On the origin of bacterial resistance to penicillin: comparison of a beta-lactamase and a penicillin target.

Structural data are now available for comparing a penicillin target enzyme, the D-alanyl-D-alanine-peptidase from Streptomyces R61, with a penicillin-hydrolyzing enzyme, the beta-lactamase from Bacillus licheniformis 749/C. Although the two enzymes have distinct catalytic properties and lack relatedness in their overall amino acid sequences except near the active-site serine, the significant similarity found by x-ray crystallography in the spatial arrangement of the elements of secondary structure provides strong support for earlier hypotheses that beta-lactamases arose from penicillin-sensitive D-alanyl-D-alanine-peptidases involved in bacterial wall peptidoglycan metabolism.

Risk factors for meticillin resistance and outcome of Staphylococcus aureus bloodstream infection in a Belgian university hospital.

The aim of this study was to identify institution-specific risk factors for meticillin resistance in Staphylococcus aureus bloodstream infection (BSI) and to evaluate the impact of meticillin resistance on mortality. A total of 154 episodes of S. aureus BSI were identified between 1 January 2002 and 31 December 2004: 66 meticillin-resistant S. aureus (MRSA) BSI and 88 meticillin-susceptible S. aureus (MSSA) BSI. Seventy-eight episodes (51%) were considered to be community-acquired and 76 (49%) as nosocomial. Risk factors associated with MRSA BSI included not living at home (P=0.001), prior antibiotic exposure (P=0.002), insulin-requiring diabetes (P=0.028) and nosocomial BSI (P=0.031), especially more than 12.5 days after admission. There was an association between BSI-related mortality and the following variables: septic shock (P<0.001), endocarditis (P=0.002) and MRSA BSI (P=0.021). In conclusion, S. aureus BSI is a serious condition, especially when septic shock or endocarditis occurs, and is aggravated by meticillin resistance. We advise glycopeptides as empirical therapy for patients not arriving from home, those exposed to antibiotics, and those with insulin-requiring diabetes and/or nosocomial BSI.

Hemophagocytic syndrome associated with extracerebral toxoplasmosis in an HIV-infected patient.

Hemophagocytic syndrome (HPS) is a clinical entity that combines non-specific clinical and biological features. The diagnosis is usually confirmed by a bone marrow examination. HPS may be primary or secondary to a malignancy or to an infectious or autoimmune disease. Since it was first described, various agents have been implicated, including viruses, bacteria, and parasites. In HIV patients, many cases occur with lymphoma or with a variety of opportunistic infections due to CMV, HHV8, Pneumocystis carinii, Mycobacterium tuberculosis, MAC, toxoplasmosis, and even pneumococcus. We report here a case of an AIDS patient presenting a HPS secondary to an extracerebral form of systemic toxoplasmosis that was only revealed by specific PCR in tissue other than the CNS.

Crystallization and preliminary X-ray data for the exocellular beta-lactamase of Bacillus licheniformis 749/C.

The exocellular beta-lactamase from Bacillus licheniformis 749/C has been crystallized from polyethylene glycol solution at pH 5.5. An X-ray examination of the monoclinic crystals shows the space group is P21, with unit cell dimensions a = 66.77 A, b = 93.77 A, c = 43.57 A and beta = 104.5 degrees. The asymmetric unit consists of two molecules of 28,500 Mr each. The crystals are suitable for structure analysis to at least 2 A resolution.

Cefetamet pivoxil in acute pyelonephritis: an open study.

Fifty-five adult patients with acute uncomplicated pyelonephritis were investigated in an open, prospective, randomized comparative study in which 31 patients were allocated to receive 1000 mg cefetamet pivoxil twice daily (or 2000 mg once daily) and 24 to receive 1000 mg cefadroxil twice daily, given orally for 10 to 15 days. Both groups were comparable for age, sex and body weight. Clinical signs and symptoms, i.e. flank tenderness, dysuria, urgency and pyuria, subsided somewhat more rapidly with cefetamet pivoxil, while defervescence was obtained by Day 3 +/- 1 in both groups. Twenty-nine of the cefetamet pivoxil patients were assessed bacteriologically. The pathogens isolated prior to treatment were E. coli (22), Proteus mirabilis (5), P. vulgaris (1) and P. stuartii (1). All 29 patients had sterile urine at treatment end. In the 22 assessable patients in the cefadroxil group, the pathogens isolated before treatment were E. coli (17), P. mirabilis (3), and K. pneumoniae (2). Six patients had relapsed at treatment end (5 E. coli and 1 P. mirabilis). Patients were re-assessed at follow-up, usually 2 to 4 weeks after the end of treatment. Four of the 29 patients in the cefetamet pivoxil group showed relapse (3 E. coli and 1 P. mirabilis) as did a further 3 in the cefadroxil group (2 E. coli and 1 P. mirabilis). The overall therapeutic outcome was considered as successful, i.e. cure or improvement, in 89.7% of the cefetamet pivoxil patients and 72.7% of those who had received cefadroxil. Tolerability was satisfactory for both trial drugs and there were only a few mild to moderately severe adverse events reported.(ABSTRACT TRUNCATED AT 250 WORDS)

[Papillomaviruses and genital cancer: the value of detection and eradication]. / Les papillomavirus et les cancers génitaux: intérêt du dépistage et de l'éradication.

Human viruses (especially papillomavirus type 16, 18, 33, herpesvirus type 2 and cytomegalovirus) are implicated in malignant transformation, particularly in cervical cancer. Screening and treatment of male partners are mandatory not only for the patient but also for epidemiological purposes, including prevention of cervical carcinoma. Careful examination with a magnifying glass of the anogenital skin and mucosa of the male partner is performed after application of 5% acetic acid in water and small reacting areas can be treated more accurately. The hypothesis of a viral role in the development of urothelial tumors is supported by various recent observation, although similar conclusions cannot currently be drawn for prostatic carcinoma.

Recurrent haemophagocytic syndrome in an HIV-infected patient.

We describe a case of recurrent haemophagocytic syndrome (HS) in an HIV-infected patient.The first episode was associated with active human herpesvirus 8 infection and progressive Kaposi's sarcoma which was successfully treated with splenectomy, foscarnet and chemotherapy. The second episode was triggered by a Clostridium difficile colitis and resolved completely after treatment with metronidazole only. Recurrent HS has rarely been described in adult patients out of the setting of relapsing malignancy or autoimmune disease.The chronic immune dysregulation and suppression due to HIV-infection may predispose our patient to development of associated HS. Prognosis of HS remains poor, especially in HIV-infected patients. Rapidly unmasking the causative factor and timely instauration of adequate treatment are critical and may improve outcome.

[The use of viloxazine in the treatment of primary enuresis]. / L'utilisation de la Viloxazine dans le traitement de l'énurésie primaire.

The use of Viloxazine (a non tricyclic antidepressant) could be a less toxic alternative to Imipramine (cardiotoxic tricyclic antidepressant) in the treatment of childhood primary enuresis. Bladder overactivity, infection or psychological disturbances should be excluded before start of treatment, the drug seems to have a good efficacy in cases of "heavy sleepers".

[Should one search for papillomavirus lesions in the male sex partner? Value of peniscopy. Literature review and personal experience]. / Faut-il rechercher les lésions à papillomavirus du partenaire masculin? Intérêt de la peniscopie. Revue de la littérature et expérience personnelle.

Human papillomavirus (HPV) infection is closely related to genital carcinoma, especially cervical cancer in woman. Screening and treatment of male partner seems to be of particularly great interest for him self and also for preventing recurrence in female. A review of literature and a personal 70 patients series give highlight on peniscopy, poor results of local therapies and the need of a long term screening in the male partner.

Management of uric acid renal obstruction by intravenous lactate.

6 patients presenting with uric acid renal obstruction were managed by alkalization of urine using intravenous perfusion of 0.16 (1/6) M sodium lactate. Despite obstructive renal failure in 3 patients, rapid relief of obstruction was obtained and surgery was not necessary in any patient. Lysis of uric acid stones by urine alkalization is well documented [1, 4-12]. Intravenous infusion of 0.16 (1/6) M sodium lactate provides rapid urinary alkalization and is effective in the relief of obstruction by dissolution of uric acid calculi.