[CXCL-13 as a biomarker in the diagnostics of neuroborreliosis]. / CXCL-13 als Biomarker in der Diagnostik der Neuroborreliose.

BACKGROUND: The chemokine CXCL-13 is a potential intrathecal biomarker for neuroborreliosis (NB). According to the literature the sensitivity of CXCL-13 in the diagnostics of NB varies between 88% and 100% and the specificity between 63% and 99.7%. The objective of this study was to analyze the sensitivity and specificity of CXCL-13 in the diagnosis of NB in an endemic area of Borrelia burgdorferi. MATERIAL AND METHODS: In a retrospective analysis of data from August 2014 to August 2016, 63 patients with clinically suspected NB were identified. The diagnosis of NB was based on the guidelines of the German Society of Neurology (DGN). RESULTS: In 10 patients a definitive diagnosis of NB could be established (CXCL-13 min. 254 pg/ml /max. >900 pg/ml). The criteria for a probable NB were fulfilled by 2 patients (CXCL-13 concentration 8 pg/ml and 69 pg/ml, respectively), 9 patients had a chronic inflammatory demyelinating disease (CXCL-13 min. 10 pg/ml/max. 649 pg/ml) and 42 patients had other neurological diagnoses. Out of these, elevated intrathecal CXCL-13 concentrations were detected in 8 patients (e. g. tuberculosis, syphilis and anti-RI antibody positive paraneoplastic syndrome). CONCLUSION: By increasing the CXCL-13 cut-off level from 20 pg/ml to 200 pg/ml, the diagnostic sensitivity for NB remains 100% and consequently the specificity increases from 69.8% to 92.4%. Moreover, a CXCL-13 cut-off set at 200 pg/ml would exclude NB in the 2 patients with probable NB. We conclude from these results that CXCL-13 represents a valuable biomarker for the exclusion of untreated NB, although with limited specificity.

A series of infections due to Capnocytophaga spp in immunosuppressed and immunocompetent patients.

OBJECTIVE: To investigate the epidemiology, microbiology and outcome of infections caused by Capnocytophaga spp. at a single center. METHODS: We report on ten documented infectious episodes caused by Capnocytophaga observed between 1994 and 1999 at the Innsbruck University Hospital. RESULTS: In seven of ten patients, Capnocytophaga septicemia was diagnosed during periods of neutropenia. In contrast, the remaining three patients had normal white blood cell counts when acquiring Capnocytophaga septicemia (one) and pleural empyema (two). Blood cultures containing long, slender, Gram-negative rods, which grew slowly under anaerobic conditions and lacked susceptibility to metronidazole, were subcultivated in a CO2-enriched atmosphere (5%). Subcultivation yielded Capnocytophaga in all ten cases within 2-12 days. The patients were then placed on appropriate antibiotic therapy, with or without additional surgical intervention, and the organism was eradicated. CONCLUSION: Identification of Capnocytophaga facilitates appropriate, and in most cases effective, antimicrobial therapy.

A simple hand hygiene exercise.

In an illustrative sequence of exercises, we teach our students how to don, use, and take off sterile gloves correctly and how to wash hands properly. During this sequence, the effect of a good handwashing technique as well as the effect of failures in aseptic technique with gloves is made directly visible by the use of finger paints. This technique helps medical staff to visualize microbial contamination of the hands and to increase the awareness of breaks in aseptic technique.

Septicaemia in an Austrian neonatal intensive care unit: a 7-year analysis.

The results of blood cultures and clinical data of 101 neonates with 110 episodes of septicaemia during a 7-y study period were reviewed. The overall incidence of culture-proven sepsis within the study period was 6.0 per 100 neonatal intensive care unit admissions and the mortality rate was 14%. Three groups of pathogens accounted for 70% of all isolates: coagulase-negative staphylococci (27%), aerobic Gram-negative rods (24%) and Enterococcus faecalis (19%). Group B streptococcus was the major pathogen of very early-onset septicaemia (within 24 h of birth), whereas late-onset infections were most commonly caused by coagulase-negative staphylococci. Birthweight <1500 g, gestational age <30 weeks of gestation and early onset of symptoms within the first week of life were associated with poor prognosis. In addition, the case fatality rate of episodes caused by Gram-negative organisms was significantly higher than that of Gram-positive bacteraemia.

[Hospital infection caused by Aspergillus--an overview of etiology and possibilities for prevention]. / Hospitalismus durch Aspergillus--Ein Uberblick über Ursachen und Möglichkeiten der Prävention.

During the last decades a sharp increase in the occurrence of invasive aspergillosis associated with a high mortality has been observed. This fact is mainly due to an increase in the number of immunosuppressed patients. Nosocomial aspergillosis usually is of exogenous origin and often related to building construction and reconstruction, road construction, contaminated ventilation systems and contaminated soil of pot plants. By institution of suitable prophylactic measures a reduction of incidence and mortality of invasive aspergillosis can be achieved. This review gives a short introduction into the epidemiology, pathogenesis and diagnosis of invasive aspergillosis and, in the second part summarizes internationally recommended guidelines for prevention of this severe complication.

Interactions of "Limax amoebae" and gram-negative bacteria: experimental studies and review of current problems.

Free-living amoebae can harbour bacteria inside their cysts giving them a microhabitat and protecting them from disinfectants. The aim of this study was to evaluate the potential importance of "Limax amoebae" as vectors for environmental and nosocomial bacteria in a hospital. It was shown that free-living amoebae are ubiquitous in the investigated hospital, occur syntopically with facultative human pathogens (Comamonas acidovorans and Pseudomonas aeruginosa) and may serve as hosts not only for these but also for bacteria isolated from clinical specimens (Escherichia coli, Proteus mirabilis and Pseudomonas aeruginosa); temperature is apparently of crucial importance for the interactions between these microorganisms. Recent studies have shown that "Limax amoebae" apart from acting as protective hosts, may also play a role for the thermotolerance, invasiveness and antibiotic-resistance of bacteria. Considering also the reduced immune-status of many patients, this "symbiosis" of free-living amoebae and bacteria might still be of underestimated hospital-hygienic importance.

Polymerase chain reaction for detection of Chlamydia pneumoniae in gargled-water specimens of children.

The objective of the present study was to establish the occurrence of Chlamydia pneumoniae by direct detection in gargled-water specimens obtained from 193 children suffering from acute or chronic respiratory infections. Specimens were analyzed by an indirect immunofluorescence test (IIF), a genus-specific antigen enzyme immunosorbent assay (EIA) and the polymerase chain reaction (PCR). The pathogen was detected in three children by PCR only. As underlying disease, chronic obstructive bronchitis resistant to therapy was reported. In two of the children, the presence of pneumonia could be verified by X-ray. With a detection threshold of target DNA obtained from two inclusion forming units (IFU), the PCR proved clearly more sensitive than EIA becoming positive at levels of 100 IFU and above. No interpretable results could be obtained for the IIF.

[Infection with Chlamydia trachomatis in patients of an ambulatory sterility clinic]. / Infektionen durch Chlamydia trachomatis bei Patientinnen einer Sterilitätsambulanz.

In order to investigate a presumed association of certain anamnestic data with Chlamydia trachomatis infection of infertile women, appropriate specimens were examined from 100 patients of an infertility clinic. PCR and nucleic acid hybridization were positive in 5% of the patients, corresponding in both tests; IgG was found in 31% and IgA in 5% of patients. The prevalence was highest in the age-group of 26-35 years (21 of 55) and higher in patients who had been trying to conceive for > 2 years (12 of 37) as than those trying < or = 2 years (3 of 13). The proportion of IgG-positive women was significantly (p = 0.03) smaller in Turkish patients (3 of 22) than in those of other origin (11 of 33 from former Yugoslavia and 15 of 39 Austrian women). The prevalence was higher in patients with reported pelvic inflammatory disease (11 of 30) as compared to patients without (15 of 50). With a pathological state of the Fallopian tubes the prevalence was 12 of 25, with normal tubes 6 of 18 (p > 0.05). Thus, there seem to exist anamnestic hints as to chlamydial infections. Because of their high prevalence in patients with sterility we recommend screening for chlamydial infection prior to undertaking any invasive diagnostic procedure of the Fallopian tubes.

Epidemiological analysis of Candida yeasts by pulsed-field gel electrophoresis.

The purpose of this study was to determine whether yeast isolates from mothers and their new-borns are of the same genotype. In this investigation, 103 parturient mothers and their children were examined for colonization by yeasts by sampling the vaginal secretions at delivery and by taking swabs from the oral mucosa and the anus of the children on the third day after parturition. The samples were cultured on Sabouraud glucoseagar and incubated for 48 h at 37 degrees C. Differentiation of the isolates was achieved biochemically by means of the Vitek AMS system and morphologically on rice extract agar. Subsequently DNA fingerprinting analysis was carried out by means of pulsed-field gel electrophoresis (PFGE). In six cases we could prove the presence of Candida spp. in the mothers as well as in their children. In all cases the strains isolated from mother and child showed the same banding pattern. Likewise, the strains isolated from the vaginal secretion and the vaginal epithelium of individual women were identical. The differences observed between strains isolated from different women were small to middling. This shows PFGE to be an efficient procedure to demonstrate the relation between strains derived from mothers and their newborns.

[Pulsed-field gel electrophoresis for the epidemiological analysis of yeast isolates]. / Wechselfeld-Gelelektrophorese zur epidemiologischen Analyse von Sprosspilzisolaten.

Up to now, pulsed field gel electrophoresis (PFGE) has been used successfully for the analysis of the chains of infection of multiresistant staphylococci, enterococci and other germs involved in hospitalism. The purpose of this study was to find out whether yeast isolates from mothers and those from their newborns differed in genotypes. In this investigation, 103 parturient mothers and their children were examined for colonization by yeasts in sampling the vaginal secret at delivery and by taking swabs from the oral mucosa and the anus of the children on the third day after parturition. The samples were cultured on Sabouraud glucose agar and incubated for 48 hrs at 37 degrees C. The differentiation of the isolates was done biochemically by means of the VITEK-AMS system and morphologically on rice-extract agar. Subsequently DNA-fingerprinting analysis was carried out. In 6 cases we could prove the presence of Candida spp. in the mothers as well as in their children. In all cases the strains from mother and child showed the same banding pattern. Likewise, the strains isolated out of the vaginal secretion and the vaginal epithelium of individual women were identical. The differences observed between strains isolated from various women were of low or medium degree. This shows the PFGE to be an efficient procedure to demonstrate the relation of strains derived from mothers and their newborns.

[Resistance spectrum of staphylococci at the Vienna general hospital (July to December 1991)]. / Resistenzverhalten von Staphylokokken am Allgemeinen Krankenhaus der Stadt Wien (Juli bis Dezember 1991).

This study describes the antibiotic resistance of 1961 staphylococcal strains that were isolated at the University Hospital of Vienna from July to December 1991. Staphylococcus aureus (SA) represented 43.2%; coagulase-negative (CNS) staphylococci 56.8%, three quarters of which were Staphylococcus epidermidis. Excepting netilmicin, the proportion of resistant strains to all antibiotics was higher with CNS than SA. Methicillin resistance (M(r)) was found in 11.8% of SA and 30.3% of CNS. Borderline oxacillin resistance (BOR) was noted in 7.4% of SA and 32.5% of CNS. It is important to note that severe or generalized infections due to M(r) staphylococci should be treated with glycopeptide antibiotics such as vancomycin or teicoplanin from the very beginning, whereas chemotherapy of those with BOR strains may also be carried out with beta lactamase-stable beta lactam antibiotics. Comparing the results of this study with those of the first half of 1991, the respective proportion of M(r) staphylococci was significantly lower than 23.6% for SA and 47.6% for CNS recorded then. As compared with the foregoing period, however, these strains demonstrated increased resistance frequencies to gentamicin (from 81.3 to 90%), amikacin (from 35.4 to 69%), netilmicin (35.4 to 55%), and ciprofloxacin (56.2 to 64%). This is taken as an indication for the epidemic spread of a clone of resistant strains.