[Necrotizing mucosal ulcers cause by anaerobic bacteria. Fusiform bacterial and spirochete infections]. / Nekrotisierende Schleimhautulzera durch Anaerobier. Fusospirochätosen.

Vincent's angina (Plaut-Vincent) is the most prominent disease caused by coinciding infections from fusibacteria and spirochaeta both belonging to obligate anaerobic bacteria. A possible symbiotic infection of both anaerobics may become manifest on the mucous membranes of the oral cavity and the oropharynx beside the tonsillas. The clinical outcome may be different and pose difficulties in the differential diagnosis. We report the case of a 29 year old female patient with necrotizing ulcera of the soft palate suspicious for stomatitis ulceromembranacea. In case necrotizing inflammations of the oral cavity area were to be found infections due to anaerobic bacteria should be considered mostly occurring as mixed infections. The correct identification by cultivation turns out to be difficult in that it requires special conditions. Furthermore, reliable detection of these bacteria necessitates careful collection and transport of patients specimens. In case of Fusospirochaetosis (Fusotreponematose) a specimen should be prepared for microscopic examination beside setting up a special culture. This is because the staining is the most suitable procedure for bacteril identification to support the clinical diagnosis of stomatitis ulceromembranacea.

Detection of Mycoplasma sp. in bronchoalveolar lavage of AIDS patients with pulmonary infiltrates.

We examined 486 bronchoalveolar lavages (BAL) including 32 from AIDS patients with pulmonary infiltrates and 20 from patients with leukemia or after transplantation. Mycoplasmas were found in 4/32 (12.5%) HIV-positive patients compared to 4/454 (< 0.9%) HIV-negative patients (p < 0.001). All of these four HIV-positive patients suffered from advanced infection (CD4 counts < 100/microL) and developed complications (Pcp, n = 2, recurrent bacterial pneumonia, n = 1, pulmonary Kaposi sarcoma, n = 1). No mycoplasmas were detected in 20 immunosuppressed patients with leukemia or after transplantation. Our data indicate that AIDS patients may be more often colonised or infected by mycoplasmas than HIV-negative patients or other immunocompromised persons. Although the etiological role of mycoplasmas for pulmonary infections in these patients remains unclear, the finding of mycoplasmas was associated with rapid progress and development of severe complications in our study.

Diagnostic value of bronchoalveolar lavage in patients with opportunistic and nonopportunistic bacterial pneumonia.

In 29 patients with community-acquired pneumonia, 24 patients with hospital-acquired pneumonia and 35 patients with pneumonia in the immunocompromised host the diagnostic value of bronchoalveolar lavage (BAL) with quantitative bacterial and fungal cultures was studied; 32 patients with noninfectious pulmonary diseases and 14 healthy volunteers served as controls. An infectious etiology could be established in 81% of the pneumonia patients without differences between the three groups; significant infection was associated with colony counts of > or = 10(4) cfu/ml. Prior antibiotic therapy lowered the yield of BAL culture only in community-acquired pneumonia (94% vs 55% positive cultures in untreated vs pretreated patients, p < 0.02). Furthermore the culture results were related to the radiographic extension of pulmonary infiltrates (92% positive cultures in multilobar vs 54% in lobar or segmental infiltrates, p < 0.001). Therapeutic consequences of BAL were shown by resistance of the isolated organisms to predefined empiric treatment regimens in 41% community-acquired pneumonia, 43% pneumonia in the immunocompromised host and 67% hospital-acquired pneumonia patients.

[Legionellosis in a newborn infant]. / Legionellose bei einem Neugeborenen.

We describe a case of successful therapy of a neonatal Legionellosis with Erythromycin. On his 6th day of life a full term newborn with normal body weight was affected by a severe pneumonia. This was at first resistant to therapy and required mechanical ventilation. Diagnosis of Legionella pneumophila serotype 1 was made by culture from bronchial lavage. Only few cases of neonatal Legionellosis have been reported until now. In three cases diagnosis was made post mortem.

[Microbiological diagnosis of lower respiratory tract infections]. / Mikrobiologische Diagnostik unterer Atemwegsinfektionen.

Successful microbiological diagnosis of lower respiratory tract infections demands a close cooperation between clinician and clinical microbiologist. Because of the broad spectrum of possible respiratory pathogens precise requests are necessary for adequate laboratory procedures. The high rate of potential pathogens requires quantitative microbiological and cytological data in order to differentiate between colonisation and infection. Pathophysiological reactions on microbial colonisation of the bronchial tree may contribute to acute exacerbations of a chronic bronchitis. The precise role of microbial nocuous agents, however, remains to be clarified.

[Bronchoscopic diagnosis of pneumonia with quantitative microbial count determination]. / Bronchoskopische Pneumoniediagnostik mit quantitativer Keimzahlbestimmung.

Micro-organism counts of bronchoalveolar lavage (BAL) and microbrush swabs were obtained from 40 immunocompetent (group A) and 23 immunosuppressed (group B) patients with nosocomial pneumonia, and a control group consisting of 40 patients with noninfectious pulmonary infiltrates. The sensitivity of BAL was high: 77.5% for group A and 85% for group B, while microbrush swabs gave many false-negative results. Microorganism counts were at or above 10(5) cfu/ml in 32 of 44 examinations (bacterial or mycotic pneumonia), but in only one case of the control group. Lower counts were obtained with localized infection and microorganisms difficult to culture (Aspergilla and Legionella). Granulocytosis in the lavage fluid was demonstrated in 38 of 41 patients with bacterial pneumonia and thus proved useful in the differential diagnosis. In 16 of 40 immunocompetent and 13 of 23 immunosuppressed patients with pneumonia the results were therapeutically of importance. Thus, invasive diagnosis is indicated especially in complicated or treatment-resistant nosocomial infections.

[Bacteriologic studies in premature rupture of fetal membranes and correlation with the clinical aspects of chorioamnionitis and the amnion infection syndrome]. / Bakteriologische Untersuchungen bei vorzeitigem Blasensprung und Korrelation zur Klinik von Chorioamniotitis und Amnioninfektionssyndrom.

One of the major complications following premature rupture of the membranes (PROM) is ascending infection. In this aspect the bacteria of the vaginal flora play a major part. Bacterial spectra of a group with PROM and another control group with punctual rupture of the membranes are comparatively analysed. This analysis is based on swabs taken from vagina and newborns. Data are interpreted in correlation to clinical picture of chorioamnionitis and amnion infection syndrome (AIS). Twelve newborns clinical suspected to have a neonatal infection are retrospectively judged. In the group with pregnant women with PROM potential pathological germs such as group B streptococci and E. coli are found more often, whereas physiological flora, specially Lactobacillus species, are clearly reduced. In newborns with AIS even germs can be detected, which so far have seemed to be more apathogenic, such as Gardnerella vaginalis. Bacteriological findings are discussed in connection with clinical parameters, specially group B streptococci are looked at more precisely. In newborns with AIS microbiological results are demonstrated including course of pregnancy and delivery. For the management of PROM alternatives are shown and advice for prophylaxis is given.

[Imipenem/cilastatin in surgical intensive medicine]. / Imipenem/Cilastatin in der chirurgischen Intensivmedizin.

26 patients from the surgical intensive care unit, University Hospital Lübeck, received imipenem/cilastatin for severe abdominal, respiratory or urogenital infections. 500 mg imipenem/cilastatin were infused i.v. over 30 min q. i. d. The treatment was successful in 84,6% of the patients suffering from severe infections. Two cases were considered to be failures. 36 of the 43 isolated pathogens (83.7%) were eliminated. Transitory elevations of liver enzymes were the most frequent side-reactions observed; an increase in serum creatinine, diarrhoea or fungal colonization were less common.

Studies on the structure of isolated chromatin in three different solvents.

Properties of calf thymus chromatin, prepared by mild procedures, have been studied in various solvents. In 0.2 mM EDTA s-values ranged from 20 to 30 S and intrinsic viscosities from 5 to 24 dl/g. Dialysis against 0.15 M NaCl or 0.2 mM MgCl2 changed these values to 80 to 100 S and 0.2 to 5 dl/g, respectively, indicating an essentially more compact structure. In 0.2 mM EDTA X-ray scattering yielded a cross section diameter of 9 nm, which is associated with the tertiary structure of chromatin fiber (M/L = 21200 Dalton/nm). By dialysis against 0.15 M NaCl or 0.2 mM MgCl2 part of the material spontaneously formed quarterny structures (cross section diameters 25-29 nm). The rest of the material with cross section diameters less than 9 nm is supposed to be more strongly sheared tertiary structure which seems to be unable to form quarterny structure due to artificial conformational changes.

[Investigation of alkylation in rat liver chromatin after application of 3H-cyclophosphamid--"fine-distribution" and kinetics]. / Untersuchungen zur Alkylierung von Chromatin in der Rattenleber nach Gabe von 3H-Cyclophosphamid--"Feinverteilung" und Kinetik

The alkylation of chromatin constituents (DNA, histones and non-histones) in liver cell nuclei was investigated at various times after intraperitoneal injection of rats with 3H-cyclophosphamid. The highest alkylation was found in the DNA, the lowest in the histones; the euchromatic portions were alkylated several times higher compared to those of the heterochromatin. The eventual elimination of 3H-activity with time indicates that cyclophosphamid leads to repair processes in the DNA, this conclusion being supported by other experimental observations. In some of the 16 subfractions of the nonhistone proteins, alkylated portions are apparantly eliminated by normal protein turnover; however, in other nonhistones this elimination is inhibited, whereby in one subfraction it seems to be accelerated. The results of analog experiments with 14C-tryptophan as a precursor for nonhistone protein synthesis serve as a reference for this. In supplementary in-vitro model experiments using triaziquon as an alkylating agent indications for DNA-Protein-cross-links in chromatin could be obtained by the technique of X-ray low angle scattering, and according to sedimentation behaviour.

Studies on deoxyribonucleoproteins. IX. Subfractions of deoxyribonucleoproteins from rat and mouse liver.

By carrier-free continuous electrophoresis, deoxyribonucleoprotein from rat and mouse liver could be separated into two subfractions. The more anodic fraction (DNP I), comprising 5 - 8 per cent of the total, contains fewer proteins (two types of histones only). [3H]Cyclophosphamide caused in vivo a 2.5 times higher alkylation of the DNA in in DNP I than of the DNA in DNP II. These and additional results led to the suggestion of a structural model with DNP I as a spacer in the deoxyribonucleoprotein fiber.