Clin Infect Dis, 2002 Dec 15, 35(12), 1484 - 90 Epub 2002 Dec 02. Epidemiology of bloodstream infection in nursing home residents: evaluation in a large cohort from multiple homes; Mylotte JM et al.; This study sought to reevaluate the epidemiology of bloodstream infection in nursing home residents . The records of 166 nursing home residents admitted to an urban, public, university-affiliated hospital with 169 episodes of bloodstream infection between January 1997 and April 2000 were retrospectively reviewed . The most common organisms isolated were Escherichia coli (27% of isolates), Staphylococcus aureus (18%; 29% were methicillin-resistant strains), and Proteus mirabilis (13%) . There was minimal resistance to quinolones and third-generation cephalosporins among aerobic gram-negative bacilli . The most common sources were the urinary tract (51% of episodes) and the lungs (11%); a source was not identified in 22% of episodes . Hospital mortality was 18% . Independent predictors of hospital mortality were a pulmonary source of infection, systolic blood pressure <90 mm Hg, and leukocytosis >20,000 cells/mm3 . Compared with other studies published in the past 2 decades, mortality was lower . The most common resistant organism was methicillin-resistant S . aureus. J Chemother, 2002 Oct, 14(5), 461 - 4 First occurrence of transferable extended-spectrum beta-lactamase hydrolyzing cefoperazone in multiresistant nosocomial strains of Klebsiella pneumoniae from two hospitals in Czech and Slovak Republics; Blahova J et al.; The occurrence of positive synergy between antibiotic discs of amoxicillin/clavulanate and cefoperazone was registered in two Klebsiella pneumoniae strains, isolated from hospitals in Czech and Slovak Republic, indicating the presence of genes coding for an extended-spectrum beta-lactamase active also against cefoperazone, a broad-spectrum cephalosporin . Sulbactam inhibited the hydrolysis of cefoperazone by cell-free lysates of these strains which substantiates its use in combination with cefoperazone . Resistance to cephalothin, cefotaxime, ceftazidime, cefoperazone, cefepime and aztreonam was transferred from K . pneumoniae isolates to Escherichia coli K-12 3110 and to Proteus mirabilis P-38 recipient strains. Biochemistry (Mosc), 2002 Oct, 67(10), 1189 - 96 Tryptophan indole-lyase from Proteus vulgaris: kinetic and spectral properties; Zakomirdina LN et al.; An efficient method for purification of recombinant tryptophanase from Proteus vulgaris was developed . Catalytic properties of the enzyme in reactions with L-tryptophan and some other substrates as well as competitive inhibition by various amino acids in the reaction with S-o-nitrophenyl-L-cysteine were studied . Absorption and circular dichroism spectra of holotryptophanase and its complexes with characteristic inhibitors modeling the structure of the principal reaction intermediates were examined . Kinetic and spectral properties of two tryptophanases which markedly differ in their primary structures are compared . It was found that although the spectral properties of the holoenzymes and their complexes with amino acid inhibitors are different, the principal kinetic properties of the enzymes from Proteus vulgaris and Escherichia coli are analogous . This indicates structural similarity of their active sites. Contemp Top Lab Anim Sci, 1997 Jan, 36(1), 94 - 96 Mandibular Osteomyelitis in a Squirrel Monkey; Silverman J et al.; Although nonhuman primates often have their canine teeth cut or removed for safe handling, osteomyelitis of the mandible or maxilla has rarely been reported in laboratory animal literature . In the case reported here, a young adult squirrel monkey had a draining skin lesion on the left mandible . The monkey was treated with trimethoprim/sulfamethoxazole . The lesion resolved, but recurred . Culture of a specimen from the deep portion of the lesion yielded Staphylococcus aureus and a Proteus sp . Radiographic findings were consistent with osteomyelitis . A sequestrum was removed intra-orally and oral administration of ciprofloxacin for 60 days led to resolution of the problem . It is assumed that infection of the left molar led to the osteomyelitis, but the definitive etiologic agent was not determined. Arch Immunol Ther Exp (Warsz), 2002, 50(5), 345 - 50 Structural and serological characterization of the lipopolysaccharide from Proteus penneri 20 and classification of the cross-reacting Proteus penneri strains 10, 16, 18, 20, 32 and 45 in Proteus serogroup O17; Sidorczyk Z et al.; O-specific polysaccharide (O-antigen) of the lipopolysaccharide of Proteus penneri 20 was studied using sugar analysis along with various one- and two-dimensional NMR spectroscopy techniques . The following structure of the polysaccharide was established: {formula: see text} It has the same carbohydrate backbone structure as that described earlier for P . penneri 16, in which the positions of the O-acetyl groups have not been determined . P . penneri 20 O-antiserum showed a strong cross-reactivity with the lipopolysaccharides of P . penneri 10, 16, 18, 32, 45 and P . mirabilis O17 . These data enable classifying these strains together with P . penneri 20 in one Proteus serogroup, O17. J Med Microbiol, 2002 Nov, 51(11), 958 - 70 The Helicobacter pylori flbA flagellar biosynthesis and regulatory gene is required for motility and virulence and modulates urease of H . pylori and Proteus mirabilis; McGee DJ et al.; Helicobacter pylori and Proteus mirabilis ureases are nickel-requiring metallo-enzymes that hydrolyse urea to NH3 and CO2 . In both H . pylori and in an Escherichia coli model of H . pylori urease activity, a high affinity nickel transporter, NixA, is required for optimal urease activity, whereas the urea-dependent UreR positive transcriptional activator governs optimal urease expression in P . mirabilis . The H . pylori flbA gene is a flagellar biosynthesis and regulatory gene that modulates urease activity in the E . coli model of H . pylori urease activity . All flbA mutants of eight strains of H . pylori were non-motile and five had a strain-dependent alteration in urease activity . The flbA gene decreased urease activity 15-fold when expressed in E . coli containing the H . pylori urease locus and the nixA gene; this was reversed by disruption of flbA . The flbA gene decreased nixA transcription . flbA also decreased urease activity three-fold in E . coli containing the P . mirabilis urease locus in a urea- and UreR-dependent fashion . Here the flbA gene repressed the P . mirabilis urease promoter . Thus, FlbA decreased urease activity of both H . pylori and P . mirabilis, but through distinct mechanisms . H . pylori wild-type strain SS1 colonised gerbils at a mean of 5.4 x 10(6) cfu/g of antrum and caused chronic gastritis and lesions in the antrum . In contrast, the flbA mutant did not colonise five of six gerbils and caused no lesions, indicating that motility mediated by flbA was required for colonisation . Because FlbA regulates flagellar biosynthesis and secretion, as well as forming a structural component of the flagellar secretion apparatus, two seemingly unrelated virulence attributes, motility and urease, may be coupled in H . pylori and P . mirabilis and possibly also in other motile, ureolytic bacteria. FEMS Microbiol Lett, 2002 Nov 19, 217(1), 43 - 50 Isolation of lacZ fusions to Proteus mirabilis genes regulated by intercellular signaling: potential role for the sugar phosphotransferase (Pts) system in regulation; Sturgill GM et al.; Using a mini-Tn5lacZ1 reporter transposon, lacZ fusions have been identified in Proteus mirabilis that are activated by the accumulation of self-produced extracellular signals . Genes identified by this approach include putative homologs of pgm, nlpA and two genes of unknown function . The extracellular signal(s) involved in activation were resistant to the effects of acid and alkali . The signal required for activation of (nlpA) cma482::lacZ was sensitive to protease, suggesting the signal is a peptide or small protein . The signals behaved as polar molecules and were not extractable with ethyl acetate . A mini-Tn5Cm insertion was identified in a probable ptsI homolog that blocked activation of the cma134::lacZ fusion by an extracellular signal . The ptsI mutation did not alter extracellular signal production and may have a role in signal response. Clin Orthop, 2002 Nov, (404), 326 - 9 A muscular lesion suggestive of focal myositis in a child with Proteus syndrome; Andres BM et al.; Proteus syndrome is a polymorphic hamartomatous disorder associated with a broad spectrum of rare congenital malformations . Many neoplasms have been linked to this condition, including lipomas, lymphangiomas, and hemangiomas . The authors describe a case of a congenital muscular lesion in a child with Proteus syndrome . This mass was painless but was growing out of proportion to her leg musculature . A magnetic resonance imaging scan and incisional biopsy showed findings consistent with focal myositis . The clinical, radiographic, and histologic characteristics of this previously undescribed lesion are discussed, with a brief review of the literature. Infect Immun, 2002 Dec, 70(12), 7022 - 32 Pathological and therapeutic significance of cellular invasion by Proteus mirabilis in an enterocystoplasty infection stone model; Mathoera RB et al.; Proteus mirabilis infection often leads to stone formation . We evaluated how bacterium-mucin adhesion, invasion, and intracellular crystal formation are related to antibiotic sensitivity and may cause frequent stone formation in enterocystoplasties . Five intestinal (Caco-2, HT29, HT29-18N2, HT29-FU, and HT29-MTX) and one ureter cell line (SV-HUC-1) were incubated in artificial urine with five Proteus mirabilis strains . Fluorescence-activated cell sorting (FACS), laser scanning microscopy, and electron microscopy evaluated cellular adhesion and/or invasion, pathologic changes to mitochondria, and P . mirabilis-mucin colocalization (MUC2 and MUC5AC) . An MTT (thiazolyl blue tetrazolium bromide) assay and FACS analysis of caspase-3 evaluated the cellular response . Infected cells were incubated with antibiotics at dosages representing the expected urinary concentrations in a 10-year-old, 30-kg child to evaluate bacterial invasion and survival . All cell lines showed colocalization of P . mirabilis with human colonic mucin (i.e., MUC2) and human gastric mucin (i.e., MUC5AC) . The correlation between membrane mucin expression and invasion was significant and opposite for SV-HUC-1 and HT29-MTX . Microscopically, invasion by P . mirabilis with intracellular crystal formation and mitochondrial damage was found . Double membranes surrounded bacteria in intestinal cells . Relative resistance to cotrimoxazole and augmentin was found in the presence of epithelial cells . Ciprofloxacin and gentamicin remained effective . Membrane mucin expression was correlated with relative antibiotic resistance . Cell invasion by P . mirabilis and mucin- and cell type-related distribution and response differences indicate bacterial tropism that affects crystal formation and mucosal presence . Bacterial invasion seems to have cell type-dependent mechanisms and prolong bacterial survival in antibiotic therapy, giving a new target for therapeutic optimalization of antibiotic treatment. Antimicrob Agents Chemother, 2002 Dec, 46(12), 3981 - 3 Biochemical characterization of TEM-92 extended-spectrum beta-lactamase, a protein differing from TEM-52 in the signal peptide; Perilli M et al.; A bla(TEM-92) gene was cloned from a Proteus mirabilis isolate and expressed in Escherichia coli . Production of the enzyme caused reduction of susceptibility to penicillins and narrow- to expanded-spectrum cephalosporins but not to moxalactam and cephamycins . Determination of kinetic parameters with the purified enzyme revealed hydrolysis of expanded-spectrum cephalosporins, while cephamycins, moxalactam, and aztreonam were very poorly or not hydrolyzed . Clavulanate and penicillanic acid sulfones acylated TEM-92 slowly, and deacylation occurred at measurable rates. Curr Infect Dis Rep, 2002 Dec, 4(6), 536 - 539 Lower Genital Tract Infections in Diabetic Women; Donders GG; The influence of glucose metabolism is seen in many infectious diseases, making diabetic patients more vulnerable to sepsis and other serious sequelae of bacterial invasion . Vaginal candidiasis is a common problem if the glycemia is poorly controlled . The level of glucose concentration in the blood after ingestion of sugar seems to explain an increased likelihood of recurrent infection . Specific immune aberrations, such as an elevated T-helper 2 response and a blunted T-helper 1 response, leading to tolerance, may result in chronic recurrent vulvovaginal candidiasis . In such patients, a low-grade infection with frequent exacerbations is seen, and treatment should be based on 24-hour glycemic control and long intermittent treatment with antifungals . Besides candidiasis, there is also evidence of an increased likelihood of cystitis . Upper urinary tract infections (UTIs) are also a frequent result of bladder colonization . Lethal emphysematous nephritis due to Candida albicans or gas-forming bacteria such as Escherichia coli, Klebsiella, Proteus, streptococci, or enterococci are known to occur in diabetic patients . Furthermore, UTIs in diabetic patients are difficult to eradicate and need longer and intense antibiotic therapy . Awareness of the increased likelihood of UTIs, frequent screening, and prolonged treatment in case of cystitis are warranted . For the prevention of UTI and bacterial vaginal infections (bacterial vaginosis, vaginal atrophy with bacterial colonization, aerobic vaginitis) estrogen therapy may be as important as antibiotic therapy . Catheterization should be limited since it promotes infection more in diabetic patients than in nondiabetic patients . In the case of recurrent vaginal candidiasis, tight control of glycemia is crucial, in addition to prolonged, intermittent therapy with antifungals. Thromb Res, 2002 Aug 15, 107(3-4), 141 - 5 Effect of resveratrol, a natural polyphenolic compound, on platelet activation induced by endotoxin or thrombin; Olas B et al.; Resveratrol (3, 4', 5-trihydroxystilbene), a natural polyphenol, is found in some plants that are used in human nutrition . Grapes are a major source for resveratrol, and a significant amount can also be found in red wine . Several experimental studies have demonstrated biological properties of resveratrol, especially its anti-inflammatory, antioxidant, anti-platelet and antitumor effects . In the present study, we investigated the first step of platelet activation-platelet adhesion stimulated by lipopolysaccharide (LPS) from Proteus mirabilis (weak stimulator) and thrombin (strong activator) in the presence of resveratrol . Our studies show that endotoxin (0.3 microg/10(8) platelets), like thrombin (0.2 U/10(8) platelets), induced the adhesion of platelets (expressed as absorbance of cell attached proteins) to collagen and fibrinogen . Preincubation of washed platelets with resveratrol at physiological plasma concentrations (25-100 microg/ml, 30 min, 37 degrees C) had an inhibitory effect on adhesion of platelets to collagen after activation by LPS alone or LPS with thrombin . The strongest effect on this process was caused by resveratrol at the concentration of 100 microg/ml . Pretreatment of platelets with resveratrol (25-100 microg/ml, 30 min, 37 degrees C) had also inhibitory effects on adhesion of platelets to fibrinogen after stimulation of these cells by LPS alone or by LPS with thrombin at the same concentration . In conclusion, we suggest that resveratrol present in human diet may be an important compound responsible for the reduction of platelet adhesion and changed reactivity of blood platelets in inflammatory process . Pharmazie, 2002 Oct, 57(10), 714 - 5 Indigoferabietone, a novel abietane diterpenoid from Indigofera longeracemosa with potential antituberculous and antibacterial activity; Thangadurai D et al.; From the stems of Indigofera longeracemosa, a novel abietane diterpenoid, indigoferabietone was isolated . The structure was established by spectral techniques . The inhibitory activity of indigoferabietone (1) tested against Mycobacterium tuberculosis and Candida albicans, and the antibacterial activity tested against Staphylococcus aureus, Proteus vulgaris, and Escherichia coli were found to be significant. J Clin Microbiol, 2002 Nov, 40(11), 4285 - 8 Modification of dienes mutual inhibition test for epidemiological characterization of Pseudomonas aeruginosa isolates; Munson EL et al.; Pseudomonas aeruginosa is an important cause of community-associated and nosocomial infections related to exposure to aqueous environments . Such infections often occur in the setting of a common-source outbreak, in which case epidemiological characterization of isolates may be necessary . In this preliminary study, a modification of the Dienes mutual inhibition test, ordinarily used to assess the relatedness of swarming Proteus mirabilis strains, was used to study 15 P . aeruginosa isolates, with the results compared to those obtained by ribotype analysis . Complete concordance was noted between the results of the Dienes test and those of ribotyping . These observations suggest that further studies are warranted to assess the utility of the modified Dienes test as a simple, inexpensive, and reliable means for epidemiological typing of P . aeruginosa. J Antimicrob Chemother, 2002 Nov, 50(5), 681 - 8 Characterization of CMY-type beta-lactamases in clinical strains of Proteus mirabilis and Klebsiella pneumoniae isolated in four hospitals in the Paris area; Decre D et al.; We isolated five clinical strains (three Proteus mirabilis and two Klebsiella pneumoniae) with beta-lactam resistance phenotypes consistent with production of an AmpC-type beta-lactamase . The predicted amino acid sequences of the enzymes were typical of class C beta-lactamases . The enzymes were identified as CMY-2, CMY-4 and a new CMY-variant beta-lactamase, CMY-12 . The AmpC beta-lactamases from the two K . pneumoniae isolates were found to be encoded on self-transferable plasmids . The genes encoding the AmpC-type beta-lactamase produced by the three P . mirabilis isolates were chromosomal . Four of the five clinical isolates were from patients transferred from Greece, Algeria and Egypt; one of the K . pneumoniae strains was recovered from a French patient . PFGE analysis and rep-PCR fingerprinting showed that the two P . mirabilis isolates from Greek patients were closely related. Arzneimittelforschung, 2002, 52(9), 699 - 705 Antimicrobial activity of dequalinium chloride against leading germs of vaginal infections; Della Casa V et al.; Dequalinium chloride (CAS 522-51-0) and povidone iodine (CAS 25655-41-8) are known as antiseptic agents and used in the local treatment of vaginal infections . Clotrimazole (CAS 23593-75-1) is an anti-fungal drug and applied primarily in the therapy of vulvo-vaginal candidiasis and to a lesser extent in bacterial vaginosis and trichomoniasis . However, antimicrobial activities of those three agents in comparison to each other have not been reported so far . To address this issue the antimicrobial activities of these agents against 18 germs relevant to vaginal infections were determined . The tested species are representatives of the genera Staphylococcus, Streptococcus, Enterococcus, Listeria, Escherichia, Proteus, Gardnerella, Bacteroides, Prevotella, Porphyromonas, Candida, and Trichomonas . All micro-organisms were susceptible to dequalinium chloride with the exception of Proteus mirabilis . At a given dose, the activity of dequalinium chloride was higher as compared to the other substances . In view of its wide antimicrobial spectrum dequalinium chloride is an efficient alternative in the local therapy of vaginal infections such as fluor vaginalis, bacterial vaginosis, aerobic vaginitis, vulvo-vaginal candidiasis and trichomoniasis. Hautarzt, 2002 Nov, 53(11), 724 - 9 {Triclosan, a topical dermatologic agent . In vitro- and in vivo studies on the effectiveness of a new preparation in the New German Formulary}; Gloor M et al.; BACKGROUND AND OBJECTIVE: Triclosan (2,4,4'-trichloro-2'-hydroxydiphenyl ether) is an antiseptic suitable for formulation as a W/O emulsion . The objective of the present study was to explore its potential utility in atopic dermatitis and prophylactic skin care following leg eczema and leg ulcer treatment . SUBJECTS AND METHODS: We performed in vitro susceptibility testing using the agar diffusion test on 602 isolates from swabs of our institution's Division of Dermatology . Additionally in an in vivo study with 15 healthy volunteers, the occlusion test and the expanded flora test were performed following the application of Hydrophobic Triclosan Cream 2% NRF (New German Formulary) 11.122 . (TC) versus untreated, triclosan-free vehicle, 1% chlorhexidine digluconate solution, and ethanol 70% . RESULTS: In vitro susceptibility testing showed excellent activity against Staphylococcus aureus, Klebsiella species, and Proteus species . TC had little or no effect on Pseudomonas, beta-hemolytic streptococci, enterococci, and Candida species . In the in vivo study, TC produced a highly significant, quantitatively substantial reduction in aerobic bacterial counts versus untreated and versus vehicle . The 1% chlorhexidine digluconate solution was significantly more effective than TC in the expanded flora test . CONCLUSIONS: As S . aureus is a relevant pathogen in atopic dermatitis, and gram-negative organisms, including Klebsiella and Proteus species, as well as S . aureus play a major role in the prophylactic skin care after leg eczema and leg ulcer treatment, TC appears to be suitable for maintenance therapy in these indications. Clin Microbiol Infect, 2002 Oct, 8(10), 641 - 5 Comparison of three chromogenic agar plates for isolation and identification of urinary tract pathogens; Chaux C et al.; OBJECTIVE: To comparatively assess the performance of three chromogenic agar plates, CPS ID2, Chromogenic UTI, and USA, for the detection and enumeration of all urinary tract pathogens and the direct identification of Escherichia coli, Proteus mirabilis and Enterococcus spp . METHODS: Two hundred and forty-three urine specimens prospectively collected from hospitalized patients were randomly inoculated in parallel on the three media . RESULTS: Of the 243 urine specimens, 235 yielded positive cultures, of which 151 were pure cultures and 84 were mixed cultures . CPS ID2, Chromogenic UTI and USA agar gave detection rates of 99.1%, 97.1% and 96.6%, respectively . The main difference in non-detection between CPS ID2 agar and the two new media concerned Staphylococcus spp . strains . Based on the total number of strains detected (n = 348), the total identification rates of E . coli, P . mirabilis and Enterococcus spp . on CPS ID2 agar, Chromogenic UTI agar and USA agar were 60.3%, 61.2% and 59.2%, respectively . CONCLUSION: The detection rates and identification rates of the three media were very close and only minor differences were noted . The lower detection rates for Chromogenic UTI and USA were mainly due to their lesser ability to support growth of Staphylococcus spp. S Afr J Surg, 2002 Aug, 40(3), 91 - 4 Is there a need for postoperative surveillance after day case groin surgery in children? Powell SF, Brown RA, Millar AJ, De Wet PM, Rode H. There is increasing awareness of the value of day case paediatric surgery in fulfilling the needs of the community . Is this cost effective, are there hidden complications and is there a need for routine follow-up? Seven hundred and thirty-one children attending the Red Cross War Memorial Children's Hospital day surgery unit over a 32-month period, and undergoing 912 procedures confined to the inguinoscrotal region, were enrolled in the study . Surgical procedures performed included inguinal herniotomy, orchidopexy and circumcision . Of the 731 children, 159 consecutive children had their inguinal and perineal skin flora analysed preoperatively and in 59 of these children three skin swabs were taken from the groin area: before routine skin preparation for surgery, after the skin preparation and on completion of the operation . Staphylococcus epidermidis predominated as the normal skin flora (70%), followed by Escherichia coli (19%) and Proteus mirabilis (10%), while S . aureus was only found in 2.5% of cases . The efficacy of cleaning with 4% chlorhexidine and 2% povidone-iodine in 70% alcohol is shown by virtual complete eradication of the organisms isolated from the preoperative skin cultures . In only 2 cases (3.4%) were organisms (S . aureus and S . epidermidis respectively) isolated following skin preparation . Cultures taken at the end of operative procedures grew predominantly S . epidermidis (5 cases, 8.5%) . Children were discharged from the day unit once they had taken fluids and had passed urine . The wounds were also checked for any evidence of bleeding . Follow-up was done 2 weeks later by means of a visit to the day unit where the same surgeon assessed wound healing according to the Southampton Wound Assessment Scale . Ninety-four per cent of the wounds had healed by primary intention; 4.5% had minor complications and 1.5% had septic complications . Our trial confirms that wound sepsis is an infrequent but significant complication of day case groin surgery . Routine follow-up by surgical day units of minor surgical cases is not warranted and will incur unnecessary cost . Only 1.5% of postoperative cases will require further medical attention and septic lesions in the lymphatic drainage area should be regarded as risk factors. Asian J Surg, 2002 Jul, 25(3), 215 - 9 Outcome of percutaneous nephrostomy for the management of pyonephrosis; Ng CK et al.; OBJECTIVE: The aim of this study was to evaluate the efficacy of percutaneous nephrostomy (PCN) drainage for the interim management of pyonephrosis . METHODS: Ninety-two consecutive patients {29 men, 63 women; mean age, 57 years; range, 23 to 88} who underwent PCN for the treatment of pyonephrosis from 1996 to 1999 were evaluated retrospectively . The clinical presentation, bacteriology and patient outcomes were analyzed . RESULTS: The majority {77%} of patients had underlying obstructing urinary calculi . Other causes of obstruction included strictures {9%}, papillary necrosis {7%}, pelvi-ureteric junction obstruction {4%} and malignant stricture {3%} . The microorganisms cultured were Escherichia coli {30%}, Klebsiella {19%}, Proteus {8%}, Pseudomonas {5%}, Enterococcus {5%}, and Candida spp {5%} . The microorganisms were sensitive to gentamicin {79%}, ceftriaxone {71%}, cephalexin {54%}, nitrofurantoin {40%}, cotrimoxazole {35%}, nalidixic acid {32%} and ampicillin {29%} . Only 30% of bladder urine cultures were positive for microorganisms; the addition of PCN cultures improved this yield to 58% . The antibiotic regimen was revised according to the PCN culture whenever there was a discrepancy . After PCN, 69% of patients underwent minimally invasive procedures as definitive treatment of the obstructing lesion . Only 14% of patients required open surgery . There was low procedure-related morbidity {14%} and low overall mortality {2%} . CONCLUSIONS: PCN cultures yield important bacteriological information . The procedure is associated with minimal morbidity, facilitates definitive treatment and provides therapeutic benefit. Curr Protein Pept Sci, 2001 Jun, 2(2), 123 - 35 Revisiting proteus: do minor changes in lectin structure matter in biological activity? Lessons from and potential biotechnological uses of the Diocleinae subtribe lectins; Cavada BS et al.; Significant differences in function have been observed among lectins structurally similar to concanavalin A, but their high homology with this widely used lectin has kept them in obscurity . The observation of large differences in the potency of many of these Diocleinae lectins as stimulators of Interferon-g production by human peripheral blood mononuclear cells has lead to a major effort to unravel their chemical structure and biological activity . Modeling studies of some of these lectins reveal conformational changes in side chains of some residues involved in the carbohydrate-binding site, with possible effects on the ability of these proteins to recognize specific carbohydrate structures . Additionally, all them constitute in fact a mixture of isolectins, which in different proportions could lead to diverse effects . The present review of the biological actions of Diocleinae lectins includes several in vitro and in vivo immunological findings, as well as their effects on insect growth and reproduction . In these systems Diocleinae lectins proved to be quite diverse in their potency . Such diversity in the biological activity of highly related proteins recalls the origin of the name protein: like Proteus, the capability of assuming various forms is the essential feature of this class of molecules. Lett Appl Microbiol, 2002, 35(4), 281 - 4 Rapid detection of Obesumbacterium proteus from yeast and wort using polymerase chain reaction; Maugueret TM et al.; AIMS: To design and evaluate PCR primers for the rapid detection of Obesumbacterium proteus . METHODS AND RESULTS: The 16S rDNA from a wild-type Obesumbacterium proteus biotype II isolate was sequenced and the resultant data used to produce specific primers for this organism . These primers discriminated between biotype I (nonbrewery) and biotype II isolates . In addition, the primers were able to detect Obesumbacterium proteus in wort and in yeast slurries in the presence of competitive bacteria . The primers were tested against a range of other beer spoilage bacteria for any cross-reactions . None were detected . CONCLUSIONS:Obesumbacterium proteus primers can detect this contaminant without generating cross-reactions to related species . SIGNIFICANCE AND IMPACT OF THE STUDY: The primers generated in this study can now be used for PCR detection assays that will contribute to early detection of this important process contaminant. Carbohydr Res, 2002 Sep 27, 337(17), 1535 - 40 Structure of the O-specific polysaccharide of Proteus penneri 103 containing ribitol and 2-aminoethanol phosphates; Drzewiecka D et al.; The O-specific polysaccharide of the lipopolysaccharide of Proteus penneri strain 103 was studied using 1H and 13C NMR spectroscopy, including 2D COSY, TOCSY, NOESY, H-detected 1H,(13)C HMQC, 1H, 31P HMQC, and HMBC experiments . It was found that the polysaccharide is built up of oligosaccharide-ribitol phosphate repeating units and thus resembles ribitol teichoic acids of Gram-positive bacteria . The following structure of the polysaccharide was established:where Etn and Rib-ol are ethanolamine and ribitol, respectively . This structure is unique among the known structures of Proteus O-antigens and, therefore, we propose classification of the strain studied into a new Proteus serogroup, O73 . The molecular basis for cross-reactivity between O-antiserum against P . penneri 103 and O-antigens of P . mirabilis O33 and D52 is discussed. Patol Clin Ostet Ginecol, 1985 Sep-Oct, 13(5), 367 - 70 {Microbiological screening and postoperative course in patients undergoing first trimester abortion}; La Rosa R et al.; PIP: Pelvic infections are a serious and widespread gynecological disease, often leading to sterility . Procedures like evacuation of the products of conception by vacuum suction are known to facilitate their appearance . 300 patients were examined the same day of the abortion (first trimester); before the hysterosuction a vaginal tampon was taken from the cervix and from the posterior fornix . The patients were invited to come back for an exam in two weeks and to refer to the clinic for any problem before then . A wet mount, aerobic and anaerobic cultures in several media and Gram stains were used to identify the pathogens . 40.3% of the tampons were positive for pathogens, mostly staphilococci (52%), but also Candida, alfa and beta hemolytic Streptococci, Proteus, E . Coli, Trichomonas . 5 patients had serious complications that required hospital admission . Only 128 patients showed up for the postoperative control; of these, 14 presented with symptoms of pelvic infection . Since pelvic infections are the most frequent complication after induced abortion, and considering the larege number of women who carry vaginal pathogens, the Authors strongly recommend a guided antibiotic profilaxis before the hysterosuction operation . Glimpse . 1985 Nov-Dec;7(6):1, 8. Honey: its antibacterial action in the treatment of gastroenteritis. {Etiopathogenic and diagnostic aspects of postabortion peritonitis} Alessandrescu D, Dumitru I, Grindu G. PIP: The causes, diagnosis, and treatment of postabortion peritonitis are discussed with reference to 85 cases, analyzing the causal agents and their sensitivity to various antibiotic treatments, and classifying them by frequency and clinical symptoms . The following germs were found in the patients: Staphylococcus hemolyticus, Esch . coli, Pseudomonas, Proteus, Procyaneus, and Enterococcus, which showed different responses to the various antibiotics used . The importance of a correct diagnosis of the cause of the disease for the proper application of intensive therapy and modern methods of treatment of infections is emphasized . The clinical evolution of a generalized peritonitis, secondary to a septic abortion, is described in detail . Afr Health, 1992 Nov, 15(1), 27 - 8 Coping with osteomyelitis; Onuba O; PIP: Osteomyelitis, or infection of the bones, is a common orthopedic condition in the young in developing countries which causes severe deformity and morbidity . Acute osteomyelitis is of hematogenous origin, and in adults it results from infected open fractures or a leg ulcer from Staphylococcus aureus (over 80%), or mixed with Streptococcus pyogenes, Pseudomonas spp, Proteus spp, Escherichia coli, and Salmonella typhi . In a classic case of acute osteomyelitis, a child under 10 presents severe bone pain, pyrexia of 39-40 degrees Celsius, and inability to use the limb . Blood culture is positive in 60% of cases, and white cell count is elevated to around 20,000/ml indicative of leucocytosis . After 12 weeks of intense infection in the bone, chronic osteomyelitis sets in . A large abscess develops in the subperiosteal soft tissue extending into the tissue planes . Discharging sinuses and fistulae appear along with bony deformity . In advanced cases, X-ray shows complete separation of the dead bones (sequestrum) or a defect in the length of bone . In acute osteomyelitis, treatment calls for the limb to be splinted and elevated . The usual regimen is to give 500 mg iv cloxacillin every 6 hours for 24-48 hours in combination with intra-muscular gentamicin (40 mg, every 8 hours) and analgesics as well as small doses of pethidine for 24 hours . Antibiotic therapy must continue for 8-12 weeks with a follow-up X-ray at 3 months to confirm complete recovery . In chronic osteomyelitis, which can linger for year, subcutaneous and subperiosteal abscesses should be drained without sequestrectomy until involucrum has formed . Public awareness has to be increased about urgent medical attention at an early stage to avoid amputation in very severe cases in adults . Biosens Bioelectron, 2002 Oct, 17(10), 893 - 9 Use of an electronic nose system for diagnoses of urinary tract infections; Pavlou AK et al.; The use of volatile production patterns produced by bacterial contaminants in urine samples were examined using electronic nose technology . In two experiments 25 and 45 samples from patients were analysed for specific bacterial contaminants using agar culture techniques and the major UTI bacterial species identified . These samples were also analysed by incubation in a volatile generation test tube system for 4-5 h . The volatile production patterns were then analysed using an electronic nose system with 14 conducting polymer sensors . In the first experiment analysis of the data using a neural network (NN) enabled identification of all but one of the samples correctly when compared to the culture information . Four groups could be distinguished, i.e . normal urine, Escherichia coli infected, Proteus spp . and Staphylococcus spp . In the second experiment it was again possible to use NN systems to examine the volatile production patterns and identify 18 of 19 unknown UTI cases . Only one normal patient sample was mis-identified as an E . coli infected sample . Discriminant function analysis also differentiated between normal urine samples, that infected with E . coli and with Staphylococcus spp . This study has shown the potential for early detection of microbial contaminants in urine samples using electronic nose technology for the first time . These findings will have implications for the development of rapid systems for use in clinical practice. Vestn Oftalmol, 2002 May-Jun, 118(3), 28 - 30 {Clinical and pathogenetic significance of Proteus mirabilis antibodies in uveitis associated with joint lesions in children and adolescents}; Katargina LA et al.; Immunological studies in 95 children with uveitis associated with juvenile chronic arthritis revealed infection with Proteus mirabilis in 14.7% cases, mainly in cases with reactive arthritis and juvenile rheumatoid arthritis (JRA) . A clear-cut relationship between P . mirabilis infection and severity of the disease was detected . In 85% children infected with P . mirabilis uveitis was associated with a rapid decrease of ocular functions and development of complications, one of the most frequent of which was vitreous fibrosis, generally not typical of classical rheumatoid uveitis . Antibodies to P . mirabilis were detected in 72.2% children with positive antinuclear factor, a marker of ophthalmoarticular rheumatic diseases . The pathogenetic significance of P . mirabilis in uveitis associated with articular involvement deserves further investigation, but even now the detection of P . mirabilis can be used as a marker of uveitis exacerbations and severity. Med Parazitol (Mosk), 2002 Jan-Mar, (1), 33 - 5 {Antimicrobial, echinococcidial and immunostimulating properties of the drug Cheblin-SK-1}; Chebyshev NV et al.; The antimicrobial properties of the drug Cheblin-CK-1 (CCK-1) were determined in mice intraabdominally inoculated with Proteus mirabilis-4691 in a dose of 140-200 million daily cultured microbial bodies . Its comparison agent was ampicillin . CCK-1 was found to act as an antibiotic similar to ampicillin in its effects . The antimicrobial activity of CCK-1 against Staphylococcus aureus and Escherichia coli isolated from the contents of echinococcal cysts from patients operated on was also established . Its echinococcidial activity was found in experiments on the cotton rats and piglets inocculated with echinococci . CCK-1 was also tested on volunteers . Before surgery, 186 patients with echinococcosis took the drug and 26 patients with the same disease did not and they served as controls . At first the drug suppressed the growth of parasitic larvocysts with destruction and death of 85-95% of germinal elements of larvocysts and then killed parasites . In patients receiving a complete course of its therapy, protein and amino acid metabolisms restored, followed by immunity recovery. Contemp Top Lab Anim Sci, 2002 Sep, 41(5), 33 - 8 Pathology of a mouse model of x-linked chronic granulomatous disease; Bingel SA; A colony of knockout mice (gene designation Cybb tm1) has been maintained at this institution for 5 years . These mice are lacking the b subunit of NADPH oxidase and are susceptible to experimental infection with Aspergillus fumigatus . The purpose of this study was to document the spontaneous diseases present in these mice which are a murine model of X-linked chronic granulomatous disease and to compare these lesions to those of chronic granulomatous disease in humans . Lesions were documented in 72 mice submitted to the necropsy service . All 72 mice had an acidophilic macrophage pneumonia, and 16 also had lobar suppurative and necrotizing pneumonias caused by Paecilomyces sp . (11 of the 16 mice), A . fumigatus (3 mice), Rhizopus sp . (1 mouse), or Candida guilliermondii (1 mouse) . Of the 72 animals, 36 had severe bacterial suppurative and necrotizing to pyogranulomatous pneumonias; lung abscesses yielded cultures of Pseudomonas aeruginosa (n = 3), Enterococcus (n = 6), Staphylococcus aureus (n = 2), S . xylosus (n = 1), coagulase-negative Staphylococcus sp . (n = 4), gram-negative enteric bacilli (n = 6), Klebsiella pneumoniae (n = 1), and Proteus mirabilis (n = 2) . Thirteen mice had a necrotizing and suppurative adenitis of the cervical lymph nodes caused by coagulase-negative Staphylococcus sp.; S . aureus, S . xylosus, and S . equorum were recovered from abscesses in the cervical lymph nodes, extremities, and head . Splenomegaly was found in 30 animals and lymphadenopathy in 11 mice . The array of spontaneously occurring infectious diseases and lesions in these mice is similar to that of human patients with chronic granulomatous disease. Emerg Infect Dis, 2002 Sep, 8(9), 918 - 23 Characterization of flagella produced by clinical strains of Stenotrophomonas maltophilia; de Oliveira-Garcia D et al.; Stenotrophomonas maltophilia is an emerging nosocomial pathogen associated with opportunistic infections in patients with cystic fibrosis, cancer, and HIV . Adherence of this organism to abiotic surfaces such as medical implants and catheters represents a major risk for hospitalized patients . The adhesive surface factors involved in adherence of these bacteria are largely unknown, and their flagella have not yet been characterized biochemically and antigenically . We purified and characterized the flagella produced by S . maltophilia clinical strains . The flagella filaments are composed of a 38-kDa subunit, SM(FliC), and analysis of its N-terminal amino acid sequence showed considerable sequence identity to the flagellins of Serratia marcescens (78.6%), Escherichia coli, Proteus mirabilis, Shigella sonnei (71.4%), and Pseudomonas aeruginosa (57.2%) . Ultrastructural analysis by scanning electron microscopy of bacteria adhering to plastic showed flagellalike structures within the bacterial clusters, suggesting that flagella are produced as the bacteria spread on the abiotic surface. Mikrobiol Z, 2002 May-Jun, 64(3), 38 - 44 {Antibiotic properties of the Pseudoalteromonas genus bacteria isolated from the Black Sea water and molluscs}; Onyshchenko OM et al.; Antagonistic properties of 41 strains of Alteromonas-like bacteria isolated from the Black Sea water and molluscs have been studied . Being grown on the rich medium "B" for marine bacteria, 21% of strains have shown high antagonistic activity against phytopathogenic fungi; 6% of strains inhibited the growth of Bacillus subtilis, Proteus vulgaris and Candida albicans . Spectrum of antagonistic activity was essentially changed on synthetic "BM" medium with acetate, glutamate, alpha-alanine as a single source of carbon and was directed against Pseudomonas aeruginosa . Culture liquids and acetone extracts of microbial biomass of 34% of the studied strains have shown activity against bacteria, fungi and cyanobacteria . Strains producing the wide spectrum of antimicrobial substances (Alteromonas macleodii, Pseudoalteromonas citrea, P . haloplanktis, P . aurantia, Pseudoalteromonas sp.), fungicidal and algocidal substances have been found . Both extra- and intracellular metabolities of marine bacteria (including the pigments) were active. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi, 2002 Jul, 16(4), 259 - 61 {Experimental study on bacteriostasis of chitosan and sodium hyaluronate}; Tang ZH et al.; OBJECTIVE: To compare the effect and coverage of bacteriostasis of chitosan and sodium hyaluronate . METHODS: Each of the five bacteria, Proteus mirabilis, Escherichia coli, Candida albicans, Pseudomonas aeruginosa, Staphylococcus aureus, was cultivated for 33 tubes of broth culture . Leaving three tubes each group as control group, ploidy diluted concentration of high relative molecular weight chitosan, low relative molecular weight chitosan and sodium hyaluronate were added respectively in the broth culture . All the tubes were cultivated for 18 hours at 37 degrees C with homeothermia . Then the growth of bacteria was observed . RESULTS: The minimal inhibitory concentrations (MIC) of high relative molecular weight chitosan were: Proteus mirabilis 0.031%, Escherichia coli 0.063%, Candida albicans 0.063%, Pseudomonas aeruginosa 0.063%, Staphylococcus aureus 0.063%; and the MIC of low relative molecular weight chitosan were: Proteus mirabilis 0.125%, Escherichia coli 0.025%, Candida albicans 0.25%, Pseudomonas aeruginosa 0.25%, Staphylococcus aureus 0.125%; bacteria grew well in each tube of sodium hyaluronate group and control group . CONCLUSION: The above results show that sodium hyaluronate has no bacteriostasis, while chitosan has bacteriostasis on broad spectrum and high relative molecular weigh: chitosan has stronger effect. Urologiia, 2002 May-Jun, (3), 21 - 5 {Effectiveness of imipenem/cilastatin (Tienam, MSD) in treating complicated infections in urology}; Derevianko II et al.; Complicated urinary infections tend to eventuate in severe pyoseptic complications--bacteriuria, sepsis . The search for methods of fighting agents of urinary infections goes in the direction of perfection of already existing methods and in the direction of design of novel antibacterial drugs . In the middle 1980s the first carbapenem drug-imipenem--was proposed for urological clinical practice . Mechanism of its action as that of the other beta-lactam antibiotics consists in impairment of synthesis of bacterial cell wall as a result of the drug penetration through the surface membrane and irreversible binding with penicillin-binding proteins . Imipenem is active against most gram-positive and gram-negative aerobic and anaerobic microorganisms which cause severe urological infections . The article presents the results of treatment of 45 patients with severe urological infections with multiple resistance of the causing agent and failure of previous treatment . Imipenem was given in a daily dose 1.5-2.0 g . Sometimes a stepwise regimen was used: 500 mg 4 times a day intravenously for the first 3-4 days, then 500 mg twice a day intramuscularly for the following 3-4 days . In detection of highly sensitive bacteria (E . coli, Proteus mirabilis) daily doses were reduced to 1 g . In long standing infection caused by Pseudomonas aeruginosa imipenem was combined with amicacin . In high surgical risk of postoperative period imipenem was given prior to surgery and continued after it for 5 to 14 days . Good therapeutic results were achieved: clinical effect reached 95.5%, antibacterial efficiency was 87.8% . Thus, imipenem is antibiotic of the first line in empirical therapy of severe bacterial infections in urology as it has a wide spectrum of antibacterial action . We believe that this drug should not be left as a reserve but used for a starting empirical therapy of severe infections in urological hospital. Arch Pathol Lab Med, 2002 Aug, 126(8), 982 - 4 Primary cutaneous alveolar rhabdomyosarcoma of the perineum; Gong Y et al.; Primary alveolar rhabdomyosarcoma (RMS) involving perineal skin is extremely rare, particularly in the infant age group . We report a case of an alveolar RMS in a newborn with abnormal symmetrical perineal overgrowth, causing ambiguous morphologic structure of the genitalia . Clinical and imaging studies were suggestive of Proteus syndrome with lymphatic malformation . Histologic examination of the mass showed cutaneous alveolar RMS with areas of embryonal and pleomorphic RMS features . Multiple superficially located, cystic-dilated spaces with loose edematous-mucoid hypocellular stroma gave a gross morphologic structure similar to that of lymphatic-type excrescences. Scand J Infect Dis, 2002, 34(6), 436 - 41 Epidemiology and prognosis of bacteremia: a 10-y study in a community hospital; Javaloyas M et al.; In order to determine the epidemiology and factors influencing the outcome of adult bacteremia in a community hospital, episodes of significant bacteremia were recorded prospectively over a 10-y period (1989-98) . The following variables were included: age, sex, etiology, acquisition and source of the bacteremia, risk factors, clinical manifestations, empirical antibiotic treatment and outcome . A total of 798 episodes of bacteremia were recorded (436 in males) and 185 (24%) were hospital-acquired . The most frequent source was the urinary tract, followed by the respiratory tract and primary bacteremia . The crude mortality was 14.4% (n = 111) and related mortality was 8.5% (n = 66) . The most frequent etiology was Escherichia coli, followed by Streptococcus pneumoniae and Staphylococcus aureus . Multivariate analysis revealed age > 70 y, nosocomial acquisition, respiratory source, primary bacteremia, septic shock, McCabe groups I and II, leukopenia, inappropriate antibiotic treatment and etiology due to S . aureus as factors associated with crude mortality . Pseudomonas aeruginosa, Proteus spp . and Bacteroides spp . were associated with related mortality . In conclusion, it is possible to modify or eliminate factors influencing the outcome of adult bacteremia . The prevention of nosocomial infection, the use of support therapies in critical patients and appropriate antibiotic treatment are measures that can improve the prognosis of patients with bacteremia. J Mol Biol, 2002 Aug 9, 321(2), 185 - 99 Interaction of the atypical prokaryotic transcription activator FlhD2C2 with early promoters of the flagellar gene hierarchy; Claret L et al.; The transcriptional activator FlhD2C2 is the master regulator of bacterial flagellum biogenesis and swarming migration, activating the "early" class II promoters of the large flagellar gene hierarchy . Using primer extensions, band-shift assays, and enzymatic and chemical footprinting, we describe the binding of the FlhD2C2 heterotetramer to the promoter regions of four class II flagella operons, fliAZ, flhBA and the divergent flgAMN and flgBCD(EFGHIJ) . Each of the promoter regions was bound by a single heterotetramer, i.e . the flgAMN and flgBCD operons are characterised by a single FlhD2C2 binding site . Binding affinity differed, and correlated with previously reported promoter strength and order of activation . Methylation protection and interference, and depurination and depyrimidation interference provided a detailed map of critical bases within a common 46-59bp DNaseI footprint overlapping the promoter -35 sequences . These data and compilation of the 12 known class II promoter sequences of Escherichia coli, Proteus mirabilis and Salmonella typhimurium allowed determination of a FlhD2C2 binding site with pseudo symmetry, comprising two 17-18bp inverted repeats, each a consensus FlhD2C2 box, separated by a 10-11bp spacer . DNaseI hypersensitivity indicated that binding may cause a conformational change in the promoter regions . Only the FlhC subunit can bind DNA independently, but the specificity and stability of the interaction is strengthened by FlhD . Here, photo-crosslinking established that both FlhC and the stabilising FlhD contact the DNA within the FlhD2C2 tetramer . Our data suggest that specificity of recognition and stability of the FlhD2C2/DNA complex require protein-protein interaction and interaction of both FlhC and FlhD subunits with DNA . These characteristics of the FlhD and FlhC subunits in the FlhD2C2/DNA complex are strikingly atypical of prokaryotic regulators. Mol Microbiol, 2002 Aug, 45(3), 865 - 74 Identification of MrpI as the sole recombinase that regulates the phase variation of MR/P fimbria, a bladder colonization factor of uropathogenic Proteus mirabilis; Li X et al.; Proteus mirabilis is a common cause of urinary tract infection (UTI) in individuals with structural abnormalities or long-term catheterization . The expression of mannose-resistant/Proteus-like (MR/P) fimbria is phase variable because of the inversion of a 251 bp DNA fragment that carries the promoter for the mrp operon . Previous studies have shown that mrpI, which is transcribed divergently from the mrp operon, encodes a recombinase capable of switching the orientation of this invertible element . In this study, we constructed isogenic mrpI null mutants from a clinical isolate of P . mirabilis, HI4320 . A polymerase chain reaction (PCR)-based invertible element assay revealed that the isogenic mrpI null mutants were locked in one phase, either expressing (locked on) MR/P fimbriae or not (locked off), which indicated that MrpI was the sole recombinase that regulated the phase variation of MR/P fimbria . The locked-on and locked-off mutants were evaluated for virulence in the CBA mouse model of ascending UTI by co-challenges with each other and with the wild-type strain . Results from these experiments demonstrated conclusively that the MR/P fimbria was a critical bladder colonization factor of uropathogenic P . mirabilis and also suggested that the ability to switch off the expression of MR/P fimbria might be important for kidney colonization. Int J Antimicrob Agents, 2002 Jun, 19(6), 471 - 4 Aetiology of chronic prostatitis; Skerk V et al.; A total of 388 patients with symptoms of chronic prostatitis and inflammatory findings in expressed prostatic secretion (EPS) or in a urine sample collected immediately after prostate massage, were examined over a 2 year period at the Outpatient Department for Urogenital Infections, University Hospital for Infectious Diseases 'Dr Fran Mihaljevic', Zagreb, Croatia . The infective aetiology was determined in 276 (71.13%) patients . Chlamydia trachomatis was the causative pathogen in 109 patients, Trichomonas vaginalis in 52, Escherichia coli in 26, enterococci in 25, Proteus mirabilis in 14, Klebsiella pneumoniae in six, Streptococcus agalactiae in eight, Ureaplasma urealyticum in seven patients with chronic prostatitis . Other patients had a mixed infection. Int J Antimicrob Agents, 2002 Jun, 19(6), 461 - 5 Vaccines for Proteus mirabilis in urinary tract infection; Li X et al.; Proteus mirabilis is a documented cause of urinary tract infection (UTI) in the complicated urinary tract . Urease-mediated urea hydrolysis is responsible for both virulence of the organism and the ability to cause urolithiasis . A urease-negative mutant of P . mirabilis is unable to initiate stone formation and colonizes the kidney at a significantly lower rate . The considerable pathology caused by P . mirabilis warrants the development of a vaccine . We have initiated the advancement of vaccine studies and have determined that the MR/P fimbria, a surface adhesin of P . mirabilis, is a promising vaccine candidate . Successful vaccination would be expected both to prevent colonization by P . mirabilis and urolithiasis. Am J Trop Med Hyg, 2002 Feb, 66(2), 163 - 9 Reactivity to bacterial, fungal, and parasite antigens in patients with lymphedema and elephantiasis; Baird JB et al.; Both secondary infections and antifilarial immunity are thought to play roles in the development and progression of lymphedema . To investigate this issue, immune responses to a panel of bacterial, fungal, and parasite antigens were examined for women with lymphedema and elephantiasis (n = 28) and for women with no clinical evidence of lymphatic dysfunction who were either microfilaremic (Mf+, n = 23) or microfilaria- and filarial antigen-negative (Ag-, n = 24) . The prevalence and intensity of delayed-type hypersensitivity (DTH) responses was similar for most recall antigens; for individual antigens, lymphedema patients were significantly more likely to be reactive only to Proteus . Lymphedema patients with a history of three or more attacks of adenolymphangitis in the last 18 months showed increased DTH reactivity to Trichophyton . Proliferative responses to fungal and bacterial antigens were similar for all three groups; however, antigen-negative women, independent of disease status, mounted greater responses to filarial antigen . In contrast, lymphedema patients had higher levels of antifilarial specific IgG1, IgG2, and IgG3 and higher IgG responses to streptolysin O than either Ag- or Mf+ women . In persons with lymphatic filariasis, immune reactivity is influenced by disease status as well as infection status. Int J Antimicrob Agents, 2002 Jul, 20(1), 18 - 27 Lomefloxacin versus ciprofloxacin in the treatment of chronic bacterial prostatitis; Naber KG; European Lomefloxacin Prostatitis Study Group; A total of 182 patients with chronic bacterial prostatitis (CBP) were recruited into this multicentre prospective, randomized clinical study . Of these, 93 were treated orally with lomefloxacin (LOMX) 400 mg once daily and 89 with ciprofloxacin (CIPX) 500 mg twice daily for 4 weeks . At 5-9 days 90/90 vs 86/86, at 4-6 weeks 82/83 vs 82/82, at 3 months 80/79 vs 78/75, and at 6 months 78/75 vs 75/72 patients aging from 18 to 70 years were evaluable bacteriologically/clinically according to a modified intention to treat evaluation . The most frequent pathogens were Escherichia coli, followed by staphylococci, enterococci and Proteus mirabilis . At 5-9 days, 4-6 weeks, 3 and 6 months after therapy the rates of eradication without superinfection per evaluable patients (100%) were 80, 72, 74, and 63% in the LOMX group and 84, 81, 82, and 72% in the CIPX group and (cure and improvement) rates were 98 vs 97%, 84 vs 90%, 86 vs 89%, and 81 vs 89% . There were no statistically significant differences (P < 0.05) between the results of the two treatment groups . Nine (5 vs 4) patients were withdrawn because of adverse events . From the bacteriological and clinical results including adverse events, the oral treatment of CBP over 4 weeks with LOMX 400 mg once daily was comparably effective and tolerable with that of CIPX 500 mg twice daily. Antimicrob Agents Chemother, 2002 Aug, 46(8), 2582 - 7 DNA gyrase and topoisomerase IV mutations associated with fluoroquinolone resistance in Proteus mirabilis; Weigel LM et al.; Mutations associated with fluoroquinolone resistance in clinical isolates of Proteus mirabilis were determined by genetic analysis of the quinolone resistance-determining region (QRDR) of gyrA, gyrB, parC, and parE . This study included the P . mirabilis type strain ATCC 29906 and 29 clinical isolates with reduced susceptibility (MIC, 0.5 to 2 microg/ml) or resistance (MIC, > or =4 microg/ml) to ciprofloxacin . Susceptibility profiles for ciprofloxacin, clinafloxacin, gatifloxacin, gemifloxacin, levofloxacin, moxifloxacin, and trovafloxacin were correlated with amino acid changes in the QRDRs . Decreased susceptibility and resistance were associated with double mutations involving both gyrA (S83R or -I) and parC (S80R or -I) . Among these double mutants, MICs of ciprofloxacin varied from 1 to 16 microg/ml, indicating that additional factors, such as drug efflux or porin changes, also contribute to the level of resistance . For ParE, a single conservative change of V364I was detected in seven strains . An unexpected result was the association of gyrB mutations with high-level resistance to fluoroquinolones in 12 of 20 ciprofloxacin-resistant isolates . Changes in GyrB included S464Y (six isolates), S464F (three isolates), and E466D (two isolates) . A three-nucleotide insertion, resulting in an additional lysine residue between K455 and A456, was detected in gyrB of one strain . Unlike any other bacterial species analyzed to date, mutation of gyrB appears to be a frequent event in the acquisition of fluoroquinolone resistance among clinical isolates of P . mirabilis. J Am Geriatr Soc, 2002 Jul, 50(7 Suppl), S230 - 5 Resistant pathogens in urinary tract infections; Nicolle LE; Antimicrobial susceptibility of bacteria causing urinary tract infection (UTI) has evolved over several decades as antimicrobial exposure has repeatedly been followed by emergence of resistance . Older populations in the community, long-term care facilities, or acute care facilities have an increased prevalence of resistant bacteria isolated from UTI . Resistant isolates are more frequent in long-term care populations than the community . Resistant isolates include common uropathogens, such as Escherichia coli or Proteus mirabilis, and organisms with higher levels of intrinsic resistance, such as Pseudomonas aeruginosa or Providencia stuartii . Isolation of resistant organisms is consistently associated with prior antimicrobial exposure and higher functional impairment . The increased likelihood of resistant bacteria makes it essential that a urine specimen for culture and susceptibility testing be obtained before instituting antimicrobial therapy . Therapy for the individual patient must be balanced with the possibility that antimicrobial use will promote further resistance . Antimicrobial therapy should be avoided unless there is a clear clinical indication . In particular, asymptomatic bacteriuria should not be treated with antimicrobials . Where symptoms are mild or equivocal, urine culture results should be obtained before initiating therapy . This permits selection of specific therapy for the infecting organism and avoids empiric, usually broad-spectrum, therapy . Where empirical therapy is necessary, prior infecting organisms should be isolated, and recent antimicrobial therapy, as well as regional or facility susceptibility patterns, should be considered in antimicrobial choice . Where empirical therapy is used, it should be reassessed 48 to 72 hours after initiation, once pretherapy cultures are available. J Chemother, 2002 Jun, 14(3), 253 - 8 Emerging antimicrobial resistances among Proteus mirabilis in Europe: report from the MYSTIC Program (1997-2001) . Meropenem Yearly Susceptibility Test Information Collection; Mutnick AH et al.; Resistance patterns that are currently problematic in Europe can vary greatly within the same species over time, among various patient populations and among geographic regions on the same continent . The results from the Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Program, which monitors carbapenem resistance rates in institutions using meropenem, were used to determine resistance differences among Proteus mirabilis . MIC results from 688 P . mirabilis strains were classified into 4 patient care groups: ICU (n=426), neutropenia patients (NP; n=145), general wards (n=97) and cystic fibrosis patients (CF; n=20) . A total of 40 centers from 12 European countries have participated since 1997, divided into 3 geographic regions (East, North, South) . All testing was performed by NCCLS reference methods and interpretive criteria, including screening of extended-spectrum beta-lactamase (ESBL) phenotypes . Over the monitored interval the resistance rates varied for each agent without a clear trend toward a greater rate . Rank order of susceptibility was: meropenem (99%) > piperacillin/tazobactam (TAZ; 96%) > cefepime (95%) > ceftazidime (CAZ; 94%) > imipenem (IPM; 92%) . Ciprofloxacin (CIP) was the least active agent tested (MIC90 4 microg/ml; 86% susceptible) . Unexpectedly, 3.6% of P . mirabilis were imipenem-resistant (MIC, > or = 16 microg/ml) . Greater rates of resistance were found for strains from NP and CF patients, and from eastern or southern European sites, usually associated with epidemic clusters . Generally susceptible species such as P . mirabilis have recently emerged as therapeutic problems in European medical centers following mutations that compromise CIP, CAZ and aminoglycoside use . Imipenem also showed decreased susceptibility of greater than 7% compared to less than 1% for meropenem . Continued surveillance by the MYSTIC Program appears to be a prudent practice to focus effective empiric treatment regimens. Ann N Y Acad Sci, 2002 Jun, 968, 213 - 21 Role of PTEN, a lipid phosphatase upstream effector of protein kinase B, in epithelial thyroid carcinogenesis; Eng C; Both benign and malignant thyroid disease are well-established components of Cowden syndrome (CS), an autosomal dominant disorder characterized by multiple hamartomas and breast cancer that may be considered a phakomatosis . The susceptibility gene for CS is PTEN, a tumor suppressor gene on 10q23.3 that encodes a lipid phosphatase that lies upstream of protein kinase B (Akt) . Interestingly, Carney complex is also a phakomatosis where multiple endocrine neoplasias are prominent and thyroid cancer might be a rare component . One of its susceptibility genes is the regulatory subunit of protein kinase A . Over the course of the last four years, investigators have found the increasing clinical spectrum of syndromes characterized by germline loss-of-function PTEN mutation . In addition to CS, subsets of such disparate syndromes as Bannayan-Riley-Ruvalcaba syndrome, Proteus syndrome, and possibly VATER with hydrocephalus and megencephaly with autistic features have been found to have germline PTEN mutations . Paradoxically, somatic intragenic PTEN mutations were rare in uncultured primary epithelial thyroid tumors, although hemizygous deletion occurred in 10-20% of thyroid adenomas and carcinomas . However, with subsequent study, it was discovered that epigenetic silencing of PTEN and perhaps inappropriate subcellular compartmentalization were two novel mechanisms of PTEN inactivation pertinent in thyroid carcinogenesis . Ectopic expression studies in vitro have borne out the importance of PTEN in the pathogenesis of epithelial thyroid neoplasias. Arthritis Res, 2002, 4 Suppl 3, S265 - 72 Epub 2002 May 09. Epidemiology and genetics of rheumatoid arthritis; Silman AJ et al.; The prevalence of rheumatoid arthritis (RA) is relatively constant in many populations, at 0.5-1.0% . However, a high prevalence of RA has been reported in the Pima Indians (5.3%) and in the Chippewa Indians (6.8%) . In contrast, low occurrences have been reported in populations from China and Japan . These data support a genetic role in disease risk . Studies have so far shown that the familial recurrence risk in RA is small compared with other autoimmune diseases . The main genetic risk factor of RA is the HLA DRB1 alleles, and this has consistently been shown in many populations throughout the world . The strongest susceptibility factor so far has been the HLA DRB1*0404 allele . Tumour necrosis factor alleles have also been linked with RA . However, it is estimated that these genes can explain only 50% of the genetic effect . A number of other non-MHC genes have thus been investigated and linked with RA (e.g . corticotrophin releasing hormone, oestrogen synthase, IFN-gamma and other cytokines) . Environmental factors have also been studied in relation to RA . Female sex hormones may play a protective role in RA; for example, the use of the oral contraceptive pill and pregnancy are both associated with a decreased risk . However, the postpartum period has been highlighted as a risk period for the development of RA . Furthermore, breastfeeding after a first pregnancy poses the greatest risk . Exposure to infection may act as a trigger for RA, and a number of agents have been implicated (e.g . Epstein-Barr virus, parvovirus and some bacteria such as Proteus and Mycoplasma) . However, the epidemiological data so far are inconclusive . There has recently been renewed interest in the link between cigarette smoking and RA, and the data presented so far are consistent with and suggestive of an increased risk. Chem Commun (Camb), 2002 Jun 7, (11), 1159 - 68 Morphine, the Proteus of organic molecules; Blakemore PR et al.; This feature article encapsulates the senior author's longstanding interests in opiate chemistry and attempts to place it within an historical context and against the backdrop of related work by others who have viewed morphine as one of the pinnacles of natural product synthesis . Biomimetic and 'bioanalogous' routes to the morphine skeleton are discussed followed by approaches based on the elaboration of phenanthrene platforms . The latter include an asymmetric synthesis of ent-morphine developed in our laboratory. Microbiology, 2002 Jul, 148(Pt 7), 2191 - 201 Swarming-coupled expression of the Proteus mirabilis hpmBA haemolysin operon; Fraser GM et al.; The HpmA haemolysin toxin of Proteus mirabilis is encoded by the hpmBA locus and its production is upregulated co-ordinately with the synthesis and assembly of flagella during differentiation into hyperflagellated swarm cells . Primer extension identified a sigma(70) promoter upstream of hpmB that was upregulated during swarming . Northern blotting indicated that this promoter region was also required for concomitant transcription of the immediately distal hpmA gene, and that the unstable hpmBA transcript generated a stable hpmA mRNA and an unstable hpmB mRNA . Transcriptional luxAB fusions to the DNA regions 5' of the hpmB and hpmA genes confirmed that hpmB sigma(70) promoter activity increased in swarm cells, and that there was no independent hpmA promoter . Increased transcription of the hpmBA operon in swarm cells was dependent upon a 125 bp sequence 5' of the sigma(70) promoter -35 hexamer . This sequence spans multiple putative binding sites for the leucine-responsive regulatory protein (Lrp), and band-shift assays with purified Lrp confirmed the presence of at least two such sites . The influence on hpmBA expression of the key swarming positive regulators FlhD(2)C(2) (encoded by the flagellar master operon), Lrp, and the membrane-located upregulator of the master operon, UmoB, was examined . Overexpression of each of these regulators moderately increased hpmBA transcription in wild-type P . mirabilis, and the hpmBA operon was not expressed in any of the flhDC, lrp or umoB mutants . Expression in the mutants was not recovered by cross-complementation, i.e . by overexpression of FlhD(2)C(2), Lrp or UmoB . Expression of the zapA protease virulence gene, which like hpmBA is also upregulated in swarm cells, did not require Lrp, but like flhDC it was upregulated by UmoB . The results indicate intersecting pathways of control linking virulence gene expression and swarm cell differentiation. Arch Dis Child Fetal Neonatal Ed, 2002 Jul, 87(1), F52 - 4 Multidrug resistant neonatal sepsis in Peshawar, Pakistan; Rahman S et al.; OBJECTIVE: To investigate the spectrum of organisms causing neonatal sepsis in Peshawar, Pakistan and to assess their sensitivity to various groups of drugs . METHODS: Blood taken from newborn babies admitted to the special care baby unit at the Khyber Teaching Hospital with a clinical diagnosis of neonatal sepsis was cultured . The data obtained from October 1997 to December 2000 were analysed and the results tabulated . RESULTS: A total of 1598 blood cultures were taken; 1003 were positive (positivity rate 62.8%) . Escherichia coli was the most common organism found (36.6%), followed by Staphylococcus aureus (29.5%), Pseudomonas (22.4%), Klebsiella (7.6%), and Proteus (3.8%) . No group B streptococcus was grown . Listeria monocytogenes was found in one cerebrospinal fluid culture . E coli and Pseudomonas showed a high degree of resistance to commonly used antibiotics (ampicillin, augmentin, and gentamicin), a moderate degree of resistance to cephalosporin (cefotaxime, ceftzidime, and ceftrioxone), and low resistance to drugs not used for newborn babies (ofloxacin, ciprofloxacin, and enoxabid) . S aureus showed a low resistance to all three groups of antibiotics . CONCLUSION: Neonatal sepsis remains one of the leading causes of neonatal admission, morbidity, and mortality in developing countries . Gram negative organisms are the major cause of neonatal sepsis in Peshawar . Such organisms have developed multidrug resistance, and management of patients infected with them is becoming a problem in developing countries. J Cell Sci, 2002 Jul 15, 115(Pt 14), 2997 - 3005 The molecular mechanism of translocation through the nuclear pore complex is highly conserved; Feldherr C et al.; In this report we investigated the activity of vertebrate nuclear transport factors in a primitive organism, Amoeba proteus, to better understand evolutionary changes in the transport mechanisms of organisms expected to have different requirements for nucleocytoplasmic exchange . It was initially determined that FxFG-containing nucleoporins and Ran, both of which are essential for nuclear import in vertebrates, as well as yeast, are also present and functional in amoebae . This suggests that there are fundamental similarities in the transport process; however, there are also significant differences . Transport substrates containing either the hnRNP A1 M9 shuttling signal (a GST/GFP/M9 fusion protein) or the classical bipartite NLS (colloidal gold coated with BSA-bipartite NLS conjugates), both of which are effectively transported in vertebrate cells, are excluded from the nucleus when microinjected into amoebae . However, when these substrates are injected along with transportin or importin alpha/beta, respectively, the vertebrate receptors for these signals, they readily accumulate in the nucleoplasm . These results indicate that although the molecular recognition of substrates is not well conserved between vertebrates and amoebae, vertebrate transport receptors are functional in A . proteus, showing that the translocation machinery is highly conserved . Since selected nuclear import pathways can be investigated in the absence of competing endogenous transport, A . proteus might provide a useful in vivo system for investigating specific molecular interactions involved in trafficking. Biol Pharm Bull, 2002 Jun, 25(6), 798 - 802 Synthesis and pharmacological activities of 1,8-naphthyridine derivatives; Leonard JT et al.; In the present study, a series of 2-substituted-4-methyl-7-amino/4,7-dimethyl-1,8-naphthyridines were synthesized and characterized by IR, 1H-NMR and elemental analysis . The compounds were investigated for anticonvulsant (125, 250 mg/kg), cardiac and antimicrobial activities . The compounds were screened for antibacterial activity against gram (+) bacteria (Staphylococcus epidermidis, Bacillus subtilis, Enterococcusfaecalis and Micrococcus luteus) and gram (-) bacteria (Proteus vulgaris, Pseudomonas aeruginosa, Escherichia coli and Salmonella typhi) . All the compounds except 2-(3'-phenylaminopropyloxy)-4-methyl-7-amino-1,8-naphthyridine exhibited significant anticonvulsant activity . The anticonvulsant activity of 2-(3-morpholino-2'-hydroxypropyloxy)-4-methyl-7-amino-1,8-naphthyridine, 2-(3'-diphenylamino-2'-hydroxypropyloxy)-4-methyl-7-amino-1,8-naphthyridine and 2-(3'-diethanolamino-propyloxy)-4,7-dimethy-1,8-naphthyridine at the dose of 250 mg/kg were found to be equivalent to diazepam (5 mg/kg) . Sympathetic blocking activity was observed with 2-(3'-phenylamino-2'-hydroxypropyloxy)-4-methyl-7-amino-1,8-naphthyridine, 2-(3'-diethanolamino-2'-hydroxypropyloxy)-4-methyl-7-amino-1,8-naphthyridine and 2-(3'-diphenylamino-2'-hydroxypropyloxy)-4-methyl-7-amino-1,8-naphthyridine only . All the compounds were devoid of antibacterial activity against the tested bacteria. J Pediatr Surg, 2002 Jul, 37(7), 1013 - 20 Principles for the surgical management of patients with Proteus syndrome and patients with overgrowth not meeting Proteus criteria; Lublin M et al.; BACKGROUND: Proteus syndrome is a rare, sporadic disorder consisting of disproportionate overgrowth of multiple tissues, vascular malformations, and connective tissue or epidermal nevi . Patients with Proteus syndrome present with diverse and variable phenotypes because of the syndrome's mosaic pattern of distribution . METHODS: Eighty patients with Proteus syndrome, satisfying published diagnostic criteria, and 51 patients with overgrowth not meeting Proteus criteria were identified from the literature . Three additional patients, one patient with Proteus syndrome and 2 patients with overgrowth, were treated at the author's institutions and are discussed in detail . All nonorthopedic and noncutaneous surgical interventions were reviewed . RESULTS: Fourteen genitourinary, 9 gastrointestinal, and 5 otolaryngologic operations were performed on patients with Proteus syndrome . Six genitourinary, 5 gastrointestinal, and 2 otolaryngologic operations were performed on patients with overgrowth not meeting Proteus criteria . Eight patients with Proteus syndrome and 4 patients with overgrowth experienced thoracic manifestations, generally diffuse cystic pulmonary lesions, but only 1 of 12 underwent surgical treatment . CONCLUSIONS: Patients with visceral manifestations of either Proteus syndrome or overgrowth not meeting Proteus criteria should be treated in a similar manner . Lesions involving the ovaries and testes, because of the high incidence of neoplasm, should be managed aggressively . Gastrointestinal and renal lesions may be managed conservatively with frequent follow-up to minimize abdominal explorations . All patients undergoing surgery should have a thorough preoperative assessment of their airway and pulmonary reserve because of the relatively high frequency of tonsillar hypertrophy and pulmonary cystic involvement . Dermatology, 2002, 204(4), 318 - 20 Proteus syndrome of the hand; Fraiture AL et al.; Proteus syndrome exhibits an expanded phenotype . We report a case with restricted macrodactyly and cerebriform hypertrophy of one palm . The differential diagnosis with macrodactyly and other hamartomatous overgrowth syndromes is discussed . Antimicrob Agents Chemother, 2002 Jul, 46(7), 2162 - 8 New carbenicillin-hydrolyzing beta-lactamase (CARB-7) from Vibrio cholerae non-O1, non-O139 strains encoded by the VCR region of the V . cholerae genome; Melano R et al.; In a previous study, an analysis of 77 ampicillin-nonsusceptible (resistant plus intermediate categories) strains of Vibrio cholerae non-O1, non-O139, isolated from aquatic environment and diarrheal stool, showed that all of them produced a beta-lactamase with a pI of 5.4 . Hybridization or amplification by PCR with a probe for bla(TEM) or primers for bla(CARB) gene families was negative . In this work, an environmental ampicillin-resistant strain from this sample, ME11762, isolated from a waterway in the west region of Argentina, was studied . The nucleotide sequence of the structural gene of the beta-lactamase was determined by bidirectional sequencing of a Sau3AI fragment belonging to this isolate . The gene encodes a new 288-amino-acid protein, designated CARB-7, that shares 88.5% homology with the CARB-6 enzyme; an overall 83.2% homology with PSE-4, PSE-1, CARB-3, and the Proteus mirabilis N29 enzymes; and 79% homology with CARB-4 enzyme . The gene for this beta-lactamase could not be transferred to Escherichia coli by conjugation . The nucleotide sequence of the flanking regions of the bla(CARB-7) gene showed the occurrence of three 123-bp V . cholerae repeated sequences, all of which were found outside the predicted open reading frame . The upstream fragment of the bla(CARB-7) gene shared 93% identity with a locus situated inside V . cholerae's chromosome 2 . These results strongly suggest the chromosomal location of the bla(CARB-7) gene, making this the first communication of a beta-lactamase gene located on the VCR island of the V . cholerae genome. Nippon Hinyokika Gakkai Zasshi, 2002 May, 93(4), 573 - 6 {A case of stone formation in the Mainz pouch using appendix as the efferent limb: a case report}; Kurizaki Y et al.; A large calculus (6.0 x 4.5 x 7.0 cm sized) in the continent urinary pouch was detected incidentally by computed tomography in a 7-year-old man with a gall bladder stone . He underwent a total cystectomy and Mainz pouch formation using appendix as the efferent limb for bladder cancer 7 years ago . Urine culture showed Proteus mirabilis and Escherichia coli, and urine pH was 8.5 . The stone was removed successfully through a pouchotomy and composed mainly of struvite . The stone analysis was MAP; 88% and CaCO3; 12% . Convalescence was uneventful . This is the first case of in Mainz pouch using appendix as the efferent limb. Ophthalmology, 2002 Jun, 109(6), 1192 - 5 A novel ophthalmic presentation of the Proteus syndrome; Sheard RM et al.; PURPOSE: To report a patient with the Proteus syndrome who had ocular complications not previously described in the literature . DESIGN: Single observational case report . METHODS: Retrospective review of the medical record and review of the literature . RESULTS: The 26-year-old man has systemic features fulfilling the diagnostic criteria for the Proteus syndrome . His ocular abnormalities are myopia, mild calcific band keratopathy, cataract, abnormal vitreous structure, vitreous hemorrhage, a large chorioretinal mass, and a resolved serous retinal detachment . CONCLUSIONS: Ocular complications are frequently reported in patients with the Proteus syndrome . Few of the patients reported in the literature have had comprehensive ocular examination by an ophthalmologist . Our patient is unique because he has been examined by ophthalmologists from childhood, and it is clear that the ocular findings may change with time . As far as we are aware, calcific band keratopathy, abnormal vitreous structure, and chorioretinal hamartoma associated with serous retinal detachment and vitreous hemorrhage have not previously been described. Ugeskr Laeger, 2002 May 13, 164(20), 2606 - 10 {Piperacillin/tazobactam--Tazocin . A penicillin-based alternative to 3rd generation cephalosporins and carbapenems}; Schonning K et al.; The antibiotic piperacillin/tazobactam has recently been licensed for use in Denmark . Piperacillin/tazobactam combines a well known beta-lactam antibiotitic, piperacillin, and an inhibitor of bacterial beta-lactamase, tazobactam . The combination of piperacillin and tazobactam compared to piperacillin alone has an expanded antimicrobial spectrum, which includes Klebsiellae, Escherichia coli, and Proteus vulgaris resistant to ampicillin, as well as beta-lactamase-producing Staphylococcus aureus . As piperacillin in itself possesses antimicrobial activity against streptococci, enterococci, and Pseudomonas aeruginosa, the antimicrobial activity of piperacillin/tazobactam indicates that the combination may constitute an alternative to third generation cephalosporins and carbapenems in the treatment of complicated intra-abdominal infections infections in critically ill patients and for the empirical treatment of acute neutropenic febrile patients, as indicated by clinical studies. J Clin Microbiol, 2002 Jun, 40(6), 2169 - 75 Evaluation of the DipStreak, a new device with an original streaking mechanism for detection, counting, and presumptive identification of urinary tract pathogens; Scarparo C et al.; DipStreak is a new urine culture device with two types of agar attached back-to-back on a plastic paddle . It combines dip-slide technology and an original streaking inoculation mechanism, allowing for bacterial counting and colony isolation . The performance of the DipStreak device with two different medium formulations, CHROMagar and MacConkey media in study A and UriSelect 3 and MacConkey media in study B, was evaluated and compared to that of the reference streak method by using plates of cystine-lactose-electrolyte-deficient (CLED) agar, tryptic soy agar with 5% sheep blood, and UriSelect 3 medium . In study A, 2,000 urine specimens were processed and 511 cultures were found positive . The DipStreak device and the UriSelect 3 and CLED medium plates gave the same detection rate, 99.7% . For the direct identification of Escherichia coli, Proteus mirabilis, and Enterococcus sp . isolates, the DipStreak device and the UriSelect 3 medium plate showed overall sensitivities of 97 and 93.4%, respectively . In study B, 3,000 urine specimens were processed and 714 cultures were found positive . The DipStreak device and the UriSelect 3 and CLED medium plates gave detection rates of 99.4, 99.9, and 99.2%, respectively . For the direct identification of E . coli, P . mirabilis, and Enterococcus sp . isolates, the DipStreak device and the UriSelect 3 medium plate showed overall sensitivities of 88 and 94.4%, respectively . In conclusion, the DipStreak device with both medium formulations represents an attractive and excellent screening method for the reliable detection, counting, and presumptive identification of urinary tract pathogens . It enables bedside urine inoculation and provides a valid means of transporting the sample back to the laboratory, decreasing drastically the rate of false-positive results due to bacterial overgrowth and reducing associated costs. J Clin Microbiol, 2002 Jun, 40(6), 2153 - 62 Detection of plasmid-mediated AmpC beta-lactamase genes in clinical isolates by using multiplex PCR; Perez-Perez FJ et al.; Therapeutic options for infections caused by gram-negative organisms expressing plasmid-mediated AmpC beta-lactamases are limited because these organisms are usually resistant to all the beta-lactam antibiotics, except for cefepime, cefpirome, and the carbapenems . These organisms are a major concern in nosocomial infections and should therefore be monitored in surveillance studies . Six families of plasmid-mediated AmpC beta-lactamases have been identified, but no phenotypic test can differentiate among them, a fact which creates problems for surveillance and epidemiology studies . This report describes the development of a multiplex PCR for the purpose of identifying family-specific AmpC beta-lactamase genes within gram-negative pathogens . The PCR uses six sets of ampC-specific primers resulting in amplicons that range from 190 bp to 520 bp and that are easily distinguished by gel electrophoresis . ampC multiplex PCR differentiated the six plasmid-mediated ampC-specific families in organisms such as Klebsiella pneumoniae, Escherichia coli, Proteus mirabilis, and Salmonella enterica serovar Typhimurium . Family-specific primers did not amplify genes from the other families of ampC genes . Furthermore, this PCR-based assay differentiated multiple genes within one reaction . In addition, WAVE technology, a high-pressure liquid chromatography-based separation system, was used as a way of decreasing analysis time and increasing the sensitivity of multiple-gene assays . In conclusion, a multiplex PCR technique was developed for identifying family-specific ampC genes responsible for AmpC beta-lactamase expression in organisms with or without a chromosomal AmpC beta-lactamase gene. Am J Infect Control, 2002 Jun, 30(4), 246 - 7 Bacterial contamination of saline nasal spray/drop solution in patients with respiratory tract infection; Brook I; This study evaluated the potential for bacterial contamination of saline nasal spray/drop solution after 3 days of clinical use in patients . Twenty patients with upper respiratory infection used the saline as a spray, and 20 patients used the solution as drops . Bacterial growth was present in 18 (907%) solution containers of the spray group and in 3 (157%) solution containers of the drops group (P <.005) . Twenty isolates were recovered from the spray group and 3 from the drops group . The predominate isolates included Staphylococcus aureus, Staphylococcus epidermidis, alpha Streptococcus species, Pseudomonas aeruginosa, Escherichia coli, and Proteus spp . This study demonstrates the contamination of nasal saline-dispensing solution used as a spray with micro-organisms that are part of the normal skin and nasal flora and gram-negative organisms of potential enteric origin . These data support the use of nasal saline-dispensing solution as drops, rather than as spray . They also illustrate the risk for crossinfection if a nasal solution is used by more than 1 patient. Aten Primaria, 2002 May 15, 29(8), 481 - 5 {Rational use of medications in the treatment of urinary infections}; Leon Gonzalez E et al.; OBJECTIVES: MAIN: to encourage the rational use of medication in the treatment of uncomplicated acute cystitis (UAC) . SECONDARY: to find the most common germs in our area and their sensitivity to medication, the most common anti-microbials used and patients age, and to evaluate the savings made through a policy of rational use of medication.Design . Retrospective, descriptive, observational study . SETTING: La Solana Health Centre jointly with the biochemistry laboratory of the Talavera Area . PARTICIPANTS: Probabilistic randomised sampling of clinical histories of women between 20 and 80 with episodes of UAC (349 in all) between 01/10/95 and 01/10/00 . MEASUREMENTS AND RESULTS: First, the laboratory evaluated 591 urine cultures of complicated/uncomplicated UTI from 01/01/00 to 01/10/00, with study of the germs involved and their sensitivities . 373 positives were isolated: E . coli (78.3%), which had the greatest sensitivity to amoxycillin/clavulanic acid, fosfomycin, nitrofurantoin and cefixime; Proteus (7.2%) and Streptococcus D (5.8%) . Second, clinical records were analysed for the following: antibiotics (norfloxacine and cyprofloxacine, the most common); length of treatment (average of 6.52.34 days); age of patient (greater number in under-65s) . CONCLUSIONS: E . coli is the most common germ in UTI and is highly sensitive to amoxy/clavulanic acid, nitrofurantoin, fosfomycin and cefixime . Resistance to cyprofloxacine and norfloxacine are starting to be significant . In UAC the three-day model should be encouraged for young women; and 7 days is recommended for the over-65s . More rational use of medication would increase efficacy and suppose a considerable economic saving in our area. J Bacteriol, 2002 Jun, 184(12), 3194 - 202 Complete nucleotide sequence of plasmid Rts1: implications for evolution of large plasmid genomes; Murata T et al.; Rts1, a large conjugative plasmid originally isolated from Proteus vulgaris, is a prototype for the IncT plasmids and exhibits pleiotropic thermosensitive phenotypes . Here we report the complete nucleotide sequence of Rts1 . The genome is 217,182 bp in length and contains 300 potential open reading frames (ORFs) . Among these, the products of 141 ORFs, including 9 previously identified genes, displayed significant sequence similarity to known proteins . The set of genes responsible for the conjugation function of Rts1 has been identified . A broad array of genes related to diverse processes of DNA metabolism were also identified . Of particular interest was the presence of tus-like genes that could be involved in replication termination . Inspection of the overall genome organization revealed that the Rts1 genome is composed of four large modules, providing an example of modular evolution of plasmid genomes. J Dermatol, 2002 Apr, 29(4), 238 - 41 Proteus syndrome; Roma P et al.; Proteus syndrome is a rare congenital hamartomatous entity . We report some new findings in a boy with this syndrome, in addition to the classical clinical and radiological features of subcutaneous masses, partial gigantism of hands and feet, bony abnormalities, and epidermal nevi . We also discuss how to reach a definitive diagnosis by using an established rating scale. Indian J Med Sci, 2001 Aug, 55(8), 434 - 8, 472 Activity of Ocimum sanctum (the traditional Indian medicinal plant) against the enteric pathogens; Geeta et al.; Aqueous & alcoholic extracts of O . sanctum were prepared . Two concentrations of these extracts (30 mg & 60 mg) were tried against the enteric pathogens & candida albicans by Agar diffusion method . Wide zones of inhibition were observed at 60 mg concentration of extract . Aqeous extract showed wider zone of inhibition when compared to alcoholic extract . Aqueous extract showed wider zones of inhibition for Klebisella, E . Coil, Proteus & Staphylococcus aureus . Alcoholic extract showed wider zone for vibrio cholerae. Protist, 2002 Mar, 153(1), 47 - 58 Competitive advantages of Caedibacter-infected Paramecia; Kusch J et al.; Intracellular bacteria of the genus Caedibacter limit the reproduction of their host, the freshwater ciliate Paramecium . Reproduction rates of infected strains of paramecia were significantly lower than those of genetically identical strains that had lost their parasites after treatment with an antibiotic . Interference competition occurs when infected paramecia release a toxic form of the parasitic bacterium that kills uninfected paramecia . In mixed cultures of infected and uninfected strains of either P tetraurelia or of P novaurelia, the infected strains outcompeted the uninfected strains . Infection of new host paramecia seems to be rare . Infection of new hosts was not observed in either mixtures of infected with uninfected strains, or after incubation of paramecia with isolated parasites . The competitive advantages of the host paramecia, in combination with their vegetative reproduction, makes infection of new hosts by the bacterial parasites unnecessary, and could be responsible for the continued existence of "killer paramecia" in nature . Caedibacter parasites are not a defensive adaptation . Feeding rates and reproduction of the predators Didinium nasutum (Ciliophora) and Amoeba proteus (Amoebozoa, Gymnamoebia) were not influenced by whether or not their paramecia prey were infected . Infection of the predators frequently occurred when they preyed on infected paramecia . Caedibacter-infected predators may influence competition between Paramecium strains by release of toxic parasites into the environment that are harmful to uninfected strains. Antimicrob Agents Chemother, 2002 Jun, 46(6), 2004 - 6 Chromosome-encoded class D beta-lactamase OXA-23 in Proteus mirabilis; Bonnet R et al.; Ten nonrepetitive Proteus mirabilis isolates, which were collected over 4 years (1996 to 1999) at the teaching hospital of Clermont-Ferrand, France, produced class D carbapenemase OXA-23 . MICs of imipenem were 0.25 to 0.5 microg/ml for these clinical isolates . Molecular typing revealed that the 10 P . mirabilis isolates originated from the same clonal strain . Hybridization of I-CeuI-generated chromosome fragments with a bla(OXA-23) probe showed that the gene was chromosome encoded in the P . mirabilis strain. J Surg Res, 2002 May 15, 104(2), 88 - 94 Effect of tumor necrosis factor alpha, interferon gamma, and interleukin-4 on bacteria-enterocyte interactions; Hess DJ et al.; BACKGROUND: Little is known about the mechanisms involved in bacterial translocation from the intestinal lumen to extraintestinal sites . Because the cytokine cascade associated with sepsis, inflammation, and trauma has been shown to affect intestinal epithelial permeability, experiments were designed to clarify the effects of selected cytokines on bacterial adherence to and internalization by cultured HT-29 and Caco-2 enterocytes . METHODS: Mature, confluent enterocytes were pretreated 48 to 72 h with tumor necrosis factor alpha (TNF-alpha), interferon gamma, (IFN-gamma), or interleukin-4 (IL-4) . Adherence of Listeria monocytogenes, Salmonella typhimurium, Proteus mirabilis, and Escherichia coli was measured by enzyme-linked immunosorbent assay and bacterial internalization was quantified by the gentamicin protection assay . Enterocyte permeability was measured by transepithelial electrical resistance and by flux of 40-kDa fluorescent dextran . Bacterial transmigration across confluent enterocytes was measured using enterocytes cultivated on permeable supports . RESULTS: TNF-alpha, IFN-gamma, and IL-4 had variable effects on bacterial adherence to HT-29 and Caco-2 enterocytes, although the most consistent finding was increased bacterial adherence associated with INF-gamma . However, none of these cytokines had a noticeable effect on bacterial internalization by either Caco-2 or HT-29 enterocytes . In addition, none of these cytokines had a noticeable effect on the permeability of confluent enterocytes as measured by transepithelial electrical resistance or dextran flux . Bacterial transmigration across confluent HT-29 enterocytes was not altered by TNF-alpha, IFN-gamma, or IL-4; however, IL-4 consistently decreased bacterial transmigration across confluent Caco-2 enterocytes . CONCLUSIONS: IFN-gamma may augment the epithelial adherence of selected species of enteric bacteria, and IL-4 may act as a barrier-sustaining agent to decrease bacterial migration across the intestinal epithelium . (c) 2002 Elsevier Science (USA). Bull Soc Pathol Exot, 2002 Mar, 95(1), 8 - 10 {Profile and sensitivity to antibiotics of 2063 uropathogenic bacteria isolated in the center of Tunisia}; Boukadida J et al.; Current bacteriological data are very useful when making therapeutic decisions in cases of non complicated urinary tract infection . In this article, we present the data gathered by a university hospital laboratory in mid-Tunisia as well as the results of 17,829 urinary cytobacteriological examinations conducted in a multidisciplinary hospital during the year 2000 . Urine was sowed on usual agar . All bacterium cultivating at least 10(5) bacteria reported to ml and at 37 degrees C in a normal atmosphere was retained; identification and sensitivity to antibiotics of the bacterium followed the recommendations of the French Society of Microbiology . We collected 2063 non-redundant bacteria of which 82.3% came from female samples . Gram negative rods were distinctly predominant with 92% of the whole bacterium and Escherichia coli represented 67% of the whole of the germs; Staphylococcus saprophyticus with 4.8% and Streptococcus agalactiae with 1% dominated Gram positive bacteria . The susceptibility of bacteria to the principal antibiotics used for the treatment of the urinary tract infection was characterised by the low percentage of sensitivity of the Gram negative rods to amoxicillin (41.2% of sensitivity for Escherichia coli and 22% for the Proteus sp), and by cotrimoxazole which preserved an activity between 63.8% for Escherichia coli and 94.7% for Staphylococcus saprophyticus . The highest percentage of sensitivity was achieved by gentamicine (99.4% of Escherichia coli and 98.9% of Staphylococcus saprophyticus) and fluoroquinolons (97.8% of Escherichia coli and 100% of Staphylococcus saprophyticus are sensible); furadoin was active on almost all Escherichia coli and Staphylococcus saprophyticus . Apart from natural resistance, colistin was constantly active . Escherichia coli and Staphylococcus saprophyticus were the major agents of the urinary tract infection . Gentamicin and fluoroquinolons showed themselves to be constantly active antibiotics . Nitrofurans and colistin deserve a better place in therapeutic choice. Carbohydr Res, 2002 Apr 30, 337(9), 835 - 40 The structure of the carbohydrate backbone of the rough type lipopolysaccharides from Proteus penneri strains 12, 13, 37 and 44; Vinogradov E et al.; The following structure of the lipid A-core backbone of the rough type lipopolysaccharides (LPS) from Proteus penneri strains 12, 13, 37, and 44 was determined using NMR and mass spectroscopy and chemical analysis of the oligosaccharides obtained by mild-acid hydrolysis, alkaline O,N-deacylation, O-deacylation with hydrazine, and deamination of the LPSs:where K=H, R=PEtN, R(1)=alpha-Hep-(1-->2)-alpha-DDHep, and R(2)=alpha-GalN (strains 12 and 13) or beta-GlcNAc-(1-->4)-alpha-GlcN (strains 37 and 44) . LPS from each strain contained several structural variants . LPS from strain 12 contained a variant with R(1)=alpha-DDHep, whereas LPS from strains 13, 37, and 44 contained structures with K=amide of beta-GalA with putrescine or spermidine . The phosphate group at O-1 of the alpha-GlcN residue in the lipid part was partially substituted with Ara4N. J Mol Diagn, 2002 May, 4(2), 114 - 7 A 39-bp deletion polymorphism in PTEN in African American individuals: implications for molecular diagnostic testing; Zhou XP et al.; Germline mutations in the PTEN/MMAC1/TEP1 tumor suppressor gene cause Cowden syndrome (CS), a hereditary hamartoma-tumor syndrome with an increased risk of breast, thyroid, and endometrial cancers, and seemingly unrelated developmental disorders, such as Bannayan-Riley-Ruvalcaba (BRR) syndrome, Proteus, and Proteus-like syndromes . Data to date suggest that irrespective of the clinical presentation, the identification of a PTEN mutation should trigger medical management which includes cancer surveillance . Clinic-based molecular diagnostic testing for germline PTEN mutations has been available for at least 2 years . This study reports on the finding of a previously unobserved heterozygous alteration (IVS7-15-->53del39) found in an African American individual who had features of CS . Further investigation revealed that 12 of 42 (28.6%) African American controls, but not individuals of Caucasian or Japanese origin, also carried this heterozygous 39-bp deletion in PTEN . Due to its location immediately upstream of the splicing site of exon 8, this polymorphism could be mistaken for a deleterious mutation in the PTEN. Life Sci Space Res, 1980, 18, 213 - 8 Growth and cell structure of Proteus vulgaris when cultivated in weightlessness in the Cytos apparatus; Kordyum VA et al.; Growth data and electron-microscopic analyses are presented for Proteus vulgaris cultures which were grown during space flight in polyethylene packets in a semisolid medium with Tryptose for 96 h . In the suboptimal culture conditions the growth and morphological characteristics of the flight and ground control variants were nearly identical, but we were able to detect a number of differences between the cellular ultrastructure of these variants . These differences testify to changes in the bacterial cell metabolism during space flight. Yonsei Med J, 2002 Apr, 43(2), 259 - 66 Proteus syndrome: a natural clinical course of Proteus syndrome; Linton JA et al.; A 16-year-old Korean male patient presented with macrodactyly, hemihypertrophy of the face and extremities, plantar cerebriform hyperplasia, a subcutaneous mass of the left chest, macrocephaly and verrucous epidermal nevi . These findings are consistent with Proteus Syndrome . The clinical features, etiology, management, natural course and differential diagnosis of this case are discussed. Indian J Med Sci, 2000 Sep, 54(9), 388 - 94 Emerging antibiotic resistance among the uropathogens; Ram S et al.; A total of 18,876 urine samples from patients of clinically suspected UTI including asymptomatic pregnant females were analysed, during the year 1997 & 1998 . Culture positivity rate was found to be 37% . The incidence of Proteus was on the rise during the year 1998 especially in hospitalized patients . The antibiotic sensitivity pattern of uropathogens was also analysed to check the emergence of drug resistance . This study has revealed that withdrawal of a particular antibiotic due to high level of resistance observed during previous years, has led to re-emergence of antibiotic sensitive mutants . Further indiscriminate use of newer antibiotics like amikacin and netilimicin is responsible for emergeny of resistant variant against these antibiotics and this lays stress upon the immediate need for national antibiotic policy. Ethiop Med J, 1999 Oct, 37(4), 237 - 46 Chronic suppurative otitis media in a children's hospital in Addis Ababa, Ethiopia; Melaku A et al.; Our knowledge of chronic suppurative otitis media is scanty in Ethiopia . This hospital-based study was, thus, conducted prospectively over a period of 2 years among children visiting a tertiary facility in Addis Ababa . Demographic, clinical, audiometric and microbiological data were collected using a preformed questionnaire . A total of 391 patients constituting 0.6% of the hospital patient population and 22.3% of those seen at the ear, nose, and throat clinic had chronic suppurative otitis media . Most (82.1%) of them were from Addis Ababa, the male to female ratio was 1.6:1, and their median age at presentation was 5.9 years . Otorrhoea had started before the age of 2 years in 269 (68.8%), was bilateral in 215 (55.0%), recurrent in 285 (72.9%), and continuous in 106 (27.1%) . Otalgia was reported in only 18% . Hearing loss was the major presenting symptom and the loss was moderate to severe (grades 2 and 3) in 32 (69.6%) and slight (grade 1) in 14 (30.4%) of the ears tested audiometrically . Malnutrition, nasopharyngitis, measles, HIV infection, tuberculosis, diabetes mellitus, neoplastic diseases, and structural abnormalities were common antecedents . Serious complications included systemic infections, otogenic meningitis, mastoiditis, and tetanus . A total of 106 bacterial isolates were cultured from ear discharges of 80 patients . Proteus species were the commonest, accounting for 40 (37.7%) followed by Staphylococcus aureus, Pseudomonas aeruginosa, and Gram negative enterics . All isolates were highly resistant to the commonly used antibiotics including penicillin, ampicillin, amoxycillin, trimethoprim-sulfamethoxazole, and chloramphenicol . Augmentin, gentamicin, and kanamycin were the only drugs to which most of the pathogens were sensitive . Marked improvement on the discharge was achieved in 64% of the 116 patients who complied with treatment . Awareness about the health implications of the disease seemed to be lacking in among the caretakers . Selective use of antibiotics and continuous aural cleansing need to be promoted . More elaborate epidemiological studies will be required to define the magnitude of the problem and identify optimal therapeutic modalities of suppurative ear disease in Ethiopia. Life Sci Space Res, 1977, 15, 113 - 8 Biological investigations of higher and lower plants aboard Soyuz 19; Dubinin NP et al.; Biological investigations carried out aboard Soyuz 19 consisted of three independent complex experiments . All biological materials aboard the spacecraft were kept in "Biocat" thermostats which maintained the required temperature . The objective of the experiment "Genetic investigations" was to determine the effect of space flight factors on the heredity of lower (Chlamydomonas reinhardi Dang) and higher (Crepis capillaris (L) Wallr and Arabidopsis thaliana (L) Heynh) plants, and on the radiosensitivity of plant seeds and the radiation effect of prior gamma-irradiation . The space flight factors decreased the survival of Chlamydomonas cells and A . thaliana plants of the first generation . They decreased the germination of seeds, increased the rate of chlorophyll mutations and embryonal lethals, produced no effect on the rate of visible mutations in unicellular algae, increased the rate of chromosome aberrations in root meristem cells C . capillaris, induced disturbances in mitosis of unicellular algae and modified the effect of prior gamma-irradiation . The experiment "Growth of micro-organisms" was conducted with a culture of Proteus vulgaris in a growth chamber . After return to the laboratory the experimental and control variants were studied for twenty-two tests . The control and experimental material differed in the average cell size, biomass distribution, the character of haemotaxis, the rate of cell migration over the substratum surface, dehydrogenase activity, ribosomal aggregation, and ultrastructural peculiarities of cells . The experiment "Embryological investigations" was carried out to study the effect of space flight factors on embryogenesis of the bony fish Brachyodanio rerio . No abnormalities were noted in the course or rate of the development of spawn cultivated in a special thermostat. Saudi Med J, 2002 Apr, 23(4), 461 - 3 Hyperimmunoglobulin-E syndrome; Mahdi OZ et al.; Two Saudi girls aged 8 years and 5 years were seen over a period of 6 years and 5 years . Their clinical presentations consisted of recurrent bilateral otitis media, repeated episodes of tonsillitis and chest infection . Cultures from the ears grew on numerous occasions Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeroginosa, Proteus species and Providencia species . The 8-year-old had a serum IgE level of 1431 iu/L, with normal levels of other immunoglobulin classes . The 5-year-old had an immunoglobulin E value of 1119 iu/L with normal values of other immunoglobulin classes . Both were human immuno-deficiency virus negative and no other causes for elevated immunoglobulin E were found . The mothers of both cases had elevated immunoglobulin E levels of 1216 iu/L and 1992 iu/L . Both fathers had normal IgE levels . A 13-year-old sibling of case one had a grossly elevated immunoglobulin E level of 2259 iu/L . She had diffuse lamellar icthyosis and recurrent episodes of chest infection and conjunctivitis . There was a good clinical response of patient one to monthly intravenous human immunoglobulin. Biochemistry (Mosc), 2002 Feb, 67(2), 265 - 76 New structures of the O-specific polysaccharides of bacteria of the genus Proteus . 1 . Phosphate-containing polysaccharides; Toukach FV et al.; The O-specific polysaccharide chains (O-antigens) of the lipopolysaccharides of five Proteus strains, P . vulgaris O17, P . mirabilis O16 and O33, and P . penneri 31and 103, were found to contain phosphate groups that link the non sugar components, e.g., ethanolamine and ribitol . The polysaccharides of P . mirabilis O16 and P . penneri 103 include ribitol phosphate in the main chain and thus resemble ribitol teichoic acids of Gram-positive bacteria . The structures of the polysaccharides were elucidated using NMR spectroscopy, including two-dimensional 1H,1H correlation spectroscopy (COSY and TOCSY), nuclear Overhauser effect spectroscopy (NOESY or ROESY), and H-detected 1H,13C and 1H,31P heteronuclear multiple-quantum coherence spectroscopy (HMQC), along with chemical methods . The structures determined are unique among the bacterial polysaccharides and, together with the data obtained earlier, represent the chemical basic for classification of Proteus strains . Based on structural similarities of the O-specific polysaccharides and serological relationships between the O-antigens, we propose to extend Proteus serogroups O17 and O19 by including P . penneri strains 16 and 31,respectively. Biochemistry (Mosc), 2002 Feb, 67(2), 201 - 11 New structures of the O-specific polysaccharides of Proteus . 2 . Polysaccharides containing O-acetyl groups; Kondakova AN et al.; Structures of five new O-specific polysaccharides of Proteus bacteria were established . Four of them, Proteus penneri 4 (O72), Proteus vulgaris 63/57 (O37), Proteus mirabilis TG 277 (O69), and Proteus penneri 20 (O17), contain O-acetyl groups in non-stoichiometric quantities, and the polysaccharide of P . penneri 1 is structurally related to that of P . penneri 4 . The structures were elucidated using NMR spectroscopy, including one-dimensional 1H- and 13C-NMR spectroscopy, two-dimensional 1H,1H correlation (COSY, TOCSY), H-detected 1H,13C heteronuclear multiple-quantum coherence (HMQC), heteronuclear multiple-bond correlation (HMBC), and nuclear Overhauser effect spectroscopy (NOESY or ROESY), along with chemical m