A case of defibrillator-associated infective endocarditis due to Campylobacter fetus.

Campylobacter spp. are Gram-negative, spiral motile bacteria. Infections caused by Campylobacter fetus are frequently of invasive character, but they are very rare. The described case of infection of a cardioverter defibrillator implantation site was effectively cured with antibiotics, but it required removal of the cardioverter defibrillator.

Problems in the diagnosis of profound trichophytosis barbae.

Zoophilic species of human dermatophytoses, such as Trichophyton mentagrophytes are significantly rare. We present a case of a 42-year-old male who for 2 months had been unsuccessfully treated and then referred to hospital with suspected actinomycosis. Lesions on the skin on his neck, submandibular area, cheeks and groins were consistent with extremely painful, merging inflammatory tumours and infiltrations with the presence of numerous pustules in hair follicles that poured purulent contents forming into yellow crusts after compression. The treatment with terbinafine was successful. The final identification of the Trichopyton mentagrophytes var. granulosum strain was performed based on a microscopic assessment of the culture, and the result of species identification was confirmed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis.

[Infective endocarditis in adults]. / Infekcje zapalne wsierdzia u doroslych.

OBJECTIVE: The aim of the research was to demonstrate that the early diagnosis of infective endocarditis influences significantly the results of treatment. METHODS: The following clinical analysis covered 56 patients, aged 18 to 81 (the average age--50 years) with infective endocarditis treated in the years 1998-2000. Data from patient history, physical examination, laboratory investigations and treatment were analysed. Apart from clinical symptoms for infective endocarditis diagnosis, also blood cultures and echocardiography were important. MAIN OBSERVATIONS: Infective endocarditis was present in 24 patients (42.8%) with heart defects, 7 (12.5%) with prosthetic heart valves, and 4 (7.1%) treated with haemodialysis. RESULTS: In 38 (67.8%) individuals, the echocardiography showed vegetations, and in 14 (25.0%) other abnormalities. Blood cultures were positive in 33 (58.9%) patients. Fever was present in 47 (83.9%) patients. The progression of heart failure appeared in 26 (46.4%) individuals. The average time of antibiotic therapy was 34 days. 11 (19.6%) patients died. 9 (16.1%) individuals had cardiosurgery operations. CONCLUSIONS: Early diagnosis of infective endocarditis is substantial as it improves patients' prognosis as to health and life.

[Influence of culture conditions on cell surface hydrophobicity of rods of genus Serratia]. / Wplyw warunków hodowli na hydrofobowe wlasciwosci paleczek z rodzaju Serratia.

The cell surface hydrophobicity (CSH) is a non-specific adhesion factor that is important in the proliferation of microorganisms on solid surfaces. Serratia spp. is a bacterium that has been increasingly implicated as a primary pathogen in numerous human infections, particularly in urinary tract infections. CSH of 60 Serratia spp. strains isolated from clinical materials was evaluated using the ammonium sulfate salt aggregation test. Bacteria were grown for 24 h and 48 h at room temperature (22 degrees C) and 37 degrees C on enrichment broth and agar (Biomed), enrichment agar with 5% human blood and medium composed of agar granulated (Becton Dickinson), neopeptone (Difco) and 1% (v/v) glycerol. CSH was estimated most frequently when the analyzed strains in enrichment broth were cultured. When grown in enrichment broth cells of Serratia spp. at room temperature were more hydrophobic (43% after 24 h and 47% after 48 h) than those at 37 degrees C (30% after 24 h and 33% after 48 h). CSH of the examined Serratia spp. strains were depended on the temperature, time of the culture of bacteria and the kind of media. The influence of the culture conditions on the changes in CSH of the analyzed bacteria may suggest significance of these properties in the pathogenesis of Serratia spp.

[Occurrence of beta-lactamase type ESBL in rods of the Serratia species]. / Wystepowanie beta-laktamaz typu ESBL u paleczek z rodzaju Serratia.

Serratia spp. has been identified as an important opportunistic pathogen agent in nosocomial infections. The aim of the study was the determination of extended spectrum beta-lactamases (ESBL) occurrence among 78 of Serratia spp. strains isolated in 1996-1998 from clinical specimens obtained from patients of State Clinical Hospital in Bydgoszcz. Identification of Serratia spp. strains was performed in automatic ATB system with ID 32GN strips (bioMérieux). The strains with ESBL activity were detected by double-disc method according to Jarlier et al. (10) with small modifications. Clavulanic acid, tazobactam and sulbactam were used as the inhibitors of ESBLs. Drug-susceptibility was determined by disc-diffusion method according to NCCLS standards. Forty-five (57.7%) of the strains were ESBL (+). All of them belonged to S. marcescens species. The majority--91.1% of strains was derived from urine, 3 from wound and 1 from blood. The obtained results indicate the necessity of monitoring of ESBL-producing strains among gram-negative rods from clinical specimen. The aims of such a procedure are to control and to prevent their dissemination within hospital, as well as to avoid therapeutic failures.

[Occurrence and susceptibility to antibiotics of Streptococcus pyogenes strains from purulent infections in soft tissues]. / Wystepowanie i antybiotykowrazliwosc szczepów streptococcus pyogenes pochodzacych z zakazen ropnych tkanek miekkich.

Occurrence and susceptibility to antimicrobial agents of Streptococcus pyogenes strains isolated from purulent infections of soft tissue were examined. The specimen was from hospital and ambulatory patients in 1996-1998. In general, 3665 samples were examined: 1841 wound swabs, 870 pus samples, 753 ulcer swabs and 101 from the decubitus ulcers. The ulcer of shank was the main diagnosis from which the Streptococcus pyogenes was isolated (38.8%). The susceptibility to antimicrobial agents according to the disc-diffusion method was analyzed among the 59 S. pyogenes strains. 10.2% strains with the MLSB resistance were detected. All S. pyogenes strains were susceptible to penicillin, new quinolons and glicopeptides.

Cerebrospinal meningitis with the presence of Acinetobacter spp.

The study was conducted on 16 strains of Acinetobacter sp. which were isolated from cerebrospinal fluid. The diagnostic material was analysed with the use of automatic BacT/Alert system (Organon Teknika). The analysis was performed in the Department of Microbiology, Medical University in Bydgoszcz. API 20NE system (bioMérieux) enabled the identification of 14 strains (87.5%) as A. baumannii, 1 strain as A. haemolyticus and 1 strain as A. lwoffii. The micro-organisms were isolated from patients whose age ranged between 4 and 66 years. These patients were treated in the departments of Neurosurgery (75.0%), Neurology (18.8%) and Intensive Therapy (6.2%). The infection of cerebrospinal fluid was caused by injury and subsequent exposure to the bacteria present in external environment. Antibiotic-sensitivity of these micro-organisms was evaluated with the help of disc-diffusion method, observing standardisation conditions outlined by NCCLS. All the strains proved sensitive to carbapenems, 15 strains were sensitive to netilmicin, 7 strains--to tobramycin and 7 strains--to amikacin. All the strains displayed multiple resistance. The only exception was A. haemolyticus. The use of two-discs allowed for the detection of ESBLs in 7 A. baumannii strains. Positive results were most frequently obtained after the combination of sublactam and aztreonam. Due to microscopic resemblance between Acinetobacter spp., and bacteria of Neisseria, Moraxella and Haemophilus genus, microbiological diagnostics should not be restricted to microscopic assessment of cerebrospinal fluid and quick serological tests evaluating the antigens of the most frequent aetiological factors. Considering multiple resistance of Acinetobacter spp. to antibiotics, the treatment should be based on sensitivity tests and the ability of a given antibiotic to penetrate into cerebrospinal fluid. In our opinion, both reasonable antibiotic policy as well as observing the principles of hygiene and monitoring infections play equally important roles in the prevention of infections with Acinetobacter spp. Such combined measures may help to prevent the spreading of multiple resistant strains in hospital environment.

Analysis of the bacterial strains isolated from urine samples of hospitalized and ambulatory patients.

Bacteria of Enterococcus spp. are now much more often isolated from various diagnostic materials in systemic infection, both in hospitalized and in ambulatory patients. The study included 571 enterococci strains isolated from urine in 1997. Species identification was performed by rapid ID32 STREP test (bioMérieux) for 327 analyzed strains. Enterococcus faecalis and Enterococcus faecium dominated (46.1% and 11.2%, respectively). Over 42% of strains were isolated from urine of patients with non-significant bacteriuria or as concomitant flora. In such cases, simplified identification was performed and the strains were determined as Enterococcus spp. The microorganisms analyzed originated primarily from the urine samples of patients hospitalized at the Department of Urology (41.8%), the Department of Neurology (11.9%) and the Department of Internal Medicine and Nephrology (9.9%). Enterococcus faecalis strains were second with respect to population count (263--10.6%), after Escherichia coli strains (464--18.8%), while Enterococcus faecium strains were the sixth (64--2.5%). Enterococcus genus took the first place among all microorganisms isolated from the urine samples. Antibiotic-sensitivity was determined for 323 enterococci strains originating from hospitalized and ambulatory patients. Enterococcus faecium strains, naturally resistant to beta-lactam antibiotics, were sensitive to nitrofuranoin in more than 50% and to norfloxacin in about 20%. Among 254 analyzed Enterococcus faecalis strains, 80.0% were sensitive to ampicillin, nitrofurantoin and high concentrations of gentamicin as well as streptomycin. Enterococci strains isolated from hospitalized patients proved sensitive to ampicillin and carbapenems in 76.8%, while strains isolated from ambulatory patients were 100% sensitive to these drugs. Examination of enterococci isolated from urine of patients hospitalized showed 33.8% sensitive to norfloxacin and 84.6% sensitive to nitrofurantoin. All the enterococci strains were sensitive to glycopeptide antibiotics: vancomycin, teicoplanin.

Clinical rejection is distinguished from subclinical rejection by increased infiltration by a population of activated macrophages.

It has been reported previously that one-third of protocol renal biopsies in asymptomatic, biochemically stable renal transplant recipients in the first 6 mo show unsuspected subclinical graft rejection (both infiltrate and tubulitis) and that subclinical rejection is a risk factor for chronic renal dysfunction. This study was performed to determine whether differences in phenotype or activation status of graft-infiltrating cells underlie these different manifestations of acute rejection. Biopsies with normal histology (n = 10), subclinical rejection (n = 13), and clinical rejection (n = 9) were studied using immunohistochemistry and computerized image analysis. Subclinical and clinical rejections had similar histologic Banff scores. Univariate analysis showed a trend for a higher infiltration with CD8+ (P = 0.053) and CD68+(P = 0.06) cells in clinical rejection. Of the activation markers studied (CD25, perforin, tumor necrosis factor-alpha), only allograft inflammatory factor-1+-activated macrophages were significantly (P = 0.014) increased in the infiltrate of clinical rejection biopsies. These data suggest that activated macrophages or their products are responsible for acute renal dysfunction associated with clinical rejection episodes.

Electron-microscopic observation of adherence of Acinetobacter baumannii to red blood cells.

It is now recognized that Acinetobacter spp. play a significant role in the colonization and infection of patients admitted to hospitals. The virulence factors of A. baumannii remains largery unknown. In this study, the adherence of A. baumannii to several species of red blood cells was investigated. The ruthenium red staining was used for electron microscopic studies. The results obtained in electron microscopy and the hemagglutination studies suggested that the thin and long fimbriae of A. baumannii participated in adhesion of these bacteria to red blood cells.

[Utilization of siderophores from the Acinetobacter genus by staphylococcal bacilli]. / Wykorzystywanie przez gronkowce sideroforów wytwarzanych przez paleczki z rodzaju Acinetobacter.

The ability of iron utilizing by means of siderophores produced by donor strains--the members of the genus Acinetobacter (8 strains) by 24 staphylococcal strains was investigated. All the donor strains synthesized hydroxamate class siderophores and six strains also catecholate class. The majority of staphylococcal strains could utilize these siderophores. Most strains utilized siderophores from A. juni 321 and A. johnsonii 349 strains. Only three staphylococcal strains were not be able to utilize siderophores from all donor strains.

[Resistance of Haemophilus sp. to antibiotics]. / Opornosc Haemophilus sp. na antybiotyki.

The present study was undertaken to determine the in vitro drug resistance of Haemophilus influenzae (68 isolates) and H. parainfluenzae (17 isolates). The tests susceptibility to Ampicillin, Amoxicilin/Clavulanic Acid, Cefaclor, Cefuroxime, Cotrimoxazole, Aztreonam, Ceftriaxone, Tetracycline, Ciprofloxacin, Rifampicin and Chloramphenicol were performed with a standard disk-diffusion method. The NCCLS methodology and susceptibility interpretative criteria were applied as described by the disk manufacturer. Beta-lactamase production was detected with nitrocefin impregnated disk (Cefinase, BBL Microbiology System). Resistance in nosocomially acquired Haemophilus isolates to several antibiotics was observed. Of the Haemophilus isolates 28.2% were Ampicillin in resistant, all were susceptible to the combination of Amoxicillin/Clavulanic acid. The Ampicillin-resistant strains were beta-lactamase producers. We observed the high resistance (70.1%) to Tetracycline and (28.2%) to SXT (Cotrimoxazole). All isolates of Haemophilus were susceptible to Ciprofloxacin. The low resistance percentages to Rifampin (1.2%), Aztreonam (3.5%) and Chloramphenicol (3.5%) was observed.

[Resistance to antibiotics of Streptococcus pneumoniae strains]. / Opornosc na antybiotyki szczepów Streptococcus pneumoniae.

Streptococcus pneumoniae strains are exhibiting increasing rates of antibiotics resistance. A rapid increase of resistance was seen not only to penicillin but also other antimicrobial agents and therefore this paper describes the study of resistance and multiresistance of pneumococci to 7 antibiotics: penicillin (P), erythromycin (E), clindamycin (CC), tetracycline (T), co-trimoxazole (SXT), cefotaxime (CTX) and vancomycin (Va), using the disk-diffusion technique according to NCCLS procedure. We tested a total of 218 S. pneumoniae strains isolated from various materials: from sputum (54), noses (117), throats (28) and different swabs specimens (19). The overall percentage of resistant isolates to penicillin was 3.7%, to erythromycin--4.1%, to clindamycin--10.6%, to tetracycline--17.4%, to co-trimoxazole--15.6%, to cefotaxime--2.3%. In the sputum was most the monoresistant strains (66.7%). The multiresistance was highest in the penicillin resistant pneumococci. With the exception of vancomycin, the number of resistant strains to non-beta-lactam antibiotics (erythromycin, clindamycin, tetracycline, co-trimoxazole) was higher in penicillin-resistant strains compared with penicillin susceptible isolates. All isolates were susceptible to vancomycin.

A comparison of three staining methods in estimation of structures on the cell wall surface of Acinetobacter junii by using electron microscope.

Two strains of Acinetobacter junii isolated from groin and nasal cavity were studied for the presence of structures on the cell wall surface. Three staining methods were used. In the first thin section were contrasted with uranyl acetate and lead citrate. In this method, only electron dense amorphous material could be seen. Using only 1% uranyl acetate, thin fimbriae were observed which in few cases were collected in bundles. Staining with ruthenium red showed bacteria with thick short and long numerous peritrichous structures. Bacteria with structures concentrated near the polar regions were seen as well. From the comparative study of three methods, two of them were found to be useful: methods with ruthenium red and with 1% uranyl acetate.

Low frequency of infiltrating cells intensely expressing T cell cytokine mRNA in human renal allograft rejection.

Immunosuppressive drugs used in clinical transplantation block cytokine mRNA transcription in vitro, but clinical rejection episodes are common. An understanding of what cytokine message is transcribed would be helpful in determining what contributes to the success of immunosuppression and provide directions for further research aimed at targeting specific cytokines. Previous studies have examined cytokine mRNA in rejecting solid organ biopsies by the reverse transcriptase polymerase chain reaction (RT-PCR) with variable results. We used nonradioactive in situ hybridization with cytokine-specific riboprobes to determine the frequency of cells expressing cytokine mRNA in the allograft infiltrate. Kidney biopsies were obtained from patients receiving protocol biopsies and with clinical evidence of rejection. Fourteen biopsies with a pathologic diagnosis of rejection were studied. Eight showed no cytokine staining, 2 expressed IL-2, and 3 expressed IL-4 and IFN-gamma. The positive cells were present at a low frequency (mean 2, range 1-5 per 10 high-power fields). The proportion of kidney biopsies expressing detectable message for interleukin-2 (IL-2), interleukin-4 (IL-4), and interferon-gamma (IFN-gamma) by in situ hybridization were similar to those reported using RT-PCR. The novel finding is that these cytokines are expressed in a few strongly positive cells in the allograft infiltrate. The vast majority of infiltrating cells are negative. This suggests that either the biopsies were performed when cytokine message was not expressed at a high level or that in human allograft recipients the sustained expression of the cytokines IL-2, IL-4, and IFN-gamma may not be necessary for graft rejection.

Identification of Pseudomonas aeruginosa on the basis of polymerase chain reaction-amplified ribosomal DNA spacer polymorphisms.

In the present study, 40 clinical strains of Pseudomonas aeruginosa were investigated by using the polymerase chain reaction (PCR). We used primers to amplify spacer regions between the 16S and 23S genes in the prokaryotic rRNA genetic loci. When the spacer amplification products were resolved by electrophoresis, the resulting patterns were characteristic for all tested strains. Only one specific PCR fragment of 580 bp was formed. This product was digested with HaeIII, HinfI and AluI restriction endonucleases. Restriction fragments produced by all three restriction endonucleases were characteristic and have the same sizes for all strains tested. The amplification product contains a conserved, internal single HaeIII restriction site. On the basis of our results, PCR amplifications of the 16S-23S spacer region for Pseudomonas aeruginosa and subsequent RFPL analysis show significant promise as a tool for the simple identification of this bacteria.

Characterization of restriction endonuclease AjoI from Acinetobacter johnsonii.

A new type II restriction endonuclease, named AjoI, was detected in Acinetobacter johnsonii. The enzyme AjoI, an isoschizomer of PstI, recognized the hexanucleotide sequence [5'-CTGCA/G-3'], with a cleavage site generating fragments of DNA with protruding cohesive 3' termini.

[Infection of burn wound with Acinetobacter baumanii]. / Zakazenie rany oparzeniowej z udzialem Acinetobacter baumanii.

This paper describes infection of burn wound with participation of Acinetobacter baumanii in three out of five patients. Species classification of 23 strains of Acinetobacter was performed by application of API 20 NE tests. The profiles obtained through these tests permitted for selection of 8 biotypes. Biotype 00010703 was isolated most frequently. All tested strains of Acinetobacter sp. were susceptible only to netilmicin, norfloxacin, pefloxacin, ofloxacin, ciprofloxacin and imipenem. Out of tested antibiotics, imipenem only was active to all isolated species of bacteria.

[Bacteroides melaninogenicus, during Fournier's gangrene]. / Bacteroides melaninogenicus, w przebiegu zgorzeli Fourniera.

In two patients (L.C., case No. 5834/215/90 and I.J., case No. 18760/140/91) Fournier's gangrene was diagnosed. From samples of necrotic and stinking secretion, strains of Bacteroides were isolated in anaerobic conditions. Application of metronidazole for treatment and surgical cleaning of the wound resulted in healing of one patient, while the second died.

[Hydrophobic properties of Acinetobacter calcoaceticus]. / Wlasciwosci hydrofobowe Acinetobacter calcoaceticus.

Evaluation of hydrophobic properties of 309 strains of Acinetobacter calcoaceticus was performed by a SAT method. Among investigated strains cultured at 22 degrees C, 103 strains were autoaggregating, representing very strong hydrophobic properties. Most of strains aggregated at concentration of 0.4-1.0 M (NH4)2SO4, exhibiting strong hydrophobic activities. Only 38 strains during culture at 22 degrees C exhibited hydrophilic surface properties. Differences between strains of anitratus variety and lwoffii variety were noted. Most auto-aggregating strains, in comparison to number of strains isolated from individual materials, were isolated from purulent materials. It is worth attention that hydrophobic activities were also present in strains isolated from nonclinical materials. Microorganisms of this group cultured at 22 degrees C auto-aggregated in as much as 50%, whereas this occurred during culture at 37 degrees C only in 26%.