Identifying poststreptococcal glomerulonephritis.

Expedient antimicrobial treatment of group A beta-hemolytic streptococcal tonsillopharyngitis prevents suppurative complications and rheumatic fever; however, timely therapy does not prevent acute poststreptococcal glomerulonephritis. Acute poststreptococcal glomerulonephritis is the most common form of postinfectious glomerulonephritis and a leading cause of acute and chronic renal failure in childhood. This article discusses clinical presentation, diagnostic workup, treatment, and prevention of poststreptococcal glomerulonephritis in adults and children in the primary care setting.

Differentiation of Enterococcus spp. by cell membrane fatty acid methyl ester profiling, biotyping and ribotyping.

AIMS: Gas chromatographic analysis of cell membrane fatty acid methyl esters (FAME), biochemical profiling (biotyping) and EcoRI restriction endonuclease profiling of DNA containing ribosomal RNA sequences (ribotyping) were compared for differentiation of Enterococcus spp. METHODS AND RESULTS: FAME profiling, biotype profiling and ribotyping of 41 strains from retail Swiss-type cheeses and five strains from culture collections resulted in 17, 25 and 26 groups, respectively, with only two pairs of strains having the same FAME group, biotype profile and ribogroup. CONCLUSION: Substantial overlap occurred in groupings assigned by the three methods. SIGNIFICANCE AND IMPACT OF THE STUDY: Differentiation of Enterococcus spp. strains increases if multiple methods are used.

Screening for cognitive impairment in the older adult.

Screening for cognitive impairment in the older adult is an often overlooked element of health promotion. Health care providers may assume that existing deficits will be apparent on routine medical encounters. Frequently, however, patients who are functionally impaired can present a convincing facade of normalcy. Objective screening is necessary to recognize decline. This article briefly reviews normal age-related changes in cognition and suggested screening tools as well as differential diagnoses, highlighting reversible aspects of impairment. Additionally, potential corrective measures are considered where appropriate. This evaluation will become even more significant as the geriatric population steadily increases.

Efficacy of novel organic acid and hypochlorite treatments for eliminating Escherichia coli O157:H7 from alfalfa seeds prior to sprouting.

This study investigated novel two-step organic acid/hypochlorite treatments as alternatives to 20000 ppm active chlorine (from calcium hypochlorite) for eliminating Escherichia coli O157:H7 from alfalfa seeds prior to sprouting. Commercially available alfalfa seeds were inoculated with a five-strain E. coli O157:H7 mixture and dried to attain ca. 10(6) CFU/g of seeds. Seeds then underwent one of several soak treatments including: (1) 5% (v/v) lactic acid for 10 min at 42 degrees C; (2) 5% acetic acid (v/v) for 10 min at 42 degrees C; (3) 2.5% lactic acid for 10 min at 42 degrees C followed by 2000 ppm active chlorine (from calcium hypochlorite) for 15 min at 25 degrees C; (4) 5% lactic acid for 10 min at 42 degrees C followed by 2000 ppm active chlorine for 15 min at 25 degrees C; or (5) 20000 ppm active chlorine for 15 min at 25 degrees C. Each treatment reduced numbers of inoculum cells by about 6.0 log10 CFU/g as determined by plating on Sorbitol MacConkey agar (SMac). Plating on non-selective brain heart infusion agar (BHI) showed that treatments 1-4 reduced counts by 2.3-4.1 log10 CFU/g, thus indicating a large proportion of injured cells. Successive lactic acid and hypochlorite treatments (3 and 4) were more lethal than either organic acid alone (1 and 2). No surviving cells were detected on SMac or BHI following treatment with 20000 ppm active chlorine (treatment 5). Regardless of the previous treatment, E. coli O157:H7 counts increased to 10(7)-10(8) CFU/g during sprouting. Germination of seeds was not adversely affected by any of the treatments (germination > 90%). Results of this study show that: (a) non-lethal cell injury must be considered when evaluating intervention treatments against E. coli O157:H7 on alfalfa seeds; (b) reductions of 2-4 log10 CFU/g can be attained without using 20000 ppm active chlorine; (c) successive lactic acid and hypochlorite treatments have greater lethality than organic acid treatments alone; and (d) none of the treatments tested can prevent regrowth of surviving E. coli O157:H7 during sprouting.

Potential use of presumptive enterococci and staphylococci as indicators of sanitary condition in plants making hard Italian-type cheese.

Raw milk, pasteurized milk, unripened cheese (1 day old), and partially ripened cheese (3 months) from 42 milk lots at a plant making hard Italian-type cheese were analyzed for presumptive enterococci using kanamycin esculin azide agar pour plates. Fully ripened (> or =10 months) cheeses, derived from other milk lots, were also tested. Numbers of presumptive staphylococci (Baird-Parker agar [B-P]) were determined in the partially and fully ripened cheeses. Presumptive enterococci were ubiquitous in raw milk, usually at levels of 2.1 to 3.0 log CFU/ml. Enterococci were detected in 11 (26%) of 42 pasteurized milk samples. Enterococci and staphylococci were detected in 39 (93%) and 6 (14%) of unripened cheeses and in 33 (80%) and 4 (10%) of partially ripened cheeses, respectively. Only eight and five samples of enterococci-positive unripened and partially ripened cheese, respectively, were made from pasteurized milk in which presumptive enterococci were detected. Of 42 samples of fully ripened cheese, 35 (83%) and 8 (19%), respectively, contained presumptive enterococci and staphylococci. Results suggest either that low numbers of presumptive enterococci survive pasteurization and cheese ripening or that contamination of cheese by enterococci occurs after pasteurization. Biochemical testing confirmed 63% of presumptive enterococci isolates. None of the 20 presumptive staphylococci isolates produced colonies typical of Staphylococcus aureus on B-P agar; the isolates were identified as 1 Staphylococcus epidermidis, 1 Staphylococcus xylosus, 2 Staphylococcus saprophyticus, 1 Staphylococcus warneri, 5 Kocuria spp., and 10 unidentified gram-positive, catalase-positive cocci. Three staphylococci isolates decreased in numbers by more than 3.0 log CFU/ml in 9.9 ml of skim milk heated 30 min in a 62.8 degrees C water bath. This finding suggests that most presumptive staphylococci detected may have been prepasteurization contaminants. Unless specificity of the kanamycin esculin azide and B-P media is improved, use of presumptive enterococci and staphylococci as indicators of postpasteurization sanitation in plants making hard Italian-type cheese cannot be recommended.

Verifying apple cider plant sanitation and hazard analysis critical control point programs: choice of indicator bacteria and testing methods.

The objectives of this study were (i) to evaluate the survival of coliforms, Escherichia coli, and enterococci in refrigerated apple cider; (ii) to develop simple and inexpensive presumptive methods for detection of these bacteria; (iii) to perform a field survey to determine the prevalence of these bacteria on apples and in apple cider; and (iv) based on our results, to recommend the most useful of these three indicator groups for use in verifying apple cider processing plant sanitation and hazard analysis critical control point (HACCP) programs. Eight of 10 coliform strains (5 E. coli, 1 Enterobacter aerogenes, and 2 Klebsiella spp.) inoculated into preservative-free apple cider (pH 3.4, 13.3(o) Brix) survived well at 4 degrees C for 6 days (< or = 3.0 log10 CFU/ml decrease). Of 21 enterococci strains (Enterococcus faecalis, E. faecium, and E. durans), only 2 E. durans and 3 E. faecium strains survived well. Simple broth-based colorimetric methods were developed that detected the presence of approximately 10 cells of coliforms or enterococci. In three field studies, samples of unwashed apples (drops and picked), washed apples, and freshly pressed cider were presumptively analyzed for total coliforms, E. coli, and enterococci using qualitative and/or quantitative methods. Drop apples were more likely than picked apples to be contaminated with E. coli (26.7% vs. 0%) and enterococci (20% vs. 0%). Washing had little effect on coliform populations and in one field study was associated with increased numbers. Total coliform populations in cider ranged from < 1 CFU/ml to > 738 most probable number/ml, depending on the enumeration method used and the sample origin. E. coli was not recovered from washed apples or cider, but enterococci were present on 13% of washed apple samples. The qualitative coliform method successfully detected these bacteria on apples and in cider. Based on its exclusively fecal origin, good survival in apple cider, and association with drop apples, we conclude that E. coli is the most useful organism for verifying apple cider sanitation and HACCP programs.

Antimicrobial resistance in pediatric upper respiratory infection: a prescription for change.

The advent of antimicrobial usage in the 1930s provided effective weaponry to combat morbidity and mortality associated with infectious disease. Today, due primarily to inappropriate antibiotic prescribing, these antimicrobial weapons are being seriously threatened by the emerging danger of antimicrobial resistance. Despite guidelines formulated by the Centers for Disease Control and Prevention (CDC) to address judicious antibiotic use in managing pediatric upper respiratory infection, much unnecessary prescribing continues. Many factors contribute to these erroneous practices, including misconceptions held by both the medical community and the public sector. Additionally, patient expectations have an impact on treatment decisions despite advice to the contrary. A review of the literature provides support for the adoption of the CDC standards of care and underlines the need to further investigate practice patterns. Measures to encourage appropriate antibiotic usage and to reverse the trend toward antimicrobial resistance are needed.

Computer-assisted eye examinations IV. "Additive" lens systems in eye refractors.

After a brief introduction to the optical principles and terms, formulas are derived which demonstrate that with conventional methods and designs it is not possible to summate with accuracy the labeled power of three or more ophthalmic lenses in tandem. The effective power of sphero-cylindrical combinations in all currently available eye refractors, when powers of eight to ten diopters are exceeded, may differ from the summated labeled power by a quarter diopter or more, which can be clinically significant. This error can be directly and readily eliminated only in computer-actuated refractors by including a computer program which calculates the effective power and makes the necessary correction.