Microbial

Curr Opin Otolaryngol Head Neck Surg, 2005 Feb, 13(1), 2 - 8
New paradigm for the roles of fungi and eosinophils in chronic rhinosinusitis; Sasama J et al.; PURPOSE OF REVIEW: Chronic rhinosinusitis represents a challenge with its poorly understood pathophysiology and limited treatment options . Potential roles of fungi and eosinophils in the etiology and pathophysiology of chronic rhinosinusitis are summarized . RECENT FINDINGS: Previously, the fungal role in chronic rhinosinusitis was limited to the rare subgroup, allergic fungal rhinosinusitis . Critical examination of earlier diagnostic criteria for allergic fungal rhinosinusitis reveals limitations . By using updated diagnostic standards and novel sensitive techniques to detect fungi, a higher number of patients can now be diagnosed with fungal rhinosinusitis . A novel non-IgE-mediated immunologic mechanism in chronic rhinosinusitis patients links the predominant eosinophilic inflammation to certain fungi . Overall, these new findings have implications for surgical and medical approaches, including anti-inflammatory and antifungal medications . SUMMARY: Several classification schemes and diagnostic criteria describe chronic rhinosinusitis and make comparisons difficult . Preselection of patient groups within the chronic rhinosinusitis population and the lack of sensitive diagnostic techniques have prevented a full understanding of the syndrome complex of chronic rhinosinusitis . New results suggest a broader role for fungi in the pathophysiology of chronic rhinosinusitis, linking the eosinophilic inflammation to the presence of certain molds in the nasal and paranasal cavities . Although fungi are commonly found in nearly everyone, only chronic rhinosinusitis patients respond to them with an eosinophilic inflammation . These findings support a shift in the etiologic understanding of chronic rhinosinusitis away from a bacteriologic infectious pathogenesis to a fungal-driven inflammatory pathophysiology . Herein, the authors review earlier studies and describe an updated view on an old paradigm.

Indian J Med Res, 2004 Dec, 120(6), 523 - 6
Chromobacterium violaceum septicaemia from north India; Ray P et al.; Though Chromobacterium violaceum is a common inhabitant of soil and water in tropical and sub-tropical regions, human infections are rare but when they do occur result in high mortality . Since the first case from Malaysia in 1927, about 150 cases have been reported in world literature . Till date 6 cases have been reported from southern and eastern parts of India . We report here a case of C . violaceum septicaemia, probably the first case from north India . The patient, a 6 and a half year old boy was admitted with high fever . The patient had anaemia, neutrophilic leucocytosis and bilateral chest infiltrates . Routine and bacteriological investigations were carried out to establish the aetiological diagnosis . C . violaceum was isolated in pure culture from blood and pus . The patient was successfully treated with ciprofloxacin and amikacin . This is probably the first documented case report of C . violaceum infection from north India and the only Indian case with septicaemia which survived.

Chest, 2005 Jan, 127(1), 233 - 241
Cytomegalovirus Infection in Critically Ill Patients: Associated Factors and Consequences; Jaber S et al.; OBJECTIVE: To determine the prevalence, associated findings, and consequences of cytomegalovirus (CMV) antigenemia in critically ill patients . DESIGN: A retrospective, case-control clinical study . SETTING: A 12-bed university hospital medical-surgical ICU . PATIENTS: Two hundred thirty-seven patients with fever for > 72 h, without proven evidence of bacteriologic and/or fungal origin, and whose pp65 antigenemia assays were studied . Patients with HIV infection and transplant recipients were excluded . INTERVENTIONS: None . MEASUREMENTS AND RESULTS: CMV antigenemia was diagnosed within 20 +/- 12 days (mean +/- SD) after ICU admission in 17% patients in whom the pathology was suspected . The 40 patients in the CMV group were matched with 40 other patients in the control group . CMV infection was linked to renal failure (58% vs 33%, respectively; p = 0.02) and steroid use (55% vs 33%, respectively; p = 0.04) . Patients with CMV had a significantly longer stay in the ICU (41 +/- 28 days vs 31 +/- 22 days, respectively; p = 0.04), a longer duration of mechanical ventilation (35 +/- 27 days vs 24 +/- 20 days, respectively; p = 0.03), a higher rate of nosocomial infection (75% vs 50%, respectively; p = 0.04), and a higher mortality (50% vs 28%, p = 0.02) . CONCLUSIONS: CMV antigenemia is not an uncommon diagnosis in critically ill ICU patients with unexplained prolonged fever after 10 days of hospitalization, regardless of their immune system status . Although associated with a higher morbidity and mortality, the clinical significance of CMV is unknown . Further prospective studies should evaluate the impact on ICU outcome and whether CMV is truly a pathogen or simply another indicator of immunosuppression.

Int J Syst Evol Microbiol, 2005 Jan, 55(Pt 1), 1 - 2
Validation of publication of new names and new combinations previously effectively published outside the IJSEM; Lack of enteral nutrition-effects on the intestinal immune system; Section of Pediatric Surgery, C . S . Mott Children's Hospital, University of Michigan Health System, Ann Arbor, Michigan, USABACKGROUND: Total parenteral nutrition (TPN) results in a loss of mucosal immune function by alterations in both phenotype and function of intraepithelial lymphocytes (IEL) . We hypothesized that the observed changes with TPN administration are caused by the lack of enteral feeding, and not to the TPN solution itself . METHODS: Mice received oral feeding (Control), TPN alone (TPN), or TPN plus oral feeding (TPN+Food) . Mice were killed after 7 days, and bacteriological cultures from spleen, liver, and mesenteric lymph nodes obtained, with bacterial translocation (BT) being defined as a positive culture . IEL phenotype was analyzed by flow cytometry . IEL messenger RNA (mRNA) cytokine expression used reverse transcriptase polymerase chain reaction (RT-PCR) . Apoptosis was detected by terminal deoxynucleotidyl transferase biotin-dUTP nick end labeling (TUNEL) staining . RESULTS: BT significantly (P < 0.05, with analysis of variance {ANOVA}) increased in the TPN group (53%) compared with Control (9%) and TPN+Food (14%) groups . TPN also resulted in a significant (P < 0.01) increase in epithelial cell apoptosis: TPN 7.6 +/- 1.1% versus Control 2.9 +/- 1.1% and TPN+Food 2.1 +/- 0.3% (mean +/- SD) . Height of the villus-crypt complex was significantly decreased in TPN mice (315 +/- 16 mum) compared with Control (431 +/- 27 mum) and TPN+Food (421 +/- 26 mum) groups . IEL phenotypes significantly changed with TPN administration: CD4(+)CD8(-) as well as CD4(+)CD8(+) subpopulations were reduced compared with Control or TPN+Food mice; as were the CD8alphabeta(+) thymus-dependent, and CD8(+)CD44(+) mature IEL . IEL cytokine mRNA expression was also significantly altered with TPN: IL-2 and IL-10 expression declined, and IL-4 IL-6, interferon gamma (IFN-gamma), transforming growth factor beta-(1) (TGF-beta(1)), and tumor necrosis factor-alpha (TNF-alpha) were increased, when compared with Control or TPN+Food mice . CONCLUSIONS: This study demonstrates that the major factor responsible for TPN-induced BT and IEL-changes is the lack of enteral feeding and not the administration of the TPN solution itself.

Cancer Biother Radiopharm, 2004 Oct, 19(5), 613 - 20
Efficacy of (99m)Tc-EDDA/HYNIC-TOC Scintigraphy in Differential Diagnosis of Solitary Pulmonary Nodules; Plachcinska A et al.; Fifty consecutive patients with solitary pulmonary nodules (SPN) on chest radiographs were studied scintigraphically after the administration of a somatostatin analog (99m)Tc-EDDA/HYNIC-TOC . The activity amounted to 740-925 MBq and a single photon emission computed tomography (SPECT) technique was applied . Verification of the nodule etiology was based on histology or cytology and bacteriology . As additional criterion for nodule benignity, its stable size in a chest radiograph for at least 3 years was accepted . In 31 patients, malignant etiologies of nodules were found . The diagnoses included: 11 adenocarcinomas, 6 squamous-cell carcinomas, 2 large-cell carcinomas, 6 nonsmall-cell lung cancers (NSCLC) of unspecified, more detailed morphology, 2 small-cell lung cancers (SCLC), 2 typical carcinoids, and 2 metastatic tumors: leiomyosarcoma and malignant melanoma . In 19 patients, the following benign tumors were diagnosed: 6 tuberculomas, 2 other granulomas, 4 hamartomas, 2 nonspecific inflammatory infiltrates, 1 abscess, 1 peripheral carcinoid of morphological characteristics of a benign tumor, 1 ectopic lesion of thyroid tissue, and 2 benign tumors of unspecified etiology, with stable size over 3 and 5 years . Positive scintigraphic results were obtained in 28 of 31 patients (90%) with malignant SPNs; among these there were 26 of 27 (96%) cases of primary pulmonary carcinoma . The remaining 2 false-negative cases included metastatic tumors: liposarcoma and melanoma . Among 19 benign lesions, 15 (79%) did not accumulate the radiopharmaceutical . The remaining 4 tumors visible on scintigrams included: 1 tuberculoma, 1 hamartoma, 1 abscess, and 1 case of nonestablished diagnosis (with stable size over 3 years) . In conclusion, scintigraphy with (99m)Tc-EDDA/HYNIC-TOC appears to be an effective procedure for differentiation between malignant and benign SPNs.

Intern Med, 2004 Dec, 43(12), 1201 - 4
Rheumatoid arthritis complicated with acute interstitial pneumonia induced by leflunomide as an adverse reaction; Kamata Y et al.; A 49-year-old Japanese man with rheumatoid arthritis acutely developed a skin eruption and severe non-productive cough seventeen days after the administration of leflunomide . Because all bacteriology findings were negative, steroid pulse-therapy was initiated promptly due to the rapidity of chest X-ray progression and the deterioration of arterial blood oxygen pressure . Although cough was induced by methotrexate, interstitial pneumonia was not detected clinically before leflunomide administration . He finally died of respiratory failure 128 days after the onset of acute interstitial pneumonia . According to the post-market surveillance, as high as approximately 1.1% of the patients on,leflunomide have developed interstitial pneumonia in Japan . It is important to emphasize that acute interstitial pneumonia due to leflunomide is a very severe and potentially fatal side effect.

Khirurgiia (Sofiia), 2003, 59(4), 3 - 7
{Mediastinitis--diagnostics and surgical treament}; SLC11A1 (NRAMP1) but not SLC11A2 (NRAMP2) polymorphisms are associated with susceptibility to tuberculosis in a high-incidence community in South Africa; Medical Biochemistry and MRC Centre for Molecular and Cellular Biology, Stellenbosch University, Tygerberg, South Africa . egvh@sun.ac.za

SETTING: Stellenbosch University Faculty of Health Sciences, and metropolitan Cape Town, Western Cape, South Africa . OBJECTIVE: To investigate whether the reported association between SLC11A1 (also NRAMP1) polymorphisms and susceptibility to tuberculosis (TB) can be confirmed in a different population, and whether polymorphisms in SLC11A2 (also NRAMP2, DCT1, DMT1) are associated with TB . DESIGN: A case-control study design was used to compare the frequencies of five polymorphisms in SLC11A1 and three in SLC11A2 between a group of bacteriologically confirmed TB patients and healthy community controls . RESULTS: The 5' (GT)9 allele in the promoter of SLC1A1 was found at significantly higher frequencies among 265 controls than in 224 pulmonary TB (PTB) patients (P = 0.002; OR 0.6; 95% CI 0.43-0.83) . Homozygotes for the TGTG deletion (1729+55del4) in the 3'UTR of SLC11A1 were over-represented among PTB patients (P = 0.013; OR 5.19; 95% CI 1.42-18.94) . Stepwise logistic regression analysis indicated that the 5' and 3' polymorphisms contribute separate main effects . Tuberculous meningitis patients (n = 22) showed the same allele and genotype frequency as PTB patients . No SLC11A2 polymorphisms tested were associated with TB . CONCLUSION: The 5' (GT)n allele driving the highest rate of transcription of SLC11A1 appears to be associated with protection against TB in the majority of the populations studied.

Zhonghua Yi Xue Za Zhi, 2004 Nov 17, 84(22), 1876 - 8
{Comparative study on cefdinir and cefaclor in the treatment of patients with mild to moderate bacterial community acquired pneumonia.}; Jiang XT et al.; OBJECTIVE: To evaluate the efficacy and safety of cefdinir in the treatment of patients with mild to moderate bacterial community acquired pneumonia (CAP) . METHODS: A prospective single-blind randomized controlled clinical study was performed comparing cefdinir with cefaclor in the treatment of sixty-four patients with CAP . The clinical and bacteriological efficacy and safety were compared between cefdinir and cefaclor in treating mild to moderate CAP . Thirty-three patients were treated with cefdinir 100 mg, orally, threatimes a day (cefdinir group), thirty-one patients were treated with cefaclor 500 mg, orally, threatimes a day (cefaclor group) . In both groups 7 - 14 d was a treatment course . RESULTS: The cure rate of cefdinir and cefaclor was 84.8% and 77.4% respectively and the overall efficacy rate was 93.9% and 87.1% respectively . The bacterial positive rates and bacterial eradication rates of the two groups were 81.8%, 80.7% and 96.3%, 88%, respectively . The adverse drug teaction rate were 3% in cefdinir group and 6.5% in cefaclor group . There was no statistical significant difference between the two groups for the above results (P > 0.05) . The time of given medicine of cefdinir and cefaclor was (10.8 +/- 1.6) d and (12.1 +/- 1.7) d (P < 0.01) respectively . CONCLUSION: cefdinir is safe and effective, shorten the course of treatment in the treatment of mild to moderate bacterial community acquired pneumonia.

Rev Med Suisse Romande, 2004 Nov, 124(11), 693 - 5
{In Process Citation}; Sibai K et al.; Lemierre syndrome (also called post-anginal sepsis or necrobacillosis) is an uncommon complication of oropharyngeal infections for which early recognition and aggressive therapy is mandatory, since it is potentially life-threatening . Due to it's rarity, with a prevalence of 0.8 cases per million in the general population, many physicians are unfamiliar with this disorder . This is attested by the fact that diagnosis most often relies on bacteriological grounds . We report the case of a patient whose diagnosis of thrombophlebitis of the internal jugular vein was made by the emergency physicians based upon clinical presentation, allowing for prompt initiation of adequate antibiotherapy . The aim of this report is to enhance general practitioner's and emergency physicians' awareness of this uncommon disorder, which should always be suspected in case of sepsis following an oropharyngeal infection.

Kekkaku, 2004 Oct, 79(10), 561 - 7
{Miss-managements in treatment failure of pulmonary tuberculosis}; Ito K et al.; PURPOSE: To investigate the risk factor of treatment failure of pulmonary tuberculosis excluding multi-drug resistant cases from the standpoint of both clinical management and tuberculosis control . OBJECT AND METHOD: Retrospective chart review of patients who admitted to Fukujuji Hospital for treatment failure of pulmonary tuberculosis excluding multi-drug resistant cases from Jan . 1993 to Dec . 2003 . RESULTS: Out of 24 treatment failure cases available for analysis, 4 cases were associated with chronic tuberculous empyema with broncho-pleural fistula, and among them, chronic empyema was considered to be the main cause of treatment failure in one case . In 6 cases, poor adherence to medication was confirmed or suspected, and 2 of these 6 cases was also associated with miss-management . In 9 cases miss-management was found without poor adherence or chronic empyema, and in 8 out of these 9 cases, miss-management was considered to be the main cause of treatment failure . In 5 cases no apparent risk factor was found, but in 2 out of these 5 cases the ignorance of the results of drug sensitivity tests (and, therefore, miss-management) was strongly suspected . Summing up, in 10 out of 24 cases (41.7%), the miss-management was considered to be the main cause of treatment failure, and it was more frequently seen than poor adherence to medication . CONCLUSION: Clinicians should be aware of these risk factors of treatment failure such as chronic empyema, weak regimen in bacteriological negative cases, rifampicin+ethambutol regimen, and miss-management of drug adverse effect . From the standpoint of tuberculosis control in Japan we considered that, in addition to DOT, strategy to secure the quality of tuberculosis treatment is by all means needed.

Vet Microbiol, 2005 Jan 31, 105(2), 103 - 11 Epub 2004 Dec 16.
Prevalence of Brucella pinnipediae in healthy hooded seals (Cystophora cristata) from the North Atlantic Ocean and ringed seals (Phoca hispida) from Svalbard; Tryland M et al.; Investigations for Brucella-infections were conducted in 29 hooded seals (Cystophora cristata) caught between Svalbard and Greenland (North Atlantic Ocean; Greenland Sea) autumn 2002, and from 20 ringed seals (Phoca hispida) caught in Billefjord, Svalbard, spring 2003 . All animals were apparently healthy and were caught in their natural habitat . Bacteriology on tissue samples from ringed seals was negative, whereas Brucella sp . were recovered in tissues from 11 of the 29 hooded seals (38%), with the highest tissue prevalence in spleen (9/29) and lung lymph nodes (9/24) . Anti-Brucella antibodies were detected in sera from 9 hooded seals (31%) (EDTA-modified Slow Agglutination test of Wright, Rose Bengal test, Complement Fixation Test, and Protein-A ELISA) . The bacterial isolates all belonged to the genus Brucella according to classical biotyping and PCR analysis based on Insertion Sequence IS711, and were shown to be typical marine mammal strains, based on the occurrence of an IS711 element downstream of the bp26 gene . Their dependency on CO(2) for growth, and the presence of one copy each of the omp2a and omp2b gene finally classified them as Brucella pinnipediae . Furthermore, all the hooded seal isolates showed an A+ M+ agglutination profile, which is different from the profile of reference seal strain 2/94 (harbour seal, Phoca vitulina) . Thus, these results indicate that B . pinnipediae may contain different biovars . The present results suggest that infection with B . pinnipediae is enzootic in this population . Since the hooded seal is commercially hunted and consumed in Norway, the pathological impact of such infections and their zoonotic potential should be further addressed.

Med Mal Infect, 2004 Aug-Sep, 34(8-9), 364 - 70
{Clinical and bacteriological diagnosis of tuberculosis}; Efficacy and safety of pharmacokinetically enhanced amoxicillin-clavulanate at 2 et al.; University of Buffalo, 3495 Bailey Ave., Medical Research 151, Buffalo, NY 14215, USA . ssethi@buffalo.edu

This randomized, controlled trial was designed to show that a short, 5-day course of pharmacokinetically enhanced amoxicillin-clavulanate at 2,000/125 mg (Augmentin XR) is as effective clinically as a longer, 7-day course of conventional amoxicillin-clavulanate at 875/125 mg (both given twice daily) in the treatment of acute exacerbations of chronic bronchitis (AECB) . Amoxicillin-clavulanate at 2,000/125 mg was designed to extend the therapeutic levels of amoxicillin in serum over the 12-h dosing interval, compared with conventional formulations, to eradicate bacterial strains for which amoxicillin MICs were < or =4 microg/ml while retaining efficacy against beta-lactamase-producing pathogens . A total of 893 patients were randomized and received study medication (amoxicillin-clavulanate at 2,000/125 mg for 443 patients and 875/125 mg for 450 patients) . Overall, 141 patients receiving amoxicillin-clavulanate at 2,000/125 mg and 135 receiving the comparator formulation had at least one pathogen identified at screening . Amoxicillin-clavulanate at 2,000/125 mg was as effective clinically in the per-protocol (PP) population at the test of cure (days 14 to 21, primary efficacy endpoint) as amoxicillin-clavulanate at 875/125 mg (clinical success rates of 93.0 and 91.2%, respectively; treatment difference, 1.8; 95% confidence interval {CI}, -2.2, 5.7) . Bacteriological success in the bacteriology PP population was high for both formulations (amoxicillin-clavulanate at 2,000/125 mg, 76.7%; amoxicillin-clavulanate at 875/125 mg, 73.0%; treatment difference, 3.8; 95% CI, -7.5, 15.0) . Both therapies were well tolerated, with a similar incidence of adverse events . Fewer than 5% of patients in each group withdrew from the study due to adverse events . The shorter, 5-day course of amoxicillin-clavulanate at 2,000/125 mg was shown to be as effective clinically as a longer, 7-day course of amoxicillin-clavulanate at 875/125 mg, with high bacteriological efficacy and no difference in tolerability.

Vet Res, 2005 Jan-Feb, 36(1), 13 - 25
The effects of inoculation of Mannheimia haemolytica into the teat of lactating ewes; Mavrogianni VS et al.; The objectives of the work described in this paper were: (i) to study the outcome of challenging ewes with Mannheimia haemolytica, at different sites of their teats, (ii) to compare the effects of two different isolates of the organism and (iii) to describe the features of the resulting lesions . Thirty-two ewes were used in the study and allocated into one of two groups (A or B, n = 16); they were challenged with one of two isolates of M . haemolytica, respectively, strain ES26L of known pathogenicity or strain VSM08L from the teat duct of a healthy ewe . Each group was further divided into four equal subgroups: the ewes in the A1/B1 subgroups were intramammarily challenged; one teat of the ewes in the A2/B2 subgroups was immersed into a broth-culture of the organisms; one teat of the ewes in the A3/B3 subgroups was inoculated 2 mm-deep, whilst one teat of the ewes in the A4/B4 subgroups was inoculated 6 mm-deep . The animals were monitored clinically, bacteriologically and cytologically before and after challenge; one animal in each subgroup was euthanised 2, 4, 7 and 11 days after challenge . All ewes in the A1/B1 subgroups developed clinical mastitis, whilst of the other animals, only one ewe in each of the A4/B4 subgroups did . Neither of the two strains used was associated with more positive bacteriological or CMT results; the A2/B2 subgroups were associated with less positive results than the A3/B3 and A4/B4 subgroups . In some ewes of the A2/B2 subgroups, mild leucocytic infiltration in the teat was evident; in the ewes of the A3/B3 subgroups, leucocytic infiltration (neutrophils, lymphocytes, plasma cells) was seen, as well as a lymphoid hyperplasia at the border between the teat duct and teat cistern; in ewes of the A4/B4 subgroups, intense subepithelial leucocytic infiltration was the salient feature . No differences were found in the severity of lesions between the two strains used or the three treatments carried out . Although strain VSM08L had been isolated from the teat duct of a healthy ewe, it caused mastitis when inoculated intramammarily; although strain ES26L is of known pathogenicity for the mammary gland, it did not cause clinical mastitis when deposited 2 mm-deep into the teat . These findings point to a protective role of the teat of ewes, which appear to limit bacterial penetration from the teat duct or cistern to the mammary gland . The lymphoid tissue, at the border between the teat duct - teat cistern, may play a significant protective role.

Pol Merkuriusz Lek, 2004, 17 Suppl 1, 156 - 9
{The results of treatment of acute haemorrhagic necrotizing pancreatitis in the own material}; Jablonski S et al.; AIM OF WORK: The retrospective estimation of surgical procedure and the results of treatment of haemorrhagic necrotizing pancreatitis in the own material . MATERIAL AND METHODS: The estimated group consist of 161 patients from the clinic treated for heavy grade of acute pancreatitis . Characteristics which qualified patients to the chosen group were: aggravating general condition, biochemical parameters of disease's progression, results of radiological investigations (USG, CT of abdomen) and bacteriological culture from peritoneal cavity . RESULTS: 142 patients (88.2%) were surgically treated in different duration periods of illness (from 0 to 53 day of illness) . Firstly, they were intensively treated with conservative treatment . After about 9.6 days they were operated on (from 0 to 51 day of treatment) . Clinical symptoms such as: rapid aggravating general condition of patients, septic shock, as well as infected necrosis in radiological and bacteriological investigations, were indication to surgical intervention . The methods of surgical treatments were: laparotomy and flow drainage 73 patients, closed drainage 31 patients, repeated relaparotomy 25, Bradley's method 13 . Mortality in the group of operated patients was 5.9% . The most common causes of death were: respiratory insufficiency 29.4%, multiorgan insufficiency 21.6%, circulatory insufficiency 13.8%, insufficiency of kidneys 9.8% CONCLUSIONS: The authors suggest that the most important in deciding about necessity and time of surgical intervention of haemorrhagic necrotizing acute pancreatitis are individual clinical characteristics of patients . The lowest mortality was in the group of operated patients in later period of illness and who did not required reoperation.

Cell Tissue Bank, 2004, 5(4), 201 - 4
Keratocyte injury in human corneas cryopreserved under standard conditions; Villalba R et al.; This study was conducted to characterize ultrastructural damage to human corneas cryopreserved by a standard protocol . The materials used were seven human corneas that were unsuitable for transplantation due to the presence of positive bacteriological cultures; they were cryopreserved according the standard procedure . After freezing and thawing, samples were obtained for scanning and transmission electron microscopy studies . Marked damage was observed in keratocytes with signs of apoptotic cellular injury . However our observations have shown that apoptosis contribute less significantly than necrosis to cellular death in keratocytes of human corneas and although the control of apoptosis is clearly desirable, in order to improve the success of cryopreserved corneas for transplant, we need to continue our investigation to reduce the effects of the necrotic process.

J Dairy Sci, 2005 Jan, 88(1), 93 - 9
Comparative efficacy of local and systemic antibiotic treatment in lactating cows with clinical mastitis; Serieys F et al.; The intramuscular administration of penethamate hydriodide over 3 consecutive days and the intramammary administration of an ampicillin/cloxacillin combination were compared in lactating cows suffering from infectious clinical mastitis in one quarter, through an open, randomized, controlled multicenter field trial . Clinical examinations were carried out on d 1 (immediately before treatment), 3, 8, 17, and 22 . Milk samples were taken from affected quarters for bacteriological analysis on d 1, 17, and 22, and from all quarters for somatic cell count (SCC) determination on d 1, 8, 17, and 22 . There was no significant difference in bacteriological and clinical cure rates between the 2 treatment groups . The systemic treatment with penethamate resulted more frequently in a reduction of the milk SCC below the threshold of 250,000 cells/mL . This also occurred in the adjacent quarters not affected by clinical mastitis but with an SCC above 250,000 cells/mL before treatment . These findings suggest that the parenteral treatment with penethamate provides collateral cure on the quarters of the cows affected by subclinical mastitis . The number of quarters per cow affected by clinical or subclinical mastitis should be considered when selecting an antibiotic treatment by the local or systemic route.

Dis Aquat Organ, 2004 Oct 21, 61(1-2), 41 - 51
Isolation and characterization of mycobacteria from striped bass Morone saxatilis from the Chesapeake Bay; Rhodes MW et al.; Mycobacteriosis in striped bass Morone saxatilis of Chesapeake Bay, USA, was first diagnosed in 1997 based on the presence of granulomatous inflammation and acid-fast bacteria in skin and spleen . To confirm histopathology, bacteriological detection and identification of mycobacteria were begun using splenic tissue from fish with and without skin ulcerations . On the basis of initial studies using a variety of selective and nonselective media, decontamination, homogenization and incubation conditions, a simple and quantitative recovery method using aseptic necropsy of splenic tissue was developed . Optimal recovery was obtained by spread-plating homogenates on Middlebrook 7H10 agar with incubation for 3 mo at 23 degrees C . Mycobacteria were recovered from 76% (n = 149/196) of fish examined . Mycobacterial densities exceeded 10(4) colony forming units x g tissue(-1) in 38% of samples (n = 63/168) that were examined using a quantitative approach . The most frequently recovered mycobacterium, present in 57% (n = 109/192) of characterized samples, was the recently named new species Mycobacterium shottsii . Polyinfections of M . shottsii and other mycobacteria were observed in 25% of samples (n = 47/192) with densities of M . shottsii usually 1 or more orders of magnitude higher than co-isolate(s) . Other mycobacteria recovered included isolates that, based on phenotypic traits, resembled M . interjectum, M . marinum, M . scrofulaceum, M . szulgai and M . triplex . M . marinum, commonly associated with fish mycobacteriosis and human disease, was recovered infrequently (3%, n = 6/192) . The presence of multiple mycobacterial types occurring at high densities suggests that a variety of mycobacteria could be causative agents of mycobacteriosis in striped bass from the Chesapeake Bay . Striped bass is the major recreational fish species in the Chesapeake Bay, and the significance of the current epizootic to human health and the potential adverse effects on fish stocks are not known.

Hist Philos Life Sci, 2003, 25(3), 391 - 412
From miasma to asthma: the changing fortunes of medical geography in America; Mitman G et al.; Historians of modern medicine often divide their subject into two parts, separated by the bacteriological revolution of the late nineteenth century, when medicine supposedly became 'scientific' for the first time . The history of medical geography--to say nothing of other subjects--calls this common view into question . At least in the United States, students of medical geography, arguably the pre-eminent medical science in an age dominated by miasmatic theories of disease, readily adapted to the discovery of germs . And although bacteriology quickly eclipsed medical geography in the world of medicine, place remained an important consideration in treating asthma (and allergies generally) throughout the post-bacteriological period.

Chir Main, 2004 Oct, 23(5), 257 - 9
{Bone tuberculosis of the thumb unmasked by an injury}; Bellarbi S et al.; Tuberculous dactylis is uncommon, which makes it difficult to differentiate from tumorous and metabolic affections . Histological analysis constitutes a reliable and easy way to achieve a positive diagnosis, especially as the bacteriological findings can be negative . We report the case of a 43-year-old woman who consulted for a painful right thumb following an injury . Radiographs showed a fracture of the proximal phalanx through a lytic lesion . Pathology examination of a biopsy specimen revealed granulomata with caseous necrosis, specific to tuberculosis . The clinical signs and radiographs resolved after anti-tuberculosis treatment for 12 months.

Eur Respir J, 2004 Dec, 24(6), 947 - 53
Levofloxacin versus clarithromycin in COPD exacerbation: focus on exacerbation-free interval; Lode H et al.; Antibiotic treatment of bacterial exacerbation of chronic obstructive pulmonary disease (COPD) shows some immediate clinical benefits and may also minimise the frequency of further recurrences . Patients (n=511) were enrolled into a randomised double-blind multicentric study comparing the exacerbation-free interval (EFI), efficacy and safety of 7-day levofloxacin versus 10-day clarithromycin in patients with COPD exacerbation . Patients were monitored over a 1-yr period . A total of 434 patients (per protocol population) received the medication for > or =5 days . The median EFI in the per protocol population was 300 days for levofloxacin and 350 days for clarithromycin . For patients with a new documented exacerbation during follow-up (n=223), the median EFI was 100.5 days in the levofloxacin group and 95 days for clarithromycin . No significant differences in EFI between groups could be observed when stratifying the study population according to microbial aetiology and severity of bronchial obstruction . Levofloxacin and clarithromycin showed similar clinical success rates . The bacteriological success rate was significantly higher in the levofloxacin group . Both antibiotics were well tolerated . In summary, levofloxacin was associated with a significantly higher bacteriological eradication rate but similar exacerbation-free interval in patients with chronic obstructive pulmonary disease exacerbation compared to clarithromycin.

J Hosp Infect, 2005 Jan, 59(1), 53 - 61
Evaluation of antibiotic use in intensive care units of a tertiary care hospital in Turkey; Erbay A et al.; The object of this study was to evaluate the appropriateness of antibiotic use in relation to diagnosis and bacteriological findings in the intensive care units (ICUs) of a 1100-bed referral and tertiary care hospital with an antibiotic restriction policy in Turkey . Between June and December 2002, patients who received antibiotics in the medical and surgical ICUs were evaluated prospectively . Two infectious diseases (ID) specialists assessed the antibiotics ordered daily . Of the 368 patients admitted to the ICUs, 223 (60.6%) received 440 antibiotics . The most frequently prescribed antibiotics were first-generation cephalosporins (16.1%), third-generation cephalosporins (15.2%), aminoglycosides (12.1%), carbapenems (10.7%) and ampicillin-sulbactam (8.7%) . Antibiotic use was inappropriate in 47.3% of antibiotics . ID specialists recommended the use of 47% of all antibiotics . An antibiotic order without an ID consultation was more likely to be inappropriate {odds ratio (OR)=13.2, P<0.001, confidence intervals (CI)=4.4-39.5} . Antibiotics ordered empirically were found to be less appropriate than those ordered with evidence of culture and susceptibility results (OR=3.8, P=0.038, CI=1.1-13.1) . Inappropriate antibiotic use was significantly higher in patients who had surgical interventions (OR=3.6, P=0.025, CI=1.2-10.8) . Irrational antibiotic use was high for unrestricted antibiotics . In particular, antibiotic use was inappropriate in surgical ICUs . Additional interventions such as postgraduate training programmes and elaboration of local guidelines could be beneficial.

Acta Chir Belg, 2004 Oct, 104(5), 601 - 3
Isolated hepatic tuberculous pseudometastasis co-existent with adenocarcinoma of the stomach; report of a case; Sen M et al.; A 10 x 9 mm metastasis-like lesion in segment V of the liver was detected, when a 70-year-old man was operated on for adenocarcinoma of the stomach . Since exact diagnosis of the hepatic lesion could not be made by frozen sections, the lesion was excised, considering it to be a metastasis of gastric adenocarcinoma . Bacteriologic and pathologic studies established a diagnosis of isolated tuberculosis of the liver . A good response to antituberculous drug therapy was noted.

Zhonghua Yi Xue Za Zhi, 2004 Oct 17, 84(20), 1678 - 80
{The epidemic of childhood tuberculosis in China}; Li L et al.; OBJECTIVE: To analyze the epidemic situation of children Tuberculosis (TB) in China . METHODS: To sum up the data of four times national TB epidemic survey from 1979 to 2000, and analyze the epidemic situation of children whose age were between 0 and 14 . RESULTS: The TB prevalence rates in children were 8.8%, 9.6%, 7.5% and 9.0% in 1979, 1984/85, 1990, 2000 . The active pulmonary TB (PTB) prevalence rates in children were 241.7/100 000 172.1/100 000, 91.8/100 000 in 1979, 1990 and 2000, the bacteriological positive PTB prevalence rates were 12.7/100 000, 12.3/100 000 in 1990 and 2000, the smear positive PTB prevalence rates were 7.5/100 000, 7.5/100 000 and 6.7/100 000 in 1979, 1990 and 2000; It was estimated there were 26.08 million children who were infected by microbacterial TB, 266 thousands children active PTB cases, 36 thousands children bacteriological positive PTB cases and 19 thousands children smear positive PTB cases in 2000 according to the data of the national population survey . the rates were 4.5%, 5.9%, 1.8%, 1.3% when comparing them to the all patients . the ratio of children TB prevalence rates between city and country were 1.8, 1.8, 1.7 and 1.2 in the four survey . CONCLUSIONS: The TB prevalence rates in children had not obvious decrease from 1979 to 2000 were not allowed to optimize to the epidemic of children TB . The bacteriological negative PTB had a bigger . The difference of children TB prevelance between city and country reduced gradually . The quantity of sample and other factors influenced the forecast value of PPD to disease, so it would be a trend of using the routine surveillance to replace the national epidemic survey . BCG still would be the an important content in our national TB control before the emergence of the new and more efficient vaccine.

J Am Vet Med Assoc, 2004 Nov 15, 225(10), 1573 - 7, 1548
Putative transmission of Mycobacterium tuberculosis infection from a human to a dog; Hackendahl NC et al.; A 3.5-year-old Yorkshire Terrier was evaluated for anorexia and vomiting; infection with Mycobacterium tuberculosis was diagnosed by use of histology, bacteriologic culture, and polymerase chain reaction (PCR) assay on various tissues . The dog was living with a human with an established M . tuberculosis infection . Findings were unique in that diagnosis of M . tuberculosis infection was obtained via PCR techniques, and isolates from the owner and dog were matched via restriction fragment length polymorphism fingerprinting . Dogs infected with M . tuberculosis from humans are most commonly infected via the respiratory tract . Clinical signs in dogs are variable and depend on the integrity of the immune system and the degree of dissemination . Diagnosis can often be obtained through histopathology and bacteriologic culture; additional diagnostic techniques are also available . Treatment of a dog with confirmed M . tuberculosis infection is controversial, and at least 6 months of multidrug treatment is required.

Clin Diagn Virol, 1995 Jul, 4(1), 15 - 25
Large-scale evaluation of an alternative strategy for confirmation of HIV antibodies; Thorstensson R et al.; Objective: To retrospectively compare the accuracy of combinations of two enzyme-linked immunosorbent assays (ELISAs) with a Western blot based strategy for identification of human immunodeficiency virus type 1 (HIV-1) seropositivity . Materials and methods: 48,977 sera, sent to the National Bacteriological Laboratory, Stockholm, Sweden, for HIV antibody determinations between October 1988 and June 1993, were investigated . All samples were tested in parallel with two different ELISAs, either Abbott Recombinant HIV-1 EIA and Wellcozyme Recombinant Anti-HIV-1 EIA, or Enzygnost Anti-HIV-1/2 and Wellcozyme Recombinant Anti-HIV-1 EIA, or Enzygnost Anti-HIV-1/2 and Wellcozyme Anti-HIV-1+2 EIA . 1565 sera repeatedly reactive by one or both ELISAs were investigated by Western blot (WB) . Furthermore, a total of 2820 referred sera, screen reactive at primary laboratories but negative on our combinations of two ELISAs were analysed by WB . Results: Out of 1244 truly HIV antibody positive samples 1203 were WB positive and 41 (3.4%) were WB indeterminate . A sensitivity of 100% was obtained by all three combinations of two ELISAs on examination of these 1244 sera including repeated testing of 5 samples with initially discrepant results . Among 2820 sera from HIV-negative individuals 649 (23%) sera were WB indeterminate . The combination of Enzygnost (indirect test with synthetic peptides) and Wellcozyme (sandwich test with recombinant and synthetic peptides) Anti-HIV 1+2 EIAs was 100% specific when used for analysis of 9111 sera . One of 30,323 HIV-1 antibody negative sera tested was initially reactive on both Enzygnost Anti-HIV 1+2 and Wellcozyme Recombinant Anti-HIV-1 EIA (competitive assay) but was found to be negative by repeated testing, resulting in a specificity of 100% for that combination of ELISAs . Abbott Recombinant Anti-HIV-1 EIA (indirect assay) combined with Wellcozyme Recombinant Anti-HIV-1 EIA was initially falsely reactive with 12 of 8272 sera of which 6 were repeatedly reactive . Conclusions: This large-scale evaluation demonstrates that combinations of two ELISAs based on different test principles and antigens increase the accuracy of the HIV antibody determination and could be used as an alternative or complement to WB.

Am J Vet Res, 2004 Nov, 65(11), 1483 - 9
Investigation of the transmission of Mycobacterium bovis from deer to cattle through indirect contact; Palmer MV et al.; OBJECTIVE: To investigate the infection of calves with Mycobacterium bovis through oral exposure and transmission of M . bovis from experimentally infected white-tailed deer to uninfected cattle through indirect contact . ANIMALS: 24 11-month-old, white-tailed deer and 28 6-month-old, crossbred calves . PROCEDURE: In the oral exposure experiment, doses of 4.3 x 10(6) CFUs (high dose) or 5 x 10(3) CFUs (low dose) of M . bovis were each administered orally to 4 calves; as positive controls, 2 calves received M . bovis (1.7 x 10(5) CFUs) via tonsillar instillation . Calves were euthanatized and examined 133 days after exposure . Deer-to-cattle transmission was assessed in 2 phases (involving 9 uninfected calves and 12 deer each); deer were inoculated with 4 x 10(5) CFUs (phase I) or 7 x 10(5) CFUs (phase II) of M . Bovis . Calves and deer exchanged pens (phase I; 90 days' duration) or calves received uneaten feed from deer pens (phase II; 140 days' duration) daily . At completion, animals were euthanatized and tissues were collected for bacteriologic culture and histologic examination . RESULTS: In the low- and high-dose groups, 3 of 4 calves and 1 of 4 calves developed tuberculosis, respectively . In phases I and II, 9 of 9 calves and 4 of 9 calves developed tuberculosis, respectively . CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that experimentally infected deer can transmit M . bovis to cattle through sharing of feed . In areas where tuberculosis is endemic in free-ranging white-tailed deer, management practices to prevent access of wildlife to feed intended for livestock should be implemented.

Braz J Infect Dis, 2004 Aug, 8(4), 305 - 10 Epub 2004 Aug.
Diagnosis of pulmonary tuberculosis by score system in children and adolescents: a trial in a reference center in Bahia, Brazil; Sant'anna CC et al.; Since 2002, the Brazilian Ministry of Health has recommended a score system for tuberculosis diagnosis of children and adolescents that does not need bacteriological positivity, because most cases in this age group have few bacteria . An observational, transversal study was carried out at the outpatient health care service of the reference medical service in Salvador, Bahia, including 164 patients with pulmonary tuberculosis, with ages ranging between 1 and 15 years of age, who were treated from 1990 to 2001 . The gold standard used to establish the diagnosis was clinical, radiological, epidemiological and based on follow-up data . The score system for diagnosis purposes was tested retrospectively . The median age and the average age of the 164 patients were 6 and 6.62 years (SD +/- 4.33), respectively . About 65% of the sample reported a history of close contact with a tuberculous adult . The BCG vaccine coverage was 70.7% (116/164) . It was found that 26% (43/164) of the patients had severe malnutrition . Out of this group, 26/43 (60.47%) were < 5mm reactive to the tuberculin test . On the other hand, out of the 91 patients with tuberculin test < 5mm, 29% (26/ 91) had severe malnutrition . The use of the score gave the following distribution: a) TB very likely in 81.7% (134/164) of the patients; b) possible TB in 15.9% (26/164) and TB unlikely in 2.4% (4/164) . Among patients who had been vaccinated more than 2 years before, there was a 9 times higher risk of finding a tuberculin test above 10 mm in individuals with probable TB in comparison with the patients with possible or unlikely TB.

Eur J Dermatol, 2004 Nov-Dec, 14(6), 421 - 3
Relapsing herpes simplex-2 folliculitis in the beard area; Foti C et al.; We describe the case of a 52-year-old immunocompetent man with recurrent folliculitis on the left cheek, associated with intense pain . Bacteriological, mycological and Tzanck tests from the lesions were negative . Histopathological study showed an aspecific flogosis pattern . Virological tests carried out on swabs and paraffin-embedded tissue sections from the facial lesions by nested PCR technique (nPCR) demonstrated the presence of herpes simplex virus type 2 (HSV\2) in both samples . Skin swabs from other healthy areas of the face resulted negative for herpetic infection . A diagnosis of recurrent herpetic folliculitis by HSV\2 was made . This case report underlines that even in immunocompetent patients HSV\2 lesions can feature atypical clinical aspects . In dermatological assessment the benefits of routine PCR techniques for differential diagnosis of herpetic infection should be considered above all for the prompt initiation of antiviral therapy and appropriate patient management.

Transfus Clin Biol, 2004 Oct, 11(4), 221 - 7
{The responsibility of the physician prescriber of blood products}; Hergon E et al.; Blood transfusion presents mainly virological, bacteriological, immunohaematological and volemic risks; with the latter two particularly concerning health establishment employees . This article tackles the physician's responsibility in blood transfusion . Taking into account the regulations that surround the activity, prescribing physicians must know and put into action the relative requirements in their practises in order to avoid taking on its responsibility, or that of the health establishment in which they work, as any lack of respect for the rules and regulations could result in being held liable for any side affects suffered by the patient . The article has the objective of identifying the main regulation requirements in order to control them despite a difficult environment, from the point of view of patients' rights regarding the benefits and the consequences of transfusion . These requirements focus mainly on information and patient consent, the prescription of blood products as well post transfusion information and the follow-up care . Proof of respect for these rule requirements must be available for each of these aspects.

Trop Anim Health Prod, 2004 Aug, 36(6), 537 - 46
Evaluation of abattoir inspection for the diagnosis of Mycobacterium bovis infection in cattle at Addis Ababa abattoir; Asseged B et al.; Detailed postmortem examinations were conducted to evaluate the efficiency of meat inspection procedures and to determine the distribution of lesions in Mycobacterium bovis-infected cattle . The study involved routine inspection at slaughter, collection of tissues for detailed examination in the laboratory, and bacteriological examination to identify M . bovis . Additionally, a 10-year (1992--2001) meat inspection record was analysed to determine tuberculosis trends in the past decade . chi2-Test and simple regression were used to analyse the data . Out of 1350 cattle examined, 1.5% were found with tuberculous lesions . Routine abattoir inspection detected only 55% of cattle with confirmed lesions . Fifty-four per cent of tuberculous lesions were found in the lungs and thoracic lymph nodes, 23% in the lymph nodes of the head, and the remaining 23% in the mesenteric and other lymph nodes of the carcase . M . bovis was additionally isolated from an animal that had no gross lesions of tuberculosis . On average, the annual rate of whole-carcase condemnation due to generalized tuberculosis was 0.024% and it has increased annually by 0.34% over the past decade . The rate of whole-carcase condemnation indicates a high degree of TB transmission and requires immediate attention from both the economic and public health points of view . The lower sensitivity of routine abattoir inspection confirms the importance of improving necropsy procedures.

Int J Syst Evol Microbiol, 2004 Nov, 54(Pt 6), 1909 - 10
Validation of publication of new names and new combinations previously effectively published outside the IJSEM; Study of the antibody response against Mycobacterium tuberculosis antigens in Warao Amerindian children in Venezuela; Catedra de Immunologia, Escuela de Medicina Jose Maria Vargas, Facultad de Medicina, Universidad Central de Venezuela, Apartado 4043, Caracas 1010A, Venezuela . zaraujo@telcel.net.ve

This study was aimed at investigating alternate methods for serodiagnosis of tuberculosis (TB), which are needed because bacteriologic diagnosis of childhood TB is difficult . A selection of 80 serum and saliva samples were tested from Warao indigenous children under 15 years of age; 34 high TB suspects (28 positive and 6 negative for the tuberculin skin test, TST) and 46 healthy contact children (32 positive and 14 negative for the TST) . Several enzyme-linked immunosorbent assay (ELISA) serological tests were developed to test for Mycobacterium tuberculosis-specific antibodies, including serum IgA, IgG, IgE, and secretory IgA (sIgA) in saliva against 3 specific antigens (PPD, HSP60, 38 kDa) . Of these, 2 antigens, PPD and 38 kDa, showed significantly higher reactivity . The sensitivity and specificity of these tests for diagnosis remained limited, between 26.5% and 38.2%, and 77.4% and 97%, respectively . Of all the samples studied and combinations realized between all isotypes and antigens combined with 3 isotypes (anti-PPD IgG, IgE, and anti-38kDa sIgA) managed to detect the largest number of patients, showing an improved sensitivity level of 64.7%, although specificity levels dropped to 81.8% . These results were compared with the Omega diagnostics commercial kit results . The commercial kits showed significantly lower reactivity (sensitivity of 20% and 13.33% to Myco G and Complex Plus, respectively) and a specificity of 100% . This study shows that in indigenous populations of Venezuela, where invasive procedures cannot be used to select samples but evaluation with a chest X-ray for radiological studies is available, the combination of 3 specific isotypes may be a useful tool to increase diagnostic accuracy with pulmonary TB in this population, when used together with clinical and epidemiological criteria.

Crit Care Med, 2004 Nov, 32(11 Suppl), S466 - 94
Diagnosis of infection in sepsis: an evidence-based review; Cohen J et al.; OBJECTIVE: In 2003, critical care and infectious disease experts representing 11 international organizations developed management guidelines for the diagnosis of infection in sepsis that would be of practical use for the bedside clinician, under the auspices of the Surviving Sepsis Campaign, an international effort to increase awareness and improve outcome in severe sepsis . DESIGN: The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee . METHODS: The modified Delphi methodology used for grading recommendations built on a 2001 publication sponsored by the International Sepsis Forum . We undertook a systematic review of the literature graded along five levels to create recommendation grades from A to E, with A being the highest grade . Pediatric considerations to contrast adult and pediatric management are in the article by Parker et al . on p . S591 . CONCLUSIONS: Obtaining a precise bacteriological diagnosis before starting antibiotic therapy is, when possible, of paramount importance for the success of therapeutic strategy during sepsis . Two to three blood cultures should be performed, preferably from a peripheral vein, without interval between samples to avoid delaying therapy . A quantitative approach is preferred in most cases when possible, in particular for catheter-related infections and ventilator-associated pneumonia . Diagnosing community-acquired pneumonia is complex, and a diagnostic algorithm is proposed . Appropriate samples are indicated during soft tissue and intraabdominal infections, but cultures obtained through the drains are discouraged.

Cas Lek Cesk, 2004, 143(9), 594 - 7
{Tuberculosis in the Czech Republic in 2003}; Homolka J et al.; BACKGROUND: 1162 new cases of tuberculosis were diagnosed in the Czech Republic in 2003; pulmonary tuberculosis represented 942 cases and in 660 cases the diagnosis of tuberculosis was bacteriologically confirmed . METHODS AND RESULTS: 355 cases were smear positive tuberculosis . The increase of certain TB cases (70%) in 2003 compared to 2002 is not statistically significant (p = 0.031) . The notification rate (incidence) in 2003 was 11,4/100 000 all cases of tuberculosis, 9,2/100 000 pulmonary tuberculosis and 6,5/100 000 certain cases of tuberculosis . CONCLUSIONS: Compared to 2002 a decline of all forms of tuberculosis was observed, this decline however was not statistically significant . The increase in bacteriologically confirmed tuberculosis and smear positive tuberculosis was also not statistically significant.

Int J Tuberc Lung Dis, 2004 Oct, 8(10), 1186 - 93
Non-tuberculous mycobacteria: patterns of isolation . A multi-country retrospective survey; Martin-Casabona N et al.; OBJECTIVE: To collect data on non-tuberculous mycobacteria (NTM) isolated from clinical laboratories in different countries to establish: 1) whether the isolation of NTM was increasing, 2) which species were increasing, and 3) whether there was any pattern of geographical distribution . DESIGN: In 1996, the Working Group of the Bacteriology and Immunology Section of the International Union Against Tuberculosis and Lung Disease contacted 50 laboratories in different countries for the necessary information . RESULTS: The number of patients reported with NTM was 36099 from 14 countries . Mycobacterium avium complex, M . gordonae, M . xenopi, M . kansasii and M . fortuitum were the five species most frequently isolated . There was a significant upward trend for M . avium complex and M . xenopi . Pigmented mycobacteria predominated in Belgium, the Czech Republic and the Mediterranean coast of Spain . Non-chromogenic mycobacteria were found to be predominant in the area of the Atlantic coast of Brazil and in Turkey, the United Kingdom, Finland and Denmark . CONCLUSIONS: There was an increase in the number of NTM isolated from clinical samples of patients . Isolation of the most frequent species is constantly changing in most of the geographical areas, and newer species are emerging due to better diagnostic techniques to detect and identify NTM.

Schweiz Arch Tierheilkd, 2004 Oct, 146(10), 461 - 8; discussion 469
Porcine circovirus as a possible cause of postweaning wasting in pigs in Switzerland; Staebler S et al.; Postweaning wasting is a major worldwide problem in pig production, particularly with respect to the disease termed postweaning multisystemic wasting syndrome (PMWS) . In addition to wasting, PMWS symptoms include respiratory distress, diarrhoea, pallor and occasional cases of jaundice . The causative agent is porcine circovirus type 2 (PCV-2) . The objective of the present study was to determine the significance of PMWS and similar conditions in Switzerland . A total of 72 weaned piglets from 26 farms showing wasting were examined for the presence of PCV-2 by immunohistochemical and histological analysis and 57 piglets from 21 farms were examined serologically . Possible causes for wasting other than PCV-2 were investigated by macroscopic, histological and bacteriological methods . PCV-2 antigen was identified immunohistochemically in the lymphatic organs in 11 of these 72 piglets . However, only 4 animals showed histological changes typical of PMWS . PCV-2 antibodies were found in 70% of the piglets . Piglets with wasting syndrome not associated with PCV-2 infection suffered from conditions including porcine proliferative enteropathy, gastric ulcers, polyserositis and polyarthritis . The most frequent condition was chronic enteritis not associated to circovirus infection . The results from the serological analyses indicate a wide distribution of PCV-2 in the Swiss pig population . However, confirmed cases of PMWS were rare in the investigated piglets.

Med Arh, 2004, 58(4), 253 - 6
{Establishment of the first medical faculty in Bosnia and Herzegovina}; Masic I; After establishment of the medical faculties in Zagreb (1917 year), Ljubljana (1919 year) and Belgrade (1921 gear), by the decision of the minister of the National education of the Independent State Croatia from 31.3.1944 . year, there were establishment the medical faculties in Sarajevo and Split the same year . The Medical faculty in Sarajevo, as the faculty of the University in Zagreb, officially began with the work 22.11.1944 . year by the opening which made the then dean of the Medical faculty in Zagreb professor (doctor) Ante Sercer . For the dean of the Medical faculty in Sarajevo was nominated professor Stanko Sielski, the renown bosnian-herzegovinian physician, the former head of the district bacteriological station in Tuzla and Banja Luka . The access lectures held professor (doctor) Mile Budak, professor (doctor) Ljudevit Thaller, professor (doctor) Ibrahim Ruzdic . The first generation of the students of the school 1944/1945 year numbered about 165 students . The teaching was organized in the complex of the building of the present residance Conac in Sarajevo, and the practical instruction was performed on the basis of the contract with the then General hospital in Sarajevo . The teachers of the faculty were the eminent professors of the Medical faculty at the University in Zagreb . From all the known person, the fact about the so called NDH (IS Croatia) to the medical faculty, for the long time were hidden from the publicity, so that about them was not spoken, till the back several years, either the momentary alive students of the generation . In this article is stated the factographia connected for the establishment and functionioning of the mentioned first medical faculty in Bosnia and Herzegovina.

Presse Med, 2004 Sep 11, 33(15), 1012 - 8
{Clinical and biological manifestations of adult-onset Still's disease}; Pouchot J et al.; A TRIAD OF FEATURES: Adult onset Still's disease (ASD) is an uncommon disorder usually associating high spiking fever, evanescent skin rash constituted of small salmon pink macules, and arthritis . NUMEROUS SYSTEMIC MANIFESTATIONS: A sore throat is common and often misleading . More than 60% of the patients develop mobile and indolent lymph nodes, usually in the cervical area . Liver involvement is common and usually limited to a mild or moderate cytolysis . However, several observations of severe hepatitis have been reported justifying strict monitoring of the liver biology in these patients . Amongst the other numerous systemic manifestations that have been reported, pericarditis is common and sometimes responsible for tamponade, the pulmonary involvement may lead to an acute respiratory distress, and the rare neurological manifestations include aseptic meningitis or cranial nerve palsy . FROM A BIOLOGICAL POINT OF VIEW: The sedimentation rate is consistently elevated and there is usually a marked elevation in the polymorphonuclears . The bacteriological survey is negative as are the immunological tests . An increase in the serum level of IL-18 might be both diagnostic and prognostic . It is the increase of the serum level of ferritin and the marked decrease in its glycosylated fraction below 20% that seem to be of more potent diagnostic value.

Chir Narzadow Ruchu Ortop Pol, 2004, 69(3), 179 - 84
{Revision hip arthroplasty after prosthesis removal in septic loosening}; Krol R; The author presents the therapeutic protocol in "hanging hip" after prosthesis removal in septic loosening, basing on a series of 11 patients--7 females and 4 males--age ranging from 31 to 67 years . On average the primary prosthesis was removed 2.5 years after implantation, while patients remained with a "hanging hip" for an average period of 2.2 years (limb shortening before revision arthroplasty was on average 4.5cm) . When qualifying patients for revision arthroplasty the following parameters were taken into account: sedimentation rate, CRP creactive protein levels, bacteriological blood culture results, cultures from the hip punctate, every-day life activity and post-op patient compliance with the therapy . Acetabular roof defects were managed according to Zuk's method . Clinical assessment of the patients was performed 6 weeks, 3, 6 and 12 months using Merle-d'Aubigne and Postel classification, while X-rays were used to assess proper prosthesis implantation . During follow-up proper prosthesis implantation was found in all cases, while no signs of re-infection, nor radiological and clinical signs of implant loosening were noted . Clinical assessment of the patients yielded 1 very good result, 7 good results and 3 satisfactory . The presented material indicates that good results can be obtained in prosthesis reimplantation after removal of the primary prosthesis because of its septic loosening.

J Clin Neurosci, 2004 Nov, 11(8), 901 - 2
Meningitis and pneuomocephalus . A rare complication of external dacryocystorhinostomy; Usul H et al.; Meningitis due to fracture of the fovea ethmoidalis during external dacryocystorhinostomy is a rare complication . We report a case of pneumocephalus and meningitis in a 51-year-old female who underwent an external dacryocystorhinostomy (DCR) . Although extracranial complications during or after external DCR have been well-described, only one case of meningitis has been reported in the literature . Physical examination, computerised tomography, lumbar puncture, and bacteriologic cultures were used to make the diagnosis . The patient responded well to antibiotic therapy . Her symptoms resolved immediately and she was discharged on the 21st post-operative day . This complication emphasises the importance of careful surgical technique and a thorough knowledge of regional anatomy, during DCR and similar procedures.

Nihon Kokyuki Gakkai Zasshi, 2004 Sep, 42(9), 810 - 4
{Pulmonary infection with Nocardia species: a report of 10 cases}; Takiguchi Y et al.; OBJECTIVE: To investigate the clinical features of pulmonary nocardiosis . PATIENTS AND METHODS: We retrospectively reviewed ten consecutive patients (5 men, 5 women; aged 25 to 80 years (average 49.3 years)) with confirmed bacteriological pulmonary nocardiosis from 1998 to 2003 . Patients were divided into two groups: infected (8 patients) and isolated (2 patients) . RESULTS: All patients had predisposing factors and/or pulmonary disease . Six were immunosuppressed by steroid therapy with or without other immunosuppressive drugs . The overall survival rate among infected patients was 75.0% (6/8), but the survival rate of patients who were diagnosed speedily by a gram-stain procedure was 85.7% (6/7) . CONCLUSIONS: Although pulmonary nocardiosis is difficult to diagnose, prompt use of the gram-staining procedure and appropriate treatment appeared to improve survival . And new diagnostic method is desirable.

Gesundheitswesen, 2004 Oct, 66(10), 682 - 7
{Surface disinfection in nursing homes -- what is the actual state? Checkup study in three Duisburg nursing homes}; Martin U et al.; The effectiveness of cleaning and disinfection of environmental surfaces was evaluated in three nursing homes using bacteriological monitoring . Samples from inmates (nose, throat and wounds) and surface cleaning equipment were also taken . Cleaning solutions, disinfectants and cleaning clothes were found to be highly contaminated in two of three institutions . Referring to the surfaces in some cases disinfection didn't reduce bacterial colony counts and seeded MRSA as a potential pathogen in one nursing home . Six MRSA-positive inmates and identical strains were registered in the environment . MRSA can be used as a marker organism to demonstrate effectiveness of cleaning . To achieve further improvement bacteriological monitoring can help in focussing special cleaning and disinfection related problems.

Biomedica, 2004 Jun, 24 Supp 1, 65 - 72
{Surgical treatment of multiresistant lung tuberculosis}; Tobon A et al.; Drug resistance has become a major problem in the treatment of tuberculosis . Pulmonary resection in combination with chemotherapy appears to be an effective measure for the treatment of multi-drug resistant pulmonary tuberculosis . A retrospective review was performed of the medical and laboratory findings of 28 patients with multi-drug resistant tuberculosis who underwent pulmonary resection for pulmonary tuberculosis between January 1990 and December 2000 at La Maria Hospital, Medellin . Twenty-one of them had medical therapy before surgery; 14 patients underwent upper lobectomy and 10 patients pneumonectomy) . The AFB negative sputum conversion rate was 88.9% (25/27) after surgery, during an average of 6 weeks . Bacteriological relapses were confirmed in 6 of 27, 4 of these 6 had AFB negative sputum . Twenty-eight patients had medical therapy after surgery . For selected patients, pulmonary resection in combination with chemotherapy should be considered an effective measure for treatment of multi-drug resistant pulmonary tuberculosis.

Cochrane Database Syst Rev . 2004 Oct 18;(4):CD004495.
Antibiotic regimens for suspected early neonatal sepsis; Mtitimila E et al.; BACKGROUND: Early acquired infection may cause severe illness or death in the neonatal period . Prompt treatment with antibiotics has shown to reduce mortality . It is not clear which antibiotic regimen is suitable for treatment of presumed early neonatal sepsis . OBJECTIVES: To compare effectiveness and adverse effects of antibiotic regimens for treatment of presumed early neonatal sepsis . SEARCH STRATEGY: The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2003), MEDLINE (1966 to August 2003), EMBASE (1980 to September 2003) and ZETOC (1993 to August 2003) databases were searched for possible studies . Pharmaceutical companies were contacted for any unpublished data . SELECTION CRITERIA: Randomised and quasi-randomised controlled studies comparing antibiotic regimens for the treatment of early neonatal sepsis (both monotherapies and combination therapies) . DATA COLLECTION AND ANALYSIS: Both reviewers screened abstracts and full reports against the inclusion criteria, appraised the quality of and extracted data from papers . For dichotomous outcomes, treatment effect was expressed as relative risk with 95% confidence interval . Meta-analysis was performed using a fixed effect model . MAIN RESULTS: Two small studies had compared monotherapy with combination therapy . There was no significant difference in mortality, treatment failure or bacteriological resistance . REVIEWERS' CONCLUSIONS: There is no evidence from randomised trials to suggest that any antibiotic regimen may be better than any other in the treatment of presumed early neonatal sepsis . More studies are needed to resolve this issue.

Mikrobiyol Bul, 2004 Jul, 38(3), 253 - 6
{Case report: subdural hemorrhage in neurobrucellosis}; Tuncer Ertem G et al.; In this report, a 49-year-old female patient who were diagnosed as neurobrucellosis by the clinical, bacteriologic and serologic findings, has been presented . The case deserved presentation and discussion since it presented with subdural hemorrhage which is a rare complication of neurobrucellosis.

Eur J Radiol, 2004 Nov, 52(2), 175 - 9
Pulmonary tuberculosis in patients with idiopathic pulmonary fibrosis; Chung MJ et al.; OBJECTIVES: Patients with idiopathic pulmonary fibrosis (IPF) have an increased risk of pulmonary tuberculosis . However, detecting pulmonary tuberculosis may be difficult due to the underlying fibrosis . The aim of this report is to describe the radiological and clinical findings of pulmonary tuberculosis in patients with idiopathic pulmonary fibrosis . MATERIALS AND METHODS: We reviewed 143 consecutive patients in whom IPF was diagnosed by either the histological or radio-clinical criteria . Among them, nine patients were histologically (n=2) or bacteriologically (n=7) confirmed to have active pulmonary tuberculosis . The location and patterns of pulmonary tuberculosis were examined on a thin section CT scan . RESULTS: The most common thin section CT findings were subpleural nodules (n=6; mean diameter, 3.2 cm) and a lobar or segmental consolidation (n=3) . The lesions were located most commonly in the right lower lobe (n=4) . The incidence of tuberculosis in patients with idiopathic pulmonary fibrosis was more than five times higher than that of the general population . CONCLUSION: The atypical manifestation of pulmonary tuberculosis is common in patients with idiopathic pulmonary fibrosis, which may mimic lung cancer or bacterial pneumonia.

J Dairy Sci, 2004 Nov, 87(11), 3770 - 7
Cow-level prevalence of paratuberculosis in culled dairy cows in Atlantic Canada and Maine; McKenna SL et al.; The prevalence of Mycobacterium avium ssp . paratuberculosis (Mptb) in culled dairy cattle in Eastern Canada and Maine was determined to be 16.1% (95% confidence interval 13.8 to 18.3%) based on a systematic random sample of abattoir cattle . Mesenteric lymph nodes and ileum from 984 cows were examined by histologic and bacteriologic methods . Histological testing was far less sensitive than bacteriologic methods for detecting infected cattle . A seasonal pattern of positive cows was also detected, with the highest proportion of cows being Mptb-positive in June (42.5%) . Overall, body condition score was not associated with prevalence of Mptb isolation.

Expert Rev Anti Infect Ther, 2004 Oct, 2(5), 787 - 94
Kingella kingae infections of the skeletal system in children: diagnosis and therapy; Yagupsky P; As the result of improved bacteriological techniques, Kingella kingae is emerging as an important cause of infections of the skeletal system in children younger than 2 years of age . This review details the bacteriological features and detection methods of this pathogen, as well as the epidemiology, clinical presentation, treatment and prognosis of septic arthritis, osteomyelitis and diskitis caused by the organism.

Semin Pediatr Infect Dis, 2004 Jul, 15(3), 150 - 4
Tuberculosis in children: considerations for children from developing countries; Nelson LJ et al.; Although accurate data are scarce for children, tuberculosis (TB) represents one of the most common infectious causes of morbidity and mortality worldwide . TB case rates have declined among children in the United States in the last decade, but they remain high among children from low-income countries and racial or ethnic minorities . Establishing the definitive diagnosis of TB in a child remains difficult and frequently relies on a constellation of history, clinical findings, and bacteriology . Recently, updated national and international treatment recommendations have been published . Contact investigation and treatment using directly observed therapy are important components of the optimal case detection and management of TB in children.

J Foot Ankle Surg, 2004 Sep-Oct, 43(5), 321 - 6
Total extrusion of the talus: a case report; Montoli C et al.; Total extrusion of the talus without recovery of the bone is a very unusual injury . The authors present a case of a 25-year-old man who sustained an open total enucleation of the talus in a motorcycle accident . The talus was not recovered at the scene of the accident . An immediate tibiocalcaneal stabilization was performed by using an external fixator . In the postoperative period, a polymicrobic infection was observed and treated with parenteral antibiotics . Nine months after injury, the patient developed an infection of both the empty space and the distal third of the tibia . A wound debridement with tibial sequestrectomy and insertion of gentamicin-impregnated polymethylmethacrylate beads was performed . Three months later, after multiple negative bacteriologic examinations, a tibiocalcaneal arthrodesis with staples and autogenous bone graft was performed . Because of a pseudoarthrosis, the patient underwent a revision of the arthrodesis by retrograde tibiocalcaneal nailing, achieving clinical and radiographic success . The definitive treatment of total enucleation of the talus is still controversial because of its rarity and the high rate of complications, such as avascular necrosis, osteomyelitis, and ankle stiffness . In this case, without recovery of the talus, retrograde nailing afforded good stability by bypassing the bone defects.

Probl Tuberk Bolezn Legk, 2004, (8), 28 - 30
{A role of the biological chip test in the determination of rifampicin resistance in Mycobacteria in adolescents with active pulmonary tuberculosis}; Firsova VA et al.; Forty-nine adolescents with active pulmonary tuberculosis were followed up to assess the biological chip test for the detection of rifampicin resistance in Mycobacterium tuberculosis (MBT) . Rifampicin resistance (rpo B gene mutation) was detected in 22 (44.9%) patients . Disseminated processes were detected in a larger proportion of the patients with rifampicin resistance than in those with MBT susceptibility (63.6 and 40.7%, respectively (p < 0.05) . Comparison of the data on MBT resistance and susceptibility, which had been obtained by bacteriological studies (nutrient medium cultuvations) and the biological chip test, revealed their agreement in 50% of the cases . A response could be showed after 2-3 months in the former case and after 2-3 days in the latter case . With the biological chip test, the resistance of MBT to rifampicin was additionally established in 38.7% of the patients with negative cultivation tests on admission and during therapy . Follow-ups have demonstrated that MBT resistance to rifampicin preserves longer with the biological microchip test than that with nutrient medium cultivation.

Osiris, 2004, 19, 133 - 48
Mapping a zoonotic disease: Anglo-American efforts to control bovine tuberculosis before World War I; Jones SD; Before World War I, British and American public health officials correlated tuberculosis in dairy cattle with severe infections in milk-drinking children . They traced bacteria in municipal milk supplies, mapped the locations of infected animals, and sought regulatory power to destroy them . Consumers, milk producers, municipal officials, veterinarians, and physicians all influenced the shape of antituberculosis regulations . Many condemned pasteurization as too costly and as masking tubercular contamination and poor sanitation . They saw milk-borne tuberculosis as an environmental as well as a bacteriological problem . Similar to other zoonotic diseases such as BSE, bovine tuberculosis blurred the boundaries between urban and rural, production and consumption, and human and animal bodies.

Khirurgiia (Mosk), 2004, (10), 31 - 3
{Treatment of intestinal insufficiency syndrome in patients with peritonitis}; Immune response in burn patients in relation to HIV infection and sepsis; Department of Surgery, University of Zimbabwe, Harare, Zimbabwe . thomas.sjoberg@unn.no

The post-burn immune dysfunction predisposes patients to sepsis and multiple organ failure leading to increased mortality . HIV infection also results in a depressed immune response . The combination of burn injury and HIV might therefore lead to an increased morbidity and mortality as compared to non-HIV infected burn patients . Twenty burn patients and 10 healthy volunteers were included in a prospective study . To evaluate their immune status, CD4+ and CD8+ T-lymphocyte counts were determined in peripheral blood . HIV serology samples were obtained on admission . Bacteriological cultures were obtained from wound surface samples and wound tissue biopsies . Six burn patients were HIV infected . Clinical signs of sepsis were observed in 10 patients . The number of CD4+ T-lymphocytes were lower in burn patients compared to healthy volunteers (P < 0.05) . HIV infected burn patients had lower CD4+ lymphocyte counts than non-HIV infected patients (P < 0.05) . Patients with clinical signs of sepsis had lower CD4+ counts compared to patients without sepsis (P < 0.05) . There was no difference in the mortality rate or the length of hospitalisation between patient groups . Burn injury, HIV infection and sepsis independently result in immunosuppression.

Trop Gastroenterol, 2004 Apr-Jun, 25(2), 73 - 5
C-reactive protein in patients with gallbladder and biliary tract diseases; Vaishnavi C et al.; C-reactive protein (CRP) assay is widely used as a clinical tool for the evaluation of bacterial infections . No study has been undertaken to evaluate the presence of CRP and/or the estimation of this protein in the bile of patients with diseases of the gallbladder (GB) . In the present study, we estimated the quantity of CRP in bile (n=358) as well as serum samples (n=186) obtained from patients with GB and biliary tract diseases, using the semiquantitative Avitex CRP kit . Bacteriological study was also done on the bile samples . CRP was positive in the bile of 56 patients, (15.6%) many of who had bacteriobilia . CRP was also present in 49 of the serum samples studied (26.3%) . Control serum samples did not show any CRP within detectable limits . Hitherto, this is the first report that investigated the level of CRP in the bile of patients with GB and biliary tract diseases, along with biliary bacterial profile.

Acta Otorrinolaringol Esp, 2004 May, 55(5), 240 - 3
{Primary nasal tuberculosis: a forgotten disease?}; Agulles Fornes MJ et al.; Nasal tuberculosis represents a rare manifestation of infection by Mycobacterium tuberculosis . Clinically, it appeared to resemble cancer presenting as a nasopharyngeal mass with concomitant enlarged lymph nodes . It is important to consider tuberculosis in the differential diagnosis of all nasopharyngeal lesions and take biopsy samples for histological and bacteriological studies . Antituberculosis treatment is satisfactory with standard anti-tuberculous chemotherapy . Although this is a rare finding, it should be considered when a patient presents with nasal obstruction.

Reprod Nutr Dev, 2004 May-Jun, 44(3), 243 - 50
Effect of frozen semen on the uterus of mares with pathological uterine changes; Guvenc K et al.; Pregnancy rates after frozen semen inseminations (AI), particularly in older and problem mares, are lower than after fresh semen AI . Uterine contractility and the inflammatory reaction after frozen semen insemination were studied in two groups of mares: the abnormal group comprised of 6 old barren mares categorized in biopsy category IIB or III, and the control group including 6 reproductively normal young maiden mares in biopsy category I or IIA . All 12 mares were inseminated in the first cycle with 2 mL of phosphate-buffered saline (PBS) and in their second cycle with 2 mL of frozen semen containing 800 x 10(6) spermatozoa . Before and 1, 2, 4, 8, and 20 to 24 h after this treatment, all mares were examined by ultrasonography for intrauterine fluid accumulations (IUFA) . The examinations were videotaped to count the number of uterine contractions later . Uterine fluid was obtained by tampon before treatment, and by the tampon method followed by uterine lavage after the last examination . Fluids were cultured bacteriologically, and polymorphonuclear leukocytes (PMN) were counted . Trypsin-inhibitor capacity (TIC), lysozyme concentration, and beta-glucuronidase (BGase) and N-acetyl-beta-D-glucosaminidase (NAGase) activities were determined in frozen-thawed tampon and lavage fluids . Both treatments induced significant neutrophilia in the uterine lumen . Although PMN concentrations were numerically higher after frozen semen AI than after PBS-treatment, the difference was not significant . There was not any difference between the mare groups either . The amount of IUFA differed only in the normal group between frozen semen AI and PBS treatment, and between 0- and 24-h samples for frozen semen AI . Although abnormal mares showed consistently more fluid than normal mares, this difference was not significant . Uterine contractions and enzyme concentrations between groups did not differ . None of the variables showed significant differences between the normal and abnormal mares in their reaction to frozen semen AI.

Mol Microbiol, 2004 Oct, 54(1), 2 - 13
A network of net-workers: report of the Euresco conference on 'Bacterial Neural Networks' held at San Feliu (Spain) from 8 to 14 May 2004; Hellingwerf KJ; In May 2004, over 100 bacteriologists from 19 different countries discussed recent progress in identification and understanding of individual signal transfer mechanisms in bacteria and in the mutual interactions between these systems to form a functional living cell . The meeting was held in San Feliu and supported by ESF and EMBO . In part through the extensive sequencing efforts of the past few years, the bulk of the bacterial signal transfer systems have been resolved and their detailed characterization is revealing such characteristics as signal specificity, signalling rate constants, molecular interaction affinities, subcellular localization, etc., which should provide a solid basis to a computational extension of this field of studies . In parallel, the new genomics techniques are providing tools to characterize the way a collection of such systems interact in an individual cell, to give rise to 'life' . Systems theory provides rational and convenient ways to bring order to the wide range of observables thus obtained . Ultimately, the performance of engineered design will have to prove whether or not we know enough about the processes involved.

Chir Ital, 2004 Jul-Aug, 56(4), 563 - 5
Percutaneous drainage and surgery for splenic abscess: a case report; Ferronato M et al.; Splenic abscess is a rare clinical entity; however, thanks to the refinement of diagnostic techniques and to the increase of population at risk its presence is discovered more frequently . In our ward we evaluated a patient by ematochimical and bacteriological exams and abdomen CT . After antibiotical therapy and percutaneous drainage the patient was discharged on the fifteenth day . One month later the patient returned to our emergency room: for the presence of two intrasplenic lesions; he underwent splenectomy . Six month after the operation, the patient was healty . The two methods (surgery and radiological drainage) cannot be compared because the indications are different . Therefore a progressively invasive therapeutic approach would appear to be indicated . If this not successful, splenectomy performed whit laparoscopic or laparotomic techniques should follow.

Int J Syst Evol Microbiol, 2004 Sep, 54(Pt 5), 1905 - 6
A replacement name of the specific epithet aurantiaca in Micromonospora aurantiaca Sveshnikova et al . 1969 (Approved Lists 1980) and a proposal to treat the combination Micromonospora aurantiaca Sveshnikova et al . 1969 as a rejected name . Request for an opinion; Euzeby JP et al.; According to Rules and Principles of the Bacteriological Code (1990 Revision), Micromonospora aurantiaca Sveshnikova et al . 1969 (Approved Lists 1980) is not correct because the specific epithet is illegitimate . The authors request the replacement of the specific epithet aurantiaca and they suggest sandarakina . They also request that the specific epithet aurantiaca in M . aurantiaca be rejected.

Int J Syst Evol Microbiol, 2004 Sep, 54(Pt 5), 1425 - 6
Validation of publication of new names and new combinations previously effectively published outside the IJSEM; Soybean: feed quality and safety . Part 1: biologically active components . A review; Institute of Animal Breeding, Nutrition and Laboratory Animal Science, Faculty of Veterinary Science, Szent Istvan University, H-1078 Budapest, Istvan u 2, Hungary . icsaky@univet.hu

A large number of soybean components have diverse biological activities . These include hormonal, immunological, bacteriological and digestive effects . The presently known allergens are listed . The divergence between chemical evaluation and biological value is highlighted . The following components are discussed: Kunitz inhibitor, Bowman-Birk inhibitor, saponins, soyacystatin, phytoestrogens (daidzein, glycitein, genistein), Maillard products, soybean hydrophobic protein, soy allergens, lecithin allergens, raffinose, stachyose, 2-pentyl pyridine . The studies describing the effects of the isolated components are reviewed.

J Invest Surg, 2004 Jul-Aug, 17(4), 203 - 9
The role of antibiotic prophylaxis with sodium ceftriaxone to prevent bacterial translocation associated with hypovolemic shock: an experimental study in rats; Weber EL et al.; One of the measures adopted to reduce or prevent intestinal bacterial translocation (BT) in patients who are in hemorrhagic shock consists of prophylactic antibiotics . This study attempted to assess the effectiveness of administering systemic antibiotic to suppress BT in rats submitted to hemorrhagic shock . Sixty-eight male Wistar rats were divided into two experiments . In experiment 1 (n = 28), the animals were randomly divided into three groups: group I (n = 7), sham operation; group II (n = 11), constituted by animals that were submitted to hemorrhagic shock by removing 40% of the volemia, and were resuscitated after 40 min of sustained shock, replacing the previously removed blood; and group III (n = 10), animals that, besides hemorrhagic shock and volemic replacement, received 50 mg/kg of sodium ceftriaxone intravenous 1 min after blood readministration . Mesenteric lymph nodes (MLN) for culture tests and segments of the small bowel were removed for histopathological studies 1 day after the operation in the three groups . In experiment 2, the same procedures were performed, except the laparotomy for removing MLN and segments of jejunal and ileal bowel, but the animals were followed during 7 days, in order to evaluate the mortality rate . In the control group (group I), the bacteriological assessment of the MLN was negative in all cases . Only 40% of the animals treated with antibiotics after hypovolemic shock (group III) presented positive bacteriological exams of the MLN, and this rate was 90% in the group of animals that did not receive this substance (group II) (p < .05) . Escherichia coli was the bacteria identified most frequently in culture tests (92.8%) . The villosities atrophy and inflammatory infiltrate of the lamina propria were the most common histological changes in the bowel, although the intensity was similar in groups II and III (p > .05), but more intense that in group I (p < .05) . The mortality rates in groups I, II, and III 7 days after hypovolemic shock were 0%, 20%, and 20%, respectively . Prophylactic antibiotics significantly reduced the presence of bacteria in the MLN in situations of hypovolemic shock, in rats . This was probably related to a lower BT . However, this aspect did not modify the mortality rate of the animals . Also, the possibility that BT may not have a significant influence in this outcome should be considered.

Ann Clin Microbiol Antimicrob . 2004 Sep 15;3(1):17.
Incidence, risk factors and mortality of nosocomial pneumonia in Intensive Care Units: A prospective study; Alp E et al.; To determine the frequency, risk factors and mortality of nosocomial pneumonia a prospective study was conducted in the intensive care units . In the study period, 2402 patients were included . The nosocomial pneumonia was defined according to the Centers for Disease Control Criteria . Overall, 163 (6.8%) of the patients developed nosocomial pneumonia and 75.5% (n = 123) of all patients with nosocomial pneumonia were ventilator-associated pneumonia . 163 patients who were admitted to the intensive care unit during the same period but had no bacteriologic or histologic evidence of pneumonia were used as a control group . The APACHE II score, coma, hypoalbuminemia, mechanical ventilation, tracheotomy, presence of nasogastric tube were found as independent risk factors . Crude and attributable mortality were 65% and 52.6%, respectively . The mortality rate was five times greater in the cases (OR: 5.2; CI 95%: 3.2-8.3) . The mean length of stay in the intensive care unit and hospital in the cases were longer than controls (p < 0.0001) . Patients requiring mechanical ventilation have a high frequency of nosocomial pneumonia.

Gesnerus, 2004, 61(1-2), 5 - 23
{The explicative models of infectious diseases in Canada in the 19th Century}; Goulet D et al.; Until the last third of the 19th Century in Canada, physicians looked for the causes of infectious diseases and adopted explicative models associated to airist theories, climatic variations and the physical environment . Rarely did they mention the social environment . Yet, the interpretation of disease plays a fundamental role in the elaboration of preventive measures . Consequently, Canadian physicians adopted a naturalist approach based on local sanitation rather than a social approach of the disease . This reinforced the concept of "predisposing causes" . By examining local conditions and, to a lesser extent, the living conditions of Quebec's population, the pre-bacteriologist theories prepared the way for the intervention of modern hygienists.

Hand Surg, 2004 Jul, 9(1), 109 - 13
A case of tuberculous tenosynovitis in a patient with systemic lupus erythematosus; Fukui A et al.; A 52-year-old woman with systemic lupus erythematosus (SLE) was infected with tuberculosis (TB) on her forearm and hand, after 16 years of steroid therapy . Debridements and anti-TB therapy were performed successfully . Recently, the risk of significant morbidity from TB has been on the rise; this appears to be a complication of steroid therapy used to treat AIDS and some collagen vascular diseases . It is thought that steroid therapy causes an increased risk of TB . In this paper, we report our experience of this SLE patient who developed tuberculous tenosynovitis . We suggest that TB infection must be considered in the differential diagnosis whenever a patient presents with a chronic wrist or hand inflammation that is non-responsive to steroid treatment . Once TB infection is suspected, both histopathological and bacteriological examinations should be performed . Emergent treatment includes surgical debridement and the institution of early anti-TB therapy immediately after completing histopathological examination.

Otolaryngol Head Neck Surg, 2004 Sep, 131(3), 207 - 14
Efficacy and safety of oral telithromycin once daily for 5 days versus moxifloxacin once daily for 10 days in the treatment of acute bacterial rhinosinusitis; Ferguson BJ et al.; OBJECTIVE: To compare the clinical and bacteriologic efficacy and safety of short-duration treatment with telithromycin given for 5 days with moxifloxacin given for 10 days in adults with acute bacterial rhinosinusitis (ABRS) . STUDY DESIGN: In this prospective, double-blind, parallel-group, randomized, multicenter study, adult patients (N = 349) with ABRS were randomized to oral telithromycin (800 mg once daily for 5 days) or to oral moxifloxacin (400 mg once daily for 10 days) and followed for 31 to 36 days . Clinical outcome was determined by the investigator at the posttherapy/test of cure (TOC) visit . Bacteriologic outcome was determined by comparing cultures taken at the pretreatment visit with cultures obtained at the posttherapy/TOC visit . The primary objective was to demonstrate equivalence of clinical cure rates in the per-protocol population between treatment groups at the posttherapy/TOC visit . RESULTS: Clinical success at TOC (primary endpoint) was achieved in 87.4% of patients in the telithromycin group compared with 86.9% for moxifloxacin (per-protocol patients; 0.5% difference between treatment groups; 95% confidence interval {CI}, -8.1, 9.2; P = 0.8930) . The bacteriologic success rates were 94.1% and 93.9%, respectively (0.2% difference between treatment groups; 95% CI, -14.2, 14.5; P = 0.9734) . Overall treatment-emergent adverse events for both drugs (mostly gastrointestinal) were mild to moderate in intensity . CONCLUSION AND SIGNIFICANCE: The clinical and bacteriologic efficacy of telithromycin 800 mg once daily for 5 days was equivalent to that of moxifloxacin 400 mg once daily for 10 days, establishing telithromycin as an important treatment option for ABRS.

Hist Sci Med, 2004 Apr-Jun, 38(2), 177 - 89
{Bacteriological war (1916-1933): from anecdote to terror}; Regnier C; Rotten corpses were occasionally used as weapons in the Antiquity . So wells and springs were usually contaminated . In 1915-1916, just after the use of poison gas on the battlefield, bacteriological suspensions were prepared to destroy men and cattle in Europe, Russia and the United of America but the attempts of using bacteriological weapons remained inefficient . Moreover the evidences of this use during the Great War are very fragile.After the war there was a consensus about inhumanity of this weapon which yet might be used if the enemy did it . Between 1925 and 1933 the debates in the Society of Nations proved that bacteriological war was possible in spite of a compromise solution between some nations . Then English journalist Wickdam Steed disclosed the German tries of bacteriological weapons in the Paris metro and the London tube in 1933 (Was this article a manipulation?).

Clin Diagn Lab Immunol, 2004 Sep, 11(5), 942 - 51
Epitope-specific antibody levels demonstrate recognition of new epitopes and changes in titer but not affinity during treatment of tuberculosis; Bothamley GH; Antibody levels rise during treatment of tuberculosis . This study examined when this rise occurred, whether there was recognition of new antigen binding sites (epitopes) on the same or different antigens, and how long specific antibody persisted . Forty patients with smear-positive pulmonary tuberculosis provided serum before and during treatment . Antibody levels were measured using a monoclonal antibody competition assay to epitopes restricted to the Mycobacterium tuberculosis complex and an enzyme-linked immunosorbent assay for lipoarabinomannan . Significant increases in antibody levels were apparent after 7 days of treatment . Five samples (12.5%) had positive titers to all epitopes at the start of treatment, and this increased to 23 (58%) during treatment . Antibody to epitopes with the poorest sensitivity (the TB23 epitope of the 19-kDa antigen and the TB78 epitope of hsp65) showed the greatest increases after treatment . Antibody to these two epitopes was also absent in some patients with relapsed tuberculosis until after treatment . Antibody titers showed a biphasic response, with a fall at 2 to 3 months of treatment . Sera from two patients showed changes in the affinity of epitope-specific antibody during treatment, whereas the majority did not . Those infected with isoniazid-resistant strains of M . tuberculosis showed a late rise in antibody . Antibody to the TB68 epitope of the 16-kDa alpha-crystallin homolog was short-lived, but it recurred with bacteriological relapse during treatment . Positive antibody titers persisted for at least 3 to 18 months after treatment . Diagnostic tests for tuberculosis should be evaluated using only pretreatment sera . Delayed antigenic recognition could be due to active suppression and/or failure to engage internal antigens of M . tuberculosis.

Mol Gen Mikrobiol Virusol, 2004, (3), 11 - 20
{PCR with subsequent sequencing of the 16S gene rRNA in species identification of mycobacteria of the non-tuberculosis complex}; Maiorova AA et al.; One hundred of mycobacterium cultures were assayed by the method of PCR with subsequent sequencing of the 16S rRNA region . The below mycobacterium species were identified: M . tuberculosis complex (n = 55), M . avium (n = 17), M . intracellulare (n = 4), M . scrofaleceum (n = 2), M . kansasii - M . gastri (n = 3), M . gordonae (n = 3), M . ulcerans - M . marinum (n = 1), M . smegmatis (m = 2), M . fortuitum (n = 11), M . peregrinum (n = 1) and M . chelonae - M . abscessus (n = 1) . The method enabled the differentiation of species M . avium from M . intracellulare and M . peregrinum from M . fortuitum, which could not be differentiated by using the classic biochemical and bacteriological methods . Genetic heterogeneity of the mycobacterium strains of M . avium, M . fortuitum and M . gordonae was also established by PCR plus sequencing of the 16S rRNA region.

Kekkaku, 2004 Jul, 79(7), 453 - 7
{A case of cervical and mediastinal lymph nodes tuberculosis, tuberculous pleurisy, spinal caries and cold abscess in the anterior chest wall}; Iwata Y et al.; A 61-year-old woman with schizophrenia that had been treated in a psychiatric hospital was admitted to our hospital because of subileus and back pain . Though subileus was improved, she had a sudden attack of fever 7 days later and developed right pleural effusion, a cold abscess in the anterior chest wall and swelling of a thumb-sized right cervical lymph node which broke through the skin . We made a diagnosis of cervical and mediastinal lymph nodes tuberculosis, tuberculous pleurisy, spinal caries and cold abscess in the anterior chest wall due to the biopsy findings of the specimen taken from the cervical lymph node, examination of pleural effusion, chest CT, bacteriological examination of the cold abscess and spinal MRI . We started chemotherapy with the antituberculous drugs (HRSZ) and symptoms except back pain improved . She complained of paresis of the both lower extremities, which completely paralyzed 8 months later in spite of continued chemotherapy . Thereafter her paralysis was gradually improved and she was able to walk by herself after 12 months chemotherapy.

Head Neck, 2004 Sep, 26(9), 823 - 8
Efficacy of piperacillin-tazobactam in the treatment of surgical wound infection after clean-contaminated head and neck oncologic surgery; Rodrigo JP et al.; BACKGROUND: Although perioperative antibiotic prophylaxis has significantly reduced surgical wound infection rates, this complication is still a frequent complication of head and neck cancer surgery . Because these infections are typically polymicrobial, our study evaluated the safety and efficacy of piperacillin-tazobactam in the treatment of surgical wound infection after clean-contaminated head and neck oncologic surgery . METHODS: In this multicenter, prospective clinical trial, 70 patients with surgical wound infection received piperacillin-tazobactam . RESULTS: Of patients who were evaluable, 92.4% were also clinically cured or improved, and the bacteriologic eradication rate was 80.3% . Of the 70 patients enrolled in the study, six (8.5%) experienced six adverse events: two cases of moderate diarrhea, one allergic skin reaction, and three cases of phlebitis . No deaths were attributable to the study drug . CONCLUSIONS: Piperacillin-tazobactam is a good choice of treatment as monotherapy for surgical wound infection after clean-contaminated head and neck oncologic surgery .

J Mater Sci Mater Med, 2001 Feb, 12(2), 107 - 10
Stability study of tetracyclines with respect to their use in slow release systems; Honnorat-Benabbou VC et al.; In the aim of optimizing implantable slow-release systems for the local delivery of antibiotics, the stability of tetracyclines was studied in water at 37 degrees C or under gamma irradiation . Four tetracyclines in their chlorhydrate form were chosen depending on their hydrophilic/hydrophobic balance . Their chemical stability was established by HPLC, and biological stability by bacteriological tests . It was shown that methacycline and doxycycline are stable in water for three days . Tetracycline and minocycline exhibit limited decomposition (less than 10%) under the same conditions . So, in vitro drug release for at most three days, appears to be possible . Besides, all four tetracyclines either in powdered form or included in a calcium phosphate matrix, kept their bacteriological activity after gamma irradiation at 32.4 kGr . Consequently, the in vivo study of these implantable slow drug release systems, can be carried out.

Appl Environ Microbiol, 2004 Sep, 70(9), 5343 - 8
Comparison of fluorescence microscopy and solid-phase cytometry methods for counting bacteria in water; Lisle JT et al.; Total direct counts of bacterial abundance are central in assessing the biomass and bacteriological quality of water in ecological and industrial applications . Several factors have been identified that contribute to the variability in bacterial abundance counts when using fluorescent microscopy, the most significant of which is retaining an adequate number of cells per filter to ensure an acceptable level of statistical confidence in the resulting data . Previous studies that have assessed the components of total-direct-count methods that contribute to this variance have attempted to maintain a bacterial cell abundance value per filter of approximately 10(6) cells filter(-1) . In this study we have established the lower limit for the number of bacterial cells per filter at which the statistical reliability of the abundance estimate is no longer acceptable . Our results indicate that when the numbers of bacterial cells per filter were progressively reduced below 10(5), the microscopic methods increasingly overestimated the true bacterial abundance (range, 15.0 to 99.3%) . The solid-phase cytometer only slightly overestimated the true bacterial abundances and was more consistent over the same range of bacterial abundances per filter (range, 8.9 to 12.5%) . The solid-phase cytometer method for conducting total direct counts of bacteria was less biased and performed significantly better than any of the microscope methods . It was also found that microscopic count data from counting 5 fields on three separate filters were statistically equivalent to data from counting 20 fields on a single filter.

Microbes Infect, 2004 Sep, 6(11), 972 - 6
Bacteriological follow-up of pulmonary tuberculosis treatment: a study with a simple colorimetric assay; Farnia P et al.; The viability of Mycobacterium tuberculosis (MTB) in serial sputum specimens from persistently smear positive patients was evaluated . The assay was based on oxidation-reduction of Alamar Blue and Malachite Green dyes that change their color in response to MTB growth . A total of 280 sputum specimens from 40 persistently smear positive TB patients and 40 sputa from non-tuberculosis patients were digested, decontaminated and examined microscopically . To check the MTB viability, the sediments from decontaminated samples were inoculated into three culture media: Lowenstein-Jensen (LJ) slants, Alamar Blue and Malachite Green culture tubes . We found that out of 280 smear positive specimens, the LJ culture was positive in 124 (44%) . The numbers of correctly identified S+/C+ cases by Alamar Blue and Malachite Green were 118 (95%) and 116 (93%), respectively . The mean time required for reporting the positive signal in Alamar Blue culture tubes was 9 versus 11 days by Malachite Green culture tubes . In the standard LJ culture media the average detection time was 27 days (P < 0.05) . The sensitivity of LJ was 99%, Alamar Blue 95% and Malachite Green 93% . The specificity was 100%, 92% and 93%, respectively . The oxidation-reduction method is rapid, sensitive and inexpensive in monitoring the treatment response of patients with pulmonary TB . Thus, using this method can be of paramount importance, particularly in resource-constrained areas.

Tijdschr Diergeneeskd, 2004 Jul 15-Aug 1, 129(14-15), 468 - 70
{Subperitoneal cyst in a Friesian mare}; Scheffer CJ et al.; The case of a 5-year-old Friesian mare with a mass in her abdomen and a gait irregularity of the left hind limb is discussed . At rectal ultrasonogrphic examination the mass appeared to be a thin-walled, anechogenic cavity in the left abdomen . By means of laparoscopy the mass could be visualized as a smooth structure, covered by peritoneum and fat . Under laparoscopic guidance the mass was punctured and fluid was aspirated . Cytological and bacteriological findings of the fluid were indicative of a cyst . After drainage of the cyst the locomotion disorder of the left hind limb disappeared . It is concluded that this horse suffered from a subperitoneal cyst, a rare disorder in humans and never previously described in horses . The case emphasizes the value of laparoscopy in the diagnosis and treatment of (intra)abdominal masses and further clearly shows that in the differential diagnosis of locomotion disorders not only structures related to the locomotion system should be taken into account.

Antibiot Khimioter, 2004, 49(3), 26 - 31
{Efficacy of moxifloxacin (Avelox) in prophylaxis of infection in patients with profound neutropenia}; Minenko SV et al.; Comparative efficacy of moxifloxacin and ciprofloxacin as prophylactics of infection in cancer patients with severe neutropenia after the chemotherapy was studied . The study included 40 patients with malignant lymphomas and solid tumore who received 52 courses of the aggressive chemotherapy . Twenty four patients (30 courses) received oral moxifloxacin in a dose of 400 mg once a day from the first day of the neutrophil count decrease below 1.0 x 10(9)/l until its recovery to > 1.0 x 10(9)/l or when the signs of infection appeared . In the control group 16 patients (22 courses) received oral ciprofloxacin in a dose of 500 mg twice a day . The patients in both the groups were compatible by the diagnosis, age and neutropenia duration . The median of the days of the febrile neutropenia duration in the patients prophylactically treated with moxifloxacin was statistically lower (2.1 vs 3.6 in the control group, p < 0.05) . The incidence of febrile neutropenia in the moxifloxacin group was significantly lower than that in the control group (73 and 100% respectively, p = 0.01) . The incidence of bacteriologically confirmed infection in the moxifloxacin group was also lower (6% vs 27.2%, p = 0.04) . Therefore, moxifloxacin proved to be a more efficient agent vs ciprofloxacin (standard prophylactic) in prevention of febrile neutropenia and neutropenic infection in cancer patients, which is likely due to its higher activity against grampositive organisms.

Antibiot Khimioter, 2004, 49(3), 17 - 21
{Clinical efficacy of clarithromycin delayed release dosage form in the treatment of community-acquired pneumonia}; Iutanova NS; The efficacy of clarithromycin retarded release dosage form in the treatment of patients with community-acquired pneumonia was estimated in a open prospective comparative study . The drug was administered in a dose of 500 mg once a day (29 patients) and in a dose of 500 mg twice a day (28 patients) . The clinical efficacy in the compared regimens amounted to 90.6 and 93.3% of the patients respectively and the bacteriological efficacy was 93.3 and 84.6% respectively . The adverse reactions were observed in 15.6 and 30.0% of the cases respectively.

J Am Vet Med Assoc, 2004 Aug 15, 225(4), 545 - 7, 538
Naturally occurring tularemia in a dog; Meinkoth KR et al.; A 4-year-old spayed female Irish Setter was examined because of acute onset of lethargy, anorexia, and weakness . The dog had eaten an adult rabbit 36 hours earlier . Tularemia was suspected because of the rabbit exposure; however, other common diseases characterized by fever, malaise, and lymphadenopathy of acute onset were also considered (ie, ehrlichiosis and Rocky Mountain spotted fever) . The dog was treated with doxycycline (5 mg/kg {2.3 mg/lb}, PO, q 24 h) for 14 days as well as supportive treatment with a balanced electrolyte solution (lactated Ringer's solution {200 mL, SC}) . The diagnosis was first established by results of bacteriologic cultures of fine-needle aspirates obtained from lymph nodes and confirmed by results of ELISA and a polymerase chain reaction assay Successful and timely antemortem diagnosis of tularemia in dogs can be accomplished through lymph node aspiration and bacteriologic culture.

Rev Soc Bras Med Trop, 2004 Jul-Aug, 37(4), 338 - 42 Epub 2004 Aug 20.
{Epidemiologic aspects of tuberculosis in the Suruí Indians, Brazilian Amazon}; Basta PC et al.; Tuberculosis persists as a serious public health problem in Brazil . Prevalence rates are alarming in certain social groups, including indigenous peoples . This article presents an epidemiological analysis of records for the Surui Indians available at the Tuberculosis Control Program in the Municipality of Cacoal, Rondonia . The study includes a descriptive statistical analysis of cases reported from 1975 to 2002 . There is evidence that the Surui have an increased risk of acquiring and dying from tuberculosis as compared to other indigenous groups in Rondonia as well as non-Indians . The average incidence coefficient for tuberculosis in the Surui was 2518.9 per 100,000 inhabitants in the period 1991-2002 . It was observed that 45% of the cases were diagnosed in children < 15 years old . Over half of the cases (63.3%) were reported in men . Only 43.2% of the cases were confirmed by sputum microscopy . The use of PPD skin tests, histopathological exams or bacteriological culture were not reported throughout the period . Attention is called to the need for prevention and control measures specifically tailored to the reality of indigenous peoples.

J Dairy Sci, 2004 Aug, 87(8), 2442 - 8
Association of CXCR2 polymorphisms with subclinical and clinical mastitis in dairy cattle; Youngerman SM et al.; The ability to identify objectively cows that are more or less susceptible to mastitis has been a long-standing goal . Genetic markers associated with inflammatory responses during mastitis could aid in selection of these cattle . One potential marker is CXCR2, a chemokine receptor required for neutrophil migration to infection sites, which contains single nucleotide polymorphisms (SNP) within the gene . The objective of this experiment was to evaluate the association of CXCR2 SNP genotypes with subclinical and clinical mastitis . Thirty-seven Holstein and 42 Jersey cows that completed at least 2 full lactations were used . Quarter foremilk samples were collected for bacteriological examination quarterly and when cows exhibited clinical mastitis . Subclinical mastitis was defined as the presence of the same pathogen in the same quarter in at least 2 of 3 consecutive samples . A significant association was detected between CXCR2 SNP +777 genotype and percentages of subclinical mastitis cases in Holsteins . Holsteins expressing genotype GG had decreased percentages of subclinical mastitis, but genotype CC cows had increased percentages of subclinical mastitis . Significant differences in clinical mastitis incidence were not detected between genotypes for either breed . This approach of genetically identifying mastitis resistant cows may represent an effective means of marker-assisted selection for mastitis and other inflammatory diseases involving neutrophils.

Antimicrob Agents Chemother, 2004 Sep, 48(9), 3343 - 8
Novel murine model of pneumococcal pneumonia: use of temperature as a measure of disease severity to compare the efficacies of moxifloxacin and levofloxacin; Bast DJ et al.; Surface temperature measured by an infrared temperature-scanning thermometer was used to evaluate disease severity and predict imminent death in a murine model of pneumococcal pneumonia . We showed that a decrease in temperature was associated with increasing severity of disease and concomitant histological changes and also that a temperature of 30 degrees C or less was a predictor of death . Furthermore, viable bacterial counts in the lungs of mice euthanized at a temperature of < or = 30 degrees C were not significantly different from those seen in the lungs of mice allowed to die without intervention . These data support temperature change as a more subtle indicator of outcome than death and demonstrate that this could be used as a reliable end point for euthanasia . To test the utility of our model in a drug trial, we examined the efficacies of moxifloxacin and levofloxacin by using temperature as a measure of disease severity prior to and during treatment . Regardless of the antibiotic used, mice assessed as moderately ill (temperature > or = 32 degrees C) at the start of treatment had better clinical and bacteriological outcomes than mice assessed as severely ill (temperature < 32 degrees C) . However, moxifloxacin offered better protection and greater bacterial clearance than did levofloxacin in all infected mice independent of disease severity . This model not only allows a more subtle evaluation of drug efficacy but also ensures a better degree of standardization and a more humane approach to drug efficacy studies involving animals.

Theriogenology, 2004 Oct 1, 62(7), 1307 - 28
Experimentally induced orchitis associated with Arcanobacterium pyogenes: clinical, ultrasonographic, seminological and pathological features; Gouletsou PG et al.; The objectives of this study were to describe the features of experimentally induced orchitis associated with Arcanobacterium pyogenes and confirm the pathogenicity of the organism for the ovine testicle . One testicle of each of nine rams was inoculated with 1.3 +/- 10(4) colony-forming-units of an A . pyogenes isolate and regular clinical, ultrasonographic, bacteriological and seminological examinations were carried out up to 204 days after challenge . The rams were sequentially euthanatized 3, 6, 9, 18, 30, 50, 71, 113 and 204 days after challenge and a gross- and histopathological examination of their testicles was performed . All rams developed clinical orchitis and general signs . The initial ultrasonographic findings were changes of size and echogenicity of the genitalia, whilst in the long-standing phase they were wider appearance of the mediastinum testis, presence of hyperechogenic foci, changes of echogenicity of the genitalia and increased echogenicity of the scrotum and tunics . The following changes in semen evaluation parametres were recorded: the pH, the percentage of dead sperms, the percentage of abnormal sperms and the number of nonsperm round cells increased, whilst the mass motility, the individual motility and the sperm concentration decreased; the following sperm defects were observed: misshapen or piriform heads, sperms with coiled tails, sperms without tail and sperms with proximal cytoplasmic droplet; at the early stages neutrophils were the prevailing nonsperm round cell type, later the proportion of immature germ cells increased and in the long-standing phase there were enlogated spermatids and leucocytes; it is noteworthy that semen evaluation parametres were restored to normal at the late stages of the disease . A . pyogenes was consistently isolated from the semen samples after challenge, as well as from the dissected genitalia . The salient post-mortem findings were: initially, subcutaneous oedema, fluid into the vaginal cavity, congested and distended vessels, increased size of the genitalia and a hard dark area inside the testicles; subsequently, there were changes of size of the genitalia, thickening of scrotum and tunics and presence of fibrin on the testicular surface; in the long-standing phase of the disorder, there were induration of scrotum and tunics with adhesion between the tunics and discolouration of the surface of the genitalia . The prominent histopathological changes were observed in the inoculated testicles; milder changes were seen in the respective epididymides; interstitial oedema, diffuse neutrophilic infiltration and extravasation were observed in the early stages after challenge; lymphocytic infiltration with concurrent fibrosis, mineralization and inspissation of the tubular elements of the seminiferous tubules and presence of vacuolated Sertoli cells were seen later; finally, regeneration of the epithelium and presence of Sertoli cells and spermatogonia with various degrees of spermatogenic activity were evident . These findings, allied to the isolation of A . pyogenes from field cases of ovine orchitis, provide clear evidence that A . pyogenes is pathogenic for the ovine genitalia; however, the mechanisms of transition of the organism from commensal to pathogenic state are not clear . It is also noteworthy that some degree of fertility was restored in the late stages of the disorder . Ultrasonography appeared to be useful for the diagnosis of intra-scrotal abnormalities, especially during investigation of the long-standing stage of the disease, after clinical findings have subsided.

Postgrad Med, 2004 Aug, 116(2), 49 - 52, 55-6, 59
Managing bite wounds . Currently recommended antibiotics for treatment and prophylaxis; Taplitz RA; Animal and human bites are common in the United States . Although evidence-based practice guidelines have not been developed, bite wounds warrant an organized, standardized approach to care to help prevent complications . Such an approach involves first eliciting a history of the circumstances surrounding the bite and the patient's medical history . Next, basic bite wound care should be performed, including cleansing and irrigation of the wound . A good understanding of bite wound bacteriology and the situations in which antibiotics may be indicated is important . Finally, rabies and tetanus prophylaxis should be considered and appropriate follow-up care ensured.

Eur J Clin Microbiol Infect Dis, 2004 Sep, 23(9), 677 - 81 Epub 2004 Aug 18.
Pneumococcal bacteremia in children: an 8-year review in two hospitals in Barcelona; Perez A et al.; In this study, 90 episodes of pneumococcal bacteremia that occurred over an 8-year period in two hospitals in Barcelona were analyzed retrospectively to determine the clinical and bacteriological characteristics of pneumococcal bacteremia, the risk factors for antibiotic resistance, the outcome, and the vaccine coverage . The mean age of the patients was 3.1 years and the male/female ratio was 1.7 . The overall rates of penicillin-non-susceptible, cefotaxime-non-susceptible, and erythromycin-resistant isolates were 48.8, 24.4, and 25.5%, respectively . Antibiotic resistance was associated with children under the age of 2 years and with previous antibiotic treatment . The percentage of antibiotic resistance was higher in the nine episodes that occurred in patients with an underlying illness . The most prevalent serotypes identified were 1, 14, 6B, 18C, 5, and 19A . Serotypes 6A/B, 14, and 19A/F were isolated primarily from children under 2, whereas serotypes 1 and 5 were recovered more frequently from older children . Apparent relationships between serotypes 6A/B, 14, and 19A/F and occult bacteremia and between serotypes 1 and 5 and bacteremic pneumonia were confounded by the age variable . The proportion of bacteremic episodes preventable by all (7-valent, 9-valent, and 11-valent) of the conjugate pneumococcal vaccines was 60% in children under 2 . In older children, the serotype coverage rate for the three formulations was 48, 87, and 87%, respectively . In summary, these data expand upon previous Spanish studies in which serotypes 1 and 5 were reported to be among the leading causes of severe systemic pneumococcal infections in children over 2, findings that should be taken into consideration when planning vaccine programmes .

Di Yi Jun Yi Da Xue Xue Bao, 2004 Aug, 24(8), 943 - 5
{Delayed diagnosis or misdiagnosis of pulmonary tuberculosis: 458 cases clinical analysis}; Dong QL et al.; OBJECTIVE: To explore the reason of delayed diagnosis or misdiagnosis of pulmonary tuberculosis . METHOD: The clinical data of 458 patients pulmonary tuberculosis patients undergoing treatment between January 1999 and December 2003 in our hospital were retrospectively analysed . RESULTS AND CONCLUSION: The reasons for delayed diagnosis or misdiagnosis are as follows: A careless attitude towards health condition by patients themselves; neglected bacteriological evidence or ignorance of tuberculosis by physicians.

Hist Cienc Saude Manguinhos, 2004 Jan-Apr, 11(1), 107 - 42
{Directions in hospital assistance in Rio de Janeiro (1923-31)}; Sanglard G et al.; Focusing on the construction of three hospitals (Gaffree e Guinle, Hospital do Cancer, and Hospital das Clinicas), the article discusses transformations in Rio de Janeiro's public health sector during the 1920s . The three facilities' architectural design - all under the responsibility of architect and engineer A . Porto d' Ave (1890-1952) - reflected concerns of both sanitary reform and new concepts in bacteriology . Some points are particularly relevant: the relation between advances in bacteriology and architectural development; the concepts and conceptions of bacteriology, on the one hand, and new paradigms in hospital construction, on the other .Discussions were taking place at a critical moment, when there was a shortage of hospital beds throughout Rio, at the same time that adoption of the traditional pavilion structure was hindered by the advances introduced by modern architecture in block.

Probl Tuberk Bolezn Legk, 2004, (6), 52 - 6
{Wide range of the use of natural lipases and esterases to inhibit Mycobacterium tuberculosis}; Annenkov GA et al.; Lipases and/or esterases (hereinafter referred to as esterases) isolated from the wax moth (Galleria mellonella) were found to have a bacteriological action on Mycobacterium tuberculosis (MBT) H37Rv . Different types of raw esterase preparations (REP) were incubated with MBT at 37 degrees C for 18 hours, the incubate was seeded on the Finn-II solid medium or intraperitoneally injected into guinea pigs in a single dose of 100,000,000 bacteria . There was no growth of MBT in the medium within 8 weeks, some variants of REP causing a destruction of the medium for 3-7 days . This "toxic" effect on the lipid-containing Finn-II medium could be lowered by the simplest techniques for purifying esterases . In the experimental guinea pigs, a tuberculous process substantially regressed: autopsy of control animals at interval of 3-6 weeks after inoculation with native MBT showed the typical picture of progressive generalized tuberculosis; at the same time a visible pathology was not noted in the animals contaminated with MBT incubated with esterases . At week 7, control guinea pigs died; the onset of a tuberculous process was observed in experimental guinea pigs at week 8 . An attempt to reveal the therapeutical effect of REP on guinea pigs with tuberculosis in a direct experiment failed . At the same time, there was a low toxicity of REP (in the used doses) for guinea pigs and B10.A(4R) mice . Based on their own findings and some data available in the literature, the authors have arrived at the following provisory conclusions: the studied REPs contain mammalian lysosomal lipase-type enzymes that determine the bacteriostatic and, perhaps, bacteriolytic effect of REP shown on MBT in vitro; there is evidence for promises of continued detailed studies of natural esterases for searching new antituberculous agents . A program of investigations of the studied and other natural esterases has been developed by taking into account the authors' developments and know-how . The study may be regarded as part of global unselected screening of biological and other materials for detecting new promising sources of drugs.

Probl Tuberk Bolezn Legk, 2004, (6), 34 - 7
{New medium for mycobacterial isolation and cultivation}; Nuratinov RA et al.; The study was undertaken to develop a new effective and cheap culture medium to be used in the bacteriology of tuberculosis . The medium prepared on the basis of geothermal nonphenol water was found to accelerate and increase detection rates, to increase the rate of accumulation of mycobacterial mass from the samples under study, to exclude mineral salts ("salty composition") from the composition of the medium, which simplifies the procedure of its preparation, reduces material and labor costs, to accelerate diagnosis and determine mycobacterial drug sensitivity, and to institute a correct treatment.

Nutr Hosp, 2004 Jul-Aug, 19(4), 236 - 42
{Human milk and very low birth weight nutrition}; Torres G et al.; INTRODUCTION: Enteral feeding strategies of very low birth weight (VLBW) infants and when to start them have changed significantly in the last few years . Controversy exists on which is the best regimen to feed this high risk group, since human milk has insufficient quantities of some nutrients . Fortification of human milk improves growth rates and maintains immunologic, metabolic and emotional benefits . OBJECTIVE: To examine if early feeding of VLBW infants with higher amounts of human milk and human milk fortifiers could improve post-natal growth and maintain human milk production . STUDY DESIGN: Prospective study with historical control . SUBJECTS AND METHODS: A group of 100 VLBW infants that were born between September 1999 and April 2000 were studied and were compared with another randomized group of similar birth weight (n = 31) that was born previously . The studied group was fed early with human milk (enteral trophic nutrition) and fortified with human milk fortifier when 100 mL/Kg/day were reached, with rapid increase of the supplies according to tolerance and hemodynamic state . The control group was not fed early with human milk and was not given human milk fortifier . The collection of human milk in the studied group was highly stimulated . Mothers extracted their milk more frequently in the "Human Milk Lactary" and lived in a "Residence for Mothers" while their neonates were in the hospital . The mothers who could travel to the hospital were allowed to extract their milk in their homes with a supervised and controlled method (serial bacteriology, "Lactary 24 Hours Program") . RESULTS: Early feeding with human milk (enteral trophic nutrition), higher amounts of human milk and fortified with human milk fortifier, improved enteral tolerance and diminished significantly the number of days needed to regain birth weight, the days of fast and the days to reach the total enteral supply . Frequent extractions of human milk increased the available amounts of milk and allowed relactation . At discharge the infants were fed on breast-milk and formulas and their growth curves were adequate at their first year of post conception age . CONCLUSION: On stable conditions, very low birth infants soon after birth, should be fed with a combination of human milk and human milk fortifiers . Our study demonstrated an improved infant post-natal growth while mothers' milk production was maintained . COMMENTS: To feed human milk with human milk fortifiers to this high risk infant group, the neonatal health team must be highly motivated and committed to encourage mothers to express their milk . This also encourages breast feeding during the subsequent months . In Latin America communities, continuance of breast feeding for longer periods of time is a public health priority.

Otolaryngol Pol, 2004, 58(3), 517 - 20
{Tuberculosis of the larynx and pharynx in hospitalized patients in ENT Department of Voivodeship Hospital in Kalisz}; Bartnik W et al.; 8 cases of tuberculosis were presented in this paper . Two patients had changes in the larynx and pharynx and one patient had pharyngeal tuberculosis and squamous carcinoma of epiglottis . Further specialty investigations e.g . MDL, biopsy, histopathological and bacteriological examinations were done and revealed proper diagnosis tuberculosis . Etiology, pathogenesis, diagnostic were described . Changes of tuberculosis were in unusual location . All patients were treated tuberculostatic drugs.

Int J Tuberc Lung Dis, 2004 Aug, 8(8), 1027 - 31
Detection of tuberculostearic acid in serum and other biological fluids from patients with tuberculosis by electron capture-gas chromatography and chemical ionisation-mass spectrometry; Daikos GL et al.; We analysed 37 clinical samples from 33 patients with bacteriologically confirmed tuberculosis, two cerebrospinal fluid samples from patients with cured tuberculous meningitis, and 14 serum samples from healthy individuals, for the presence of tuberculostearic acid (TSA) by frequency pulsed electron capture-gas chromatography (FPEC-GC) and chemical ionisation gas chromatography-mass spectrometry (CIGC-MS) . TSA was detected in 36 of the 37 samples from patients with active tuberculosis and none of the patients with cured tuberculous meningitis; only one of 14 controls generated a similar chromatographic profile . Analysis of biological fluids by FPEC-GC and CIGC-MS for the presence of TSA may be a valuable method for rapid diagnosis of tuberculosis.

Respir Med, 2004 Aug, 98(8), 726 - 9
An assessment of the cost-effectiveness of fast tracking bacteriological specimens for mycobacteria; Babores M et al.; A virtual model, using six predetermined criteria for fast tracking tuberculosis specimens was devised to improve the cost effectiveness of the MB/BacT system . All specimens received at a central laboratory were audited for the six criteria over a 6-month period . By assuming that only those specimens fulfilling these criteria were fast tracked the theoretical cost savings could be calculated . To prevent possible delay in speciating mycobacteria, the number of criteria were expanded to nine, and a further 6 month audit carried out . In the first 6-month period, 728 specimens were tested . Had the initial hypothetical criteria excluded some of the specimens, only 351 specimens would have been tested through the fast-track system at a saving of pounds sterling 942 (dollars 1696), (52%) of the total cost, but five culture results positive for environmental mycobacteria would have been delayed . In a second 6-month survey the criteria were expanded . Using these no positive culture would have been missed but the savings would only have been 26% of the total cost . Introducing exclusion criteria for rapid testing can improve the cost effectiveness of rapid culture methods with no important loss of clinically necessary information.

Int J Lepr Other Mycobact Dis, 2004 Jun, 72(2), 143 - 8
Single nucleotide polymorphisms (SNPs) at -238 and -308 positions in the TNFalpha promoter: clinical and bacteriological evaluation in leprosy; Vanderborght PR et al.; Tumor necrosis factor alpha (TNFalpha) plays a key role in orchestrating the complex events involved in inflammation and immune response . The presence of single nucleotide polymorphisms (SNPs) within the promoter region of the TNFa gene has been associated with a number of diseases . The aim of this study was to investigate the distribution of polymorphisms at positions -238 (G/A) and -308 (G/A) at the TNFalpha promoter, and its association to the outcome of different clinical forms of leprosy . Furthermore, the bacteriological index (BI) was evaluated among genotyped multibacillary (MB) patients in order to investigate the possible influence of each polymorphism on the bacterial load . This study included a total of 631 leprosy patients being 401 MB and 230 paucibacillary (PB), that was further separated according to its ethnicity (Afro- and Euro-Brazilians) . The combination of SNPs in haplotypes generated three different arrangements: TNFG-G, TNFG-A and TNFA-G . In spite of the marked differences observed in the frequency of the haplotypes along the ethnic groups, no statistical differences were observed in haplotype frequencies between MB and PB patients . The BI analyses showed a lower bacteriological index among the -308 carriers, while the BI of the -238 carriers was higher . Although no significance has been achieved in this analysis regarding the influence of the polymorphisms to the development of the clinical outcome, it seems that in a different stage (among the MB patients) the polymorphisms could contribute to the degree of severity observed.

Yan Ke Xue Bao, 2004 Jul, 20(2), 107 - 12
{Expression changes of protein kinase Calpha during differentiation of mouse embryonic stem cells into neuron-like cells}; Gao Q et al.; PURPOSE: To study the expression of protein kinase Calpha (PKCalpha) during differentiation of mouse embryonic stem cells (ESC)into neuron-like cells in an attempt to elucidate their role in signaling . METHOD: ES-D3 cells were subjected to an 18-day induction procedure which consisted of 4 days of culture as embryoid bodies (EBs) without all-trans retinoic acid (RA) followed by 14 days of culture in the presence of RA, then the EBs were plated separately onto gelatin-coated 6-well culture dishes coated glass coverslip for immunohistochemistry, onto 100-mm-diameter bacteriological (nontissue culture) dish for Western blot assay and RT-PCR, and were cultivated and collected cells for 1, 3, 5, 7 and 14 days in the presence of RA . RESULTS: Staining of PKCalpha was strong and distributed throughout the cells, especially in the cytoplasm and membrane . Western blot analysis exhibited a band of approximately 84 kD with the antibody specific to PKCalpha . After induction of RA, PKCalpha was present in significantly lower levers in induced ESC as compared with that in ES-D3 cells at first, then PKCalpha isoform was found in slightly higher amounts and resumed on 14th day . CONCLUSION: This study was characterized the PKCalpha isoenzyme profile in RA-induced differentiation of ESC into neuron-like cells and suggests that PKCalpha may play a very important role in differentiation of mouse ESC along the neuronal pathway.

Ultraschall Med, 2004 Aug, 25(4), 292 - 5
Biliary infarction mimicking liver metastasis; Weiler H et al.; A 38-year-old man with a history of chronic alcohol abuse had suffered from numerous acute episodes of chronic pancreatitis in the last 7 years . Those episodes were complicated by the formation of a pseudocyst in the pancreatic head . He presented himself with vomiting and abdominal pain as well as diarrhoea for 10 days . In the ultrasound examination of the liver numerous circumscribed hypoechoic formations in both lobes of the liver were found . A subsequent computerised tomography scan confirmed multiple hypodense liver lesions . Because of suspected metastasis or abscesses in the liver, sonographically guided fine needle biopsies of these liver structures were carried out . The histological examination of the liver specimens showed bile infarcts and proliferated bile ducts; there were no signs of a malignant or infectious process . The bacteriological cultures of the biopsy specimens were negative.

Rev Port Pneumol, 2004 May-Jun, 10(3), 205 - 15
{Tuberculosis profile in HIV+ patient before and after the use of high activity antiretroviral treatment}; Belmiro VM et al.; The high activity antiretroviral treatment (HAART) induces the restoration of the number and function of CD4+ T lymphocytes and is changing the landscape of tuberculosis in patients HIV-infected . The objective of this study is to evaluate the clinical, radiographic features and evolution of these patients and compare to the results obtained in a previous study with patients with no HAART use . A retrospective transversal study (with HAART) was done with patients HIV-infected that began the tuberculosis treatment in the Gaffree e Guinle University Hospital, from 1997 to 2001 and compared to a previous study (no HAART) that was done from 1989 to 1990 . The population studied was: 107 patients (with HAART) and 152 patients (no HAART) and in both studies there were a higher frequency in young white males . The relevant results included: (a) an increase in bacteriology and histopathology diagnosis confirmation; (b) a decrease number of associated diseases during tuberculosis treatment; (c) a higher end-treatment and the death rate decreased from 55% (no HAART) to 8% (with HAART); (d) pulmonary tuberculosis was more frequent in both studies although extra-pulmonary forms were more common than in general population . We concluded that the use of HAART turned the history of tuberculosis in HIV patients getting similar to that non-immunosupressed.

Eur Radiol, 2005 Jan, 15(1), 53 - 8 Epub 2004 Aug 03.
Remitting/relapsing idiopathic hypertrophic spinal pachymeningitidis: comprehensive imaging work-up and MR monitoring; Claus E et al.; We present the initial MR and PET work-up in a diabetic 31-year-old female patient presenting with spinal cord compression because of abnormal meningeal tissue and highlight the close correlation between the clinical course and the monitoring of the lesions on MR images . The combination of non-specific inflammatory signs at histopathological examination and of the negative results of a comprehensive bacteriological and serological testing led to the diagnosis of idiopathic hypertrophic spinal pachymeningitidis . The abnormal tissue showed mild glucose uptake at whole-body FDG-PET examination . Repeated MR follow-up examinations during corticoid treatment only demonstrated partial shrinkage of the abnormal tissue . Symptomatic relapse and re-increase in lesion size on MR images occurred concomitantly after an 11-month symptom-free remitting interval under tapering corticoid treatment.

Avian Dis, 2004 Apr-Jun, 48(2), 233 - 7
Studies of the transmission routes of Ornithobacterium rhinotracheale and immunoprophylaxis to prevent infection in young meat turkeys; van Veen L et al.; The importance and prevention of the horizontal as well as the vertical transmission of Ornithobacterium rhinotracheale were investigated . In our first experiment we observed that specific-pathogen-free broiler chickens that were placed in hatching incubators at a commercial turkey hatchery during hatch showed respiratory tract lesions at postmortem examination that were positive for O . rhinotracheale by bacteriology and immunohistology . It appeared that vertical transmission occurred and that horizontal transmission of O . rhinotracheale is possible . In a second experiment, the turkeys derived from vaccinated parents showed significantly fewer respiratory tract lesions at postmortem examination at 16 days of age than the birds derived from nonvaccinated parents . In a third experiment, all vaccinated young birds, regardless of the vaccination state of their parents, showed significantly fewer respiratory tract lesions at 6 wk of age . We concluded that vaccination of the breeders reduces vertical transmission and that vaccination of the progeny is needed to resist challenge at 6 wk of age.

Int J Syst Evol Microbiol, 2004 Jul, 54(Pt 4), 1005 - 6
Validation list no . 98 . Validation of publication of new names and new combinations previously effectively published outside the IJSEM; Reliability et al.; Service d'hepatogastroenterologie, Inserm U537, Sterilisation centrale, Service de Microbiologie, CHU Bicetre, 78 rue du General Leclerc, 94275 Le Kremlin-Bicetre, FranceBACKGROUND: The choice between reusable and single-use devices for ERCP depends on various medical and economic criteria . This study evaluated the reliability and the safety (risk of cross-contamination) of reusable devices . A cost analysis of the use of reusable devices also was conducted . METHODS: All patients referred for ERCP that required use of a sphincterotome or a retrieval basket were eligible for inclusion in a clinical study of 4 different devices (3 types of sphincterotome, 1 type of retrieval basket) . All devices were steam sterilized . Before each use, each device was subjected to bacteriologic and virologic tests (hepatitis C virus, hepatitis B virus markers) . Devices were examined before and after each procedure . The numbers of safe and efficient procedures that could be performed with each device were assessed . Three strategies were compared in a cost analysis: internal reprocessing (strategy 1), external reprocessing (strategy 2), and single-use (strategy 3) . Inputs used were the results of the clinical study, hospital data for 1 year of endoscopic activity, and market prices . RESULTS: A total of 342 patients underwent the following procedures: sphincterotomy (248 patients), stent insertion (59 patients), use of basket without sphincterotomy (14 patients), and diagnostic ERCP/unsuccessful cannulation (21 patients) . At the time of ERCP, 36 patients had viral or bacterial infection . Fifty instruments were used (20 single-lumen sphincterotomes, 10 double lumen sphincterotomes, 20 retrieval baskets) . Overall, the median number of efficient uses per device was 10 . The median number of efficient uses by each type of device was the following: single-lumen sphincterotome, 12; double-lumen sphincterotome, 8; and, retrieval baskets, 10 . All virologic and bacteriologic tests for all instruments were negative . The cost-optimization analysis found that strategy 1 is cost effective (euro37,283/y) compared with strategy 2 (euro40,101/y) and especially with Strategy 3 (euro115,210/y) . CONCLUSIONS: Reuse of the sphincterotomes and baskets evaluated in this study during ERCP is safe in terms of infectious hazards . Because they endure numerous uses, reusable instruments are cost effective, especially when compared with single-use accessories.

Res Vet Sci, 2004 Dec, 77(3), 187 - 8
Fatal meningitis in a calf caused by Mannheimia varigena; Catry B et al.; Mannheimia varigena was identified as the etiologic agent of meningitis in a young Belgian White Blue heifer calf . Species identification of the bacterium was done by phenotyping and molecularly confirmed by tDNA-PCR . Standard bacteriological examination might fail to differentiate species belonging to the genus Mannheimia.

J Vet Med A Physiol Pathol Clin Med, 2004 May, 51(4), 196 - 202
Evaluation of stratification factors and score-scales in clinical trials of treatment of clinical mastitis in dairy cows; Hektoen L et al.; There is often a need to reduce sample size in clinical trials due to practical limitations and ethical considerations . Better comparability between treatment groups by use of stratification in the design, and use of continuous outcome variables in the evaluation of treatment results, are two methods that can be used in order to achieve this . In this paper the choice of stratification factors in trials of clinical mastitis in dairy cows is investigated, and two score-scales for evaluation of clinical mastitis are introduced . The outcome in 57 dairy cows suffering from clinical mastitis and included in a clinical trial comparing homeopathic treatment, placebo and a standard antibiotic treatment is investigated . The strata of various stratification factors are compared across treatments to determine which other factors influence outcome . The two score scales, measuring acute and chronic mastitis symptoms, respectively, are evaluated on their ability to differentiate between patients classified from clinical criteria as responders or non-responders to treatment . Differences were found between the strata of the factors severity of mastitis, lactation number, previous mastitis this lactation and bacteriological findings . These factors influence outcome of treatment and appear relevant as stratification factors in mastitis trials . Both score scales differentiated between responders and non-responders to treatment and were found useful for evaluation of mastitis and mastitis treatment.

Transfusion, 2004 Aug, 44(8), 1238 - 42
Validation and assessment of a blood-donor arm disinfectant containing chlorhexidine and alcohol; Wong PY et al.; BACKGROUND: To minimize the bacterial contamination rate in blood collected from donors, a study was designed to evaluate the suitability of a single-use chlorhexidine-alcohol antiseptic for donor arm preparation at all blood collection venues in Australia . STUDY DESIGN AND METHODS: A prospective study of bacterial load on the skin was performed on 616 blood donors' arms before and after disinfection using a direct swabbing and plating technique . Disinfection was achieved with a swab containing 1 percent chlorhexidine gluconate with 75 percent alcohol, which was applied to the skin in a prescribed method . Feedback from blood donors and staff was obtained using questionnaires . RESULTS: After disinfection, 99 percent of donor arms had bacterial counts of 5 cfu per plate or less, and 99.5 percent had counts of 10 cfu per plate or less, respectively . The mean colony count for all donors after disinfection was 0.39, and the percentage reduction was 99 compared to predisinfection . Sixteen donors (3%) noted transient skin irritation . The majority of staff (64%) preferred not to use the new disinfectant due to the difficulty opening the packaging and an excessive amount of antiseptic solution per pack . CONCLUSION: The bacteriologic study showed that the disinfectant satisfied the requirements of the Australian Red Cross Blood Service for use to prepare blood-donor arms before venesection . An improvement to the packaging was required before it could be acceptable to all staff.

Minerva Ginecol, 2004 Apr, 56(2), 141 - 7
Sexually transmitted diseases and pelvic inflammatory disease; Grio R et al.; AIM: The aim of this study was to determine the prevalence in the Turin area of the pathogens most implicated in pelvic inflammatory disease (PID), with particular regard to which risk factors the population taken into consideration is exposed to . METHODS: From January 1st 1997 to December 31(st) 2001, 13809 women, aged between 14-54, all subjects being fertile and sexually active, were examined for the first time at St . Anna Hospital in Turin for the diagnosis of sexually transmitted diseases (STDs) . A total of 5559 unselected patients were divided into 2 groups according to the presence (1721) or absence (3838) of subjective symptoms related to PID . Both groups underwent a cervico-vaginal bacteriological test for common pathogens, Candida spp., T . vaginalis, bacterial vaginosis, C . trachomatis, Mycoplasma spp., N . gonorrhoeae . The prevalence of each micro-organism was coupled with the anamnestic data collected from a pre-determined questionnaire submitted to all patients . The questionnaire collected personal data: age at the time of first sexual intercourse; the number of partners in the last 6 months; the type of contraceptives used . Statistical analysis was performed using a chi squared test . RESULTS: In our analysis 2 factors proved to be decisive for a correct PID diagnosis: a subjective symptomatology and an anamnesis mainly focused on risk factor evaluation . This result is in accordance with what has been emphasized many times in the literature, i.e . many of these infections have only a few or no symptoms at all . CONCLUSION: Greater attention to the anamnestic data collection would therefore be the key to focusing the clinical investigations on those who are at a major risk to contracting STDs.

Cell Tissue Bank, 2000, 1(2), 155 - 60
The evolution of quality systems in human bone banking: the u.s . Experience; Kostiak PE; This paper illustrates the evolutionary changes that have taken place in human bone banking in the United States since the 1970s to the present, with an emphasis on quality control systems . Specific examples of quality controls are outlined, along with their intended purposes . Particular importance is placed on the gradual change in emphasis from bacteriological concerns to viral concerns and quality control systems.

Kidney Blood Press Res, 2004, 27(3), 197 - 9 Epub 2004 Jul 13.
One for all--a multi-use dialysis system for effective treatment of severe thallium intoxication; Kielstein JT et al.; Guided by the idea of providing a stable electrolyte composition of the dialysate, the late Bernd Tersteegen designed a machine ingeniously combining the advantages of a closed tank hemodialysis system with the efficacy and bacteriological safety of a single-pass system . Several thousand dialysis sessions have been performed with this system in the chronic hemodialysis population . Recently, highly efficient (i.e . high volume) dialysis systems have been successfully introduced for the treatment of critically ill patients in the intensive care unit as extended dialysis . Furthermore, they can also be a safer, more effective and less costly alternative to traditional extracorporeal techniques in the treatment of severe intoxication . In a case-based approach, we review the increasing use of such a system .

J Chir (Paris), 2004 May, 141(3), 150 - 6
{Abdominopelvic actinomycosis: a tumoral syndrome due to bacterial infection}; Sergent F et al.; The purpose of this review is to define the diagnostic steps and treatment of abdominopelvic actinomycosis . Three cases are described which illustrate the variety of clinical presentations ranging from acute peritonitis to chronic pseudo-tumor . The diagnosis of actinomycosis is rarely made pre-operatively . Bacteriologic culture is seldom helpful and imagery findings are non-specific . The diagnosis is usually made retrospectively based on histologic examination . In women, an intrauterine contraceptive device is often a concomitant factor . Long-term antibiotic treatment (several Months) with high-dose penicillin-based medications is the mainstay of therapy . Despite a high risk of complications, surgery is often necessary both for diagnosis and treatment . Resection or drainage may diminish the dosage and duration of antibiotic therapy, and helps to minimize infectious complications . Actinomycosis should be included in the differential diagnosis of abdominopelvic tumors, inflammatory bowel disease, and endometriosis-particularly in a woman with an intrauterine contraceptive device.

Vaccine, 2004 Jul 29, 22(21-22), 2827 - 35
Development and evaluation as vaccines in mice of Brucella melitensis Rev.1 single and double deletion mutants of the bp26 and omp31 genes coding for antigens of diagnostic significance in ovine brucellosis; Cloeckaert A et al.; The live attenuated Brucella melitensis Rev.1 strain is considered the best vaccine available for the prophylaxis of brucellosis in sheep caused by either B . melitensis or Brucella ovis . However, its application stimulates antibody responses in vaccinated animals indistinguishable by the current conventional serological tests from those observed in infected animals . The periplasmic protein BP26 and the outer membrane protein (OMP) Omp31 are immunodominant antigens in the serological responses of B . melitensis and B . ovis infected sheep, respectively . Accordingly, vaccine strain Rev.1 single and double deletion mutants of the bp26 and omp31 genes were developed, based on the principle that the use of such mutants as vaccines in association with diagnostic tests based on BP26 and Omp31 antigens would allow the serological differentiation between infected and vaccinated animals . The deletion mutants obtained were indistinguishable from the parental Rev.1 strain by conventional bacteriological and typing tests . The expression of their major surface antigens, as determined by reactivity with specific monoclonal antibodies (MAbs), remained unaffected, i.e . smooth-lipopolysaccharide (S-LPS) and OMPs besides in the expression of the antigens whose respective genes were deleted . The bp26 and omp31 deletions did not modify the kinetics of splenic infection nor the residual virulence of Rev.1 in the BALB/c mouse model . Vaccination of BALB/c mice with the deletion mutants conferred significant protective immunity against B . melitensis strain H38 or B . ovis strain PA challenges, to the same extent as that induced by parental Rev.1 strain . Thus, these Rev.1 bp26 or omp31 deletion mutants are promising vaccine candidates against B . melitensis and B . ovis infections and will be further evaluated in sheep.

Rev Laryngol Otol Rhinol (Bord), 2004, 125(1), 3 - 16
{Clinical practice guidelines: surgical treatment of tympanic membrane perforations in children}; Denoyelle F et al.; A study group emanating from the French Society of Otolaryngologists and Associated Paediatric Otologists, anaesthetists and bacteriologists carried out a review of the world literature regarding the indications, technique and results of simple myringoplasty in children . The group assessed the levels of evidence present in published articles and the opinions of experts in the field, due to the lack of sufficient evidence . The study group then established recommendations for good practice . These were sent to otolaryngologists, paediatricians, general practitioners and anaesthetists involved in the care of children under the age of 15 presenting with a simple non-infected tympanic membrane perforation and without affection of the ossicular chain . The full text of the recommendations is provided.

Tuberk Toraks, 2004, 52(2), 137 - 44
{Evaluation of 105 cases with tuberculous pleurisy}; Mihmanli A et al.; Tuberculous pleurisy has still importance in the group of exudative pleurisy . In this study we aimed to evaulate clinical, radiological, biochemical, bacteriological and histopathological findings of 105 cases with tuberculous pleurisy retrospectively, between January 1999 and December 2002 . Female/male ratio was approximately 1/9 and mean age was 32.6 (range:15-68) . The common symptoms were chest pain (75.2%), cough (54.3%) and dyspnea (47.6%) . In 17% cases parenchymal lesions were seen in the chest radiography while parenchymal lesions were found 52% of patients by computed tomography . Adenosine deaminase levels in pleural fluid were high in 80% of cases . PPD reactions was found positive in 84.7% of case . Sputum was studied in 52 cases . In 6 (11.5%) patients both ARB and culture were positive but in 4 (7.7%) patients was only culture positive . Pleural fluid ARB examination of all patients was negative whereas culture was positive only in 5 (5%) of patients . In two patients pleural biopsy material culture was positive for ARB . Cytological examination of pleural fluid revealed lymphocyte predominance in 81 (81%) of cases . Eightyone patients had pleural biopsy and pathologic evaluation revealed tuberculosis in 59 (73%) of them . At the end of the treatment 24 (23%) patients had pleural thickening . Pleural fluid LDH level of the patients with pleural thickining was higher than the other patients sigificantly (p=0.024).It is concluded that, pleural biopsy is the most effective diagnostic method for the tuberculous pleurisy and in the patient with elevated pleural LDH level, pleural thickening seems more.

Am J Epidemiol, 2004 Jul 15, 160(2), 97 - 101
Vignettes of the history of epidemiology: Three firsts by Janet Elizabeth Lane-Claypon; Winkelstein W Jr; In 1912, Janet Elizabeth Lane-Claypon, a British medical scientist 35 years of age who had already contributed substantial research findings in the fields of reproductive physiology and the bacteriology and biochemistry of milk, reported the results of a retrospective cohort study of weight gain during the first year of life among 204 infants fed boiled cows' milk compared with 300 infants fed human breast milk . The results of her investigation revealed that, up to the age of 208 days, breastfed infants gained more weight than infants fed boiled cows' milk . After that time period, weight gain was equal in the two groups . Lane-Claypon described, discussed, and analyzed her data for the possibility that her findings were due to sampling variation or confounding, and she used Student's t test to evaluate observed differences in weight gain in small subsets of the study population . As far as is known, this was the first use of the retrospective (historical) cohort design and the t test in an epidemiologic study.

Arch Pediatr, 2004 Jul, 11(7), 822 - 5
{Peritoneal tuberculosis in children: report of two cases}; Blanc P et al.; Peritoneal tuberculosis is an uncommon presentation of extra-pulmonary tuberculosis in children . It usually presents as ascites, abdominal pain, anorexia and weight loss . CASES REPORT: We report two adolescent patients who presented with ascites, fever, weight loss and abdominal distension . In one case, the diagnosis was late, and confirmed by ascites culture . In the second case, a laparoscopy was performed and showed whitish nodules involving the entire abdominal cavity, compatible with peritoneal tuberculosis, later confirmed bacteriologically . CONCLUSION: Peritoneal tuberculosis presents with nonspecific symptoms . Because laboratory investigations may not be helpful, diagnosis may be difficult . Peritoneal-fluid adenosine deaminase (ADA) determination and coelioscopy seem to be the best way to make a rapid diagnosis.

Arch Pediatr, 2004 Jul, 11(7), 789 - 93
{Bacterial pneumopathies of the newborn: diagnostic and therapeutic aspects}; Oulai S et al.; OBJECTIVES: To describe the diagnosis and therapeutic management of bacterial pneumopathies in a neonatology unit located in a tropical area . METHODS: Transverse and prospective survey over an 18-month period . The diagnosis was based on the comparison of anamnestic features with clinical, biological and radiological features . A research was made in order to determine the causal agent in the blood, in cerebrospinal fluid, in urines, in pleural liquid and skin lesions . A treatment by two antibiotics was administered through parenteral route . RESULTS: Risk factors were found in 61 selected patients . Polypnea was associated with signs of respiratory distress in 53 patients . Blood abnormalities were present in 47, 5% of the cases . All the patients showed a positive C reactive protein and abnormal X-rays . The diagnosis was confirmed bacteriologically in 32, 8% of the cases . The association of a third-generation cephalosporin with an aminoside was prescribed in 44 cases . The initial antibiotic therapy was not relevant in 19, 7% of the cases . The lethality rate was 24, 6% . The scarcity of bacteriological confirmation led us to consider the combination of radiological abnormalities with respiratory distress as significant symptoms of bacterial pneumopathy . Biological and anamnestic features were considered as extra elements . CONCLUSION: The severity of clinical features, the nature of germs and their sensitivity to antibiotics in our local environment led us to recommend a large prescription of third-generation cephalosporins combined to aminoglycosides.

Med Sci Monit, 2004 Jul, 10(7), CS31 - 6 Epub 2004 Jun 29.
The use of drotrecogin alfa (activated) in severe sepsis during acute pancreatitis - two case studies; Machala W et al.; BACKGROUND: Twenty-five percent of patients with diagnosed acute pancreatitis (AP) present a severe form of it . One of the most widespread complications of such a form is severe sepsis or septic shock, in which mortality can reach 80% . A complication of this state is multiple organ failure, which requires multi-directional treatment in an intensive care unit (ICU) . Among the standard therapies are: control of the source of infection, supportive treatment of failed organ function, and others (e.g . dietary therapy, pain management, and physiotherapy) . It is also now possible to use recombinant human activated protein C {drotrecogin alfa (activated); Xigris, Eli Lilly, USA} in the treatment of severe sepsis . CASE REPORT: In this study, the cases of two patients in whom severe sepsis was found during the course of acute pancreatitis are presented . In both cases it was established clinically (by laparotomy) and bacteriologically that necrosis-altered fragments of the pancreas were the sources of infection . CONCLUSIONS: Both the cases presented indicate that drotrecogin alfa (activated) interrupts the developmental cascade of severe sepsis . Proofs of the efficacy of the treatment were improvements in the functions of organs previously insufficient during the course of sepsis . The rapid elimination of the drug allowed planning therapy strategies (the possibility of conducting surgical operations and smaller therapeutic interventions) without the risk of increased bleeding . The decision to use Xigris in severe sepsis during AP should always include consideration of the risk of bleeding in connection with the local status within the pancreas.

Australas Radiol, 2004 Jun, 48(2), 148 - 53
Specificity and sensitivity of chest radiographs in the diagnosis of paediatric pulmonary tuberculosis and the value of additional high-kilovolt radiographs; De Villiers RV et al.; Tuberculosis (TB) remains the most common notifiable infectious disease in South Africa . The diagnosis of pulmonary TB in children is often very difficult because of the non-specific radiological signs and inter-observer variation in the interpretation of radiographs . The frontal high-kilovolt (kV) radiograph has been used to assess the effect of TB adenopathy on the tracheobronchial tree and to detect endobronchial lesions . The aims of the present study were to assess the specificity and sensitivity of chest radiographs in the diagnosis of pulmonary TB and to assess whether the addition of the high-kV radiograph affects these parameters . The study group consisted of paediatric patients suspected of having pulmonary TB over a 6-year period . These patients had clinical, bacteriological and radiographic examinations . Radiographs were examined by one experienced radiologist in two sittings separated by a 6-week interval . On the first sitting, only standard radiographs were examined and, on the second sitting, these were supplemented with high-kV radiographs . Differences in the detection of each recognized radiological feature of pulmonary TB before and after the addition of the high-kV film were analysed for statistical significance . The frequency of radiographic findings in our study compared favourably with other reports . No statistically significant differences for the detection of radiographic features consistent with pulmonary TB, or for the diagnosis of pulmonary TB, were demonstrated between the two sittings . Specificity increased from 74.4% to 86.6% with the addition of the high-kV view and sensitivity remained constant at 38.8% . The present study does not support the routine use of the frontal high-kV radiograph for the diagnosis of pulmonary TB . This paper also confirms the findings of others, that standard chest radiographs are a poor indicator of pulmonary TB in children.

Pol Arch Med Wewn, 2004 Mar, 111(3), 339 - 42
{Extrapulmonary tuberculosis: case of a 70-year-old woman suffering from cutaneous lymph node, renal and bone tuberculosis }; Kowalski R et al.; We have described a case of a 70-year-old woman, treated for a pancreas cancer, which was diagnosed for many months because of atypical skin lesions, lymphadenopathy and progressing cachexia . Despite many autoimmunological, serological, histopathological, bacteriological and mycological examinations there was no diagnosis . Finally the case of extrapulmonary tuberculosis involving skin, lymph nodes, kidneys and bones was diagnosed . After the introduction of antituberculotic therapy we are observing some clinical improvement and regression of symptoms.

Probl Tuberk Bolezn Legk, 2004, (5), 32 - 5
{Bacteriological diagnosis of mycobacteriosis: possibilities and prospects}; Otten TF et al.; The results of identification of Mycobacterium non-tuberculosis isolated in the North-West Region of the Russian Federation, which have been obtained in the past 20 years, are presented . The identification was made by bacteriological and biochemical studies . M . avium-intracellulare complex is the man causative agent of mycobacteriosis . The currently available methods of chromatography and molecular genetics, which are designed for accelerated detection and species-specific identification of Mycobacterium, are briefly reviewed.

J Coll Physicians Surg Pak, 2004 Mar, 14(3), 157 - 60
Qualitative assessment of bacteriological quality and chlorination status of drinking water in Lahore; Anwar MS et al.; OBJECTIVE: Qualitative assessment of bacteriological quality and chlorination status of drinking water in Lahore . DESIGN: Descriptive study . PLACE AND DURATION OF STUDY: Lahore city from October 2000 to September 2001 . MATERIALS AND METHODS: A total of 2160 water samples from distribution system were tested from nine different localities of Lahore . These localities represented areas with different socioeconomic conditions (SEC) . Twenty water samples were tested from each locality from the same taps each month . All the water samples were subjected to H2S strip test for determination of bacteriological contamination as well as orthotolidine test for detection of chlorine . RESULTS: Four hundred and forty-six (20.64%) samples were positive for bacterial contamination . It was observed that contamination was the maximum in low SEC areas (32.22%), followed by intermediate SEC areas (18.47%) and high SEC areas (11.25%) . The difference was found to be statistically significant (p<0.01) among different areas . Only 27.73% samples were chlorinated . Positivity of samples for chlorine was the lowest in areas with low SEC(20.69%) and highest (32.77%) in areas with high SEC, the difference being statistically significant . Maximum contamination was present in samples tested during summer months(June-August) of the year (31.11%), followed by autumn months (September-November) of the year (20.9%), spring months (March-May) of the year (18.7%) and winter months (December-February) of the year (11.85%) . Samples tested during summer months showed the highest positivity (77.96%) for chlorine (p<0.001) as compared with other months of year . Among chlorinated samples 12.32% showed bacterial contamination . However, contamination was significantly higher (p<0.001) among non-chlorinated samples . CONCLUSION: Bacterial contamination of piped water is a significant problem in Lahore . Regular chlorination and monitoring of water supplies can improve it.

Indian J Pediatr, 2004 Jun, 71(6), 517 - 21
Comparative evaluation of cefpodoxime versus cefixime in children with lower respiratory tract infections; Sengupta J et al.; OBJECTIVE: The emergence of penicillin and macrolide resistant strains, responsible for Acute Lower Respiratory Tract Infections in children has offered third generation cephalosporins the platform to perform . The aim of the present study was to evaluate two third generation oral cephalosporins for their empirical use in community acquired lower respiratory tract infections in pediatric patients . An assessment of the clinical cure and bacteriological eradication rates and an overall tolerability was made . METHODS: It was a prospective, open, comparative, multicentric study . 776 children (Mean age 10 years) with LRTIs were included and randomly allotted to two groups respectively . A total of 396 children were given cefpodoxime susp 5 mg/kg b.i.d . and 380 patients on cefixime 4 mg/kg b.i.d . for 10-14 days . RESULTS: At the end of therapy, the clinical success with cefpodoxime was 97% as against 86.8% with cefixime . Bacterial eradication was 93.4% with cefpodoxime and 82.9% with cefixime . CONCLUSION: Cefpodoxime has been found to be a well-tolerated and superior alternative to cefixime synergistically documenting the extended spectrum of activity.

Ann Thorac Surg, 2004 Jul, 78(1), 273 - 6
Thoracoscopic management of postpneumonectomy empyema; Gossot D et al.; BACKGROUND: Even when there is no associated bronchopleural fistula, empyema is a serious complication of pneumonectomy . Aggressive surgical treatments are usually applied . However, a minimally invasive approach might achieve satisfactory results in selected patients . METHODS: Out of 17 patients presenting with a postpneumonectomy empyema (PPE), 11 had a thoracoscopic approach . There were 9 males and 2 females, (age, 38-74; mean, 59 years) . Ten patients had no proven bronchopleural fistula (BPF) . One of them had a minor (< 3 mm) BPF . Empyema was confirmed by thoracentesis and bacteriological examination . All patients had immediate chest tube drainage and underwent emergency thoracoscopic debridement of the empyema . No irrigation was used postoperatively . RESULTS: There was no mortality and no morbidity related to the procedure . The average duration of thoracoscopic debridement was 62 minutes (range: 45-80 minutes) . In 8 patients the chest tube was removed between the fifth and thirteenth postoperative day (average, 8.6 days) . They were discharged between the 9th and 24th postoperative day . In 3 patients, clinical and/or biological signs of infection persisted and reoperation was decided at day 5, day 10, and day 11 . All 3 patients underwent open-window thoracostomy . The average follow-up of the 8 patients who underwent only thoracoscopy was 10 months (range, 2-27 months) . None had recurrent empyema . The patient who presented with a minor BPF remained asymptomatic and is doing well after a 27 month follow-up . CONCLUSIONS: Thoracoscopy might be a valuable approach for patients presenting with PPE with or without minor bronchopleural fistula.

MMW Fortschr Med, 2004 Apr 15, 146(16), 34 - 7
{Acute arthritis}; Gomes M et al.; In the case of inflammatory disease of the joints, the first diagnostic step is to determine whether the patient has monoarthritis, oligoarthritis or polyarthritis . After excluding a septic or a crystal-related process by joint puncture and synovial fluid analysis, further laboratory investigations including immunological and bacteriological tests can contribute to the diagnosis, and imaging procedures may also be useful . Primary therapy can be provided with NSAIDs or easy-on-the-stomach coxibs . Where indicated, antibiotics or, if warranted by the diagnosis and in the presence of persistent effusion, corticosteroids.

Curr Opin Pulm Med, 2004 Jul, 10(4), 299 - 304
Recent advances in parapneumonic effusion and empyema; Chapman SJ et al.; PURPOSE OF REVIEW: Complicated parapneumonic effusion and empyema continue to account for significant morbidity and mortality, and uncertainties remain regarding their optimal management . This review describes recent advances in this field, as well as areas for future research . RECENT FINDINGS: Recent advances have addressed the pathogenesis, bacteriology, and treatment of pleural infection . Key areas for research in the development of empyema include the interplay between inflammatory and coagulation cascades and development of fibrosis within the pleural space . The varied bacteriology of empyema has been more clearly defined, and in particular the differences between community- and hospital-acquired infection highlighted . Studies of treatment have focused particularly on the roles of intrapleural fibrinolytics and surgery . SUMMARY: Increased understanding of the pathogenesis of empyema may ultimately yield novel therapeutic targets . Comprehensive descriptions of the bacteriology of empyema aids antibiotic choice, and the use of intrapleural DNase shows promise in facilitating drainage of infected pleural fluid . Uncertainties remain, such as the role of intrapleural fibrinolytics and the optimal timing of surgical intervention.

Curr Probl Diagn Radiol, 2004 May-Jun, 33(3), 127 - 45
Complicated acute pediatric bacterial sinusitis: Imaging updated approach; Vazquez E et al.; Acute bacterial sinusitis is usually a clinical diagnosis . Orbital complications require emergent evaluation with computed tomography . Using the orbital septum as an anatomic landmark, such infections can be classified as pre- or postseptal and treated with the most adequate therapy, ie, oral or intravenous antibiotics or surgical endonasal drainage . Intracranial complications can be seen in 3.7% to 11% of these patients, often with subtle clinical symptoms and signs . Radiologists play a decisive role in the final management of these patients and should be familiar with the most relevant complications . In this article, we present a retrospective review of all pediatric patients referred to our department for paranasal sinuses and orbital computed tomography because of acute complicated bacterial sinusitis . They were studied with an emergent enhanced facial and cranial computed tomography within 24 hours of admission, followed by magnetic resonance imaging when intracranial complications were suspected . Particular emphasis is placed on the imaging algorithm and the most relevant complications; we correlate imaging findings with clinical and bacteriological data.

Kansenshogaku Zasshi, 2004 May, 78(5), 389 - 97
{Bacteriological features of Mycobacterium haemophilum isolated from skin lesions in an immunodeficient patient}; Saito H et al.; A 53-year-old, male patient presented with pain in the middle area of the back of his left foot . The painful area was associated with a reddish dome-shaped swelling of 24 by 18 mm which had ulcerated in the center part . Histopathologically, the cutaneous lesion consisted of an ulcer surrounded by abscess and granuloma and numerous acid-fast organisms were observed . Subsequently, the area just below the left inguinal area developed redness and swelling approaching the size of a quail egg . The patient responded favorably with rifampicin, levofloxacin, and minocycline therapy . The patient was immunodeficient, but negative for HIV-1 and HIV-2 antibodies and the etiology of his immunodeficient state is unclear . Skin tissues or pus were cultured at 37 degrees C on 2% Ogawa and BBL MGIT . Acid-fast organisms were recovered on MGIT within 4 to 12 days, while 2% Ogawa medium failed to recover acid-fast bacteria . Using growth from the positive MGIT tube as inoculum, MycoBroth, 7H9 broth, 7H11.2% Ogawa supplemented with or without iron complexes, and blood agar were inoculated and cultured at 30 and 37 degrees C . Growth at 30 and 37 degrees C was seen with MycoBroth, 7H9, hemin (60 microM) or ferric ammonium citrate (15 mg/ml) supplemented 7H11 and blood agar as well as 7H11 supplemented with factor X . Growth at 30 degrees C only was observed for ferric ammonium citrate supplemented 7H9 and 2% Ogawa . Generally, growth at 30 degrees C was better than that at 37 degrees C in all media . No growth at either temperature was observed with hemin or factor X supplemented 2% Ogawa . With respect to the biochemical characterization, the isolate was negative for niacin, nitrate reduction, urease, arylsulfatase, Tween 80 hydrolysis, catalase, 68 degrees C catalase, acid phosphatase, and tellurite reduction, while strongly positive for neutral red test . Sequencing of the 16S rRNA gene showed the isolate to be consistent with Mycobacterium haemophilum . Based on the composite characterization, the isolate was identified as M . haemophilum . This is the second case report of M . haemophilum infection in Japan in the literature.

Int J Environ Health Res, 2004 Apr, 14(2), 151 - 6
An investigation on physical, chemical, and bacteriological quality of municipally supplied and well waters of the towns and city centre in the province of Niğde, Turkey; Kara E et al.; Physical, chemical, and bacteriological properties of municipally supplied water and well water in selected towns and the city centre (Nigde, population 76,000) of the province of Nigde, located in central Anatolia, in Turkey, were investigated in this study . A composition of 70 samples were collected, 31 from Nigde city centre; 17 from Bor; 8 from Ulukisla; 6 from Altunhisar; 6 from Ciftlik and 2 from Camardi . Analyses showed that all the samples collected were found to have been chemically safe to consume for domestic purposes . Twenty-three water samples were found potentially unsafe because of the existence of coliform bacteria in them, which was probably caused by the inexistence of sufficient chlorination . Physical tests indicated that 11 water samples were found to have deposit; therefore, the use of such water causes risks where human health is a concern, based upon Turkish national standards (TSE, 1984).

Transplant Proc, 2004 May, 36(4), 905 - 6
Tuberculosis in renal transplants in Rio de Janeiro; Matuck TA et al.; Retrospective analysis of 982 renal transplants over 21 years (1981 to 2002) sought to evaluate the prevalence of tuberculosis (TB) . This analysis included 74 patients: 30 with a past TB history, who had INH prophylaxis since the beginning of immunosuppression, and 44 who only became TB infected after receiving transplants . The diagnosis of TB was made by a compatible medical situation with bacteriological/histological confirmation, which when not possible, underwent a therapeutic test occur . The average time for the illness to surge was 3 years . The mortality rate was 34.9% (15/44) . Patients with hepatitis C were more affected . Among those who used INH prophylaxis only one contracted TB, showing that the drug displayed a protection rate of 96.6% (29/30).

Aust N Z J Obstet Gynaecol, 2004 Jun, 44(3), 228 - 32
Cervical surveillance as an alternative to elective cervical cerclage for pregnancy management of suspected cervical incompetence; Higgins SP et al.; OBJECTIVE: The aim of the present study was to compare the outcome of pregnancies among patients with suspected cervical incompetence treated either by elective cervical cerclage or an alternative management program involving cervical surveillance . DESIGN, SETTING AND METHODS: A prospective cohort study was performed in two groups of patients at risk of cervical incompetence with singleton gestations attending the Royal Women's Hospital, Melbourne, Australia, from 1996 to 2000 . The first group was managed by their obstetric carers with an elective cerclage, while the second group was managed conservatively as part of a cervical surveillance program offered to patients attending the Department of Perinatal Medicine for pregnancy care . This program consists of weekly visits from 16 weeks' gestation and involves alternating transvaginal ultrasound assessment of cervical morphometry with cervico-vaginal bacteriology and fetal fibronectin swabs . Empiric insertion of a cerclage is undertaken when there is evidence of significant cervical shortening (cervical canal <2.5 cm in length at </=24 weeks) . RESULTS: A total of 135 patients were identified for the study . Ninety-seven patients had an elective cervical cerclage inserted . Thirty-eight patients were followed through the cervical surveillance program . Twelve (32%) of the surveillance patients had a cerclage inserted at a mean gestational age of 20.6 weeks . There were no statistically significant differences between the groups in terms of maternal demographics or risk assessment scoring . One out of 38 (2.6%) patients of the surveillance group and 18/97 (18.6%) of the elective cerclage group delivered before 30 weeks' gestation (P = 0.034) . CONCLUSIONS: Our study suggests that by only inserting a cerclage when indicated on the basis of ultrasound assessment of cervical morphometry, the number of cerclages required can be reduced while the perinatal outcome is significantly improved.

Clin Microbiol Infect, 2004 Jun, 10(6), 512 - 20
Once-daily oral gatifloxacin vs three-times-daily co-amoxiclav in the treatment of patients with community-acquired pneumonia; Lode H et al.; A double-blind, double-dummy, multicentre, multinational, parallel-group study was designed to establish proof of equivalence between oral gatifloxacin and oral co-amoxiclav in the treatment of 462 patients with mild-to-moderate community-acquired pneumonia . Eligible patients were randomised equally to either gatifloxacin 400 mg once-daily plus matching placebo for 5-10 days, or amoxycillin 500 mg + clavulanic acid 125 mg three-times-daily for 5-10 days . The primary efficacy endpoint was clinical response (clinical cure plus improvement) at the end of treatment . Overall, a successful clinical response was achieved in 86.8% of gatifloxacin-treated patients, compared with 81.6% of those receiving co-amoxiclav, while corresponding rates of bacteriological efficacy (eradication plus presumed eradication) were 83.1% and 78.7%, respectively . The safety and tolerability profile of gatifloxacin was comparable to that of co-amoxiclav, with adverse gastrointestinal events, e.g., diarrhoea and nausea, being the most common treatment-related adverse events in both groups . The study showed no evidence of gatifloxacin-induced phototoxicity, musculoskeletal disorders, or hepatic and renal problems . Overall, this study showed that gatifloxacin was equivalent clinically to a standard course of co-amoxiclav in patients with community-acquired pneumonia, and that gatifloxacin was safe and well-tolerated.

J Dairy Res, 2004 May, 71(2), 169 - 74
Influence of intramammary infection and non-infection factors on somatic cell counts in dairy goats; Luengo C et al.; A total of 1304 goat udder halves were sampled monthly during an entire lactation (6262 samples) with the aim of identifying factors affecting milk somatic cell count (SCC) . Bacteriological analyses for identification of mastitis pathogens were carried out on all samples and SCC was also determined . All animals were examined for infection by caprine arthritis-encephalitis virus (CAEV) using a commercial ELISA test kit . Results obtained were arranged in two databases (whole-lactation average half-udder database and monthly half-udder database) and two mixed models were applied . Random effects of half udder nested into flock and fixed effects of flock, intramammary infection (IMI) status, number of kids born, length of lactation and interaction of parity with IMI status were significant for the first database . CAEV infection and its interaction with IMI status was not significant . Milk SCC was significantly increased for infected udder halves and milk from udder halves infected with minor pathogens had lower SCC than udder halves infected with major pathogens . For healthy udder halves, SCC was higher in older animals but this effect was not evident in halves with IMI . Multiple birth and short-duration lactation were factors associated with elevated milk SCC . The second mixed model considered repeated measures in time for consecutive samplings throughout lactation (stage of lactation) which was also a significant factor with increasing stage of lactation . The influence of all these factors should be taken into account in the establishment of more reliable diagnostic SCC thresholds for IMI.

Zh Mikrobiol Epidemiol Immunobiol, 2004 Mar-Apr, (2), 106 - 9
{Immunologic methods in the diagnostics and treatment of nosocomial cases of pneumonia}; Khvatov VB et al.; The publications on the etiology, bacteriological and immunochemical diagnostics of pneumonia, as well as on the role of immunotherapy and prophylaxis in the treatment of this disease, are analyzed . The importance of immunological methods in the diagnostics of pneumonia is pointed out . Approaches to the immunotherapy and immunoprophylaxis of pneumonia are updated.

Eur J Radiol, 2004 Jul, 51(1), 54 - 60
Mammographic and sonographic features of tuberculous mastitis; Sakr AA et al.; From December 1999 to April 2001, 10 cases of tuberculous mastitis were presented to the Radiology Unit at the Medical Research Institute of Alexandria University for mammographic and sonographic evaluation . Sixty percent presented with masses, 50% mastalgia, 40% discharge, and 10% complained of skin sinus . In 30% of the patients the complaint was bilateral . All cases underwent full mammographic and ultrasonographic (US) studies, and US-guided fine needle aspiration . Also pathological, bacteriological analysis, and polymerase chain reaction (PCR) were done to all patients to prove the tuberculous nature of their lesions . Thirty percent of the cases had surgical excision on their masses . On mammography 30% were found to have mass lesion mimicking malignant tumors, 40% smooth bordered masses, 40% axillary or intramammary adenopathy, 30% asymmetric density, 30% duct ectasia, 20% with skin thickening and nipple retraction, 20% with macrocalcification, and 10% with skin sinus . On US 60% had hypoechoic masses, 40% focal or sectorial duct ectasia, and 50% axillary adenopathy . History of tuberculosis was found in 30% of the cases . Chest X-ray was positive in 20% and breast magnetic resonance imaging was done to one patient who had skin sinus.

Rev Prat, 2003 Sep 30, 53(14), 1554 - 60
{Antibiotic therapy: from pharmacology to decision making}; Potel G et al.; The decision of an antibiotic treatment depends first on clinical and bacteriological data . Then PK/PD (pharmacodynamics/pharmacokinetics) of antibiotics must be taken into account in order to optimise the dosing regimen, and to reach the targeted serum concentrations . The good oral bioavailability of some drugs allows the use of the oral route, at the beginning of the treatment, or shortly after an initial successful i.v . administration, even in severe infections.

J Clin Microbiol, 2004 Jun, 42(6), 2602 - 8
Bovine tuberculosis (Mycobacterium bovis) in wildlife in Spain; Aranaz A et al.; Mycobacterium bovis infection in wildlife and feral species is a potential source of infection for livestock and a threat to protected and endangered species . The aim of this study was to identify Spanish wild animal species infected with M . bovis through bacteriological culture and spacer oligonucleotide typing (spoligotyping) of isolates for epidemiological purposes . This study included samples from red deer (Cervus elaphus), fallow deer (Dama dama), wild boar (Sus scrofa), Iberian lynx (Lynx pardina), hare (Lepus europaeus), and cattle (Bos taurus) . They were collected in several geographical areas that were selected for their unique ecological value and/or known relationships between wildlife and livestock . In the areas included in this survey, M . bovis strains with the same spoligotyping pattern were found infecting several wild species and livestock, which indicates an epidemiological link . A locally predominant spoligotype was found in these areas . Better understanding of the transmission and distribution of disease in these populations will permit more precise targeting of control measures.

Am J Respir Crit Care Med, 2004 Sep 1, 170(5), 561 - 6 Epub 2004 Jun 07.
Tuberculosis treatment outcomes: directly observed therapy compared with self-administered therapy; Jasmer RM et al.; Effective treatment of tuberculosis requires adherence to a minimum of 6 months treatment with multiple drugs . To improve adherence and cure rates, directly observed therapy is recommended for the treatment of pulmonary tuberculosis . We compared treatment outcomes among all culture-positive patients treated for active pulmonary tuberculosis (n = 372) in San Francisco County, California from 1998 through 2000 . Patients treated by directly observed therapy at the start of therapy (n = 149) had a significantly higher cure rate compared with patients treated by self-administered therapy (n = 223) (the sum of bacteriologic cure and completion of treatment, 97.8% versus 88.6%, p < 0.002), and decreased tuberculosis-related mortality (0% vs . 5.5%, p = 0.002) . Rates of treatment failure, relapse, and acquired drug resistance were similar between the two groups . Forty-four percent of patients who received self-administered therapy had risk factors for nonadherence and should have been assigned to directly observed therapy . We conclude that treatment plans that emphasize directly observed therapy from the start of therapy have the greatest success in improving tuberculosis treatment outcomes.

Treat Respir Med, 2004, 3(2), 123 - 31
Hospital-acquired pneumonia in critically ill patients: mortality risk stratification upon onset; Leroy O et al.; STUDY OBJECTIVES: To identify, in patients experiencing hospital-acquired pneumonia (HAP), prognostic factors present at disease onset and build an algorithm capable of stratifying mortality risk upon HAP onset . DESIGN: Observational cohort from January 1994 to December 2001 . SETTING: One intensive care unit (ICU) from a university-affiliated, urban teaching hospital . PATIENTS: All consecutive patients exhibiting bacteriologically documented HAP either on ICU admission or during ICU stay . INTERVENTIONS: Data collection and multivariate analysis using Chi-Square Automatic Interaction and Detection technique . RESULTS: 168 patients were studied . The overall mean mortality rate was 49.4% . Upon onset of HAP, five independent variables allowed binary stratification of mortality risk . These consisted of underlying diseases (nonfatal versus ultimately and rapidly fatal diseases), Simplified Acute Physiology Score II (less than versus > or =37), platelet count (less than versus > or =150,000/mm3), chest x-ray involvement (1 versus >1 lobe), and PaO2/FiO2 (less than versus > or =167 mm Hg) . A branching algorithm consisting of these five variables identified patients with HAP at both low (<35%) and high (>75%) risk of mortality . CONCLUSION: Mortality in ICU patients with HAP may be predicted early, upon onset of HAP, by the cumulative use of prognostic factors in an algorithm.

Diagn Cytopathol, 2004 Jun, 30(6), 386 - 8
Pitfalls in the cytological classification of borderline leprosy in the Ridley-Jopling scale; Singh N et al.; This is a blinded, retrospective, correlative study of classification of leprosy by cytomorphology, clinical examination, and bacterial density . One hundred consecutive adequate aspirates from skin lesions of leprosy were studied . The Ridley-Jopling (R-J) five-group classification system was used . May-Gruenwald-Giemsa (MGG) and Ziehl-Neelsen (Z-N) stains were employed . Complete clinical, cytological, and bacteriological concordance was found in 88 patients . One-step mismatch in classification was seen in 12 patients with cytomorphological features of borderline-borderline (BB/mid-borderline) leprosy . Cytomorphological features of BB leprosy in aspirates from skin lesions should alert the cytopathologist to the possibility that the bacteriological index (BI) may vary widely . Appropriate steps must be taken to ensure accurate reporting of BI .

Int J Syst Evol Microbiol, 2004 May, 54(Pt 3), 633 - 4
Notification that new names and new combinations have appeared in volume 54, part 1, of the IJSEM.
{C-reactive protein in patients with bacteriological positive lung tuberculosis}
Ito K, Yoshiyama T, Wada M, Ogata H.

Department of Research, Research Institute of Tuberculosis, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan . ito@jata.or.jp

PURPOSE: To investigate the usefulness of measuring C-reactive protein in the diagnosis of lung tuberculosis . OBJECT: Tuberculosis patients treated by chemotherapy at Fukujuji Hospital from Jan./1/2000 to Dec./31/2001 . METHOD: Chart review . RESULTS: CRP are negative in 13.3% (95%CI: 8.9-17.7%) in sputum smear positive lung tuberculosis patients (N = 226), and in 73.0% (95%CI: 62.0-84.0%) of sputum smear negative culture positive lung tuberculosis patients (N = 63) . CONCLUSION: Usefulness of measuring C-reactive protein in the diagnosis of bacteriological positive lung tuberculosis is limited.

J Small Anim Pract, 2004 May, 45(5), 254 - 8
Dermatitis and lymphadenitis resembling juvenile cellulitis in a four-year-old dog; Neuber AE et al.; A four-year-old, entire male toy poodle was presented with a two-and-a-half-week history of ocular discharge progressing to periorbital alopecia, depigmentation, alopecia and ulceration around the muzzle . There was also a haemorrhagic discharge from the ears, pyrexia, lethargy and generalised lymphadenopathy . The clinical, cytological, bacteriological and histopathological findings were consistent with a diagnosis of dermatitis resembling juvenile cellulitis in an adult dog . Glucocorticoid therapy led to rapid resolution of the clinical signs and the dog has remained in remission for two years after cessation of treatment.

Bull Hist Med, 2004 Spring, 78(1), 108 - 47
Epidemic encephalitis and American neurology, 1919-1940; Kroker K; Encephalitis lethargica, also known as epidemic encephalitis, emerged as a new infectious disease near the end of the First World War . Bacteriologic, epidemiologic, and clinical investigation produced no clear consensus regarding the nature of the disease, even as several other experimentally demonstrable "encephalitides" appeared on the scene . By 1940, new encephalitis lethargica cases had almost entirely disappeared, and neurologists renamed this once-novel infection as an amorphous syndrome of marginal interest . A variety of forces influencing the fate of encephalitis lethargica's epidemic status can be seen at work in the Matheson Commission, whose members hoped to use encephalitis as a model disease that might supplant their reliance on clinical phenomenology with a causal analysis of nervous disease grounded in the laboratory . When it failed to live up to these expectations, the model was abandoned . Epidemic encephalitis was soon forgotten.

Shanghai Kou Qiang Yi Xue, 1995 Mar, 4(1), 12 - 3
{Preliminary clinical study of endodontic antiseptic in monotithic type chlorhexidine controlled release delivery system}; Ling JQ et al.; The purpose of clinical study was to assess the bacteriological status of the root canal after disinfection with the monotithic type chlorhexidine enrolled release delivery system (CCROS).In experiments the monotithic type CCRDS was found to be more effective than the reservoir type CCRDS.The root canals of 24 teeth with apical periodontitis were completely instrumented and irrigated with sodium hypochloride.After the instrumentations,12 teeth were treated with the monotitihic type CCRDS,12 teeth were treated with formocresol.Bacterological samples from the root canals were taken after 5 days using an anaerobic technique.The results indicated that monotithic type CCRDS was more effective than formocresol in obtaining bacteria-free root canals(Chi-square test P<0.05).The advantages of an antiseptic with along lasting effect for the elimination of bacteria form the root canal and for the prevention of reinfection were emphasized.

Rev Med Brux, 2004 Apr, 25(2), 99 - 102
{Tuberculous sacroiliitis: report of a case}; Brasseur P et al.; Our case concerns a 32-year old Cameroonian male presenting with tuberculous sacroiliitis . Diagnosis was made on the basis of a positive abscess needle aspirate . Tuberculous sacroiliitis is rare and generally an isolated phenomenon . Its insidious presentation leads to delayed diagnosis . The affection is often overlooked due to lack of awareness of the clinicians, the usually good condition of the patient and minimal signs of sacroiliac joint infection . Haematological data are frequently non contributory . High risk groups include developing countries immigrants, immunodepressed patients and low socioeconomic status . Accurate diagnosis is based on percutaneous synovial fluid or abscess aspirate bacteriology . CT-scan and NMR are the most helpful radiological examinations.

Methods Mol Biol, 2004, 268, 475 - 79
beta-Glucuronidase method to determine mastitis levels in goat milk; Oliszewski R et al.; Mastitis is a general term that refers to the inflammation of the mammary gland . It is the most common illness in dairy farms and it has different causes, mainly a great number of germs that infect the gland.These infectious diseases induce gross variations in milk composition, reflected by physical, chemical, and bacteriological changes . They produce milk jellification, a decrease in important components such as lactose, casein, and fats and minerals such as calcium, phosphorus, and potassium and increases in other unimportant technological components, such as serum proteins and chlorides; all these affect the cheese efficiency and the starter culture action.Assuming that cheese making is the principal use of goat milk in industry, an evaluation of the quality of the milk used as the raw material is of fundamental importance . It is impossible to obtain quality products by using milk with an anomalous chemical composition.Somatic cell count (SCC) is the indicator most used for mastitis detection . These cells, which are contained in milk, can be grouped into three types: epithelial cells, blood cells, and cytoplasmatic particles . During an attack of mastitis, the immune defenses of the udder are activated, polynucleated leukocytes pass from the blood toward the mammary gland in large numbers, and the number of somatic cells in the milk increases.The level of somatic cells in goat milk is characterized by great variability between different countries and between regions of the same country . Different authors show averages between 750,000 and 5,400,000 cells/mL . These values differ greatly between cow and goat milk, mainly because normally nonleukocytic cell-like particles can be found as a result of the particular apocrine secretion process in the goat mammary gland . These particles are large fragments of cytoplasm originating from the distal portion of alveolar secretory cells and are of similar size (5-30 microm in diameter) to milk leukocytes . They contain abundant RNA-positive granular material (associated with dilated cisternae of the rough endoplasmic reticulum), large amounts of protein, and some lipids, but no DNA . Thus it is important to use techniques that disregard these other substances and allow only a count of somatic cells.

Nucl Med Commun, 2004 Feb, 25(2), 171 - 5
The usefulness of 99mTc sulfur colloid bone marrow scintigraphy combined with 111In leucocyte scintigraphy in prosthetic joint infection; El Espera I et al.; AIM: To assess the extent to which bone marrow scintigraphy (BMS) makes the interpretation of leucocyte scintigraphy (LS) easier and improves its diagnostic value . METHODS: Seventy-three 111In LSs, 99mTc hydroxymethylene diphosphonate bone scintigraphies (BSs) and 99mTc sulfur colloid BMSs were performed in 60 patients with suspected infection related to a hip prosthesis or knee prosthesis, either in situ (+group, n = 43) or after removal for septic loosening (-group, n = 30) . Bacteriological samples were obtained from all patients . LS was interpreted together with BS (LS-BS) or with BMS (LS-BMS) by three independent readers . RESULTS: The concordance among readers, estimated by the kappa test, was average with LS-BS (kappa/kappam coefficients = 0.58, 0.58 and 0.46, respectively, for the three pairs of readers) and excellent with LS-BMS (kappa/kappam coefficients = 1.00 for the three pairs of readers) . With LS-BS, 64/219 interpretations were equivocal whereas only one was equivocal with LS-BMS . Sensitivity, specificity and accuracy of LS-BMS were, respectively, 80%, 94% and 91% in the +group, and 33%, 100% and 93% in the -group . CONCLUSION: We conclude that (1) the interpretation of the results for LS-BMS is very easy, in contrast to LS-BS; (2) the diagnostic value of LS-BMS for detecting infected joint prostheses is good; and (3) additional data are needed to assess the accuracy of LS-BMS when the prosthesis has been removed.

Methods Mol Biol, 2004, 266, 191 - 211
Real-time PCR; Saunders NA; The development of instruments that allow real-time monitoring of fluorescence within PCR reaction vessels is a significant advance in clinical bacteriology . The technology is very flexible, and many alternative instruments and fluorescent probe systems are currently available . Real-time PCR assays can be completed very rapidly, because no manipulations are required after amplification . Identification of amplification products by probe detection in real time is highly accurate compared with size analysis on gels . Analysis of the progress of the reaction allows accurate quantification of the target sequence over a very wide dynamic range, provided suitable standards are available . Finally, probe melting analysis can detect sequence variants including single base mutations.

Methods Mol Biol, 2004, 266, 139 - 66
Molecular diagnostics: current options; Millar BC et al.; Diagnostic medical bacteriology consists of two main components: identification and typing . Molecular biology has the potential to revolutionize the way in which diagnostic tests are delivered in order to optimize the care of infected patients, whether they are in hospital or in the community . Since the discovery of the polymerase chain reaction (PCR) in the late 1980s, an enormous amount of research has enabled the introduction of molecular tests into several areas of routine clinical microbiology . Molecular biology techniques continue to evolve rapidly, and many laboratories have been reluctant to introduce these new methods due to concerns that the technology would become outdated . In consequence, the vast majority of clinical bacteriology laboratories do not currently use any molecular diagnostics, although such technology is becoming more widespread in specialized regional laboratories, as well as in national reference laboratories . Presently, molecular biology offers a wide repertoire of techniques and permutations . This chapter is intended to explore the application of these in the diagnostic laboratory setting.

Methods Mol Biol, 2004, 266, 17 - 28
Public databases: retrieving and manipulating sequences for beginners; Woodford N; This chapter outlines the basic requirements for finding and exploring sequences of interest in public databases, such as GenBank . As such, it is not aimed at experienced sequencers, for whom this will be "second nature," but at the many clinical bacteriologists who rarely have need of DNA sequences in their usual work, and who would like to develop their interest in what can appear to be a daunting area . The topics discussed include finding and retrieving sequences from GenBank, identifying homologous sequences using BLAST searches, resources for accessing microbial genomes, and the Protein Data Bank . Finally, recommendations are made for useful software (freeware) and online sequence manipulation resources.

Methods Mol Biol, 2004, 266, 3 - 15
Bacterial genomes for the masses: relevance to the clinical laboratory; Pallen MJ; Bacterial genome sequencing has revolutionized the research landscape and promises to deliver important changes to the clinical microbiology laboratory, through the identification of novel diagnostic targets and through the birth of a new discipline or "genomic epidemiology." Current progress and future prospects for exploitation of genome sequences in clinical bacteriology are reviewed.

Am J Surg, 2004 May, 187(5A), 29S - 33S
Understanding experimental biology of skin equivalent: from laboratory to clinical use in patients with burns and chronic wounds; Ehrlich HP; A major breakthrough in burn wound care was the early excision of the burn and its immediate coverage with a skin autograft . A search for a skin-graft substitute began to reduce the autografting-related trauma at the donor site . One entry was skin equivalence, which contains 3 components: (1) living fibroblasts, suspended in (2) a native collagen matrix, the surface of which is covered with (3) viable keratinocytes . The tissue-cultured dermal fibroblasts are derived from human foreskin . The fibroblasts are grown in cell culture dishes as a monolayer and are retrieved by limited trypsin digestion . The fibroblast suspension is mixed with serum-supplemented culture medium and native acid-soluble collagen . The entire mixture, called a dermal equivalent, is placed in a bacteriological Petri dish before transfer to a 37 degrees C incubator . The collagen rapidly polymerizes, trapping cells in the dermal equivalent . During the initial 4 hours, fibroblasts elongate and spread, causing a decrease in the thickness of the dermal equivalent . After 6 hours, the dermal equivalent undergoes a decrease in diameter as a consequence of the reorganization of the collagen . A freshly isolated suspension of human skin-derived keratinocytes is seeded on the surface of a several-day-old floating dermal equivalent . The keratinocytes proliferate, covering the surface of the dermal equivalent . The keratinocytes deposit basement membranes beneath them and undergo epidermal cell differentiation, leading to the formation of a basal layer beneath differentiated cell layers . Both cell populations retain viability and release cell factors that have a positive effect on wound closure . The placement of skin equivalence within a chronic wound may share structural attributes with a skin graft, but its function is to accelerate closure.

Infect Dis Clin North Am, 2004 Jun, 18(2), 293 - 309, table of contents
The major infectious epidemic diseases of Civil War soldiers; Bollet AJ; Two thirds of the 600,000 deaths of Civil War soldiers were caused by disease . Physicians during the war kept detailed records and reports, which were tabulated, discussed in detail, and published after the war . These records include case histories, autopsy descriptions, photographs, and photomicrographs; they are the best records of the medical experiences of any of America's wars, even those in the twentieth century . Because the Civil War occurred just before the discoveries of bacteriology, these records are of particular historical interest.

Tuberk Toraks, 2003, 51(3), 289 - 97
{Evaluation of Nazilli Tuberculosis Dispensary activities executed between June 1996-May 2000: Pre-DOT situation}; Arpaz S et al.; Objective: To evaluate Nazilli Tuberculosis Dispensary activities executed between 1st June, 1996- 31st May, 2000 and to compare differences among 12-month-periods . Design: Retrospective analyses of data . Settings: People living in the villages under responsibility of Nazilli Tuberculosis Dispensary . Population: People examined in out-patient clinic as symptomatic cases, for health report or during contact examination, number of mycobacteriological and radiological examinations, and tuberculosis cases detected in each year . Main Results: Average number of newly diagnosed tuberculosis patient in every 12-month-period was 105 . The average rate for new tuberculosis cases finding was 52.5% . Pulmonary tuberculosis was in 74.8% of all tuberculosis cases . The range of smear positive pulmonary tuberculosis cases in all tuberculosis cases differed from 49% to 71% and a decrease in the rate of cases with no sputum smear from 18% to 3% were observed . The average of bacteriological conversion rate at the end of second therapy month was 70.5% . The average of cure rate in new smear positive patients was 82% . According to drug susceptibility test results, 13 of new smear positive cases and 5 of old cases were multi-drug resistant tuberculosis . Conclusion: Although the treatment success of either new smear positive or old smear positive tuberculosis cases were high, it is necessary to plan strategies for increasing the new case finding rate to 70%, the rate suggested by World Health Organization . The data obtained by this study showed that hopeful results may be achieved by stable staff and team-work in tuberculosis dispensary.

Int J Syst Evol Microbiol, 2004 May, 54(Pt 3), 999 - 1000
Proposal of Nakamurella gen . nov . as a substitute for the bacterial genus Microsphaera Yoshimi et al . 1996 and Nakamurellaceae fam . nov . as a substitute for the illegitimate bacterial family Microsphaeraceae Rainey et al . 1997; Tao TS et al.; The bacterial genus Microsphaera Yoshimi et al . 1996 is illegitimate because of priority of the fungal genus Microsphaera (Wallr.) Lev . {Principle 2, Rule 51b(4) of the Bacteriological Code} . Therefore, a new genus name, Nakamurella, is proposed for the bacterial genus . The type species Microsphaera multipartita Yoshimi et al . 1996 becomes Nakamurella multipartita gen . nov., comb . nov . Due to the illegitimacy of the only genus in the family Microsphaeraceae Rainey et al . 1997, this family name is replaced by the new bacterial family name Nakamurellaceae.

Int J Syst Evol Microbiol, 2004 May, 54(Pt 3), 631 - 2
Validation of publication of new names and new combinations previously effectively published outside the IJSEM; Detection of Mycobacterium tuberculosis by a polymerase chain reaction colorimetric dot-blot assay; Centro de Desenvolvimento Cientifico e Tecnologico, Fundacao Estadual de Producao e Pesquisa em Saude-Porto Alegre, RS, BrazilSETTING: A public health laboratory in a tuberculosis-endemic region in Brazil . OBJECTIVE: To evaluate the accuracy of a combined polymerase chain reaction (PCR) colorimetric dot-blot protocol for Mycobacterium tuberculosis detection in clinical samples in a public health laboratory . DESIGN: Eighty clinical samples (13 cerebrospinal fluid, 31 induced sputum, 17 expectorated sputum, eight bronchoalveolar lavage and 11 pleural fluid) were assayed with the developed protocol . The accuracy of polymerase chain reaction (PCR) dot-blot methodology was compared to PCR agarose gel electrophoresis (PCR-AG) using as a gold standard the bacteriological result (culture and biochemical identification) combined with clinical follow-up . One internal region of the IS6110 repetitive element of the M . tuberculosis complex was selected for amplification and the amplified product transferred to nylon membranes to be detected by biotinylated DNA probe . RESULTS: Overall sensitivity and specificity obtained were respectively 90% and 97% for PCR-AG and 95% and 97% for the PCR dot-blot . Among the 56 respiratory specimens, the sensitivity and specificity results for PCR-AG were respectively 88% and 95%, and for PCR dot-blot they were 94% and 95% . Among the 24 non-respiratory specimens the sensitivity and specificity results were respectively 83% and 100% for PCR-AG, and 100% and 100% for the PCR dot-blot protocol . CONCLUSION: The results demonstrated that the PCR dot-blot assay may be helpful in the diagnosis of tuberculosis, and feasible even in resource-poor countries.

Int J Tuberc Lung Dis, 2004 Feb, 8(2), 194 - 203
Tuberculosis and gender: exploring the patterns in a case control study in Malawi; Crampin AC et al.; BACKGROUND: In many populations there is an excess of tuberculosis in young women and older men . We explored possible explanations for these patterns, concentrating on human immunodeficiency virus (HIV) status, pregnancy, smoking, cooking smoke exposure, contact with tuberculosis cases within the household or outside, and gender differences in health service usage and diagnostic delay . DESIGN: Case control study in Karonga District, Malawi . METHODS: Cases were new tuberculosis patients with bacteriological or histological evidence of tuberculosis . Controls were selected in the community using field-based random sampling . RESULTS: The study included 598 tuberculosis cases and 992 controls, with an excess of tuberculosis in young females and older males . This was more marked in HIV-positive individuals . HIV infection was a similarly strong risk factor for tuberculosis in both men and women . Tuberculosis was associated with having a family or household contact with tuberculosis for both men and women . For women, but not men, contacts outside the close family and household were also a risk factor for tuberculosis . Tuberculosis was not associated with current or recent pregnancy, or with smoking or smoke exposure . There were no differences between men and women in health service usage or delay . CONCLUSIONS: In this population, HIV infection and contacts with known tuberculosis patients are important determinants of the gender distribution of cases.

Int J Tuberc Lung Dis, 2004 May, 8(5), 636 - 47
Global epidemiology of childhood tuberculosis; Nelson LJ et al.; Tuberculosis (TB) in children has been less of a public health priority in recent years, despite the fact that TB is an important cause of childhood morbidity and mortality worldwide . Data on trends in childhood TB are scarce in the published literature . The diagnosis of TB in children is difficult, and rarely rests on bacteriologic confirmation . Surveillance data for children in many countries are lacking and there are few epidemiologic studies . However, in regions of the world such as sub-Saharan Africa where adult TB is increasing, this trend is likely occurring among children as well . This review documents an increase in childhood TB in many parts of the world . Risk factors vary by region . Improvements in global surveillance of childhood TB, investigation of the role of national TB programs (NTPs) in improving the control of childhood TB, and better identification of risk factors for childhood disease will be crucial to future control efforts for childhood TB . This might include assessment of optimal methods of contact investigations and an analysis of NTP data to assess risk factors for adverse outcomes (e.g., death, default, treatment failure) among children . Ultimately, these data will ensure the success of interventions to reduce the burden of childhood TB using strategies that specifically target this population . As children represent the future burden of TB disease, these efforts could significantly reduce the overall global burden of TB in years to come.

J Wildl Dis, 2004 Jan, 40(1), 32 - 41
Serologic survey for antibodies against Mycobacterium a vium subsp . paratuberculosis in free-ranging cervids from Norway; Tryland M et al.; Affinity between protein-G and immunoglobulins from red deer (Cervus elaphus), moose (Alces alces), roe deer (Capreolus capreolus), and reindeer (Rangifer tarandus tarandus) was tested in a competition binding assay . Sera from red deer, reindeer, and moose inhibited the assay less than sera from cattle (less affinity), whereas sera from roe deer showed a slightly higher affinity to protein-G than did sera from cattle . The conclusion was made that protein-G could be used instead of anti-species antibodies for these cervid species, where the aim of the screening was to look for exposure or lack of exposure to mycobacteria in the tested populations . Serologic screening of 1,373 free-ranging cervids for antibodies against Mycobacterium avium subsp . paratuberculosis was conducted . All sera were tested by a protein-G-based antigen-absorbed enzyme-linked immunosorbent assay (ELISA) . Seropositive moose (10/537; 1.9%), red deer (14/371; 3.8%), roe deer (6/49; 12.2%), and semidomesticated reindeer (11/325; 3.4%) were found, whereas wild reindeer (n = 91) were seronegative . In addition, the red deer sera were tested with a commercial ELISA, by which two animals tested positive and nine were suspicious of having M . avium subsp . paratuberculosis antibodies . Tissue samples and feces from 10 moose originating from a population with a clustering of seropositive animals were investigated by histology and bacteriology with negative results . Paratuberculosis has never been diagnosed in free-ranging or farmed cervid species in Norway . Thus, further studies are indicated to prove that the present findings reflect an infection with M . avium subsp . paratuberculosis.

Probl Tuberk Bolezn Legk, 2004, (2), 48 - 50
{Abdominal tuberculosis in the clinical picture of visceral diseases}; Makhmudov UN et al.; The present-day situation requires that a physician should be broad-minded and alert to abdominal tuberculosis . To diagnose abdominal tuberculosis in internal medicine is a challenge, which has been evidenced by studies of the clinical picture of abdominal tuberculosis in 75 patients . The polymorphism and clinical features of abdominal tuberculosis under the present conditions are shown . In 37 (49.3%) patients, abdominal tuberculosis was revealed during surgical interventions . By taking into account the inadequate informative value of indirect studies, the absence of early pathognomic symptoms of the disease and reliable criteria for evaluating the activity of the process, the authors propose to use invasive endoscopic studies of the abdomen, by making biopsy of the involved tissue . The morphological and bacteriological studies of the biopsy specimens obtained permit verification of the diagnosis of abdominal tuberculosis.

Vet Microbiol, 2004 May 20, 100(1-2), 65 - 76
Efficacy of different commercial and new inactivated vaccines against ovine enzootic abortion; Garcia de la Fuente JN et al.; The protective efficacy of two inactivated commercial (A, B) and two new inactivated vaccines (M7, QS) against ovine enzootic abortion was determined in two separate experiments in sheep . Vaccine A contained chlamydiae propagated in chicken embryos, adjuvated with Marcol 82, and vaccine B contained chlamydiae cultured in cell monolayers, adjuvated with aluminium hydroxide . For the preparation of the experimental vaccines, Chlamydophila abortus AB7 strain was cultured in McCoy cells and adjuvated with QS-21 (QS) or Montanide ISA 773 (M7) . The ewes were vaccinated twice subcutaneously and challenged at 90 days of gestation . Protection was evaluated by clinical, bacteriological and serological examinations, and compared to two control groups: one of infected but not vaccinated ewes, and another of vaccinated but not infected ewes . The experimental vaccines induced considerably better protection than the two commercial ones . The new vaccine M7 especially showed no abortions, a good antibody response, the highest newborn lamb weights and the lowest level of C . abortus shedding at lambing.

Arch Pediatr, 2004 May, 11(5), 432 - 5
{Cardiorespiratory arrest in full term newborn infants: six case reports}; Gatti H et al.; Cardiorespiratory arrest occurring within the first two hours of life of a perfectly normal newborn is a very seldom event hitherto unreported . Six infants born after an uneventful pregnancy by normal vaginal delivery, with a normal Apgar score and physical examination, were found with unexpected cardiorespiratory arrest requiring cardiac and respiratory resuscitation early after birth . All were lying in the prone position, their face covered up while facing mother's abdomen, breast or neck . All mothers were primipara . All newborns but one died . Biological and bacteriological samples were normal and early onset neonatal sepsis was ruled out . Autopsy, performed in five infants, was not contributive . We hypothesize that the sudden and unexpected cardiorespiratory arrest occurring in these normal newborns was secondary to acute upper airway obstruction . To prevent this life threatening post-natal asphyxic episode, it is essential to ensure that the face of a newborn lying down upon mother's breast and abdomen is properly and continuously cleared.

Vet Rec, 2004 Apr 24, 154(17), 527 - 30
Distemper virus as a cause of central nervous disease and death in badgers (Meles meles) in Denmark; Hammer AS et al.; During the summer of 2002 a distemper-like disease was observed in the free-ranging badger population in Denmark . It was characterised by grand seizures, abnormal behaviour and death; the badgers all had severe chronic pneumonia and some had non-suppurative encephalomyelitis . In this study, eight of the affected badgers were examined by gross pathological, histological, immunohistological, bacteriological, parasitological and virological methods, and were diagnosed with distemper; canine distemper virus was identified.

Am J Respir Crit Care Med, 2004 Aug 15, 170(4), 400 - 7 Epub 2004 May 06.
Bronchiectasis, exacerbation indices, and inflammation in chronic obstructive pulmonary disease; Patel IS et al.; Relationships between high-resolution computed tomography (HRCT) findings in chronic obstructive pulmonary disease (COPD) and bacterial colonization, airway inflammation, or exacerbation indices are unknown . Fifty-four patients with COPD (mean {SD}: age, 69 {7} years; FEV(1), 0.96 {0.33} L; FEV(1) {percent predicted}, 38.1 {13.9}%; FEV(1)/forced vital capacity {percent predicted}, 40.9 {11.8}%; arterial partial pressure of oxygen, 8.77 {1.11} kPa; history of smoking, 50.5 {33.5} smoking pack-years) underwent HRCT scans of the chest to quantify the presence and extent of bronchiectasis or emphysema . Exacerbation indices were determined from diary cards over 2 years . Quantitative sputum bacteriology and cytokine measurements were performed . Twenty-seven of 54 patients (50%) had bronchiectasis on HRCT, most frequently in the lower lobes (18 of 54, 33.3%) . Patients with bronchiectasis had higher levels of airway inflammatory cytokines (p = 0.001) . Lower lobe bronchiectasis was associated with lower airway bacterial colonization (p = 0.004), higher sputum interleukin-8 levels (p = 0.001), and longer symptom recovery time at exacerbation (p = 0.001) . No relationship was seen between exacerbation frequency and HRCT changes . Evidence of moderate lower lobe bronchiectasis on HRCT is common in COPD and is associated with more severe COPD exacerbations, lower airway bacterial colonization, and increased sputum inflammatory markers.

Reprod Domest Anim, 2004 Feb, 39(1), 8 - 12
Comparative study on five different commercial extenders for boar semen; Vyt P et al.; Increasing interest in a longer preservation of diluted boar sperm raises questions in the field concerning the choice of the extender . The aim of this study was to evaluate the longevity of boar sperm extended in currently used commercial semen extenders . Three long-term extenders and two short-term extenders were compared for different semen quality parameters that can be assessed under routine laboratory conditions . Sperm morphology, motility, pH and bacteriological contamination were investigated during a 7-day period . The number of dead spermatozoa did not differ significantly among the extenders (p > 0.05) . Sperm motility was not only related with storage period but most of all with pH, especially in long-term extenders . Differences between the different extenders were prominent (p < 0.05); the sperm preserved in only one long-term extender showed good motility during the whole test period . In all cases, the pH of the extended semen increased by 0.3-0.5 in the first days of storage and was significantly correlated with a decrease in motility . Bacteriological quality had no significant influence on motility or pH of the semen . In conclusion, we can state that in both short-term extenders and in only one long-term extender, sperm longevity, as evaluated by the parameters used in this study, was sufficient during the preservation period . To preserve the quality of diluted boar semen during long-term storage, the choice of the long-term extender is important . In addition, the monitoring of the pH of extended boar semen in our study emphasizes the importance of the buffering capacity of semen extenders.

Surg Neurol, 2004 May, 61(5), 464 - 6; discussion 466-7
Cranial-epidural tuberculosis presenting as a scalp swelling; Shahat AH et al.; BACKGROUND: Unlike the brain tuberculoma, tubercular osteomyelitis of the skull is very rare and not sufficiently described in the literature . Awareness of this entity makes diagnosis possible . CASE DESCRIPTIONS: Two unique cases of cranial and epidural tuberculosis (TB) with absence of intradural and brain involvement are presented . Both patients presented with scalp swellings but extending through the calvarium into the epidural space . Histologic/bacteriologic confirmation of tuberculosis was obtained from biopsy specimens . Magnetic resonance imaging (MRI) findings of this rare lesion are described for the first time . CONCLUSIONS: Inflammatory scalp lesions with skull involvement and epidural extension should be investigated for tuberculous etiology . With early diagnosis and a combination of surgical and medical management, all cases of skull tuberculosis are potentially curable.

Microb Pathog, 2004 Jun, 36(6), 311 - 8
Susceptibility of immunodeficient mice to aerosol and systemic infection with virulent strains of Francisella tularensis; Chen W et al.; Previous studies have shown that IFN-gamma, TNF-alpha and NOS-2, but not B cells, are crucial for host defense against primary systemic infection with the attenuated live vaccine strain (LVS) of Francisella tularensis . In this study, we examined the importance of these and additional immune components in host resistance against infection with virulent strains of F . tularensis initiated by systemic and airborne routes . Wild-type (WT) mice and mice deficient in IFN-gamma, TNFR1R2, NOS-2, or B cells were equally susceptible to low dose ( approximately 10 colony forming units) aerosol or intradermal challenge with virulent type B F . tularensis, and succumbed to the infection between days 6 and 8 post-inoculation . Quantitative bacteriology showed that IFN-gamma-/- and B cell-/- mice consistently harbored up to one log(10) more bacteria in their lungs, spleens and livers than WT mice at day 5 post aerosol exposure . Surprisingly, however, compared to other strains of KO mice and WT control mice, IFN-gamma-/- mice showed only mild liver damage as assessed by histopathology and liver function tests . Additional experiments established that even mice with broad immunodeficiency (SCID, neutropenic, splenectomized or thymectomized mice and mice treated with corticosteroid) were no more susceptible to aerosol-initiated infection with virulent type B or type A F . tularensis than immunosufficient control mice . Combined, our results indicate that, unlike LVS, normal type A and type B F . tularensis strains are so extremely virulent that even immunocompetent mice are virtually defenseless to low dose aerosol and intradermal challenges with them.

Acta Vet Hung, 2004, 52(1), 85 - 95
Pharmacokinetics and clinical efficacy of cefotaxime for the treatment of septicaemia in dogs; Sumano H et al.; Considering the already known pharmacological features of cefotaxime, a study with two approaches of pharmacokinetics and clinical efficacy in septicaemic dogs was carried out . Pharmacokinetic variables were defined for doses of 10 mg/kg, and 20 mg/kg, utilising a quantitative bacteriological analysis . Values for half-life (T1/2 beta) at 10 mg/kg were 0.8, 1.48 and 1.52 h for the i.v., s.c . and i.m . routes, respectively . Corresponding values for the 20 mg/kg dose for the same routes were 0.8, 1.49 and 1.53 h, respectively . Relatively fast clearance (ranging from 0.58 to 0.64 L/kg/h) allowed a maximum dose interval of 12 h . The above-stated doses of cefotaxime were administered i.v . to 40 cases of septicaemia, clinically divided into 20 moderately severe cases treated with 10 mg/kg i.v., of cefotaxime bid, and 20 severe ones, treated with 20 mg/kg i.v . of cefotaxime bid . Injections continued until a previously defined criterion of 'clinically recovered' was obtained . Thereafter, a follow-up treatment was established using the same dose and dose-interval but through the s.c . route . Due to the apparent volumes of distribution obtained (ranging from 0.48 to 0.51 L/kg), considering the overall clinical efficacy obtained (90% for the 10 mg/kg dose and 75% for the 20 mg/kg dose), and due to the rapid improvement observed after a few doses of the drug (1.8 to 2.5 doses to 'clinical improvement'), it is safe to postulate such doses of cefotaxime as excellent choices for the treatment of septicaemia in dogs.

Trop Med Int Health, 2004 May, 9(5), 551 - 8
Split-drug regimens for the treatment of patients with sputum smear-positive pulmonary tuberculosis--a unique approach; Santha T et al.; OBJECTIVE: To evaluate the efficacy of split-drug regimens for treatment of patients with sputum smear-positive pulmonary tuberculosis in south India . DESIGN: Randomized controlled clinical trial where eligible patients were randomly allocated to: (i) 2RE(3)HZ(3)(alt)/4RH(2) (split I): rifampicin plus ethambutol given on one day and isoniazid plus pyrazinamide the next day for first 2 months followed by rifampicin plus isoniazid twice weekly for 4 months, or (ii) 3RE(3)HZ(3)(alt)/3RH(2) (split II): similar to regimen 1, except duration was 3 months in each phase, or (iii) 2REHZ(3)/4RH(2) (control): rifampicin, isoniazid, ethambutol and pyrazinamide, given thrice weekly for 2 months followed by isoniazid and rifampicin twice weekly for 4 months . All patients were followed up clinically and bacteriologically every month up to 2 years and every 6 months for up to 5 years . RESULTS: A favourable response (cultures negative for Mycobacterium tuberculosis during the last 2 months of treatment) was observed in 91% of 407 patients in split I, 94% of 415 in split II and 89% of 418 in the control regimen . Ninety-one per cent of 370 patients in split I, 93% of 389 in split II and 90% of 370 in control regimens had quiescent disease at the end of 60 months . Gastrointestinal symptoms were more frequent under the control regimen (P = 0.01) . CONCLUSION: Split-drug regimens were as effective as the control regimen in terms of favourable response at the end of treatment and quiescent disease at 5 years, and caused fewer gastrointestinal side-effects.

J Med Assoc Thai, 2004 Mar, 87(3), 333 - 9
Acute lupus hemophagocytic syndrome: report of a case and review of the literature; Mootsikapun P et al.; The authors reported a case of systemic lupus erythematosus (SLE) with an unusual presentation . The patient presented with acute febrile illness along with progressive pancytopenia related to increasing hemophagocytic activity of histiocytes in the bone marrow . Concomitant polyarthritis, myositis, nephritis, high titer of antinuclear factor (1:2,560) and positive test for anti-DNA antibody made him fit the diagnostic criteria of SLE . No definite evidence of associated infections was confirmed by bacteriologic, serologic and viral studies . He did not respond to empiric antibiotic therapy but dramatically responded to corticosteroid treatment . Therefore, diagnosis of acute lupus hemophagocytic syndrome was made . The clinical presentation, laboratory diagnosis, and management of the patient are discussed and the literature was reviewed and presented.

Clin Microbiol Infect, 2004 May, 10(5), 403 - 8
A randomised, double-blind, double-dummy comparative study of gatifloxacin with clarithromycin in the treatment of community-acquired pneumonia; Lode H et al.; Eligible patients were randomised in this multicentre, randomised, double-blind, double-dummy parallel-group study in a ratio of 1:1 to either gatifloxacin 400 mg once-daily for 5-14 days plus matching placebo, or clarithromycin 500 mg twice-daily for 5-14 days . The primary outcome measure was clinical response (clinical cure plus improvement) at the end of treatment . Secondary endpoints were clinical response at end of study, clinical cure at end of treatment and end of study, bacteriological response at end of treatment and end of study, and treatment duration . The overall clinical response was similar in the two treatment groups, with 92.2% of gatifloxacin-treated patients cured or improved at the end of treatment, compared with 93.1% of those receiving clarithromycin . Corresponding bacteriological response rates (eradication plus presumed eradication) were 96.7% and 87.5%, respectively . The study drugs were well-tolerated, with nausea (gatifloxacin) and bitter taste (clarithromycin) being the only treatment-related adverse events with a frequency of > 5% . No patients experienced phototoxicity, hepatic or renal dysfunction, tendonitis or crystalluria . Oral gatifloxacin 400 mg once-daily appeared to be a safe and effective alternative to clarithromycin in the treatment of community-acquired pneumonia.

Rev Pneumol Clin, 2004 Feb, 60(1), 39 - 42
{Laryngeal disorder revealing unrecognized pulmonary tuberculosis}; Margery J et al.; Laryngeal tuberculosis is exceptional and identification in this localization can reveal clinically unrecognized pulmonary tuberculosis . We report two cases illustrating this situation . The pseudo-tumor aspect observed at endoscopy may be wrongly suggestive of neoplasia . Bacteriological examination provides the diagnosis . New methods of genomic diagnosis (Gen-Probe) and culture now allow particularly rapid diagnosis . Outcome is always favorable with standard anti-tuberculosis treatment.

Cochrane Database Syst Rev . 2004;(2):CD002109.
Antibiotics for community acquired pneumonia in adult outpatients; Bjerre LM et al.; BACKGROUND: Community-acquired pneumonia (CAP) is a common condition representing a significant disease burden for the community, particularly for the elderly . Because antibiotics are helpful in treating CAP, they are the standard treatment and CAP thus contributes significantly to antibiotic use, which is associated with the development of bacterial resistance and side-effects . Although several studies have been published concerning CAP and its treatment, the available data arises mainly from studies conducted in hospitalized patients and outpatients . There is no concise summary of the available evidence that can help clinicians in choosing the most appropriate antibiotic . OBJECTIVES: Our goal was to summarize the evidence currently available from randomized controlled trials (RCTs) concerning the efficacy of alternative antibiotic treatments for CAP in ambulatory patients above 12 years of age . SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2, 2003) which contains the Cochrane Acute Respiratory Infections Group's trial register; MEDLINE (January 1966 to September week 3, 2003), and EMBASE (January 1974 to March 2003) . Studies were also identified by checking the bibliographies of studies and review articles retrieved as well as by perusing medical journals . To identify any additional published or unpublished studies, we contacted the following antibiotics manufacturers: Abbott, AstraZeneca, Aventis, Boehringer-Ingelheim, Bristol-Myers-Squibb, GlaxoSmithKline, Hoffmann-LaRoche, Lilly, Merck, Merck Sharp & Dohme, Novartis, Pfizer, Pharmacia, Sanofi, and Yamanouchi . No language restrictions were applied in any of the search strategies . SELECTION CRITERIA: We included all randomized controlled trials (RCTs) in which one or more antibiotics were tested for the treatment of CAP in ambulatory adolescent or adult patients . Studies testing one or more antibiotic and reporting the diagnostic criteria used in selecting patients as well as the clinical outcomes achieved were included . No language restrictions were applied . DATA COLLECTION AND ANALYSIS: Data were extracted and study reports assessed by two independent reviewers (LMB and TJMV) . Authors of studies were contacted as needed to resolve any ambiguities in the study reports . The data were analyzed using the Cochrane Collaboration's RevMan 4.2.2 Software . Differences between reviewers were resolved by discussion and consensus . MAIN RESULTS: Three randomized controlled trials involving a total of 622 patients aged 12 years and older diagnosed with community acquired pneumonia were included . The quality of the studies and of the reporting was variable . A variety of clinical, radiological and bacteriological diagnostic criteria and outcomes were reported . Overall there was no significant difference in the efficacy of the various antibiotics under study . REVIEWERS' CONCLUSIONS: Currently available evidence from RCTs is insufficient to make evidence-based recommendations for the choice of antibiotic to be used for the treatment of community acquired pneumonia in ambulatory patients . Pooling of study data was limited by the very low number of studies . Individual study results do not reveal significant differences in efficacy between various antibiotics and antibiotic groups . Multi-drug comparisons using similar administration schedules are needed to provide the evidence necessary for practice recommendations.

Gac Sanit, 2004 Mar-Apr, 18(2), 101 - 7
{Factors associated with latent tuberculosis infection in the contacts of tuberculosis patients}; Alseda M et al.; BACKGROUND: As tuberculosis control programs have reached acceptable levels in the identification and treatment of persons with active tuberculosis, the next step should be to develop methods of preventing new cases . Persons with latent tuberculosis infection (LTI) are considered to have a higher risk of developing active tuberculosis . The objective of this study was to evaluate the prevalence of LTI and its associated factors in the contacts of tuberculosis patients . METHODS: We studied the contacts of tuberculosis patients who were examined in the Center for Tuberculosis Control and Prevention in Lleida (Spain) from 1991-1997 . Factors associated with the index case (demographic, radiographic, bacteriologic and therapeutic) and tuberculin skin test results and demographic data in contacts were collected . Data on HIV infection, injection drug use and alcohol consumption in tuberculosis patients were also collected . The associations were assessed by obtaining crude and adjusted odds ratios . RESULTS: The prevalence of LTI among contacts was 36.1% (780/2,161) . In the multivariate analysis a higher frequency of LTI was detected in contacts older than 14 years (ORa = 3.34; 95% CI, 2.51-4.45), contacts who had a higher degree of exposure to the index case (ORa = 1.96; 95% CI, 1.59-2.42), contacts of pulmonary tuberculosis patients (ORa = 1.54; 95% CI, 1.01-2.35), contacts of patients with a positive sputum smear (ORa = 1.51; 95% CI, 1.15-1.99), contacts of patients with caverns on chest x-ray (ORa = 1.27; 95% CI, 1.01-1.61) and contacts of patients with delayed treatment (ORa = 1.31; 95% CI, 1.05-1.62) . CONCLUSIONS: The overall prevalence of LTI in the contacts of patients with tuberculosis was high . Among the factors studied, delayed treatment in the index case was independently associated with the frequency of LTI in tuberculosis contacts . Measures for the early diagnosis and treatment of tuberculosis should be intensified.

Rev Neurol (Paris), 2004 Apr, 160(4 Pt 1), 419 - 23
{Diagnosis and treatment of extensive vertebral tuberculosis}; N'Dri Oka D et al.; Tuberculous spondylodiscitis called Pott's disease is the most common presentation of vertebral tuberculosis . Atypical presentation is rare and its diagnosis also difficult . We report a retrospective analysis of 7 immunocompetent patients treated for extensive vertebral tuberculosis . Five men and two women, between 5 and 39 Years . The median age was 24 Years . Clinical features were incomplete tetraplegia (4 cases), complete paraplegia (1 case) incomplete paraplegia (1 cases), and lumbocruralgia (1 case) . Spinal X-ray revealed spondylodiscitis . Both CT Scan and MRI are very useful to determine the extent of the lesions . Bacteriological and histological diagnosis can be deficient . For this reason, we insist on a the contribution of antituberculous treatment to diagnosis . But the appearance of drug-resistance can limit the role of antituberculous chemotherapy in achieving diagnosis.

Nucl Med Commun, 2004 May, 25(5), 527 - 32
What is the role of bone scintigraphy in the diagnosis of infected joint prostheses?
Segura AB, Munoz A, Brulles YR, Hernandez Hermoso JA, Diaz MC, Bajen Lazaro MT, Martin-Comin J.
AIM: To analyse the role played by bone scintigraphy in the diagnosis of infected joint prostheses . METHODS: The study included 77 patients, aged 32-77 years, in whom infection of a joint prosthesis (48 hip, 29 knee) was suspected . In all patients the following examinations were performed consecutively: a two-phase Tc methylene diphosphonate (Tc-MDP) bone scan, a Tc hexamethylproplyene amine oxime (Tc-HMPAO) labelled white blood cell (WBC) scan, and a Tc microcolloid bone marrow (BM) scan . The minimum interval between examinations was 48 h . The diagnoses were based on data obtained from bacteriological cultures . RESULTS: The bone scan was positive in all patients and 28 of them had an infection (sensitivity 100%, specificity 0%) . The WBC scan was positive in 61 patients but only 27 had an infection . The WBC scan was negative in 16 patients, and the possibility of infection was discarded in 15 of these cases (sensitivity 96%, specificity 30%) . The results of the bone marrow scan were not compatible with those of the WBC scan (suggestive of infection) in 27 patients: 26 of them had prosthesis infection . The results of both examinations were compatible in the other 34 patients and the possibility of infection was discarded in 33 of these patients (sensitivity 92.8%, specificity 98%) . The addition of a BM scan to a WBC scan decreased the sensitivity from 96% to 92.8% but increased specificity from 30% to 98% . The addition of a bone scan to this dual combination did not alter the results . CONCLUSIONS: When infection of a prosthesis is suspected the diagnostic procedure should start with a WBC scan followed, if positive, by a BM scan . This procedure reduces the cost, the time required for a diagnosis, and the dose of radiation received by the patient.

J Neuroradiol, 2004 Mar, 31(2), 153 - 6
{MRI appearance of lumbar epidural abscesses: report of three cases}; Semlali S et al.; The authors report three cases of non-tuberculous epidural abscess . Presenting symptoms included lumbar back pain, muscle spasms, soft tIssue swelling, and neurological deficits in all three cases . MR imaging was helpful for diagnosis and showed involvement of perivertebral soft tissues and an epidural abscess of variable size . There was no significant involvement of intervertebral disks or vertebrae . Diagnosis was confirmed by bacteriologic exam . Clinical outcome was favourable with antibiotic treatment.

Environ Pollut, 2000 Jul, 109(1), 91 - 107
Problems of quality designation in diffusely polluted urban streams - the case of Pymme's Brook, north London; Faulkner H et al.; Downstream patterns in the biology and bacteriology of Pymme's Brook (north London) between 1985 and 1992, are compared with the local Environment Agency (EA, England and Wales) quality classification of the site, revealing a considerable discrepancy . Although downstream contaminant dispersal patterns showed that at low flow the brook was less successful in absorbing contaminants at polluted surface water outfall (PSWO) entry points than it was at high flow (supporting the low flow strategy of contemporary audit schedules), this effect was found to vary downstream in response to reoxygenation from less polluted outfalls . Additionally, temporal variations in suspended solids, Escherichia coli counts, sediment-bound and soluble pollutant concentrations at low flow, and during two sampled storms, revealed that significant pollutant transfer was concentrated in the 'first flush' of storm events . A downstream survey of sediment-bound lead (Pb) found that concentrations in the bed sediments, which were likely to be mobilised during a first flush, were significantly higher than in solution . So, a complex pattern of downstream contaminant dispersal emerges, which varies with differing antecedent conditions, and through storms . These results indicate that: (1) the new General Quality Assessments (GQA) audit schedule proposed by the EA for England and Wales remains inappropriate for diffusely polluted, urban environments, because it omits routine E . coli counts and sediment-bound heavy metals; and that (2) when audit is based on chemical determinants alone, the choice of site and timing of audit excessively influence quality designations . Pre-audit planning surveys and more reliable alternatives to the use of chemical audit for urban watercourses, are discussed as possible ways forward for the design of quality audit schedules . Implications for the monitoring schedules in operation in other EU countries and the USA are also considered.

Environ Pollut, 1995, 88(3), 321 - 32
The impact of airport de-icing on a river: The case of the Ouseburn, Newcastle upon Tyne; Turnbull DA et al.; The damaging effects of airport de-icers to adjacent waterways have been suggested by a number of studies, but none have been able to demonstrate these effects in a field situation . The Ouseburn is a part-urban and partrural catchment of varied land-use and includes a tributary which drains the Newcastle International Airport . The tributary contributes only 3-5% of the river's average flow, yet it had a disproportionately adverse impact upon the river . This paper demonstrates how this was linked to the airport's winter application of urea salt de-icers . An integrated approach involving hydrological, chemical, bacteriological and macroinvertebrate sampling was used . During cold weather, higher levels of ammonia were recorded in the tributary and downstream, and concentrations peaked during runoff events . It is suggested that hydrolysis, facilitated by urea digesting bacteria, and surface runoff is the mechanism by which ammonia enters the stream . The airport tributary had a less diverse macroinvertebrate fauna than expected and had larger numbers of bacteria which were able to utilise urea . In-situ bioassay experiments found large deaths of Gammarus pulex (L.) and low biotic indices at a site downstream of the airport tributary confluence . Together with elevated ammonia levels this suggested that urea application adversely impacted on the main stream's water quality and ecology . The airport authorities have responded by changing to a less toxic de-icer.

Oftalmologia, 2003, 59(4), 60 - 4
{Decontamination of ocular globes--comparison of three methods}; Bobeico V et al.; PURPOSE: Determination of the success degree of the three decontamination methods for the purpose of choosing the decontamination method before the prelevation of the cornea for its best preservation . MATERIAL AND METHOD: The studied decontamination methods were: 1 . Immersion of the ocular globe in Betadina (polividon--iod) 2 . Immersion of the ocular globe in Silver Nitrate 3 . Washing of the ocular globe with Gentamicina . 30 animal eyes (pig) were used, 10 for each method . A bacteriological sample was prelevated from each ocular globe, before and after the decontamination . Afterwards the cornea was immersed in solution of Inosol type, following the indicator of the Inosol for 10 days . RESULTS: In each conjunctival the microbial population was present before the decontamination . Positive samples existed after the decontamination for every method, microbial concentration being however greatly reduced in the first 2 samples . The contamination of the conservation environment occurred for a cornea in the case of Betadine, for 2 cornea in the case of Silver Nitrate and for 7 corneas in the case of Gentamicin . CONCLUSIONS: 1 . Decontamination with Gentamicin 33 mg/ml solution is inefficient . 2 . The efficacy of Silver Nitrate and Betadine solution is similarly . 3 . The best option is immersion of the globe in Betadine solution.

Aust Vet J, 2003 Oct, 81(10), 627 - 32
Toxoplasmosis in Indo-Pacific humpbacked dolphins (Sousa chinensis), from Queensland; Bowater RO et al.; OBJECTIVE: To describe the clinical signs, gross pathology, serology, bacteriology, histopathology, electron microscopy and immunohistochemistry findings associated with toxoplasmosis in four Indo-Pacific humpbacked dolphins (Sousa chinensis) that stranded in Queensland in 2000 and 2001 . DESIGN: Clinical assessment, gross necropsy, and laboratory examinations . PROCEDURE: Necropsies were performed on four S . chinensis to determine cause of death . Laboratory tests including serology, bacteriology, histopathology and transmission electron microscopy were done on the four dolphins . Immunohistochemistry was done on the brain, heart, liver, lung, spleen and adrenal gland from various dolphins to detect Toxoplasma gondii antigens . RESULTS: Necropsies showed all of four S . chinensis that stranded in Queensland in 2000 and 2001 had evidence of predatory shark attack and three were extremely emaciated . Histopathological examinations showed all four dolphins had toxoplasmosis with tissue cysts resembling T . gondii in the brain . Tachyzoite stages of T . gondii were detected in the lungs, heart, liver, spleen and adrenal gland, variously of all four dolphins . Electron microscopy studies and immunohistochemistry confirmed the tissues cysts were those of T . gondii . All four dolphins also had intercurrent disease including pneumonia, three had peritonitis and one had pancreatitis . CONCLUSION: Four S . chinensis necropsied in Queensland in 2000 and 2001 were found to be infected with toxoplasmosis . It is uncertain how these dolphins became infected and further studies are needed to determine how S . chinensis acquire toxoplasmosis . All four dolphins stranded after periods of heavy rainfall, and coastal freshwater runoff may be a risk factor for T . gondii infection in S . chinensis . This disease should be of concern to wildlife managers since S . chinensis is a rare species and its numbers appear to be declining.

Pol Merkuriusz Lek, 2004 Jan, 16(91), 8 - 11
{Immunosuppression in the treatment of vascular prosthesis infection with arterial transplantation}; Pupka A et al.; AIM: The purpose of this study is to evaluate the use of immunosuppression in treatment of prosthetic graft infections with arterial transplantation . MATERIAL AND METHODS: In this paper 29 cases of the massive aorto-ilio-femoral graft infection treated by the replacement of infected prosthesis with arterial homograft are presented . The arterial allograft was stored with application of cold ischemia method in preservation solution at 4 degrees C . During the follow up period the patients were divided into two groups: group received immunosuppressive regimen after surgery (n = 16) and group without immunosuppression (n = 13) . The Duplex-Doppler ultrasound, the scintigraphy with use of Technetium-labeled leukocytes, bacteriological and antigenic examination and blood levels of Cyclosporin A were used in the diagnostic trial of infection and of the healing process of the homograft . In both groups there was performed evaluation of arterial wall by using the scanning electron microscopy . RESULTS: In the group with immunosuppression no complications due to the homograft's wall degradation and deficiency of cell mediated immunity in infections were noticed . In the group without immunosuppression there were observed complications related to the impairment of the allograft wall: in 3 cases--the graft rupture, in 2 cases--the graft true aneurysm and homograft thrombosis in 3 cases . CONCLUSION: The use of immunosuppression in transplantation of artery produces increase in survival rate and improves function of arterial graft.

Indian J Chest Dis Allied Sci, 2004 Apr-Jun, 46(2), 121 - 4
A thyroid tubercular abscess and bilateral symmetrical hilar lymphadenopathy: a rare association; Gupta R et al.; An 18-year-old boy presented with a rare association of a thyroid tubercular abscess and bilateral symmetrical hilar lymphadenopathy . He was put on a Category I regimen with standard short course daily chemotherapy of four anti-tubercular drugs under the National Tuberculosis Programme . After a six-month of anti-tubercular treatment (ATT), the boy showed clinical and bacteriological improvement . The thyroid scan with Technetium 99 (Tc 99) and the chest skiagram also became normal.

Nihon Kokyuki Gakkai Zasshi, 2004 Mar, 42(3), 232 - 8
{Immunological studies in cases of pulmonary Mycobacterium avium complex infection without predisposing conditions}; Ochiai S et al.; Peripheral blood mononuclear cells (PBMCs) taken from 39 primary pulmonary MAC patients and 11 control subjects were stimulated in vitro with a protein antigen PPD-B derived from M . intracellulare . Then, the activated response of the peripheral blood lymphocytes (PBLs) and the production of interferon-gamma (IFN-gamma) and interleukin-10 (IL-10) were measured . The 39 primary pulmonary MAC patients were divided into A and B groups the former patients satisfying all of the criteria for the diagnosis of nontuberculous mycobacterial disease proposed by the American Thoracic Society, with the exception of the bacteriologic criteria, and the latter, who satisfied all without exception . The 39 patients were also divided into 3 groups according to disease severity judged from chest CT features . Severity in grades 1, 2 and 3 groups were mild, moderate and severe, respectively . We compared the activated response of PBLs and the production of IFN-gamma and IL-10 by PBMCs of the control group and each patient group . The number of lymphocytes and activated T cells and the concentration of the IFN-gamma after stimulation with PPD-B were lower in each group of primary pulmonary MAC patients than in the control group . IL-10 was significantly higher in each group of primary pulmonary MAC patients than in the control group (36.6 +/- 11.8 pg/ml), and higher in group B (131.6 +/- 14.9) than in group A (81.1 +/- 31.5) . There was no significant difference in the IL-10 concentration between the grade 1, 2 and 3 groups . These results suggested that the cell-mediated immunity of primary pulmonary MAC patients was suppressed as the disease progressed, and the increased production of IL-10 was related to this suppression.

Eur Spine J, 2004 Aug, 13(5), 419 - 24 Epub 2004 Apr 07.
Postoperative spondylitis after posterior lumbar interbody fusion using cages; Ha KY et al.; The recommended surgical options for postoperative wound infections after instrumented spine surgery include a wide debridement and irrigation with antibiotics . In most cases, implant removal is not recommended for a solid fusion . However, there are few reports on the treatment choices for persistent postoperative wound infections following a posterior lumbar interbody fusion (PLIF) using cages . This paper reviewed ten patients referred to our department, who underwent revision surgery for a postoperative, deep infection after a PLIF with cages . The surgery included an anterior radical debridement and interbody fusion with removal of all implants . The clinical and laboratory results, including a bacteriologic study for the causative organism and the radiological changes, were analyzed . All patients complained of persistent severe back pain after the primary surgery . MRSA was the main organism found in these patients (five cases) . Complete bony fusion was obtained in nine patients (90%) . In one patient, back pain and radiating pain prevented him from returning to his original work . Despite the anterior interbody fusion with an autogenous iliac bone graft, all cases had a complete collapse of the intervertebral disc space, without a dislodgement or collapse of the graft bone . The mean loss of the height and lordosis in the involved segment was 12.7 mm (range 4-46 mm) and 5.6 degrees (range 0-15 degrees ), respectively . Anterior radical debridement with the removal of all implants would be an effective way to manage patients with postoperative spondylitis after a PLIF using cages.

Medicina (Kaunas), 2004, 40(3), 201 - 4
Thyroid tuberculosis; Simkus A; The aim of this article is to collect and to review reference data about thyroid tuberculosis from all-over the world and to analyze urgency and changeability of this problem since 19th century until now . Data show that there are cases of thyroid tuberculosis still occurring in many countries of the world, including highly developed countries . It turned out that the disease can manifest in various ways and that it does not have specific symptoms characteristic only to thyroid tuberculosis . The main method for establishing diagnosis is fine-needle aspiration with subsequent bacterioscopical, bacteriological or biological investigation . Still, for verification of diagnosis, ultrasonography, even computerized tomography and the newest serological diagnostic methods of tuberculosis may be necessary . In conclusion, thyroid tuberculosis should be differentiated from other diseases of thyroid: various types of thyroiditis, Graves disease and nodular goiter . It is particularly vital to distinguish thyroid tuberculosis from thyroid cancer, in attempt to avoid unnecessary thyroid surgery . While treating thyroid tuberculosis, there is a choice of thyroid surgery, antituberculous drugs and repeated puncture drainage procedures . Sometimes these methods can be combined.

J Med Primatol, 2004 Apr, 33(2), 109 - 12
Tuberculosis-like lesions arising from the use of Freund's complete adjuvant in an owl monkey (Aotus sp.); Malaga CA et al.; An apparently normal, non-tuberculin-reacting, splenectomized owl monkey presented tuberculosis-like lesions of the lung at necropsy . Histological and bacteriological examination failed to demonstrate the presence of acid-fast organisms . Retrospective inquiry showed the animal had been inoculated using complete Freund's adjuvant during a malaria vaccine trial . Lesions observed were compatible with lipid embolism of the adjuvant in the lungs.

Pediatrics, 2004 Apr, 113(4 Suppl), 945 - 51
How environmental hazards in childhood have been discovered: carcinogens, teratogens, neurotoxicants, and others; Miller RW; Review of the literature reveals that environmental hazards cause adverse health effects that include sterility, infertility, embryotoxicity, low birth weight, skin lesions, neurodevelopmental defects, immunologic disorders, cancer, and fear of late effects . They have been identified mostly by astute practitioners but also by a bacteriologist, an animal experimentalist, 5 factory workers in childless marriages, and a tipsy bystander in an economically impoverished area of Baltimore . Dust on a parent's work clothes has transported a hazard at work to a hazard at home (lead, asbestos, and chlordecone) . Causality is established by showing a dose-response effect and reproducing the effect in studies of other exposed groups or by using another epidemiologic method, eg, prospective instead of retrospective study . Also, the findings should be biologically plausible and not attributable to a concomitant variable such as cigarette smoking . Contrary to front-page newspaper headlines, incidence rates for childhood leukemia are not rising . Preserving specimens for future studies has been valuable: blood from people who were exposed to dioxin in Seveso, Italy; mummified umbilical cords containing methyl mercury at Minamata Bay, Japan; and Guthrie dried blood spots to screen retrospectively for 43 genetic disorders and a specific prenatal cytogenetic abnormality in some children with 1 form of leukemia . Recommendations are given for enhancing interest in environmental hazards and their discovery by clinicians.

Klin Oczna, 2003, 105(6), 407 - 9
{Clinical efficacy of ciprofloxacin 0.3%9 (Ciloxan) in the treatment of bacterial infections of the external eye segment}; Stankiewicz A et al.; PURPOSE: The main subject of the study was to evaluate efficacy of ciprofloxacin 0.3% ophthalmic solution (Ciloxan) in the treatment of bacterial conjunctivitis and surgical prophylaxis . Safety and comfort of topical ciprofloxacin treatment was also examined . MATERIAL AND METHODS: Two study arms: 99 patients with bacterial conjunctivitis (A group) and 48 patients awaiting cataract surgery (B group--total 147 subjects in both groups) received ciprofloxacin 0.3% ophthalmic solution (Ciloxan) 4 doses a day for seven days . Bacteriological evaluation was established before and after treatment for each eye . RESULTS: 95 out of the 99 patients (96%) in the first arm were completely cured (all signs and symptoms of the bacterial conjunctivitis were eliminated) . In the second arm complete eradication of bacterial flora was achieved in 46 out of 48 pretreated patients (96%) . CONCLUSIONS: Topical ciprofloxacin 0.3% (iloxan) was found very effective and fast in reduction of typical signs and symptoms of bacterial conjunctivitis as well as in eradication of bacterial flora before surgery treatment.

Ann Biol Clin (Paris), 2004 Jan-Feb, 62(1), 110 - 4
{Meningitis due to Capnocytophaga canimorsus with misleading initial digestive symptom}; Biedermann P et al.; We set out a case of Capnocytophaga canimorsus septicemia complicated by a meningitis in a chronic alcoholic male pensioner . The Capnocytophaga canimorsus bacterium contaminated the patient after his dog licked little varicose wounds . Initial symptoms led to a digestive infectious syndrome . Capnocytophaga canimorsus grows more slowly than usual bacteria and appeals to a bacteriological deductive reflection which is provided in this article for its identification in a general hospital . In order not to lose time with that infection which can be lethal, we describe the patient's ground, clinical signs which can be expected and we propose a probabilistic antibiotic therapy while waiting for the laboratory diagnosis . Copyright John Libbey Eurotext 20003.

Presse Med, 2004 Mar 13, 33(5), 318 - 20
{Multiple actinomycosis brain abscesses}; Liotier J et al.; BACKGROUND: Actinomycosis is a subacute or chronic bacterial infection, which can affect immunocompetent or immunodeficient subjects . It most often occurs in cervico-facial or thoracic-abdominal locations . Central nervous system infection is rare but of severe prognosis . CASE REPORT: A 56 year-old woman with no history of immunodepression was admitted with unexplained fever, inappropriate behaviour, and spatial and temporal disorientation . The progressive worsening of the neurological signs let to coma and mechanical ventilation was required . Brain imaging showed multilocation cerebral abscesses . Stereotaxial biopsy permitted diagnosis of actinomycosis . Patient's outcome was favourable following appropriate dual antibiotherapy without surgical exeresis . DISCUSSION: When lacking bacteriologic identification, diagnosis of cerebral actinomycosis is performed by pathologic findings . Dual antibiotherapy allows full recover, even in the case of multilocation cerebral abscesses.

Acta Leprol, 2003, 12(3), 123 - 8
Pattern of bacillary clearance in multibacillary leprosy patients with multidrug therapy; Kumar A et al.; The bacteriological index (BI) of the skin smears is traditionally one of the important parameters of assessment of severity and of progress of leprosy under multidrug therapy . The present study reports on BI clearance among 578 multibacillary treated leprosy patients and the factors that influence this clearance . The patients were treated till smear negativity or for 2 years fixed duration and their skin smears periodically examined every 6 to 12 months till negativity (and even afterwards) . We confirm that bacterial clearance is a slow process . The time taken for each log-unit decline in BI is between 13.6 to 24 months probably depending on initial BI level . The rate of smear negativity appears to be dependent on immune competence of the patients as reflected by a rapid BI decline in borderline BT-BB patients vis-a-vis BL-LL lepromatous patients both in the low and high BI group . Patients who had several episodes of ENL, took significantly longer time (63.7 months versus 53.5 months, p<0.0001) to become smear negative than those without ENL.

Enferm Infecc Microbiol Clin, 2003 May, 21 Suppl 2, 75 - 80
{The present and future of medical mycology}; Rodriguez-Tudela JL et al.; During the second part of xx century, the prevalence of fungal infections has raised inexorably . The main cause has been the increase of number of immunosupressed patients and the new aggressive therapeutic approaches . Since 1970, the annual incidence of candidosis and aspergilosis has increased 40 and 6.5 times, respectively . Additional studies reported in USA and Europe indicated that Candida produce between 5-10% of all episodes of nosocomial sepsis . In this revision, we analyse the present situation of Medical Mycology including the most relevant aspects as: a) the increase of incidence in fungal infections; b) the problems of the diagnosis including classical and new methodologies and antifungal susceptibility testing, and c) the uncertainties of the treatment due to the arrival of new formulations and new antifungalsThe future of Medical Mycology depends in many factors but molecular biology will play the central role although this discipline will develop slower than other microbiology areas as virology or bacteriology . Although the increase of incidence in invasive fungal infections has been enormous, we must not forget that any group in solitary could not answer the many unresolved questions . Thus, the call for research executed by Instituto de Salud Carlos III for financing Thematic Research Networks could be the starting point for a new time in invasive fungal infections.

Kekkaku, 2004 Feb, 79(2), 55 - 8
{Tuberculosis control programme for the elderly with special focus on early detection}; 99mTc-EDDA/HYNIC-TOC scintigraphy in the differential diagnosis of solitary pulmonary nodules; Department of Nuclear Medicine, Medical University, Lodz, Poland . anna@csk.am.lodz.pl

Forty-three consecutive patients with solitary pulmonary nodules (SPNs) on chest radiographs were studied scintigraphically after administration of the somatostatin analogue (99m)Tc-EDDA/HYNIC-TOC . The objective of the study was to assess the usefulness of the procedure for differentiation of SPNs as malignant or benign . The administered activity was 740-925 MBq, and a single-photon emission computed tomography imaging technique was employed . Verification of the nodule aetiology was based on histology or cytology and bacteriology . A stable tumour size on chest radiography for at least 3 years was accepted as an additional criterion of benignity . In 29 patients, nodules were found to be malignant . The diagnoses included ten adenocarcinomas, five squamous cell carcinomas, two large cell carcinomas, six non-small cell lung cancers without specification of the more detailed morphology, two small cell lung cancers, two typical carcinoids and two metastatic tumours (leiomyosarcoma and malignant melanoma) . In 14 patients the following benign tumours were diagnosed: four tuberculomas, one other granuloma, three hamartomas, one non-specific inflammatory infiltrate, one abscess, one peripheral carcinoid with the morphological characteristics of a benign tumour, one ectopic lesion of thyroid tissue and two benign tumours of unspecified aetiology with a stable size over 3 and 5 years respectively . Positive scintigraphic results were obtained in 26 of the 29 patients (90%) with malignant SPNs; among these, 24 of the 25 (96%) cases of primary pulmonary carcinoma yielded positive results . The remaining two false negative cases were the metastatic tumours, liposarcoma and melanoma . Of the 14 benign lesions, ten (71%) did not accumulate the radiopharmaceutical . The remaining four benign tumours that were visible on scintigrams comprised one tuberculoma, one hamartoma, one abscess and one case in which the diagnosis could not be established (the tumour had a stable size over 3 years) . In conclusion, scintigraphy with (99m)Tc-EDDA/HYNIC-TOC appears to be an effective procedure for differentiation between malignant and benign SPNs . A fully credible assessment of the clinical efficacy of this procedure requires further study in a larger number of patients.

Presse Med, 2004 Feb 28, 33(4), 235 - 40
{Meningitis with direct negative bacteriological examination . Prospective assessment of a decision making tree}; Boutoille D et al.; OBJECTIVE: Elaboration of a decision-making tree for differential diagnosis of bacterial and viral meningitis, when initial Gram's staining is negative . Method One-Year prospective study in an adult emergency department . Comparison with the immediately-preceding period . RESULTS: 56 patients were included . Only 4 bacterial meningitis, but none misdiagnosed . 86% sensitivity and 83% specificity for viral meningitis (n=40) . Rate of patients hospitalised more than 24 hours decreasing from 62.5 to 41% (p=0.05) . Antibiotic chemotherapy decreasing from 55 to 16% (p<0.001) . CONCLUSION: This decision-making tree safely allows emergency differentiation between bacterial and viral meningitis, when initial Gram's staining is negative . It consequently leads to decreased rates of useless hospitalisations and antibiotic treatments . We believe that this method can be helpful during outbreaks of viral meningitis.

Ann Dermatol Venereol, 2004 Feb, 131(2), 198 - 200
{Mycobacterium fortuitum skin infection occurring after a facelift}; Angeli K et al.; INTRODUCTION: Mycobacterium fortuitum skin infections are rare and usually iatrogenic . We report a case with cervical involvement following a facelift . OBSERVATION: A 65 year-old woman, without past history, underwent bilateral surgical facelift, complicated by cutaneous necrosis and treated with directed healing at home . Six weeks later, an abscessed nodule appeared under the left maxillary and was drained surgically . Then other pre-auricular and left cervical inflammatory nodules appeared without adenopathy or fever . M . fortuitum was isolated in bacteriological samples . The initially probabilistic antibiotherapy with carithromycin, subsequently adapted with amikacine and cirprofloxacine and then imipeneme for a total duration of 3 months, led to the clinical cure . DISCUSSION: Mycobacterium fortuitum is a rapidly growing, ubiquitous, mycobacteria responsible for nosocomial infections in immunocompetent patients, notably following plastic surgery . Contamination occurs where there has been a rupture in the skin barrier through contact with a vector (water, surgical material, antiseptic.) . Treatment, which is not codified, consists in the association of surgery and antibiotics for several months.

Int J Syst Evol Microbiol, 2004 Mar, 54(Pt 2), 349 - 57
Polyphyly of true branching cyanobacteria (Stigonematales); Gugger MF et al.; Cyanobacteria with true branching are classified in Subsection V (formerly order Stigonematales) in the phylum CYANOBACTERIA: They exhibit a high degree of morphological complexity and are known from particular biotopes . Only a few stigonematalean morphotypes have been cultured, and therefore the high variability of morphotypes found in nature is under-represented in culture . Axenic cultures of Chlorogloeopsis and Fischerella sensu Rippka et al . were, to date, the only representatives of this Subsection in phylogenetic studies . The 16S rDNA sequence analysis data in this report confirm that heterocyst-forming cyanobacteria are a monophyletic group . However, unlike previous studies have suggested, these 16S rDNA data on new Stigonematales strains show that the true branching cyanobacteria are polyphyletic and can be separated into at least two major groups defined by their branching type, the first group being characterized by T-branching and the second group by Y-branching . Cyanobacteria with intercalary heterocysts and either no branching or false-branching also formed separate clusters . In consequence, our phylogenetic data do not correlate with the bacteriological and traditional classifications, which distinguish filamentous heterocystous cyanobacteria with or without true branching (Nostocales/Stigonematales).

Int J Syst Evol Microbiol, 2004 Mar, 54(Pt 2), 307 - 8
Validation of publication of new names and new combinations previously effectively published outside the IJSEM; Salvage chemotherapy with cyclophosphamide for recurrent et al.; Department of Neurology, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, California 90033, USA . chamberl@usc.edu

BACKGROUND: The primary objective of the current prospective Phase II study of cyclophosphamide (CYC) in adult patients with recurrent, temozolomide-refractory glioblastoma multiforme was to evaluate 6-month progression-free survival (PFS) . METHODS: Forty patients (28 men and 12 women) ages 28-67 years (median age, 51.5 years), with recurrent glioblastoma multiforme were treated . All patients had been treated previously with surgery and involved-field radiotherapy (median dose, 60 grays {Gy}; range, 59-61 Gy) . In addition, all patients were treated adjuvantly with either nitrosourea-based chemotherapy (21 patients: procarbazine, lomustine, and vincristine in 13 patients; carmustine in 8 patients) or temozolomide (19 patients) . Twenty-one patients who were treated previously with a nitrosourea were treated with temozolomide at the time of first recurrence . Twenty-one patients were treated with CYC at the time of second recurrence, and 19 patients were treated with CYC at the time of first recurrence . CYC was administered intravenously on 2 consecutive days (750 mg/m2 per day) every 4 weeks (operationally defined as a single cycle) . Neurologic and neuroradiographic evaluations were performed every 8 weeks . RESULTS: All patients were evaluable . In total, 170 cycles of CYC (median, 2 cycles; range, 2-12 cycles) were administered . CYC-related toxicity included alopecia in all patients (100%), anemia in 6 patients (3.5%), thrombocytopenia in 7 patients (4.1%), and neutropenia in 9 patients (5.3%) . Four patients required transfusions (two required red blood cell transfusion, and two required platelet transfusion) . One patient developed neutropenic fever without bacteriologic confirmation . No treatment-related deaths occurred . Seven patients (17.5%; 95% confidence interval {95% CI}, 8-33%) exhibited a neuroradiographic partial response, 11 patients (27.5%; 95% CI, 15-44%) had stable disease, and 22 patients (55%) had progressive disease after a single cycle of CYC . The time to tumor progression ranged from 2 months to 18 months (median, 2 months) . Survival ranged from 3 months to 24 months (median, 4 months) . In patients with either a neuroradiographic response or stable disease (n = 18 {45%}), the median time to tumor progression was 6 months (range, 4-18 months; 95% CI, 6-8 months), and the median survival was 10 months (range, 5-24 months; 95% CI, 8-10 months) . The 6-month PFS rate was 20% . CONCLUSIONS: CYC exhibited modest efficacy with acceptable toxicity in the current cohort of adult patients with recurrent glioblastoma multiforme, all of whom had previously experienced treatment failure after temozolomide chemotherapy .

J Insect Physiol, 2004 Feb-Mar, 50(2-3), 185 - 93
Eastern tent caterpillars (Malacosoma americanum) cause mare reproductive loss syndrome; Webb BA et al.; A new equine abortigenic disease, mare reproductive loss syndrome (MRLS), was recognized and significantly impacted the Ohio Valley in the springs of 2001 and 2002 . MRLS caused approximately 330 million US dollars in losses in 2001 . An epidemiological investigation of MRLS associated occurrence of the disease with exposure to eastern tent caterpillars (M . americanum) . This work investigates the epidemiological association between M . americanum and MRLS to determine if this association was correlative or causative . A pilot study and simulated exposure to M . americanum and their excreta on pasture grasses . The pilot study advanced exposure of pregnant mares to M . americanum materials and 18 of the 29 mares in the study aborted with symptoms of MRLS before other cases were reported in the region . In, three of seven mares exposed to M . americanum aborted, while mares in control (n=6) and M . americanum frass (n=7) treatments had no losses . In, mares were fed frozen insect larvae in feed buckets mixed with oats . Abortions occurred in three of five mares receiving frozen M . americanum, while mares that were fed autoclaved M . americanum (n=5) or frozen gypsy moth larvae (n=4) had no abortions due to MRLS . In, M . americanum larvae were dissected and fractionated . Statistically significant numbers of abortions occurred only in the positive control group and in association with the M . americanum exoskeleton . All abortions induced by exposure to M . americanum exhibited changes in echogenicity of fetal fluids and bacteriological findings post abortion that were consistent with MRLS . These studies support the hypothesis that ingestion of M . americanum larvae induces the MRLS-type equine abortions, and provide experimental evidence that this lepidopteran larva can cause an abortigenic disease in a vertebrate host.

Bull Soc Pathol Exot, 2003 Jan, 96(5), 362 - 7
{Clinical forms of the cutaneous tuberculosis}; Tigoulet F et al.; Since Laennec's description of the "prosector's wart" in 1826, science has made great strides forward . The cutaneous forms of the infection with Mycobacterium tuberculosis are various . The most common clinical forms of cutaneous tuberculosis are lupus vulgaris and scrofuloderma . The clinical forms of cutaneous tuberculosis are usually classified according to the patient's immune status, and the way through which the skin has been infected . Nonetheless, as in leprosy, a classification based on the importance of the bacterial inoculum in situ is possible . Subsequently the diagnosis should be considered as easy in the multibacillary forms and much more difficult in the paucibacillary forms . In the former, the diagnosis should rely on bacteriological data . In the latter, the diagnosis will rely on the association of epidemiological, clinical and histological data whereas genomic amplification with PCR may be of potential interest.

Shanghai Kou Qiang Yi Xue, 2000 Dec, 9(4), 225 - 7
{The bacteria detection and drug sensitivity test from infected root canals}; Yu LY et al.; OBJECTIVE:To provide bacteriological basis for curing infected root canals with sensitive drugs.METHODS:We have made bacterial cultivation for 56 cases with infected root canals and drug sensitive test with agar dilution.RESULTS:The rates of bacteria detection and positive rates from infected root canals were high . Anaerobia and aerobia were sensitive to different kinds of antibiotics . CONCLUSION:Bacteria have close relation to infected root canals . Sensitive drugs should be selected in clinical treatment.

Surg Infect (Larchmt), 2003 Winter, 4(4), 317 - 26
Vaccinia virus complement control protein increases early bacterial clearance during experimental peritonitis; Scott MJ et al.; BACKGROUND: Complement is one of the first immunological pathways activated in peritonitis . It functions to initiate and augment the innate immune response . Complement activation has also been shown to contribute to multiple organ failure after sepsis . Vaccinia virus complement control protein (VCP) is an immunomodulatory protein encoded by vaccinia virus and binds complement components C3b and C4b of the complement cascade to inhibit both the classical and alternative pathways of complement activation . This study investigates the effect of complement inhibition by recombinant (r) VCP on bacterial clearance after cecal ligation and puncture (CLP) . Methods: Swiss Webster mice were intravenously given either 20 mg/kg rVCP in 0.2 mL of normal saline, or 0.2 mL of normal saline alone, at the time of CLP . After 4 and 18 h, samples of peritoneal washout, blood, liver, and lung were collected for bacteriology, myeloperoxidase (MPO) assay for neutrophil accumulation, differential cell counts, and interleukin (IL)12 ELISA . Statistical analysis was by Mann-Whitney U test for bacteriology, and analysis of variance (ANOVA) for MPO and IL-12 concentrations . RESULTS: Aerobic and anaerobic bacterial levels were significantly lower at 4 h after treatment with rVCP (p < 0.05) in peritoneal lavage, blood, and liver compared with controls . There were no differences in bacterial levels at 18 h . There were no differences in myeloperoxidase concentrations or in the differential cell counts between the groups at either 4 or 18 h after CLP . IL-12 concentrations in serum or peritoneal washout were also not different . CONCLUSIONS: rVCP enhances early bacterial clearance in mice after CLP, although not through neutrophil recruitment, as MPO concentrations and cell counts were not different . rVCP may, however, increase neutrophil function potentially by prevention of accumulation of complement factors that inhibit leukocytes . Further studies will be needed to elucidate this pathway.

Yonsei Med J, 2004 Feb 29, 45(1), 17 - 22
An outbreak of tularemia in Western Black Sea region of Turkey; Gurcan S et al.; The aim of this study was to investigate the source and the size of a tularemia outbreak in a village located in a non-endemic area . Five patients from the same village were admitted to hospital with the same complaints all within one week of September 2001 . Tularemia was suspected and a diagnosis was made after physical and anamnesis examinations . The village was visited the same week that the patients were admitted to the hospital, in the January and April 2002 . The villagers were examined and screened serologically by microagglutination method and the water sources were investigated bacteriologically . A total of 14 people were found to be infected from the outbreak and the oropharyngeal form was the only clinical presentation . Antibody titers ranged between 1 : 80 and 1 : 640 . The patients responded well to the aminoglycoside plus tetracycline therapy . Examination of the pipewater and three springs revealed that all the water sources were contaminated by coliforms, however, Francisella tularensis could not be isolated in glucose-cystine medium . Antibody levels stayed stable or decreased seven months after . Tularemia had not been reported in this area before, so the first patients were misdiagnosed . In conclusion tularemia should be considered in differential diagnosis of patients with fever, sore throat and cervical lymphadenopaties.

J Clin Microbiol, 2004 Mar, 42(3), 996 - 1002
Comparison of conventional bacteriology with nucleic acid amplification (amplified mycobacterium direct test) for diagnosis of tuberculous meningitis before and after inception of antituberculosis chemotherapy; Thwaites GE et al.; The role of nucleic acid amplification techniques in the rapid diagnosis of tuberculous meningitis remains uncertain . We compared the performance of Ziehl-Neelsen (ZN) staining, the Gen-Probe amplified Mycobacterium tuberculosis direct test (MTD), and culture with 341 cerebrospinal fluid specimens from 152 adults (73 with and 79 without tuberculous meningitis) before and after inception of antituberculosis chemotherapy . The sensitivity, specificity, and positive and negative predictive values of ZN staining before treatment were 34/66 (52%), 79/79 (100%), 34/34 (100%), and 79/111 (71%), compared with 25/66 (38%), 78/79 (99%), 25/26 (96%), and 79/120 (66%) for MTD . The sensitivity of combined ZN staining and MTD (either positive) was 45/66 (68%) . The sensitivity of staining and culture fell more rapidly than that of MTD after the start of treatment: after 5 to 15 days of treatment, MTD was more sensitive than ZN staining (12/43 {28%} versus 2/43 {2%}; P = 0.013) . Slower bacterial clearance was observed if M . tuberculosis was resistant to isoniazid and/or streptomycin: resistant organisms were more likely to be cultured from cerebrospinal fluid after 2 to 5 days of treatment than fully sensitive organisms (P < 0.001) . The sensitivities of ZN staining, MTD, and the two tests combined were improved by repeated sampling to 38/59 (64%), 35/59 (59%), and 49/59 (83%), respectively . In conclusion, ZN staining of the cerebrospinal fluid is at least as good as MTD for the rapid diagnosis of tuberculosis and is much faster and less expensive . However, the combination of these methods on serial samples detects more cases . Alternative tests are still urgently required.

J Nucl Med, 2004 Mar, 45(3), 438 - 44
99mTc-HMPAO-leukocyte scintigraphy in patients with symptomatic total hip or knee arthroplasty: improved diagnostic accuracy by means of semiquantitative evaluation; Pelosi E et al.; The aim of this study was to evaluate the diagnostic value, in suspected infectious prostheses, of (99m)Tc-labeled hexamethylpropyleneamine oxime ((99m)Tc-HMPAO) leukocyte scintigraphy interpreted with the addition of a semiquantitative analysis . METHODS: By means of a retrospective review, we included a group of 78 consecutive patients with suspected hip or knee prosthesis infection . We performed 91 (99m)Tc-HMPAO-leukocyte scintigraphies and examined 95 localizations that were suspect . Images were acquired at 3 different time points after the injection of the labeled leukocytes: 50 min (early images), 4 h, and 24 h (late images) . The scintigraphic examinations were independently evaluated by 3 observers; qualitative and semiquantitative analyses were performed . The final diagnosis of infection was based on surgical, histologic, and bacteriologic data and follow-up . RESULTS: On qualitative analysis, sensitivity, specificity, and accuracy were 80.4%-87%, 65.3%-71.4%, and 75.8%-77.9%, respectively . On semiquantitative analysis, sensitivity, specificity, and accuracy were 95.6%, 95.8%, and 95.8%, respectively . The analysis of 95% confidential intervals showed statistically significant differences in specificity and accuracy between semiquantitative and qualitative analyses . CONCLUSION: In those patients who underwent (99m)Tc-HMPAO-leukocyte scintigraphy for suspected hip or knee prosthesis infection, the addition of a semiquantitative evaluation to the qualitative analysis of early and late images leads to a significant improvement in both specificity and accuracy.

Trop Anim Health Prod, 2004 Feb, 36(2), 117 - 21
Protection against brucellosis in goats, five years after vaccination with reduced-dose Brucella melitensis Rev 1 vaccine; Diaz-Aparicio E et al.; The protection conferred by the reduced-dose Rev 1 Brucella melitensis vaccine in goats that had been immunized 5 years previously was evaluated . Sixteen goats vaccinated 5 years before with Rev 1 (1 x 10(5) cfu) and 5 non-vaccinated goats were challenged with B . melitensis 16M (4 x 10(5) cfu) using the conjunctival route . After giving birth or aborting, the goats were sacrificed and tissue samples were taken for bacteriological study . The challenge strain was recovered in 12%, of the animals from the vaccinated group, and in (80% of the control group . It is concluded, therefore that the use of reduced-dose Rev 1 protects goats vaccinated in endemic areas for at least 5 years after immunization.

Br J Dermatol, 2004 Feb, 150(2), 353 - 6
Generalized pustular psoriasis complicated by acute respiratory distress syndrome; Abou-Samra T et al.; Psoriasis has a chronic and relatively benign course . However, severe complications are possible . One rare complication is acute interstitial pneumonitis . This entity should be suspected when a patient presents with dyspnoea and high fever . Knowledge of this pathology is crucial, for although it is essential to rule out aetiologies requiring specific management such as microbial infection or drug-related syndromes, diagnosis should not be delayed as its severe clinical course is improved by corticosteroids . We report two patients with an acute respiratory distress syndrome arising during the course of pustular psoriasis . Repeated bacteriological testing in lungs and blood remained negative . In both cases lung involvement was severe, requiring artificial ventilation . Dramatic clinical resolution was obtained by using corticosteroids . Besides infectious causes and drug hypersensitivity to methotrexate or acitretin, acute respiratory distress syndrome, sometimes due to a pulmonary capillary leak syndrome, is a rare cause of pneumonitis in the course of psoriasis, and may be fatal . Its pathogenesis is unknown . However, animal models suggest a role for T-helper (Th) 1 lymphocytes, known to be activated in psoriasis, and a role for tumour necrosis factor-alpha, a major Th1 cytokine, in alveolar damage.

Dis Colon Rectum, 2004 Mar, 47(3), 392 - 4
Development of epidural abscess following surgical drainage of perianal abscess: report of a case; Ohana G et al.; PURPOSE: A case of epidural abscess originating from a perianal abscess is reported . METHODS: The history of the patient, erythrocyte sedimentation rate, magnetic resonance imaging, and bacteriological tests were used to reach a diagnosis and the possible mechanism . RESULTS: Epidural abscess was suspected because the patient had a fever and intense low back pain following drainage of a perianal abscess . Magnetic resonance imaging was used to correctly diagnose the epidural abscess and bacteriologic studies disclosed the pathophysiologic mechanism . CONCLUSIONS: Epidural abscess is an extremely rare complication of perianal abscess . It should always be suspected in a patient with acute onset of back pain, fever, history of recent infection, and an elevated erythrocyte sedimentation rate, because delay in diagnosis can cause neurologic compromise and even death.

Radiology, 2004 Mar, 230(3), 785 - 91
US-guided percutaneous cholecystostomy: features predicting culture-positive bile and clinical outcome; Sosna J et al.; PURPOSE: To assess sonographic and clinical features that might be used to predict infected bile and/or patient outcome from ultrasonography (US)-guided percutaneous cholecystostomy . MATERIALS AND METHODS: Between February 1997 and August 2002 at one institution, 112 patients underwent US-guided percutaneous cholecystostomy (59 men, 53 women; average age, 69.3 years) . All US images were scored on a defined semiquantitative scale according to preset parameters: (a) gallbladder distention, (b) sludge and/or stones, (c) wall appearance, (d) pericholecystic fluid, and (e) common bile duct size and/or choledocholithiasis . Separate and total scores were generated . Retrospective evaluation of (a) the bacteriologic growth of aspirated bile and its color and (b) clinical indices (fever, white blood cell count, bilirubin level, liver function test results) was conducted by reviewing medical records . For each patient, the clinical manifestation was classified into four groups: (a) localized right upper quadrant symptoms, (b) generalized abdominal symptoms, (c) unexplained sepsis, or (d) sepsis with other known infection . Logistic regression models, exact Wilcoxon-Mann-Whitney test, and the Kruskal-Wallis test were used . RESULTS: Forty-seven (44%) of 107 patients had infected bile . A logistic regression model showed that wall appearance, distention, bile color, and pericholecystic fluid were not individually significant predictors for culture-positive bile, leaving sludge and/or stones (P =.003, odds ratio = 1.647), common bile duct status (P =.02, odds ratio = 2.214), and total score (P =.007, odds ratio = 1.267) . No US covariates or clinical indices predicted clinical outcome . Clinical manifestation was predictive of clinical outcome (P =.001) and aspirating culture-positive bile (P =.008); specifically, 30 (86%) of 35 patients with right upper quadrant symptoms had their condition improve, compared with one (7%) of 15 asymptomatic patients with other known causes of infection . CONCLUSION: US variables can be used to predict culture-positive bile but not patient outcome . Clinical manifestation is important because patients with right upper quadrant symptoms have the best clinical outcome . Copyright RSNA, 2004

Respirology, 2004 Mar, 9(1), 96 - 101
Randomized trial of yoga as a complementary therapy for pulmonary tuberculosis; Visweswaraiah NK et al.; OBJECTIVE: The present prospective, randomized trial compared the efficacy of anti-tuberculosis treatment (ATT) with two separate programs (yoga and breath awareness), on lung capacities and bacteriological status in pulmonary tuberculosis patients . METHODOLOGY: A total of 1009 pulmonary tuberculosis patients were screened and 73 were alternately allocated, to yoga (n = 36) or breath awareness (n = 37) groups, with 48 patients completing the 2-month trial . Patients aged between 20 and 55 years, who were sputum-positive on three consecutive examinations, had no prior ATT, and no comorbidities or extrapulmonary tuberculosis were included . In addition to ATT, one group practised yoga (n = 25) and the other practised breath awareness (n = 23) for 6 h per week, each session being 60 min . The main outcome measures were: symptom scores, bodyweight, FVC, FEV(1), FEV(1)/FVC%, sputum microscopy, sputum culture, and postero-anterior view of the CXR . RESULTS: At the end of 2 months, the yoga group showed a significant reduction in symptom scores (88.1%), and an increase in weight (10.9%), FVC (64.7%) and FEV(1) (83.6%) (P = 0.001, in all comparisons, paired t-test) . The breath awareness group also showed a significant (paired t-test) reduction in symptom scores (16.3%, P= 0.02), and an increase in weight (2.1%, P= 0.003) and FEV(1) (63.8%, P= 0.04) . Significantly more patients in the yoga group showed sputum conversion based on microscopy on days 30 and 45 compared to the breath awareness group (P = 0.045 and P= 0.002, respectively, chi(2) test) . Ten of 13 in the yoga group had negative sputum culture after 60 days compared with four of 19 in the breath awareness group (P = 0.005, chi(2) test) . Improvement in the radiographic picture occurred in 16/25 in the yoga group compared to 3/22 in the breath awareness group on day 60 (P = 0.001, chi(2) test) . CONCLUSIONS: The improved level of infection, radiographic picture, FVC, weight gain and reduced symptoms in the yoga group suggest a complementary role for yoga in the management of pulmonary tuberculosis.

Chin Med J (Engl), 2004 Feb, 117(2), 264 - 9
Prophylactic treatment with growth hormone improves intestinal barrier function and alleviates bacterial translocation in stressed rats; Ding LA et al.; BACKGROUND: Damage to the gut barrier often occurs during critical illnesses . In such cases, it is very important to alleviate impairment of the intestinal barrier and protect intestinal barrier function . This study investigated the protective effect of growth hormone on intestinal barrier function in rats under stress . METHODS: This study consisted of prospective, randomized, and controlled animal experiments . Twenty-five Sprague-Dawley rats served as total parenteral nutrition (TPN) models and were divided into three groups: TPN group, sepsis (Sep) group, and growth hormone (GH) group . Another 8 rats served as normal controls . Each group received different stress stimuli . Rats were fed for 7 days, and samples were taken for examination 24 hours after gavaging with dual saccharides . RESULTS: The architecture of the small intestinal mucosa in the Sep group showed the most severe damage among all groups . Nitric oxide levels in blood plasma and immunoglobulin A levels in the intestinal mucosa of the GH group were significantly lower than in the Sep group (P < 0.02) . There were no significant changes in CD3 counts and in the CD4/CD8 ratio between the four groups . Dual sugar tests and bacteriological examinations revealed that intestinal permeability and rate of bacterial translocation in the GH group were lower than in the Sep group (P < 0.01, respectively) . CONCLUSION: Prophylactic treatment with growth hormone can alleviate damage to intestinal barrier function caused by trauma and endotoxemia in rats under stress.

Int J Tuberc Lung Dis, 2004 Jan, 8(1), 106 - 13
Prospective evaluation of in-house polymerase chain reaction for diagnosis of mycobacterial diseases in patients with HIV infection and lung infiltrates; Schijman AG et al.; SETTING: Rapid diagnosis of tuberculosis (TB) in AIDS is critical for optimal treatment to reduce mycobacterial dissemination, HIV-1 replication and mortality . The inadequate sensitivity of Ziehl-Neelsen staining and its inability to distinguish atypical mycobacteria delays accurate diagnosis . OBJECTIVE: To evaluate the polymerase chain reaction (PCR) for diagnosis of TB in bronchoalveolar lavage (BAL), blood and extra-pulmonary samples from patients with AIDS and pulmonary infiltrates . DESIGN: Specimens from 103 HIV-1-infected patients were prospectively analysed using bacteriological methods and IS6110-PCR . Smear-positive samples were also tested using 16S ribosomal-DNA-PCR to identify Mycobacterium avium complex (MAC) infections . Gold standard diagnosis relied on positive cultures or treatment outcome . RESULTS: Thirty-four patients exhibited TB, one TB and MAC and four MAC . The sensitivity of IS6110-PCR was 100% in smear-positive samples, 81.8% in smear-negative BAL, 66.7% in extra-pulmonary samples and 42.9% in blood . Its specificity was 97.1% in BAL and 100% in extra-pulmonary and blood specimens . The 16S rDNA-PCR identified M . avium from all smear-positive samples that grew MAC . CONCLUSIONS: IS6110-PCR proved useful in evaluating episodes with probable clinical diagnosis of pulmonary or mixed TB and negative smears, whereas 16S rDNA-PCR would be helpful for prompt differential diagnosis of MAC in smear-positive specimens.

Int J Tuberc Lung Dis, 2004 Jan, 8(1), 59 - 69
Vertical transmission of Mycobacterium tuberculosis in KwaZulu Natal: impact of HIV-1 co-infection; Pillay T et al.; BACKGROUND: Increases in perinatal TB have paralleled the exacerbation of the TB epidemic in KwaZulu Natal . The exact risks for vertical transfer of Mycobacterium tuberculosis (VTRTB) to the baby are unknown, as is the impact of HIV-1 co-infection, which frequently accompanies maternal TB disease in the region . DESIGN: Prospective case series study of 82 HIV-1-infected and 25 non-infected pregnant mothers, King Edward VIII Hospital, KwaZulu Natal, South Africa . RESULTS: Perinatal mortality in HIV-1/TB diseased mothers was 85/1000 and associated with maternal anaemia (P = 0.02); 46% of newborns were premature, 66% low birth weight and 49% intrauterine growth restricted . These were significantly higher than overall hospital rates (P < 0.01, OR 4.8, 95%CI 3.2-7.0) . Sites of detection of maternal TB, distribution of bacteriologically-proven TB, obstetric comorbidity and perinatal morbidity were similar in HIV-1-infected and non-infected mothers . VTRTB was detected in 16 newborns (16%), occurring similarly in bacteriologically-proven and suspected maternal TB disease, with no difference between HIV-1-infected and non-infected mothers . Eleven newborns with VTRTB were HIV-1 exposed; 64% acquired HIV-1 and died from rapidly progressive disease by 10 months of age . HIV-1-infected mothers and their exposed newborns had significantly lower CD4 counts . No association between perinatal maternal viral load, CD4 count or VTRTB was detected . CONCLUSION: Mothers with TB disease in pregnancy are at risk for significant perinatal morbidity, mortality and VTRTB.

J Microbiol Methods, 2004 Mar, 56(3), 365 - 73
Comparison of RNA- and DNA-based species diversity investigations in rhizoplane bacteriology with respect to chloroplast sequence exclusion; Nikolausz M et al.; Comparative sequence analysis of 16S rDNA genes is a popular method of investigating microbial communities but problems arise when the subjects are rhizoplane consortia . The culture independent direct isolation of DNA from root sample results in huge amounts of plant DNA, and the universal primers designed for the domain Bacteria will amplify chloroplast ribosomal genes as well . A clone library generated from such a PCR product will be dominated by chloroplast, and the emulation of numerous chloroplasts and rhizoplane bacterial 16S rDNA for primers also distorts the results of different fingerprinting analyses . To resolve this problem, a new approach has been developed . The ribosome content is correlated with the metabolic activity of cells; therefore, RNA-based methods seem to be appropriate to exclude cell organelles (e.g . chloroplast) and dormant bacterial cells . A rapid RNA isolation and a reliable reverse transcription (RT)-PCR method were developed to investigate rhizoplane bacterial community and the results were compared with a total DNA isolation-based method of the same sample . 16S rRNA and DNA PCR products were cloned and screened by restriction analysis . The relative abundance of chloroplast amplicons in DNA and RNA clone libraries was compared and a significant decrease was detected (from 63% and 71% to 1% and 7%, respectively).

Int J Syst Evol Microbiol, 2004 Jan, 54(Pt 1), 3 - 6
Notification that new names and new combinations have appeared in volume 53, part 5, of the IJSEM.
{Fournier's gangrene: anatomo-clinical features in adults and children . Therapy update}
Rodriguez Alonso A, Perez Garcia MD, Nunez Lopez A, Ojea Calvo A, Alonso Rodrigo A, Rodriguez Iglesias B, Barros Rodriguez JM, Benavente Delgado J, Nogueira March JL.

Servicio de Urologia, Hospital Xeral-Cies, Vigo PontevedraFournier's gangrene is a skin infectious-necrotising process in the peri-neogenital area affecting males, usually in their sixties or seventies . Isolated flora from cultures of the necrotic lesion is commonly multi-microbial . In a majority of cases both aerobic and anaerobic micro-organisms are found in the cultures, Escherichia coli being the most commonly identified germ . Although considered in the past an idiopathic condition, in most patients today a genitourinary, anorectal or dermal triggering factor can be identified . There are a series of systemic host debilitating disorders such as diabetes mellitus, chronic alcohol abuse, and malignant neoplasia that are associated to this condition and may be considered risk factor to suffer this disease . Fournier's gangrene in children show specific bacteriological, pathogenic, clinical, therapeutic and prognostic features that distinguish it from that in adults . The most extensively accepted management for this condition includes therapy with broad-spectrum parenteral antibiotics and early and aggressive surgical debridement of the necrotic areas . Mortality continues to be high, ranging between 10-80% in the various series . Finally, a group of 7 patients with Fournier's gangrene is analyzed (1991-1998) aiming to establish a comparison between our results and those seen in recent series.

Pneumologie, 2004 Feb, 58(2), 83 - 91
{Parapneumonic effusion and pleural empyema - topical aspects of classification, diagnosis and treatment}; Kolditz M et al.; Parapneumonic effusions can be diagnosed in about 40 - 50 % of patients with bacterial pneumonia, and therefore should be considered as a frequent condition . Despite their prevalence, there is limited consensus about diagnostic pathways and therapeutic procedures due to the lack of evidence-based data available . The classification of parapneumonic effusions is based on morphological, chemical and bacteriological criteria . Dependent on the complexity of the effusion, available management approaches include observation without intervention, thoracentesis, chest tube drainage with or without local fibrinolysis and the surgical options VATS and thoracotomy . This overview summarizes the actual aspects of classification, diagnosis and treatment of the parapneumonic effusion and draws conclusions for the daily management of this condition.

Homeopathy, 2004 Jan, 93(1), 17 - 20
Evaluation of a homeopathic complex in the clinical management of udder diseases of riverine buffaloes; Varshney JP et al.; We report an uncontrolled observational study of the treatment of udder diseases of buffalo, using a homeopathic complex medicine . Mastitis is an economically important disease of buffaloes . In India economic losses due to mastitis are estimated at 526 million US dollars annually . Conventional veterinary treatment relies on costly antibiotics; cure rate is only 60% in field conditions with a problem of milk residues . The present investigation was undertaken to evaluate the effectiveness of a homeopathic complex in the management of clinical udder health problems of riverine buffaloes . Cases of subclinical mastitis were excluded from the study . A total of 102 mastitic quarters (fibrosed--40, nonfibrosed--62) and five cases each of blood in milk and udder oedema in lactating buffaloes were treated with a homeopathic complex consisting of Phytolacca 200c, Calcarea fluorica 200c, Silicea 30c, Belladona 30c, Bryonia 30c, Arnica 30c, Conium 30c and Ipecacuanha 30c . The diagnosis of udder diseases and recovery criterion was based on physical examination of udder and milk and CMT/WST score . Bacteriological analysis and somatic cell count were not performed . Treatment was 80 and 96.72% effective in cases of fibrotic mastitis and nonfibrosed mastitis respectively . Recovery period was 21-42 days (fibrosed) and 4-15 days (nonfibrosed) . Udder oedema and blood in milk responded favourably in 2-5 days . Cost of treatment was 0.07 US dollars per day . The homeopathic complex medicine may be effective and economical in the management of udder health problems of buffaloes . Definitive conclusions are premature due to the limited number of observations and lack of control group.

Hist Cienc Saude Manguinhos, 2003, 10(Suppl 2), 475 - 98
{The beginnings of the smallpox vaccine in São Paulo: a little known story}; Teixeira LA et al.; This discussion of smallpox prevention practices in the state of Sao Paulo focuses primarily on the Instituto Vacinogenico, created in 1892 as part of a sanitation reform that modernized public health in Sao Paulo state . Established and headed until 1913 by the renowned Sao Paulo surgeon Arnaldo Vieira de Carvalho, the institute was responsible for statewide distribution of the smallpox vaccine derived from animals . It operated on its own until 1918, when it was made part of the Instituto Bacteriologico.

Chirurgia (Bucur), 2000 Jan-Feb, 95(1), 11 - 5
{Laparoscopic treatment of acute cholecystitis . Incidence of anatomo-clinical variations (271 cases)}; Cresienzo D et al.; The study is based on 1050 laparoscopic cholecystectomies for gallstones performed between 1991-1999, out of which 271 were preoperatively considered as acute cholecystitis (25.8%) . The clinical, biological and ultrasound criteria were rigorously respected . The preoperative period of 1 to 5 days (mean--2.5) was used for re-equilibration and antibiotic and antithrombotic therapy . The intraoperative criteria were clinical, echolaparoscopical, cholangiographical and bacteriological and established in 219 cases the diagnostic of acute cholecystitis . The final diagnostic, on histopathological basis, confirmed the preoperative diagnosis of acute cholecystitis in 224 cases . The microscopical reexamination in the remainding controversy cases reclassified other 18 as acute cholecystitis (final concordance ratio--242:271) . The preoperative overvaluation may be consecutive to a too rapid (before the constitution of specific lesions) or too delayed intervention (the aspect becoming chronical) . The elements of diagnostic discordance are raising the problem of case selection and the necessity for standard classification of histological lesions in acute cholecystitis.

Kurume Med J, 2003, 50(3-4), 81 - 5
Evaluation of percutaneous endoscopic gastrostomy in elderly patients with silicosis and co-morbidities; Kawano M et al.; To clarify the indications and usefulness of Percutaneous endoscopic gastrostomy (PEG) in patients with Silicosis and some co-morbidities, we analyzed eight cases of silicosis, who suffered from dysphagia and had received a PEG for tube feeding during the period from 1998 to 2002 . The characteristics, and clinical course, of each case were statistically analyzed before and during PEG usage . All cases were bed-ridden males, with a mean age of 80 years . The profusion rate (PR) grade of silicosis was for five cases in category 2, and for three cases in category 4 . Most of the co-morbidities were dementia (five cases), and chronic heart failure (four cases) . There were no significant improvements in the measured nutrition criteria (albumin, lymphocytes) nor in respiratory function (arterial O2) between before and during PEG usage . Tube feeding through the PEG was not performed in three cases because of repeated aspiration pneumonia . The mean duration of PEG usage was 9 months, ranging from 5 to 20 months . Five cases died of the co-morbidities . Furthermore, there was significant deterioration in the bacteriological data (p = 0.001), suggesting a worsening of the swallowing disturbances during PEG usage, or the emergence of more resistant organisms as a result of empirical antibiotic therapy . The present results suggest that the indications of PEG in cases of severe chronic obstructive pulmonary disease (COPD) such as silicosis, associated with other morbidities, and with dysphagia, are somewhat limited . The patient's general condition should be an important factor in deciding whether or not this technique should be used.

Chirurgia (Bucur), 2000 Mar-Apr, 95(2), 169 - 77
{Causes of failure in the treatment of postoperative peritonitis}; Vasile I et al.; The authors analyze a group of 49 postoperative peritonitis, which represent 0.57% of a total of 8550 surgical interventions performed over the last 7 years and 1.19% of 4100 laparotomies carried out in an elective operation orientated general surgery department . The mortality rate was 28.57% (14 patients) among the 49 studied cases, which represents 25% of all deaths recorded in our department over the same time interval . A full account on postoperative peritonitis vital prognostic factors is given, insisting on: specific bacteriology (nosocomial infections), peculiar etiologies (10 out of 14 fatalities were originally operated on for digestive cancers), different associations of postoperative peritonitis with other infectious and noninfectious postsurgical complications (as encountered in all 14 deaths), type of postoperative peritonitis (13 death out of 14 were due to generalized peritonitis), postoperative peritonitis secondary to ignored lesions at the original operation (3 cases--3 deaths), surgical treatment limitation (late operative timing which was responsible of 9 deaths); treatment inadequacies of peritonitis and its cause--5 fatalities.

J Clin Microbiol, 2004 Feb, 42(2), 917 - 8
Bartholin's gland abscess caused by Brucella melitensis; Peled N et al.; We report herein a case of Bartholin's gland abscess caused by Brucella melitensis . Clinical microbiology laboratory workers in areas where this disease is endemic should be familiar with the bacteriological features of this organism and consider the possibility of a brucellar etiology in a broad range of clinical settings.

Int J Lepr Other Mycobact Dis, 2003 Dec, 71(4), 308 - 19
Long-term efficacy of 2 year WHO multiple drug therapy (MDT) in multibacillary (MB) leprosy patients; Cellona RV et al.; Relapse rate estimates after 2 year WHO multiple drug therapy (MDT) in multi-bacillary (MB) leprosy vary . Between 1987 and 1994, 500 MB leprosy patients completing 2 year MDT were enrolled in a prospective relapse study . The majority of patients (N = 316) were treated and followed at the physician-staffed Cebu Skin Clinic (CSC), whereas others (N = 184) received therapy from government clinics and were followed by CSC technicians in the field . Relapse definition was an increased bacteriologic index (BI) and new skin lesions, supplemented with mouse footpad inoculations . Through 2002, follow-up was 5368 person-years, with a mean of 10.8 years per patient . The absolute relapse rate was 3% (15/498; 0.28/100 person-years), with a cumulative risk estimate of 3.9% at 15 yrs . For a subset of 217 patients followed for >or=12 yrs or until relapse, relapses occurred in 9% (13/142) attending the CSC, versus 3% (2/75) assessed in the field (p = 0.09) . The rate for patients followed at CSC for >or=12 yrs and a pre-treatment BI >or=2.7+ was 13% (13/98) . All relapses were BL or LL, with pre-treatment BI's of >or=2.7+ . Relapses occurred long after completion of therapy, between 3 and 11 yrs from the midpoint of the examination without relapse to detection, or between 6 to 13 yrs to the actual year of detection, 7 occurring at >or=10 yrs . Lesion material from all relapses contained M . leprae that was rifampin and clofazimine sensitive, whereas 3 showed partial or full dapsone resistance . {Follow-up rigor and time}, medical expertise, and pre-treatment bacterial load influence relapse rates after 2 yr MDT.

Am J Rhinol, 2003 Nov-Dec, 17(6), 369 - 77
A comparison of the efficacy of telithromycin versus cefuroxime axetil in the treatment of acute bacterial maxillary sinusitis; Buchanan PP et al.; BACKGROUND: Telithromycin, a new ketolide, exhibits potent activity against respiratory pathogens, including resistant strains . METHODS: Five days of telithromycin (800 mg once daily) was compared with 10 days of cefuroxime axetil (250 mg twice daily) in subjects (n = 593) with acute bacterial maxillary sinusitis (ABMS) . Bacteriologic sampling was accomplished by sinus puncture or nasal endoscopy . The primary efficacy variable was clinical outcome at the posttherapy/test-of-cure evaluation in clinically evaluable patients . RESULTS: Clinical cure was achieved in 85.2% of telithromycin patients and 82.0% of cefuroxime axetil patients (difference in proportions, 3.2%; 95% confidence interval, -7.1-13.4%) . Satisfactory bacteriologic response rates were comparable . Treatment-emergent adverse events for both drugs were mild or moderate . The most frequently reported treatment-emergent adverse events were nausea and diarrhea . CONCLUSION: Once-daily telithromycin for 5 days was equivalent in efficacy to twice-daily cefuroxime axetil for 10 days in patients with ABMS . Telithromycin is a suitable option for short-course therapy of ABMS.

J Indian Med Assoc . 2003 Jul;101(7):436, 438.
A multicentric study to evaluate efficacy and safety of cefetamet pivoxyl in lower respiratory tract infections in Indian patients; Badyal DK et al.; This multicentric, open label, non-comparative study was designed to evaluate the extended spectrum of third generation oral cephalosporin, cefetamet pivoxyl in the treatment of patients with lower respiratory tract infections . This study was conducted among 111 patients with clinical, radiological and bacteriological findings consistent with the diagnosis . After obtaining written informed consent, patients were given cefetamet 500 mg tablet twice a day for 7 days . Cefetamet consistently decreased all clinical signs and symptoms at post-therapy visit . All the treated patients were either cured or improved . Cefetamet was well tolerated with a low incidence of drug related adverse events . The findings of this study indicate that cefetamet pivoxyl was well tolerated and is suitable option for the treatment of patients with lower respiratory tract infection.

Mikrobiyol Bul, 2003 Oct, 37(4), 301 - 7
{Prolonged hepatitis A: three case reports}; Yesilkaya A et al.; In this report, three patients, admitted to Ankara University Faculty of Medicine, Ibni Sina Hospital, Clinical Bacteriology and Infectious Diseases Department, with the diagnosis of acute viral hepatitis A have been discussed because of their clinical and/or biochemical relapses . Following conservative treatment and bedrest, the liver transaminases decrease to nearly normal levels but a second peak was observed later in three of the cases . Other viral, metabolic and autoimmune factors which could lead to the increase of liver transaminases were ruled out . Anti-HAV IgM antibodies became negative in 2 to 4 months later, and liver enzymes returned to normal in 4 to 5 months after onset of their illnesses . As a result, it was concluded that conservative follow-up and therapy would be sufficient since the prognosis of A hepatitis is usually benign even if it relapsed.

Rev Pneumol Clin, 2003 Dec, 59(6), 348 - 56
{Levofloxacine for the treatment of pneumococcal pneumonia: results of a meta-analysis}; Bru JP et al.; Levofloxacine is a fluoroquinolone presenting good anti-pneumococcal activity, including against strains with reduced sensitivity to penicillin . Four randomized controlled studies have compared the efficacy of levofloxacine versus other antibiotics (amoxacillin-clavulanic acid, amoxicillin, ceftriaxone, ceftriaxone plus cefuroxime +/- erythromycin) for the treatment of acute community-acquired pneumonia in adults . Grouping the 1,738 analyzable patients in these four studies, a meta-analysis was performed on the sub-group of 275 patients with documented pneumococcal infection (86 with bacteriemia) in order to compare the efficacy of levofloxacine with that of the comparer antibiotics . The trials were homogeneous, allowing the meta-analysis . The overall rate of clinical success was 88.6% in the levofloxacine group and 86.7% in the comparer group . The interval of confidence for the difference in the rate of estimated clinical success was between -5.65% and +9.39% . Bacteriologically, the rate of eradication was 90.2% and 90.4% respectively with an interval of confidence for the difference between -7.83% and +7.36% . The results of this meta-analysis confirmed that the efficacy of levofloxacine for the treatment of acute community-acquired pneumococcal pneumonia is not inferior to that of the comparers; the interval of confidence for the difference in the estimated rate of success did not include the breaking point of non-inferiority (-10% set for the clinical studies) and included zero.

Int J Syst Evol Microbiol, 2004 Jan, 54(Pt 1), 293 - 301
Status of strains that contravene Rules 27(3) and 30 of the Bacteriological Code . Request for an opinion; Euzeby JP et al.; In the period from January 2001, at least 207 new names proposed in articles in the International Journal of Systematic and Evolutionary Microbiology or cited in Validation Lists are not in accordance with Rules 27(3) and 30 of the Bacteriological Code . The purpose of the present Request for an Opinion is to clarify the status of the names listed and to provide a solution whereby they may be considered to be validly published.

Int J Syst Evol Microbiol, 2004 Jan, 54(Pt 1), 1 - 2
Validation of publication of new names and new combinations previously effectively published outside the IJSEM; Effectiveness of an internal teat seal in the prevention of new intramammary infections during the dry and early-lactation periods in dairy cows when used with a dry cow intramammary antibiotic; Department of Clinical and Population Sciences, Veterinary Teaching Hospital, University of Minnesota, St . Paul 55108, USA . godde002@umn.edu

The objectives of this study were to determine the effect of infusion with an internal teat seal at dry off, when used as an adjunct to long-acting antibiotic infusion at dry off, on the risk for acquiring a new intramammary infection (IMI) during the dry period, prevalence of IMI and linear score (LS) after calving, and risk for experiencing a clinical mastitis event between dry off and 60 DIM . A total of 437 cows from 2 dairy herds, with no clinical mastitis and 4 functional quarters, were enrolled at dry off . Prior to the final milking, all quarters were sampled for bacteriological culture and SCC analysis . After milking, all 4 quarters were infused with a commercially available long-acting dry cow antibiotic . Two contralateral quarters were then infused with an internal teat seal (Orbeseal, Pfizer Animal Health, New York) . Following calving the teat seal was stripped out at first milking . Duplicate milk samples were collected between 1 to 3 DIM and again between 6 to 8 DIM for culture and SCC analysis . Quarters treated with Orbeseal had significantly lower prevalence of IMI at 1 to 3 DIM (tx = 22.8%, control = 29.1%), had significantly fewer quarters that acquired a new IMI between dry off and 1 to 3 DIM (tx = 20.2%, control = 25.4%), and had significantly fewer quarters affected by a clinical mastitis event between dry off and 60 DIM (tx = 5.9%, control = 8.0%) . Multivariable analysis showed a significant effect of treatment, with treated quarters being 30% less likely to develop a new IMI between dry off and 1 to 3 DIM, 31% less likely to have an IMI present at 1 to 3 DIM, 33% less likely to experience a clinical mastitis event between dry off and 60 DIM, and having significantly lower linear score measures at 1 to 3 DIM and 6 to 8 DIM, compared with control quarters.

Ann Trop Paediatr, 2003 Dec, 23(4), 259 - 63
Pyrexia of unknown origin in children: a review of 102 patients from Turkey; Ciftci E et al.; Pyrexia of unknown origin (PUO) has not been appropriately investigated in Turkish children and therefore a study was undertaken to determine the causes of PUO and to evaluate which clinical procedures are useful in establishing a diagnosis . A total of 102 children fitting the classical PUO criteria seen in our clinic between 1995 and 2002 were investigated retrospectively . Infections, collagen vascular disorders, malignancy and miscellaneous conditions constituted 44.2%, 6.8%, 11.7% and 24.5% of cases, respectively, while 12.8% of the cases remained undiagnosed . Enteric fever, brucellosis and respiratory tract infections were the most commonly encountered infections, whereas familial Mediterranean fever was the commonest non-infectious disorder . Biopsy, aspiration, serology, bacteriology, radiology and observation of the clinical course were the most useful diagnostic procedures.

Arch Pathol Lab Med, 2004 Feb, 128(2), 205 - 9
Use of polymerase chain reaction to diagnose tuberculous arthritis from joint tissues and synovial fluid; Titov AG et al.; CONTEXT: Tuberculosis of the joints and bones is a significant worldwide problem, often leading to joint and bone destruction . The diagnosis of this disease manifestation is difficult . OBJECTIVE: To assess the role of conventional diagnostics compared to polymerase chain reaction applied to samples obtained at arthroscopy . DESIGN: This was an open observational study that was blinded to the microbiologist, histopathologist, and molecular biologist responsible for assessing the main outcome measures . PATIENTS: Seven patients (8 samples) with joint and bone tuberculosis and 14 patients (16 samples) with nontuberculous joint and bone disease . INTERVENTION: Arthroscopic examination and tissue sample collection . MAIN OUTCOME MEASURES: Mycobacterium tuberculosis staining, culture, and histopathologic assessment of caseating granulomas vs polymerase chain reaction . RESULTS: Polymerase chain reaction was positive in all cases of true tuberculosis and falsely identified 2 samples as positive, both however, in patients who had lung tuberculosis in the past . CONCLUSIONS: Conventional bacteriological methods for demonstration of M tuberculosis are not very sensitive and can be time-consuming . Polymerase chain reaction of arthroscopically obtained joint tissue biopsies appears promising in the early diagnosis of tuberculous arthritis.

J Wildl Dis, 2003 Oct, 39(4), 824 - 9
Safety of revaccination of pregnant bison with Brucella abortus strain RB51; Olsen SC et al.; From December 1998 through February 1999, a study was conducted in a Brucella-infected bison herd to evaluate the safety of booster vaccination of adult bison (Bison bison) with 6 x 10(9) colony forming units (CFU) of Brucella abortus strain RB51 (SRB51) that had previously been vaccinated as yearlings with 1 x 10(10) CFU of SRB51 . Abortions or other adverse effects were not observed after SRB51 booster vaccination . At 10 wk after adult vaccination, pregnant and nonpregnant bison (n = 65) were randomly selected for bacteriologic sampling of targeted maternal tissues during abattoir processing . Fetal tissues were also sampled in pregnant bison . The SR351 recovered from tissue samples of eight of 48 pregnant bison and none of 17 nonpregnant bison . In three of the eight culture-positive bison, SRB51 was recovered from fetal tissues . In three additional bison, one pregnant and two nonpregnant, B . abortus biovar 1 field strain was recovered from internal iliac or supramammary lymphatic tissues . Results of this study suggest the possibility that the SRB51 vaccine can be safely used to booster vaccinate pregnant bison in a Brucella-infected bison herd . Our data also reaffirms the potential for B . abortus field strains to persist in bison until attainment of reproductive age, despite extensive use of vaccination and serologic testing.

Klin Khir, 2003 Oct, (10), 13 - 5
{Micro-organism translocation and acute anastomosis inflammation after stomach resection}; Gulov MK et al.; The results of examination of 42 patients with an acute anastomositis after performance of gastric resection were analyzed . Clinical classification was elaborated for detailed interpretation of the anastomosits diagnosis and choice of therapy . Close correlative inter-relatioship between severity of anastomositis and degree of gastric mucosa colonization by micro-organisms was established basing on analysis of the laboratory and bacteriological investigations results.

Arthritis Rheum, 2004 Jan, 50(1), 259 - 64
Emergence of lyme arthritis after autologous chondrocyte transplantation; Marlovits S et al.; We report herein the first known incidence of the emergence of borrelial arthritis following autologous chondrocyte transplantation for repair of a cartilage defect . The patient had no recent manifestation of Lyme borreliosis, but 15 years earlier had had an expanding erythematous lesion after a tick bite . The current infection resulted in massive joint swelling, elevated body temperature, dissemination of the graft, and transplant failure . Results of routine bacteriologic studies were negative . A diagnosis of Lyme arthritis was first considered following the detection of Borrelia-specific serum antibodies . Additional evidence was provided when borrelial DNA sequences were detected in the synovial fluid through polymerase chain reaction . The diagnosis was confirmed by culture of Borrelia burgdorferi from the synovial fluid . The possibility of a dormant borrelial infection should be considered in patients who undergo repair of cartilage defects with autologous chondrocyte transplantation . We recommend that synovial fluid and joint tissue be screened for the presence of viable Borrelia before transplantation of an autologous graft.

J Am Acad Dermatol, 2004 Feb, 50(2), 203 - 9
Osteoarticular complications of erysipelas; Coste N et al.; BACKGROUND: Rare osteoarticular complications occurring after erysipelas have been reported . We describe 9 patients in whom various osteoarticular complications developed during erysipelas . OBJECTIVE: We sought to analyze osteoarticular complications during erysipelas, paying special attention to clinical, bacteriologic, and radiologic data . METHODS: Data were retrospectively recorded from the files of patients seen in 3 dermatologic centers between 1998 and 2000 . They included laboratory tests, bacteriologic cultures, radiologic investigations, and treatment modalities and outcome of both erysipelas and osteoarticular complications . RESULTS: We observed 9 patients (7 men and 2 women; mean age 49.6 years) who first presented with typical erysipelas of the lower limb and then osteoarticular complications developed during the course of their disease, always localized to a joint contiguous to the erysipelas plaque . These complications included: relatively benign complications, ie, bursitis (n = 5) or algodystrophy (n = 1), occurring after erysipelas with favorable course; and more severe complications, ie, osteitis (n = 1), arthritis (n = 1), and septic tendinitis (n = 1), occurring after erysipelas characterized by local cutaneous complications (abscess, necrosis) . CONCLUSIONS: Osteoarticular complications of erysipelas can be divided into the 2 groups of nonseptic complications (mainly bursitis), which are characterized by a favorable outcome, and septic complications (osteitis, arthritis, tendinitis), which require specific, often prolonged treatment and, sometimes, operation . Their diagnosis is on the basis of clinical and radiologic findings rather than joint aspirations, which are usually not possible through infected skin tissue.

Heart Surg Forum, 2003, 6(5), 434 - 7
A new technique for the treatment of delayed sternotomy healing: the vacuum therapy; Demaria RG et al.; BACKGROUND: The treatment of nonhealing and infected sternotomies after cardiac surgery is a challenging task, with its increased rates of mortality, morbidity, and costs . Local vacuum therapy (V.A.C . system) allows treatment of local infections, thanks to continuous aspiration and the sealed dressing that stimulates granulation tissue formation . The purpose of this clinical investigation was to evaluate vacuum therapy in cardiac surgery for achieving healing of delayed sternotomy closure after cardiac surgery . MATERIALS AND METHODS: From January 1998 to December 2002, 7 patients who underwent coronary artery bypass surgery under cardiopulmonary bypass by median sternotomy approaches presented a nonhealing infected sternal surgical wound that was treated with local vacuum therapy . Aspiration maintained between -125 mm Hg and -200 mm Hg was carried out on the entire surface of the wound with a sponge connected hermetically to an aspiration system . The treatment was associated with antibiotic therapy adapted to the results of bacteriological studies of the aspirates . RESULTS: All patients with delayed sternotomy closure healed in approximately 8 weeks (2-12 weeks) with the exception of one patient who died of multiorgan failure after a satisfactory muscular pectoral flap . Treatment was possible with vacuum therapy alone (n = 2), with vacuum therapy in association by second intention with a skin graft (n = 1), or both with a muscular pectoral flap (n = 4) . Sternal stability appears to be an important factor for achieving satisfactory and complete healing . CONCLUSIONS: This new therapy offers an alternative to the classic treatment of infected sternotomies in cardiac surgery, especially in preparing rewiring and muscular flaps for complicated cases with sternal instability or alone . The treatment must be instituted early to be more effective.

Zh Mikrobiol Epidemiol Immunobiol, 2003 Nov-Dec, (6), 107 - 9
{Prevention of epidemiological consequences during an extreme situation caused by the natural disaster in the Republic of North Ossetia-Alania}; Butaev TM et al.; Information on the organization of interaction between different services responsible for restoration works, sanitary cleaning, disinfection under the conditions of the emergency situation is presented . The activity of the sanitary and epidemiological services in the areas in the Republic of North Ossetia-Alania, affected by high flood, is described . Measures aimed at the epidemiological surveillance of acute enteric infections, the control of the quality of drinking water and foodstuffs, the bacteriological study of material samples taken from humans, vaccinal and phage prophylaxis have taken an important place in the work of the institutions of sanitary and epidemiological surveillance . As the result of all these measures the sanitary and epidemiological service has managed to prevent the aggravation of the sanitary and epidemiological situation in the republic.

Zh Mikrobiol Epidemiol Immunobiol, 2003 Nov-Dec, (6), 34 - 7
{Basic activity of the Railroad Center of the State Sanitary and Epidemiologic Surveillance at the Vladikavkaz train station of the North Caucasus Railroad in the prevention of infectious diseases in an emergency situation}; Abisalov AB; The article deals with the data on the activity of the Railroad (RR) Center of State Sanitary and Epidemiological Surveillance at the train station of Vladikavkaz of the North Caucasian RR at the period of the liquidation of the consequences of the natural calamity in June-July 2002 . In accordance with the situation, the scheme of the interaction with the territorial services and departments were worked out, the operative plans of antiepidemic measures were rectified, the sanitary, hygienic and bacteriological control on the quality of drinking water supply and foodstuffs on RR trains and stations was strengthened, the work on sanitary education among the personnel and passengers in the zone of responsibility of the RR Center of State Sanitary and Epidemiological Surveillance of the North Caucasian RR was activated.

J Clin Microbiol, 2004 Jan, 42(1), 264 - 8
Prevalence of Bartonella henselae in Italian stray cats: evaluation of serology to assess the risk of transmission of Bartonella to humans; Fabbi M et al.; Bartonella henselae is the major etiological agent of cat scratch disease in humans . Cats act as the natural reservoir of B . henselae and can transmit the infection to humans by a bite or scratch . The prevalence of B . henselae in cat populations was evaluated by serological and bacteriological tests . A total of 769 stray cats from three urban and three rural areas in northern Italy were sampled between January 1999 and December 2000 . The positive and the negative predictive values of serological tests with respect to bacteremic status were evaluated . Tests of a total of 140 cats (18%) resulted in detection of bacteremia . A total of 540 cats were tested by serology; 207 (38%) were seropositive . Of the 531 cats tested by both methods, the results for 65 (12.2%) showed both bacteremia detection and seropositivity . The molecular typing of the isolates showed that 20.6% of bacteremic cats were infected with B . henselae type I strain, 61.1% were infected with B . henselae type II, and 18.3% were coinfected with both . A statistically significant difference in antibody and bacteremia prevalences among geographical areas was detected . Statistical analysis showed no association between characteristics such as seroprevalence-bacteremic status, sex, general health status, and the presence of ectoparasites . The negative predictive value of serological test was 84.7%, and the positive predictive value was 31.8% . Receiving operator characteristic analysis of the data showed that serological tests had a low predictive value in relation to the bacteremic status of a cat; in surveys aimed at assessing the real risk of B . henselae infection in a human population, therefore, we suggest the use of blood culture as the reference test . Nevertheless, both blood culture assays and serological tests for Bartonella infection should be performed for a complete evaluation of the health status of cats.

Clin Diagn Lab Immunol, 2004 Jan, 11(1), 111 - 4
Antibody reactivity to Omp31 from Brucella melitensis in human and animal infections by smooth and rough Brucellae; Cassataro J et al.; Group 3 of outer membrane proteins (OMPs) of Brucella includes Omp25 and Omp31, which share 34% identity . Omp25 is highly conserved in Brucella species, and Omp31 is present in all Brucella species, except Brucella abortus . Antibodies to Brucella melitensis Omp31 have been sought only in infected sheep, and Western blotting of sera from infected sheep did not reveal anti-Omp31 reactivity . We obtained recombinant purified Omp31 (B . melitensis) and tested its recognition by sera from humans and animals suffering from brucellosis by an indirect enzyme-linked immunosorbent assay (ELISA) . Serum samples from 74 patients, 57 sheep, and 47 dogs were analyzed; brucellosis was confirmed by bacteriological isolation in all ovine and canine cases and 31 human cases of brucellosis . Thirty-five patients (47%) were positive for antibodies to Omp31, including seven cases of Brucella suis infection, two cases of B . abortus infection, and three cases of B . melitensis infection . Of 39 sheep naturally infected with B . melitensis (biovars 1 and 3), 23 (59%) were positive for antibodies to Omp31 . Anti-Omp31 antibodies were also detected in 12 of 18 rams (67%) in which Brucella ovis was isolated from semen . Antibodies to Omp31 were also found in 41 (87%) of the 47 dogs, including 13 with recent infection . These results suggest that an indirect ELISA using recombinant purified Omp31 from B . melitensis would be of limited value for the diagnosis of human and animal brucellosis . Nevertheless, the potential usefulness of this antigen in combination with other recombinant proteins from Brucella should not be dismissed.

Int J Clin Pract, 2003 Dec, 57(10), 919 - 20
Guillain-Barré syndrome associated with acute neurobrucellosis; Namiduru M et al.; We report the case of a 14-year-old girl with Guillain-Barre syndrome associated with brucellosis due to Brucella melitensis . The diagnosis was established by the isolation of B . melitensis from her blood and by the determination of high levels of Brucella aglutinins in her sera and cerebrospinal fluid . A combination of rifampin, co-trimoxazole and physical therapy resulted in complete healing within 30 days . Antibrucellar treatment continued for 12 weeks . This case report suggests that brucellosis should be kept in mind in the aetiology of Guillain-Barre syndrome in the endemic areas for brucellosis, and bacteriological and serological tests for brucellosis should be performed.

Pneumologia, 2003 Apr-Jun, 52(2), 99 - 110
{Success rate in patients with lung TB registered in Braşov county between 1990 and 2001}; Macavei C; The purpose of the present study was to assess the success rate of TB pulmonary cases registered in the district of Brasov between 1 january 1990-31 December 2001 and followed from 0 to 154 months . The retrospective study for 1990-1994 and prospective for 1995-2001 included 4369 pulmonary cases over 14 years in age, respectively 3912 new and 587 relapsed cases . To these patients were analysed the favorable and unfavorable evolutions, including relapses cases . The evaluation of the first treatment after National TB Program's 2001-2005 standards showed 2893 favorable evolutions, respectively 1612 (42.4%) cured and 1281 (33.7%) completed treatment and unfavorable evolutions 795 cases: 284 failures (7.5%), 345 defaulters (9%) and 166 TB deaths (4.4%) . To these were associated 224 (5.9%) relapses cases appeared after 12 months from the begining of the treatment . Between relapses cases were analysed as favorable evolutions 332 cases respectively 207 (36.6%) cured and 125 (22.1%) completed treatment and unfavorable evolutions 217 cases: 68 failures (12%), 118 defaulters (20.9%) and 31 TB deaths (5.5%) . To these were associated 38 (6.7%) relapses cases appeared after 12 months from begining of the treatment . An age group of new cases with the highest percentage of the favorable evolutions, respectively 89% (p < 0.001) at women was 15-24 years and for the unfavorable evolutions, respectively 33% at men was 35-44 (p < 0.05) and over 65 years . The comparison on the bacteriological categories between new and relapses cases showed that the percentage of the favorable evolutions was significantly higher at new-cases . At new cases after 12 years of supervision, the rate of success varied a little and registered the less value of 77% at 9 years of monitoring, and finally a level of 78.5% . At relapses cases, after a diminution in the first 3 years until 59.2%, the value bring up year after year and registered a peak of 72.4% at 8 years of monitoring . After 12 years, the rate of success of the first retreatment was 58.8% representing the less level of the whole interval . For the new cases at the first treatment the risk of failure was 8.6%, default 10.3% and tb death 5% and for the relapses cases at the first retreatment the risk of failure was 15.8%, default 25.2% and TB death 7.2% . The risk of relapse for new cases varied between 2.9% at 2 years and 1% at 10 years, and for the relapses cases between 6.1% at 2 years and 1% after 8 years of monitoring . The preoccupation for augmentation the level of the success of the first treatment might improve the performances on the long time in tuberculosis control.

Kulak Burun Bogaz Ihtis Derg, 2003 Aug, 11(2), 33 - 8
{Microbiology of the external auditory canal in patients with asteatosis and itching}; Karakus MF et al.; OBJECTIVES: We examined the microbiology of the external auditory canal in patients with asteatosis and itching and evaluated the efficacy of topical 2% alcohol and boric acid solution in patients with normal flora . PATIENTS AND METHODS: Bacteriological and mycological cultures were obtained from 76 ears of 45 patients (36 females, 9 males; mean age 41.8 years; range 17 to 66 years) presenting with normal otoscopic findings and no history of ear diseases . Treatment protocols were planned according to the culture results . Patients with normal flora were administered topical 2% alcohol and boric acid solution to relieve itching . RESULTS: Cultures yielded normal flora in 65 ears (85.5%), bacterial pathogenic flora in 10 ears (13.1%), and mycosis in one ear (1.3%) . Complaints of itching decreased significantly following treatment with alcohol and boric acid solution in patients with normal flora (p<0.05) . No correlation was detected between age and the severity of itching (p>0.05) . CONCLUSION: Despite normal otoscopic findings, external auditory canal cultures may show pathogenic colonization in patients with asteatosis . Topical administration of alcohol and boric acid solution seems to relieve itching in patients with normal flora.

West Afr J Med, 2003 Sep, 22(3), 250 - 2
Interference by malaria in the diagnosis of typhoid using Widal test alone; Ohanu ME et al.; A total of 270 febrile patients (130 males and 140 females) aged between 15 and 59 were screened using thick and thin blood film stains for malaria, bacteriologic culture and Widal test for enteric fevers . Sixty (22%) were positive for malaria while 38 (14%) were positive for enteric fevers out of which 16 (26.6%) concomitantly had malaria parasite . Cases without malaria parasite (MP) or enteric fever organism were 172 (63.7%) and classified as pyrexia of unknown origin (PUO) . Forty-four were strictly malaria cases out of which 36 (82%) were due to Plasmodium falciparum, and all had antibody Widal titres > or = 160 to 0 antigen while 4 (9%) were due to Plasmodium malariae, 3 (6.8%) were due to P . ovale and 1 (2.3%) was due to P . vivax . Twenty (52.6%) of the 38 patients with enteric fever had typhoid, all had Widal titres > or = 160 to 0 antigen . In all, antibody reaction Widal titres to H antigen were < 20 . There was no statistical significant difference {chi2 = 327.2, P > 0.05} between Widal titres of malaria and typhoid cases . Hence using Widal test alone, one cannot differentiate typhoid fever from malaria . In another 250 healthy adults, of equal sex distribution, used as controls 12 (4.8%) had malaria parasite and 4 (1.6%) had enteric fever organisms . While only 4 (1.6%) gave Widal titre of 80 to 0 antigen the rest had antibody titres of < 20 to O antigen . Malaria could interfere with serological diagnosis of typhoid and hence lead to over diagnosis of typhoid in Nigeria.

J Pak Med Assoc, 2003 Oct, 53(10), 472 - 8
Septic arthritis of the hip in children--Aga Khan University Hospital experience in Pakistan; Umer M et al.; OBJECTIVE: To present clinical, radiological and bacteriological features and short term outcome of septic arthritis of the hip in children . METHODS: There were 23 male and 16 female children, including 6 neonates and 10 infants with a mean age of 3.9 years . Diagnosis of septic hip was made on clinical grounds, supplemented by X-rays, leukocyte count and the erythrocyte sedimentation rate (ESR) . Thirty nine patients with 40 hips were followed for a mean time period of 76 weeks . All patients had a positive joint aspirate (pus) and underwent surgical decompression along with intravenous antibiotic therapy . RESULTS: Symptoms of pain, fever and restricted range of hip motion were common to all patients . The mean leukocyte count was 14,000 and the mean ESR was 63 mm . Cultures of blood and joint aspirate were positive in 9 and 28 patients respectively . Staphylococus Aureus was the commonest organism (14 patients) identified, and only one patient had Hemophilus influenzae . Seven patients had a mixed osteoarticular infection . Positive clinical response was noted in the mean time period of 8.6 days . In follow-up, four cases developed myositis ossificans and 2 cases showed signs of partial growth plate destruction . CONCLUSION: Our findings of the absence of H . influenzae and the presence of a number of gut organisms are different from the previous studies . Duration of symptoms was an important prognostic factor and correlated well with the final outcome . Early surgical decompression was found to be the treatment of choice . A combined osteoarticular infection should be kept in mind in cases which show a poor response after the initial joint debridement.

Hepatogastroenterology, 2003 Nov-Dec, 50(54), 1821 - 4
Microbiology difference between colonized catheters and catheter-related bloodstream infections; Lin C et al.; BACKGROUND/AIMS: Central vein catheters for patients receiving total parenteral nutrition have a high incidence of colonized catheters and catheter-related bloodstream infections . However, the actual incidence and bacterial pattern have not been well studied . This study was undertaken to investigate the difference in bacteriology between colonized catheters and catheter-related bloodstream infections . METHODOLOGY: From January 1997 to March 1998, 354 patients receiving total parenteral nutrition were included in this study . The patients ranged in age from 49 to 80 years, 151 women and 203 men . Colonized catheters and catheter-related bloodstream infections were defined . RESULTS: The culture was performed in 249 catheter tips (249 of 614, 40.6%) . Sixty tips were found to have organisms . The organisms cultured from colonized catheters were Gram(+) aerobic bacteria (34, 56.7%), fungi (14, 23.3%), and Gram(-) aerobic bacteria (12, 20%) . The organisms cultured from catheter-related bloodstream infections were fungi (16, 64%), Gram(-) aerobic bacteria (5, 20%), and Gram(+) aerobic bacteria (4, 16%) . Dermatogenic infection in colonized catheters should be stressed, but systemic fungal infection in catheter-related bloodstream infections should be emphasized . CONCLUSIONS: A striking difference exists in bacterial species between colonized catheters and catheter-related bloodstream infections . Further studies on different treatment strategy for colonized catheters and catheter-related bloodstream infections should be undertaken . The combined approach of a total parenteral nutrition team, sterile protocols, and early diagnosis of fungemia should be advocated for the total parenteral nutrition patients.

J Small Anim Pract, 2003 Dec, 44(12), 541 - 5
Maxillary bone epithelial cyst in a dog; Featherstone H et al.; A swelling ventromedial to the left eye of a one-year-old, neutered male Labrador failed to respond to antibiotic and anti-inflammatory therapy . Plain and contrast radiography revealed a spherical, radiolucent area, 1.5 cm in diameter, dorsomedial to the fourth maxillary premolar and rostral to the ethmoid region . The lesion was thin-walled, with a smooth radiopaque margin, and was clearly demarcated from the surrounding structures . Dacryocystography demonstrated no apparent physical association between the lesion and the nasolacrimal duct, the latter appearing normal . Ultrasonography of the lesion showed a round, anechoic structure consistent with the appearance of a cyst . Prior to surgical excision of the lesion, intralesional fluid was aspirated . Bacteriology of the fluid was negative for both aerobic and anaerobic organisms . Cytological examination of the fluid showed a few macrophages and small lymphocytes; neither significant inflammatory component nor neoplastic cells were found . Histology showed the lesion to be a benign epithelial cyst . The dog recovered uneventfully and there was no clinical evidence of recurrence within a two-year follow-up period.

Aust Crit Care, 2003 Nov, 16(4), 126 - 32
Critical care nurses be aware: Lemierre's syndrome is on the rise; Jane R et al.; Lemierre's syndrome (LS) typically occurs in previously healthy young adolescents and young adults who become acutely ill following an attack of pharyngotonsillitis . Also known as post anginal sepsis, those afflicted develop pyrexia, rigours and multiple metastatic abscesses that lead to septic thrombophlebitis of the internal jugular vein . In the pre-antibiotic era this particularly virulent syndrome had a mortality rate in excess of 90%, but since the introduction of antibiotics and the widespread treatment of throat infections, it has became almost unknown . However, due to a number of factors, including a reduction in the use of antibiotics for the treatment of sore throats, misdiagnosis and/or improvements in microbiology diagnostic techniques, several reports have indicated a resurgence of the condition . This has major ramifications for critical care nurses as LS is still associated with significant morbidity and mortality . This paper discusses the aetiology, pathophysiology, bacteriology, diagnosis and management aspects of this syndrome . A case study of a young woman is presented to illustrate the complexity of the condition, and highlight how early diagnosis and prompt initiation of appropriate intravenous antibiotic therapy ensured a favourable clinical outcome.

Acta Vet Hung, 2003, 51(4), 465 - 73
Wild boars (Sus scrofa) as reservoirs of Brucella suis biovar 2 in Croatia; Cvetnic Z et al.; This work presents the results of findings for brucellosis in wild boars and domestic swine in two regions of Croatia . In the region of Djakovo the blood samples of 211 wild boars were analysed and in 29.4% of the samples serologically positive reactions were established . In the same region the blood samples of 1080 domestic swine on pastures were also analysed and positive serological reactions were established in 12.3% . In the regions around Lonjsko Polje the blood samples of 53 wild boars were analysed and in 22.6% of them positive serological reactions were established . On several locations around Lonjsko Polje the blood samples of 901 domestic swine were serologically analysed and 13.5% of the swine were found to be seropositive . Bacteriological analyses of submitted materials from 24 wild boars resulted in isolation of Brucella from seven (29.2%) samples, and from 43 samples originating from domestic swine that had aborted and had been serologically positive, Brucella were isolated from 25 (58.1%) swine, as well as from 10 (62.5%) out of 16 aborted piglets . In all the isolates Brucella suis biovar 2 was identified . Wild boars are carriers and reservoirs of Brucella suis biovar 2 in Croatia.

Rinsho Byori, 2003 Nov, 51(11), 1124 - 31
{Undergraduate teaching project on clinical laboratory medicine}; Kayaba H; Undergraduate teaching in clinical laboratory medicine is at the center of contemporary medical education . Students are expected to learn advanced laboratory medicine and basic diagnostic skills such as blood sampling, peripheral blood cell counting, blood typing, cross match test, urinalysis, electrocardiography, and bacteriological examinations through their training program . In our department, we have compulsory lectures, a basic practical training course and an advanced training course for the medical students . The compulsory lectures are programmed for the students in the fourth grade to obtain basic knowledge of clinical laboratory medicine and the patho-physiology of diseases . The teaching staff makes every effort to make their lectures exciting and interesting . As we experienced as medical students in the past, boring lectures give students nothing but a nap . For every senior teaching staff in our school, it is obligatory to be evaluated on their lectures by the students and other teaching staff every year to improve their teaching skills and materials . Teaching materials utilizing personal computers and the Internet are becoming more and more important . The basic practical training course is for the students in the fifth grade . The laboratory technicians help us teach students basic diagnostic skills in this program . The students in the advanced training course have to attend morning conferences in the department, including reverse clinico-pathological conferences and laboratory investigations . The reversed clinico-pathological conferences are popular among the students . Through our training programs, we hope that the students raise many questions that they solve themselves in the future, as well as learning established clinical laboratory medicine.

Int J Tuberc Lung Dis, 2003 Dec, 7(12 Suppl 3), S384 - 90
Tuberculosis contact investigations: outcomes in selected areas of the United States, 1999; Jereb J et al.; SETTING: Twenty-nine United States jurisdictions . OBJECTIVE: To determine yields of tuberculosis (TB) contact investigations . METHODS: Health departments within the jurisdictions reported counts and outcomes from routine contact investigations for cases reported in 1999 . RESULTS: The 29 jurisdictions reported 9199 TB cases, 51.9% of the US and Puerto Rico 1999 total, and listed 67585 contacts . While 571 (10.6%) of 5405 pulmonary cases confirmed by sputum bacteriology had no contacts listed, 13904 contacts were listed for other cases that were unlikely to be contagious . Diagnostic evaluation was completed for 56100 contacts (83.0%), with 561 TB cases found . Of 13083 contacts found to have latent TB infection, 5746 (44.5%) completed treatment to prevent TB . Loss to follow-up and self-discontinuation of treatment accounted for 70% of reasons why treatment was not completed . CONCLUSION: Contact investigations capture substantial numbers of TB cases and latent TB infections, but the impact on prevention is limited by the poor treatment rates for infected contacts . Contacts should be sought for each potentially contagious TB case; why so many contacts are sought for cases who are unlikely to be contagious needs to be determined.

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