Pretransplant serum ferritin and C-reactive protein as predictive factors for early bacterial infection after allogeneic hematopoietic cell transplantation

Although fluoroquinolones or other antibiotics are commonly used to prevent bacterial infections after hematopoietic cell transplantation (HCT), because of the growing presence of multidrug-resistant microorganisms, it is important to identify patients who are more likely to benefit from antibacterial prophylaxis. To evaluate risk factors for early bacterial infection after allogeneic HCT, we retrospectively analyzed clinical data for 112 consecutive adult patients with hematological malignancies who received transplants without any antibacterial prophylaxis. The cumulative incidence of bacterial infection at 30 days after transplantation was 16%. Among various pre-transplant factors, only high serum ferritin (>700 ng/mL, 47 patients) and high C-reactive protein (CRP) (>0.3 mg/dL, 28 patients) levels were significantly associated with the development of bacterial infection in a multivariate analysis (hazard ratio (95% confidence interval): ferritin, 4.00 (1.32-12.17); CRP, 3.64 (1.44-9.20)). In addition, septic shock and sepsis with organ failure were exclusively observed in patients who had high ferritin and/or high CRP levels. These results suggest that pretransplant serum ferritin and CRP levels can be useful markers for predicting the risk of early bacterial infection after allogeneic HCT. It may be prudent to limit antibacterial prophylaxis to patients with predefined risk factors to ensure the safety of HCT with the use of fewer antibiotics.

Streptococcal emm types in Hawaii: a region with high incidence of acute rheumatic fever

BACKGROUND

The clinical epidemiology of group A streptococcal (GAS) infections in Hawaii seems different from that in the continental United States with frequent skin infections and endemically high rates of acute rheumatic fever (ARF).

METHODS

GAS emm types in Hawaii were determined to identify any possible association between the emm types and specific clinical manifestations. A convenience sample of 1482 Hawaii GAS isolates collected between February 2000 and December 2005 was used. All isolates were characterized by emm sequence typing. The distribution of emm types in Hawaii was compared with the published continental US data for pharyngeal and invasive GAS strains, the CDC database from similar time periods, as well as with emm types present in a candidate GAS vaccine.

RESULTS

Ninety-three distinct emm types were recognized among the 1482 GAS isolates. The most frequently identified emm types in order of decreasing frequency were 12, 1, 28, 4, 22, 77, 81, 58, 65/69, 49, 74, 85, 92, 75, 101 and 2. Of this study sample, 27 of the 50 invasive GAS isolates belonged to uncommon continental US emm types (54% in Hawaii cultures vs. 10% reported from the continental US). Of the 1179 pharyngeal isolates, 509 belonged uncommon continental US emm types (43% in Hawaii cultures vs. 27% reported from the continental US).

CONCLUSIONS

The prevalent emm types in Hawaii differ from those in the continental US. The prevalence of these unusual emm types might limit the effectiveness of any proposed multivalent type-specific GAS vaccine in Hawaii.

Group A Streptococcal Isolates Temporally Associated with Acute Rheumatic Fever in Hawaii: Differences from the Continental United States

BACKGROUND

The annual incidence of acute rheumatic fever (ARF) in Hawaii has remained several times higher than that in the continental United States, particularly among ethnic Polynesians. The emm types of Streptococcus pyogenes that are associated with this nonsuppurative complication have, to our knowledge, not been previously reported in Hawaii.

METHODS

Patients with ARF were identified through an active surveillance system at Kapiolani Medical Center (Honolulu, HI), the only pediatric tertiary care referral hospital in Hawaii. Specimens were obtained by throat culture from patients who met the Jones criteria for ARF at the time of presentation (63 patients), prior to penicillin treatment, and from consenting family contacts (10 individuals). Eight patients and 2 close family contacts with positive throat culture results were identified from February 2000 through December 2005. Group A streptococci isolates were characterized by emm sequence typing.

RESULTS

Unusual emm types were temporally associated with the onset of ARF. Emm types 65/69 (from 2 patients), 71, 92, 93, 98, 103, and 122 were isolated from the 8 patients with ARF, and emm types 52 and 101 were isolated from the 2 household contacts.

CONCLUSIONS

So-called rheumatogenic emm types and/or serotypes, which were previously associated with ARF in the continental United States, were not found in this study. Instead, emm types that are not commonly included among group A streptococci isolates in the continental United States and that are seldom, if ever, temporally associated with ARF were identified. These findings suggest that unusual group A streptococci emm types play a significant role in the epidemiology of ARF in Hawaii.

Characterization of a community cluster of group a streptococcal invasive disease in Maui, Hawaii

A community cluster of severe group A streptococcal skin infections occurred in Maui, Hawaii with 3 fatal cases of necrotizing fasciitis in 2002. emm types 1, 12, 58, 74, 85 and 109 were identified from 8 patients. emm types 74 and 109 have not been previously described in the United States according to the Centers for Disease Control and Prevention database. The identification of uncommon emm types suggested that group A streptococcal sero-types in Hawaii are different from those in the continental United States and can result in serious disease.

Impaired gastric slow waves induced by spatial disorientation and effect of domperidone

OBJECTIVES

Our aims were to investigate the dominant frequency and regularity of gastric myoelectrical activity during motion sickness induced with the advanced spatial disorientation demonstrator (ASDD) and to evaluate the effect of domperidone on gastric myoelectrical activity and gastrointestinal symptoms during motion sickness.

METHODS

Thirteen healthy volunteers participated in this study. This study was executed using the ASDD, which could duplicate several spatial disorientation phenomena in a safe, controlled environment. Each subject participated in two sessions and received oral administration of 10 mg domperidone before the study in one of the sessions. In each session, three 15-min EGG recordings were made before, during, and after rotation. The symptoms were scored by Graybiel's scale of motion sickness before and after rotation. All EGG data were subjected to computerized spectral analysis to obtain the percentage of normal 2-4 cycles/min (cpm) slow waves, percentage of tachygastria, EGG dominant frequency and power, and instability coefficient of the dominant frequency.

RESULTS

We have found that the percentage of normal gastric slow wave was decreased (control session: 86.2 +/- 4.0% vs 70.0 +/- 5.4%, p < 0.01; domperidone session: 82.7 +/- 4.6% vs 69.8 +/- 5.6%, p < 0.03) and the percentage of tachygastria was increased (control session: 8.7 +/- 3.2% vs 17.8 +/- 5.6%, p < 0.01; domperidone session: 9.2 +/- 3.3% vs 18.1 +/- 3.5%, p < 0.01) after rotation in both sessions. The minute-by-minute variation of the gastric slow wave frequency was significantly increased during rotation in both sessions (control: 0.74 +/- 0.16 vs 1.35 +/- 0.19, p < 0.01; domperidone: 0.90 +/- 0.20 vs 1.47 +/- 0.17, p < 0.01). Domperidone did not prevent dysrhythmia or the symptoms of motion sickness.

CONCLUSIONS

The percentage of normal gastric slow waves is decreased and the percentage of tachygastria is increased with spatial disorientation. Domperidone does not prevent gastric dysrhythmia or the symptoms of motion sickness induced with spatial disorientation.

Visual influence on the magnitude of somatogravic illusion evoked on advanced spatial disorientation demonstrator

BACKGROUND

The somatogravic illusion (SGI) is a kind of spatial disorientation caused by a linear sustained acceleration. Pilots believe that visual cues, such as a visible horizon or texture flow, reduce this illusion. This study was performed to evaluate the influence of visual stimuli on the SGI using the Advanced Spatial Disorientation Demonstrator (ASDD).

METHODS

There were eight healthy males who were exposed to a 0.58 g x axis linear acceleration on the ASDD, where the direction of the resultant gravitoinertial force was equivalent to 30 degrees pitch-up. One of the following visual stimuli was presented during each acceleration: BLANK (no visual cues); HORIZON (a visible horizon without motion); and TEXTURE (vertical lines moving toward the subject evoking vection). The subjective magnitude of the SGI in ordinal scale was observed; and in interval scale, the deviation of the moving point kept at the subjective horizon was observed. The differences among visual stimuli were analyzed.

RESULTS

The subjective magnitude of the SGI (p < 0.01) and the deviation of the moving point (p < 0.05) were significantly smaller in HORIZON than in BLANK and TEXTURE. No difference was demonstrated between BLANK and TEXTURE. The linear vection produced by the TEXTURE stimulus did not affect the SGI.

CONCLUSION

The data indicated that the presence of a visible horizon reduced the magnitude of the SGI. On the other hand, the presence of a vection stimulus did not influence the magnitude of the SGI.

Repression of motility and flagellin production at 37 degrees C is stronger in Listeria monocytogenes than in the nonpathogenic species Listeria innocua

Listeria monocytogenes and Listeria innocua differ markedly in virulence but are indistinguishable by classical taxonomic criteria. Both species are actively motile and produce abundant flagellin at 22 degrees C. We have found, however, noticeable differences between L. monocytogenes and L. innocua in motility and flagellin production at 37 degrees C. At this temperature, L. monocytogenes strains were virtually nonmotile and produced little or no detectable flagellin, whereas strains of L. innocua were frequently motile and produced substantial amounts of flagellin. This flagellin was recognized by a Listeria genus-specific monoclonal antibody that also recognized flagellin produced at 22 degrees C. These results suggest differential regulation of flagellin production between L. monocytogenes and L. innocua at 37 degrees C.

Monoclonal antibodies with a high degree of specificity for Listeria monocytogenes serotype 4b

Strains of Listeria monocytogenes serotype 4b account for a large fraction of sporadic listeriosis cases, as well as all major food-borne epidemics attributed to this pathogen. We have identified a set of three monoclonal antibodies which showed a high degree of specificity for strains of L. monocytogenes serotype 4b. Two of these antibodies (c74.33 and c74.180, isotypes immunoglobulin M [IgM] and IgG3, respectively) recognized all serotype 4b strains, whereas antibody c74.22 (isotype IgG1) failed to recognize certain epidemic-associated strains. The corresponding antigens were located on the surface of the bacteria and were expressed following bacterial growth in different media and over a wide range of temperatures (4, 22, and 37 degrees C). Heating L. monocytogenes cells at 80,90, or 100 degrees C abolished reactivity for c74.22 but not for c74.33 MAb. These MAbs were negative for all of the non-Listeria strains tested, including representatives of several gram-negative and gram-positive species. The surface antigen recognized by c74.22 appeared to be associated with the ability of the bacteria to enter (invade) mammalian cells in culture.

Hypoxia-induced fatal aircraft accident revealed by voice analysis

The voice communication was the only clue of the fatal F-104J accident encountered during high-altitude intercept procedures, and it was analysed to prove the presence of hypoxia as a causal factor. A simulated low-pressure chamber flight was undertaken, and the subject's voice, saying the same words as the pilot, was analyzed in the same way. Comparison of these two voices revealed a similarity in characteristic changes of the sound spectrum and time course. The blurred formation of formant, fundamental, and harmonic frequencies, as well as the obscured gap in pre-vocal cord opening time (VOT) of the sound spectrogram, were thought to be the effects of hypoxia. Lowered fundamental frequency of the pilot's voice, even at the stressful period of attack, has strongly suggested decreased vigilance due to hypoxia. Through these findings, it was concluded that the cause of the accident was probably hypoxia in the pilot.

Seroepidemiology of human syncytial virus: antibody prevalence in the Pacific

A seroepidemiological survey of the human syncytial (foamy) virus was done by means of an indirect immunofluorescence test on 1,717 sera from nine different Pacific island territories. The specificity of the reaction was verified by neutralization tests. The study indicated that the virus is ubiquitous in this part of the world, with no region being entirely free of antibody. The antibody prevalence ranged from a low of 1.2% in Ponape to a high of 15.6% in the Cook Islands. The average prevalence for the nine insular communities was 6.9%.