Pseudomonal breast infection.

Breast infection and breast sepsis secondary to Pseudomonas aeruginosa is uncommon. We report two cases of pseudomonal breast infection leading to septic shock and abscess formation in women with non-responding breast infection. The management of breast infection is broad-spectrum antibiotics and ultrasound with aspiration of any collection. To treat breast infection effectively, the causative organism must be isolated to enable appropriate antibiotic therapy.

Developmental stress, social rank and song complexity in the European starling (Sturnus vulgaris).

Bird song is a sexually selected trait and females have been shown to prefer males that sing more complex songs. However, for repertoire size to be an honest signal of male quality it must be associated with some form of cost. This experiment investigates the effects of food restriction and social status during development on song complexity in the European starling (Sturnus vulgaris). Birds that experienced an unpredictable food supply early in life produced a significantly smaller repertoire of song phrases than those with a constant food supply. Social status during development was also significantly correlated with repertoire size, with dominant birds producing more phrase types. This study therefore provides novel evidence that social as well as nutritional history may be important in shaping the song signal in this species.

Song as an honest signal of developmental stress in the zebra finch (Taeniopygia guttata).

In a wide range of bird species, females have been shown to express active preferences for males that sing more complex songs. Current sexual selection theory predicts that for this signal to remain an honest indicator of male quality, it must be associated with an underlying cost of development or maintenance. There has been considerable debate questioning the costs associated with song production and learning. Recently, the nutritional stress hypothesis proposed that song complexity could act as an indicator of early developmental history, since the song control nuclei in the brain are laid down early in life. Here we test the nutritional stress hypothesis, by investigating the effects of dietary stress on the quality of adult song produced. In addition, we tested the effects of elevated corticosterone during development on song production to test its possible involvement in mediating the effects of developmental stress. The results demonstrate that both dietary restriction and elevated corticosterone levels significantly reduced nestling growth rates. In addition, we found that experimentally stressed birds developed songs with significantly shorter song motif duration and reduced complexity. These results provide novel experimental evidence that complex song repertoires may have evolved as honest signals of male quality, by indicating early developmental rearing conditions.

Uncertain clinical utility of contemporary strategies for microalbuminuria testing.

AIMS: To determine whether conventional dipstick tests for proteinuria accurately identified patients with diabetic nephropathy and whether repeat testing for elevated albumin excretion and screening for urinary tract infection was required as part of the screening process for microalbuminuria. METHODS: Random urine for albumin/creatinine ratio (ACR) was measured in all patients over a 6-month period. Patients who had a positive test (>3.5 mg/mmol) were requested to provide two further samples for re-testing and a mid-stream urine specimen to screen for asymptomatic bacteriuria. The evaluation of accuracy of dipstick proteinuria was carried out in the samples collected over a fixed 2-week period. RESULTS: Dipstick vs. ACR--Of 221 samples collected, 142 were negative, 58 had 1+ and 21 had 2+ or more for dipstick proteinuria. At a threshold of 2+, the majority (81%) had ACR in the overt nephropathy range (>30 mg/mmol) and none had it below 10 mg/mmol, whereas at 1+, only 28% had ACR in the overt nephropathy range and 19% even had normoalbuminuria. Repeat Testing--Of the 1832 patients who had microalbuminuria measured, 673 had a positive test and 248 returned repeat samples. Eighty-one patients returned two samples, of which 16 had discordant results, and 161 patients gave three samples, of which only 23 were false positives. The majority of these 39 patients had low-grade microalbuminuria (ACR 3.5-10 mg/mmol) in their first sample. The absolute benefit of repeat testing was only to 3.4% of the population who screened positive, while in a further 2.3% (two-sample responders) there was potential for confusion because of discordant results. Infection Screening--Of the 248 samples, only 31 had evidence of urinary infection. CONCLUSION: Dipstick proteinuria of 1+ does not necessarily represent significant nephropathy. There is little or no benefit in repeat testing outside of the low microalbuminuria range but compliance to such testing is poor. Screening for asymptomatic bacteriuria as part of microalbuminuria screening is of questionable value.

Song as an honest signal of past developmental stress in the European starling (Sturnus vulgaris).

Bird song is a sexually selected male trait where females select males on the basis of song quality. It has recently been suggested that the quality of the adult male song may be determined by nutritional stress during early development. Here, we test the 'nutritional-stress hypothesis' using the complex song of the European starling. Fledgling starlings were kept under experimental treatment (unpredictable short-term food deprivations) or control conditions (ad libitum food supply), for three months immediately after independence. We measured their physiological and immune responses during the treatment and recorded song production during the following spring. Birds in the experimental group showed increased mass during the treatment and also a significantly suppressed humoral response compared with birds in the control group. There was no difference between the groups in the cell-mediated response. Next spring, males in the experimental group spent less time singing, sang fewer song bouts, took longer to start singing and also sang significantly shorter song bouts. These data support the hypothesis that both the quality and quantity of song produced by individual birds reflect past developmental stress. The results also suggest the 'nutritional-stress hypothesis' is best considered as a more general 'developmental-stress hypothesis'.

Song, sexual selection, and a song control nucleus (HVc) in the brains of European sedge warblers.

Female sedge warblers select males that have more complex songs as mates. This study tests two predictions concerning HVc, a telencephalic nucleus that is essential for song learning and production: first, that males with more complex songs will have a larger HVc, and second that males who pair successfully will have a larger HVc than unpaired males. Data on song composition and pairing status were collected from wild sedge warblers breeding in Hungary. We found significant positive correlations between three song attributes (repertoire size, song complexity, and song length) and the size of HVc. Males that paired successfully also had more complex songs (repertoire size and song complexity, though not song length) than males that did not. However, we find no direct evidence that males who paired successfully had a larger HVc than unpaired males. These findings are discussed in relation to the possible functions of HVc and also to current views on sexual selection and the evolution of the song control pathway.

Song as an indicator of male parental effort in the sedge warbler.

Repertoire size has been found to be a sexually selected trait in a number of bird species, although the advantages of mating with a male who possesses a complex song remain unclear. We studied the potential role of song as an indicator of male parental effort in the sedge warbler Acrocephalus schoenobaenus. The male provisioning rate was used as a measure of male parental effort and was found to increase with nestling age and brood size. When controlling for chick age, brood size and other variables, we found a highly significant positive correlation between a measure of song complexity (repertoire size) and male parental effort. Both male parental effort and repertoire size were found to be positively correlated with chick weight when controlling for chick age. We found no correlation between a measure of song output (amount of song flighting) or territory size and parental effort. Repertoire size is known to be the most important cue in female choice amongst sedge warblers and we discuss the possible reasons for this. We suggest that, in choosing a male with a large repertoire, a female obtains not only indirect benefits but also direct benefits in the form of increased parental effort.

Improved recovery of antibiotic-stressed microorganisms on inclusion of saponin in aerobic blood culture media.

The recovery rates and times to detection of microorganisms isolated from two similar blood culture media, one containing saponin, were compared. A total of 2117 blood cultures were analysed in a prototype automated blood culture system. Significantly more gram-positive organisms (P<0.05) and gram-negative organisms (P<0.05), including Enterobacteriaceae (P<0.05) were recovered from the lytic medium. Average time to detection in the lytic medium was 15.8 h, compared to 22.7 h in the other medium (P<0.001). The improved recovery of microorganisms was most pronounced in blood samples obtained from patients being treated with antibiotics at the time of venesection. In vitro experiments on antibiotic affected bacteria confirmed the protective effect of saponin.

Use of prototype automated blood culture system and gas-liquid chromatography for the analysis of continuous ambulatory peritoneal dialysis associated infection.

AIMS: (1) To compare the recovery of organisms from continuous ambulatory peritoneal dialysis (CAPD) effluent fluid obtained from patients with clinical evidence of peritonitis, with an automated system (AS) and the Septichek blood culture system; (2) to evaluate the times to detection of organisms with the two systems; (3) to identify anaerobes from CAPD samples by extended anaerobic culture and gas-liquid chromatography (GLC). METHODS: 168 CAPD effluent fluid samples were studied, representing 157 episodes of peritonitis in 97 patients. CAPD samples were inoculated into two AS bottles-one anaerobic, one aerobic-and a Septichek bottle; samples were also examined for cell count, Gram stain, and direct culture. Culture bottles were then subcultured onto various media, and any organisms isolated were identified. After routine culture, GLC was performed on culture fluid in the anaerobic AS and Septichek bottles. When volatile fatty acids were detected, the broths were cultured anaerobically on specialised medium for a further five days. RESULTS: 147 organisms were isolated from the 168 samples: 96 (57%) yielded growth of significant organisms by direct culture, as compared to 129 (76.8%) by both AS and Septichek. There was no significant difference in isolation rates between AS and Septichek, but time to detection was more rapid with the AS system (p < 0.002). GLC showed volatile fatty acid in 15 specimens; of these, 14 subsequently grew anaerobic organisms. CONCLUSIONS: AS was comparable to Septichek for numbers of isolations. Speed to detection was faster with the AS, which may be an advantage in management of patients with CAPD peritonitis. GLC showed anaerobes in several cases which would not have been detected without prolonged anaerobic culture; thus anaerobic cultures are recommended for patients who are unresponsive to antimicrobials or who have evidence of bowel perforation.

A reassessment of the in-vitro activity of colistin sulphomethate sodium.

The in-vitro activity of colistin sulphomethate sodium was compared with that of other commonly used antimicrobial agents against 377 recent clinical isolates of Gram-negative bacteria (including 94 strains of Pseudomonas aeruginosa from patients with cystic fibrosis) and 16 organisms with defined resistance patterns. Colistin was active against most strains of P. aeruginosa (MIC90 4 mg/L), Shigella spp. (MIC90 0.5 mg/L), Salmonella spp. (MIC90 1 mg/L), Acinetobacter spp. (MIC90 2 mg/L), Citrobacter spp. (MIC90 1 mg/L), Escherichia coli (MIC90 1 mg/L), Klebsiella spp. (MIC90 8 mg/L) and Enterobacter spp. (MIC50 1 mg/L). No useful activity was demonstrated against Providentia spp. or Serratia spp. The results show that colistin remains a useful antimicrobial agent against Gram-negative bacteria, particularly those strains which are resistant to more commonly used antibiotics.

Multidrug-resistant Streptococcus pneumoniae.

Antimicrobial resistance in pneumococci is well established. Of major concern is the development of resistance to penicillin; however, reduced susceptibility to other commonly used agents such as chloramphenicol, erythromycin, and tetracycline has also been observed with increasing frequency. We wish to report the isolation of a clinical strain of Streptococcus pneumoniae with intermediate susceptibility to penicillin (minimum inhibitory concentration, 1 mg/L), which was also resistant to numerous other antimicrobial agents.

Development of o.a.s.i.s., a new automated blood culture system in which detection is based on measurement of bottle headspace pressure changes.

o.a.s.i.s. (Unipath Ltd., Basingstoke, United Kingdom) is a new automated blood culture system. The metabolism of microorganisms is detected by measuring changes in the pressure of the headspace of blood culture bottles. These changes are measured by monitoring the position of a flexible sealing septum, every 5 min, with a scanning laser sensor. This noninvasive system can detect both gas absorption and production and does not rely solely on measuring increasing carbon dioxide levels. A research prototype instrument was used to carry out an evaluation of the media, the detection system, and its associated detection algorithm. In simulated blood cultures, o.a.s.i.s. supported growth and detected a range of clinical isolates. Times to positivity were significantly shorter in o.a.s.i.s. than in the BACTEC 460 system. Results of a clinical feasibility study, with a manual blood culture system as a control, confirmed that o.a.s.i.s. was able to support the growth and detection of a variety of clinically significant organisms. On the basis of these findings, full-scale comparative clinical trials of o.a.s.i.s. with other automated blood culture systems are warranted.