Preliminary readings of antimicrobial susceptibility panels: A simple, fast and inexpensive way to detect bacterial resistance and enhance antibiotic treatment of bloodstream infections

Increasing incidence of resistant bacteria needs faster identification (ID) and antibiotic susceptibility testing (AST) in order to improve antimicrobial treatment of severe infections. We propose a preliminary reading of the AST MicroScan® panels coupled with mass spectrometry ID. A total of 157 bacterial clinical isolates were processed for routine ID and AST (in 22 cases, ID and AST were performed directly from positive blood culture bottles). For gram-negatives, data from the initial and final readings were recorded and compared [89.9% category agreement (CA), 6.9% very major errors (VME)]. In adition all the 32 ESBL producers were detected at 5.3-8.6 hours. For Staphylococcus aureus, all the 16 MRSA isolates were detected at 4.5 to 7.5 hours. Thus, we find our preliminary readings approach as a simple, inexpensive and reliable way to detect and identify the most prevalent resistant bacteria in our institution on the same day that ID/AST is performed.

Localized mucosal leishmaniasis caused by Leishmania infantum mimicking cancer in the rhinolaryngeal region

The clinical, microbiological, and histopathological findings of six patients with mucosal leishmaniasis are reported. Five of these patients were Spanish with no history of travel abroad, while the other was from Bolivia but had lived in Spain for more than 5 years. Two patients had no underlying disease, while the other four had several other medical conditions. Lesions were located in the nose in three patients and in the larynx in the other three. Symptoms included difficulty in swallowing, nasal obstruction, dysphonia, and polypoid lesions mimicking cancer. The diagnosis was based on the identification of parasites, or on PCR assay or culture. Five patients were treated with liposomal amphotericin B and the other with antimonial compounds.

[Schizophenia and premorbid infections]

Schizophrenia is a disease of unknown etiology. Many authors have studied its association with infections. By meta-analysis viruses are the most studied agents, relationship with the Borna virus and human endogenous retrovirus W. Also, C. pneumoniae and C. psittaci DNA in blood are more common in patients. Finally, there is association with parasitism by T. gondii, despite the existence of publication bias. Serologically, in our environment, anti-Toxoplasma IgG may be a risk factor related to schizophrenia, and may have potential value for better diagnosis and prevention.

In vitro activity of β-lactam and non–β-lactam antibiotics in extended-spectrum β-lactamase–producing clinical isolates of Escherichia coli

The activity of different beta-lactam and non-beta-lactam antibiotics was assessed against extended-spectrum beta-lactamase (ESBL)-producing and non-ESBL-producing clinical isolates of Escherichia coli. A phenotypic study to discover the presence of ESBLs in 399 clinical isolates of E. coli was made by the disk diffusion method following the Clinical and Laboratory Standards Institute (formely NCCLS, 2004) guidelines. The activity of different antibiotics was subsequently studied using the automated VITEK 2 system (bioMérieux, Marcy l'Etoile, France). One hundred fifteen isolates proved to be ESBL-producing and 284 non-ESBL-producing. Among the former, percentage susceptibilities to the antibiotics assayed were meropenem and amikacin, 100%; piperacillin/tazobactam, 97.4%; cefepime, 94.8%; amoxicillin/clavulanic acid, 84.3%; tobramycin, 84.3%; gentamicin, 83.5%; cefoxitin, 83.5%; nitrofurantoin, 71.3%; cotrimoxazole, 46.1%; norfloxacin, 29.6%; ciprofloxacin, 27%; and ofloxacin, 26.1%.

A new successful therapy for fetal chylothorax by intrapleural injection of maternal blood

We present two cases of fetal chylothorax and hydrops diagnosed at 20 weeks' gestation, both of which underwent successful intrauterine treatment. In Case 1, a transient, near total resolution began 2 weeks after an iatrogenic hemothorax following a second thoracocentesis performed at 24 + 6 weeks. Because of pleural fluid reaccumulation, a Cesarean section was performed at 36 weeks. The 3805-g female neonate was admitted to neonatal intensive care but was discharged 50 days later in a healthy condition. In Case 2, resolution occurred after a third thoracocentesis and a second pleural injection of maternal blood, performed at 26 weeks. A 2660-g female neonate was delivered vaginally at 38 weeks. The infant remained asymptomatic and was discharged aged 4 days. Our experience suggests a possible useful role of intrapleural blood injection for the treatment of fetal chylothorax.

Scanning electron microscopy of the wild boar and pig lingual papillae

Lingual papillae of wild boar and pig were studied by means of scanning electron microscopy (SEM). Vallate papillae appear with the typical circumvallate morphology. Their papillary bodies show conical or fungiform-like and spicule-like pseudopapillae in both animals. Taste pores were seen in the papillary grooves. Microplicae or pits are visible at high magnification. In pig and wild boar similar foliate papillae were observed. Pig has less but wider leaves than wild boar. Taste pores on papillary walls were viewed. At high magnification microplicae were seen. Morphologically, fungiform papillae correspond with their denomination. Taste pores open onto the upper surface and they are easily identifiable by SEM. The rostral and lateral regions contain the major number of fungiform papillae. The lateral papillae of wild boar and pig show a high number of pores per papilla. These regions must be considered important in taste sensitivity. Lateral papillae in both animals could provide a source of taste buds for study. In both animals the fungiform papillary epithelium showed a pitted appearance as a consequence of keratinization by food environmental stress. The filiform papillae can be both simple and compound (with body and hairs). Large conical papillae are located caudally and curved in the same direction. Filiform and conical papillae have a function in food mastication, handling and deglutition.

Fungiform papillae of the pig and the wild boar analyzed by scanning electron microscopy

Fungiform papillae of wild boar and pig were studied by scanning electron microscopy (SEM). Four regions were defined on the tongue: rostral, medial and caudal thirds and lateral sides. Morphologically the fungiform papillae correspond with their denomination. Rostral and lateral tongue regions presented the largest average number of fungiform papillae. Taste pores opened onto the upper surface of the papillae and were easily identifiable by SEM. The total number of fungiform taste pores from both animals was the highest reported in the literature. The lateral papillae of wild boar and pig contained the largest average number of pores per papilla. This region must be important in taste sensitivity. Lateral and rostral papillae from both animals can provide a source of taste buds for study since each fungiform papilla presents numerous taste buds and these papillae are very abundant.

A study of the chick thymus microenvironment during development: analysis by monoclonal antibodies against thymic epithelium

The process of T-lymphocyte differentiation within the thymus involves a series of molecular interactions. In this work we have carried out an analysis of the chick thymus microenvironment in order to evaluate its heterogeneity during development. We have produced 11 monoclonal antibodies whose staining patterns detected by the immunoperoxidase technique allowed us to divide them into five groups. A first group (E19-E2, P0-E5, and P15-T1) binds to thymic medullary stroma showing a reticular pattern on medullary epithelial cells and whose significance would be related to thymic stromal secretion. The second group of monoclonal antibodies (P15-T3) stains thymic corpuscles of 10- and 15-day chicks. The third group of antibodies includes P0-E1, P0-E3, P5-A6, and P15-T2 whose staining pattern is both medullary and cortical. The fourth group (P10-HB1 and P10-HB2) binds to thymic stromal and cortical thymocytes, and the fifth group (P5-A1) is characterized by the staining of medullary vessels of 5-day chicks. These five groups of monoclonal antibodies corroborate the existence of an antigenic diversity of the chick thymus microenvironment. Their possible relationships with T-cell differentiation and stromal-thymocyte interactions are discussed.

Simultaneous determination of toluene and xylene metabolites in urine by gas chromatography

A gas chromatographic method for simultaneous determination of hippuric and o-, m-, and p-methylhippuric acids (metabolites of toluene and xylene) in urine is described. The analytical procedure is based on the extraction of the aromatic metabolites with ethyl acetate containing the internal standard and on a methylation with 3-methyl-1-p-tolyltriazene. With this method, which does not require much time and handling, the different acids can be satisfactorily determined with high sensitivity and specificity. A statistical study shows a good reproducibility for the determination of hippuric and o-, m-, and p-methylhippuric acids. The coefficient of variation for 10 determinations in all cases was less than 5%.

Direct evidence of luteal insufficiency in women with habitual abortion

Plasma levels of progesterone were measured during the luteal phase in 10 of 15 women with clinical histories of at least three spontaneous abortions in the last three gestations, and in 15 healthy nonpregnant women during the same phase of the ovarian cycle. Progesterone values found in the women with habitual abortion were lower (P less than 0.05-0.005) than in the nonpregnant group almost throughout the period of observation. The habitually aborting women who became pregnant again aborted between the seventh and 12th weeks. Their progesterone concentrations were less than 6 ng/ml, 48-72 hours before vaginal bleeding or abortion. These values were compared with those found during the first 12 weeks in normal pregnancy (P less than 0.001). The results suggest a useful method of evaluating the treatment of habitual abortion.

Trichloroethylene exposure. Simulation of uptake, excretion, and metabolism using a mathematical model

The absorption, distribution, and excretion of trichloroethylene, as well as the kinetics of formation and elimination of trichloroethanol (TCE) and trichloroacetic acid (TCA) were simulated by a mathematical model. The results of this model have been satisfactorily compared with those obtained experimentally from pulmonary elimination of the solvent and from urinary excretion of the metabolites. The model permitted a study of the distribution of the solvent in the different tissues of the organism as well as an evaluation of the body burden of TCE and TCA. The influence of the duration and repetition of the exposure on the urinary eliminations of TCE and TCA was studied, and showed that the excretion of the first metabolite represents the most recent exposure while that of the second is related to the average exposure of the preceding days. The study of the pulmonary elimination of trichloroethylene during single or repeated exposures showed a linear relationship between the alveolar concentration of the solvent approximately 15 hours after the end of the exposure and the quantity of trichloroethylene accumulated in the fatty tissues.