Spondylodiscitis due to Aerococcus urinae: a first report.

Aerococcus urinae is an uncommon urinary tract pathogen which causes infections predominantly in elderly persons with local and general predisposing conditions. There are few case reports of severe infections caused by Aerococcus urinae among which only 14 cases of endocarditis caused by Aerococcus urinae have been reported. We report the first case of Aerococcus urinae spondylodiscitis. The patient responded to 4 weeks of amoxicillin and clindamycin, and to 5 months of amoxicillin alone.

Nomenclature of major antimicrobial-resistant clones of Streptococcus pneumoniae defined by the pneumococcal molecular epidemiology network.

The emergence of disease caused by penicillin-resistant and multidrug-resistant pneumococci has become a global concern, necessitating the identification of the epidemiological spread of such strains. The Pneumococcal Molecular Epidemiology Network was established in 1997 under the auspices of the International Union of Microbiological Societies with the aim of characterizing, standardizing, naming, and classifying antimicrobial agent-resistant pneumococcal clones. Here we describe the nomenclature for 16 pneumococcal clones that have contributed to the increase in antimicrobial resistance worldwide. Guidelines for the recognition of these clones using molecular typing procedures (pulsed-field gel electrophoresis, BOX-PCR, and multilocus sequence typing) are presented, as are the penicillin-binding profiles and macrolide resistance determinants for the 16 clones. This network can serve as a prototype for the collaboration of scientists in identifying clones of important human pathogens and as a model for the development of other networks.

Chlamydia pneumoniae induces interleukin-10 production that down-regulates major histocompatibility complex class I expression.

Recently, it was demonstrated that CD8(+) T cells are important for the response against Chlamydia pneumoniae. By use of the human monocytic cell line U937 and human monocytes taken from peripheral blood, we investigated the effect of infection on various molecules critical for CD8(+) T cell function. A strong secretion of interleukin (IL)-10 by infected cells was observed, together with an inhibited expression of major histocompatibility complex (MHC) class I antigens, but without significant alteration of tumor growth factor-beta secretion or MHC class II expression. Recombinant IL-10 added to uninfected U937 cells decreased the expression of MHC class I, whereas blocking antibodies to IL-10 and its receptor abolished the C. pneumoniae-induced inhibition of MHC class I expression. Analysis of our data provides evidence that IL-10 secretion induced by C. pneumoniae infection of monocytic cells down-regulates the expression of MHC class I molecules and thereby might reduce the presentation of bacterial epitopes by MHC. This would decrease the ability of CD8(+) T cells to eliminate infected cells.

[Surgery of labio-maxillo-palatal clefts during humanitarian mission in the Philippines]. / Chirurgie des fentes labio-maxillo-palatines en mission humanitaire aux Philippines.

After describing the Philippines and the Comité de Soutien Enfance Philippines, a humanitarian association with a three-fold objective: to build, to educate and to treat, the authors present the organization and practical conduct of their missions abroad which have enabled them to treat almost 400 patients with cleft lip and palate between the ages of 3 months and 46 years.

Comparative in vitro susceptibility of a tetracycline-resistant Chlamydia trachomatis strain isolated in Toulouse (France).

BACKGROUND AND OBJECTIVES: We recently reported the first isolation of a tetracycline-resistant Chlamydia trachomatis strain in Toulouse from a woman treated with tetracycline. To characterize this isolate, its in vitro susceptibility was compared with those of 34 other C. trachomatis isolates recovered in Toulouse. STUDY DESIGN: The susceptibilities of C. trachomatis strains were determined in terms of minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) using McCoy cells in 96-well microdilution plates, with an inoculum of 5.10(3) to 1.10(4) inclusion-forming units/ml. The antimicrobial agents tested were tetracycline, azithromycin, erythromycin, ofloxacin, and pristinamycin. RESULTS: No difference was observed between the MICs and MBCs except for the tetracycline. Tetracycline-resistant strain MIC and MBC were > 64 micrograms/ml, although < 1% of the bacterial population showed resistance. For the other isolates, the MIC of tetracycline was < or = 0.25 microgram/ml. The antibiotics other than tetracycline were active in vitro against all strains. CONCLUSIONS: These results show that the tetracycline resistance observed in Toulouse differs from the "heterotypic resistance" described previously in the United States in multiresistant C. trachomatis isolates. They confirm that the resistance we observed may be a new phenomenon.

Tetracycline-resistant Chlamydia trachomatis in Toulouse, France.

We report the first isolation of a tetracycline-resistant Chlamydia trachomatis strain in Toulouse, France. Culture of a post treatment endocervical specimen from a woman treated with tetracycline grew C. trachomatis. The patient was retreated with pristinamycin and cured. The minimal inhibitory concentration (MIC) and the minimal bactericidal concentration (MBC) of tetracycline for the patient isolate were > 64 micrograms/ml although 1% of the population of organisms showed resistance. Conversely for 34 C. trachomatis isolates recovered since 1988 from patients before treatment, in Toulouse, all the MICs of tetracycline were < or = 0.25 microgram/ml. If the isolation of tetracycline-resistant C. trachomatis was the result of persisting organisms, the management of chlamydial infections could be changed.

[Syphilitic labial leucokeratosis]. / Leucokératose labiale syphilitique.

BACKGROUND: Several diagnoses, including syphilis, can be entertained in patients with leukokeratosis of the buccal mucosa. We report a case of labial leucokeratosis which revealed latent syphilis. CASE REPORT: A 36-year-old man with a past history of genital syphilis chancre which have been treated 12 years earlier, developed buccal leucokeratosis with no other clinical manifestation. Histology showed dermal infiltration containing plasma cells, polynuclears and lymphocytes. Blood tests were positive for syphilis. Complementary examinations were unable to detect another localization. Leucokeratosis regressed completely after one injection of Extencilline. There has been no recurrence at one year. DISCUSSION: The clinical and histological presentations of syphilis can mimic different skin diseases. Serodiagnosis alone is significant. Isolated buccal lesions are rarely described in syphilis suggesting serodiagnosis should always be ordered. Whatever the clinical stage of the diseases, serological surveillance after treatment for syphilis is essential.

[Comparative study of minimal inhibiting concentrations of doxycycline, ofloxacin and erythromycin against 18 recent isolates from Chlamydia trachomatis (1994-1995)]. / Etude comparative des concentrations minimales inhibitrices de la doxycycline, de l'ofloxacine et de l'érythromycine sur 18 isolats récents (1994-1995) de Chlamydia trachomatis.

In vitro activity of the 3 antimicrobial agents, against 18 recent isolates of Chlamydia trachomatis: 11 from urethral samples and 7 from endocervical samples, was tested by cell culture technique. HeLa 229 cells maintained in antibiotic-free MEM medium supplemented with 10% fetal calf serum and 2 mM glutamine were seeded into 96-well culture plates. After inoculation with 10(2) to 10(3) inclusion-forming units/ml of each strain of C. trachomatis, the culture medium was replaced by a maintenance medium containing 1 micrograms/ml of cycloheximide and serial two fold dilutions of the antibiotics. After 48 h incubation at 36 degrees C in 5% CO2 atmosphere, cells were fixed and inclusion bodies were stained using fluorescein-conjugated anti-Chlamydia monoclonal antibodies. MICs were defined as the lowest antibiotic concentrations required to inhibit the development of a single inclusion. MICs 90% (mg/l) were 0.054 for doxycyclin, 0.700 for ofloxacin and 0.150 for erythromycin. These results confirm the effective in vitro activity of the three antibiotics tested against C. trachomatis.

[Bacteria isolated in 1994-1995 in female upper genitalia infections and in male urethritis. Distribution and sensitivity to antibiotics]. / Bactéries isolées en 1994-1995 au cours des infections gynécologiques hautes et des uréthrites masculines. Distribution et sensibilité aux antibiotiques.

OBJECTIVE: Classify antibiotics according to their individual activity so as to identify those suitable for empiric therapy. METHODS: We studied bacterial strains isolated from patients with urethritis (n = 189) and upper genital tract infections (n = 163) between June 1994 and February 1995 in 3 hospital and 4 community laboratories. Upper genital tract infections were divided into two groups: proven infection on laparoscopy specimen (n = 79) and suspected infection with isolation of pathogen in cervical samples (n = 84). Pathogens isolated were: Chlamydia trachomatis in 36/12/15 cases respectively, Mycoplasma hominis in 12/20/13, Ureaplasma urealyticum in 55/30/15, Neisseria gonorrhoeae in 40/2/0, Haemophilus spp in 20/2/1, group B streptococci in 7/1/8, E. coli in 8/1/17 and miscellaneous in 11/8/15. The minimal inhibitory concentrations for all strains were determined in 4 laboratories for ofloxacin, erythromycin and doxycyclin against C. trachomatis, M. hominis and U. urealyticum, and for ofloxacin, erythromycin, doxycyclin, amoxicillin+clavulanate, cefotaxime and gentamicin against the other strains. The activity score (% susceptibility to each antibiotic weighted by the frequencies of each isolate in urethritis and upper genital tract infection based on recent French epidemiologic data) was calculated for each antibiotic. CONCLUSION: The antibiotics with the best empiric activity scores in urethritis were, in decreasing order: doxycyclin (90.4%), ofloxacin (88.1%), and erythromycin (50.2%). The most active combinations in upper genital tract infections were ofloxacin+amoxicillin (100%), doxycyclin+cefotaxime+metronidazole (95.9%) and doxycyclin+amoxicillin (95.3%).

Molecular analysis by pulsed-field gel electrophoresis of penicillin-resistant Streptococcus pneumoniae from Toulouse, France.

A sample of 28 penicillin-resistant Streptococcus pneumoniae strains isolated between 1991 and 1993 in a large hospital in Toulouse, France, was characterized by pulsed-field gel electrophoresis of genomic DNA. Also included were 6 penicillin-susceptible clinical isolates from Toulouse and 12 penicillin-resistant strains from different parts of the world. The restriction endonucleases ApaI and SmaI were used to digest intact chromosomes, and the fragments were resolved by field-inversion gel electrophoresis. Seven major pattern types could be recognized among the penicillin-resistant isolates from Toulouse. Nine of these isolates could be assigned to two clones that were also found in Spain and were associated with serotypes 6B and 9V. A third clone was isolated in South Africa and in Spain and contained serotype 23F isolates. The profiles obtained by field-inversion gel electrophoresis suggested that 15 of the 16 penicillin-resistant serogroup 23 isolates from Toulouse belonged to the same Spanish 23F clone. The molecular test profiles of penicillin-susceptible strains differed from those of resistant strains of the same serotype except those of 9V strains. These data underline the importance of the geographic spread of resistant clones from Spain in the emergence of penicillin-resistant pneumococci in France.

Pulsed field gel electrophoresis for molecular epidemiology of penicillin resistant Streptococcus pneumoniae strains.

The emergence of strains of Streptococcus pneumoniae resistant to penicillin and other antibiotics has become a major concern for antimicrobial therapy of pneumococcal infections. The spread of that resistance over the world increases the need for their epidemiological surveillance: specific epidemiological markers are required. In this study, pulsed field gel electrophoresis of genomic DNA was carried out on sixteen resistant isolates of S. pneumoniae from different parts of the world and fifteen resistant isolates from Toulouse. The restriction endonucleases ApaI and SmaI were used to digest intact chromosomes and the fragments were resolved by field inversion gel electrophoresis (FIGE). Each digest produced 10 to 19 fragments for comparison between strains. The polymorphism obtained with FIGE was greater than that obtained with serotyping which appeared to be not a good criterion for genetic relatedness. Three common clones could be recognized among the penicillin-resistant isolates. Two clones were found in Spain and in Toulouse and were associated with serotypes 6B and 9V, respectively. The third clone was isolated in South Africa and in Spain and contained serotype 23F isolates and one serotype 19F strain. The FIGE profiles observed in this study also demonstrated that serogroup 23 multiresistant strains isolated in Toulouse are genetically closely related and might have originated from the same Spanish 23F clone. These results underline the importance of the geographic spread of resistant clones in the increase in the incidence of penicillin-resistant pneumococci. They indicate that pulsed field gel electrophoresis should be an effective tool for the typing of resistant S. pneumoniae strains capable of tracing their origin.

Rheologic effects of plasma substitutes used for preoperative hemodilution.

This study was designed to compare the influence of various plasma substitutes, administered for preoperative hemodilution, on blood rheology. We studied 40 patients, ASA grade I, who underwent elective facial reconstructive surgery and received 4% albumin (n = 10), 3.5% dextran 40 (n = 10), gelatin (n = 10), or hydroxyethyl starch (HES) (n = 10). Ten patients, undergoing the same surgical procedure without hemodilution, were chosen as controls. After hemodilution, hematocrit was decreased approximately 30%. Fibrinogen decreased in all tested groups except in the gelatin group. Plasma viscosity decreased with albumin (1.13 +/- 0.05 to 1.06 +/- 0.03 mPa.s; P < 0.01) and increased with HES (1.15 +/- 0.04 to 1.22 +/- 0.05 mPa.s; P < 0.01). At a high shear rate, the blood viscosity decreased in all groups. In contrast, at a low shear rate and at 40% corrected hematocrit, the blood viscosity decreased in the albumin (15.9 +/- 1.9 to 13.1 +/- 2.1 mPa.s; P < 0.01) and the dextran 40 (16.9 +/- 2.9 to 12.8 +/- 2.5 mPa.s; P < 0.01) groups and was unchanged in the gelatin and the HES groups. Erythrocyte aggregation (measured with primary aggregation time) was markedly decreased in the albumin (3.27 +/- 1.74 to 7.03 +/- 2.95 s; P < 0.01) and in the dextran 40 (2.72 +/- 0.58 to 6.24 +/- 2.55 s; P < 0.001) groups, unchanged with HES, and increased with gelatin (2.41 +/- 0.90 to 1.55 +/- 0.33 s). These findings suggest that albumin and dextran 40 may be the plasma substitutes of choice for preoperative hemodilution when this technique aims to improve rheologic conditions.

DNA fingerprinting of Streptococcus pneumoniae strains by pulsed-field gel electrophoresis.

Pulsed-field gel electrophoresis of genomic DNA was carried out on Streptococcus pneumoniae strains to determine its value in the epidemiological survey of pneumococcal infections. Twenty-one clinical strains were chosen to cover a broad range of diversity according to geographic location, penicillin susceptibility, serotype, and multilocus enzyme electrophoresis (MLEE) pattern. The restriction endonucleases ApaI and SmaI were used to digest intact chromosomes, and the fragments were resolved by field inversion gel electrophoresis (FIGE). Each digest produced 10 to 19 fragments for comparison between strains. All the strains, including strains of the same serotype and strains with the same MLEE profile, had different FIGE patterns. In some cases, the restriction patterns differed by only a few fragment bands, and two isolates differed only in the location of a single DNA fragment. The polymorphism obtained with FIGE was greater than those obtained with serotyping and MLEE analysis. The stability of the FIGE profiles was established by testing of two independent clones derived from pneumococcus strain R36A. These results indicated that pulsed-field gel electrophoresis should be an effective tool for the typing of S. pneumoniae strains, capable of subdividing serotypes or MLEE types and of tracing the origin of pneumococcal strains.

[Multicenter study of the in vitro sensitivity of genital mycoplasmas to antibiotics]. / Etude multicentrique de la sensibilité in vitro des mycoplasmes génitaux aux antibiotiques.

The in vitro susceptibility of Ureaplasma urealyticum (Uu) and Mycoplasma hominis (Mh) was evaluated in a multicentric study performed in seven hospitals from different geographic areas in France. During a three month period, 324 Uu and 72 Mh clinical isolates were tested using a system ready for use, SIR Mycoplasma (Sanofi Diagnostics Pasteur). For Uu, the percentage of strains intermediate (I) or resistant (R) was as follows: doxycycline (3), minocycline (2.5), lymecycline (6.7), erythromycin (72, most I), josamycin (0.9), clindamycin (88), pristinamycin (0.3), ofloxacin (34, most I). For Mh, the percentage of strains I or R was respectively: doxycycline (2.7), minocycline (5.5), lymecycline (15.2), erythromycin (100), clindamycin (1.4), ofloxacin (2.7), josamycin (0) and pristinamycin (0). Comparable results were observed in the different geographic areas. The frequency of acquired resistances does not justify modifications in the usual treatment of genital mycoplasma infections but leads to monitor their susceptibility to antibiotics.

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.

[Recent bacteriologic data: from physiopathology to treatment]. / Données bactériologiques récentes: de la physiopathologie au traitement.

Bacterial vaginosis is characterized by a change in the vaginal ecosystem in which Lactobacillus spp, the dominant members of the normal flora, are replaced by an association of various bacterial species including Gardnerella vaginalis, anaerobes (Bacteroides spp, Prevotella spp, Porphyromonas spp, Peptostreptococcus spp and Mobiluncus spp) and Mycoplasma hominis. The reasons for this imbalance are unknown, although the loss of lactobacilli that produce hydrogen peroxide (which is toxic for G. vaginalis and numerous anaerobes) may be an essential element. The introduction of one or several of these species into the vagina (they can occasionally be isolated in small numbers even in the absence of vaginosis) following intercourse or from the intestinal tract may also play a role. G. vaginalis itself is not considered to cause vaginosis, but is almost always present and multiplies rapidly; in addition, it has a high capacity for adherence to epithelial cells both in vivo and in vitro. It is now agreed that the concomitant growth of one or several anaerobic species is required for bacterial vaginosis to develop. Our knowledge of the bacteriology of bacterial vaginosis has implications for diagnosis and treatment. It is now possible to obtain a precise bacteriologic diagnosis, not by culturing G. vaginalis (a costly and low-yield procedure), but by direct examination of the vaginal flora after Gram staining, which shows the replacement of lactobacilli by a characteristic polymorphic flora. Therapy is based on the use of antibiotics such as the imidazoles, which are active against G. vaginalis and anaerobes, but not against the commensal lactobacilli.(ABSTRACT TRUNCATED AT 250 WORDS)

[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.