5,5′-Diamino-BIPHEP ligands bearing small selector units for non-covalent binding of chiral analytes in solution

A dynamic axially chiral BIPHEP-ligand with 3,5-dichlorobenzoyl amide selector units for non-covalent binding of phenylalanine derivatives has been developed.

[Mental disorders in hospitalized children of migrant families from the Mediterranean]

From 1.1.1988 to 31.12.1992 928 inpatients at the child- and adolescent psychiatric clinic "Rheinhöhe" were recorded and studied. At that time the service area for this clinic for psychiatric care contained mixed rural/urban localities of four Southhessian sectors including a part of Frankfurt/M. The number of inpatients of Mediterranean origin in relation to German inpatients were significantly lower than expected but higher compared with earlier studies. The pattern of psychiatric disorders differed also in these two populations. The distribution according to sexes showed an moderate higher male rate for both groups (1.2:1). To study the differences in detail, 163 Mediterranean and German patients were matched according to age, gender, school education and SES and subsequently the Mediterranean patients were divided into those with a short- vs. a long-term-assimilation experience. As a result the significant higher rate of psychotic disorders among the Mediterranean treated inpatients counted for the different patterns, especially among the short-term assimilated patients. On the other hand, externalizing disorders were found to be significantly higher among the long-term assimilated Mediterranean inpatients but also among the German inpatients in contrast to the short-term assimilated migrant inpatients from the Mediterranean regions. Suicidal attempts were significantly more frequent among the Mediterranean girls than among their German counterparts. Thus key differences for utilising inpatient services remained; the reasons accounting for these dissimilarities are questionable and noteworthy for psychiatric care.

Successful treatment of cerebral toxoplasmosis in a marrow transplant recipient: contribution of a PCR test in diagnosis and early detection

We report successful treatment of cerebral toxoplasmosis in an unrelated donor marrow transplant recipient. The clinical diagnosis was confirmed by polymerase chain reaction (PCR) amplification for T. gondii-DNA performed both on cerebrospinal fluid and blood leukocytes. Retrospective testing of stored blood samples demonstrated positive leukocyte PCR signal detected up to 52 days prior to onset of clinical symptoms. This case highlights the value of PCR in the diagnosis and early detection of cerebral toxoplasmosis.

CTX-M-5, a novel cefotaxime-hydrolyzing beta-lactamase from an outbreak of Salmonella typhimurium in Latvia

At a children's hospital in Riga, Latvia, isolates identified as Salmonella typhimurium were found to be resistant to expanded-spectrum cephalosporins. Two of the resistant strains were analyzed for the mechanism of cephalosporin resistance. Isoelectric focusing revealed a common beta-lactamase with a pI of 8.8. In addition, one of the strains produced a pI 7.6 beta-lactamase. A transconjugant producing only the pI 7.6 enzyme was susceptible to expanded-spectrum cephalosporins; therefore, this enzyme was most likely SHV-1. Transformants producing only the pI 8.8 beta-lactamase were resistant to cefotaxime and aztreonam but were susceptible or intermediate to ceftazidime. A substrate profile determined spectrophotometrically with purified enzyme revealed potent activity against cefotaxime, with a relative kcat value of 95 (benzylpenicillin equal to 100). The enzyme showed lower relative kcat values for ceftazidime (3.3) and aztreonam (9.3). In addition, the enzyme was inhibited by clavulanate, sulbactam and tazobactam, with 50% inhibitory concentrations of 19, 100, and 3.4 nM, respectively. These results indicated the presence of an unusual extended-spectrum beta-lactamase. The gene expressing the pI 8.8 beta-lactamase was cloned. Nucleotide sequencing revealed a beta-lactamase gene that differs from the gene encoding CTX-M-2, which also originated from S. typhimurium, by 11 nucleotides, 4 of which result in amino acid substitutions: Ala27Thr, Val230Gly, Glu254Ala, and Ile278Val. These results indicated the presence of a novel extended-spectrum beta-lactamase, designated CTX-M-5, that specifically confers resistance to cefotaxime.

Linear single-dose pharmacokinetics of ganciclovir in newborns with congenital cytomegalovirus infections. NIAID Collaborative Antiviral Study Group

The pharmacokinetic characteristics of ganciclovir were determined in neonates (age range, 2 to 49 days) after an 1-hour intravenous infusion of a single dose of either 4 mg/kg (n = 14) or 6 mg/kg (n = 13). Twenty-seven newborns with symptomatic cytomegalovirus inclusion disease were enrolled in this open phase I-II pharmacokinetics, safety, and tolerance trial of ganciclovir at one of two doses. Ganciclovir disposition was best described by a one-compartment open model with zero-order input and first-order elimination. The mean elimination half-life (t1/2) for both dose groups was 2.4 hours. The mean apparent volume of distribution (Vd) was 669 +/- 70 ml/kg for the 4 mg/kg group and 749 +/- 59 ml/kg for the 6 mg/kg group. The mean total body clearance (CL) for the 4 mg/kg and 6 mg/kg groups was 189 +/- 28 ml/hr/kg and 213 +/- 21 ml/hr/kg, respectively. No significant differences were observed in Vd or CL between the two groups. The Vd, expressed in milliliters, increased with increasing patient weight (r = 0.689; p = 0.0001). The CL, expressed in milliliters per hour per kilogram, increased with increasing age (r = 0.413; p = 0.032). No significant differences were observed between the two dose groups for the area under the curve normalized for dose (AUC/Dose) or the maximum plasma concentration normalized for dose (Cmax/Dose), indicating that ganciclovir exhibited linear pharmacokinetics in these neonates.

Sporadic legionellosis in the United States: the first thousand cases

As of 30 September 1979, 1005 confirmed cases of sporadic legionellosis caused by Legionella pneumophila serogroups 1 to 4 in U.S. residents had been reported to the Centers for Disease Control; 19% were fatal. All but 2% of the 1005 cases were associated with pneumonia documented by chest radiograph. About 75% of the cases occurred in June through October. The risk of acquiring sporadic legionellosis was increased among males and persons 50 years or older; persons with renal disease necessitating dialysis or transplantation, with chronic bronchitis or emphysema, with diabetes mellitus, and with cancer (10 selected sites or types); persons who smoke; and persons being treated with immunosuppressive drugs. Increasing age and chronic bronchitis or emphysema were associated with increased risk of death. The sensitivity of culturing L. pneumophila from specimens positive by direct immunofluorescence was estimated to be 45%. The distribution of serogroups 1, 2, 3, and 4 of L. pneumophila in 57 fresh, not previously examined direct fluorescent antibody-positive specimens was 84%, 11%, 4%, and 2%, respectively; all 26 strains isolated from these specimens were of one of these four serogroups.

Legionnaires' disease bacterium: prevalence of antibody reacting with the organism in patients suspected of having infection with Pneumocystis carinii

Using indirect immunofluorescence, we examined 713 serum specimens submitted for Pneumocystis carinii serologic studies from 566 patients for antibody to the Legionnaires' disease bacterium. This group was chosen because it presumably consisted largely of immunosuppressed patients with acute respiratory illnesses. Of patients tested, 3.4% had titers of 1:128 or greater to Legionella pneumophila. Four (3.7%) of 107 patients for whom multiple specimens were submitted showed diagnostic increases in titer. The proportion of seropositive specimens did not vary with the age, sex, or geographic location of the patients or with season of the year in which the specimens were submitted. In a separate group of 138 serum specimens from 48 patients undergoing marrow transplantation, only 1 seropositive specimen was detected. No estimate of incidence is possible from these studies, but serologic evidence of past or current infection with Legionella pneumophila is uncommon in patients in whom Pneumocystis carinii pneumonia is suspected on clinical grounds. Nevertheless, Legionnaires' disease can affect the immunosuppressed host and should be considered in the differential diagnosis of pneumonia in such a patient.

Acute histoplasmosis. Description of an outbreak in northern Louisiana

An outbreak of acute histoplasmosis occurred in northern Louisiana in September 1977. All six men who cleared a field of bamboo cane known to be a blackbird roosting site were affected. All had clinical and roentgenographic findings of acute pulmonary histoplasmosis, and all recovered. Seroconversion or fourfold rise in antibody to Histoplasma capsulatum yeast--or mycelial-form antigens were demonstrated in five. Immunodiffusion testing showed that all six patients developed H capsulatum M bands, and two developed H bands specific for active infection. The H capsulatum was isolated from the soil in the cane field. This is the first report of an outbreak of histoplasmosis in Louisiana and the first known isolation of H capsulatum from Louisiana soil.

Prevalence of antibody to Legionella pneumophila in middle-aged and elderly Americans

An indirect fluorescent antibody (IFA) test was used to establish the background prevalence of antibody to Legionella pneumophila in single serum specimens from 1,143 persons. The serum specimens had been obtained from volunteers 46 years of age and older who were not acutely ill and who resided in the areas of Atlanta, Georgia; Washington, D.C.; Houston, Texas; and Rochester, New York. The overall prevalence of seropositivity (reciprocal titer, greater than or equal to 64) was 1.7%. The prevalence of seropositivity did not vary with age, sex, or geographic location. Groups of persons in which the prevalence of reciprocal titers of greater than or equal to 64 is significantly higher than 1.7% may have unusually great exposure to L. pneumophila. In the population tested, a reciprocal IFA titer of greater than or equal to 64 would have a specificity of 98.3% in the diagnosis of an acute illness as Legonnnaires' disease.

Viral hepatitis associated with day-care centers

From September 1976 through March 1978, we investigated 11 outbreaks of non-B viral hepatitis associated with Louisiana day-care centers. The outbreaks included 168 cases, most of which were erroneously considered "sporadic" cases of non-B viral hepatitis prior to the investigations. Thirteen percent of all non-B viral hepatitis cases reported in the New Orleans metropolitan area during 1977 were associated with one of the outbreaks. Most of the cases in each outbreak and 85% overall were in older, usually adult, contacts of children attending the day-care centers. Within the household, parents appeared to be at greatest risk, particularly those who had 1- to 2-year-old children in the day-care center. Day-care center outbreaks of non-B hepatitis are easily overlooked and may be more widespread than is currently appreciated.

Sporadic community-acquired Legionnaires' disease in the United States. A case-control study

One hundred patients with sporadic, community-acquired, serologically confirmed Legionnaires' disease were matched with control subjects known by the patients (acquaintance controls) and control subjects chosen from among patients with negative serodiagnostic tests for Legionnaires' disease (clinical controls). Each clinical control subject was also matched with an acquaintance control of his own. Legionnaires' disease patients had smoked more cigarettes, consumed more alcohol, and were more likely to have resided near excavation sites than acquaintance or clinical control subjects. Parallel differences between clinical controls and their acquaintances were not seen. Legionnaires' disease patients had traveled away from home for more time during the 2 weeks before onset of illness than had their acquaintances. The difference was of greater magnitude than that between clinical control subjects and their acquaintances. Legionnaires' disease patients were more likely to have resided near construction sites than clinical controls, and there were more construction workers among patients than among clinical control subjects.