Acute postoperative endophthalmitis caused by Staphylococcus lugdunensis.

Acute postoperative endophthalmitis caused by Staphylococcus lugdunensis is infrequently reported in clinical studies. Five cases of acute postcataract surgery endophthalmitis caused by S. lugdunensis were taken from a multicenter prospective study conducted in four university-affiliated hospitals in France (2004 to 2005). These cases were characterized by severe ocular inflammation occurring with a mean delay of 7.6 days after cataract surgery, severe visual loss (hand motions or less in three cases), and dense infiltration of the vitreous. Each of these patients was initially treated by using a standard protocol with intravitreal (vancomycin and ceftazidime), systemic, and topical antibiotics. Given the severity of the endophthalmitis, even though bacteria were sensitive to intravitreal antibiotics, pars plana vitrectomy was needed in four cases. The final visual prognosis was complicated by severe retinal detachment in three cases. The microbiological diagnosis was reached by using conventional cultures with specific biochemical tests and eubacterial PCR amplification followed by direct sequencing.

[Microbiological and clinical diagnosis of acute endophthalmitis]. / Diagnostic microbiologique des endophtalmies aiguës.

The microbiological study identifies the bacterial spectrum after surgery, in acute, delayed-onset, or chronic endophthalmitis. DNA amplification of eubacterium-specific sequences in DNA extracted from ocular samples is a new tool for the etiological diagnosis of endophthalmitis. The most successful way to identify bacteria in endophthalmitis is the association of conventional cultures and panbacterial PCR on vitreous samples. Both techniques are complementary. The efficacy of these new molecular techniques should modify our future therapeutic strategies.

[Sweet's syndrome and motor neuron disease associated with esophageal carcinoma]. / Síndrome de Sweet y afectación de motoneurona asociados a carcinoma de esófago.

The paraneoplastic syndromes are an a group of clinical manifestations of uncommon frequency that they are associated with tumors and they often are precursors of these. The Sweet's syndrome is a dermatosis characterized by fever, erythematous plaques and infiltrate consisting of mature neutrophils. It occurs occasionally in association with hematologic malignancies and is very rare with solid tumors. The isolated motor neuron disease is rare like paraneoplastic syndrome. We report the case of a patient with epidermoid carcinoma of esophagus that it was diagnosed after beginning clinically with two paraneoplastic syndromes: Sweet's syndrome and motor neuron disease.

Synergistic hemolytic activity of Staphylococcus lugdunensis is mediated by three peptides encoded by a non-agr genetic locus.

Some strains of the coagulase-negative Staphylococcus lugdunensis produce a synergistic hemolytic activity (SLUSH), phenotypically similar to the delta-hemolysin of S. aureus. Reverse-phase high-pressure liquid chromatography of supernatants from S. lugdunensis 307 yielded three late-eluting peaks of 3.5 kDa with synergistic hemolytic activity. A degenerate oligonucleotide probe was designed from partial amino acid sequences of the 23-amino-acid (aa) tryptic fragments from one of the three peaks and hybridized to a single 2.8-kb HindIII chromosomal fragment. The relevant portion of this fragment was cloned by PCR, and sequencing showed the presence of three related open reading frames (ORFs), SLUSH-A, SLUSH-B, and SLUSH-C, preceded by an unrelated short potentially coding sequence (ORF-X), cotranscribed on a polycistronic 838-nucleotide mRNA. The amino acid sequences of the peptides from the three peaks align perfectly with the predicted sequences from the three SLUSH ORFs (peak I = SLUSH-B; peak II = SLUSH-C; peak III = SLUSH-A). These three peptides are closely related (amino acid homology, >76%) and do not show significant homology to S. aureus delta-hemolysin but do resemble a Salmonella typhimurium invasin and the "gonococcal growth inhibitor," a bacteriocin secreted by Staphylococcus haemolyticus. The predicted ORF-X gene product is a 24-aa peptide with no homology to the SLUSH peptides.

[Listeriosis in the nonpregnant adult during an epidemic outbreak on Grand Canary]. / Listeriosis en el adulto no gestante durante un brote epidémico en Gran Canaria.

Twenty-two cases of community-acquired epidemic listeriosis were recorded from December 31st, 1991, to May 15th, 1993, at the Nuestra Señora del Pino Hospital, Las Palmas. The incidence during this outbreak was 31 times higher than the corresponding incidence in the last few years. Twelve cases occurred in pregnant women and/or neonates and ten in non-pregnant adult individuals. Our aim was to study the clinical, biological, radiological, and evolutive issues in non-pregnant adult patients. Six patients had some immunosuppressive condition: cancer, chemotherapy, AIDS, diabetes, and alcoholism. Eight patients had documented involvement of central nervous system: 6 cases of meningitis and 3 of cerebritis (one case had both meningitis and cerebritis); in the remaining two patients associated with seizures and acute confusional states, respectively. A neurological involvement was not documented because of the fulminant clinical course. CSF examination revealed mononuclear predominance in half of meningitis cases and was normal in two of the three cerebritis cases. The mean time from admission to diagnosis was 3.5 days. All patients but the two who died in the first hours of the disease received ampicillin and an aminoglycoside. The response to therapy was excellent with exception of one patient with meningitis who died in the fourth day of therapy. The clustering of listeriosis cases should alert physicians about the possibility of an epidemic outbreak. Listeria infection in non-pregnant adult individuals in this outbreak showed a high rate of neurological involvement, with focal cerebritis and pleocytosis with a mononuclear predominance in meningitis.