Predictive factors, microbiology and outcome of patients with parapneumonic effusion.

We aimed to determine the incidence, clinical consequences and microbiological findings related to the presence of pleural effusion in community-acquired pneumonia, and to identify predictive factors for empyema/complicated parapneumonic effusion. We analysed 4,715 consecutive patients with community-acquired pneumonia from two acute care hospitals. Patients were classified into three groups: no pleural effusion, uncomplicated parapneumonic effusion and empyema/complicated parapneumonic effusion. A total of 882 (19%) patients had radiological evidence of pleural fluid, of whom 261 (30%) met criteria for empyema/complicated parapneumonic effusion. The most important event related to the presence of uncomplicated parapneumonic effusion was a longer hospital stay. Relevant clinical and microbiological consequences were associated with empyema/complicated parapneumonic effusion. Five independent baseline characteristics could predict the development of empyema/complicated parapneumonic effusion: age < 60 yrs (p = 0.012), alcoholism (p = 0.002), pleuritic pain (p = 0.002), tachycardia >100 beats·min⁻¹ (p = 0.006) and leukocytosis >15,000 mm⁻³ (p < 0.001). A higher incidence of anaerobes and Gram-positive cocci was found in this subgroup of patients. We conclude that only the development of empyema/complicated parapneumonic effusion carried relevant consequences; this condition should be suspected in the presence of some baseline characteristics and managed by using antimicrobials active against Gram-positive cocci and anaerobes.

The cloning and expression of Pfacs1, a Plasmodium falciparum fatty acyl coenzyme A synthetase-1 targeted to the host erythrocyte cytoplasm.

Plasmodium is unable to carry out de novo fatty acid synthesis and has to obtain these compounds from their host for subsequent activation by thioesterification with coenzyme A. This activity is catalyzed by a fatty acyl-CoA synthetase enzyme (EC 6.2.1.3). Here, we describe a novel gene from P. falciparum whose recombinant purified product from baculovirus-transfected insect cell line had the enzymatic activity of a long-chain fatty acyl-CoA synthetase. It was named pf acs1, since it belongs to a multi-member gene family as revealed by the sequence of several clones and a multi-band pattern in Southern blots. The sequence specifies a product of 820 amino acid residues. It was transcribed and expressed in infected erythrocytes having an apparent molecular mass of 100 kDa. Immuno-labeling of infected erythrocytes with a specific antibody against the carboxy-terminal part of the PfACS1 localized the product early after the erythrocyte invasion in vesicle-like structures budding off the parasitoforous membrane toward the red cell cytoplasm. Its unique carboxy- terminal structure of 70 extra amino acid residues, longer than any other reported acyl-CoA synthetase, is probably related to its localization in the cytoplasm of the host erythrocyte. The phylogenetic relationship among other AMP-forming enzymes, placed PfACS1 closer to Saccharomyces cerevisiae, sharing significant amino acid identities, especially in the conserved signature motif that modulates fatty acid substrate specificity and ATP/AMP-binding domains. Taking into account the importance of this enzymatic activity for the parasite, its extra-cellular location inside the infected erythrocyte, and the divergence with respect to the homologous human enzymes, it may be an important protein as a potential target candidate for chemotherapeutic antimalaria drugs.

Antiparasitic effects of the intra-Golgi transport inhibitor megalomicin.

The macrolide antibiotic megalomicin (MGM) has been shown to inhibit vesicular transport between the medial- and trans-Golgi, resulting in the undersialylation of cellular proteins (P. Bonay, S. Munro, M. Fresno, and B. Alarcón, J. Biol. Chem. 271:3719-3726, 1996). Due to the effects of MGM on the Golgi and on the replication of enveloped viruses, we decided to test whether it has any antiparasitic activity. The results showed that MGM has potent activity against the epimastigote stage of Trypanosoma cruzi, producing a 50% inhibitory concentration (IC50) of 0.2 microg/ml. Furthermore, MGM was also active against the intracellular replicative, amastigote form of T. cruzi, completely preventing its replication in infected murine LLC/MK2 macrophages at a dose of 5 microg/ml. Although less potent, MGM was also active against Trypanosoma brucei epimastigotes (IC50, 2 microg/ml) and Leishmania donovani and Leishmania major promastigotes (IC50, 3 and 8 microg/ml, respectively). MGM also blocked intracellular replication of the asexual stage of Plasmodium falciparum-infected erythrocytes at 1 microg/ml. Finally, MGM was active in an in vivo model, resulting in the complete protection of BALB/c mice from death caused by acute T. brucei infection and significantly reducing the parasitemia. These results suggest that MGM is a potential drug for the treatment of veterinary and human parasitic diseases.