Listeria monocytogenes-associated respiratory infections: a study of 38 consecutive cases.

OBJECTIVES: Listeria monocytogenes (Lm) is a foodborne human pathogen responsible for severe infections, including septicaemia, neurolisteriosis, and maternal-foetal and focal infections. Little is known about Lm-associated respiratory tract or lung infections. METHODS: We conducted a retrospective study of culture-proven cases of Lm pleural infections and pneumonia reported to the French National Reference Centre for Listeria from January 1993 to August 2016. RESULTS: Thirty-eight consecutive patients with pleural infection (n = 32), pneumonia (n = 5), or both (n = 1) were studied; 71% of these were men. Median age was 72 (range 29-90). Two patients presented with concomitant neurolisteriosis. All patients but one reported at least one immunosuppressive condition (97%), with a median number of 2 (range 0-5), including 29% (8/28) with current exposure to immunosuppressive therapy and 50% (17/34) with ongoing neoplasia; 75% (21/28) reported previous pleural or pulmonary disease. Antibiotic therapy mostly consisted in amoxicillin (72%) associated with aminoglycoside in 32%. Chest-tube drainage was performed in 7/19 patients with empyema (37%); 25% of the patients (7/30) required intensive care management. In-hospital mortality reached 35% and occurred after a median time interval of 4 days (range 1-33 days). Three patients had recurrence of empyema (time interval of 1 week to 4 months after treatment completion). Altogether, only 13/31 patients (42%) diagnosed with Lm respiratory infection experienced an uneventful outcome at 2-year follow-up. CONCLUSION: Lm is a rare but severe cause of pneumonia and pleural infection in older immunocompromised patients, requiring prompt diagnosis and adequate management and follow-up.

Nonsurgical resolution of caudal mediastinal paraesophageal abscess in a cat.

A one-year-old, castrated male domestic short hair cat was admitted with a history of anorexia, regurgitation and pyrexia for two days. Fever and leukocytosis were identified. There were a large soft tissue density oval mass in the caudal mediastinum on thoracic radiographs, a fluid-filled oval mass in the caudal mediastinum on ultrasonography, and left-sided and ventrally displaced and compressed esophagus on esophagram. On esophageal endoscopy, there were no esophageal abnormalities. CT findings with a fluid filled mass with rim enhancement indicated a caudal mediastinal paraesophageal abscess. The patient was treated with oral antibiotics, because the owner declined percutaneous drainage and surgery. The patient was admitted on emergency with severe respiratory distress; and ruptured abscess and deteriorated pleuropneumonia were suspected. With intensive hospitalization care and additional antibiotic therapy, the patient had full recovery.

Effect of bovine apo-lactoferrin on the growth and virulence of Actinobacillus pleuropneumoniae.

Actinobacillus pleuropneumoniae (App) is a Gram-negative bacterium that causes porcine pleuropneumonia, leading to economic losses in the swine industry. Due to bacterial resistance to antibiotics, new treatments for this disease are currently being sought. Lactoferrin (Lf) is an innate immune system glycoprotein of mammals that is microbiostatic and microbicidal and affects several bacterial virulence factors. The aim of this study was to investigate whether bovine iron-free Lf (BapoLf) has an effect on the growth and virulence of App. Two serotype 1 strains (reference strain S4074 and the isolate BC52) and a serotype 7 reference strain (WF83) were analyzed. First, the ability of App to grow in iron-charged BLf was discarded because in vivo, BapoLf sequesters iron and could be a potential source of this element favoring the infection. The minimum inhibitory concentration of BapoLf was 14.62, 11.78 and 10.56 µM for the strain BC52, S4074 and WF83, respectively. A subinhibitory concentration (0.8 µM) was tested by assessing App adhesion to porcine buccal epithelial cells, biofilm production, and the secretion and function of toxins and proteases. Decrease in adhesion (24-42 %) was found in the serotype 1 strains. Biofilm production decreased (27 %) for only the strain 4074 of serotype 1. Interestingly, biofilm was decreased (60-70 %) in the three strains by BholoLf. Hemolysis of erythrocytes and toxicity towards HeLa cells were not affected by BapoLf. In contrast, proteolytic activity in all strains was suppressed in the presence of BapoLf. Finally, oxytetracycline produced synergistic effect with BapoLf against App. Our results suggest that BapoLf affects the growth and several of the virulence factors in App.

[Iatrogenic pleuropneumonia complicating central venous cannulation in a very low birth weight infant]. / Jatrogenna pleuropneumonia jako powilkanie cewnikowania zyl centralnych u noworodka.

BACKGROUND: Central venous cannulation is necessary for long-term parenteral nutrition in premature infants. Peripherally inserted long catheters are commonly used in these patients but even this relatively simple technique can end in serious complications. We present a case in which perforation of the vena cava and migration of the catheter to the intrapleural space resulted in multiple organ failure and death. CASE REPORT: A 700 g bw. infant, born at 28 weeks of gestation, was referred to our centre because of suspected bowel perforation. In the referring hospital, the infant had a central venous catheter inserted peripherally. The catheter migrated to the right intrapleural space, and parenteral formula was delivered over several hours to the right pleura, resulting in hydrothorax with serious compression of the lung and atelectasis. Emergency laparotomy did not reveal any pathology and a chest tube was inserted into the right pleura; the effusion fluid contained a large number fat particles. The child's condition worsened and he died 16 days after surgery because of multiple organ failure and sepsis. CONCLUSION: Accidental migrations of central venous catheters to the pleural space have been described by many authors. It can result in severe pneumonia, cardiac tamponade or sepsis and is often fatal. We conclude that central venous catheters in premature infants should be inserted under ultrasonography or fluoroscopy. Catheters should never be forced along vessels; their size ought to be adjusted to age, and a free outflow of blood should be obtained before they are used.

[Adult-onset Still's disease with pulmonary and cardiac involvement and response to intravenous immunoglobulin]. / Acometimento pulmonar e cardíaco em doença de Still do adulto e resposta à imunoglobulina intravenosa.

Cardiopulmonary manifestations of adult-onset Still's disease (AOSD) include pericarditis, pleural effusion, transient pulmonary infiltrates, pulmonary interstitial disease and myocarditis. Serositis are common but pneumonitis and myocarditis are not and bring elevated risk of mortality. They may manifest on disease onset or flares. Previously reported cases were treated with high-dose glucocorticoids and immunosupressants and, when refractory, intravenous immunoglobulin (IVIG). We report an AOSD patient whose flare presented with severe pleupneumonitis and myopericarditis and, following nonresponse to a methylprednisolone pulse, high dose of prednisone and cyclosporine A, recovered after a 2-day 1g/kg/day IVIG infusion.

Ocorrência de Actinobacillus pleuropneumoniae biótipo 1 em pulmões de suínos com pleuropneumonia no Norte de Portugal / Occurrence of Actinobacillus pleuropneumoniae biotype 1 in swine with pleuropneumonia in the North of Portugal

The isolation and identification of Actinobacillus pleuropneumoniae in swine lungs with pleuropneumonia in the North of Portugal were reported. A total of 127 swine lungs with and without lesions were examined. The system of lesions classification was based on a semi-quantitative method. Diagnosis was made by isolation and identification of the etiological agent in typical lesions. The occurrence of observed lesions was 75.6 percent and the occurrence of isolation of A. pleuropneumoniae was 19.7 percent. In 25 out of 96 (26.0 percent) lung samples with lesions of pleuropneumonia, A. pleuropneumoniae was isolated.

Pleuropneumonia as a sequela of myelography and general anaesthesia in a Thoroughbred colt.

A 3-year-old Thoroughbred colt was presented to the University Veterinary Centre Camden for evaluation of ataxia. The horse was anaesthetised to facilitate cervical radiography and myelographic examination of the spinal cord. Recovery from anaesthesia was uneventful. Five days after general anaesthesia the horse re-presented with pleuropneumonia. It was euthanased 24 hours after presentation on humane grounds. Necropsy revealed severe tracheal erosion over the middle third of the ventral surface of the trachea, pleuropneumonia and narrowing of the cervical cord between C4 and C6. It is postulated that extension and flexion of the neck during myelography resulted in movement of the endotracheal tube cuff, causing the tracheal lesion and predisposing the colt to pleuropneumonia. Severe tracheal lesions and pleuropneumonia have not been reported as sequela of equine myelography, and should be considered as possible complications following repeated cervical manipulation during myelography in the horse.

[Varicella: previously healthy children sometimes develop complications]. / Waterpokken: soms complicaties bij voorheen gezonde kinderen.

Three healthy boys, 3.5, 5 and 1.5 years of age, were admitted to hospital with a severe bacterial skin infection, cerebellar ataxia, and pneumonia, respectively, one week after the onset of varicella. They recovered completely after treatment. Studies in Europe report complications from varicella in 2.5% of healthy children. Most of these are neurological complications and secondary bacterial infections of skin and soft tissue. Last year, a European consensus was published that recommended that all healthy children be vaccinated against chickenpox. In The Netherlands, routine varicella zoster virus (VZV) vaccination has not (yet) been implemented. We propose a new discussion on the possible inclusion of VZV vaccination in the national vaccination programme.

Novel genes affecting urease acivity in Actinobacillus pleuropneumoniae.

Characterization of a series of urease-negative transposon mutations of Actinobacillus pleuropneumoniae revealed that many of the mutants had insertions 2 to 4 kbp upstream of the urease gene cluster. A 5-kbp upstream region of DNA was sequenced and found to contain six open reading frames (ORFs) transcribed in the same orientation as the urease genes. As well, a partial ORF, apuR, 202 bp upstream of these six ORFs, is transcribed in the opposite orientation. The predicted product of this partial ORF shows homology with many members of the LysR family of transcriptional regulators. Five of the ORFs (cbiKLMQO) appear to form an operon encoding a putative nickel and cobalt periplasmic permease system. The cbiM and cbiQ genes encode proteins that have sequence similarity with known cobalt transport membrane proteins, and the cbiO gene encodes a cobalt transport ATP-binding protein homologue. The product of the cbiK gene is predicted to be the periplasmic-binding-protein component of the system, though it does not show any sequence similarity with CbiN, the cobalt-binding periplasmic protein. Escherichia coli clones containing this putative transport operon together with the urease genes of A. pleuropneumoniae were urease positive when grown in unsupplemented Luria-Bertani broth, whereas a clone containing only the minimal urease gene cluster required the addition of high concentrations of NiCl(2) for full urease activity. This result supports the hypothesis that nickel is a substrate for this permease system. The sixth ORF, utp, appears to encode an integral membrane protein which has significant sequence identity with mammalian urea transport proteins, though its function in A. pleuropneumoniae remains to be determined.

[Acute pleuro-pneumonitis resulting from leptospirosis]. / Une pleuro-pneumopathie sévère révélant une leptospirose.

We report a case of acute pneumonitis with pleural effusion and respiratory distress syndrome that was the inaugural sign of leptospirosis in a 37-year-old patient exposed to rat dejections at home. The patient was given penicillin and oxygen therapy with evacuation of the pleural effusion. Lung manifestations in leptospirosis usually occur as non-specific cough and hemoptysis. Pleural effusion is uncommon. Adult respiratory distress syndrome and profuse hemoptysis can also occur, requiring special care.

Towards an understanding of equine pleuropneumonia: factors relevant for control.

OBJECTIVE: To review relevant literature on factors associated with the development of equine pleuropneumonia. DESIGN: A review of the literature using a range of databases including Current Contents, Medline, ChemAbstracts, Biological Abstracts and CAB and a comprehensive search strategy which involved use of keywords, author and subject category searches. Additional sources included review of articles cited by key accumulated references. RESULTS: Since the early years of this century, many of the "gaps" in our knowledge of the pathogenesis of this disease have been filled. We now know that equine pleuropneumonia results from contamination of the lower respiratory tract with bacteria similar to the normal oropharyngeal microbiota of the horse and that transportation of any mode, especially over long distances (and consequently with no or short rest periods), is the single most important predisposing factor for this disease. This is associated with restraint of horses such that they are unable to lower their heads, which leads to increased opportunity for lower respiratory tract contamination and a reduced opportunity for clearance. Strenuous exercise also results in lower respiratory tract contamination and exercise subsequent to transportation exerts additive detrimental effects on the defenses of the lower respiratory tract. CLINICAL IMPLICATIONS: While modern veterinary medicine and surgery have significantly reduced the death rate from pleuropneumonia, horses that develop the disease have a high probability of not returning to their prior use. This underscores the importance of developing the most effective strategies for its prevention.

[THe etiology of pleuropneumopathies in infants and small children]. / Etiologia pleuropneumopatiilor la sugar si copilul mic.

In a follow-up study during 20 years (1975-1994) we observed, beside clinical aspects, the evolution of pleuropneumopathies in infants and small children (1-3 years of age), and the etiology of these infections. The casuistry includes 456 children-237 infants (51,97%) and 219 small children, between 1-3 years of age (48,02%), which were admitted in Clinical Children's Hospital from Oradea (Clinical Hospital for Children) with pleuropneumopathies. 4 intervals of time were analyzed comparatively, each of 5 years, starting with a number of 235 cases in the first one and reaching only 45 observations in the last one. The etiology was dominated by coagulase-negative and coagulase-positive Staph, aureus (34,20-60,40%), Strept. pneumoniae (14,10-40,00%). From the Gram negative bacteria, there were identified Kl. pneumoniae (2,20-9,80%), Pseudomonas sp. (2,20-5,19%), E. coli and Proteus sp. (1,70-2,20%). There were 2,90-9,85% of cases with a potential of pathogenicity, in various associations. In the last 10 years, the number of cases with unprecised etiology is growing (22,50-33,30%) probably because of the implication of anaerobe and coagulase-negative staphylococci, no tests of isolation and identification being made for them.

Case-control study of risk factors for development of pleuropneumonia in horses.

Risk factors for development of pleuropneumonia were determined by reviewing medical records of 45 horses with pleuropneumonia and 180 control horses examined between Jan 1, 1980 and Jan 1, 1990. Factors considered included age, breed, sex, occupation, transport farther than 500 miles within the previous week, racing within the previous 48 hours, viral respiratory tract infection or exposure to horses with viral respiratory tract disease within the previous 2 weeks, and vaccination against influenza or rhinopneumonitis within the previous 6 months. Results indicated that Thoroughbreds were at a greater risk of developing pleuropneumonia than were other horses, and Standardbreds were at a reduced risk. Transport farther than 500 miles and viral respiratory tract disease or exposure to horses with respiratory tract disease were determined to be risk factors for the development of pleuropneumonia.

Equine pleuropneumonia.

Pleuropneumonia is a clinically important equine disease, predisposed by a number of identifiable factors. Successful management is largely dependent on early identification and prompt initiation of appropriate treatment strategies. Rapid resolution of the disease process is associated with appropriate treatment commenced within 48 h of the causative insult. Lower airway contamination by oropharyngeal organisms and subsequent extension into the pulmonary parenchyma results in respiratory dysfunction and systemic toxaemia. Acute disease is associated with the isolation of facultatively anaerobic organisms, especially beta-haemolytic Streptococcus spp. and Pasteurellaceae. Delayed or inappropriate treatment is likely to result in chronic disease characterized by the involvement of anaerobic bacteria and a poor response to therapy. The primary mode of treatment for anaerobic infection of the human thorax is surgical drainage and resection of necrotic tissue but whilst such techniques have been described for the management of equine pleuropneumonia, the size of the equine thoracic cavity hinders accurate diagnostic evaluation and successful completion of such intervention. The chronic nature and cost of ongoing treatment and limitations on choice of antimicrobial agents warrant a poor prognosis for survival and a poorer prognosis for return to athletic endeavour.

Molecular investigation of the role of ApxI and ApxII in the virulence of Actinobacillus pleuropneumoniae serotype 5.

The extracellular hemolytic toxins (ApxI and ApxII) of Actinobacillus pleuropneumoniae are thought to be important factors in this microorganism's virulence and the pathogenesis of swine pleuropneumonia. Using the polymerase chain reaction, the apxI locus of a non-hemolytic, avirulent mutant of A. pleuropneumoniae serotype 5 (mIT4-H) generated by chemical mutagenesis (Inzana T. J., Todd J., Veit H. P. Microb Pathog 1991; 10: 281-96) was found to contain deletions that affected major parts of the entire apxICABD operon, thus inactivating each gene in the operon. The apxII locus was not affected. Monoclonal antibodies to ApxI and ApxII were used to confirm that ApxI was not synthesized, and that ApxII was synthesized but not secreted from the cell. The apxICABD genes and apxIBD genes were cloned into a broad host range vector to obtain plasmids pJFF800 and pJFF801, respectively. Each recombinant plasmid was electroporated into strain mIT4-H to obtain strain mIT4-H/pJFF800 and strain mIT4-H/pJFF801, respectively. Strain mIT4-H/pJFF800 exported ApxI and ApxII, and produced hemolytic activity comparable to or exceeding that of wild type strain J45. Strain mIT4-H/pJFF801 exported only ApxII and produced weak hemolytic activity. Strain mIT4-H/pJFF800 was virulent in mice, and had an LD50 of about 2 x 10(6) colony forming units. In contrast, mIT4-H/pJFF801 and mIT4-H were essentially avirulent in mice, and LD50s for these strains could not be calculated. Strain mIT4-H/pJFF800 was virulent in pigs and caused lethal pleuropneumonia, whereas parent strain mIT4-H was avirulent. Strain mIT4-H/pJFF801 was also able to induce pleuropneumonia in pigs, although a higher dose was required to induce lesions similar to those caused by mIT4-H/pJFF800. Thus, A. pleuropneumoniae strains that produce ApxI and ApxII require ApxI for full virulence and toxic activity in pigs. However, other factors including ApxII contribute to the virulence of A. pleuropneumoniae in pigs.

Inflammation and increased numbers of bacteria in the lower respiratory tract of horses within 6 to 12 hours of confinement with the head elevated.

Confinement of horses with their heads elevated for periods up to 24 hours was used to evaluate the extent and the effects of bacterial contamination of the equine lower respiratory tract. Significant (P < 0.05) increases in bacterial numbers (up to 10(9) colony forming units/mL in transtracheal aspirate derived samples) occurred within 6 or 12 hours in most horses. Pasteurella/Actinobacillus spp and Streptococcus spp were most commonly isolated. Lowering of the head for 30 minutes every 6 hours to facilitate postural drainage did not prevent multiplication of organisms to levels equivalent to those achieved by horses where the head was elevated for 24 hours. When horses were released from confinement and heads were no longer maintained in an elevated position, clearance of accumulated secretions and bacteria occurred within 8 to 12 hours. Thus, confinement with the head elevated resulted in significant bacterial contamination and multiplication within the lower respiratory tract during a period often encountered in routine management procedures, such as transportation. The clearance of accumulated secretions occurred over a prolonged period after release from such confinement.