Bacterial complications of primary varicella in children

Bacterial complications of varicella in 84 patients younger than 16 years of age (48 females; median age, 2.9 years) who required hospitalization between 1985 and 1995 were retrospectively analyzed. The purpose of the study was to describe demographics, clinical manifestations, bacteriology, and factors affecting outcome. Seventy-six percent of patients were younger than 5 years of age. The eldest children in households were significantly underrepresented (P = .00025). Skin infections occurred in 61 patients (73%), and deep-seated infections and/or shock occurred in 23 (27%). The latter complications were significantly associated with thrombocytopenia (P = .011) and bacteremia (P = .014) at the time of admission, prolonged fever (P = .001), prolonged hospitalization (P < .0001), intensive care management (P < .0001), and fatal outcome (P = .019). Group A beta-hemolytic streptococcus (59% of isolates) and Staphylococcus aureus (28%) were the predominant isolates. Before and after 1990, five (31%) of 16 and 13 (62%) of 21 streptococcal complications, respectively, were invasive infections (P = .09). These data underscore the need for universal immunization against chickenpox.     

Bacterial urinary tract infections in diabetes

Diabetes mellitus has a number of long-term effects on the genitourinary system. These effects predispose to bacterial urinary tract infections in the patient with diabetes mellitus. Bacteriuria is more common in diabetic women than in nondiabetic women because of a combination of host and local risk factors. Upper tract infection complications are also more common in this group. Diabetic patients are at higher risk for intrarenal abscess, with a spectrum of disease ranging from acute focal bacterial pyelonephritis to renal corticomedullary abscess, to the renal carbuncle. A number of uncommon complicated urinary tract infection complications occur more frequently in diabetics, such as emphysematous pyelonephritis and emphysematous pyelitis. Because of the frequency and severity of urinary tract infection in diabetic patients, prompt diagnosis and early therapy is warranted. A plain abdominal radiograph is recommended as a minimum radiographic screening tool in the patient with diabetes presenting with systemic signs of urinary tract infection. Ultrasonography or further radiographic studies such as CT scanning may also be warranted, depending on the clinical picture, to identify upper urinary tract complications early for appropriate intervention.     

Potential complications of influenza A infections

A case of pure red cell aplasia appearing 6 months following thymectomy is reported in a 43-year-old man. Immunofluorescence studies of the patient's bone marrow have demonstrated the presence of membrane-bound IgG on the majority of erythroblasts and some mature erythrocytes. It is suggested that the IgG represents anti-erythroid autoantibodies. The number of Ig-bearing lymphocytes in peripheral blood was decreased as was the level of immunoglobulins indicating a B-lymphocyte deficiency. T-lymphocyte functions were without remarks. The patient was initially treated with corticosteroids and oxymetholone. He responded well to this therapy but relapsed 9 month later. Cyclophosphamide treatment was started and followed by a complete haematologic remission.     

Acute necrotizing cutaneous streptococcal infection following bites or scratch by dog or cat

INTRODUCTION: Domestic animal bites or scratches are quite frequent. Among banal bacteria isolated from infected bites or scratches, group A streptococcus seems to be frequently associated with severe infections. CASE REPORTS: Three cases of acute necrotizing cutaneous streptococcal infections, following cat or dog bite or scratch are reported. Twice, group A streptococcus was isolated from cutaneous swabs. In the third case, previous antibiotic therapy had sterilised bacteriological samples. Diagnosis was ascertained on the basis of clinical presentation and significant antistreptococcal antibodies elevation. Skin necrosis around the inoculation area was observed in the 3 cases. Cicatrisation required an average of two months under appropriate treatment. DISCUSSION: An evolution towards cutaneous necrosis localized to the initially injured area is common to these three cases. This peculiar evolution is worth to be known in order to choose an effective anti streptococcal antibiotherapy whenever domestic animals bites and scratches are to be treated.     

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INTRODUCTION: High-resolution computed tomography (HRCT) with iodinated contrast material has been used by many authors to study solitary pulmonary nodules (SPNs). The degree of enhancement was correlated with the nodule malignancy. MATERIAL AND METHODS: Forty adult patients were examined, before and after contrast agent administration, with incremental dynamic CT. We selected 22 patients with SPNs (3-30 mm phi, except one with 40 mm phi). The CT numbers of the inner nodule were calculated before and 1, 2 and 3 minutes after the i.v. administration of a weight-related dose (1.5 mL/kg/min) of nonionic iodinated contrast agent. A dose of 100 mL contrast agent was used in the first 6 patients. The difference in CT numbers between unenhanced images and the images with maximum enhancement (max. attenuation) was also calculated. RESULTS: Histologic diagnoses included 4 tuberculomas, 3 hamartomas and 15 malignant tumors (9 adenocarcinomas, 5 squamous cell carcinomas and 1 non-Hodgkin lymphoma). The CT numbers (in Hounsfield units, HU) of malignant nodules ranged 12-31 HU (mean: 21.5 HU) before contrast agent administration; the "long-standing" tuberculomas ranged 11-22 HU (mean: 16.5 HU) and the hamartomas had a mean density of 10.5 HU. We excluded for the study two "fresh" tuberculomas, one of which was surrounded by a low-attenuation infiltrate (the halo sign). We selected a threshold value of 20 HU on enhanced CT images to distinguish malignant (> or = 20 HU) from benign (< or = 20 HU) nodules. All lung cancers had complete enhancement (mean density: 35.5 HU). With 20 HU as the threshold value for a positive test, sensitivity was 100%, specificity 85.7%, positive predictive value 93.8% and negative predictive value 100%; test bias was 1.067. CONCLUSION: Positron emission tomography (PET) with 2-[fluorine-18] fluoro-2-deoxy-D glucose is reported to be as accurate as enhanced HRCT, but it does not provide accurate morphological information, is not widely available and it is quite expensive: therefore, in our opinion, CT should be preferred. After examining over 100 patients, we may use our results in the decision analysis comparing surgical risk with cancer risk.     

Bacterial colonization as a potential source of nosocomial respiratory infections in two types of spirometer

The potential risk of spirometers in the transmission of respiratory infections has not been yet established. We performed a prospective cross-sectional study to determine the rate of colonization of a water-sealed spirometer and a pneumotachograph, and the potential risk of cross-transmission of microorganisms to patients using each of these devices. Fifty four patients (aged 51 +/- 18 (mean +/- SD) yrs) were included in the study. All of them had undergone forced spirometry with bronchodilator response by means of the water-sealed spirometer (n = 36) or the pneumotachograph (n = 18). None had a clinically apparent respiratory infection at the time of the study. Routine hygiene measures for respiratory equipment were performed before the study protocol. Samples for microbiological cultures of different parts both of the water-sealed spirometer (proximal and distal tubing, bell and water-bell) and pneumotachograph (proximal and distal tubing) were taken daily before and after the usual series of lung function tests during a 5 day period. Pharyngeal swab cultures were obtained before spirometry and 7 days later in each subject. Thirty six out of a total of 40 (90%) culture samples from the water-sealed spirometer showed microbial growth compared to 4 out of 30 (13%) samples obtained from the pneumotachograph (p < 0.0001). Significant colonization of the water-sealed spirometer was apparent after the third day of the study. The microorganisms most frequently isolated were penicillium sp. (62%), Pseudomonas fluorescens (32%), and Burkholderia cepacea (48%). Distal tubing, water and water-bell were the parts of the water-sealed spirometer that showed higher colonization counts (> or = 10(4) colony-forming units (cfu).mL-1). No transmission sequence of potentially pathogenic microorganisms from equipment to patients or vice versa could be demonstrated. In summary, the water-sealed spirometer frequently became colonized by microorganisms. The potential hazard of such equipment as reservoirs of microorganisms suggests a need for the implementation of new hygiene measures for their maintenance.     

Bacterial and viral parenchymal infections of the brain

We reviewed the literature addressing the use and complications associated with low-viscosity distention fluids in urologic and hysteroscopic procedures. The possible causes of fluid complications included elevated intrauterine pressure, myometrial invasion, prolonged operating time, and operative trauma to the cervix or uterine body. Physiologic electrolyte solutions create only fluid overload, and treatment requires cardiovascular support and diuresis. Nonelectrolytic solutions result in acute dilutional hyponatremia, which has been referred to as the transurethral resection of the prostate syndrome. Treatment requires diuresis and a rapid, controlled return of the serum sodium level to 120-130 mmol. These complications can be minimized with proper use of equipment and careful monitoring of fluid volumes. To recognize and treat them, the surgeon must be knowledgeable about the fluid being used and the difficulties it may cause.     

Bacteriologic analysis of infected dog and cat bites. Emergency Medicine Animal Bite Infection Study Group

BACKGROUND AND METHODS: To define better the bacteria responsible for infections of dog and cat bites, we conducted a prospective study at 18 emergency departments. To be eligible for enrollment, patients had to meet one of three major criteria for infection of a bite wound (fever, abscess, and lymphangitis) or four of five minor criteria (wound-associated erythema, tenderness at the wound site, swelling at the site, purulent drainage, and leukocytosis). Wound specimens were cultured for aerobic and anaerobic bacteria at a research microbiology laboratory and, in some cases, at local hospital laboratories. RESULTS: The infected wounds of 50 patients with dog bites and 57 patients with cat bites yielded a median of 5 bacterial isolates per culture (range, 0 to 16) at the reference laboratory. Significantly more isolates grew at the reference laboratory than at the local laboratories (median, 1; range, 0 to 5; P<0.001). Aerobes and anaerobes were isolated from 56 percent of the wounds, aerobes alone from 36 percent, and anaerobes alone from 1 percent; 7 percent of cultures had no growth. Pasteurella species were the most frequent isolates from both dog bites (50 percent) and cat bites (75 percent). Pasteurella canis was the most common isolate of dog bites, and Past. multocida subspecies multocida and septica were the most common isolates of cat bites. Other common aerobes included streptococci, staphylococci, moraxella, and neisseria. Common anaerobes included fusobacterium, bacteroides, porphyromonas, and prevotella. Isolates not previously identified as human pathogens included Reimerella anatipestifer from two cat bites and Bacteroides tectum, Prevotella heparinolytica, and several porphyromonas species from dog and cat bites. Erysipelothrix rhusiopathiae was isolated from two cat bites. Patients were most often treated with a combination of a beta-lactam antibiotic and a beta-lactamase inhibitor, which, on the basis of the microbiologic findings, was appropriate therapy. CONCLUSIONS: Infected dog and cat bites have a complex microbiologic mix that usually includes pasteurella species but may also include many other organisms not routinely identified by clinical microbiology laboratories and not previously recognized as bite-wound pathogens.     

Dental plaque flora of the dog with reference to fastidious and anaerobic bacteria associated with bites

Animal bite wounds are amongst the most common types of traumatic injuries in humans. The organisms isolated from these wounds generally reflect the oral flora of the biting animal, and may be fastidious in nature and difficult to identify. This study was undertaken to determine the prevalence of Eikenella corrodens, Actinobacillus actinomycetemcomitans, Porphyromonas and Prevotella spp. in supragingival dental plaque collected from the right maxillary canine and carnassial teeth and the right mandibular canine tooth of dogs. In part one of the study, 30 dogs were used. E. corrodens was found in 62% of these dogs and 44% of individual plaque samples. A. actinomycetemcomitans was not detected in any of the dogs sampled. In part two, 34 dogs were used to determine the prevalence of the black pigmented anaerobic bacilli (Porphyromonas and Prevotella spp.). Porphyromonas gingivalis was present in 68% of these dogs and 47% of individual plaque samples. Prevotella intermedia was present in 44% of the dogs and 23% of individual plaque samples. The recently described Porphyromonas canoris, Porphyromonas salivosa, Porphyromonas cangingivalis, Porphyromonas cansulci, Porphyromonas crevioricanis and Prevotella denticola species were isolated from only 9%, 6%, 3%, 3%, 3% and 3% of dogs respectively. Porphyromonas gingivicanis was not isolated from any of the animals sampled. In conclusion, black-pigmented anaerobic bacilli were isolated from 91% of the animals sampled and therefore constitute a significant risk with respect to bite wound infections. It is also suggested that the prevalence of E. corrodens in wound infections has been underestimated in previous reports because of use of inappropriate techniques for detecting this organism.     

Animal bites at the casualty department of the Oslo City Council]

During a 2-year period all Casualty Department data charts with the diagnosis "animal bite" were reviewed as part of internal quality control. Of 1,051 recorded episodes, 503 (48%) were women and 147 (14%) children under 16 years of age. 951 (90%) wounds were treated without closure. Half of the patients were not given antibiotics on the first visit, whereas one third were given penicillin. Tetanus status had been evaluated on 1,015 (97%) charts. Most bites were caused by dogs (76%), cats (17%), and horses (2%). Children were the victims of 118 (15%) dog bites, eight (4%) cat bites, and ten (53%) horse bites. More victims of dog bites than cat bites arrived within 12 hours of injury. German shepherd was the dog breed most often reported. Men were at greater risk of being bitten by dogs, adult women by cats and young girls by horses. Dogs bit children most frequently in the face and head areas and adults on the hands. In contrast, two thirds of children and adults were bitten by cats on the hands. Nearly all bite wounds were superficial and healed uneventfully; either without antibiotics, or with penicillin after wound treatment without closure. Computerized injury charts may ensure improved documentation of relevant information and simplify future quality control and research.     

Bacterial flora in chronic inner ear infections in adults

The human genome carries multiple copies of sequences related to endogenous retroviral DNA. We report here the distribution of a new multicopy long terminal repeat (LTR) sequence that has been a part of an endogenous retrovirus-like sequence RTVL-H2. Twenty-four human chromosomes were either separated by flow sorting or by using rodent cells carrying a single human chromosome, and the DNA was subjected to Southern analyses using the RTVL-H2 DNA as a probe. The RTVL-H2 LTRs were distributed among all the human chromosomes, but the density and the profile differed from chromosome to chromosome. The same chromosome obtained from different individuals showed essentially the same chromosome-specific patterns. The distribution of the RTVL-H2 LTRs among different chromosomes did not correlate with the distribution of LTRs from another endogenous retroviral DNA, HERV-A, strongly suggesting that there is no preferred chromosome or a region thereof, for the integration. The possibility of rearrangement or amplification after integration is discussed.     

Bacterial adherence and its importance in the pathogenesis of infections

Bacteria usually attack the susceptible animal or human organisms at mucosal surfaces of the respiratory, gastrointestinal or genitourinary tract. To colonize these surfaces they must penetrate a number of nonspecific defense barriers including cleansing mechanisms such as sneezing, coughing, peristalsis and fluid flow. Successful microorganisms escape recognition by soluble immune or nonimmune molecules, and bind to the mucosal surfaces via specialised molecules exposed on their surface (adhesions) which recognize and interact with complementary molecules (receptors) on the surface of specific host cells. This key step in the pathogenesis of infectious diseases is currently the subject of intensive investigation. In this review the mechanism and the role of adherence in different bacterial infections are considered.     

Sandvik sells stake in French hardmetal producer as Q2 bites

Sandvik is selling its 49 per cent stake in French cobalt and tungsten producer Eurotungstene Poudres SA to the majority shareholder, Eramet. The move underscores the Swedish hardmetals and tooling group's determination to concentrate on core activities. Sandvik is a major supplier of cemented carbide and high-speed steel tools with 37,000 employees and annual sales last year of around $6 billion.This is a short news story only. Visit www.metal-powder.net for the latest powder metallurgy industry news.