Lemierre's syndrome with spondylitis and pulmonary and gluteal abscesses associated with Mycoplasma pneumoniae pneumonia.

Lemierre's syndrome, a systemic anaerobic infection caused by Fusobacterium necrophorum, is characterized by an acute oropharyngeal infection, septic thrombophlebitis of the internal jugular veins, sepsis, and multiple metastatic infections. It commonly leads to pulmonary parenchymal abscesses and occasionally to septic arthritis, osteomyelitis, or liver or spleen abscesses. Reported here is a case of spondylitis and pulmonary and gluteal abscesses that occurred as part of a classic presentation of Lemierre's syndrome. Treatment with imipenem and clindamycin was successful.

[Chronic fistulating wound infection after Lichtenstein repair of inguinal hernia, caused by a small colony variant of Staphylococcus aureus]. / Chronisch fistelnde Wundinfektion nach Lichtensteinreparation einer Leistenhernie, verursacht durch eine Small-colony-Variante von Staphylococcus aureus.

We report a case of chronic wound infection (abscess, fistula) after a Lichtenstein repair of inguinal hernia. After surgical treatment (mesh explantation), a small-colony variant (SCV) of Staphylococcus aureus was cultured microbiologically. SCV represent subpopulations of Staphylococcus aureus which are associated with chronic infections and which respond poorly to usual treatment regimes. In this case surgery and specific antibiotic treatment with flucloxacillin and rifampicin were successful.

Bacteriological and serological findings in a further case of transfusion-mediated Yersinia enterocolitica sepsis.

A 13-year-old patient developed severe shock due to administration of a Yersinia enterocolitica-contaminated red blood cell concentrate. Y. enterocolitica (serotype O:9, biotype II) was cultivated from the residual blood in the blood bag and from a stool sample of the blood donor. In the donor's plasma immunoglobulin M (IgM), IgA, and IgG antibodies against Yersinia outer proteins (YopM, -H, -D, and -E) were found. Since the donor remembered a short-lasting, mild diarrhea 14 days prior to blood donation, a transient attack of Yersinia enteritis may be associated with a longer than expected period of asymptomatic bacteremia that causes contamination of donor blood. Serological screening for IgM antibodies against Yersinia outer proteins might offer a way to reduce the risk of transfusion-associated Y. enterocolitica sepsis.

Persistent wound infection after herniotomy associated with small-colony variants of Staphylococcus aureus.

A small-colony variant (SCV) of Staphylococcus aureus was cultured from a patient with a persistent wound infection (abscess and fistula) 13 months after herniotomy. The strain was nonhemolytic, nonpigmented and grew only anaerobically on Schaedler agar. As it was coagulase-negative, it was initially misidentified as a coagulase-negative Staphylococcus. In further analysis, however, the microorganism was shown to be an auxotroph that reverted to normal growth and morphology in the presence of menadione and hemin (Schaedler agar) and could be identified as a SCV of Staphylococcus aureus. Surgery and antibiotic treatment of the patient with flucloxacillin and rifampicin for 4 weeks resulted in healing of the chronic wound infection.

A randomized study comparing fluconazole with amphotericin B/5-flucytosine for the treatment of systemic Candida infections in intensive care patients.

In this prospective, randomized study fluconazole and amphotericin B/5-flucytosine were compared in the treatment of systemic candidiasis. Seventy-two non-neutropenic intensive care patients with systemic Candida infections were enrolled. Thirty-six patients were randomly assigned to receive fluconazole (400 mg on the first day then 200 mg) and 36 were randomized to amphotericin B/5-flucytosine (1.0-1.5 mg/kg body weight every other day and 3 x 2.5 g flucytosine/day) for 14 days following the diagnosis. There was no statistically significant difference in clinical outcome in regard to the treatment of pneumonia and sepsis: 18/28 of the patients were treated successfully with fluconazole and 17/27 with amphotericin B/5-flucytosine. For the treatment of peritonitis, however, amphotericin B/5-flucytosine was more effective than fluconazole (55% vs. 25%). Furthermore, amphotericin B/5-flucytosine was found to be superior to fluconazole with regard to pathogen eradication (86% vs. 50%). Fluconazole was associated with less toxicity than amphotericin B/5-flucytosine.

Evaluation of commercial kits for quantitative identification and tests on antibiotic susceptibility of genital mycoplasmas.

In this study, commercial media and kits for identification and tests for antibiotic susceptibility of genital mycoplasmas were evaluated in comparison to standardized methods. A total of 298 specimens was routinely enrolled. Our results showed that all media corresponded for qualitative and semiquantitative identification with a specificity of 100% for both microorganisms and a sensitivity of 94% for U. urealyticum and of 88% for M. hominis. Standard methods were superior to commercial kits for qualitative and quantitative identification (sensitivity 85-97% for U. urealyticum and 79-83% for M. hominis). There were large discrepancies when testing antibiotic susceptibility.

[Endocarditis from Erysipelothrix rhusiopathiae]. / Endokarditis durch Erysipelothrix rhusiopathiae.

Erysipelothrix rhusiopathiae only seldom causes cases of endocarditis. Contact with infectious animals leads to endocarditis of the left heart with high lethality. Vancomycin and aminoglycosides, which are often used in gram-positive endocarditis, show no effect.

Histomorphology of experimental listeriosis.

This paper is a survey of the histomorphology of experimental listeriosis based on cooperative studies performed within the past ten years. The influence of various parameters of the infectious agent (pathogenic Listeria monocytogenes serovar 4b, nonpathogenic Listeria innocua serovar 6b etc.) as well as of the host (euthymic NMRI-mice conditioned with dextran sulfate 500 or cyclosporin A, athymic nude mice etc.) on the course, morphology and outcome of the Listeria infection was investigated. From the experimental models used and the studies performed much could be learned concerning the factors that determine the histomorphological manifestations of listeriosis in humans.

Alteration of non-specific resistance to infection with Listeria monocytogenes.

The experimental infection of murine hosts with Listeria monocytogenes is often used as a model for cell-mediated immunity. However, the natural immunity or non-specific resistance to listeriosis can be influenced by the parasite itself and also by a wide array of endogenous and exogenous host factors. The most important host factor in inbred mouse strains is their genetically determined susceptibility or resistance to Listeria monocytogenes. Secondly, the age of the mice is crucial for the outcome of infection. Resistance is only slowly developed by newborn mice, while aged mice possess an increased non-specific resistance as compared to young adult animals. Resistance is further influenced by the nutritional status, by pregnancy or by a simultaneous second antigenic stimulation. Regarding exogenous factors, macrophage blocking agents can totally abolish the resistance to listeriosis, while a lot of immunomodulating agents, such as BCG, killed Bordetella pertussis or Propionibacterium acnes organisms, lipopolysaccharides, suramin etc., can either increase or decrease the resistance. The mononuclear phagocyte system seems to be the main target of all these immunomodifiers. The timing between listeria infection and application of the immunomodulator determines the effect on non-specific resistance. A simultaneous injection of parasite and immunomodulator results in a decrease of resistance, while the application of immunoadjuvants several days before infection can dramatically increase the resistance to listeriosis. The delicate equilibrium of the mononuclear phagocyte system must therefore be taken into account, when infection with Listeria monocytogenes is used to test for immune-modifying agents, which are intended for use in humans or animals.

Murine model for therapy of listeriosis in the compromised host. III. The effect of rifampicin.

10 different strains of Listeria monocytogenes tested in vitro were found to be susceptible to rifampicin showing minimal inhibitory concentrations between 0.0075 and 0.06 microgram/ml. Mice infected with a virulent strain of L. monocytogenes were treated with this antibiotic. Bacterial counts rapidly declined. In dextran sulfate-treated animals, deprived of their macrophage system and consequently highly susceptible to Listeria infection, rifampicin was able to protect the animals. Furthermore, nude athymic mice, chronically infected with L. monocytogenes, were also nearly cured. A few remaining bacteria, however, started to multiply after cessation of therapy, so that a relapse was noted. Development of resistance of L. monocytogenes to rifampicin during treatment was not observed.

[Evaluation of a new latex agglutination test for identification of staphylococcus aureus]. / Beurteilung eines neuen Latex-Agglutinations-Tests zur Identifizierung von Staphylococcus aureus.

286 clinical isolates of staphylococci and 19 Micrococcus spp. were tested in a new latex agglutinating test to detect bound coagulase and protein A simultaneously. Coagulase-positive strains of staphylococci (n = 119) were all found to be latex-positive. Negative latex agglutination test results were obtained with 154 out of 167 coagulase-negative strains, the other 13 (7.8%) strains gave positive latex tests. Furthermore 3 out of 19 Micrococcus strains yielded positive agglutinating results. According to the results presented a negative latex test allows a rapid exclusion of S. aureus. A positive latex test requires the determination of further typical characteristics to differentiate among the staphylococcal isolates.

The role of macrophages in primary and secondary infection of mice with Salmonella typhimurium.

Elimination of macrophages with high-molecular dextran sulphate (DS) markedly impairs resistance of mice to primary infection with smooth, virulent strains of Salmonella typhimurium, whereas stimulation of this system by killed Bordetella pertussis organisms increases resistance. In infection with rough, avirulent strains of S. typhimurium the elimination of macrophages was not followed by an essential loss of resistance, and it appears that other non-specific defence mechanisms, for example the complement system, may have compensated for the lack of macrophages. Macrophages, therefore, play an important role in defence during primary infection with virulent strains. In immunity to challenge infection with S. typhimurium, macrophages play an even more significant role. Treatment with DS completely removes immunity, and both humoral and cell-mediated immune mechanisms seem to require the participation of macrophages.

Macrophage function in senescence.

Although the parenteral injection of dextran sulfate 500 (DS 500; 50 mg/kg body weight) into 22-month-old NMRI mice resulted in a complete loss of resistance when administered 1 day before the sublethal (4.5 X 10(3)) infection with Listeria monocytogenes, the consequences in aged animals were less dramatic than in young adult (2- to 3-month-old) controls. This was documented by prolonged survival times as well as reduced numbers of Listeriae in spleen. This indicates that aged mice possess an increased paghocytic capacity, as compared to young adult animals. In aged mice the DS 500-induced loss of resistance could be completely abolished by pretreatment with 3 X 10(9) heat-killed Bordetella pertussis organisms 4 days before the DS 500 injection, i.e., 5 days before listeric infection. This indicates that aged NMRI mice possess remarkable reserves in phagocytic activity.

Biological activity of Bordetella pertussis in lipopolysaccharide-resistant mice.

Effects of Bordetella pertussis organisms, such as adjuvanticity, induction of hypersplenia, and leukocytosis as well as modification of nonspecific resistance to infection and typical morphological response of lymphatic organs, were studied in the lipopolysaccharide-resistant C3H/HeJ mouse strain. It was shown that B. pertussis exerted all of these effects in C3H/HeJ mice, although the morphological response, hypersplenia, and modification of resistance to infection with Listeria monocytogenes in such animals were less pronounced than those in lipopolysaccharide-sensitive mouse strains. This indicated that the biological activity of B. pertussis as determined in the present studies, is due partly to structural components other than lipopolysaccharide.

Murine model for therapy of listeriosis in the compromised host. I. Effect of ampicillin.

Therapy of listeriosis with ampicillin was examined in two murine models with compromised defense mechanisms. In mice treated with dextran sulfate paralysing the function of the macrophage system, ampicillin was less able to reduce death rates as well as bacterial counts in the spleens than after infection of normal mice. In nude mice with chronic listeriosis, treatment with ampicillin was started 8 days after infection. The numbers of viable listeria cells decreased under therapy, but a bacteriologic cure was not achieved in a 6-day schedule. Relapse followed cessation of therapy.

Stimulation of cell-mediated resistance in mice to infection with Listeria monocytogenes by vitamin A.

Vitamin A given as retinol-acetate, retinol-palmitate as well as the derivates retinoic acid and a retinoid, strongly fortified the resistance of mice to infection with virulent cells of Listeria monocytogenes. However, strong enhancement of resistance was only achieved when high toxic doses of vitamin A were given. Apparently, this effect was due to a stimulation of the function of the mononuclear phagocytic system rather than of the T lymphocyte.

Age-related defense against infection with intracellular pathogens.

Young adult (6--12 weeks old) and aged (20--24 months old) NMRI mice were infected with various intracellular parasites. The following results were obtained: (1) After a sublethal infection with Listeria monocytogenes, aged mice were found to show a resistance similar to that of young adults. A challenge infection with this pathogen was followed by specific immunity of long duration in both age-groups. (2) On the other hand, young animals were significantly more resistant to Salmonella typhimurium than aged mice. It was concluded that this was due to the LD50 which was 14 times greater for 2-month-old than for 20-month-old mice. Furthermore, during 7 weeks after infection there were more S. typhimurium in the spleens of senescent mice than in those of young adult controls. (3) Aged mice showed highly increased susceptibility to the weakly virulent DX strain of Toxoplasma gondii. Almost all aged animals died whereas the control mice survived. When death of the aged mice was prevented by treatment with sulfadiazine after infection with the DX strain, the aged mice were found to be as well protected against subsequent infection with the strongly virulent BK strains as the young adult mice. These results suggest that the susceptibility of the aged animal to infectious agents may considerably vary from one pathogen to another.