Quantitative real-time PCR tests for diagnostic and prognostic purposes in cases of legionellosis.

The usefulness of two quantitative real-time PCR assays (qrt-PCRmip targeting Legionella pneumophila, and qrt-PCR16S targeting all Legionella species) performed on lower respiratory tract (LRT) samples for diagnostic and prognostic purposes in 311 patients hospitalized for community-acquired pneumonia (CAP) in Rhône-Alpes (France) was evaluated. The Now Legionella urinary antigen test (UAT) from Binax (Portland, ME, USA) was used as a reference test. Samples were divided into two groups. Group A included 255 CAP patients admitted to Chambery hospital in 2005 and 2006. The Now Legionella UAT was positive in 14 patients. Sensitivities, specificities, positive predictive and negative predictive values for both qrt-PCR tests were 63.6, 98.7, 77.7 and 97.4%, respectively. Group B included 56 consecutive legionellosis patients diagnosed during a 4-year period (2003-2006) at the Grenoble University Hospital. The qrt-PCR16S and qrt-PCRmip displayed a sensitivity of 82.14 and 80.4%, respectively. Among the 70 legionellosis cases, L. pneumophila serogroup 1 was isolated in 15; qrt-PCRmip was positive in another 36, suggesting L. pneumophila infection, whereas the Legionella species involved could not be determined in the remaining 19 cases. The Legionella burden in LRT samples at the time of admission was determined in 46 patients using qrt-PCR16S tests, 44 for qrt-PCR mip groups A and B patients. It varied from 1.9 to 8.35 log(10) DNA copies/mL of LRT sample for qrt-PCR16S and from 1.9 to 8.11 log(10) DNA copies/mL of sample for qrt-PCRmip. High bacterial loads in LRT samples at hospital admission were significantly associated with higher Fine classes, the need for hospitalization in an intensive care unit and for prolonged hospitalization.

High-resolution imaging of biological and other objects with an X-ray digital camera.

A high-resolution CCD X-ray camera based on YAG:Ce or LuAG:Ce thin scintillators is presented. The high resolution in low energy X-ray radiation is quantified with several test objects. The achieved spatial resolution of the images is <1 microm. The objects used for imaging are grids and small animals with parts of several microns in extent. The high-resolution imaging system can be used with different types of ionizing radiation (X-ray, electron, UV, and VUV) and for non-destructive micro-radiography and synchrotron beam inspection.

Detection of an outbreak of methicillin-resistant Staphylococcus aureus with reduced susceptibility to glycopeptides in a French hospital.

Staphylococcus aureus isolates were screened for reduced susceptibility to glycopeptides with an initial glycopeptide agar screening test, followed by confirmation of the strains thus identified by two Etest strip techniques and population analysis. This procedure detected 48 methicillin-resistant S. aureus (MRSA) isolates with reduced susceptibility to glycopeptides from 24 patients among 883 MRSA isolates tested. The dissemination of a single clone was confirmed by pulsed-field gel electrophoresis.

[Rhône-Alpes observatory of Streptococcus pneumoniae in 1999: 35 cases of meningitis]. / Observatoire Rhône-Alpes du pneumocoque en 1999: 35 cas de méningites.

In 1999, in Rhône-Alpes region, in a survey of resistance to antibiotics of Streptococcus pneumoniae, 35 cases of meningitis were observed. A retrospectic questionnary was sent to each participant. MICs to Penicillin, Amoxicillin and Cefotaxime were determined with ATB-PNEUMO gallery or E-test and by disk diffusion for the other antibiotics. The results were interpreted according to the recommendations of the CA-SFM. Mean age was 38.1 years (range : 1 month -78 years) and sex-ratio 2/5. Eight patients had previously received antibiotics, 22 patients had risk factors and 23 were transferred in intensive care unit. The patients received C3G + glycopeptide in 15 of 16 children and in 13/19 adults according to the consensus recommendations. Diagnostic was made on the direct examination of CSF in 83%, and blood cultures was positive in 74.3% of cases. The percentage of PRP was 48.6% with 17.1% of intermediate-amoxicilline and 14.3% intermediate-cefotaxime strains. Resistance to trimethoprim-sulfamethoxazole was 45.7%, to chloramphenicol 30% and to fosfomycin 6.9%. All the strains were susceptible to rifampicin and vancomycin. Among the 17 PRP strains, 7 were belonging to serotype 6 (6 in children). The clinical outcome was fatal in 7 male cases (20%), without risk factors in 3 children and 6 of 7 strains were susceptible to penicillin. Six patients (17%) had auditive and/or neurologic sequellaes. This study shows that nearly 50% of strains isolated in meningitis, in Rhône-Alpes region, were not susceptible to penicillin, and confirms the frequency of sequellaes while the mortality is not related with the resistance of strains to the antibiotics.

Avances en el PMK-R / Advances in PMK-R

El objetivo de este trabajo es presentar un actualización de la investigación que sobre el PMK de Mira y López hemos realizado en la Universidad de Barcelona. El artículo consta de dos partes claramente diferenciadas. A) Una revisión conceptual en la que se redefinen: 1) los conceptos clásicos de respuesta miokinética por respusta propioceptiva; 2) el concepto de significación psicológica de la respuesta motora, según el espacio en que esta se da, por la significación de las respuestas propioceptivas, según poblaciones seleccionadas en base a criterios psicológicos; 3) los rasgos de personalidad por la correlación de la respuestas a cuestionarios verbales; 4) el concepto de coherencia intrapsiquica, por una definición empírica del mismo, según la correlación obtenida entre mano dominante y no dominante. B) Una revisión metodológica en la que presentamos el nuevo PMK-R como una alternativa, basada en las aportaciones de la informática en su capacidad de digitalización y procesamiento de la información, aplicadas a la presentación, corrección y análisis de las respuestas.

O objetivo deste trabalho é apresentar uma atualização da investigação querealizamos na Universidade de Barcelona, sobre o PMK de Mira y López.O artigo consta de duas partes claramente diferenciadas. A) Uma revisãoconceitual na qual se redefinem: 1) os conceitos clássicos de respostamiocinética por resposta propioceptiva; 2) o conceito de significaçãopsicológica da resposta motora, segundo o espaço em que esta se dá, pelasignificação das respostas propioceptivas, segundo população selecionadacom base em critérios psicológicos; 3) os traços de personalidade pelacorrelação da resposta motora com as respostas a questionários verbais; 4)o conceito de coerência intrapsíquica, por uma definição empírica domesmo, segundo a correlação obtida entre mão dominante e não dominan-te. B) Uma revisão metodológica onde apresentamos o novo PMK-R comouma alternativa, baseada nas contribuições da informática em sua capacida-de de digitalização e processamento da informação, aplicadas à apresenta-ção, correção e análise das respostas

Comparative in vitro activity of penicillin G, levofloxacin, moxifloxacin, telithromycin, pristinamycin, quinupristin-dalfopristin and linezolid against ofloxacin-intermediate and -resistant Streptococcus pneumoniae.

Screening by ofloxacin disk was carried out on 1158 strains of Streptococcus pneumoniae in order to investigate the in vitro bacteriostatic activity of penicillin G, levofloxacin, moxifloxacin, telithromycin, linezolid, pristinamycin and quinupristin-dalfopristin against ofloxacin-intermediate and -resistant S. pneumoniae strains. It was concluded that these new antimicrobial agents could be useful for the treatment of pneumococcal infections caused by penicillin-sensitive and -resistant S. pneumoniae, and would represent a valid therapeutic option for patients allergic to beta-lactams, should they prove to be potent in vivo.

[Evaluation of the E-test and the ATB-PNEUMo battery for determining the beta-lactam MIC for Streptococcus pneumoniae in daily practice]. / Evaluation du E-test et de la galerie ATB-PNEUMo dans la détermination des CMI aux bêtalactamines de Streptococcus pneumoniae en pratique quotidienne.

In 1999, during the survey of resistance of Streptococcus pneumoniae to antibiotics by 31 clinical laboratories of Rhône-Alpes area, MIC to penicillin (P), amoxicillin (AMX) and cefotaxime (CTX) of 877 PRP strains or with a diameter of inhibition to oxacillin inferior to 26 mm, were determined by each institution by E-test (n = 220 strains) or ATB-PNEUMO (n = 657 strains). MICs of these three antibiotics were determined by dilution in agar medium by the coordinating center. The essential agreement was respectively for ATB-PNEUMO and E-test 89% versus 84% for P (p > 0.05), of 86% vs 79% for AMX (p < 0.01), and of 91% vs 86% for CTX (p = 0.03). When the strains were classified in clinical category, the differences were significant (p < 0.001) for AMX (85% vs 71%) and for CTX (82% vs 75%) but not for P (73% vs 78%). ATB-PNEUMO method was more sensitive than E-test for the detection of strains susceptible to P (90 vs 73%), to AMX (83 vs 78%) and to CTX (80 vs 72%) and for the strains intermediate to AMX (90 vs 78%). On the contrary, E-test is more specific than ATB-PNEUMO for the detection of P-resistant strains (94 vs 86%). Finally, the specificity of both methods is the same for detection of P-S, AMX-R and CTX-I strains.

Sales of nonprescription cold remedies: a unique method of influenza surveillance.

In 1976, the National Institute of Allergy and Infectious Disease sponsored a nationwide network for influenza surveillance. In this paper, in addition to reporting the surveillance findings in Los Angeles, sales of nonprescription cold remedies in a large supermarket chain were evaluated as an indicator of influenza activity in the community. Twenty-seven isolates of influenza B occurred between February 17 and April 26, 1977. Peak influenza B activity occurred from mid-March to early April, 1977. A 5-10% increase in percent of respiratory and febrile respiratory illness seen in outpatient clinics was observed in late December and January. No variation in these statistics occurred during the peak of influenza activity. In contrast, sales of nonprescription cold remedies were apparently influenced by influenza B activity. Peak sales (345% increase) occurred 4 wk after the first influenza B isolate and 1 wk before peak influenza activity was documented by peak rates of isolation.

Epidemic measles in young adults. Clinical, epidemiologic, and serologic studies.

An outbreak of measles at the University of California at Los Angeles provided the opportunity to study clinical, epidemiologic, and serologic characteristics of the disease in young adults in the present vaccine era. Of the 34 cases studied, 18 occurred in persons who thought they were immune. Fifteen of 19 seronegative students vaccinated during the epidemic responded with a secondary (IgG) antibody response. Antibody prevalence studies indicated that 91% of the student population had measles antibody at the onset of the outbreak, and history relating to measles correlated poorly with antibody prevalence. Of 212 adults vaccinated, 58% complained of one or more symptoms. Seventeen percent were confined to bed, and in three women vaccine-associated illness was notably severe. That measles will continue to be a problem in adults with our present national approach to immunization is predicted.

[A new case of acute lymphoblastic leukemia with Philadelphia chromosome in the child (author's transl)]. / Un nouveau cas de leucémie aiguë lymphoblastique de l'enfant avec chromosome Philadelphie.

The systematic study of the medullary karyotype in the course of haemopathies has led us to a new case of Philadelphia chromosome in an acute lymphoblastic leukemia. This was a case of a 13 year old child. Is this a particular class of haemopathy? Do such observations put a question on the dual theory of the origins of blood germ cells? The elaborate medullary karyotype in the course of haemopathy may solve this problem. A rigorously nosological classification is essential for appraising the therapeutic plan chosen and making a pronosis.

Revaccination of previous recipients of killed measles vaccine: clinical and immunologic studies.

Clinical and immunologic studies were performed in association with revaccination with live measles vaccine in 75 adolescents 11 to 14 years after immunization with killed measles vaccine. Ten subjects had local pain with swelling or erythema or both at the injection site; in three, the local reactions were severe and disturbing systemic complaints were also noted. These marked reactions were more common in subjects in whom the interval between the last dose of killed vaccine and the dose of live vaccine of the primary immunization series was less than or equal to 2 months, in subjects with prevaccination serum HAI antibody titers of less than or equal to 5, and in subjects with high measles antigen specific lymphocyte stimulation ratios. Serum complement levels could not be correlated with clinical reactions. Measles specific lymphocyte stimulation ratios were significantly higher in recipients of killed vaccine than in three compara,ive groups, in subjects with a killed-live interval in the initial vaccine series of less than or equal to 2 months as compared with greater than or equal to 3 months, and in subjects with prevaccination HAI antibody titers of less than or equal to 5 as compared with titers greater than or equal to 10. Although both low serum antibody and high measles specific lymphocyte reactivity were associated with marked local reactions, and probably indicative of susceptibility to atypical measles, our findings suggest that exaggerated lymphocyte reactivity is of greater importance in the adverse clinical response.

Measles revaccination. Persistence and degree of antibody titer by type of immune response.

During a measles immunization campaign 203 children were enrolled in an antibody response study. Of this group, follow-up clinical data and sera samples were available from 125 children three weeks after immunization and from 90 children ten months later. Seventy-six of the children had been previously vaccinated, ten had a history of measles and 39 denied vaccination or illness. Twenty-six of the children had prevaccination hemagglutination inhibiting antibody titers of less than 5. Of this group 12 had a primary immune response (IgM measles antibody) with geometric mean titers (GMT) of 90 and 40 three weeks and ten months respectively after vaccination. In contrast, the other 14 children with initial titers of less than 5 had secondary immune responses (only IgG measles antibody) with GMTs of 28 and 9 three weeks and ten months after vaccination. Since the antibody responses in these children who had previously been stimulated by measles antigen were modest and transient, it is suggested that booster immunization may not be effective in preventing future secondary vaccine failures. Also noted in this study was a poor correlation between historical data and actual measles antibody.

Vesicular lesions in adults due to echovirus 11 infections.

Echovirus 11 was recovered from vesicular lesions in two adults. Patient 1 had a severe disseminated vesicular exanthem. Patient 2 had a mild vesicular enanthem. Both were clinically suspected of having herpesvirus hominis lesions. Serologic studies indicate that these viruses were similar to each other and also to the "U" prime strain.

Clinical trials with inactivated monovalent (A/New Jersey/76) and bivalent (A/New Jersey/76-A/Victoria/75) influenza vaccines in Los Angeles children.

Clinical and serologic responses to inactivated influenza virus vaccines were studied in 444 children in Los Angeles under doubld-blind, placebo-controlled protocols. One- and two-dose regimens employing monovalent (A/New Jersey/76) and bivalent (A/New Jersey/76-A/Victoria/75) vaccine were studied in separate trials. In a single dose, whole-virus vaccines were more potent than split-product vaccines as primary inducers of immunity against influenza A/New Jersey/76 virus. Split-product vaccines were better tolerated clinically and, after two-dose regiments, produced rates of seroconversion (greater than 90%) against A/New Jersey/76 virus comparable to those produced by two doses of whole-virus vaccines. Analysis of heterotypic antibody responses induced by monovalent A/New Jersey/76 vaccines revealed only slight increases in antibody against influenza A/Victoria/75 virus. After vaccination with bivalent vaccines, levels of antibody against influenza A/Victoria/75 virus were significantly higher in subjects who received high doses of split-product vaccines than in subjects who received whole-virus vaccines.

IgM and IgG antibody responses after immunization of children with inactivated monovalent (A/New Jersey/76) and bivalent (A/New Jersey/76-A/Victoria/75) influenza virus vaccines.

The character of the immune response to inactivated monovalent influenza A/New Jersey/76 and bivalent influenza A/New Jersey/76-A/Victoria/75 vaccines was studied in children six months to 18 years of age. Titers of hemagglutination-inhibiting antibody in sera taken after vaccination were measured before and after treatment with 2-mercaptoethanol. IgG antibody predominated in responses to the influenza A/Victoria/75 component of bivalent vaccines. In contrast, specific IgM antibody to influenza A/New Jersey/76 virus developed after administration of both monovalent and bivalent vaccines and appeared to characterize the immune response to this antigenic "shift" strain in children. Prevalences of IgM antibody against influenza A/New Jersey/76 virus did not differ significantly by age. This finding implies that type rather than extent of previous experience with influenza determines the IgM antibody response to an antigenic "shifts." Split-product vaccines produced significantly fewer IgM antibody responses to influenza A/New Jersey/76 virus than did whole-virus vaccines, a phenomenon that may correlate with their diminished reactogenicity and immunogenicity in children.