion

The working hypothesis of infective endocarditis can be substantiated by serologic testing, which, if positive, provides one additional minor criterion. Moreover, quantification of the antibody response to P. acnes, though not specific, may assist in the differentiation between contaminants and an infection. This quantification may have implications for the patient management, e.g. indication for and choice of the antibiotic therapy.

Analysis of volatile organic compounds of bacterial origin in chronic gastrointestinal diseases

BACKGROUND

The aim of this study was to determine whether volatile organic compounds (VOCs) present in the headspace of feces could be used to diagnose or distinguish between chronic diseases of the gastrointestinal tract and apparently healthy volunteers.

METHODS

A total of 87 people were recruited, divided between 4 categories: healthy volunteers (n = 19), Crohn's disease (n = 22), ulcerative colitis (n = 20), and irritable bowel syndrome (n = 26). They each supplied fecal samples before, and except for the healthy volunteers, after treatment. Fecal samples were incubated in a sample bag with added purified air at 40°C and headspace samples were taken and concentrated on thermal sorption tubes. Gas chromatography-mass spectrometry then desorbed and analyzed these. The concentrations of a selection of high-abundance compounds were determined and assessed for differences in concentration between the groups.

RESULTS

Crohn's disease samples showed significant elevations in the concentrations of ester and alcohol derivates of short-chain fatty acids and indole compared with the other groups; indole and phenol were elevated in ulcerative colitis and irritable bowel syndrome but not at a statistically significant level. After treatment, the levels of many of the VOCs were significantly reduced and were more similar to those concentrations in healthy controls.

CONCLUSIONS

The abundance of a number of VOCs in feces differs markedly between Crohn's disease and other gastrointestinal conditions. Following treatment, the VOC profile is altered to more closely resemble that of healthy volunteers.

Microbial volatile compounds in health and disease conditions

Microbial cultures and/or microbial associated diseases often have a characteristic smell. Volatile organic compounds (VOCs) are produced by all microorganisms as part of their normal metabolism. The types and classes of VOC produced is wide, including fatty acids and their derivatives (e.g. hydrocarbons, aliphatic alcohols and ketones), aromatic compounds, nitrogen containing compounds, and volatile sulfur compounds. A diversity of ecological niches exist in the human body which can support a polymicrobial community, with the exact VOC profile of a given anatomical site being dependent on that produced by both the host component and the microbial species present. The detection of VOCs is of interest to various disciplines, hence numerous analytical approaches have been developed to accurately characterize and measure VOCs in the laboratory, often from patient derived samples. Using these technological advancements it is evident that VOCs are indicative of both health and disease states. Many of these techniques are still largely confined to the research laboratory, but it is envisaged that in future bedside 'VOC profiling' will enable rapid characterization of microbial associated disease, providing vital information to healthcare practitioners.

Advances in electronic-nose technologies developed for biomedical applications

The research and development of new electronic-nose applications in the biomedical field has accelerated at a phenomenal rate over the past 25 years. Many innovative e-nose technologies have provided solutions and applications to a wide variety of complex biomedical and healthcare problems. The purposes of this review are to present a comprehensive analysis of past and recent biomedical research findings and developments of electronic-nose sensor technologies, and to identify current and future potential e-nose applications that will continue to advance the effectiveness and efficiency of biomedical treatments and healthcare services for many years. An abundance of electronic-nose applications has been developed for a variety of healthcare sectors including diagnostics, immunology, pathology, patient recovery, pharmacology, physical therapy, physiology, preventative medicine, remote healthcare, and wound and graft healing. Specific biomedical e-nose applications range from uses in biochemical testing, blood-compatibility evaluations, disease diagnoses, and drug delivery to monitoring of metabolic levels, organ dysfunctions, and patient conditions through telemedicine. This paper summarizes the major electronic-nose technologies developed for healthcare and biomedical applications since the late 1980s when electronic aroma detection technologies were first recognized to be potentially useful in providing effective solutions to problems in the healthcare industry.

Magnetic resonance spectroscopy in the diagnosis and etiological definition of brain bacterial abscesses

We report two patients with bacterial brain abscesses whose etiological diagnosis was correctly proposed by association of diffusion weighted images (DWI) and magnetic resonance spectroscopy (MRS) with conventional MRI. Both patients presented ring enhancing lesions with evidences of restricted diffusion. On MRS, the abscess caused by aerobic bacteria presented lactate and aminoacids peaks and the abscess caused by anaerobic facultative bacteria showed also acetate and succinate peaks. These results are in agreement with an unique previous study that related MRS pattern with bacterial etiology. Conventional MRI, associated with DWI and MRS is effective in diagnosing bacterial abscess and promising in exploring its etiology.

Characterization of volatile organic compounds and odors by in-vivo sampling of beef cattle rumen gas, by solid-phase microextraction, and gas chromatography-mass spectrometry-olfactometry

Volatile organic compounds (VOCs) and odors in cattle rumen gas have been characterized by in-vivo headspace sampling by solid-phase microextraction (SPME) and analysis by gas chromatography-mass spectrometry-olfactometry (GC-MS-O). A novel device enabling headspace SPME (HS-SPME) sampling through a cannula was designed, refined, and used to collect rumen gas samples from steers. A Carboxen-polydimethylsiloxane (PDMS) fiber (85 microm) was used for SPME sampling. Fifty VOCs from ten chemical groups were identified in the rumen headspace. The VOCs identified had a wide range of molecular weight (MW) (34 to 184), boiling point (-63.3 to 292 degrees C), vapor pressure (1.05x10(-5) to 1.17x10(2) Pa), and water solubility (0.66 to 1x10(6) mg L-1). Twenty-two of the compounds have a published odor detection thresholds (ODT) of less than 1 ppm. More than half of the compounds identified are reactive and have an estimated atmospheric lifetime of <24 h. The amounts of VFAs, sulfide compounds, phenolic compounds, and skatole, and the odor intensity of VFAs and sulfide compounds in the rumen gas were all higher after feeding than before feeding. These results indicate that rumen gases can be an important potential source of aerial emissions of reactive VOCs and odor. In-vivo sampling by SPME then GC-MS-O analysis can be a useful tool for qualitative characterization of rumen gases, digestion, and its relationship to odor and VOC formation.

Bronchoalveolar lavage examined by solid phase microextraction, gas chromatography–mass spectrometry and selected ion flow tube mass spectrometry

Samples (210 in total) of broncholaveolar lavages (BALs), obtained from patients hospitalized with pneumonia in various departments of two hospitals, were analysed using the method of solid phase microextraction-gas chromatography (SPME-GC) with FID detection. Up to 20% (9% unequivocally, 11% probably) of these samples was found to contain volatile fatty acids (VFAs) in the series from acetic acid to heptanoic acid. Importantly, the presence of these acids indicates the presence of fermenting anaerobic bacteria, which were not detected by the conventional microbiological examination. Other compounds, namely the heptanol and cyclohexanone, were also detected by this method in some samples. Cyclohexanone occurred almost exclusively in samples from patients receiving intensive care with mechanical ventilation, and is suspected to originate from plastic parts of ventilators. Selected representative samples were also analysed using further methods, namely gas chromatography-mass spectrometry (GC-MS) of native and silylated samples, and selected ion flow tube mass spectrometry (SIFT-MS). These methods confirmed the identities of above mentioned compounds, and detected numerous other compounds tentatively identified as various alcohols, aldehydes, ketones, esters and hydrogen cyanide, HCN. Most of these compounds occurred in small amounts and their origin and diagnostic significance remains uncertain, except, that is, for the HCN, which indicates the presence of Pseudomonas aeruginosa.

Pyogenic brain abscess: findings from in vivo 1.5-T and 11.7-T in vitro proton MR spectroscopy

BACKGROUND AND PURPOSE

Metabolites in pyogenic brain abscesses, as detected with in vivo proton MR spectroscopy, are different from those found in brain and can help differentiate pyogenic brain abscesses from necrotic neoplasms. We compared the findings of in vivo with those of in vitro MR spectroscopy and categorized the MR spectral patterns with respect to the causative organisms and abscess size.

METHODS

Fifteen patients with pyogenic brain abscesses underwent in vivo 1.5-T (1)H MR spectroscopy and had findings of ring enhancement. The causative organisms were determined from cultures of aspirated pus. Single-voxel (1)H MR spectroscopy was performed with the point-resolved method (1600/270, 135 TR/TE). In six representative patients, in vitro 11.7-T (1)H MR spectra were obtained from the aspirated pus.

RESULTS

Three in vivo MR spectral patterns were noted: A) presence of lactate at 1.3 ppm, cytosolic amino acids (leucine, isoleucine, and valine) at 0.9 ppm, alanine at 1.50 ppm, and acetate at 1.92 ppm, with the presence or absence of succinate at 2.4 ppm and lipids (0.8-1.3 ppm), representing mostly obligate anaerobes or a mixture of obligate and facultative anaerobes; B) presence of lactate at 1.3 ppm and cytosolic amino acids at 0.9 ppm, with the presence or absence of lipids but not acetate or alanine (0.8-1.3 ppm), representing mostly obligate aerobes or facultative anaerobes; and C) presence of lactate at 1.3 ppm alone, showing small abscess. Additional resonance peaks of lysine at 1.73 and 3.0 ppm, glutamate/glutamine at 2.09-2.36 ppm, taurine at 3.24 and 3.42 ppm, glycine at 3.55 ppm, and amino acids at 3.75 ppm could be observed in the in vitro MR spectra.

CONCLUSION

Results from the in vivo observations were satisfactorily verified by the in vitro experiments. The in vitro measurements may offer complementary information that cannot be extracted from in vivo MR spectra. Determination of the three (1)H MR spectral patterns may be helpful in devising the best possible treatment plans for patients with pyogenic abscesses.

Recognition of anaerobic bacterial isolates in vitro using electronic nose technology

AIMS

Use of an electronic nose (e.nose) system to differentiation between anaerobic bacteria grown in vitro on agar media.

METHODS AND RESULTS

Cultures of Clostridium spp. (14 strains) and Bacteroides fragilis (12 strains) were grown on blood agar plates and incubated in sampling bags for 30 min before head space analysis of the volatiles. Qualitative analyses of the volatile production patterns was carried out using an e.nose system with 14 conducting polymer sensors. Using data analysis techniques such as principal components analysis (PCA), genetic algorithms and neural networks it was possible to differentiate between agar blanks and individual species which accounted for all the data. A total of eight unknowns were correctly discriminated into the bacterial groups.

CONCLUSIONS

This is the first report of in vitro complex volatile pattern recognition and differentiation of anaerobic pathogens.

SIGNIFICANCE AND IMPACT OF THE STUDY

These results suggest the potential for application of e.nose technology in early diagnosis of microbial pathogens of medical importance.

Evaluation of cerebral abscesses by diffusion-weighted MR imaging and MR spectroscopy

Cerebral abscess may sometimes mimic necrotic tumor and cystic metastases both clinically and radiologically. The imaging findings may be indistinguishable on conventional magnetic resonance imaging. Although recent studies have shown that cerebral abscess displays restricted diffusion on diffusion-weighted imaging (DWI), it is not pathognomic. Necrotic tumor and cystic metastases may occasionally have restricted diffusion on DWI. Since the urgency of surgical intervention and approach of surgery is different, MR Spectroscopy may be used in conjunction with DWI in establishing the correct diagnosis.

Identifying bacteria in human urine: current practice and the potential for rapid, near-patient diagnosis by sensing volatile organic compounds

Urinary tract infection (UTI) represents a significant burden for the National Health Service. Extensive research has been directed towards rapid detection of UTI in the last thirty years. A wide range of microbiological and chemical techniques are now available to identify and quantify bacteria in urine. However, there is a clear and present need for near, rapid, sensitive, reliable analytical methods, preferably with low-running costs, that could allow early detection of UTI and other diseases in urine. Here we review the "state of the art" of current practice for the detection of bacteria in urine and describe the advantages of the recent "e-nose" technology as a potential tool for rapid, near-patient diagnosis of UTI, by sensing volatile organic compounds (VOCs).

Discrimination of Brin Abscess and Cystic Tumor by In Vivo Proton Magnetic Resonance Spectroscopy

Proton magnetic resonance (MR) spectroscopy was evaluated for the differentiation of brain abscesses and cystic brain tumors. Proton MR spectroscopy was performed in vivo in two patients with brain abscess and eight patients with various cystic brain tumors (anaplastic astrocytoma, glioblastoma, and metastatic brain tumor). MR imaging with contrast medium demonstrated ring-like enhanced mass lesions in all patients. The various resonance peaks in proton MR spectra were assigned to metabolites according to chemical shifts. Treatment of the cystic brain lesions was based on the information from proton MR spectroscopy. Aspirated pus from one patient with brain abscess was examined using ex vivo proton MR spectroscopy. The in vivo spectra of brain abscess contained resonance peaks attributed to acetate, lactate, alanine, amino acids, and lipids in both cases, and an additional peak of succinate in one case. In vivo spectra of the neoplasms contained resonance peaks corresponding to lactate, lipids, choline, creatine, and N-acetyl aspartate. Proton MR spectroscopy is useful for discriminating brain abscess from cystic tumors with similar neuroimaging appearance, which is very important for determining the treatment strategy.

Cerebral mucormycosis: proton MR spectroscopy and MR imaging

Proton magnetic resonance spectroscopy (MRS) was integrated with magnetic resonance imaging (MRI) in the evaluation of a case of cerebral mucormycosis. MRS showed markedly elevated lactate, depleted N-acetyl aspartate and metabolite resonances attributable to succinate and acetate. The spectroscopy profile is essentially similar to that of bacterial abscess but without the commonly seen resonances of the amino acids valine, leucine and isoleucine. Our extensive literature review did not yield any reports of MRS findings on cerebral mucormycosis. MRS prospectively limited the differential diagnoses given the otherwise nonspecific and complex MR imaging findings in our immunosuppressed patient.

Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis

BACKGROUND

Pregnant women with bacterial vaginosis may be at increased risk for preterm delivery. We investigated whether treatment with metronidazole and erythromycin during the second trimester would lower the incidence of delivery before 37 weeks' gestation.

METHODS

In 624 pregnant women at risk for delivering prematurely, vaginal and cervical cultures and other laboratory tests for bacterial vaginosis were performed at a mean of 22.9 weeks' gestation. We then performed a 2:1 double-blind randomization to treatment with metronidazole and erythromycin (433 women) or placebo (191 women). After treatment, the vaginal and cervical tests were repeated and a second course of treatment was given to women who had bacterial vaginosis at that time (a mean of 27.6 weeks' gestation).

RESULTS

A total of 178 women (29 percent) delivered infants at less than 37 weeks' gestation. Eight women were lost to follow-up. In the remaining population, 110 of the 426 women assigned to metronidazole and erythromycin (26 percent) delivered prematurely, as compared with 68 of the 190 assigned to placebo (36 percent, P = 0.01). However, the association between the study treatment and lower rates of prematurity was observed only among the 258 women who had bacterial vaginosis (rate of preterm delivery, 31 percent with treatment vs. 49 percent with placebo; P = 0.006). Of the 358 women who did not have bacterial vaginosis when initially examined, 22 percent of those assigned to metronidazole and erythromycin and 25 percent of those assigned to placebo delivered prematurely (P = 0.55). The lower rate of preterm delivery among the women with bacterial vaginosis who were assigned to the study treatment was observed both in women at risk because of previous preterm delivery (preterm delivery in the treatment group, 39 percent; and in the placebo group, 57 percent; P = 0.02) and in women who weighed less than 50 kg before pregnancy (preterm delivery in the treatment group, 14 percent; and in the placebo group, 33 percent; P = 0.04).

CONCLUSIONS

Treatment with metronidazole and erythromycin reduced rates of premature delivery in women with bacterial vaginosis and an increased risk for preterm delivery.

1H MRS of human brain abscesses in vivo and in vitro

Five patients, each with a brain abscess, were examined by means of 1H MR spectroscopic imaging in vivo. The aspirated pus was analyzed in vitro by means of 1D and 2D COSY 1H MRS. In addition to resonance lines from compounds (lactate, alanine and lipids) often found in the spectra from intracranial tumors, resonance lines were detected from a number of markers of infectious involvement (acetate, succinate, and various amino acids). These results suggest that 1H MRS in vivo might contribute in establishing noninvasively a differential diagnosis between brain abscess and tumor.

Capillary gas chromatography of cellular carbohydrates as a means for the differentiation of fastidious, slow-growing or anaerobic gram-negative bacteria--a review

The phenotypic differentiation of microaerophilic or anaerobic Gram-negative bacteria of human origin is traditionally based on the analysis of metabolic characteristics. Due to outstanding growth requirements of many kinds of parasitic bacteria, e.g. of the facultatively and strictly anaerobic members of the human periodontal flora, conventional biochemical tests are time-consuming and sometimes lead to doubtful results. Commercial diagnostic test kits often produce misidentifications because of insufficient databases or inappropriate test combinations. In this situation, cytochemical methods can provide an alternative. Especially in the case of Gram-negative bacteria which contain considerable amounts of carbohydrates in their cell wall lipopolysaccharide layers, capillary gas chromatography of peracetylated carbohydrate derivatives prepared from bacterial whole cell hydrolysates proved to be useful to characterize individual species, and sometimes even subspecies. As soon as a pure culture is available, the derivatization of the cellular carbohydrates to their peracetylated aldononitriles and peracetylated O-methyloximes, respectively, needs only about four hours and the gas chromatographic spectra are easy to evaluate.

Use of gas liquid chromatography as an adjunct to conventional bacteriological methods in the diagnosis of anaerobic cerebral abscess

Forty cases of cerebral abscesses were studied prospectively to establish the microbial agents implicated in these cases. Chronic otitis media (14 patients, 35%), congenital heart disease (five patients, 12.5%),a and meningitis (five patients, 12.5%) were among the important predisposing factors. Streptococcus (14 patients, 35%) was the most common causative pre-isolated, the predominant species being Streptococcus milleri (11 patients, 27.5%). Other organisms isolated included Proteus mirabilis in six patients (15%) and Staphylococcus aureus in five patients (12.5%). Anaerobes (12 patients, 30%), predominantly Bacteroides sp. (eight patients, 20%), played an important role in these cases, the majority of which were isolated in mixed cultures. Gas-liquid chromatographic analysis of pus detected the presence of anaerobes in another 11 cases of cerebral abscess, in which cultures of anaerobes were negative. Therefore, gas-liquid chromotography is useful as an adjunct to conventional bacteriological methods in providing a rapid and sensitive means of detecting anaerobes in pus obtained especially from patients who had received antibiotic therapy prior to hospitalization.

A microbiological and clinical review of the acute dentoalveolar abscess

Early microbiological studies of acute suppurative dental infection implicated streptococci or staphylococci as the causative microorganisms but recent studies suggest that the microbial flora of acute dentoalveolar abscess is usually polymicrobial, predominantly involving CO2-dependent streptococci, strictly anaerobic Gram-positive cocci and strictly anaerobic Gram-negative bacilli. These differences are probably due to poor sampling techniques and inadequate culture methods used in the early investigations. It is now accepted that specimens should be obtained by aspiration to avoid contamination and processed promptly using strict anaerobic culture. Traditionally the bacterial strains isolated have been regarded as members of the normal oral commensal microflora but it is becoming increasingly apparent from experimental infections that they have pathogenic properties. Although the vast majority of isolates have been found to be sensitive to a variety of antimicrobial agents there would not appear to be a uniformly effective drug. At the present time a penicillin, such as amoxycillin, would probably be the first choice antimicrobial agent with the addition of metronidazole if clinical improvement does not occur.

Rapid identification of Haemophilus influenzae serovar b by gas liquid chromatography using carbohydrate fingerprints

Carbohydrates from whole-cell hydrolysates of 18 strains of the species Haemophilus influenzae (5 strains belonging to serovar b) were analysed by gas-liquid chromatography. The identity of the carbohydrate components was confirmed by comparison with the retention times of reference sugars and by gas chromatography mass spectrometry. Evidence was obtained that Haemophilus influenzae serovar b can easily be identified by the presence of one large peak representing ribitol. The method described can be routinely applied in bacteriological laboratories equipped with a gas chromatograph. It gives results within approximately 4 h, it is reproducible and easy to perform. Even single colonies isolated directly from agar plates can be used for analysis without further subculturing.

D-lactic acid measurements in the diagnosis of bacterial infections

Body fluids suspected of bacterial infection were cultured and examined for the presence of D-lactic acid, a specific bacterial metabolite. We examined 206 patients and 264 specimens. D-Lactic acid was found in concentrations of greater than or equal to 0.15 mM in 11 of 11 infected and 6 of 40 noninfected ascitic fluids, 6 of 6 infected and 4 of 33 noninfected pleural fluids, 4 of 4 infected and 0 of 13 noninfected synovial fluids, and 26 of 27 infected and 2 of 130 noninfected cerebrospinal fluids. The overall sensitivity was 79.7%, and the specificity was 99.5% when the D-lactic acid concentration was at least 0.15 mM. The most important clinical utility of the D-lactic acid measurement appears to be for patients with bacterial infection in various body compartments and in patients who have already received antimicrobial therapy. An elevation in D-lactic acid may indicate the presence of bacterial infection even when cultures are negative.

Rapid diagnostic methods for aspergillosis

Conventional laboratory methods are always unsatisfactory for the antemortem diagnosis of systemic mycoses, especially aspergillosis, in immunocompromised patients and those with acquired immune deficiency syndrome (AIDS), regardless of their age. There is increasing proof that aspergillosis is not limited to pulmonary, sinus or nasal regions. These facts, plus the high mortality rate, indicate a tremendous need for reliable and rapid methods of diagnosing this infection. Accordingly, refined techniques such as solid-phase radioimmunoassay (SPIRA), crossed-immunoelectrophoresis (CIE), crossed-radioimmunoelectrophoresis (CRIE), radioallergosorbent test (RAST), radioimmunoprecipitation assay (RIPA), paper radioimmunosorbent test (PRIST), computerized enzyme-linked immunosorbent assay (ELISA), biotin avidin enzyme-linked immunosorbent assay and gas-liquid chromatography (GLC) are being considered or used in clinical laboratories for diagnosing aspergillosis. The advantages and limitations of the RIA, ELISA and GLC methods are briefly discussed.

Anaerobic bacterial meningitis

We report a case of anaerobic bacterial meningitis in which a rapid diagnosis was achieved by direct gas-liquid chromatography of cerebrospinal fluid.

Quantitative gas chromatographic analysis of volatile fatty acids in spent culture media and body fluids

Gas chromatographic analysis of volatile fatty acids for identification of obligately anaerobic bacteria and for presumptive diagnosis of anaerobic infections is now widely practiced. However, it is difficult to compare data because only a qualitative analysis is done or only chromatograms are presented instead of quantitative data on volatile fatty acid production. We compared three stationary phases for volatile fatty acid analysis of aqueous solutions and four methods of pretreating samples for gas chromatography. Quantitative analysis could be done accurately by using Carbowax as the stationary phase after pretreatment of spent culture media with Dowex columns. If only qualitative analysis is required (e.g., for presumptive diagnosis of anaerobic infections), ether extraction and headspace analysis are equally suitable. The overall variation coefficient for volatile fatty acid production by four reference strains of obligately anaerobic bacteria after 24 h of incubation was approximately 10%.

Analysis by gas liquid chromatography of production of volatile fatty acids by anaerobic bacteria grown on solid medium

Volatile fatty acids produced in Robertson's cooked meat medium by a range of clinically relevant anaerobes were compared by gas liquid chromatography with those produced in blood agar. The same volatile fatty acid profiles were obtained in both media, although the concentration of acids was lower in blood agar. We conclude that detection of volatile fatty acids from a pure culture of an organism on solid medium is practicable and offers advantages over the conventional technique.

Evaluation of gas-liquid chromatography for the rapid diagnosis of Clostridium difficile associated disease

Direct gas-liquid chromatography of faecal specimens with isocaproic acid as a marker was used for the rapid diagnosis of Clostridium difficile associated diarrhoeal diseases. Ninety stools were examined and results were compared with conventional culture on selective medium and cytotoxin assay in tissue culture. Using a combined analysis of isocaproic acid and butyric acid peak heights we defined three categories: positive, negative, and indeterminate. When the indeterminate group was excluded, the positive and negative predictive values of gas-liquid chromatography analysis were 86.9% and 85% respectively compared with culture and 71.4% and 95% respectively compared with cytotoxin assay.

Succinic acid, a metabolic by-product of Bacteroides species, inhibits polymorphonuclear leukocyte function

Anaerobes, in particular Bacteroides spp., are the predominant bacteria present in mixed intra-abdominal infections, yet their critical importance in the pathogenicity of these infections is not clearly defined. Succinic acid, a major fatty acid by-product of Bacteroides metabolism, was tested for its effect on neutrophil function to determine whether it might play a role in enhancing the virulence of Bacteroides-containing infections. At pH 5.5 but not pH 7.0, succinic acid at concentrations commonly found in clinical abscesses profoundly inhibits in vitro neutrophil function. It virtually obliterates phagocytic killing of Escherichia coli and reduces neutrophil random migration and chemotactic response to formyl-methionyl-leucyl-phenylalanine and C5a. These effects occur in conjunction with a reduced chemiluminescent peak and delayed time to the peak. The effect on neutrophils is only partially reversible by multiple washings. These findings suggest that succinic acid may be an important Bacteroides virulence factor when present in the microenvironment of a mixed intra-abdominal infection in which concentrations are high and the pH of the medium is reduced.

Diagnosis of anaerobic infection by gas chromatographic estimation of volatile fatty acids

Nine hundred and eighty-one fluid specimens were analysed by culture and by gas chromatography. The presence of obligate anaerobes was best predicted if one or more of the volatile acids isobutyric, butyric, isovaleric, valeric, isocaproic or caproic acid were detected in the specimen. Propionic acid was not a good indicator of the presence of obligate anaerobes. The agreement between gas chromatography and culture for obligate anaerobes in the main study (841 specimens, 232 culture positive) was: co-positivity 82%; co-negativity 92%. Falsely negative specimens contained anaerobes which had probably not produced sufficient of their characteristic volatile fatty acids to be detected. When it was the sole infecting anaerobe, Bacteroides fragilis seemed especially likely to be missed by gas chromatography. Forty-five of the 51 falsely positive specimens probably represented failure to culture anaerobes rather than spurious volatile fatty acid detection.

Gas-liquid chromatography in the diagnosis of anaerobic infections: a three year experience

Nearly two thousand clinical samples were examined by direct gas-liquid chromatography over a three year period. Absence of volatile fatty acids (VFAs) in the samples correlated well with negative culture results for anaerobic bacteria. In general the presence of acetic acid alone correlated well with the presence of aerobic organisms, whereas the presence of a mixture of VFAs correlated well with the presence of anaerobic organisms, either alone or in combination with aerobes. However a proportion of such VFA-positive samples gave no growth on culture. Swabs gave comparable results to samples of pus or exudates except that a higher proportion of the former were VFA-negative but culture positive.

Gas-liquid chromatography in routine processing of blood cultures for detecting anaerobic bacteraemia

Gas-liquid chromatography was performed on 233 positive blood cultures and findings were compared with culture results. Obligate anaerobic bacteria were recovered from 78 out of 79 blood cultures containing butyric or iso-valeric acids, or both; from 28 out of 69 blood cultures containing succinic acid; and from only one out of 41 blood cultures containing succinic but not butyric or iso-valeric acid. Good correlations (88%) were found for the recovery of anaerobic bacteria and the detection of butyric and/or iso-valeric acids. Detecting volatile fatty acids by gas-liquid chromatography performed on blood cultures at the first signs of growth can therefore provide an early and reliable indication of the presence of anaerobic bacteria.

Gas chromatography in the identification of microorganisms and diagnosis of infectious diseases

Gas-liquid chromatography (GLC) continues to find increasing applications in the characterization of microorganisms and the diseases associated with them. GLC has been used to characterize microorganisms through qualitative and quantitative analyses of cellular structural components and soluble extracts and metabolic by-products. Chromatographic patterns, or fingerprints, can be used to differentiate between very closely related microorganisms, even strain differences, and provides a potentially powerful tool for future taxonomic studies and more precision in definitive microbial classification. However, the most valuable use of GLC is in the identification of disease through patterns obtained by direct analysis of body fluids. Chromatographic fingerprints of microbial metabolites and compounds associated with the host response to infection and even noninfectious disease can be used to develop relatively simple GLC diagnostic methods. These methods are specific, sensitive, and rapid. This review examines the use of GLC for identification of infectious diseases through the analysis of body fluids, spent culture media, and cellular materials and suggest other clinical areas where its diagnostic potential has yet to be developed.

Headspace analysis of volatile metabolites of Pseudomonas aeruginosa and related species by gas chromatography-mass spectrometry

Gas chromatographic-mass spectrometric analysis of headspace volatiles was performed on cultures of 11 strains of Pseudomonas aeruginosa and 1 strain each of Pseudomonas cepacia, Pseudomonas putida, Pseudomonas putrefaciens, Pseudomonas fluorescens, and Pseudomonas maltophilia. All strains of Pseudomonas aeruginosa produced a distinctive series of odd-carbon methyl ketones, particularly 2-nonanone and 2-undecanone, and 2-aminoacetophenone. The other strains failed to produce 2-aminoacetophenone. Two sulfur compounds, dimethyldisulfide and dimethyltrisulfide, were present in strains of P. aeruginosa and in variable amounts in other species. Butanol, 2-butanone, 1-undecene, and isopentanol were also detected in P. aeruginosa cultures.

Anaerobic bacteria in nonspecific vaginitis

To study the cause of nonspecific vaginitis, we analyzed vaginal fluid from normal women and from 53 women with nonspecific vaginitis, using quantitative anaerobic cultures and gas-liquid chromatography for short-chained organic-acid metabolites of the microbial flora. In normal vaginal fluid, lactate was the predominant acid, and the predominant organisms were lactobacillus and streptococcus species (lactate producers). In nonspecific vaginitis, lactate was decreased, whereas succinate, acetate, butyrate, and propionate were increased, the predominant flora included Gardnerella (Haemophilus) vaginalis (acetate producer), and anaerobes, which included bacteroides species (succinate producers) and peptococcus species (butyrate and acetate producers). After metronidazole therapy, symptoms and signs of nonspecific vaginitis cleared, butyrate and propionate disappeared, and lactate and lactate-producing organisms became predominant. We conclude that certain anaerobes act with G. vaginalis as causes of nonspecific vaginitis, and that a high ratio of succinate to lactate in vaginal fluid is a useful indicator in the diagnosis of this condition.

Primary meningitis caused by Bacteroides fragilis and Fusobacterium necrophorum

A fatal case of meningitis due to Bacteroides fragilis and Fusobacterium necrophorum is reported. This appears to be the first case in which meningitis due to these organisms was not secondary to a disease elsewhere in the body. The organisms are difficult to culture and strict anaerobic methods should be used whenever they are suspected. Intravenous metronidazole is probably the antibiotic of choice.

Rapid diagnosis of anaerobic empyema by direct gas-liquid chromatography of pleural fluid

Sixty samples of pleural fluid from 52 patients were subjected to direct gas-liquid chromatographic studies, and results were correlated with findings from microbiologic cultures. Fourteen patients had anaerobic empyema, 22 had aerobic infections, and 16 had sterile pleural effusions. Multiple volatile fatty acids or succinic acid or both were found as markers of anaerobic infection in all but one instance. Aerobic infections and sterile pleural fluids were characterized by the absence of multiple volatile fatty acids or succinic acid. Infection with Bacteroides, when present, was characterized by a major product of succinic acid. One patient infected with Peptococcus magnus (which does not produce fatty acids or succinic acid) could not be diagnosed by gas-liquid chromatograms. Two patients without anaerobic bacteria in the pleural effusions but who had infections associated with Bacteroides fragilis outside the pleural space demonstrated succinic acid in the pleural fluid. With these exceptions, the presence of volatile fatty acids or succinic acid in pleural fluid was considered characteristic of anaerobic empyema. Direct gas-liquid chromatographic study of pleural fluids is, therefore, recommended as a routine procedure for rapid diagnosis of anaerobic empyema.

Rapid gas-chromatographic method for identification of metabolic products of anaerobic bacteria

The volatile fatty acids, alcohols, nonvolatile fatty acids, and ketones produced by anaerobes can be separated and identified by using a single type of gas-chromatographic column. A rapid and simple procedure is described.

The rapid laboratory diagnosis of anaerobic infection

In order to assess the rapid laboratory diagnosis of anaerobic pyogenic infection, we compared the results of Gram stains, ultra-violet fluorescence and gas chromatography, all performed directly on pus, with those of anaerobic culture. Fluorescence was most rapid but there were many negatives unless Bacteroides melaninogenicus was present. Gas chromatography was rapid and sensitive but there were some false negatives, often in pure Bacteroides fragilis infection, and a few false positives. Gram-staining was also rapid, but only helpful on its own when there were large numbers of organisms of mixed or characteristic morphology. The three methods together almost always provided a reliable and rapid presumptive diagnosis of anaerobic pyogenic infection.

Rapid presumptive identification of anaerobes in blood cultures by gas-liquid chromatography

Production of volatile and nonvolatile metabolic acids in blood culture broths by aerobic, facultative anaerobic, and obligate anaerobic bacteria was analyzed by gas-liquid chromatography. Anaerobic blood culture isolates were presumptively identified by the qualitative analysis of volatile fatty acids. Isolates, with a characteristic Gram stain reaction and cellular morphology, were identified by the following acid patterns: Bacteriodes fragilis group with acetic and propionic acids; Fusobacterium with acetic, butyric, and usually propionic acids; Veillonella with acetic and propionic acids; gram-positive cocci with acetic and butyric acids; and Clostridium with acetic and butyric acids.

Detection of anaerobic wound infection by analysis of pus swabs for volatile fatty acids by gas-liquid chromatography

Swabs were able to absorb enough extractable volatile fatty acids from broth cultures of anaerobic organisms for detection and analysis by gas-liquid chromatography (GLC). Similarly, volatile fatty acids were often detected in swabs dipped into liquid pus. Fifty-three liquid pus specimens were then investigated fully to determine if GLC analysis of swab samples gave the same result as microbial culture of the specimens and GLC analysis of the liquid pus. Anaerobic bacteria failed to grow from 36 and volatile fatty acids were not extracted from swabs of 31 of these pus samples but were extracted from swabs of five. Anaerobic bacteria were isolated from 17 of the specimens, and in 15, volatile fatty acids were also detected in the swab samples; in two, volatile fatty acids were absent from both swab samples and liquid pus. In this study, results by culture and GLC analysis of swabs were similar in 87% of specimens.

Rapid diagnosis of anaerobic infections by gas-liquid chromatography

It was postulated that the short chain fatty acids (SCFA) produced by anaerobic bacteria might serve as microbial markers in purulent material. Eighteen pus specimens from various sources were analysed by gas-liquid chromatography (GLC), and the SCFA detected were compared with the microorganisms isolated by conventional methods. It was found that the detection of propionic, isobutyric, butyric, or isovaleric acids by direct GLC of pus specimens is strong evidence for anaerobic infection but not specific for Bacteroides fragilis. It was also shown that the presence of succinic acid in pus specimens does not necessarily indicate infection by anaerobes. It can be concluded that direct GLC of purulent material provides a rapid and reliable presumptive method for the differentiation between anaerobic and aerobic infections.

Rapid diagnosis of beta-haemolytic streptococcus group B endocarditis by buffy-coat examination and gas-liquid chromatography

A semicomatose 34-year-old man had fever, heart murmur, and multiple gangrenous lesions. Several blood cultures were negative. Cultures of the heart valve grew beta-haemolytic streptococcus group B. The organism was seen in buffy-coat examination of the venous blood. The gas-liquid chromatogram of the serum was different from those of normal controls and of patients with invasive candida infection; it closely mimicked the one obtained from the organism itself. These studies promise to be valuable diagnostic adjuncts.