Characteristics of fauces microflora in children treated in intensive care units]

Characteristic features of fauces aerobic microflora in children treated in intensive care units (ICU) were analysed. For comparison fauces microflora in children outpatients and in children patients from general surgical units was investigated. A retrospective analysis of all the smears without exception for 2 years (a total of 2120) revealed a direct dependence of the changes in the fauces microflora composition on the patient condition and the antibiotic load. It was shown that the fauces indigenic microflora in ICU patients was more often replaced by enterococci, gramnegative enteric bacteria and nonfermenting bacteria which are not usual under the normal conditions. The flora in such cases was represented by monoculture. Thus, microorganisms natural for the fauces i.e. Haemophilus influenzae and Neisseria spp. were not practically detected in the fauces of the ICU patients (0.5 and 0.4 per cent, respectively). Grampositive cocci in the children of the surgical units and in the outpatients included alpha-hemolytic streptococci in association with beta-hemolytic or nonhemolytic streptococci. No such bacteria were isolated from the ICU newborns. The associations of gramnegative organisms from the ICU patients included 40 variants. Seventy-eight association variants of Pseudomonas aeruginosa were mainly represented by the combinations with Serratia spp. and Klebsiella spp. as well as with coagulase negative staphylococci or enterococci, especially in the ICU newborns. The results of the study demonstrated that the target-aimed antibiotic therapy providing eradication of P.aeruginosa in the ICU patients was not always justified because of possible superinfection practically due to any organism from the association. Massive antibiotic therapy with pressing on gramnegative flora in the ICU patients induced selective contamination of the mucosa by polyresistant enterococci thus increasing their potential role in the development of hospital infections.     

The dynamics of the species composition, antilysozyme activity and antibiotic resistance of the causative agents of soft-tissue surgical infection]

The dynamics of the microflora in the foci of surgical infection in 54 patients was studied. Staphylococci and streptococci prevailed among the primarily isolated causative agents. In complicated forms of surgical infection of soft tissues the change of causative agents, mainly to gram-negative opportunistic microflora with a higher level of resistance to antibiotics and high antilysozyme activity, was observed more often than in noncomplicated forms of such infection.     

Cariogenicity depends more on diet than the prevailing mutans streptococcal species

This review aims to compare the occurrence and distribution of mutans streptococci in Africa, Europe, and North America and in addition will try to offer explanations for existing relationships among salivary mutans streptococci counts, dietary patterns, and dental caries. The literature reveals that salivary mutans streptococci counts in child populations of the three continents are comparable. The distribution of mutans streptococci species, with a predominance of S. mutans followed by S. sobrinus, and the virtual absence of other mutans streptococci species are also comparable. Although it is widely believed that diet has an important effect on mutans streptococci counts, this review provides evidence that this does not hold true when variations in dietary patterns are moderate, as they normally are in real-life situations. Since the diets of the child populations in the three continents vary moderately, a strong dietary-induced effect on salivary mutans streptococci counts cannot be expected. The observed analogous salivary mutans streptococci counts in these child populations are thus 'not surprising' but are in accordance with the conceptual expectation. The differences in caries experience in children of the three continents cannot be explained by the prevailing mutans streptococci species but instead should be attributed to differences in the cariogenicity of the various diets. The fact that the cariogenicity of the diet determines the development of dental caries while hardly affecting the mutans streptococci counts explains the limited value of the latter as an indicator of dental caries. The reviewed literature shows that mutans streptococci are ubiquitous in children aged 7 years and older in Africa, Europe, and North America. Mutans streptococci should therefore be considered as belonging to the indigenous microflora of the human mouth.     

The aspects of psychophysiological analysis of erroneous actions performed by astronauts

The experience of manned space missions points to the fact that cosmonaut-operator plays an important role in providing the efficiency and reliability of the crew-spacecraft system. However, the spaceflight factors can have a negative effect on working capacity of crewmembers and give rise to their operational errors. The paper deals with the methodical approach to analysis of the interrelationship of errors and psychophysiological state of cosmonauts as well as the ways of its realization. Described are the system of indices used for expert assessment of the psychophysiological state, peculiarities of work-rest schedule, and intra- and intergroup interaction. Potentialities of this approach are evidenced by results of the analysis of data from one of the MIR missions.     

Residential colonization of orbital complex "Mir" environment by penicillium chrysogenum and problem of ecological safety in long-term space flight

Results of many years of the survey of highly specific evolution of quantitative and species composition of microflora of the MIR environment are reviewed. Analysis of the data enabled listing of microorganisms-declinous fungi with the ability of residential colonization of structural materials of the interior and equipment of habitable modules of the space station. Results of the studies of variability and level of similarity/affinity on the basis of DNA, polymorphism of strains isolated in space flight, convincingly confirmed this characteristic in the Penicillium chrysogenum cultures. In view of the common origin determined from the signs of genetic alliance, the P. chrysogenum strains isolated on MIR in 1995 can be considered descendants of the cultures found at the beginning of the MIR operation. This ecological expansion of P. chrysogenum in the space station environment gains in prominence due to the fact that representative of this particular species known for its active biodestructive nature were, as a rule, detected in the areas where structural materials of the SALYUT and MIR space stations incurred biological degradation.     

Nature of geometric (Berry) potentials

Previous studies have found that the fluoride concentration of plaque growing on or adjacent to glass ionomer cement (GIC) is increased and the proportion of mutans streptococci in plaque is reduced. So far, there are only a few studies of the long-term effect of glass ionomer fillings on plaque in vivo. The aim of this study was to determine whether old GIC fillings have effects on plaque fluoride and microflora and whether this effect can be increased by topical application of fluoride on GIC fillings in vivo. The participants were 27 adults with at least 3 GIC fillings about 3 years old. Plaque was collected from sites adjacent to the GIC fillings and from the contralateral teeth, after which a 1.2% fluoride gel was applied to all teeth. Three days later, plaque was collected from the same sites as before. Stimulated saliva was also collected at both appointments. The results show that none of the patients had elevated levels of fluoride in their saliva either before or 3 days after the fluoride treatment. The fluoride concentration was 0.51 microgram/mg protein in plaque on GICs and 0.35 microgram/mg protein in plaque on contralateral teeth (p = 0.028). After the fluoride treatment, the respective fluoride concentrations were 0.59 microgram/mg and 0.75 microgram/mg (p = 0.849). No significant differences in the proportion of mutans streptococci and lactobacilli in plaque from GIC and contralateral teeth were found. The results suggest that the fluoride concentration of plaque growing on old GIC fillings is slightly increased. In this study, however, this had no significant effect on the cariogenic microflora.(ABSTRACT TRUNCATED AT 250 WORDS)     

Posture, locomotion, spatial orientation, and motion sickness as a function of space flight

This article summarizes a variety of newly published findings obtained by the Neuroscience Laboratory, Johnson Space Center, and attempts to place this work within a historical framework of previous results on posture, locomotion, motion sickness, and perceptual responses that have been observed in conjunction with space flight. In this context, we have taken the view that correct transduction and integration of signals from all sensory systems is essential to maintaining stable vision, postural and locomotor control, and eye-hand coordination as components of spatial orientation. The plasticity of the human central nervous system allows individuals to adapt to altered stimulus conditions encountered in a microgravity environment. However, until some level of adaptation is achieved, astronauts and cosmonauts often experience space motion sickness, disturbances in motion control and eye-hand coordination, unstable vision, and illusory motion of the self, the visual scene, or both. Many of the same types of disturbances encountered in space flight reappear immediately after crew members return to earth. The magnitude of these neurosensory, sensory-motor and perceptual disturbances, and the time needed to recover from them, tend to vary as a function of mission duration and the space travelers prior experience with the stimulus rearrangement of space flight. To adequately chart the development of neurosensory changes associated with space flight, we recommend development of enhanced eye movement systems and body position measurement. We also advocate the use of a human small radius centrifuge as both a research tool and as a means of providing on-orbit countermeasures that will lessen the impact of living for long periods of time with out exposure to altering gravito-inertial forces.     

Microflora of the nasal cavity and its sensitivity to antibiotics in patients with chronic rhinitis treated by cryotherapy

Cryotherapy is used in treatment of chronic rhinitis and pharyngitis. The effect of cryotherapy on the qualitative and quantitative composition of the microflora was studied. Staphylococci prevailed in the rhinitis patients, streptococci, Clebsiella and Neisseria being registered more rarely. The staphlococcal isolates were highly sensitive to monomycin, neomycin, erythromycin and levomycetin. The results of the dynamic study showed that the flora composition did not significantly change during cryotherapy and the sensitivity level of the staphylococcal isolates to the antibodies remained unchanged.     

The adaptation of the blood circulation to the long-term microgravity: ballistic-cardiographic investigation during 14 month space flight

Specificity of the use of ballistocardiography (BCG) in space flight is considered. In particular, the contactless method makes it possible to continue recording during the night hours and study the ultradian rhythms reflective of the state of higher autonomous centers. As was stated, on months 7 to 8 of the mission by cosmonaut-physician Polyakov the BCG amplitude rose in concert with activation of the higher autonomous centers that were apparently involved in maintaining the established cardiovascular homeostasis. By months 11 to 13 on mission, the BCG amplitude decline resulted in an increase in the SCG/BCG index representing the amount of myocardium energy spent on blood transport.     

Transformation of vibrios with R factors from enterobacteria

The microflora of normal skin in 16 patients with repeated staphylococcal and streptococcal skin infections was examined to determine whether abnormalities existed which would indicate a protective role for the indigenous flora against colonization by pathogens. Five sites-hands, feet, axilla, groin and back-were examined quantitatively and qualitatively and compared with a control group. Total populations of indigenous flora were significantly higher from patients with repeated skin infections of the back, axillae and feet. The frequency of isolation of different species from normal skin was comparable between the control and experimental groups, with the exception of the incidence of Staphylococcus aureus and Proteus species which were isolated only from patients with repeated skin infections. Gram-negative bacteria were isolated with comparable frequency between the two groups, but patients with repeated skin infections tended to carry gram-negative bacteria on multiple sites. It was concluded from the high population of indigenous flora and the types of microogranisms present that the microflora of normal skin did not appear to protect patients with repeated skin infections against colonization by pathogens. The presence of high populations of Staphylococcus aureus on the normal skin of patients with repeated skin infections would appear to be the most important contributing factor.     

The effect of head-to-trunk position on the direction of arm movements before, during, and after space flight

This contribution deals with the examination of the consequences of different head-to-trunk positions on arm movements under normal gravity and during prolonged space flight. One of the objectives of this study was to investigate the influence of weightlessness on the condition of the spatial analysis system. Aimed arm movements in the horizontal plane (pointings towards two visual targets) were recorded, first with eyes open, head straight (learning part), then with eyes closed, head straight and during yaw or roll position of the head (performance part). Measurements related to these different head-to-trunk-positions were taken in one short-term and nine long-term cosmonauts preflight, inflight, and postflight. Terrestrial control experiments were carried out with an extended experimental design in 14 healthy volunteers. The analysis of these experiments revealed that, with eyes closed and the head in yaw position, cosmonauts before flight and control subjects exhibit significant slants of the movement plane of the arm. Contrary to terrestrial measurements, in space experiments roll tilt of the head to the right is correlated with considerable counterclockwise slant of the movement plane. This slant of the movement plane of the arm was interpreted as tilt of the internal representation of the horizontal coordinate. The effect is larger with greater distortion induced by the changed head position and with larger muscular involvement to keep this position. This effect is also increased by the reduction of information (for example, in microgravity). The amount and the direction of the horizontal offset of the arm movements are shown to be dependent on the head-to-trunk position, too. Additionally, we have found changes in the amplitude and in the duration of the arm movement, in the vertical offset, and in the curvature of the movement paths, depending on the experimental conditions.     

Properties of extracellular products produced by group A streptococci isolated from patients with streptococcal toxic shock syndrome

Extracellular products of group A streptococci isolated from patients with streptococcal toxic shock syndrome (STSS) were examined. The outline of the discussion of the 3 products are as follows; streptolysin O (SLO), proteinase and erythrogenic toxin. SLO and proteinase showed a relatively large amount of products more than erythrogenic toxin. SLO produced by group A streptococci isolated from the patient with STSS had an isoelectric point (pI) of 6.0 and a molecular weight of 64,000 and showed hemolytic activity in the presence of 2-mercaptoethanol (2-ME). Furthermore, the hemolytic activities of all components were inhibited by gamma-globulin and cholesterol. Proteinase had pIs of 8.7 and 8.9, and a molecular weight of 21,000. These data suggest that STSS clinical criteria probably reflects a characteristic of a large amount of products of individual S. pyogenes isolates.     

Significance of normal oropharyngeal flora in the development of streptococcal pharyngitis and outcome of penicillin therapy

Pharyngitis is one of the most frequent diseases in children. The most important of the bacterial infections is due to Streptococcus pyogenes. For many years, penicillin is considered to be the drug of choice for streptococcal pharyngitis, although failure rates of up to 20% have been reported. One of possible explanations for penicillin treatment failure is presence of other species of bacteria in the normal oropharyngeal flora that can interfere with colonization and growth of Streptococcus pyogenes and influence the development of pharyngitis. A wide variety of microorganisms, including alpha-haemolytic streptococci and anaerobic bacteria, are present within the oropharynx (table 1). The strain of alpha-haemolytic streptococci is in interference with Streptococcus pyogenes. By producing bacteriocins, they inhibit colonization and growth of Streptococcus pyogenes and assist in its eradication. Anaerobic bacteria may play a direct or indirect role in development of pharyngitis. They may be directly responsible for specific forms of pharyngitis or contribute indirectly with possibility of synergy between them and Streptococcus pyogenes. Beta-lactamase-producing aerobic and anaerobic organisms may contribute to penicillin treatment failure. By producing beta-lactamase within the tonsillar tissue, they destroy penicillin and protect streptococci from the antibacterial effect of penicillin. Pharyngeal bacterial flora may vary according to the state of the patient (Figure 1). During an acute infection and in the cases of treatment failure and recurrent pharyngitis the number of alpha-haemolytic streptococci declines, while there is an increase in the number of anaerobic and beta-lactamase-producing organisms. After successful treatment the number and type of bacteria is similar to those found within normal tissue. Knowing the distribution and changes in pharyngeal bacterial flora is important for choosing the optimal drug for treatment of streptococcal pharyngitis. Although penicillin reduces the number of interfering beta-haemolytic streptococci, because of its advantages, if remains the drug of choice for the treatment of streptococcal pharyngitis. In cases of treatment failure and recurrent infections cephalosporins and macrolides may be a useful alternative to penicillin because they possess relatively poor activity against alpha-haemolytic streptococci, resistance to beta-lactamase and because of better penetration into tonsilar tissue.     

Effects of a 12-month prophylactic programme on selected oral bacterial populations on root surfaces with active and inactive carious lesions

In 15 caries-active patients, with a total of 770 exposed root surfaces, the effect of fluoride therapy and professional tooth cleaning was studied during a 1-year period. Dental plaque from 92 of the root surfaces and whole saliva samples were analysed at baseline and after 12 months for the presence of specific bacteria. The results showed that the number of active carious lesions had decreased from 99 to 46, while the inactive lesions had increased from 69 to 124. Of the active lesions which had been converted into inactive lesions, most were on the buccal and fewest were located on the distal surfaces. Lower plaque scores were found on sound and inactive root surfaces compared to active surfaces. The salivary concentrations of mutans streptococci and lactobacilli remained constant during the 12-month observation period. There was a tendency for higher levels of Streptococcus mutans in plaque from active lesions compared with sound root surfaces, whereas an inverse relationship was noted for the Streptococcus oralis group. No significant differences in the Actinomyces naeslundii counts were detected. In conclusion, the 12-month prophylactic programme had an effect on the clinical surface characteristics of root caries, but the components of the oral microflora selected for study seemed to be relatively unaffected during the observation period.     

Comparison of four methods for the detection of fecal streptococci in water

The objective of this study was to select an effective and fast method for the detection of socalled fecal streptococci in water by comparing a method according to the German drinking water standard, a membrane filtration method according to the ISO-draft standard 7899/2, the Chromocult Enterococcus Broth (Merck) and the Enterolert-System (IDEXX). The study was based on a collective of 297 water samples derived from different stages of water treatment and distribution, as well as from individual water supplies. The sensitivity, reliability, and selectivity of the single methods in relation to their practicability was evaluated. Concerning false positive and false negative results, the tests were proved by metabolic characterization of the isolated strains. The advantages and disadvantages of the methods resulting from the investigated criteria are discussed. The work is part of a comparative study within the scope of the DIN ad-hoc-committee "fecal streptococci".     

Physiological responses of horses to a treadmill simulated speed and endurance test in high heat and humidity before and after humid heat acclimation

Food movements during complete feeding sequences on soft and hard foods (8 g of chicken spread, banana, and hard cookie) were investigated in 10 normal subjects; 6 of these subjects also ate 8 g peanuts. Foods were coated with barium sulfate. Lateral projection videofluorographic tapes were analyzed, and jaw and hyoid movements were established after digitization of records for 6 subjects. Sequences were divided into phases, each involving different food management behaviors. After ingestion, the bite was moved to the postcanines by a pull-back tongue movement (Stage I transport) and processed for different times depending on initial consistency. Stage II transport of chewed food through the fauces to the oropharyngeal surface of the tongue occurred intermittently during jaw motion cycles. This movement, squeeze-back, depended on tongue-palate contact. The bolus accumulated on the oropharyngeal surface of the tongue distal to the fauces, below the soft palate, but was cycled upward and forward on the tongue surface, returning through the fauces into the oral cavity. The accumulating bolus spread into the valleculae. The total oropharyngeal accumulation time differed with initial food consistency but could be as long as 8-10 sec for the hard foods. There was no predictable tongue-palate contact at any time in the sequence. A new model for bolus formation and deglutition is proposed.     

Characteristics of the staphylococci isolated from the udder of cows with mastitis

A total of 175 strains of Staphylococcus aureus and 67 strains of Staphylococcus epidermidis were studied, isolated from 486 samples of milk secretion taken aceptically from the individual quarters of the udder of cows affected with subclinical and purulent (clinical) mastitis. The staphylococci were referred to as the causative agent of mastitis in case they were the only microflora in the seedings of the investigated material. Tests were applied as given in Fig. 1 to characterize the strains. It was found that mastitis in cows could be due to both plasma coagulating staphylococci (Staphylococcus aureus) and coagulase-negative Staphylococcus epidermidis organisms. The two Staphylococcus species were isolated from cows with clinical and subclinical mastitis. The division between pathogenic and nonpathogenic Staphylococcus strains by the plasma-coagulating symptom proved impossible, and this made it necessary to use other tests for pathogenicity. It became evident that the thing Staph. aureus and Staph. epidermidis had in common when isolated from cows with mastitis was the production of a gold-like pigment and delta hemolysin. Similarly to Staph. aureus isolated animals, the bovine Staph. epidermidis organisms did not possess fibrinolysin and rarely produced hemolysin. The isolated organisms belonging to the coagulase-positive staphylococci corresponded by their basic properties to Staphylococcus aureus var. bovis as described in the literature. The cultures of Staphylococcus epidermidis isolated under similar conditions showed in a considerable per cent of the cases somewhat different behaviour.     

Microbiology of liver and spleen abscesses

To study the aerobic and anaerobic microbiology of liver and spleen abscesses and correlate the results with predisposing factors, potential causes and routes of infection, clinical and laboratory data of 48 patients with liver abscesses and 29 with spleen abscesses treated between 1970 and 1990 were reviewed retrospectively. In liver abscesses, a total of 116 isolates (2.4 isolates/specimen) was obtained; 43 were aerobic and facultative species (0.9 isolates/specimen) and 73 were anaerobic species or microaerophilic streptococci (1.5 isolates/specimen). Aerobic bacteria only were isolated from 12 (25%) abscesses, anaerobic bacteria only from eight (17%), and mixed aerobic and anaerobic bacteria from 28 (58%); polymicrobial infection was present in 38 (79%). The predominant aerobic and facultative isolates were Escherichia coli (11 isolates), Streptococcus group D (8), Klebsiella pneumoniae (5) and Staphylococcus aureus (4). The predominant anaerobes were Peptostreptococcus spp. (18 isolates), Bacteroides spp. (13), Fusobacterium spp. (10), Clostridium spp. (10) and Prevotella spp. (4). There were 12 isolates of micro-aerophilic streptococci. S. aureus and beta-haemolytic streptococci were associated with trauma; Streptococcus group D, K. pneumoniae and Clostridium spp. with biliary disease; and Bacteroides spp. and Clostridium spp. with colonic disease. In splenic abscesses, a total of 56 isolates (1.9 isolates/specimen) was obtained; 23 were aerobic and facultative species (0.8 isolates/specimen), 31 were anaerobic species or micro-aerophilic streptococci (1.1 isolates/specimen) and two were Candida albicans. Aerobic bacteria only were isolated from nine (31%) abscesses, anaerobic bacteria from eight (28%), mixed aerobic and anaerobic bacteria from 10 (34%) and C. albicans in two (7%); polymicrobial infection was present in 16 (55%). The predominant aerobic and facultative isolates were E. coli (5 isolates), Proteus mirabilis (3), Streptococcus group D (3), K. pneumoniae (3) and S. aureus (4). The predominant anaerobes were Peptostreptococcus spp. (11 isolates), Bacteroides spp. (5), Fusobacterium spp. (3) and Clostridium spp. (3). S. aureus, K. pneumoniae and Streptococcus group D were associated with endocarditis, E. coli with urinary tract and abdominal infection, Bacteroides spp. and Clostridium spp. with abdominal infection and Fusobacterium spp. with respiratory infection.     

Vaginal microbiology of women with acute recurrent vulvovaginal candidiasis

Alterations in the autochthonous vaginal microflora can predispose women to recurring attacks of Candida vaginitis. Quantitative aerobic and anaerobic cultures were obtained from 24 premenopausal women with acute recurrent vulvovaginal candidiasis and from 21 healthy asymptomatic premenopausal women. Lactobacillus species constituted the predominant flora in both groups, with a mean log10 CFU/ml of 8.7, a total isolation rate of 96%, and a mean of 1.6 Lactobacillus species isolated per patient compared with a mean log10 CFU/ml of 8.9, a total isolation rate of 90%, and a mean of 1.2 Lactobacillus species isolated per patient in the vaginitis and control groups, respectively. The results of this small study failed to provide evidence of an altered or abnormal vaginal bacterial flora in women with non-antibiotic-induced recurrent vulvovaginal candidiasis suffering from acute Candida vaginitis.     

The role of Staphylococcus epidermidis persistence factors in the infectious process

The species composition of microflora was determined and the etiological role of S. epidermidis was shown in some purulent inflammatory diseases (maxillary sinusitis, urethritis). The role of the complex of S. epidermidis persistence factors in the chronization of the infectious process and the formation of the resident carrier state was established.