Salt gland adenitis associated with bacteria in Blue Penguins (Eudyptula minor) from Hauraki Gulf (auckland, New Zealand)

Three blue penguins (Eudyptula minor) were rescued between July 2006 and January 2007 off the east coast of Auckland, New Zealand. They were taken to a rehabilitation center, where they subsequently died in May 2007 and were submitted for necropsy. There was unilateral enlargement of the salt glands with disseminated small, pale, and firm foci in all birds. Histologic examination of the affected glands demonstrated the presence of multifocal granulomas and areas of severe squamous metaplasia of the collecting ducts. The remaining gland had areas of hyperplasia, dysplasia, and necrosis with a severe granulomatous inflammatory reaction. Intralesional gram-negative bacteria were detected, but, unfortunately, bacterial culture was unrewarding. No further cases were observed in penguins in the subsequent year, and the primary cause of the salt gland adenitis remains uncertain.

Bacterial contamination of commercial chicken eggs in Grenada, West Indies

In Grenada, backyard flocks and unorganized poultry farms contribute to the major share of table eggs and moreover regulations for processing of eggs before retail sale are not at all enforced. To evaluate the bacterial contamination of table eggs, a total of 450 eggs collected from different sources including small farms (150 eggs), large farms (120 eggs), road side vendors (120 eggs) and supermarkets (60 eggs), were cultured for the bacteria. A total of 226 bacterial cultures predominantly of the family Enterobacteriaceae were obtained with a higher proportion from shell membrane (54.4%) than from yolk samples (45.6%). There was no significant difference (P< 0.05) in the number of isolates between various sources indicating the contamination at farm level. The study indicates the need for optimum hygienic conditions at the farm level to decrease the bacterial load.

Antibiotic-resistance patterns of bacterical pathogens isolated from ornamental fish in Trinidad and Tobago

Ornamental fish farming forms an important part of the local aquaculture industry in Trinidad and Tobago, and the number of farms has been increasing annually. This study was designed to ascertain the prevalence of bacterial pathogens from fish and pond water, and determine the resistance of the bacteria to commonly used antimicrobial agents. A total of 1204 bacterial isolates were recovered: from 575 fish slurry and 111 water samples from 17 aquaculture farms. Isolates from fish were identified as belonging to 19, and those from water samples were grouped in 18 genera. The predominant genera isolated were (in descending order) Aeromonas spp., Pseudomonas spp., Plesiomonas spp., Chromobacterium spp., Enterobacter spp. and Serratia spp. Screening against 8 antimicrobial agents showed that 95.1 percent (774 of 814) of isolates from fish slurry, and 98.4 percent (254 to 258) of isolates from pond water were resistant to one or more antimicrobial agents ( P> 0.05, X2). The highest resistance (55-94 percent) were to ampicillin, oxytetracycline and erythromycin, but relatively lower resistance (4-14 percent) occurred to gentamycin and norfloxacin (P< 0.05; X2). It was concluded that the high prevalence of bacterial pathogens in ornamental fish coupled with their high levels of resistance to antimicrobial agents may pose therapeutic problems as well as health risks to farmers, workers and fish hobbyists

Frequency and characteristics of selected enteropathogens in fecal and rectal specimens from childhood diarrhea in Trinidad, 1998-2000

Objective. To determine the prevalence and characteristics of selected enteric pathogens in diarrheic children in six counties of Trinidad. Methods. This cross-sectional study was conducted from April 1998 through March 2000, using standard methods, to detect Salmonella spp., Shigela spp., enteropathogenic Escherichia coli (EPEC), Campylobacter spp., Yersinia spp., Cryptosporidium parvum, and parasite ova. The antibiograms of the enteropathogens were determined using disk diffusion method.Results. A total of 236 samples; 86 samples originated directly from 17 health centers in two counties (St. George East and St. George West), while 150 samples were obtained from Trinidad Public Health Laboratory, having been submitted by private practitioners and personel from six counties in Trinidad. Of the 236 samples, 33 (14.0 percent) were positive for Shigella, 4 (1.7 percent) for Salmonella, and 1 (0.4 percent) was positive for hook worm ova. All the samples were negative for Cryptosporidium parvum and Yersinia spp. With the 86 samples collected directly from the health centers, in St. George East County the frequency of Shigella was 20.0 percent (12 of 60), compared with 26.9 percent (7 of 26) for samples from St. George West County, but the difference was not statistically significant (P> 0.05 with the chi-square test). For the 150 samples from the six counties that had been submitted directly to the Trinidad Public Health Laboratory, 14 of them (9.3 percent) were positive for Shigella, a figure statistically significantly lower than that found with the samples sampled directly from the health centers (P< 0.05 with the chi-square test). Sh. sonnei was the predominant serotype detected, accounting for 28 of the 33 Shigella isolates (84.8 percent) recovered from the 236 samples. Overall, the frequency of detection of enteropathogens had no seasonal pattern nor relationship to the county of origin. Of the 37 isolates of Salmonella and Shigella tested for antimicrobial sensitivity, all of them were sensitive to ciprofloxacin, gentamicin, and cefotaxime. In terms of resistance, 3 of the 37 isolates (8.1 percent) exhibited resistance to ampicillin, 1 (2.7 percent) to chloramphenicol, and 1 (2.7 percent) to sulfamethoxazole/ trimethoprim. Conclusions. Of the enteropathogens for which assays were done, Shigella sonnei was the most prevalent, and it has the highest probability of being an important etiological agent of childhood diarrhea in Trinidad (AU)

The effectiveness of the Gram stain of high vaginal swabs in the diagnosis of bacterial vaginosis at the University Hospital of the West Indies [abstract]

OBJECTIVE: To correlate the gram-stain of high vaginal swabs (HVS) with the diagnosis of bacterial vaginosis (BV) and to compare this with bacterial culture reports to determine whether any useful additional information is gained by culture. METHODS: HVS submitted to the microbiology laboratory (UWI) from patients diagnosed clinically with vaginal infection were used in this study. Specimens were submitted from the Family Planning, Gynaecology and Antenatal clinics at the University Hospital of the West Indies. Swabs were placed in Stuart's Transport Medium and taken to the microbiology laboratory within 24 hours. The specimens were subjected to standard bacteriological procedures of culture on blood and MacConkey agar and microscopic procedures of wet prepartion and gram stain. The gramstain was recorded on a specially designed data sheet for each patient with a standardized scoring method for the evaluation of gram-stained smears based on the recognition of both presence and amount of significant morphotypes. This result was then compared with the bacterial culture, available a few days later, to see the degree of correlation and to determine whether any relevant additional information was gained. Almost 60 percent of the specimens collected yielded no pathogens on culture. However, one-third of this 60 percent was diagnosed as BV by standardized scoring method. One-third of all specimens submitted yielded yeast (Candida albicans and yeast not-Candida albicans) on culture and by gram stain. Streptococcus group B was isolated in < 4 percent of all specimens and a miscellaneous group of organisms including Klebsiella sp, Pseudomonas sp and anaerobic Streptoccus made up the rest of bacterial isolates. CONCLUSIONS: The standardized scoring method of evaluating the HVS gram stains yielded a more accurate and rapid diagnosis of BV than the traditional culture method. This is worthy of further study, as implementation of this method would result in considerable cost and time saving. (AU)

Facing antibiotic resistance

Antibiotic resistance reflects the natural selection pressure which favours those species, variants or strains resistant to antibiotic action. (AU)

Prevalence of Bacterial Pathogens and Susceptibility Patterns from clinical sources in Trinidad

During a 12-month period (January-December, 1997), bacterial isolates of specimens from in-patients and out-patients of the Eric Wiliams Sciences Complex (EWMSC) were reviewed. A total of 3,513 specimens were processed, 43.1 percent from in-patients and 56.9 percent from out-patients. Of the 3,513 specimens, 1,129 (32.1 percent) yielded positive cultures. Micro-organisms from wounds, sputum and genital tract accounted for 90.2 percent, 51.5 percent and 31.8 percent, respectively, of all isolates. E coli (17.4 percent) and Enterococci (12.2percent) were the predominant isolates and were also the major pathogens from blood stream infections, 25.8 percent and 18.2 percent, respectively, followed by P aeruginosa, 15.2 percent. High levels of resistance were seen to ampicillin, augmentin (amoxicillin-clavulanic acid) and tetracycline. The most effective antibiotics were ceftazidime (no resistance in E coli Citrobacter spp, non-typhoidal Salmonella and Group B streptococci, 63.2 percent resistance in Acinetobacter spp, 15.2 percent in Enterobacter spp, 17.4 percent in Klebsiella spp.], erythromycin (no resistance in Enterobacter and Citrobacter spp, and 89.5 percent in Acinetobacter (spp), erythromycin (no resistance in Groups A and B streptococci, 85.1 percent in S aurens and S pneumoniae). The spectrum of isolates will provide clinicians with data on which to base their "best guess" aetiologic agent and choice of antibiotics when faced with infectious diseases in areas where laboratory assistance is not readily available.(Au)

Antimicrobial resistance seen as an emergent problem by physicians in Trinidad - Poster abstract

OBJECTIVE: To understand the influences of antibiotic prescription practices of physicians in Trinidad on emergent bacterial resistance. DESIGN AND METHOD: A pre-tested questionnaire was self-administered to physicians to determine the factors influencing the choices and outcomes of antimicrobial prescribing. RESULTS: 56 physicians with a mean of 7.1 years experience participated in the survey. The most frequent prescriptions were for urogenital infections (50 percent), respiratory tract infections (48.2 percent) and skin and soft tissue infections (46.4 percent). Amoxil was the drug of choice for respiratory infections (42.1 percent), Flagyl and Septra (17.9 percent) each for genitourinary (GU) infections and doxycycline (41.4 percent) for STD's. Only 8.9 percent of physicians prescribed antibiotics for the common cold/flu. Patient's well-being was the priority in prescribing followed by emergent bacterial resistance. Approximately 76.7 percent of participants observed resistance in the community, especially to Amoxil (26.1 percent). Overprescribing (61.7 percent) was viewed as a major contributor to resistance. Physicians would like to depend on the laboratory to curtail resistance and want more educational programmes. CONCLUSIONS: This study identified the recognition of bacterial resistance as a physician concern and a need to study antibiotic use.(AU)

An analysis of the bacterial flora of meat carcasses

Meat production at the Kingston and St. Andrew and Orchard Farm Abattoir is undertaken under grossly unsatisfactorily conditions. Extensive microbial contamination could have adverse implications for the health of consumers of meat produced at the abattoirs. This study sought to determine the microbial quality and safety of the carcasses produced at the abattoirs as well as the knowledge, attitude and practice of abattoir workers with respect to sanitary slaughter and processing of animals. Samples were taken from approximately 25 percent bovine and porcine carcasses produced at the abattoir over a two-week period. Laboratory analyses were performed on these samples to determine the coliform count, E. coli count and the presence of salmonella. The condition under which slaughtering took place was observed. Informal interviews with butchers to determine their knowledge, attitude and practice with respect to sanitary slaughter were also conducted. The results showed extensive contamination of the carcasses produced. The E. coli count on carcasses, fell well outside acceptable standards. The presence of Salmonella also fell outside the limits of acceptable standards at one of the abattoirs. The presence of salmonella was detected on meat from the other abattoir though within acceptable limits. Poorly maintained facilities and equipment and lack of aseptic technique in processing and the use of untreated water in the abattoir were factors which impacted on the quality of meat produced. The study concluded that the meat produced at the Kingston and St. Andrew and Orchard Farm abattoirs places consumers at risk of contracting food borne disease. There were no significant differences between quality and safety of meat produced at the two establishments. There is need for effective quality control systems to be established in the abattoirs with a view to correcting process defects and ultimately reduce the levels of contamination of the carcass.(Au)

Paediatric nosocomial urinary tract infection at a regional hospital

From a total of 26,603 admissions to the paediatric wards, 1360 paediatric nosocomial urinary tract infections (PNUTI) were identified during a 5-year retrospective chart review at the SFGH. The ages ranged from 3 days to 13 years, with 46 percent boys and 54 percent girls. The highest rates of PNUTI per service per 100 admissions were seen in the nursery (11.28) followed by paediatric surgery (2.89) and paediatric medicine (2.86). Although the greatest number of PNUTI occurred in the nursery, comparison between the years was not statistically significant. About 90 percent (1218 of 1360) of PNUTI occurred in catheterized patients. No documentation was found specifying the type of catheterization (intermittent or continuous). About 90 percent (1210 of 1360) of isolates were single organisms with Escherichia coli, Proteus mirabilis, Klebsiellla spp. and group B streptococci accounting for a total of approximately 70 percent of all pathogens. However, the composition of the most common isolate in each service differed. The most common isolate in the nursery was E. coli, in the paediatric medical and surgical services the most common isolates were Klebsiella spp. and Proteus mirabilis, respectively. Proteus mirabilis was isolated predominantly from boys with structural abnormality of the urethral tract. No PNUTIs were complicated by bacteraemia. The antibiotics with least effectiveness (in increasing order) for UTIs were cephalexin, ampicillin, trimethoprim, co-trimoxazole and tetracycline. The most effective antibiotics were nalidixic acid, gentamicin and amoxicillin-clavulanic acid.(AU)

Is acne vulgaris due to excessively hot showers?

Acne vulgaris is a skin disorder with obstruction of the pilo sebaceous canal, increased sebum, skin surface lipid changes, and bacterial involvement. It is more common in temperate zones winter and the distribution is mainly on the face, the back of the neck, the back and chest. We believe hot showers, which are more common in cold climates, damage the skin and remove the protective lipids leading to bacterial entry. The areas affected are those which are usually exposed to the highest water temperature. Forty women were randomised into groups: Group A took hot showers (temperature > 40 degrees C) for one month and Group B cold water showers (temperature <40 degrees C) also for one month. The subjects were examined weekly to determine the number of acne lesions present on the face, neck, chest and back. The investigators were blinded as to the water temperature of each subject. Thirty women completed the study successfully 14 in Group A and 17 in Group B. There were no group differences in age, parity, race, confounding variables (steroids, iodides and hairoils.) and mean number of acne lesions prior to inervention. There was a significant difference in the mean group temperature for weeks one, two and four. The mean hot water temperatures were 43.6 (SD 18.3), 40.7 (SD 6.14) while mean group cold water temperatures were 35.8 (SD 1.09), 33.5 (SD 1.05) and 35.5 (SD 1.05 respectively. In week three the mean group temperatures were similar 38.7 (SD 2.61) and 38.6 (SD 12.50). There was however no group difference in the number of acne lesions with time (p=0.225) as determined by Anova. In conclusion, we did not find that hot showers had any impact on the occurrence of acne lesions (AU)

Tunglasis among five communities in south-western Trinidad, West Indies

The prevalence of Tunga penetrans Linn. within the five townships of Granville, Fullerton, Icacos, Coromandel and Cedros south-western Trinidad, West Indies. as determined by physical examination of all inhabitants present during the survey, were 17.0 percent (38/223 subjects), 15.7 percent (36/237), 31.4 percent (102/325), 17.4 percent (42/242) and 17.9 percent (50/280), respectively. The rate in Icacos was significantly higher than in the other four sites (P < 0.001). Not only were males more likely to be infected than females in all five study sites (P < 0.007) but chigoe-flea burdens were also higher in males than in females (P < 0.012), with mean S. D.) burdens of 5.44 (2.54) fleas/male infected subject and 2.38 (2.00) fleas/female infected subject. Feet were significantly more infected than other areas of the body (P < 0.001). Analysis of variance revealed that the interactions between prevalence of chigoe-flea infection and geographical location (P = 0.0058) and between sex of infected subject and site of infection (P = 0.0109) were highly significant but that between geographical location and sex of infected subject was not significant (P > 0.30). At least seven species of bacteria, with varying sensitivities to antibiotics, were isolated from 16 patients with sepsis associated with their T. penetrans infections: Streptococcus pyogenes, beta-haemolytic Streptococcus (not group A), Klebsiella aerogenes, Enterbacter agglomerans, Staphylococcus aureus, Escherichia coli and a Bacillus species. Clostridium tetani was not isolated(AU)

Pulmonary pathogens in induced sputum in persons with Human Immunodeficiency Virus (HIV) in Trinidad

A study was undertaken to identify the common micro-organisms occuring in induced sputum specimens from HIV-infected/non-infected individuals with pulmonary manifestations in Trinidad. Only 13 percent of HIV seropositive patients with pneumonia were found to be positive for P. carinii. This low yield may have been due to low prevalence of the P. carinii in Trinidad or to prior antibiotic therapy. Active mycobacterial infection was demonstrated in only 13 percent HIV seropositive patients with pneumonia, though 43 percent HIV patients had a clinical diagnosis of tuberculosis. This may have been due to the low sensitivity of the acid-fast technique. The most common microbial pathogen is identified in HIV patients with pneumonia was Candida sp. Followed by gram negative bacteria. A listing is made of the various organisms occuring singly or mixed in HIV seropositive and HIV seronegative patients (AU)

Pharmacoeconomics of intravenous antibiotic use in serious infections

A pharmacoeconomic study of 15 antibiotics available in Barbados was performed. The antibiotics studied were amoxycillin/clavulanate, ampicillin/sulbactam, cefazolin, cefotaxime, ceftazidime, ceftriaxone, clindamycin, cloxacillin, cotrimoxazole, gentamicin, imipenem, metronidazole, piperacillin/tazobactam, and vancomycin. The costs of use of these compound were calculated for a five-day course using a formula comprising eight categories: antibiotic purchase cost, maintenance of intravenous access, drug delivery cost, drug monitoring cost, dose readjustment, general monitoring cost, 'sharps' disposal cost and adverse effects. The cost of adverse effects were not included in this study due to lack of accurate data. The total cost of antibiotic use (in U.S. dollars) ranged from $42.52 to $463.73 per five-day course. Generic compound were less expensive ($45.52-$98.23) than brand-name compounds ($106.18 - $463.73). Antibiotic purchase costs accounted for proportions of total costs ranging from 7 to 93 percent. Non-drug costs represented a much greater proportion of total costs of generic compounds. For most compound the non-drug costs were related to the frequency of dosing, but for gentamicin the non-drug costs were relatively higher because of the need for monitoring of serum gentamicin levels. Efficacy and freedom from side-effects will remain the most important determinants in the choice of antibiotic therapy. However, pharmacoeconomic analyses can provide prescribers with the information required to make cost-effective choices for treatment of their patients (AU)

Acute-phase protein response is impaired in severely malnourished children

The reponse of plasma levels of C-reactive protein and serum amyloid A were assessed in two groups of malnourished children. Sixty-six severely malnourished children were studied at admission. Fifty of these had clinical and/or laboratory evidence of infection. C-reactive protein was not elevated in 23 (46 percent) and serum amyloid A was not raised in 29 (58 percent) of these 50 children. Surviving children(n=62) received two doses of diphtheria-pertussis-tetanus vaccine, to which the C-reactive protein and serum amyloid A responses were measured. The first was given early in recovery, the second after nutritional rehabilitation. Ten mildly malnourished children acted as controls, receiving a single dose of diphtheria-pertussis-tetanus vaccine. The responses of both C-reactive protein and serum amyloid A to diphtheria-pertussis-tetanus vaccine were significantly less in early recovery than after nutritional recovery. The response of the midly malnourished group was no different from that of the severely malnourished group in early recovery, but was less than their response on discharge. The acute-phase protein response of malnourished children is impaired. This may have prognostic implications as the reponse plays a central role in promoting healing. (Summary)

Bacterial meningitis in children in Barbados: a decade later - abstract

Forty-eight paediatric patients admitted with bacterial meningitis during a 10-year period, comprising 22 males (46 percent) and 26 females (54 percent), were reviewed. Ages ranged between 7 weeks and 12 years (mean 2.7 years). The mean 10-year incidence was 29/10,000 ward admissions, with a peak incidence of 69/10,000 admissions in 1989. The highest seasonal prevalence occurred during the dry months. Twenty-five patients (52 percent) were less than 2 years of age. Predominant symptoms were fever (85 percent), gastrointestinal (65 percent), and lethargy (40 percent). Frequently associated illnesses included upper respiratory infections in 21 (44 percent), and otitis media in 5(10 percent) of cases. H. influenzae was cultured from the cerebrospinal fluid in 34 cases (71 percent), S. pneumoniae in 4 cases (8 percent), and no organism in 10 cases (21 percent). Thirteen patients (27 percent) had received antibiotic therapy within a week of admission. Initial therapy consisted of parenteral ampicillin and chloramphenicol in 37 cases (77 percent), penicillin and chloramphenicol in 9 cases (19 percent) chlodramphenicol in 1 (2 percent), and trimethoprin/sulfamethoxazole in 1 case (2 percent). These data support a case for routine administration of H. influenzae B vaccine which will lead to the eradication of, or reduction of the overall incidence of bacterial meningitis in childhood (AU)

Cutaneous infections in Trinidad

Skin infection is common in patients with any skin diseases where pruritus is a prominent feature. A retrospective analysis was performed on the results of skin swab cultures from patients with eczema and a variety of other conditions. This paper presents the findings of bacteriologic culture and sensitivity testing of 131 swabs from 122 patients over a period of 22 months and examines the results in terms of the reported relationship between scabies and acute poststreptococcal glomerulonephritis. Staphylococcus aureus was most often isolated, and this appears to indicate that antistaphylococcal antibiotics should be the first line of treatment in the absence of the results of cultures. (AU)

Bacterial vaginosis

Bacterial vaginosis is a common, non-inflammatory infection of the vagina. It is characterised by the presence of a thin, homogenous, greyish-white discharge. The differential diagnosis includes infection with Trichomonas vaginalis and Candida albicans. A diagnosis of bacterial vaginosis maybe made by the detection of three of the following: characteristic discharge, pH of 5 or greater, clue cells and a positive KOH amine test. Culture of vaginal discharge is not necessary to effect a diagnosis. Bacterial vaginosis responds readily to treatment with metronidazole at a dosage of 400 mg twice daily for seven days, although a proportion of patients suffer a recurrence of symptoms. Treatment of sexual partners may be necessary in such cases. Bacterial vaginosis results from the synergistic interaction of Gardnerella vaginalis and obligateanaerobes, including Bacteroides and Mobiluncus speciess. The pathogenesis, laboratory diagnosis, treatment, and the mechanisms by which these organisms produce the symptoms of bacterial vaginosis are discussed (AU)