Development of an Infection-Responsive Fluorescent Sensor for the Early Detection of Urinary Catheter Blockage.

Formation of crystalline biofilms following infection by Proteus mirabilis can lead to encrustation and blockage of long-term indwelling catheters, with serious clinical consequences. We describe a simple sensor, placed within the catheter drainage bag, to alert of impending blockage via a urinary color change. The pH-responsive sensor is a dual-layered polymeric "lozenge", able to release the self-quenching dye 5(6)-carboxyfluorescein in response to the alkaline urine generated by the expression of bacterial urease. Sensor performance was evaluated within a laboratory model of the catheterized urinary tract, infected with both urease positive and negative bacterial strains under conditions of established infection, achieving an average "early warning" of catheter blockage of 14.5 h. Signaling only occurred following infection with urease positive bacteria. Translation of these sensors into a clinical environment would allow appropriate intervention before the occurrence of catheter blockage, a problem for which there is currently no effective control method.

A newborn with hemorrhagic meningoencephalitis due to Proteus mirabilis.

Neonatal meningoencephalitis is a severe condition for the developing brain of a newborn. Radiologic findings of necrosis and liquefaction due to hemorrhagic meningoencephalitis may be confused with brain abcess. In this article, we report a neonate having liquefaction necrosis due to hemorrhagic meningoencephalitis mimicing intracranial abscess due to Proteus mirabilis. We would like to describe the clinical course and evolution of brain imaging and emphasize the importance of the serial MR imaging (MRI).

Native valve Proteus mirabilis endocarditis: successful treatment of a rare entity formulated by in vitro synergy antibiotic testing.

Infective endocarditis caused by Proteus mirabilis is a rare and poorly reported disease, with no well-defined effective antibiotic regimen. Here, we present a case of P. mirabilis aortic valve endocarditis. We reviewed prior cases and treatment regimens, and devised effective treatment, which was guided by in vitro sensitivity and synergy testing on the pathogen. Our patient survived without complications or the need for a surgical intervention.

Proteus mirabilis abscess involving the entire neural axis.

Intramedullary spinal cord abscesses are rare and potentially devastating lesions usually associated with other infective processes such as bacterial endocarditis, or pulmonary or urogenital infection. We describe a 2-year-old girl who presented with an infected dermal sinus leading to an intraspinal abscess. This abscess eventually spread and involved the entire neural axis leaving her quadriparetic. Drainage of the abscess resulted in recovery and the child regained normal function of her limbs. To our knowledge this is the first documented case of an intramedullary abscess involving the entire neural axis.

A high throughput, minimally invasive, ultrasound guided model for the study of catheter associated urinary tract infections and device encrustation in mice.

PURPOSE: Catheter associated urinary tract infections are one of the most common health care associated infections. The condition is frequently complicated by encrustation, which blocks the catheter lumen. Preclinical research is limited by the lack of relevant high throughput and cost-effective animal models. Current models are restricted to female mice, associated with major transurethral loss of catheter materials during micturition, highly invasive and complex. We present an ultrasound guided, minimally invasive model that enables catheter associated urinary tract infection and catheter encrustation studies in each mouse gender. MATERIALS AND METHODS: Catheter segments (4 mm) were implanted in murine bladders percutaneously in 15 males and 5 females, and transurethrally in 15 females using the Seldinger technique under ultrasound guidance. Proteus mirabilis was instilled intraluminally. Catheter encrustation was monitored by ultrasound. Bacteria were quantified in urine, and catheters and encrustation were analyzed on day 6 or 21. RESULTS: Percutaneous and transurethral catheter implantations were performed in a mean ± SE 3.6 ± 0.8 vs 2.5 ± 0.5 minutes in all mice. Ultrasound confirmed that 100% and 66% of implanted catheters, respectively, remained indwelling during the study period. Catheter encrustation developed in P. mirabilis infected urine 48 hours after instillation and an increase with time was detected by ultrasound. Fourier transform spectroscopy of the encrustation confirmed a typical struvite spectrum. Control catheters remained sterile during 21 days. CONCLUSIONS: Our minimally invasive, reproducible percutaneous technique is suitable for studying catheter associated urinary tract infection in each gender. Infecting urine with P. mirabilis generates a preclinical model of catheter encrustation within 3 days. The progression of encrustation can be monitored in vivo by ultrasound, making this image based model suitable for assessing novel antibacterial and anti-encrustation therapies.

Proteus Takayasu's arteritis with unusual intracranial granulomatosis as initial manifestation.

Takayasu's arteritis (TA) is an inflammatory vasculitis of aorta and its branches, its low incidence limited our recognition to this entity. We sometimes can confuse this disease with polyarteritis nodosa and other vasculitis when no conventional "big artery" involved in TA cases. Here we report a 26-year-old man with Takayasu's arteritis who presented with a provisional intracranial granulomatosis first and then saccular aneurysms between celiac trunk and arteria hepatica communis and many other proteus manifestations, which is seldom described before.

Potential use of 68Ga-apo-transferrin as a PET imaging agent for detecting Staphylococcus aureus infection.

INTRODUCTION: (67)Ga citrate has been extensively used to detect infection and inflammation since 1971. However, its clinical utility is compromised due to several limitations. The present project explored whether (68)Ga-apo-transferrin ((68)Ga-TF), when prepared in vitro, is a useful agent for positron emission tomography (PET) imaging of bacterial infection. METHODS: An infection was induced in male Wistar rats by injecting 5 × 10(5) CFU units of Staphyococcus aureus in the right thigh muscle. (68)Ga-TF was synthesized by mixing (68)GaCl(3) with apo-transferrin (TF, 2 mg) in sodium carbonate (0.1 M, pH 7.0) and incubating at 40 °C for 1 h. Animals were injected with 10-15 MBq of (68)Ga-TF containing approximately 0.2 mg TF and imaged at different time intervals using Siemens Biograph PET-CT. RESULTS: When (68)Ga-TF were injected in the infected rats, the infection lesion was detectable within 20 min post injection. The biodistribution showed the uptake at the lesion increased with time as shown by significantly increased standard uptake values for up to 4 h post injection. There was a considerable decrease in the background activity during the same period of study, giving higher target-to-muscle ratios. Blood pool activity at 3 h post injection was insignificant. (68)GaCl(3) (when not conjugated to TF) did not localize at the infection lesion up to 120 min post injection. CONCLUSION: The preliminary results suggest that (68)Ga-TF is capable of detecting S. aureus infection in the rat model, within an hour after intravenous injection.

[One-stage revision of knee endoprosthesis due to periprosthetic infection and Klippel-Trenaunay syndrome]. / Einzeitiger Knieendoprothesenwechsel bei periprothetischer Infektion und Klippel-Trenaunay-Syndrom.

We present the case of a patient with Klippel-Trenaunay syndrome (KTS) who underwent a one-stage revision of an infected total knee arthroplasty. A detailed orthopedic description of KT is presented as well as a discussion on the implementation of one-stage or multi-stage revision following infections of total knee arthroplasty. Due to vascular anomalies with severe coagulation problems, soft tissue swelling and increased risk of infection, surgical treatment of such patients presents a special challenge.

Multifocal Proteus mirabilis osteomyelitis requiring bilateral amputation in an HIV-positive patient.

We present a rare case of multifocal Proteus mirabilis osteomyelitis in an HIV-positive patient. Despite the patient's good immune status as assessed by her CD4 cell count and the aggressive treatment, she eventually underwent bilateral above-knee amputations to eradicate the infection. Multifocal Proteus mirabilis osteomyelitis can have an unpredictable clinical course with a severe outcome in HIV-positive patients.

[Bladder rupture caused by spontaneous perforation of an infected urachal cyst]. / Blasenruptur durch spontane Perforation einer infizierten Urachuszyste.

Anomalies of the fetal urachus are rare. Normally, the postnatal urachus presents as a fibrous band extending from the bladder to the umbilicus. Urachal cysts may occur in postnatal life. Spontaneous perforation of urachal cysts is a very rare condition, which clinically may not be distinguishable from other acute abdominal conditions. We report a case of a 63-year-old male with a history of recurrent urinary tract infections and a bladder rupture caused by a spontaneous perforation of an infected urachal cyst. The symptomatology showed abdominal rigidity and pain, a palpable mass in the lower abdomen, and hematuria. Laboratory findings showed leukocytosis and an increased CRP level. The bladder rupture was confirmed by cystography. Bacteriologic examination identified Proteus vulgaris, Corynebacterium species, and Klebsiella pneumoniae. Most of the published cases in the literature report about intraperitoneal perforation of infected urachal cysts. In the present case, we found a spontaneous perforation of an infected urachal cyst leading to an extraperitoneal bladder rupture with an extraperitoneal limitation of the infection. The definitive therapy was complete surgical excision including a cuff of the bladder, drainage, and systemic broad-spectrum and local application of antibiotics. The further course was uneventful.

Sonographic detection of multiple brain abscesses in a newborn with IgA deficiency.

We report the case of a neonate with selective IgA deficiency and multiple brain abscesses diagnosed with sonography. Brain sonography revealed multiple abscesses in the left hemisphere; the abscesses ranged from 10 to 20 mm. Cultures obtained from the cerebrospinal fluid and blood were positive for Proteus mirabilis. The neonate responded promptly to broad-spectrum antibiotic therapy and had no neurologic sequelae. Because IgA deficiency is associated with infections, we believe it was a predisposing factor for the brain abscesses.

Nephrobronchial fistula secondary to xantogranulomatous pyelonephritis.

We report a case of staghorn nephrolithiasis that evolved into xanthogranulomatous pyelonephritis with perinephric abscess, nephrobronchial fistula, and lung abscess. The patient was an intravenous drug abuser who tested positive for human immunodeficiency virus, without evidence of acquired immunodeficiency syndrome. He presented with a 2-month history of untreated repeated episodes of left flank pain and hyperpyrexia. Treatment involved left nephrectomy, debridement of abscess, tube drainage, and intravenous antibiotics. The patient illustrates the need to consider untreated nephrolitiasis as a predisposing factor for pulmonary complications.

Intravascular ultrasound diagnosis of aortic graft infection.

BACKGROUND: To assess the value of intra-aortic ultrasound (US) for diagnosing intraprosthetic vegetations in atypical aortic graft infection. METHODS: A 66-year-old man presented with fever 12 months after emergency insertion of a straight infrarenal aortic graft because of rupture of an inflammatory abdominal aneurysm. Blood cultures, leukocyte scan, transabdominal US study, and digital angiography were negative. Spiral CT was equivocal. The patient was imaged with a mechanically rotating US transducer at 12.5-MHz from inside the graft. RESULTS: Intravascular catheter ultrasound showed mobile lesions at the graft wall in the absence of periprosthetic fluid. Immediately after the procedure the patient developed several small cutaneous septic infarctions on both feet. At operation the presence of graft infection was confirmed. CONCLUSIONS: This case report suggests that intra-aortic US may constitute a helpful adjunctive modality in suspected atypical infection of prosthetic aortic grafts.

Infectious temporomandibular joint disease in the horse: computed tomographic diagnosis and treatment of two cases.

Diagnostic imaging and treatment of unilateral destructive temporomandibular joint disease in two horses is described and discussed. Computed tomography appeared to be the best imaging technique for these lesions. The disease can be followed by functional recovery after the infection has resolved.

Spontaneous drainage of an infratentorial extradural empyema: case report.

We describe a 21-year-old male who presented with spontaneous drainage of an infratentorial extradural empyema secondary to mastoiditis. Following eradication of the primary source, the patient was commenced on high dose intravenous antibiotics. Serial computed tomography (CT) revealed complete resolution of the pus collection. Antibiotic therapy was successful and no neurosurgical intervention was necessary.

Delayed CT findings in acute renal infection.

The computed tomography (CT) findings in twelve patients with acute renal infection examined immediately and 3 h after i.v. contrast medium are reported. Three patients also had delayed scans at 6 h. Three main features were observed on the delayed scans: 1 a delayed nephrogram with streaky, wedge shaped or round high density areas. The areas of high density were at the same sites of the inhomogeneous areas of reduced density on the early scans; 2 focal contrast medium staining or a rim of increased density around abscesses; 3 focal areas of increased density at sites distant from the low density areas seen on the early scans. It is postulated that the delayed areas of increased density replace early areas of reduced density caused by ischemia due to vasospasm and/or compressing oedema of the vascular bed or by tubular obstruction. Delayed CT appears to be useful because it improves diagnostic confidence and gives a more exact evaluation of the extent of infection.