[Two cases of inexplicable autochthonous malaria in Toulouse, France]. / Deux cas inexpliqués de paludisme autochtone a Toulouse, France.

Malaria involving both Plasmodium falciparum and vivax was observed in two patients hospitalized in the same room of the Cardiology Department of the Purpan University Hospital in Toulouse, France. One patient was in coma without fever by the time of diagnosis. None of the patients had traveled to malaria areas within the last 33 years. Epidemiological investigations failed to detect malaria in family members, hospital staff, or other patients. Transmission due to transfusion of infected blood, use of contaminated surgical instrumentation, or bite of an autochthonous anopheles mosquito was reasonable ruled out. Since Toulouse International Airport is located less than three kilometers from the Purpan University Hospital, the most likely explanation was airport-acquired malaria due to the bite of a mosquito imported by an aircraft coming from abroad. The hypothesis that an Anopheles mosquito survived the plane trip and then was blown into the patients' room was supported by temperature and wind conditions prevailing at the time of infection.

In vitro evaluation of activities of azithromycin, clarithromycin and sparfloxacin against Chlamydia trachomatis.

The in vitro activities of azithromycin, clarithromycin and sparfloxacin were evaluated by studying inhibition of in vitro Chlamydia trachomatis propagation in McCoy cells, comparatively with erythromycin, ofloxacin and tetracycline. Fifteen clinical isolates of C. trachomatis were tested with an inoculum of 5.10(3) inclusion--forming units in a 96--well microtiter plate. Minimal inhibitory concentration (MIC) ranges were as follows: azithromycin, 0.06 to 0.125 microgram/ml; clarithromycin, 0.008 microgram/ml; erythromycin, 0.06 to 0.125 microgram/ml; ofloxacin 0.5 to 1 microgram/mg; sparfloxacin, 0.03 to 0.06 microgram/ml; and tetracycline 0.125 to 0.25 microgram/ml. Minimal bactericidal concentration (MBC) ranges, calculated from passage into antibiotic--free medium, were as follows: azithromycin 0.25 to 0.5 microgram/ml; clarithromycin, 0.03 to 0.125 microgram/ml; erythromycin, 0.25 to 2 micrograms/ml; ofloxacin, 0.5 to 1 microgram ml; sparfloxacin, 0.03-0.06 microgram/ml; and tetracycline, 1 to 4 micrograms/ml. Clarithromycin and sparfloxacin showed the greatest activity and clinical studies of these agents in C. trachomatis infections are therefore indicated.

[In vitro sensitivity to antibiotics of genital mycoplasmas isolated in Toulouse. Study of new molecules (macrolides and quinolones)]. / Sensibilité in vitro aux antibiotiques des mycoplasmes génitaux isolés à Toulouse. Etude de nouvelles molécules (macrolides et quinolones).

The minimal metabolism-inhibiting concentrations (MMC) of 11 antibiotics were determined for 40 strains each of M. hominis and U. urealyticum using a terminal color change broth method. All strains were recovered in 1990. Resistance to tetracycline (MMC greater than 8 mg/l) was found for 12.5% of strains of M. hominis and U. urealyticum, as compared with 5% in 1985. Rokitamycin was the most active macrolide against M. hominis (MMC 90: 0.06 mg/l). U. urealyticum strains were susceptible to all the macrolides tested, with the greatest activities being seen for rokitamycin and clarithromycin (MMC 90: 0.06 mg/l and 0.12 mg/l respectively). Sparfloxacin was the most active quinolone against both species. Human clinical trials designed to evaluate these new molecules for the treatment of mycoplasmal and ureaplasmal genital infections are warranted.

In vitro activity of sparfloxacin and other antimicrobial agents against genital pathogens.

The in vitro activity of sparfloxacin was determined for 60 strains of Neisseria gonorrhoeae, 15 strains of Chlamydia trachomatis and 40 strains each of Gardnerella vaginalis, Mycoplasma hominis, and Ureaplasma urealyticum and compared with those of ampicillin, azithromycin, clarithromycin, erythromycin, ofloxacin, temafloxacin and tetracycline. Sparfloxacin was active against all the strains studied and appeared to be the most potent quinolone tested. Sparfloxacin had the lowest MICs against N. gonorrhoeae (MICs 0.002-0.06 micrograms/ml). Its MICs against C. trachomatis (0.03-0.06 micrograms/ml) were higher than those of clarithromycin but lower than those of the other antimicrobial agents. Sparfloxacin was particularly active against tetracycline-susceptible as well as resistant strains of M. hominis (MICs, 0.06 micrograms/ml) and U. urealyticum (MICs 0.125-1 micrograms/ml). Because of this in vitro activity and its tissue distribution, sparfloxacin might be a valuable therapeutic agent for treating major bacterial sexually transmitted diseases.

[First isolation in France of a penicillinase-non producing Neisseria gonorrhoeae with high level tetracycline resistance]. / Premier isolement en France d'une souche de Neisseria gonorrhoeae non productrice de pénicillinase présentant un haut niveau de résistance à la tétracycline.

We report the first isolation in France of a penicillinase-non producing Neisseria gonorrhoeae with high level tetracycline resistance. The minimal inhibitory concentrations (MICs) of nine antibiotics were determined by agar dilution for the tetracycline resistant strain and 39 other penicillinase-non producing N. gonorrhoeae strains which were isolated during the same year (1989), in Toulouse. No difference was observed between the MICs except for the tetracycline (tetracycline-resistant strain MIC = 32 mg/l). The commonly used antibiotics other than tetracycline were active in vitro against all the strains. The plasmid content of the tetracycline-resistant strain was analysed by agarose gel electrophoresis and revealed the presence of two plasmids: the 2.6-megadalton in cryptic plasmid and the 25.2-megadalton Tet M conjugative plasmid.

The activity of clarithromycin and its 14-hydroxy metabolite against Haemophilus influenzae, determined by in-vitro and serum bactericidal tests.

The in-vitro activity of clarithromycin and its main metabolite 14-hydroxy clarithromycin against Haemophilus influenzae was evaluated by determining minimum inhibitory and minimum bactericidal concentrations. The 14-hydroxy metabolite was more active than the parent compound against H. influenzae. The activity of the parent compound/metabolite combination was evaluated against 20 strains of H. influenzae by the chequerboard technique. The combination was synergistic against seven isolates in terms of fractional bactericidal concentration index and against five isolates in terms of fractional inhibitory concentration index; the combination demonstrated additive activity against the remaining strains. Serum bactericidal activity against H. influenzae was measured in sera from six healthy volunteers who had received 250 mg clarithromycin by mouth. The area under the serum bactericidal activity curve correlated with the area under the curves for clarithromycin and 14-hydroxy clarithromycin, and with the in-vitro susceptibility of the strains tested. Serum bactericidal activity was detected at 30 min after dosing and lasted for 5-6 h.

[In vitro activity of 5 new quinolones against Gardnerella vaginalis]. / Activité in vitro de cinq nouvelles quinolones sur Gardnerella vaginalis.

The minimal inhibitory concentrations (MICs) of five new quinolones were determined by agar dilution, for 50 clinical isolates of Gardnerella vaginalis. They are compared with those of metronidazole, ampicillin, erythromycin and tetracycline which are widely used for the treatment of lower genital tract infections in women. The MICs of rosoxacin and pefloxacin are high, but those of ofloxacin (MIC 50, 2 mg/l), fleroxacin (MIC 50, 2 mg/l) and ciprofloxacin (MIC 50, 1 mg/l) are lower. They can explain the effectiveness observed with this latter antibiotic in vivo, and allow their clinical experiment.

[Surveillance of Neisseria gonorrhoeae strains isolated in Toulouse. In vitro antibiotic sensitivity and plasmid content]. / Surveillance des souches de Neisseria gonorrhoeae isolées à Toulouse. Sensibilité aux antibiotiques in vitro et contenus plasmidiques.

The minimal inhibitory concentration (MIC) of twelve antibiotics was determined by the method of dilution in agar for 50 non penicillinase-producing and 15 penicillinase-producing Neisseria gonorrhoeae (PPNG) strains. The commonly used antibiotics are active in vitro against all the strains. For the non PPNG stains, no difference was observed between the MICs with a previous investigation, in 1980. New quinolones are highly active against all the strains tested but two, with decreased sensitivity. Since 1980, 16 PPNG strains were isolated (2.2%) and analysed for plasmid content. Asian type plasmid (7.4 kb) was present in 9 strains and african type (5.3 kb) in 7 strains. The conjugative plasmid (39 kb) was present in 5 strains and the cryptic plasmid (4.4 kb) in all the strains.

Lower genital tract infections in women: comparison of clinical and epidemiologic findings with microbiology.

We screened 392 women attending the Laboratory of Microbiology of Toulouse Purpan Hospital for symptoms of lower genital tract infection for six microorganisms. Rates of isolation of Neisseria gonorrhoeae, Chlamydia trachomatis, Candida albicans, Mycoplasma hominis, and Gardnerella vaginalis were 1%, 7.7%, 29.8%, 23.8%, and 37.5%, respectively. Trichomonas vaginalis was detected by direct examination in specimens from 3.1% of patients. Another goal of this study was to determine the relative prevalence of these microorganisms in relation to clinical and epidemiologic findings. C. trachomatis was isolated significantly more often from patients under 25 year old (P less than 0.001), from those who use oral contraceptives (P less than 0.01), from those who have a male sexual partner with symptoms of sexually transmitted disease (P less than 0.001), and from those who present signs of cervicitis (P less than 0.05). Isolation of C. albicans was significantly associated with vulvar pruritus (P less than 0.01), vulvitis (P less than 0.01), and vaginitis (P less than 0.001). G. vaginalis and M. hominis are significantly associated with bacterial vaginosis (P less than 0.001). This syndrome was diagnosed clinically in 27.2% of our study population and was highly correlated with use of an intrauterine device (P less than 0.05).

In vitro activity of six quinolone derivatives against Neisseria gonorrhoeae.

The in vitro activities of six quinolone derivatives, rosoxacin, pefloxacin, ofloxacin, ciprofloxacin, A-56619 and A-56620, were compared with those of penicillin, cefotaxime, spectinomycin, chloramphenicol, tetracycline and erythromycin against 50 nonpenicillinase-producing and 15 penicillinase-producing Neisseria gonorrhoeae strains. Ciprofloxacin was the most active compound in vitro (MIC50, 0.004 mg/l) followed by ofloxacin and A-56620 (MIC50, 0.008 mg/l), A-56619 and cefotaxime (MIC50, 0.016 mg/l). The six quinolones are highly active against all the strains tested but 2, with decreased sensitivity.

[Sensitivity of Kingella kingae to antibiotics]. / Sensibilité aux antibiotiques de Kingella kingae.

Kingella kingae is a small Gram negative rod of the Neisseriaceae family, formerly called Moraxella kingae. This microorganism is found occasionally in the oral cavity and is capable of causing infections. We report three cases of septic arthritis in children due to K. kingae. In vitro susceptibility of the recovered strains was tested using determination of MICs in agar. The strains were susceptible to penicillin, ampicillin, ticarcillin, cephalothin, cefotaxime, gentamicin, chloramphenicol, tetracycline, trimethoprim-sulfamethoxazole, and pefloxacin, less susceptible to erythromycin and resistant to lincomycin (MIC 32 mg/l).

[Evaluation of the API ATB-CMI system for testing the sensitivity of Haemophilus influenzae to antibiotics. Comparison with other technics and reflections on interpretation criteria]. / Evaluation du système API ATB-CMI pour l'étude de la sensibilite aux antibiotiques de Haemophilus influenzae. Comparaison avec d'autres techniques et réflexions sur les critères d'interprétation.

The API ATB-MIC system was used for antibiotic sensitivity testing of H. influenzae (following addition of NAD and hemin). Results were compared to those obtained with agar dilution and disc diffusion. Eighty-four strains with a variety of resistance phenotypes (including beta-lactamase-producing strains and strains resistant to chloramphenicol, tetracycline or kanamycin) were tested. The API ATB-MIC system studies the susceptibility of H. influenzae to antibiotics by determining minimal inhibitory concentrations. Agreement between the methods ranged from 83% to 98% according to the antibiotic. Discrepancies involved ampicillin, minocycline and, to a lesser extent, chloramphenicol. These discrepancies had no influence on the interpretation of results except in one instance involving chloramphenicol. Comparison of the results obtained with each of the three methods leads to a discussion of the criteria that indicate resistance of H. influenzae and of the cutoff concentrations and diameters used for other species. Criteria indicating resistance are production of beta-lactamase for ampicillin, production of enzyme, a MIC above 2 mg/l or a diameter below 26 mm for chloramphenicol, and a diameter below 18 mm or a MIC above 4 mg/l for tetracycline and minocycline.

[Prevalence of antibiotic resistance of Haemophilus influenzae isolated in France: a year of activities of the network of surveillance for H. influenzae infections]. / Prévalence de la résistance aux antibiotiques des Haemophilus influenzae isolés en France: un an d'activité du réseau de surveillance des infections à H. influenzae.

The prevalence of antimicrobial resistance among clinical isolates of Haemophilus influenzae was assessed in France. A total of 705 isolates, obtained from CSF (98 strains), blood (76), ears (118), eyes (164), lower respiratory tract specimens (144), genital specimens (28), and various other specimens (71) were examined. These isolates were obtained from microbiological laboratories distributed throughout France and were sent to the Center for the study of H. influenzae during one year. Biotype of isolates was determined by use of API 10 E system and serotype was determined by slide agglutination procedure. All isolates were examined for beta-lactamase production with a chromogenic test. Susceptibility to ampicillin, cefotaxime, gentamicin, kanamycin, chloramphenicol, tetracycline, minocycline, erythromycin and rifampicin was determined by disk diffusion test and MIC determination by agar dilution procedure. Drug resistance was observed for 92 strains (13%). The overall resistance was 11.2% to ampicillin (all but one strain were beta-lactamase producers), 9% to tetracycline (Tc), 3.4 to chloramphenicol (Cm) and 6.8% to kanamycin (Km). Eleven phenotypes of resistance were observed: the most frequently observed were Ap-Km-Tc, Ap, Ap-Km-Cm-Tc, Ap-Tc, Ap-Km, Tc. Antimicrobial resistance rates varied by specimens: resistance to ampicillin concerned 12.2% of the strains from CSF, 10.5% from blood, 12.5% from sputum, 16.1% from ears, 6.7% from eyes; tetracycline resistance concerned 14.2%, 10.5%, 10.4%, 7.6% and 4.8% of the same strains respectively; resistance to chloramphenicol concerned 4%, 5.2%, 1.3%, 3.3% and 2.4% of the strains respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

[Multicenter study of the activity of pefloxacin on bacteria isolated in a hospital milieu]. / Etude multicentrique de l'activité de la péfloxacine sur les bactéries isolées en milieu hospitalier.

Minimal inhibitory concentrations (MICs) of pefloxacin were evaluated by agar dilution for 3422 bacterial strains isolated in nine hospitals. Enterobacteriaceae proved very sensitive to pefloxacin: 62 p. 100 of 1743 strains tested had MIC less than or equal to 0.12 and 90 p. 100 less than or equal to 1 microgram/ml; but the percent of strains with MIC greater than or equal to 2 varied among the different groups of Enterobacteriaceae: 2.7 p. 100 for E. coli to 39 p. 100 for Serratia. 55 p. 100 for Pseudomonas and 81 p. 100 of Acinetobacter were inhibited by 1 micrograms/ml or less (mode MIC 1 and 0.5 micrograms/ml). Haemophilus sp.: 0.03 and 0.06 micrograms/ml and Gonococci were very sensitive to pefloxacin. The spectrum of pefloxacin extended to Gram positive cocci: MIC of Staphylococci were 0.06 to 8 micrograms/ml (mode MIC: 0.5); Enterococci, other Streptococci and Pneumococci were less sensitive: 2 and 4 micrograms/ml for the majority of strains. Concerning anaerobic bacteria, pefloxacin was more active against Clostridium (0.5 to 1 microgram/ml generally), than against Bacteroides (4 to 16 micrograms/ml).

Comparison of antibiotic resistance of gram-negative bacilli with beta-lactam and aminoglycoside antibiotics.

In 1981 a comparison of the resistance rates of aminoglycosides, penicillins, cephalosporins, and nalidixic acid was made in species of gram-negative rods between a hospital in Toulouse, France and one in Brooklyn, New York. The results showed similar rates of resistance from both institutions. Both institutions showed high rates of aminoglycoside resistance; high ampicillin resistance among salmonella and Pseudomonas mirabilis in France and shigella in New York City; similar rates of resistance to cephalosporins and finally, markedly different incidences of resistance to naladixic acid. Analysis of medical records over several years indicated a gradual but continuing increase in resistance to aminoglycosides. The majority of such isolates had been isolated from patients in intensive care units. Few differences in the rates of resistance to the cephalosporins were noted between the two institutions, either for the older or newer agents in this group. Further, no increase in resistance was noted to this group of antibiotics in the previous 5 yr.

[Enzymatic profile and plasmid content of Neisseria polysacchareae]. / Profil enzymatique et contenu plasmidique de "Neisseria polysacchareae".

The enzymatic profile of "Neisseria polysacchareae" was determined by using chromogenic substrate (API System), and was compared to that of N. meningitidis, N. gonorrhoeae and N. lactamica. The tested classes of enzymes were aminopeptidase, proteases, esterases, lipases, glycosidases, phosphatase and phosphoamidase. "N. polysacchareae" exhibited various aminopeptidase and protease activities and a strong esterase activity. No lipase and glycosidase activities were detected by the tested substrates. The strains of "N. polysacchareae" differed from that of N. meningitidis in the presence of hydroxyproline aminopeptidase and the lack of gamma-glutamyl-transferase activity. Five strains harboured extrachromosomal elements. The plasmids were of 4.2 Kb in size in four cases and of more than 40 Kb in four cases. Three strains simultaneously harboured these two plasmids. This plasmid content is another characteristic of strains of this new taxon. No phenotypic modification was observed in plasmid-containing strains.

[Multicenter study of the in vitro effect of imipenem (N-formimidoyl-thienamycin) on hospital bacteria]. / Etude multicentrique de l'activité in vitro de l'imipenem (N. formimidoyl-thiénamycine) sur les bactéries hospitalières.

Minimal inhibitory concentrations (MICs) of imipenem were evaluated by agar dilution for 2 895 bacterial strains isolated in 9 hospitals. Imipenem proved highly active against Enterobacteriaceae, with an MIC less than or equal to 0.25 for 63% of the 1 556 tested strains, less than or equal to 1 for 89.6% and less than or equal to 4 for 99%. The different groups of Enterobacteriaceae exhibited similar mode MICs (0.12 to 0.25), with the exception of Serratia (0.25-0.5), P. mirabilis (0.5), indole-positive Proteus (2), and Providencia (1). MICs of most cefotaxime-resistant strains were within the susceptibility range. Imipenem also exhibited satisfactory activity against P. aeruginosa (mode MIC 1-2) and Acinetobacter sp. (mode MIC: 0.25-0.5). MICs ranged from 0.03 to 4 (mode MIC: 0.5) for Haemophilus sp. and 0.25 to 1 for Gonococci, regardless of beta-lactamase-production status. MICs for Meningococci were less than or equal to 0,06. Methicillin-susceptible Staphylococci had low MICs, ranging from 0.008 to 0.5 (mode MIC : 0.016); MICs for methicillin-resistant strains varied widely, from 0.016 to 64, and were higher after incubation at 30 degrees C. Streptococci, except for Enterococci, and Pneumococci were highly susceptible (usually 0.008-0.03); MICs for Enterococci varied from 0,12 to 32 (mode MIC: 1-2). Except for four C. difficile strains, all tested anaerobic strains were inhibited by concentrations less than or equal to 1 (mode MICs: 0.06 for C. perfringens and 0.03 for B. fragilis).

[Effect ofloxacin on Haemophilus influenza, Streptococcus pneumoniae and Neisseria meningitidis. Comparison with similar molecules]. / Activité de l'ofloxacine sur Haemophilus influenzae, streptococcus pneumoniae et Neisseria meningitidis. Comparaison avec des molécules voisines.

The in vitro activities of the new quinolone derivatives ofloxacin, ciprofloxacin, norfloxacin, and pefloxacin against strains of Haemophilus influenzae, Streptococcus pneumoniae and Neisseria meningitidis were compared to that of nalidixic acid. Determination of minimal inhibitory concentrations (MICs) was done by agar dilution tests. The new drugs were more active than nalidixic acid. N. meningitidis and H. influenzae (regardless of beta-lactamase production) were highly susceptible. All H. influenzae strains were inhibited by less than or equal to 0.12 mg/l; mode MICs were 0.03 mg/l for norfloxacin and pefloxacin, and 0.50 mg/l for nalidixic acid. All N. meningitidis strains were inhibited by 0.06 mg/l and mode MICs of the new drugs were less than or equal to 0.03 mg/l. Mode MICs for S. pneumoniae were 4 mg/l for norfloxacin and pefloxacin (range 1-16 and 2-8 mg/l respectively) and 1 mg/l for ofloxacin (range 1-4 mg/l). Ofloxacin exhibited a bactericidal activity on H. influenzae (range MBC 0.06-0.50 mg/l; mode MBC: 0.06 mg/l).