Vocim analysis of laryngeal images: is breathiness related to the glottic area?

289 Shigella strains were isolated from children at the paediatrics department of Ankara University. 75% of the isolates were S. sonnei and 24.8% were S. flexneri. Each strain was tested for resistance to 9 antimicrobial agents. 79% of the isolates were resistant to streptomycin (S), 56% to tetracycline (T), 55.7% to trimethoprim-sulfamethoxazole (SXT), 27.7% to ampicillin (Am) and 19.7% to chloramphenicol (C). None of the isolates was resistant to ciprofloxacin, nalidixic acid, cephalothin, ampicillin-sulbactam and ceftriaxone. 56% of the isolates were resistant to 3 or more antimicrobial agents. The most frequent pattern of resistance of S. sonnei and S. flexneri strains was SXT, T, S (39.6%) and Am, SXT, T, S, C (48.6%), respectively (p < 0.0001). These results demonstrate that trimethoprim-sulfamethoxazole should not be used in the treatment of shigellosis.     

Using equipment in unfamiliar clinical settings: audiology screening

To develop a better and selective medium for the isolation of Shigella spp., MacConkey's Agar (MAC) was modified by adding potassium tellurite (K2TeO3) at a concentration of 1 microgram/ml. The formulation designated Teknaf Enteric Agar (TEA) was studied for the inhibitory effect of potassium tellurite on the growth of different enteric bacteria, and as a medium for isolating Shigella spp. from clinical stool samples (n = 3125). We observed that the growth of E. coli was effectively inhibited on TEA with no effect on the growth of S. dysenteriae type 1 and S. flexneri. A total of 2019 Shigellae were isolated through the combined use of TEA, MAC, and Salmonella-Shigella Agar (SS). On TEA, 1921 S. dysenteriae type 1 and S. flexneri were isolated as compared to 1765 from the combined use of MAC and SS. A total of 194 of S. dysenteriae type 1 and S. flexneri were exclusively isolated from TEA as compared to 38 which were only made from MAC and SS. We conclude that TEA significantly increased the overall isolation rate of Shigella spp. as compared to the combined use of MAC and SS (P < 0.0001), although it is not suitable for the isolation of S. sonnei.     

High percentage of antibiotic resistance in Shigella infections in children in Cura?ao

OBJECTIVE: To evaluate antimicrobial treatment and resistance in clinical childhood shigellosis. DESIGN: Retrospective. SETTING: St. Elisabeth Hospital, Willemstad, Cura?ao, Dutch Antilles. METHOD: From September 1991 through August 1995 shigellosis was diagnosed in 93 children out of 456 hospitalised with gastroenteritis (S. flexneri in 60, S. sonnei in 32, S. dysenteriae in 1). From hospital and laboratory records, the clinical presentation, antibiotic treatment and duration of hospitalization were indexed as well as the antibacterial resistance pattern of shigellae. RESULTS: Of the hospitalised children 52 (56%) were treated with antibiotics. Ampicillin was given most frequently (71%), followed by the combination trimethoprim-sulfamethoxazole (25%). Isolated shigellae were resistant to ampicillin in 52% and to trimethoprim-sulfamethoxazole in 34%; 42% of the antibiotic treatments were in accordance with susceptibility of the isolated Shigella. CONCLUSION: A high percentage of shigellae isolated on Cura?ao was resistant to the most frequently used antibiotics ampicillin and trimethoprim-sulfamethoxazole.     

Studies on bacillary dysentery cases of overseas travellers--during 1979 to 1995

A total of 36,780,440 overseas travellers during 1979-1995 (17 years) were quarantined at Osaka and Kansai Airport Quarantine Station, 84,777 travellers reported themselves suffer from diarrhoea. Stools from 29,587 persons were bacteriologically examined. Various enteropathogenic bacteria were isolated from 9,766 (33.0%) patients of the stools examined. Isolated species were as follows: Plesiomonas shigelloides (3,234 cases); Salmonella spp. (2,236 cases); enterotoxgenic Escherichia coli (1,621 cases); Vibrio parahaemolyticus (1,959 cases); and Shigella spp. (1,242 cases). 1,278 different Shigella strains were isolated from 1,242 cases who were thus diagnosed as bacillary dysentery patients. The suspected regions or countries for infection of these cases were analysed. The serovars and antibiotic-sensitivities of the isolated strains were examined. Colicine typing of S. sonnei strains were also done. The results can be summarized as follows. 1) The most cases (53.4%) were infected in India. 2) The percentage distribution of sub-species of the strains was as follows; S. sonnei (57.8%), S flexneri (29.8%), S. boydii (8.4%), and S. dysenteriae (4.0%), respectively. 3) The major colicine type of S. sonnei strains were type 6 and 0. 4) The percentage of Antibiotic-resistant strains of each sub-species was S. dysenteriae (92.2%), S. sonnei (89.4%), S. flexneri (87.1%), and S. boydii (84.9%), respectively. The percentage of Antibiotic-resistant strains of S. flexneri were increased annually.     

Etiology of bloody diarrhea in Bolivian children: implications for empiric therapy. Bolivian Dysentery Study Group

In Bolivia, few data are available to guide empiric therapy for bloody diarrhea. A study was conducted between December 1994 and April 1995 to identify organisms causing bloody diarrhea in Bolivian children. Rectal swabs from children <5 years old with bloody diarrhea were examined for Salmonella, Shigella, and Campylobacter organisms; fecal specimens were examined for Entamoeba histolytica. A bacterial pathogen was identified in specimens from 55 patients (41%). Shigella organisms were found in 39 specimens (29%); 37 isolates (95%) were resistant to ampicillin, 35 (90%) to trimethoprim-sulfamethoxazole, and 24 (62%) to chloramphenicol, but all were susceptible to nalidixic acid. Only 1 of 133 stool specimens contained E. histolytica trophozoites. Multidrug-resistant Shigella species are a frequent cause of bloody diarrhea in Bolivian children; E. histolytica is uncommon. Clinical predictors described in this study may help identify patients most likely to have Shigella infection. Laboratory surveillance is essential to monitor antimicrobial resistance and guide empiric treatment.     

Resistance to antibiotics of Shigella strains isolated in Somalia

The resistance to antibiotics of 240 Shigella strains isolated in Somalia from 1973 to 1976 was studied. Many strains, particularly those of Shigella dysenteriae type 1, were found to be resistant to more than one drug. In view of their resistance to ampicillin, chloramphenicol, streptomycin, tetracycline, and sulfonamides, it is suggested that polymyxin B or M sulfate - which have proved to be effective in vivo - should be used for the treatment of clinically typical cases of bacillary dysentery.     

Aplasia cutis congenita: report of one case

CONTEXT: Shigella dysenteriae type 2 is rare in the United States, and outbreaks associated with this pathogen are uncommon. OBJECTIVE: To determine the magnitude and source of an outbreak of S dysenteriae type 2. DESIGN: Retrospective cohort. SETTING: Laboratory of a large medical center. PATIENTS: Case patients were identified as laboratory workers who had diarrhea on or after October 28 and a positive stool culture or temperature greater than 37.8 degrees C. Laboratory workers with diarrhea only were probable case patients. MAIN OUTCOME MEASURES: We interviewed laboratory staff and performed identification, serotyping, and pulsed-field gel electrophoresis on isolates from case patients, implicated food, and laboratory stock culture. RESULTS: From October 29 through November 1, a total of 12 (27%) of 45 laboratory staff developed severe, acute diarrheal illness; 8 had S dysenteriae isolated from stool and 4 were hospitalized. All case patients reported having eaten muffins or doughnuts placed in the staff break room on October 29. Pulsed-field gel electrophoresis showed stool isolates from 9 case patients were indistinguishable from S dysenteriae type 2 recovered from an uneaten muffin and from the laboratory's stock strain, a portion of which was missing. CONCLUSIONS: The source of the outbreak was most likely the laboratory's stock culture, which was used to contaminate the pastries. Results of this investigation underscore the need for adequate precautions to prevent inadvertent or intentional contamination from highly pathogenic laboratory specimens.     

Antimicrobial-resistant Salmonella spp isolated from healthy broiler chickens after slaughter

Of 105 Salmonella organisms of any serotype selected from a sample of 1,824 serotyped salmonellae isolated during a nationwide bacteriologic survey of healthy broiler chickens after slaughter, 60 (57%) were resistant to 1 or more antimicrobial agents and 47 (45%) were resistant to 2 or more agents. Highest resistance was to tetracycline (45%), streptomycin (41%), sulfisoxazole (19%), gentamicin (10%), and trimethoprim/sulfamethoxazole (8%). Additional isolates of S typhimurium, heidelberg, agona, and enteritidis were selected from the sample of 1,824 isolates for testing because of the high frequency with which these 4 serotypes are isolated from human patients. The highest frequency of resistance among 104 isolates of S heidelberg, 92 isolates of S typhimurium, and 30 isolates of S agona was to streptomycin (33 to 57%), sulfisoxazole (33 to 50%), tetracycline (26 to 50%), and gentamicin (13 to 40%); 51 to 63% of these isolates were resistant to 1 or more agents and 37 to 59% were resistant to 2 or more agents. Resistance to ampicillin among these 3 serotypes was uncommon (0 to 4%). In contrast, 15 of 19 tested isolates (79%) of S enteritidis were resistant to ampicillin and 13 of the 19 isolates (68%) were resistant only to ampicillin. This pattern of resistance was associated with a specific bacteriophage type and indicated the potential role of bacterial clones in determining the frequency and patterns of antimicrobial resistance in populations of broiler chickens. Resistance to gentamicin and trimethoprim/sulfamethoxazole was higher than that previously reported and is of public health concern because of the frequency with which these drugs are used to treat bacterial infections in human patients.     

Isolation of Shigella dysenteriae serotypes 11, 12, and 13 from patients with diarrhea in Bangladesh

Nine isolates of bacteria biochemically resembling Shigella dysenteriae but not belonging to the 10 recognized serotypes were isolated from patients with diarrhea in Bangladesh. Further studies suggested that two, one, and six isolates belonged to the recently recognized S. dysenteriae serotypes 11, 12, and 13, respectively.     

Short- and long-term effects of calcitonin and calcium administration on blood calcium, magnesium and inorganic phosphorus in post menopausal osteoporosis

As a consequence of the civil war that devastated Burundi in October 1993, more than 300,000 refugees settled in the neighboring country of Rwanda. We describe the outbreak of dysentery due to Shigella dysenteriae type 1 (Sd1) that developed in Nzangwa, a camp hosting some 20,000 Burundese refugees. Between November 17, 1993 and March 10, 1994, 6,122 cases of bloody diarrhea were notified by the health information system of the camp. The overall attack rate was 32.3%, and the fatality rate was 3.8%. Children under five years of age were the most affected group of the population. All dysentery cases were treated with nalidixic acid for 5 days. The compliance assessment showed that less than 50% of the ambulatory patients completed the 5-day regimen. From 35 stool samples obtained from the refugees, seven Sd1 strains were isolated, of which three were multi-resistant to nalidixic acid. These results confirmed the morbidity and mortality of Sd1 outbreaks in the displaced populations of Central Africa. We also emphasize the difficulties in implementing effective prevention measures and appropriate case management strategies in this environment. To improve the management of patients in large Sd1 outbreaks with limited resources, we devised a clinical classification of cases according to the risk of dying.     

Ampicillin resistance mediated by the R plasmid in strains of Shigella flexneri]

Forty Shigella flexneri strains isolated from children attended to at the Children's Hospital of Camagüey during an outbreak of acute diarrheal disease were studied; the minimal inhibitory concentration of ampicillin was determined. 33 strains (82.5%) were resistant to higher concentrations: 8 to 16 micrograms/mL, and 7 were susceptible to 4 micrograms/mL concentrations. Resistance plasmid (R) extraction was carried out in all the isolated strains and a common plasmid was found this plasmid was purified and transferred to Escherichia coli HE 101. Resistance transmission was tested.     

Structure of the Shigella dysenteriae haem transport locus and its phylogenetic distribution in enteric bacteria

The ability to transport and use haemin as an iron source is frequently observed in clinical isolates of Shigella spp. and pathogenic Escherichia coli. We found that many of these haem-utilizing E. coli strains contain a gene that hybridizes at high stringency to the S. dysenteriae type 1 haem receptor gene, shuA. These shuA-positive strains belong to multiple phylogenetic groups and include clinical isolates from enteric, urinary tract and systemic infections. The distribution of shuA in these strains suggests horizontal transfer of the haem transport locus. Some haem-utilizing pathogenic E. coli strains did not hybridize with shuA, so at least one other haem transport system is present in this group. We also characterized the chromosomal region containing shuA in S. dysenteriae. The shuA gene is present in a discrete locus, designated the haem transport locus, containing eight open reading frames. Several of the proteins encoded in this locus participate with ShuA in haem transport, as a Salmonella typhimurium strain containing the entire haem transport locus used haem much more efficiently than the same strain containing only shuA. The haem transport locus is not present in E. coli K-12 strains, but the sequences flanking the haem transport locus in S. dysenteriae matched those at the 78.7 minute region of E. coli K-12. The junctions and flanking sequences in the shuA-positive pathogenic E. coli strains tested were nearly identical to those in S. dysenteriae, indicating that, in these strains, the haem transport locus has an organization similar to that in S. dysenteriae, and it is located in the same relative position on the chromosome.     

Shigellae isolated in 1997--plasmid profiles and antibiotic resistance

INTRODUCTION: Shigella spp is one of the most frequently isolated bacteria causing acute diarrhea with us. Genetics of pathogenicity of Shigella spp. includes chromosomal and plasmid genes. Most virulence factors are coded by invasion plasmid antigen genes residing on a 180-230 MDa plasmid. There is a big problem with multiple resistance of Shigella spp. strains, which is mostly plasmid-borne. Genetic analysis of bacterial cells, that is plasmid profile analysis, is important for investigation of sources and ways of spreading of the infection. All isolates originating from the same clone have identical plasmid profiles, i.e. number and size of plasmids. The aim of the investigation was: comparing the type of resistance to antimicrobical agents found in epidemic and nonepidemic. Shigella strains isolated in 1997, analyzing plasmid profiles of these isolates and confirming their epidemic connection. MATERIAL AND METHODS: Susceptibility to antibiotics was examined by a standard disc-diffusion method. Plasmid profiles of 40 strains (20 from the outbreak and 20 from sporadic cases) were tested using a method of alkaline lysis by Birnboim and Doly followed by electrophoresis in agarose gel. RESULTS: Shigella strains were resistant to antimicrobial agents which are most commonly used. Epidemic isolates shared the same resistance type, they were resistant to cephalexin, streptomycin and co-trimoxazole. The dominant type of resistance of nonepidemic strains was to ampicillin, streptomycin and co-trimoxazole. Strains isolated during the outbreak had identical plasmid profiles (2 plasmid bands of 55 and 1.5 MDa). Non-epidemic isolates had different plasmid profiles as well as type of resistance. CONCLUSION: Strains of Shigella spp. isolated during an outbreak had the same type of resistance and the same plasmid profiles, which indicated their origin from the same clone. The plasmid profile analysis is a reliable and precise method for determination of epidemic connection of Shigella isolates.     

Resistance to nalidixic acid. A misconception due to underdosage

The clinical impression of inordinate selection of resistant mutants to nalidixic acid cannot be substantiated on close scrutiny when sensitive infections are treated at a full dosage of 4 gm/day. When 27 consecutive patients were treated with 4 gm of nalidixic acid per day, resistance developed in the bacteriuric population in only 7%. Moreover, resistance in the fecal reservoir was surprisingly minimal and much less than that reported for sulfonamides, tetracyclines, and ampicillin. The observation is important because multiply-resistant Enterobacteriaceae maintain their sensitivity to nalidixic acid since extrachromosomal R-factor resistance to nalidixic acid has never been demonstrated and cannot be transferred from one organism to another. In vitro data on 100 sensitive strains of Enterobacteriaceae show that the developmental of resistance to nalidixic acid is inversely proportional to the concentration of nalidixic acid regardless of whether the inoculum size is 10(5) or 10(8) bacteria per milliliter. Underdosage (less than 4 gm/day) with nalidixic acid is the probable cause of excessive resistance.     

Medical mummies: the history of the Burns Collection

Of the 43 Aeromonas spp. isolated from various clinical samples 94% isolates were Beta-lactamase producers. The isolates were tested for sensitivity by disc diffusion method which is commonly used in Pakistan. MIC was determined by using Epsilometer test (E-test) method. More than 80% isolates were sensitive to cephalosporins and quinolones. However, resistance to commonly used antibiotics was very high, 94% isolates were resistant to ampicillin which corresponds to the betalactamase production. More than 60% of the isolates were resistant to cotrimoxazole and 40% to chloramphenicol, hence quinolones and cephalosporins appear to be the drugs of choice for treating serious Aeromonas infections. The MIC range of Aeromonas was best for cefotaxime < 0.06 - 1.0 ug/ml. MIC 90 for cefotaxime was 0.50 ug/ml, for imipenem 0.25 ug/ml and for ciprofloxacin 2.0 ug/ml.     

Short-term clinical study on a new aqueous humor drainage implant for refractory glaucoma

Alkaline phosphatase-conjugated oligonucleotide probes were developed to detect the gene coding for Vero toxin 1 (VT1) and Vero toxin 2 (VT2). Using these probes, 3 hr was enough to detect VT genes when suspicious colonies of enterohaemorrhagic Escherichia coli (EHEC) were obtained on an agar plate. The results of a hybridization test with 144 isolates of EHEC O157 and one isolate of Shigella dysenteriae Type 1 agreed exactly with the immunological detection, reversed passive latex agglutination (RPLA) test, of VTs in their culture supernatants. The sensitivity levels of these probes for the detection of VT genes were 100%. The specificity of these probes were also tested with a total of 1,002 strains of Escherichia coli other than EHEC and 8 strains of Shigella sp. other than Shigella dysenteriae Type 1; the results showed 100% specificity.     

In vitro antimicrobial activity of DR-3355, a new quinolone antibacterial agent, against clinical isolates of enteritis-causing bacteria]

We determined the minimum inhibitory concentration (MIC) of DR-3355, a newly developed quinolone-derivative antibacterial agent, against clinical isolates of various bacterial species from enteritis patients, and compared them with those of ofloxacin (OFLX), ciprofloxacin (CPFX), nalidixic acid (NA), ampicillin (ABPC), kanamycin (KM). MIC90 of DR-3355 against 94 strains of Shigella spp. and 5 strains of Escherichia coli, 36 strains of Salmonella spp., 22 strains of Vibrio cholerae, 5 strains of Vibrio parahaemolyticus, and 19 strains of Campylobacter jejuni were 0.05, 0.10, 0.0025, 0.39, and 0.78 micrograms/ml, respectively. These values were 1/2 of that of OFLX, and two times of that of CPFX. MIC90 of DR-3355, OFLX and CPFX against C. jejuni were 0.78 micrograms/ml. MIC90 of DR-3355 against isolates from enteritis patients except for Vibrio spp., were 1/30 to 1/60 of those of NA, ABPC, and KM.     

Antimicrobial resistance and epidemiological study of Haemophilus influenzae strains isolated in Portugal. The Multicentre Study Group

In the course of a multicentric surveillance study, nine laboratories sent 375 isolates of Haemophilus influenzae to the Sector de Resistência aos Antibióticos (SRA) from the National Institute of Health in Lisbon, between 1 January and 31 December 1992. The majority of the H. influenzae isolates were from the respiratory tract (84.8%); only 5.1% were of invasive origin. Overall resistance for ampicillin was 11.7%, tetracycline 3.7%, and chloramphenicol 2.4%. All isolates tested were fully susceptible to cefotaxime, ceftriaxone, ciprofloxacin and rifampicin. Multiresistance was rare, occurring only in 2.4% of the isolates, although 50% of the ampicillin resistant strains had at least one additional resistance marker. Forty two isolates (11.2%) produced a TEM-1 type beta-lactamase, as shown by isoelectric focusing. beta-lactamase production was not detected in two of the ampicillin resistant strains. Fifteen of the 42 beta-lactamase producing strains (35.7%) contained detectable DNA plasmid: nine harboured large plasmids with an apparent molecular mass of 45 or 54 kb depending on their resistance phenotype and six harboured a small plasmid of 5 kb. In order to study transfer of resistance in both ampicillin and multiresistant strains conjugation experiments were performed for 14 isolates, seven of which harboured a large plasmid and seven had no detectable plasmid DNA. All 14 transferred their resistance phenotype but only a single large plasmid could be demonstrated in ten transconjugants. Restriction endonuclease analysis of plasmids from six representative transconjugants, isolated in different hospitals, revealed that there was no dissemination of a single R plasmid, which suggests an independent process of acquisition of resistance genes.     

Shigella isolates in stool

A total of 447 Shigella strains were isolated from stool samples during 1989-1991. Of these 270 (60%) were from children. Among the different species and serotypes Sh. flexneri 60 (13.4%) and Sh. sonnei Phage 139 (65%) were the most frequently isolated strains. 154 (34.4%) strains were resistant to three and 179 (40%) to more than three antibiotics. Some strains of Shigella were found to be resistant to furazolidine and neomycin.     

Emerging quinolone-resistant Salmonella in the United States

We conducted a national survey of antimicrobial resistance in human clinical isolates of Salmonella between July 1, 1994, and June 30, 1995. Every tenth nontyphoidal Salmonella isolate received at state public health laboratories in the United States during this period was tested for resistance to 12 antimicrobial agents, including two quinolones, nalidixic acid, and ciprofloxacin. Emerging quinolone resistance was detected; of 4,008 isolates tested, 21 (0.5%) were resistant to nalidixic acid, and one (0.02%) was resistant to ciprofloxacin. Continued surveillance for quinolone-resistant Salmonella is necessary, particularly after the recent approval of a fluoroquinolone for use in animals intended for food in the United States.