Parasitic screening of a refugee population in Illinois.

In a one year period in Illinois, 4,695 stool specimens from refugees for parasitologic screening and 733 diarrheal specimens from non-refugees were tested by routine ova and parasite examination- concentration and permanent stained smear. Patients infected with pathogens were as follows: African group (48.9%), Middle Eastern group (56.5%), Southeast Asian group (48.9%), Eastern European group (46.6%), Hispanic group (38.0%) and non-refugee group (20.7%). The study showed differences between the various groups of refugees and the non-refugee group. The need for routine screening of this population was clearly shown.

Use of DNA fingerprinting to assess tuberculosis infection control.

BACKGROUND: DNA fingerprinting establishes the genetic relatedness of Mycobacterium tuberculosis isolates and has become a powerful tool in tuberculosis epidemiology. OBJECTIVE: To use DNA fingerprinting to assess the efficacy of current tuberculosis infection-control practices. DESIGN: Retrospective molecular and descriptive epidemiologic study. SETTING: A 700-bed urban public hospital that follows the Centers for Disease Control and Prevention (CDC) guidelines for tuberculosis infection control. PATIENTS: 183 patients who had positive cultures for M. tuberculosis from 1 April 1995 to 31 March 1996. RESULTS: 173 of 183 M. tuberculosis isolates from the study period underwent DNA fingerprinting. Fingerprinting revealed that five isolates represented false-positive cultures and that 91 (54%) of the remaining 168 isolates were in 15 DNA fingerprinting clusters, which ranged in size from 2 to 29 isolates. Risk factors for clustering were birth in the United States, African-American ethnicity, homelessness, substance abuse, and male sex. Retrospective epidemiologic analysis of inpatient and outpatient visits by the 91 patients who had clustered isolates revealed only one possible instance of patient-to-patient transmission. CONCLUSIONS: The DNA fingerprinting of all M. tuberculosis isolates from a 1-year period revealed one possible instance of nosocomial transmission and five false-positive M. tuberculosis cultures. However, these results did not lead to changes in infection-control practices or in clinical care. The study findings do not support the use of DNA fingerprinting for nosocomial tuberculosis surveillance, but they suggest that compliance with the CDC tuberculosis infection-control guidelines may control patient-to-patient transmission in high-risk urban hospitals.

Atypical Streptococcus pyogenes from an ear discharge.

An atypical variant of Streptococcus pyogenes was isolated from a discharge from a child's ear. Although this variant streptococcus grew aerobically on chocolate agar, the isolate would not grow on blood agar, the medium used to screen for S. pyogenes, unless it was incubated anaerobically or incubated in air with cocarboxylase.

Rhodococcus meningitis in an immunocompetent host.

Rhodococcus species are increasingly being recognized as pathogens, especially in patients infected with the human immunodeficiency virus. Most cases of rhodococcus infection in these patients are due to Rhodococcus equi and involve the lungs. CNS infections due to Rhodococcus species are rare, and meningitis due to non-equi Rhodococcus has never been reported in a healthy host. We report a case of meningitis due to non-equi Rhodococcus in a previously healthy 24-year-old woman. We also review and summarize the reported cases of CNS infections caused by Rhodococcus species.

Multicenter clinical evaluation of a continuous monitoring blood culture system using fluorescent-sensor technology (BACTEC 9240).

The BACTEC 9240 (Becton Dickinson Diagnostic Instrument Systems, Sparks, Md.) is a new continuous-monitoring blood culture system that uses internal, fluorescent-CO2 sensors. In a multicenter clinical trial, organism yield and times to detection with the prototype BACTEC 9240 system were compared with those of the BACTEC NR 660 system. Equal volumes of blood were inoculated into the bottles included in the study blood culture sets (aerobic and anaerobic 9240 and NR6A and NR7A bottles). A total of 9,391 aerobic and 8,951 anaerobic bottle pairs were inoculated with 9,801 blood specimens. A total of 587 clinically significant positive blood cultures and 415 cases of sepsis were studied. The standard 9240 aerobic bottle detected significantly more Staphylococcus aureus (P < 0.05), coagulase-negative staphylococci (P < 0.01), and total microorganisms (P < 0.001) than the NR6A bottle. The standard 9240 anaerobic bottle detected significantly more coagulase-negative staphylococci (P < 0.001), members of the family Enterobacteriaceae (P < 0.01), and total microorganisms (P < 0.001) than the NR7A bottle. A total of 420 positive cultures were detected in both systems; for 284, the time to detection was equivalent with both systems (within 12 h); for 123, the 9240 system was faster; and for 13, the NR 660 system was faster (P < 0.001). The average times to detection for the 9240 and the NR 660 systems were 20.2 and 27.5 h, respectively. Ninety-nine cultures were positive only in the 9240 system, and 68 cultures were positive only in the NR 660 system (P < 0.02). The 9240 system also detected significantly more episodes of bacteremia (P < 0.001). The false-positive rates for the 9240 and NR 660 systems were 2.2 and 2.3%, respectively. The false-negative rates for the two systems after 5 days of incubation did not differ significantly. The contamination rates for the 9240 and NR 660 systems were 1.9 and 1.5%, respectively (P < 0.05). In conclusion, the prototype 9240 system detected more clinically significant positive blood cultures and did so sooner than the NR 660 system, with the additional advantages of full automation, continuous monitoring, and noninvasive sampling.

Clinical characteristics of seven cases of diarrhea associated with a novel acid-fast organism in the stool.

In the last 4 years, we have identified an acid-fast, autofluorescent organism in the stool of seven patients with diarrhea. The organism was identified as a cyanobacterium-like organism by the Centers for Disease Control (Atlanta) and as a coccidian by researchers in Peru and at the University of Arizona (Tucson). We present reports on the seven cases and a review of the literature. Three patients were known to be seropositive for the human immunodeficiency virus (HIV). All complained of watery diarrhea that had begun 3 days to 8 months before presentation. Colonoscopy in two patients showed a normal mucosal pattern; a biopsy for one of these patients showed chronic nonspecific inflammation of the colon. Examination of stool for ova and parasites revealed multiple oval and round nonrefractile organisms with well-defined walls that resembled large cryptosporidia; they measured 8-9 microns in diameter. These organisms did not stain by Giemsa or gram methods but were acid-fast by Kinyoun carbolfuchsin and Ziehl-Neelsen stains. The organisms fluoresced as blue under ultraviolet light. In the immunocompetent patients, diarrhea lasted an average of 19 days and resolved spontaneously. Diarrhea persisted in the HIV-seropositive patients. The clinical course and organism resembled those reported for travelers and HIV-seropositive patients. This organism may represent a newly identified cause of watery diarrhea in humans.

Clinical evaluations of the Wellcolex Colour Shigella and Salmonella tests.

The Wellcolex Colour Salmonella and Shigella tests are rapid latex agglutination procedures for grouping Salmonella and Shigella using an antibody attached to multicolored latex particles. The tests correctly grouped 46 (100%) of 46 Salmonella clinical isolates in groups A through E and G, 42 (100%) of 42 Shigella clinical isolates, and seven (88%) of eight Shigella stock cultures. The stock culture missed had been passed through many transfers and may have lost some of its antigenicity. The Wellcolex Colour Salmonella test was also found useful in detecting and grouping Salmonella spp. directly from blood culture bottles.

Isolation of salmonellae from dried rattlesnake preparations.

Salmonella arizonae and other Salmonella serovars were isolated from four different rattlesnake preparations which were used for self-treatment of various diseases. A case of disseminated S. arizonae infection is reported in a patient who had acquired immunodeficiency syndrome and ingested dried rattlesnake.

Identification of Campylobacter pylori by using the rapID NH system.

Campylobacter pylori has been associated with chronic active antral gastritis. The organism was isolated from 19 of 45 gastric mucosal biopsies on blood agar plates with increased CO2 at 35 degrees C. The RapID NH system, a set of dehydrated substrates for preformed enzymes, was used to assist in the identification of C. pylori. All C. pylori gave the same biochemical profile, and it was different from those of all other organisms in the profile index of the manufacturer. The RapID NH system is useful in the identification of C. pylori.

Cost containment of formalin-preserved stool specimens for ova and parasites from outpatients.

Three individual formalinized stool specimens from each of 123 patients were pooled and examined for ova and parasites. Results obtained from the pooled specimens were compared with those obtained with the three individual specimens used to make the pooled specimens. Of 123 sets examined, 92 were negative and 31 were positive for ova and parasites. The pooled specimens were positive and all individual specimens were negative eight times, whereas the pooled specimens were negative and the individual specimens were positive twice. The data indicated that the pooled system is a useful and economical method of screening for ova and parasites.

Vaginitis caused by nutritionally variant Streptococcus pyogenes.

A nutritionally variant Streptococcus pyogenes was isolated from a vaginal specimen. The organism was isolated in essentially pure culture with a few colonies of normal vaginal flora. The bacterium was identified as Streptococcus pyogenes with the use of rapid test kits and the presence of group A antigen.

Isospora belli and Cryptosporidium sp. from a patient not suspected of having acquired immunodeficiency syndrome.

Several protozoa including Cryptosporidium sp. and Isospora belli were found in a stool specimen from a patient not suspected of having Acquired Immunodeficiency Syndrome (AIDS). As a result of the parasitologic findings, serologic tests were ordered that verified the diagnosis of AIDS. All stool specimens are routinely tested for presence of acid fast organisms with a modified acid fast technique.

Nutritionally variant Streptococcus pyogenes from a periorbital abscess.

A nutritionally variant Streptococcus pyogenes strain was isolated from a periorbital abscess. The organism was identified with the use of three rapid biochemical test kits, and the group A antigen was detected by conventional serology as well as direct antigen detection tests.

Rapid commercial test for direct detection of group A streptococci in throat swabs.

The Hybritech Strep A ICON was used for direct testing of 1016 throat specimens for group A beta-hemolytic streptococci. Both the test and culture were negative in 829 specimens (81.6%); both were positive in 164 cases (16.1%); the test was positive and culture negative in 9 cases (0.9%); and the test negative and culture positive in 14 cases (1.4%).

Survey of multiply resistant Providencia stuartii in a chronic care unit.

Providencia stuartii was cultured over a 4-year period from the urinary tract, throat, perineum, axilla and stools of patients in a long-term chronic care unit, the most common site of colonization being the urinary tract. A total of 17 patients had Prov. stuartii bacteraemia and manipulation of the urinary tract preceded bacteraemia in 10 cases. Eighty-two per cent of the patients had long-term urinary tract colonization from 1 month to 4 years. Although most isolates were resistant to all aminoglycosides except amikacin, the organisms were all susceptible to thienamycin, ceftazidime, cefotaxime, ceftizoxime and moxalactam.

Inducible expression of an aminoglycoside-acetylating enzyme in Providencia stuartii.

Strains of Providencia stuartii were collected from a chronic-care geriatric ward of a large Veteran's Administration hospital. Two strains of P. stuartii, and one of Escherichia coli isolated from the same ward, were transferred five times in the presence of gentamicin or netilmicin. At the fifth transfer the MICs of both gentamicin and netilmicin for the two P. stuartii strains had increased at least ten-fold. The MICs for the E. coli remained essentially unchanged. Enzyme assay demonstrated increased activity of an aminoglycoside-2'-acetylating enzyme in P. stuartii during the period of the transfers. Five subsequent transfers in the absence of aminoglycosides resulted in return of enzyme activity to the initial level. Neither of the P. stuartii strains tested contained any detectable plasmid DNA. The 2'-acetylating enzyme in some strains of P. stuartii can be induced to high levels of activity by exposure to gentamicin or netilmicin.

Prevalence of enteric parasites in homosexual patients attending an outpatient clinic.

A total of 372 pooled stool specimens from 274 homosexual men with diarrhea were submitted for parasitologic examination over a 2.5-year period. Each two-vial pooled specimen set contained portions of stool from 3 consecutive days in Formalin and polyvinyl alcohol. Of the 274 patients, 133 (48.5%) harbored one or more intestinal protozoa, with 161 (43.3%) of the 372 specimens submitted being positive for one or more organisms. The parasites identified included Entamoeba histolytica (71 patients), Giardia lamblia (22 patients), Endolimax nana (106 patients), Entamoeba coli (39 patients), Entamoeba hartmanni (25 patients), Dientamoeba fragilis (3 patients), Iodamoeba bütschlii (2 patients), and Chilomastix mesnili (2 patients). Cryptosporidium sp. (2 patients) and Isospora belli (1 patient) were also detected. Results of this study support the experience of other workers regarding high rates of infection with intestinal parasites in the homosexual population and also indicate that symptomatic individuals belonging to this acquired immunodeficiency syndrome risk group be screened for both common and uncommon intestinal pathogens.

Preoperative antimicrobial preparation of the colon with povidone-iodine enema.

To evaluate the efficacy of povidone-iodine enemas as a means of preoperative bowel preparation in colonic surgery, 52 mongrel dogs were randomized into two groups. Group 1 received oral neomycin-erythromycin combinations in the usual clinical doses, while Group 2 received a single 500-ml 5 percent povidone-iodine enema preoperatively. Quantitative bacterial counts obtained at the time of colonic resection revealed that povidone-iodine was equally effective in reducing the anaerobes, but was significantly superior to neomycin-erythromycin combinations in reducing the aerobic colony counts. Bursting pressures, measured three weeks later, were equal in both groups. Despite elevated blood-iodine levels, no systemic toxicity was noted in Group 2 dogs. It is concluded that half-strength povidone-iodine, given as a single enema preoperatively, is equally effective as standard preoperative antibiotic preparations and may be the ideal preparation in urgent or emergency colonic operations. Due to reported toxicity of povidone-iodine in burn wounds, we suggest that initial trials be limited to emergency cases where the potential benefits possibly will be greater than the theoretic risk of iodine toxicity.

Manifestations of Kingella kingae infections in adults: resemblance to neisserial infections.

Kingella kingae is a rare human pathogen. Most reported infections are in children and involve endocardium, vascular space, and skeletal tissues. We report herein two cases of K. kingae infection recently seen in adults. Kingella kingae caused acute meningitis in a patient with sickle cell anemia and in the second patient with alcoholic liver disease, sepsis with a petechial rash. The clinical presentation due to K. kingae closely resembled that caused by related Neisseria genus.