Microbiological

Appl Environ Microbiol, 1999 Aug, 65(8), 3493 - 501
IS1631 occurrence in Bradyrhizobium japonicum highly reiterated sequence-possessing strains with high copy numbers of repeated sequences RSalpha and RSbeta; Isawa T et al.; From Bradyrhizobium japonicum highly reiterated sequence-possessing (HRS) strains indigenous to Niigata and Tokachi in Japan with high copy numbers of the repeated sequences RSalpha and RSbeta (K . Minamisawa, T . Isawa, Y . Nakatsuka, and N . Ichikawa, Appl . Environ . Microbiol . 64:1845-1851, 1998), several insertion sequence (IS)-like elements were isolated by using the formation of DNA duplexes by denaturation and renaturation of total DNA, followed by treatment with S1 nuclease . Most of these sequences showed structural features of bacterial IS elements, terminal inverted repeats, and homology with known IS elements and transposase genes . HRS and non-HRS strains of B . japonicum differed markedly in the profiles obtained after hybridization with all the elements tested . In particular, HRS strains of B . japonicum contained many copies of IS1631, whereas non-HRS strains completely lacked this element . This association remained true even when many field isolates of B . japonicum were examined . Consequently, IS1631 occurrence was well correlated with B . japonicum HRS strains possessing high copy numbers of the repeated sequence RSalpha or RSbeta . DNA sequence analysis indicated that IS1631 is 2,712 bp long . In addition, IS1631 belongs to the IS21 family, as evidenced by its two open reading frames, which encode putative proteins homologous to IstA and IstB of IS21, and its terminal inverted repeat sequences with multiple short repeats.

Appl Environ Microbiol, 1999 Aug, 65(8), 3312 - 8
Characterization of methanotrophic bacterial populations in soils showing atmospheric methane uptake; Holmes AJ et al.; The global methane cycle includes both terrestrial and atmospheric processes and may contribute to feedback regulation of the climate . Most oxic soils are a net sink for methane, and these soils consume approximately 20 to 60 Tg of methane per year . The soil sink for atmospheric methane is microbially mediated and sensitive to disturbance . A decrease in the capacity of this sink may have contributed to the approximately 1% . year(-1) increase in the atmospheric methane level in this century . The organisms responsible for methane uptake by soils (the atmospheric methane sink) are not known, and factors that influence the activity of these organisms are poorly understood . In this study the soil methane-oxidizing population was characterized by both labelling soil microbiota with (14)CH(4) and analyzing a total soil monooxygenase gene library . Comparative analyses of {(14)C}phospholipid ester-linked fatty acid profiles performed with representative methane-oxidizing bacteria revealed that the soil sink for atmospheric methane consists of an unknown group of methanotrophic bacteria that exhibit some similarity to type II methanotrophs . An analysis of monooxygenase gene libraries from the same soil samples indicated that an unknown group of bacteria belonging to the alpha subclass of the class Proteobacteria was present; these organisms were only distantly related to extant methane-oxidizing strains . Studies on factors that affect the activity, population dynamics, and contribution to global methane flux of "atmospheric methane oxidizers" should be greatly facilitated by use of biomarkers identified in this study.

J Vet Med Sci, 1999 Jun, 61(6), 717 - 20
Sequence analysis and expression of Nramp-1 gene in Bcgr and Bcgs mice; Nakanaga K et al.; Nucleic acid sequence of complemental DNA open reading frame for Nramp-1 gene was compared among DBA/2 (Bcgr), C57BL/6 (Bcgs) and C57BL/6-Bcgr mice which was previously developed as M . avium-resistant mouse strain (Xu, et al . Veterinary Microbiology 50:73-79 (1996) . Total RNA was isolated from various organs of DBA/2, C57BL/6 and C57BL/6-Bcgr . Nramp-1 cDNA was constructed from their mRNAs by gene amplification (PCR) technique and their open reading frame sequences were compared . The results clearly showed that our C57BL/6-Bcgr was almost identical with the DNA sequence of the DBA/2 mice . In contrast, C57BL/6-Bcgs mice differed only on the substitution of adenine for guanine of the nucleic acid at position 596 . This corresponded to the site of amino acid substitution (glycine to asparate) at position 169 in predicted NRAMP which had been reported . The expression of Nramp-1 mRNA was more prominent in spleens and livers and there appeared to be no significant difference among the strains of mice.

Antonie Van Leeuwenhoek, 1999 Jan-Feb, 75(1-2), 5 - 19
The beta-lactam antibiotics: past, present, and future; Demain AL et al.; The discovery and development of the beta-lactam antibiotics are among the most powerful and successful achievements of modern science and technology . Since Fleming's accidental discovery of the penicillin-producing mold, seventy years of steady progress has followed, and today the beta-lactam group of compounds are the most successful example of natural product application and chemotherapy . Following on the heels of penicillin production by Penicillium chrysogenum came the discoveries of cephalosporin formation by Cephalosporium acremonium, cephamycin, clavam and carbapenem production by actinomycetes, and monocyclic beta-lactam production by actinomycetes and unicellular bacteria . Each one of these groups has yielded medically-useful products and has contributed to the reduction of pain and suffering of people throughout the world . Research on the microbiology, biochemistry, genetics and chemistry of these compounds have continued up to the present with major contributions being made by both individual and collaborative groups from industry and academia . The discovery of penicillin not only led to the era of the wonder drugs but provided the most important antibiotics available to medicine . Continued efforts have resulted in the improvement of these compounds with respect to potency, breadth of spectrum, activity against resistant pathogens, stability and pharmacokinetic properties . On the research front, major advances are being made on structural and regulatory biosynthetic genes and metabolic engineering of the pathways involved . New semisynthetic compounds especially those designed to combat resistance development are being examined in the clinic, and unusual non-antibiotic activities of these compounds are being pursued . Although seventy years of age, the beta-lactams are not yet ready for retirement.

Ir J Med Sci, 1999 Apr-Jun, 168(2), 111 - 3
HpSA: assessment of a new non-invasive diagnostic assay for Helicobacter pylori infection in an Irish population; McNamara D et al.; BACKGROUND: The diagnosis of Helicobacter pylori is an essential element in the management of many common gastrointestinal pathologies . Previously diagnosis was dependent on the availability of endoscopic biopsy samples . The advent of non invasive assays such as the C13Urea breath test and Elisa serology have enabled diagnosis and treatment to be undertaken in the primary care setting . The isolation of Helicobacter pylori antigen from stool has led to the development of a new non-invasive test . AIM: A prospective study was designed to assess and compare the performance of Premier Platinum HpSA with current gold standard tests . METHODS: Consecutive patients undergoing a gastroscopy for investigation of dyspepsia at the Meath and Adelaide hospitals were enrolled . At endoscopy gastric biopsies were taken for histology, microbiology and rapid urease testing . In addition all subjects had C13UBT, serology and stool tests performed . Individuals who were H . pylori positive received standard proton pump inhibitor based triple therapy . Following treatment all tests, apart from serology were repeated . RESULTS: 54 patients were enrolled, 46 per cent were H . pylori positive . HpSA had a sensitivity and specificity and positive and negative predicted values of 96 per cent, 75 per cent and 80.6 per cent, 75.8 per cent respectively and compared favourably with all other tests . The sensitivity and specificities of the other tests were, histology 79.2 per cent and 100 per cent, culture 68 per cent and 100 per cent, rapid urease test 75 per cent and 100 per cent, serology 75 per cent and 96 per cent and C13 urea breath test 100 per cent and 96.6 per cent . CONCLUSION: The detection of H . pylori antigen in stool by means of a HpSA assay is a new and effective non-invasive means of diagnosis which can be performed in a routine laboratory setting . It is simple to perform and has possible advantages over other non-invasive tests, detecting actual antigen indicating current active infection.

Cas Lek Cesk, 1999 May 24, 138(11), 329 - 32
{Lyme borreliosis}; Mrazek V et al.; The authors present a review of contemporary views on the most frequent anthropozoonosis--Lyme borreliosis . They mention its history, microbiology of the causal agent Borrelia burgdorferi, epidemiology, pathogenesis, laboratory and clinical diagnosis . The authors describe also briefly the clinical stages, forms and possible treatment.

Plant J, 1999 Jun, 18(5), 571 - 6
A bacterial haloalkane dehalogenase gene as a negative selectable marker in Arabidopsis; Naested H et al.; The dhlA gene of Xanthobacter autotrophicus GJ10 encodes a dehalogenase which hydrolyzes dihalo- alkanes, such as 1, 2-dichloroethane (DCE), to a halogenated alcohol and an inorganic halide (Janssen et al . 1994, Annu . Rev . Microbiol . 48, 163-191) . In Xanthobacter, these alcohols are further catabolized by alcohol and aldehyde dehydrogenase activities, and by the product of the dhlB gene to a second halide and a hydroxyacid . The intermediate halogenated alcohols and, in particular, the aldehydes are more toxic than the haloalkane substrates or the pathway products . We show here that plants, including Arabidopsis, tobacco, oil seed rape and rice, do not express detectable haloalkane dehalogenase activities, and that wild-type Arabidopsis grows in the presence of DCE . In contrast, DCE applied as a volatile can be used to select on plates or in soil transgenic Arabidopsis which express dhlA . The dhlA marker therefore provides haloalkane dehalogenase reporter activity and substrate dependent negative selection in transgenic plants.

Blood Rev, 1999 Jun, 13(2), 91 - 104
Microbiology confirmatory tests for blood donors; Dow BC; Blood donations collected in Scotland are currently screened for the presence of HBsAg, anti-HIV 1 + 2, anti-HCV and syphilis antibodies . Approximately 1% of all donations are found to repeatedly react to one of these four markers on screening but very few represent true infection . These samples must be sent to the designated confirmatory laboratory whose main role is to identify the true positive amongst a sea of 'false positives' . A battery of tests is used for this purpose, usually applied in a defined sequence . The use of such 'confirmatory algorithms' for each marker has been developed by most countries over the years and is now essential to the confirmatory process . The advent of gene amplification techniques such as PCR for initially pooled and eventually single donation testing will be the next challenge for confirmatory laboratories and will demand standards of confirmation as accurate as currently performed with the present serological markers.

Rev Inst Med Trop Sao Paulo, 1999 Mar-Apr, 41(2), 87 - 94
Influence of microbiota in experimental cutaneous leishmaniasis in Swiss mice; de Oliveira MR et al.; Infection of Swiss/NIH mice with Leishmania major was compared with infection in isogenic resistant C57BL/6 and susceptible BALB/c mice . Swiss/NIH mice showed self-controlled lesions in the injected foot pad . The production of high levels of interferon-gamma (IFN-gamma) and low levels of interleukin-4 (IL-4) by cells from these animals suggests that they mount a Th1-type immune response . The importance of the indigenous microbiota on the development of murine leishmaniasis was investigated by infecting germfree Swiss/NIH in the hind footpad with L . major and conventionalizing after 3 weeks of infection . Lesions from conventionalized Swiss/NIH mice were significantly larger than conventional mice . Histopathological analysis of lesions from conventionalized animals showed abscesses of variable shapes and sizes and high numbers of parasitized macrophages . In the lesions from conventional mice, besides the absence of abscess formation, parasites were rarely observed . On the other hand, cells from conventional and conventionalized mice produced similar Th1-type response characterized by high levels of IFN-gamma and low levels of IL-4 . In this study, we demonstrated that Swiss/NIH mice are resistant to L . major infection and that the absence of the normal microbiota at the beginning of infection significantly influenced the lesion size and the inflammatory response at the site of infection.

Curr Opin Rheumatol, 1999 Jul, 11(4), 244 - 50
Enthesitis in spondyloarthropathy; McGonagle D et al.; Inflammation at the insertions of ligaments, tendons, or joint capsules to bone, which is termed enthesitis, is a characteristic feature of spondyloarthropathy . Because of the relative inaccessibility of the enthesis, the inflammatory, microbiologic, and immunologic events at that site have been poorly defined . Recent magnetic resonance imaging studies have drawn attention to the ubiquitous nature of enthesitis in spondyloarthropathies, especially adjacent to synovial joints . This may have implications for the mechanisms of synovitis in spondyloarthropathies . Magnetic resonance imaging studies also suggest that enthesitis lesions may be extensive, which could explain the diffuse nature of bone changes seen in some patients with spondyloarthropathies . The importance of enthesitis as a skeletal phenomenon in spondyloarthropathies has gained further support from transgenic models in which either tumor necrosis factor-alpha or bone morphogenetic protein-6 overexpression result in entheseal-associated polyarthropathy.

Clin Invest Med, 1999 Jun, 22(3), 111 - 8
Testing for HIV among patients with tuberculosis in Montreal; Geduld J et al.; OBJECTIVE: To determine the rate of HIV testing among patients with tuberculosis (TB) in Montreal, and to identify patient characteristics associated with physician screening patterns . Knowledge of local patterns of HIV testing among patients with TB could be used to facilitate the development of strategies to improve compliance with recommendations that all patients with TB be screened for HIV . DESIGN: Retrospective chart review . PATIENTS: All patients with TB reported to the Montreal Public Health Unit from 1992 to 1994 (ages 19 to 50) and from 1992 to 1995 (ages 18 and under) and for whom a chart could be reviewed . OUTCOME MEASURES: Patients with TB screened versus not screened for HIV infection, analyzed to determine which variables independently predict the likelihood of screening for HIV infection . RESULTS: Of the 376 patients with TB for whom data were available, 192 (51%) were screened for HIV . Of those, 33 (17%) had been tested before having received the diagnosis of TB . Multivariate analysis revealed that patients with TB who were male, aged 30 to 39, had a positive sputum smear, displayed at least 1 clinical symptom, received the TB diagnosis from a microbiologist or infectious disease specialist, or reported 1 or more HIV risk factors were more likely to be screened for HIV . CONCLUSIONS: HIV screening of patients with TB is selective, depending on both patient and physician characteristics . Physicians' awareness of recommendations needs to be increased to improve the diagnosis and treatment of TB/HIV co-infection.

Rapid Commun Mass Spectrom, 1999 Jul, 13(13), 1334 - 1338
Determination of (15)N in (15)N-enriched nitrite and nitrate in aqueous samples by reaction continuous flow quadrupole mass spectrometry; Russow R; The (15)N tracer method is the most suitable method for studying complex N transformation processes in microbiology and biochemistry . It entails the constant determination of the (15)N abundance of the inorganic nitrogen (N) compounds nitrite and nitrate . However, (15)N analytical methods are time-consuming, difficult to automate, and require at least 10 microg of N per determination . An additional obstacle in the case of nitrite is that it usually only occurs in very small amounts (ppb) dwarfed by much larger quantities of nitrate (ppm) . More useful is an approach in which the N compound is selectively converted into a gaseous form suitable for direct measurement by mass spectrometry . By using this 'reaction continuous-flow mass spectrometry' (R/CFMS) we developed methods for the (15)N determination of nitrite and nitrate from tracer experiment samples, i.e . artificially enriched in (15)N . Because both methods are based on the same principle, one continuous flow setup connected directly to a quadrupole mass spectrometer for all determinations was used . Nitrite and nitrate are reduced to NO by iodide and titanium(III) chloride, respectively . The technique developed ensures a precision of relative standard deviation </=3% if at least 0.5 and 2 microg N with an abundance of >/=1 at.% are to be measured for nitrite and nitrate, respectively .

Stat Med, 1999 Jul 15, 18(13), 1641 - 56
A test to detect replication in HIV serological data labelled by birth date based on the number of matching pairs in a sample; Greenhalgh D et al.; Diagnoses of HIV infection are reported to the Public Health Laboratory Service (PHLS) by microbiologists through a voluntary confidential surveillance scheme . Names are not recorded on the database but the date of birth of the individual concerned is usually available . This paper discusses a statistical method to detect repeated counting of individuals in these and similar data based on the number of matching pairs in the sample . The test is based on the theoretical result that the null hypothesis of all birth dates equally likely and all individuals distinct minimizes the expected number of matching pairs in the sample . Five of the 16 birth years in the sample taken in 1991 show evidence of more replication than would be expected by chance using a 5 per cent level test . When the test is repeated taking into account a small but statistically significant seasonal variation in the birth rate, the results are very similar .

J Clin Microbiol, 1999 Aug, 37(8), 2587 - 91
Evaluation of the PrimeCapture CMV DNA detection plate system for detection of cytomegalovirus in clinical specimens; Davoli EH et al.; With the availability of anticytomegalovirus (CMV) therapeutic agents, rapid detection of CMV is important in the care and management of the immunosuppressed patient . The PrimeCapture CMV DNA Detection Plate System (PC-PCR) was evaluated for the detection of CMV in blood and cerebrospinal fluid (CSF) . The resolution of discordant results was performed by consensus testing utilizing a combination of conventional cell culture (TC-CPE), the CMV-antigenemia (CMV-Ag) assay, one or more in-house CMV nested PCR assays, and/or patient evaluation and follow-up . Of 51 blood specimens from 34 patients, 23 (45%) were identified as true positives . PC-PCR was significantly more sensitive than the CMV-Ag assay, TC-CPE, or a combination of both tests . The sensitivities, specificities, positive predictive values (PPV), and negative predictive values (NPV) for PC-PCR, the CMV-Ag assay, TC-CPE, and a combination of CMV-Ag and TC-CPE were 78, 75, 72, 81%; 46, 100, 100, 70%; 39, 100, 100, 67%; and 58, 100, 100, 73%, respectively . CMV was not detected or isolated in CSF, resulting in a combined PC-PCR sensitivity, specificity, PPV, and NPV of 77, 90, 68, and 93%, respectively . Among those laboratorians considering the incorporation of molecular CMV diagnostics into their clinical microbiology or virology laboratories, the CMV PC-PCR offers a relatively simple-to-perform and sensitive assay system.

Diagn Microbiol Infect Dis, 1999 Jul, 34(3), 245 - 62
Cryptosporidia and microsporidia--waterborne diseases in the immunocompromised host; Franzen C et al.; Cryptosporidia and microsporidia are emerging parasitic pathogens in immunocompetent and immunocompromised individuals . Cryptosporidium infects several wild and domestic animals that excrete oocysts into the environment and contaminated water represents the major source of infection for humans . Waterborne transmission of Cryptosporidium is a major risk for humans and appropriate measures have to be taken to protect immunocompetent and immunocompromised individuals to become infected . For microsporidia, the sources and ways of transmission are not well documented . Although several animal hosts have been identified recently, the relevant reservoirs of human microsporidia are still unknown . Also, the routes of spreading are unknown . Is microsporidiosis a zoonotic disease that will be transmitted through close contact with infected animals or is contaminated surface water responsible for transmission and represents a relevant reservoir? This review is designed to give information on these two emerging intestinal parasites in a format that will be useful to clinical microbiologists, physicians interested in infectious diseases, and public health personnel.

Commun Dis Public Health, 1999 Jun, 2(2), 151 - 2
Roles and responsibilities of safety officers and advisers; Tearle P; Health and safety should be integrated into all practices and procedures at work . This article looks at the differences between safety officers/advisers, also known as safety practitioners and appointed safely representatives, examining their roles and responsibilities within working environments in general and specifically in microbiology laboratories and offices.

Commun Dis Public Health, 1999 Jun, 2(2), 149 - 50
Future accreditation of clinical microbiology laboratories; Djemal K; Accreditation organisations in the United Kingdom (UK) are seeking to harmonise their practices to comply with internationally recognized standards . As organisations and laboratories work towards achieving alignment with the international accreditation standards, the standards currently applied in clinical microbiology laboratories are likely to change . The enforcement of international standards may demand extra resources to accommodate the necessary changes and it is important that laboratory staff become aware of the potential influence of international accreditation standards on clinical microbiology.

Commun Dis Public Health, 1999 Jun, 2(2), 122 - 5
Enterovirus infections in England and Wales: laboratory surveillance data: 1975 to 1994; Maguire HC et al.; Microbiology laboratories in England and Wales reported 40,366 culture confirmed isolates of echovirus (24,628; 61%) and coxsackievirus (B 11,714; 29%, A 4024; 10%) infections to the PHLS Communicable Disease Surveillance Centre (CDSC) in the 20 years from 1975 to 1994 . Nearly half of the organisms were isolated from faeces, and 5741 were isolated from cerebrospinal fluid (75% of them echovirus, 13% coxsackie B, and 12% coxsackie A) . Isolation rates for all enteroviruses were highest among infants aged 1 to 2 months . Sixty per cent of patients were aged under 5 years, 10% 5 to 9 years, and only 6% 35 years or over . Predominant serotypes were similar to those reported in other countries including the United States, Finland, and Belgium . Seventy-one per cent of reports were made between July and mid December . Periodicity varied between groups and serotypes: some demonstrated peaks at intervals of two to five years . There was evidence of spread of epidemic serotypes across Europe in certain years . Data collected between March and May each year enabled the strains circulating in the following 'season' to be predicted . Such information might be used to warn clinicians to anticipate particular clinical presentations.

Circulation, 1999 Jul 13, 100(2), 155 - 63
Subunit expression of the cardiac L-type calcium channel is differentially regulated in diastolic heart failure of the cardiac allograft; Hullin R et al.; BACKGROUND: Left ventricular diastolic dysfunction is a major cause of cardiac allograft failure . Multimeric L-type calcium channels (alpha1-, alpha2/delta-, and beta-subunits) are essential for excitation/contraction coupling in the heart . Their gene expression was studied in allografts that developed diastolic heart failure . METHODS AND RESULTS: mRNA levels of calcium channel subunits were measured by competitive reverse transcriptase-polymerase chain reaction in microbiopsy samples from the interventricular septum . Size and tissue variabilities between biopsy samples were assessed by determination of cardiac calsequestrin mRNA levels . In the cardiac allografts studied, mRNA levels in microbiopsy samples were considered to represent left ventricular gene expression, because septal and left ventricular gene expression in Northern blots was equivalent, and left ventricles contracted homogeneously . Biopsy samples (n=72) were taken from allografts with normal left ventricular end-diastolic pressure (LVEDP; 8 to 13 mm Hg; n=30), moderately elevated LVEDP (14 to 18 mm Hg; n=26), and elevated LVEDP (19 to 28 mm Hg; n=16) . Increased LVEDP was related to slowed diastolic relaxation determined by the time constant tau (r2=0.86), whereas systolic performance (dP/dt; ejection fraction) was preserved . With increasing LVEDP, mRNA levels of the pore-forming alpha1c-subunit (n=15) and of the regulatory alpha2/delta-subunit (n=17) remained unchanged but decreased exponentially (r2=-0.83) for the regulatory beta-subunit (n=40) . Compared with cardiac allografts with normal LVEDP (n=15), beta-subunit mRNA level was reduced by 75% at elevated LVEDP (n=9; P=0.012) . In an explanted, diastolically failing cardiac allograft, beta-subunit expression was reduced correspondingly by 72% and 76% on the mRNA level in septal and left ventricular myocardium and by 80% on the protein level . CONCLUSIONS: The downregulated expression of the calcium channel beta-subunit might contribute to altered calcium handling in diastolically failing cardiac allografts.

Luminescence, 1999 Jan-Feb, 14(1), 19 - 22
Application of a new high sensitivity luminometer for industrial microbiology and molecular biology; Andreotti PE et al.; A compact new luminometer (FB12) has been developed based on a 370-630 nm photon counter and measuring chamber that can accommodate a range of sample formats . The FB12 permits measurements as low as 1000 molecules of luciferase in reporter gene assays . Its sensitivity for ATP is limited by reagent background . If ATP assay reagents had no chemical background, 2 fg of ATP could be detected using 3 SD of instrument background as the detection limit . The FB12 has a dynamic range of six decades and operates under its own microprocessor programme or protocol-based PC software that is integrated with Microsoft(R) Excel(R) . An injector port above the sample measuring position allows connection of external reagent injectors . Applications are performed using protocols provided with the FB12 or user defined protocols . Examples are presented that illustrate use of the instrument for research and industrial applications .

Monaldi Arch Chest Dis, 1999 Apr, 54(2), 115 - 9
Bronchoalveolar lavage and transbronchial lung biopsy in alveolar and/or ground-glass opacification; Cazzato S et al.; In order to assess the diagnostic yield of bronchoalveolar lavage (BAL) and transbronchial lung biopsy (TBB) in pulmonary diseases with a ground-glass and/or alveolar pattern on high-resolution computed tomography (HRCT) scan, a prospective study was undertaken . Thirty-six patients (17 males, 19 females), mean age 53 yrs, selected on the basis of the presence of an alveolar and/or ground-glass pattern on chest HRCT scan, were submitted to fibreoptic bronchoscopy . All patients underwent BAL . TBBs were performed in 33 cases . A specific diagnosis was achieved, taking into account data obtained by means of serology, microbiology, cytology and histopathology in appropriate clinical settings . Twelve (33%) patients only had the appearance of a ground-glass opacity, whereas 24 (67%) had associated areas of airspace consolidation . BAL was performed in all cases and gave a definitive diagnosis in 21 (58%) . The diagnostic yield of BAL in patients with only ground-glass opacities was no different from that in those patients also showing areas of alveolar consolidation (58 versus 58%) . In eight patients (six with ground-glass opacity and two with alveolar consolidation), BAL provided useful but not definitive information . In these patients, a definitive diagnosis was achieved by means of TBB in seven cases and by open lung biopsy in one case . TBB was performed in 33 out of 36 patients and gave positive results in 25 (76%) . The diagnostic yield of TBB in patients showing areas of alveolar consolidation was significantly higher than in those with pure ground-glass opacity, i.e . 95% (21 of 22) and 36% (4 of 11) respectively (p < 0.001) . BAL and TBB were performed during the same bronchoscopy in 33 patients, and an accurate diagnosis was achieved in 30 (91%) . Overall, the diagnostic yield of TBB (76%) and BAL (56%) did not differ significantly in the whole patient group (p = 0.12), or in patients with a ground-glass opacification (58 versus 36%, p = 0.3) . However, in patients with areas of alveolar consolidation, the diagnostic sensitivity of TBB (95%) was significantly greater than the diagnostic sensitivity of BAL (54%) (p = 0.03) . In conclusion this study shows that high-resolution computed tomography can be helpful in predicting the diagnostic accuracy of bronchological procedures, in particular of bronchoalveolar lavage and transbronchial biopsy, and that alveolar and/or ground-glass are favourable patterns for these diagnostic tools.

Am J Respir Crit Care Med, 1999 Jul, 160(1), 346 - 8
Initial microbiologic studies did not affect outcome in adults hospitalized with community-acquired pneumonia; Sanyal S et al.; Microbiologic studies (MBSs) fail to identify a specific pathogen in more than 50% of patients with community-acquired pneumonia (CAP) . The 1993 American Thoracic Society guideline (ATS-GL) for the management of CAP advised selecting initial antibiotic regimens based on severity of illness and comorbidities . Our study evaluated the role of initial MBS in adult patients hospitalized with CAP and treated according to the ATS-GL . In 184 patients hospitalized at our facility for CAP in 1996, and treated according to the ATS-GL, 25 (14%) failed to respond to initial antibiotic regimens . In these nonresponders, there was no difference in mortality between those in whom antibiotics were changed empirically, and those with MBS-guided changes . We conclude that initial MBS may not be warranted in many adult patients admitted for CAP . Exceptions include patients with conditions that predispose to less common, more resistant pathogens.

J Appl Microbiol, 1999 Jun, 86(6), 999 - 1007
Low level chemiluminescence from liquid culture media; Vogel R et al.; Low level chemiluminescence (CL) can be observed from autoclaved liquid culture media, as used in microbiology . The light emission is oxygen-dependent and arises from reactions following auto-oxidation of reducing Maillard products which are formed during autoclaving . The inhibition of this CL by radical scavengers and antioxidants has been studied . As superoxide radicals and hydrogen peroxide are predominantly involved in the initiation of the CL, the investigation of CL from culture media offers a convenient tool for the detection of exogenous (medium-mediated) oxidative stress being imposed onto micro-organisms in culture . Transition metal ions showed, dependent on concentration, both inhibitory and stimulating effects on the CL, which was also affected by the presence of complexing agents . Iron porphyrins and related complexes displayed a very efficient quenching of the CL, which may be of particular importance, as aerobic micro-organisms have been previously shown to be very efficient in quenching the CL from culture media.

Appl Environ Microbiol, 1999 Jul, 65(7), 3084 - 94
Photosynthetic bradyrhizobia from Aeschynomene spp . are specific to stem-nodulated species and form a separate 16S ribosomal DNA restriction fragment length polymorphism group; Molouba F et al.; We obtained nine bacterial isolates from root or collar nodules of the non-stem-nodulated Aeschynomene species A . elaphroxylon, A . uniflora, or A . schimperi and 69 root or stem nodule isolates from the stem-nodulated Aeschynomene species A . afraspera, A . ciliata, A . indica, A . nilotica, A . sensitiva, and A . tambacoundensis from various places in Senegal . These isolates, together with 45 previous isolates from various Aeschynomene species, were studied for host-specific nodulation within the genus Aeschynomene, also revisiting cross-inoculation groups described previously by D . Alazard (Appl . Environ . Microbiol . 50:732-734, 1985) . The whole collection of Aeschynomene nodule isolates was screened for synthesis of photosynthetic pigments by spectrometry, high-pressure liquid chromatography, and thin-layer chromatography analyses . The presence of puf genes in photosynthetic Aeschynomene isolates was evidenced both by Southern hybridization with a Rhodobacter capsulatus photosynthetic gene probe and by DNA amplification with primers defined from photosynthetic genes . In addition, amplified 16S ribosomal DNA restriction analysis was performed on 45 Aeschynomene isolates, including strain BTAi1, and 19 reference strains from Bradyrhizobium japonicum, Bradyrhizobium elkanii, and other Bradyrhizobium sp . strains of uncertain taxonomic positions . The 16S rRNA gene sequence of the photosynthetic strain ORS278 (LMG 12187) was determined and compared to sequences from databases . Our main conclusion is that photosynthetic Aeschynomene nodule isolates share the ability to nodulate particular stem-nodulated species and form a separate subbranch on the Bradyrhizobium rRNA lineage, distinct from B . japonicum and B . elkanii.

Appl Environ Microbiol, 1999 Jul, 65(7), 2987 - 93
Mechanism of pyrite dissolution in the presence of Thiobacillus ferrooxidans; Fowler TA et al.; In spite of the environmental and commercial interests in the bacterial leaching of pyrite, two central questions have not been answered after more than 35 years of research: does Thiobacillus ferrooxidans enhance the rate of leaching above that achieved by ferric sulfate solutions under the same conditions, and if so, how do the bacteria affect such an enhancement? Experimental conditions of previous studies were such that the concentrations of ferric and ferrous ions changed substantially throughout the course of the experiments . This has made it difficult to interpret the data obtained from these previous works . The aim of this work was to answer these two questions by employing an experimental apparatus designed to maintain the concentrations in solution at a constant value . This was achieved by using the constant redox potential apparatus described previously (P . I . Harvey, and F . K . Crundwell, Appl . Environ . Microbiol . 63:2586-2592, 1997; T . A . Fowler, and F . K . Crundwell, Appl . Environ . Microbiol . 64:3570-3575, 1998) . Experiments were conducted in both the presence and absence of T . ferrooxidans, maintaining the same conditions in solution . The rate of dissolution of pyrite with bacteria was higher than that without bacteria at the same concentrations of ferrous and ferric ions in solution . Analysis of the dependence of the rate of leaching on the concentration of ferric ions and on the pH, together with results obtained from electrochemical measurements, provided clear evidence that the higher rate of leaching with bacteria is due to the bacteria increasing the pH at the surface of the pyrite.

Curr Opin Microbiol, 1999 Jun, 2(3), 299 - 305
Ribosomal DNA sequencing as a tool for identification of bacterial pathogens; Kolbert CP et al.; Conventional methods for the identification and characterization of clinical isolates of bacterial pathogens sometimes fall short when such isolates exhibit unusual phenotypic profiles . Recent advances in DNA sequencing technology have greatly enhanced the ability of the microbiologist to determine the identity of a bacterial isolate . Given the relative objectivity of DNA sequence information and growing availability of sequence information databases, a significant movement is now afoot to use molecular methods for the identification of clinical pathogens.

Cardiovasc Intervent Radiol, 1999 May-Jun, 22(3), 246 - 8
Post-traumatic pseudocyst of the spleen: sclerotherapy with ethanol; Volk M et al.; We report a case of successful percutaneous treatment of a chronic post-traumatic splenic pseudocyst using alcohol as the sclerosing agent . A 26-year-old man presented with a symptomatic cystic mass located in the spleen . Aspiration of 300 ml of fluid was only temporarily effective, and therefore a drainage catheter was placed 3 days later . After histopathologic and microbiologic exclusion of a malignant or infectious origin, local sclerotherapy with alcohol was performed because of recurrence after percutaneous drainage . This therapy was repeated six times within 2 weeks . Two weeks later, the remaining volume was determined to be 16 ml . Six months after treatment the cyst was no longer visible . To our knowledge this is the first case of a chronic post-traumatic splenic cyst treated with alcohol . Percutaneous sclerotherapy of a symptomatic post-traumatic splenic pseudocyst may be an alternative to surgical treatment.

Retina, 1999, 19(3), 213 - 7
Hypodermic needles: a new source of penetrating ocular trauma in Indian children; Jalali S et al.; PURPOSE: To study the clinico-microbiologic profile and visual prognosis of ocular injuries caused by disposable hypodermic needles used by children to squirt water . METHODS: We analyzed 19 consecutive cases of hypodermic needle injury seen at our institute . RESULTS: The average age of the patients was 10.3 years (range, 4-20 years) . A small self-sealed corneal or scleral laceration was seen in 11 eyes; in 8 eyes, the site of injury was occult . Initial visual acuity was no light perception (3 eyes) or hand motion or light perception (16 eyes) . Surgery in 18/19 eyes included vitrectomy with intraocular antibiotic injections for endophthalmitis (14 eyes), evisceration for panophthalmitis (2 eyes), and cataract extraction for traumatic cataract (2 eyes) . Final visual acuity was no light perception or light perception only in 10 eyes, 20/400-20/60 in three eyes, and 20/40 or better in six eyes . CONCLUSIONS: Severe ocular morbidity may result from improper disposal of hypodermic needles.

Cell Mol Life Sci, 1999 May, 55(5), 751 - 70
Immune responses to DNA vaccines; Kowalczyk DW et al.; DNA vaccines, based on plasmid vectors expressing an antigen under the control of a strong promoter, have been shown to induce protective immune responses to a number of pathogens, including viruses, bacteria and parasites . They have also displayed efficacy in treatment or prevention of cancer, allergic diseases and autoimmunity . Immunologically, DNA vaccines induce a full spectrum of immune responses that include cytolytic T cells, T helper cells and antibodies . The immune response to DNA vaccines can be enhanced by genetic engineering of the antigen to facilitate its presentation to B and T cells . Furthermore, the immune response can be modulated by genetic adjuvants in the form of vectors expressing biologically active determinants or by more traditional adjuvants that facilitate uptake of DNA into cells . The ease of genetic manipulation of DNA vaccines invites their use not only as vaccines but also as research tools for immunologists and microbiologists.

Artif Organs, 1999 May, 23(5), 460 - 2
Experimental wound healing with electrical stimulation; Reger SI et al.; The effect of alternating current (AC) and direct current (DC) stimulation was studied on experimental pressure ulcer healing in a new monoplegic pig model . The study was conducted in 30 healthy young Hanford minipigs . The rate of wound healing, histology, vascularization, collagen formation, microbiology, perfusion, and the mechanical strength of the healed wounds were studied . Normal pigskin was compared to denervated control and denervated AC and DC stimulated healed skin . Hind limb denervation was by right unilateral extradural rhizotomies from the L2 to S1 nerve roots . Reproducible uniformly controlled Stage III or higher tissue ulcers were created . When compared to the control wounds, both the AC and DC stimulated wounds showed reduced healing time and increased perfusion in the early phases of healing . DC stimulation reduced the wound area more rapidly than AC, but AC stimulation reduced the wound volume more rapidly than DC . The electrical stimulation did not reduce the strength of the healing wounds below those of the nonstimulated controls . The applied current appears to orient new collagen formation even in the absence of neural influences.

Przegl Lek, 1999, 56(1), 72 - 5
{The effectiveness of conservative treatment of cervical lesions using the LLETZ and CO2 laser}; Lisowski P et al.; Development made on the carcinogenesis process of the cervical lesions and increased detection of the early precancerous lesions enable discontinuance of radical treatments for non-radical techniques which it is of vital importance to young women of the child-bearing capacity . The aim of this study was to determine the efficacy of the non-radical treatment of the cervical lesions using LLETZ procedure (Large Loop Excision of Transition Zone) and laser CO2 vaporisation . 2046 women aged 18-46 who were diagnosed for cervical lesions were treated in the Institute of Obstetrics and Gynaecology Medical School of Bialystok in the years 1994-97 . 216 of which were histologically confirmed for CIN I-III diagnosis . The choice between LLETZ or laser CO2 was made based on a pre-treatment examination (cytology, colposcopy, microbiology test and punch biopsy) . The final results were evaluated from 6 months to 4 years after the treatment . The effectiveness of CO2 laser was 94.6% and was similar to LLETZ--96.4% . In spite of almost complete agreement in both procedures, the LLETZ seems to be more preferred because of the possibility of histological post-treatment verification.

Med Clin (Barc), 1999 May 15, 112(17), 641 - 5
{The usefulness of the bone marrow examination in the etiological diagnosis of prolonged fever in patients with HIV infection}; Fernandez-Aviles F et al.; BACKGROUND: To analyze the usefulness of bone marrow (BM) study in the diagnosis of fever of unknown origin (FUO) in patients infected by the human immunodeficiency virus (HIV) in a single center during a period of 42 months . PATIENTS AND METHODS: 182 episodes of FUO in 162 patients p3th HIV infection were studied . Age, sex, risk factor for HIV infection, hemoglobin level, counts of leucocytes, neutrophils, lymphocytes, CD4 positive lymphocytes, platelets and levels of hepatic enzymes, albumin and beta 2-microglobulin were studied . BM aspirate was performed in all episodes for cytologic and microbiologic examination, and BM biopsy was done in 43 . Analysis of factors related with the probability of diagnosis by BM examination was carried out . RESULTS: The median age was 33 years (range, 22-70), and 123 were males . Drug abuse was the most frequent risk factor for HIV infection (63%) . One hundred thirty patients had previous AIDS diagnosis before they were evaluated for unexplained fever . A specific diagnosis was achieved in 161 episodes (88%) and the most frequent diagnoses were Mycobacterium spp . (55%) and Leishmania spp . (14%) infections . Fifty-four episodes (30%) were diagnosed by BM examination, and in 36 (20%) BM study was the only diagnostic tool . Examination of the BM aspirate yielded the diagnosis in 40 out of the 178 episodes (13%), whereas BM biopsy was a diagnostic tool in 8 (19%); in 9 additional cases (21%) granulomas were observed . Microbiologic study of BM smears for mycobacterial infections was positive in 28 of the 143 episodes (19%), and the culture for Leishmania was positive in 2 out of the 42 cases . The presence of thrombocytopenia (< 75 x 10(9)/l) and elevated serum levels of aspartate-aminotransferase (AST) (> 100 U/l) were the factors associated with a high probability to obtain the diagnosis through BM study . CONCLUSIONS: In patients infected by the HIV and unexplained fever, BM examination is an useful procedure for the diagnosis, particularly in areas where infections by Mycobacterium spp . and Leishmania are prevalent . So that, in our setting, systematic use of this procedure is justified for diagnosis of FUO in those patients.

Arch Dis Child, 1999 Jul, 81(1), 64 - 7
Vulvovaginitis: clinical features, aetiology, and microbiology of the genital tract; Jaquiery A et al.; AIM: To clarify the contribution of clinical and environmental factors and infection to the aetiology of vulvovaginitis in premenarchal girls, and to determine clinical indicators of an infectious cause . DESIGN: It was necessary first to define normal vaginal flora . Cases were 50 premenarchal girls > 2 years old with symptoms of vulvovaginitis; 50 controls were recruited from girls in the same age group undergoing minor or elective surgery . RESULTS: Interview questionnaire showed no difference between cases and controls in regards to hygiene practices, exposure to specific irritants, or history of possible sexual abuse . Normal vaginal flora was similar to that described in previous studies, with the exception of organisms likely to be associated with sexual activity . 80% of cases had no evidence of an infectious cause . In the 10 cases in whom an infectious cause was found, there was significantly more visible discharge and distinct redness of the genital area on examination compared with other cases . CONCLUSIONS: The findings suggest that vulvovaginitis in this age group is not usually infectious or necessarily related to poor hygiene, specific irritants or sexual abuse, although any of these can present with genital irritation . The possibility of sexual abuse should always be considered when a child presents with genital symptoms, but our data indicate it is not a common contributing factor . Infection is generally associated with vaginal discharge and moderate or severe inflammation.

J Zoo Wildl Med, 1999 Mar, 30(1), 100 - 10
Brucella-induced abortions and infection in bottlenose dolphins (Tursiops truncatus); Miller WG et al.; Two bottlenose dolphins (Tursiops truncatus) aborted fetuses that died as a result of Brucella infection . Brucella placentitis occurred in both cases . Infected placenta and vaginal/uterine fluids may transmit Brucella species to other cetaceans . In a third case, an identical organism was cultured from lung necropsy tissue of an adult female T . truncatus . Microbiology, specific polymerase chain reaction, and pulsed-field gel electrophoresis results supported the designation of an additional genomic group(s), Brucella delphini, for isolates adapted to T . truncatus . Current serologic diagnostic tests reliable for known Brucella species are unreliable in detecting dolphin brucellosis . Our findings, together with previous reports, suggest that dolphin brucellosis is a naturally occurring disease that can adversely impact reproduction in cetaceans . The zoonotic significance of cetacean brucellosis is unknown, although the disease has not been reported in people who have frequent contact with dolphins . Further studies on the zoonotic aspects, distribution, prevalence, virulence, and impact of this disease in cetaceans and other marine mammal species are needed.

J Clin Microbiol, 1999 Jul, 37(7), 2241 - 7
Validity of interpretation criteria for standardized Western blots (immunoblots) for serodiagnosis of Lyme borreliosis based on sera collected throughout Europe; Hauser U et al.; Western blotting (WB; immunoblotting) is a widely used tool for the serodiagnosis of Lyme borreliosis (LB), but so far, no generally accepted criteria for performance and interpretation have been established in Europe . The current study was preceeded by a detailed analysis of WB with whole-cell lysates of three species of Borrelia burgdorferi sensu lato (U . Hauser, G . Lehnert, R . Lobentanzer, and B . Wilske, J . Clin . Microbiol . 35:1433-1444, 1997) . In that study, interpretation criteria for a positive WB result were developed with the data for 330 serum samples (from patients with LB in different stages {n = 189} and from a control group {n = 141}) originating mostly from southern Germany . In the present work, the interpretation criteria for strains PKo (Borrelia afzelii) and PBi (Borrelia garinii) developed in the previous study were reevaluated with 224 serum samples (from patients with LB in different stages {n = 97} and from a control group {n = 127}) originating from throughout Europe that were provided by the European Union Concerted Action on Lyme Borreliosis (EUCALB) . De novo criteria were developed on the basis of the reactivities of the EUCALB sera and were evaluated with the data for the samples from southern Germany . Comparison of all results led to the following recommendations: For WB for immunoglobulin G (IgG), at least two bands among p83/100, p58, p43, p39, p30, OspC, p21, p17, and p14 for PKo and at least one band among p83/100, p39, p30, OspC, p21, and p17b for PBi; for WB for IgM, at least one band among p39, OspC, and p17 or a strong p41 band for PKo and at least one band among p39 and OspC or a strong p41 band for PBi . WB with PKo was the most sensitive, and this strain is recommended for use in WB for the serodiagnosis of LB throughout Europe.

J Hosp Infect, 1999 May, 42(1), 1 - 6
Laboratory role in the management of hospital acquired infections; Wilson MP et al.; The microbiology laboratory has many important roles . It must collaborate with the infection control team on the investigations of outbreaks . During outbreaks, it must save relevant samples, look for reservoirs and undertake typing techniques, all of which should be timely . New technology should be available to detect, identify and characterize micro-organisms . Molecular biological techniques have enhanced the speed and sensitivity of detection methods and have allowed the laboratory to identify organisms that do not grow or grow slowly in culture . Molecular techniques also enable the microbiologist to identify antibiotic resistance genes and to 'fingerprint' hospital organisms, thereby facilitating studies of nosocomial transmission.

Adolesc Med, 1995 Feb, 6(1), 45 - 54
Infectious Hepatitis A and Enteric Hepatitis E; Rose E et al.; Infectious hepatitis A and enteric hepatitis E have a peak incidence in late adolescence or young adulthood . Using a 14-year-old boy as an example, the authors trace the course of hepatitis A through the preicteric and icteric phases, the development of persistent jaundice, relapse, and liver failure . The discussion of hepatitis E addresses microbiology and clinical course of the condition.

Microbiol Mol Biol Rev . 1999 Jun;63(2):265.
A paean to Microbiology and Molecular Biology Reviews; Schaechter M; This article celebrates the accomplishments of Microbiology and Molecular Biology Reviews from its early days to the present time . The importance of this journal in the professional lives of microbiologists is emphasized, and examples of outstanding reviews are presented.

Int J Food Microbiol, 1999 Mar 1, 47(1-2), 141 - 6
Predicting fungal growth: the effect of water activity on Penicillium roqueforti; Valik L et al.; The effect of water activity on the colony growth of Penicillium roqueforti is studied by predictive modelling techniques . Measured colony diameter growth curves are fitted to estimate the growth rate and lag phase of the curves . The colony growth rate was modelled by a quadratic function of transformed water activity (a(w)) values, as suggested by Baranyi et al . (Food Microbiol . 10 (1993) 43-59) . The lag time was modelled as a function of water activity, by means of the sum of a constant term and a hyperboloid function of a(w) raised to the second power . The lag-phase of Penicillium roqueforti was found insensitive to the water activity in the range of its higher (a(w) > 0.92) values.

Clin Lab Sci, 1999 Jan-Feb, 12(1), 12 - 3
The use of interactive technology in the classroom; Kresic P; This article discusses the benefits that clinical laboratory science students and instructors experienced through the use of and integration of computer technology, microscopes, and digitizing cameras . Patient specimens were obtained from the participating clinical affiliates, slides stained or wet mounts prepared, images viewed under the microscope, digitized, and after labeling, stored into an appropriate folder . The individual folders were labeled as Hematology, Microbiology, Chemistry, or Urinalysis . Students, after obtaining the necessary specimens and pertinent data, created case study presentations for class discussions . After two semesters of utilizing videomicroscopy/computer technology in the classroom, students and instructors realized the potential associated with the technology, namely, the vast increase in the amount of organized visual and scientific information accessible and the availability of collaborative and interactive learning to complement individualized instruction . The instructors, on the other hand, were able to provide a wider variety of visual information on individual bases . In conclusion, the appropriate use of technology can enhance students' learning and participation . Increased student involvement through the use of videomicroscopy and computer technology heightened their sense of pride and ownership in providing suitable information in case study presentations . Also, visualization provides students and educators with alternative methods of teaching/learning and increased retention of information.

Adolesc Med, 1990 Oct, 1(3), 565 - 582
Sexually Transmitted Diseases in Homosexual Youth; Remafedi G; The prevalence of sexually transmitted diseases (STDs) in homosexual populations is due to a complex interrelationship of host and pathogen factors . This chapter explores the risk factors, epidemiology, microbiology, clinical aspects, and prevention of STDs in homosexual youth . This discussion focuses on male adolescents, because STDs are uncommon among exclusively homosexual women.

Appl Environ Microbiol, 1999 Jun, 65(6), 2341 - 9
Effect of temperature on structure and function of the methanogenic archaeal community in an anoxic rice field soil; Chin KJ et al.; Soil temperatures in Italian rice fields typically range between about 15 and 30 degrees C . A change in the incubation temperature of anoxic methanogenic soil slurry from 30 degrees C to 15 degrees C typically resulted in a decrease in the CH4 production rate, a decrease in the steady-state H2 partial pressure, and a transient accumulation of acetate . Previous experiments have shown that these changes were due to an alteration of the carbon and electron flow in the methanogenic degradation pathway of organic matter caused by the temperature shift (K . J . Chin and R . Conrad, FEMS Microbiol . Ecol . 18:85-102, 1995) . To investigate how temperature affects the structure of the methanogenic archaeal community, total DNA was extracted from soil slurries incubated at 30 and 15 degrees C . The archaeal small-subunit (SSU) rRNA-encoding genes (rDNA) of these environmental DNA samples were amplified by PCR with an archaeal-specific primer system and used for the generation of clone libraries . Representative rDNA clones (n = 90) were characterized by terminal restriction fragment length polymorphism (T-RFLP) and sequence analysis . T-RFLP analysis produced for the clones terminally labeled fragments with a characteristic length of mostly 185, 284, or 392 bp . Sequence analysis allowed determination of the phylogenetic affiliation of the individual clones with their characteristic T-RFLP fragment lengths and showed that the archaeal community of the anoxic rice soil slurry was dominated by members of the families Methanosarcinaceae (185 bp) and Methanosaetaceae (284 bp), the kingdom Crenarchaeota (185 or 284 bp), and a novel, deeply branching lineage of the (probably methanogenic) kingdom Euryarchaeota (392 bp) that has recently been detected on rice roots (R . Grosskopf, S . Stubner, and W . Liesack, Appl . Environ . Microbiol . 64:4983-4989, 1998) . The structure of the archaeal community changed when the temperature was shifted from 30 degrees C to 15 degrees C . Before the temperature shift, the clones (n = 30) retrieved from the community were dominated by Crenarchaeota (70%), "novel Euryarchaeota" (23%), and Methanosarcinacaeae (7%) . Further incubation at 30 degrees C (n = 30 clones) resulted in a relative increase in members of the Methanosarcinaceae (77%), whereas further incubation at 15 degrees C (n = 30 clones) resulted in a much more diverse community consisting of 33% Methanosarcinaceae, 23% Crenarchaeota, 20% Methanosaetaceae, and 17% novel Euryarchaeota . The appearance of Methanosaetaceae at 15 degrees C was conspicuous . These results demonstrate that the structure of the archaeal community in anoxic rice field soil changed with time and incubation temperature.

J Clin Pathol, 1999 Jan, 52(1), 54 - 60
Use of bar code readers and programmable keypads to improve the speed and accuracy of manual data entry in the clinical microbiology laboratory: experience of two laboratories; Shaw R et al.; AIM: To assess the effect of the use of bar code readers and programmable keypads for entry of specimen details and results in two microbiology laboratories . METHODS: The solutions selected in each laboratory are described . The benefits resulting from the implementation were measured in two ways . The speed of data entry and error reduction were measured by observation . A questionnaire was completed by users of bar codes . RESULTS: There were savings in time and in reduced data entry errors . Average time to enter a report by keyboard was 21.1 s v 14.1 s for bar coded results entry . There were no observed errors with the bar code readers but 55 errors with keystroke entries . The laboratory staff of all grades found the system fast, easy to use, and less stressful than conventional keyboard entry . CONCLUSIONS: Indirect time savings should accrue from the observed reduction in incorrectly entered data . Any microbiology laboratory seeking to improve the accuracy and efficiency of data entry into their laboratory information systems should consider the adoption of this technology which can be readily interfaced to existing terminals.

Cornea, 1999 May, 18(3), 257 - 61
Single culture media in infectious keratitis; Waxman E et al.; PURPOSE: To evaluate the usefulness of the various culture media used in the traditional workup in infectious keratitis . METHODS: Microbiology data sheets from all corneal cultures performed at the University of California Davis Medical Center over a 1-year period were reviewed retrospectively . RESULTS: Bacterial cultures were sent in 76 cases . In 19 cases, culture specimens from ulcers were plated onto blood, chocolate, and inhibitory mold agar and were inoculated into an anaerobic medium . In 58 cases, blood and chocolate agar were sent . In 70% of cases, blood and chocolate agar provided identical information . Inhibitory mold agar was positive twice in 39 plates sent . A fungal pathogen had been identified on chocolate agar plates sent for these cases . CONCLUSION: In the evaluation of infectious keratitis, plating onto chocolate agar or blood agar alone is a reasonable alternative to sending multiple cultures.

Br Dent J, 1999 Apr 10, 186(7), 345 - 7
Barriers to the use of a diagnostic oral microbiology laboratory by general dental practitioners; Roy KM et al.; OBJECTIVE: To identify barriers on the use of diagnostic microbiology facilities in general dental practice . DESIGN: A cross-sectional survey using a postal questionnaire . SETTING: Primary/secondary care interface between the diagnostic oral microbiology laboratory, University of Glasgow Dental Hospital and School, Glasgow and dental practitioners within the surrounding health boards, 1998 . SUBJECTS: All GDPs (797) within Argyll and Clyde, Ayrshire and Arran, Lanarkshire and Greater Glasgow Health Boards . MAIN OUTCOME MEASURES: The responses were expressed as both absolute and relative frequencies . RESULTS: Responses were received from 430 (55%) . The most frequent reason for failure to use the service was lack of information, with more than half of the respondents claiming to be unaware of the facility . Lack of request forms and sampling equipment were also viewed as barriers to using the service . CONCLUSIONS: The laboratory is failing to successfully communicate its role in addressing the growing burden of antibiotic resistance in the community and must be more proactive in encouraging appropriate use and increasing accessibility of the service to GDPs.

Front Biosci, 1999 May 15, 4, e34 - 41
Inhibitor resistant class A beta-lactamases; Bonomo RA et al.; Beta-lactamase inhibitors (clavulanic acid, tazobactam, and sulbactam) greatly enhance the therapeutic efficacy of their partner antibiotics (amoxacillin, ampicillin, piperacillin, and ticarcillin) against common enteric and non-enteric organisms possessing class A beta-lactamases . Unfortunately, the number of class A enzymes being discovered that are resistant to these combinations is increasingly rapidly . The TEM and SHV class A beta-lactamases resistant to inhibitors have point mutations in critical amino acids important for catalysis . Compared to the wild type beta-lactamase, inhibitor resistant enzymes are inefficient at hydrolyzing benzylpenicillin, aminopenicillins, and cephalosporins . Nevertheless, hyper-production of these enzymes resulting from mutations in the promoter region can confer substantial levels of resistance . Understanding the microbiologic and kinetic properties of these inhibitor resistant class A beta-lactamases can lead to the design of more potent beta-lactam compounds as well as more effective inhibitors.

Mikrobiol Z, 1999 Jan-Feb, 61(1), 3 - 31
{The patterns in the molecular biology of the adenoviruses (the results of a 20-year study at the Institute of Microbiology and Virology of the National Academy of Sciences of Ukraine)}; Diachenko NS; Scientific data of the highest importance and priority concerning regularities of structural and functional organization of proteins of adenoviruses capsids and peculiarities of expression of the virus genome are as follows: New antigen determinants of hexon and adenovirus fiber have been discovered, their different nature (conformational or linear) and different orientation, depending on the spatial organization of proteins, have been proved; localization of some epitopes has been determined with the help of synthesised antigen-active peptides, imitating them . Some regularities of structural and functional organization of adenovirus hexon have been determined on the basis of comparative analysis of antigenic specificity and primary structure of proteins being apart in taxonomic respect . The conception of immunoactivation (infectivity neutralization) of adenoviruses has been developed, and a mathematical model of this process has been first proposed, which determines the impact of antibodies to several antigenic determinants of hexon and fiber as well as interferon and complement . The unknown peculiarities of the adenovirus genome expression were studied in the dynamics of productive infection or under the effect of modified nucleosides, proteolysis inhibitors and those of different nature promising for chemotherapy of adenovirus infection . Lymphotropicity of adenoviruses was established and a model of the mixed infection of lymphocytes with adenoviruses, HIV, and Epstein-Barr virus of the herpes virus family was proposed for the first time . It was determined that the mutual interference of viruses was developed at the process of a single or successive infection and this was important to understand AIDS immunopathogenesis . Data presented substantiate the ways of creation of modern efficient preparations for diagnosis, prophylaxis and chemotherapy of adenovirus infection.

Arch Intern Med, 1999 May 10, 159(9), 970 - 80
Processes and outcomes of care for patients with community-acquired pneumonia: results from the Pneumonia Patient Outcomes Research Team (PORT) cohort study; Fine MJ et al.; BACKGROUND: Although understanding the processes of care and medical outcomes for patients with community-acquired pneumonia is instrumental to improving the quality and cost-effectiveness of care for this illness, limited information is available on how physicians manage patients with this illness or on medical outcomes other than short-term mortality . OBJECTIVES: To describe the processes of care and to assess a broad range of medical outcomes for ambulatory and hospitalized patients with community-acquired pneumonia . METHODS: This prospective, observational study was conducted at 4 hospitals and 1 health maintenance organization in Pittsburgh, Pa, Boston, Mass, and Halifax, Nova Scotia . Data were collected via patient interviews and reviews of medical records for 944 outpatients and 1343 inpatients with clinical and radiographic evidence of community-acquired pneumonia . Processes of care and medical outcomes were assessed 30 days after presentation . RESULTS: Only 29.7% of outpatients had 1 or more microbiologic tests performed, and only 5.7% had an assigned microbiologic cause . Although 95.7% of inpatients had 1 or more microbiologic tests performed, a cause was established in only 29.6% . Six outpatients (0.6%) died, and 3 of these deaths were pneumonia related . Of surviving outpatients, 8.0% had 1 or more medical complications . At 30 days, 88.9% (nonemployed) to 95.6% (employed) of the surviving outpatients had returned to usual activities, yet 76.0% of outpatients had 1 or more persisting pneumonia-related symptoms . Overall, 107 inpatients (8.0%) died, and 81 of these deaths were pneumonia related . Most surviving inpatients (69.0%) had 1 or more medical complications . At 30 days, 57.3% (non-employed) to 82.0% (employed) of surviving inpatients had returned to usual activities, and 86.1% had 1 or more persisting pneumonia-related symptoms . CONCLUSIONS: In this study, conducted primarily at hospital sites with affiliated medical education training programs, virtually all outpatients and most inpatients had pneumonia of unknown cause . Although outpatients had an excellent prognosis, pneumonia-related symptoms often persisted at 30 days . Inpatients had substantial mortality, morbidity, and pneumonia-related symptoms at 30 days.

J Clin Microbiol, 1999 Jun, 37(6), 2106 - 8
Mycobacterium bovis BCG causing vertebral osteomyelitis (Pott's disease) following intravesical BCG therapy; Aljada IS et al.; We report a case of Mycobacterium bovis BCG vertebral osteomyelitis in a 79-year-old man 2.5 years after intravesical BCG therapy for bladder cancer . The recovered isolate resembled M . tuberculosis biochemically, but resistance to pyrazinamide (PZA) rendered that diagnosis suspect . High-pressure liquid chromatographic studies confirmed the diagnosis of M . bovis BCG infection . The patient was originally started on a four-drug antituberculous regimen of isoniazid, rifampin, ethambutol, and PZA . When susceptibility studies were reported, the regimen was changed to isoniazid and rifampin for 12 months . Subsequently, the patient was transferred to a skilled nursing facility for 3 months, where he underwent intensive physical therapy . Although extravesical adverse reactions are rare, clinicians and clinical microbiologists need to be aware of the possibility of disseminated infection by M . bovis BCG in the appropriate setting of clinical history, physical examination, and laboratory investigation.

J Clin Microbiol, 1999 Jun, 37(6), 1967 - 70
Comparison of three commercial systems for identification of yeasts commonly isolated in the clinical microbiology laboratory; Wadlin JK et al.; We evaluated three commercial systems (RapID Yeast Plus System; Innovative Diagnostic Systems, Norcross, Ga.; API 20C Aux; bioMerieux-Vitek, Hazelwood, Mo.; and Vitek Yeast Biochemical Card, bioMerieux-Vitek) against an auxinographic and microscopic morphologic reference method for the ability to identify yeasts commonly isolated in our clinical microbiology laboratory . Two-hundred one yeast isolates were compared in the study . The RapID Yeast Plus System was significantly better than either API 20C Aux (193 versus 167 correct identifications; P < 0.0001) or the Vitek Yeast Biochemical Card (193 versus 173 correct identifications; P = 0.003) for obtaining correct identifications to the species level without additional testing . There was no significant difference between results obtained with API 20C Aux and the Vitek Yeast Biochemical Card system (P = 0.39) . The API 20C Aux system did not correctly identify any of the Candida krusei isolates (n = 23) without supplemental testing and accounted for the major differences between the API 20C Aux and RapID Yeast Plus systems . Overall, the RapID Yeast Plus System was easy to use and is a good system for the routine identification of clinically relevant yeasts.

J Clin Microbiol, 1999 Jun, 37(6), 1752 - 7
Density and molecular epidemiology of Aspergillus in air and relationship to outbreaks of Aspergillus infection; Leenders AC et al.; After five patients were diagnosed with nosocomial invasive aspergillosis caused by Aspergillus fumigatus and A . flavus, a 14-month surveillance program for pathogenic and nonpathogenic fungal conidia in the air within and outside the University Hospital in Rotterdam (The Netherlands) was begun . A . fumigatus isolates obtained from the Department of Hematology were studied for genetic relatedness by randomly amplified polymorphic DNA (RAPD) analysis . This was repeated with A . fumigatus isolates contaminating culture media in the microbiology laboratory . The density of the conidia of nonpathogenic fungi in the outside air showed a seasonal variation: higher densities were measured during the summer, while lower densities were determined during the fall and winter . Hardly any variation was found in the numbers of Aspergillus conidia . We found decreasing numbers of conidia when comparing air from outside the hospital to that inside the hospital and when comparing open areas within the hospital to the closed department of hematology . The increase in the number of patients with invasive aspergillosis could not be explained by an increase in the number of Aspergillus conidia in the outside air . The short-term presence of A . flavus can only be explained by the presence of a point source, which was probably patient related . Genotyping A . fumigatus isolates from the department of hematology showed that clonally related isolates were persistently present for more than 1 year . Clinical isolates of A . fumigatus obtained during the outbreak period were different from these persistent clones . A . fumigatus isolates contaminating culture media were all genotypically identical, indicating a causative point source . Knowledge of the epidemiology of Aspergillus species is necessary for the development of strategies to prevent invasive aspergillosis . RAPD fingerprinting of Aspergillus isolates can help to determine the cause of an outbreak of invasive aspergillosis.

Rev Clin Esp, 1999 Mar, 199(3), 132 - 5
{Primary resistance of Mycobacterium tuberculosis in 10 hospitals of the community of Castille and Leon . Group of Microbiologists from Castille and Leon}; Alberte Castineiras A et al.; OBJECTIVE: To determine the primary drug resistance (PDR) of Mycobacterium tuberculosis in ten hospitals in the Castile-Leon Community for a five-year period (1991-1995), in a sanitary area with almost two millions of inhabitants . MATERIAL AND METHODS: The sensitivity of 825 strains of Mycobacterium tuberculosis to antituberculous drugs was studied using the proportion method; 773 strains were from HIV-negative patients and 52 from HIV-positive patients . RESULTS: Thirty-four out of the 824 strains were resistant to one or more drugs: 31 (4%) from HIV-negative patients and 3 (5.7%) from HIV-positive patients . The resistance to the different drugs for strains from HIV-negative patients was: streptomycin, 2.4%; isoniazid, 1.8%; ethambutol, 0.6%, and rifampin, 0.2% . For HIV-positive patients, resistance to streptomycin was 5.7% and to isoniazid 1.9% . Resistance to a single agent was the resistance mode observed most commonly: 23 (2.9%) in HIV-negative patients and 2 (3.3%) in HIV-positive patients . There was not a single strain resistant to isoniazid and rifampin . CONCLUSIONS: The incidence of PR in the surveyed area was low, including isoniazid . The group of HIV-positive patients did not show a significant increase in resistance (p = 0.4; OR, 1.44; 95% CI, 0.43-4.86) . Regular surveillance of drug resistance is recommended to adjust therapeutic regimes.

Trop Gastroenterol, 1998 Oct-Dec, 19(4), 145 - 7
Prevalence of hepatitis B virus infection amongst healthy Nepalese males; Manandhar K et al.; Sera from 478 healthy Nepalese males, inhabiting various districts of five development regions of Nepal were collected from October 1996 to March 1997 and examined for the presence of HBsAg by third generation ELISA and latex agglutination test in the laboratory of Central Department of Microbiology, Tribhuvan University, Kirtipur . The surface antigen was detected by ELISA in 4% (19/478) of subjects studied . However, different results were obtained in Latex agglutination test . The correlation between the results obtained from these two different tests is statistically significant (X2 = 85.11, P < 0.05) . The results obtained from ELISA showed the probability of Nepal to fall in WHO category of intermediate endemicity zone for hepatitis B infection . The percent positivity of HBsAg was found to increase steadily from Eastern (2%) to Far Western (6%) development regions . None of the samples represented from Kathmandu valley were positive for HBsAg . Hepatitis B infection was present in the age groups of 16-20 years and 36-40 years . The levels of ALT were assayed in all samples recorded positive for HBsAg from ELISA . Sixteen percent (3/19) of the infected subjects had raised ALT levels while 84% (16/19) had normal levels.

Infect Immun, 1999 May, 67(5), 2266 - 76
Membrane topology and cellular location of the Treponema pallidum glycerophosphodiester phosphodiesterase (GlpQ) ortholog; Shevchenko DV et al.; Recent reports that isolated Treponema pallidum outer membranes contain an ortholog for glycerophosphodiester phosphodiesterase (GlpQ) (D . V . Shevchenko, D . R . Akins, E . J . Robinson, M . Li, O . V . Shevchenko, and J . D . Radolf, Infect . Immun . 65:4179-4189, 1997) and that this protein is a potential opsonic target for T . pallidum (C . E . Stebeck, J . M . Shaffer, T . W . Arroll, S . A . Lukehart, and W . C . Van Voorhis, FEMS Microbiol . Lett . 154:303-310, 1997) prompted a more detailed investigation of its physicochemical properties and cellular location . {14C}palmitate radiolabeling studies of a GlpQ-alkaline phosphatase fusion expressed in Escherichia coli confirmed the prediction from DNA sequencing that the protein is lipid modified . Studies using Triton X-114 phase partitioning revealed that the protein's amphiphilicity is due to lipid modification and that a substantial portion of the polypeptide is associated with the T . pallidum peptidoglycan sacculus . Three different approaches, i.e., (i) proteinase K treatment of intact treponemes, (ii) indirect immunofluorescence analysis of treponemes encapsulated in agarose beads, and (iii) opsonophagocytosis of treponemes incubated with antiserum against recombinant GlpQ by rabbit peritoneal macrophages, confirmed that GlpQ is entirely subsurface in T . pallidum . Moreover, rabbits hyperimmunized with GlpQ were not protected against intradermal challenge with virulent treponemes . Circular dichroism spectroscopy confirmed that the recombinant form of the polypeptide lacked discernible evidence of denaturation . Finally, GlpQ was not radiolabeled when T . pallidum outer membranes were incubated with 3-(trifluoromethyl)-3-(m-{125I}iodophenyl)-diazarene, a photoactivatable, lipophilic probe which promiscuously labels both proteins and lipids within phospholipid bilayers . Taken as a whole, these studies indicate that the T . pallidum GlpQ ortholog is a periplasmic protein associated predominantly with the spirochete's peptidoglycan-cytoplasmic membrane complex.

Infect Immun, 1999 May, 67(5), 2233 - 40
Replication of Toxoplasma gondii, but not Trypanosoma cruzi, is regulated in human fibroblasts activated with gamma interferon: requirement of a functional JAK/STAT pathway; Ceravolo IP et al.; To study the role of tryptophan degradation by indoleamine 2, 3-dioxygenase (INDO) in the control of Trypanosoma cruzi or Toxoplasma gondii replication, we used human fibroblasts and a fibrosarcoma cell line (2C4) . The cells were cultured in the presence or absence of recombinant gamma interferon (rIFN-gamma) and/or recombinant tumor necrosis factor alpha (rTNF-alpha) for 24 h and were then infected with either T . cruzi or T . gondii . Intracellular parasite replication was evaluated 24 or 48 h after infection . Treatment with rIFN-gamma and/or rTNF-alpha had no inhibitory effect on T . cruzi replication . In contrast, 54, 73, or 30% inhibition of T . gondii replication was observed in the cells treated with rIFN-gamma alone, rIFN-gamma plus rTNF-alpha, or TNF-alpha alone, respectively . The replication of T . gondii tachyzoites in cytokine-activated cells was restored by the addition of extra tryptophan to the culture medium . Similarly, T . gondii tachyzoites transfected with bacterial tryptophan synthase were not sensitive to the microbiostatic effect of rIFN-gamma . We also investigated the basis of the cytokine effect on parasite replication by using the three mutant cell lines B3, B9, and B10 derived from 2C4 and expressing defective STAT1alpha (signal transducer and activator of transcription), JAK2 (Janus family of cytoplasmic tyrosine kinases), or JAK1, respectively, three important elements of a signaling pathway triggered by rIFN-gamma . We found that rTNF-alpha was able to induce low levels expression of INDO mRNA in the parental cell line, as well as the cell line lacking functional JAK2 . In contrast to the parental cell line (2C4), rIFN-gamma was not able to induce the expression of INDO mRNA or microbiostatic activity in any of the mutant cell lines . These findings indicate the essential requirement of the JAK/STAT pathway for the induction of high levels of INDO mRNA, tryptophan degradation, and the anti-Toxoplasma activity inside human nonprofessional phagocytic cells.

Clin Chem, 1999 May, 45(5), 739 - 45
Genetic testing and the clinical laboratory improvement amendments of 1988: present and future; Schwartz MK; CLIA '88 superseded CLIA '67 . CLIA '88 set standards designed to improve quality and expanded federal oversight to virtually all clinical laboratories in the United States . Presumably because genetics testing was then in its infancy, CLIA '88 did not devote a special section to genetics testing . Biochemical and immunochemical tests used to evaluate inborn errors of metabolism and other genetic entities were categorized as analytes in the Clinical Chemistry section, and DNA probes used primarily in infectious disease were included in Microbiology . The legal, social, economic, and ethical implications of genetic testing and the rapid commercialization of these tests led to recommendations that genetic testing be defined as a laboratory specialty with a subsection in CLIA . The advisory committee created under CLIA was assigned to review these recommendations . The committee agreed that genetics testing was sufficiently different from other areas already included in CLIA to warrant a separate section . Two definitions were adopted . The more clear-cut one is for molecular genetic and cytogenic tests . This includes the analysis of human DNA/RNA in evaluating genetic diseases . The second definition is not as clear-cut and is for the analysis of proteins and metabolites used predominantly to detect inborn errors of metabolism . Many of these analytes already are categorized according to their uses for other purposes . The recommendations for genetic testing include detailed and specific proposals concerning personnel, confidentiality and informed consent, quality control, contamination, proficiency testing, validation of tests, special reporting, retention of records, and reuse of tested specimens.

Enferm Infecc Microbiol Clin, 1999 Mar, 17(3), 119 - 25
{Evaluation of a simple rapid polymerase chain reaction (PCR) technique for the diagnosis of Helicobacter pylori infection in childhood}; Munoz C et al.; BACKGROUND: The purpose of this study was to evaluate the use of polymerase chain reaction (PCR) applied to the diagnosis Helicobacter pylori infection in the pediatric population, by means of a rapid and simple method of extraction and posterior detection by a colorimetric hybridation of amplified H . pylori DNA . METHODS: Fifty three gastric biopsies, obtained through upper gastrointestinal endoscopy from 53 patients with gastric pathology (45 recidivant abdominal pain and eight hematemesis), were processed from october 1995 to july 1996 . Three non invasive tests were performed: detection of IgG by (Cobas) Core Anti-H . pylori EIA (Roche), breath test with 13C-urea and PCR of dental plaque, as well as four invasive ones: histologic study, culture into selective (Pylori Agar, bioMerieux) and non selective media (Columbia Agar with 5% sheep blood, bioMerieux), test of rapid urease and PCR of gastric biopsies . A 20% solution of Chelex 100 resin (DNA Extraction Reagen, Perkin Elmer) was used for DNA extraction, amplification was performed from gen ureA (Clayton, 1992) and amplified DNA was detected by colorimetric hybridation (PCR ELISA, Boehringer, Mannheim) . Duration of the PCR process was: extraction 25 min, amplification two hours and detection three hours . RESULTS: Results of culture and PCR from gastric biopsies agreed in 84.3% of cases (27 positives, 16 negatives and two not determined) . Two samples were positive by culture and negative by PCR, and were considered as PCR false negatives due to positivity of three or more other tests . Six samples were negative by culture and positive by PCR, being considered as culture false negatives due to positivity of three or more other tests . Sensitivity of PCR and culture was 94.2 and 82.8% . Specificity was 100% for both tests . None of the dental plaque samples was positive . CONCLUSIONS: When invasive techniques are to be done for microbiologic diagnose of H . pylori, PCR increases the confirmation rate of infection; the present procedure enables daily routine work due to its simplicity and its short turnaround time.

Enferm Infecc Microbiol Clin, 1999 Mar, 17(3), 113 - 8
{outbreak of invasive pulmonary mycosis in neutropenic hematologic patients in relation to remodelling construction work}; Gaspar C et al.; BACKGROUND: An increase was observed in the number of cases of invasive pulmonary mycosis in neutropenic hematologic patients coinciding with construction work being carried out in the Hospital Clinico San Carlos (Madrid, Spain) . The aim of this study was to confirm the existence of an outbreak, identify the factors related and adopt adequate control measures . METHODS: A descriptive, epidemiologic, environmental microbiologic study was performed . The incidence of cases in the study period and a control period was compared . Air samples were collected in the affected area and other areas of hospitalization not related to the construction work . The ventilation system of the Hemalotogy Isolation Unit (HIU) was also sampled . The control measures undertaken included: hermetic sealing of the construction work adjacent to hematology followed by transfer of the patients to another floor of the hospital . RESULTS: The existence of an outbreak was confirmed (significant increase in the incidence, p = 0.017) . Eleven cases and one death by massive hemoptisis were reported . The mean total fungal count and to Aspergillus spp were 120 and 35 UFC/m3, respectively in the hematologic hospitalization area adjacent to the construction work and 37 and 5 UFC/m3 in other areas (p < 0.001) . Contamination was detected in the ventilation system of the HIU by A . fumigatus (125 UFC/m3 of air from the interior of the conduct) . CONCLUSIONS: An elevated number of fungal spores found in samples from the hematologic hospitalization area as well as no further new cases being reported following the transfer of the patients suggest that the outbreak was related to the adjacent construction work being carried out.

Retina, 1999, 19(2), 98 - 102
Microbiologic yields and complication rates of vitreous needle aspiration versus mechanized vitreous biopsy in the Endophthalmitis Vitrectomy Study; Han DP et al.; PURPOSE: To compare the microbiologic yields and complication rates associated with vitreous needle tap and vitreous biopsy in the Endophthalmitis Vitrectomy Study (EVS) . METHODS: Of 420 EVS patients with postoperative endophthalmitis, 201 received immediate vitreous tap or biopsy (without pars plana vitrectomy) by random assignment and 193 completed 9-12 months of follow-up . Vitreous specimens were obtained by biopsy with a 20-gauge vitrectomy cutting instrument or by needle tap with a 22-27-gauge needle . If resistance to aspiration by needle tap was noted, a vitreous biopsy was performed . RESULTS: Of 201 patients undergoing tap or biopsy, 70 (35%) had needle tap, 127 (63%) had mechanized biopsy, and 4 (2%) had initial needle tap that was aborted to mechanized biopsy ("abort" eyes) . Intraoperative hyphema occurred in 2 tap eyes (3%), 3 biopsy eyes (2%), and 0 (0%) abort eyes . Postoperative retinal detachment developed in 8 (11%) tap eyes, 10 (8%) biopsy eyes, and 0 (0%) abort eyes (not significant) . Respective rates of culture and gram stain positivity were 69% and 42% in tap eyes and 66% and 41% in biopsy eyes (not significant) . The rate of severe visual loss (final acuity <5/200) was significantly higher in tap eyes (16 eyes, 24%) compared with biopsy eyes (13 eyes, 11%) and abort eyes (0 eyes, 0%; P = 0.043) . The difference was largely explained by the greater proportion of virulent organisms in the tap eyes compared with biopsy eyes . When visual acuity outcome was defined by other thresholds (20/40 and 20/100), the difference was not significant . CONCLUSIONS: This study showed no significant differences between mechanized vitreous biopsy and needle tap with respect to microbiologic yield, operative complications, short-term (9-12 months) retinal detachment risk, or visual outcome . Choice of vitreous sampling procedure must depend on the clinical judgment of the surgeon.

Pathology, 1999 Feb, 31(1), 67 - 9
CSF bacterial antigen detection tests offer no advantage over Gram's stain in the diagnosis of bacterial meningitis; Mein J et al.; While bacterial antigen detection (BAD) tests have been used on cerebrospinal fluid (CSF) with success in the diagnosis of bacterial infection in developing countries, their value in the developed world has been recently questioned . In Darwin, Northern Territory (NT), there are good diagnostic resources but high rates of infectious disease, so it was unclear which findings were applicable to our own population . This study aimed to determine the utility of the BAD tests in detection of bacterial meningitis from CSF in patients studied at Darwin, using a retrospective review of hospital case records and microbiology laboratory reports, over a 19 month period, and utilising a clinical component in the case definition of bacterial meningitis . The sensitivity of the BAD test in the diagnosis of acute bacterial meningitis was 28.6%, with a specificity of 98.7% and a positive predictive value of 85.7% . The cost per positive test was computed at $240 . No cases of bacterial meningitis which were positive on the BAD test were missed on Gram's stain of CSF . We conclude that in our setting BAD tests alone are not sensitive enough to confidently diagnose bacterial meningitis . BAD tests are more costly and offer no advantage in speed of diagnosis or in antibiotic pre-treated patients, compared to routine Gram's stain.

Pathology, 1999 Feb, 31(1), 47 - 50
A fluffy white traveller: imported Coccidiodes immitis infection in an Australian tourist; Baird RW et al.; Pulmonary coccidioidomycosis is a rare cause of pulmonary nodules and respiratory infection in travellers to endemic areas . An Australian tourist suffered an acute respiratory illness while on holiday in Mexico . She subsequently developed erythema nodosum and was noted to have a left pulmonary nodule on chest X-ray after return to Australia . The diagnosis of Coccidioides immitis infection was established by histology and culture of the resected lung lesion . The patient made an uneventful recovery and received one month of therapy with ketoconazole . Culture of the fungus took place under controlled Class 3 conditions . An unusual fungal infection in Australia, coccidioidomycosis poses special risks to staff of microbiology laboratories.

Am J Vet Res, 1999 Apr, 60(4), 473 - 80
Evaluation of severe disease induced by aerosol inoculation of calves with bovine respiratory syncytial virus; Woolums AR et al.; OBJECTIVE: To develop a model of bovine respiratory syncytial virus (BRSV) infection that induces severe disease similar to that seen in some cattle with naturally acquired BRSV infection . ANIMALS: 25 male Holstein calves, 8 to 16 weeks old . PROCEDURE: 17 calves were given a low-passage field isolate of BRSV by aerosolization; 8 control calves were given supernatant from noninfected cell culture . Disease was characterized by evaluating clinical signs, virus isolation and pulmonary function tests, and results of blood gas analysis, gross and histologic postmortem examination, and microbiologic testing . RESULTS: Cumulative incidence of cough, harsh lung sounds, adventitious sounds, and dyspnea and increases in rectal temperature and respiratory rate were significantly greater in infected calves . Three infected calves developed extreme respiratory distress and were euthanatized 7 days after inoculation . Virus was isolated from nasal swab specimens from all infected calves but not from mock infected calves . On day 7 after inoculation, mean PaO2 and PaCO2 were significantly lower, and pulmonary resistance was significantly higher, in infected calves . During necropsy, infected calves had varying degrees of necrotizing and proliferative bronchiolitis and alveolitis with syncytial formation . The 3 calves euthanatized on day 7 had emphysematous bullae in the caudal lung lobes; 1 had unilateral pneumothorax . CONCLUSION AND CLINICAL RELEVANCE: Severe disease similar to that seen in some cattle with naturally acquired BRSV infection can be induced in calves with a single aerosol exposure of a low-passage clinical isolate of BRSV . Our model will be useful for studying the pathogenesis of BRSV infection and for evaluating vaccines and therapeutics.

Infection, 1999 Jan-Feb, 27(1), 63 - 66
Microbiology in intraabdominal infections: what is the message for clinical studies? (Opinion paper); Condon RE; Bacterial flora participating in intraabdominal infections are well known . Data are reviewed here documenting the constant antibiotic susceptibility of this flora despite many years of widespread use of antibiotics . The flaws inherent in the concept of "microbiologic efficacy" in evaluating antibiotic efficacy are examined . Among the possible results of a clinical trial, outcomes not in accord with antibiotic sensitivity data occur regularly . Factors such as host defense responses, source control and inoculum density also influence the outcome in a clinical trial but are not currently being measured . Recommendations for improved conduct of trails are made.

J Clin Microbiol, 1999 May, 37(5), 1612 - 6
Pseudoepidemic of Aspergillus niger infections traced to specimen contamination in the microbiology laboratory; Laurel VL et al.; We report a pseudo-outbreak of Aspergillus niger that followed building construction in our clinical microbiology laboratory . Because outbreaks of invasive aspergillosis have been linked to hospital construction, strategies to minimize dust in patient care areas are common practice . We illustrate that the impact of false-positive cultures on patient care should compel laboratories to prevent specimen contamination during construction.

Med Mycol, 1999 Feb, 37(1), 11 - 7
Comparison of four commercialized biochemical systems for clinical yeast identification by colour-producing reactions; Paugam A et al.; We compared the ability of four commercially available yeast identification systems for routine laboratory hospital use: Auxacolor (AUX) (Sanofi Diagnostics Pasteur, Marne-la-Coquette), Fungichrom I (FUC) and Fungifast I Twin (FUF) (International Microbio, Toulon), Api Candida (API) (bioMerieux, Lyon) . These systems are based on obtaining a biochemical profile easily defined by colorimetric reactions . We tested 202 yeasts belonging to 19 species which were included or were not included in the manufacturer's data base of the identification systems . Without extra tests, for all the organisms tested, after 24 h of incubation, the percentage of organisms correctly identified was 48% for AUX, 75% for FUC, 77% for FUF and 81% for API . However, if we consider the ratio of the number of correct identifications without extra tests with the number of yeasts included in the manufacturers' data bases (sensitivity) the results increased to 61% for AUX, 81% for FUC, 91% for FUF and 83% for API . These systems are particularly well adapted to medical use, they are simple to set up, interpret, and have very good efficiency for the yeasts most commonly isolated in clinical specimens . The findings reported here indicate that the most favourable results were obtained with FUF and API systems.

Vopr Pitan, 1999, 68(1), 46 - 8
{Medical aspect of food starch}; Maksimov VI et al.; In the review are considered aspects of food starch such as its relationship with cancer of the large intestine, its absorption, digestion and metabolism, influence of starch on the composition and biochemical characteristics of microbiocenosis.

Hosp Med, 1999 Jan, 60(1), 24 - 8
Gastrointestinal manifestations of HIV infection; Blanshard C; As patients with human immunodeficiency virus (HIV) infection become more immunocompromised, gastrointestinal symptoms become more common . Most symptoms result from opportunistic infections and can be diagnosed and treated by gastroenterologists, although medical microbiology and histopathology input is essential.

J CANNT, 1998 Fall, 8(4), 20 - 1
Hepatitis B vaccine as a cause of false positive hepatitis B surface antigen; Olde C et al.; The hemodialysis unit at The Toronto Hospital routinely vaccinates its patients against hepatitis B using Engerix B Hepatitis B Vaccine (Recombinant) . A new positive hepatitis B surface antigen (HBsAg) was flagged by the lab, but upon investigation it was discovered that the patient had received hepatitis vaccine two days earlier . The infectious diseases service was consulted and the case was referred to the microbiologist . Subsequent testing showed a conversion to negative antigen . We decided to test other patients who had just been vaccinated to see if we could replicate our results . Seven other patients were selected, and we found the incidence of false positive HBsAg to be 50% . The duration of the vaccine-induced positive HBsAg lasted no more than two weeks . Our results are compatible with the results found in the current literature.

Am J Infect Control, 1999 Apr, 27(2), 158 - 64
Outcomes of a postdischarge surveillance system for surgical site infections at a Midwestern regional referral center hospital; Fields CL; BACKGROUND: Postdischarge surveillance has been reported in the literature as one method for detecting surgical site infections (SSIs) that more traditional methods of surveillance (review of readmission data, monitoring of microbiology, radiology, pharmacy antibiotic usage reports, and medical record review) fail to include . METHODS: This article describes a postdischarge surveillance program that used surgeon questionnaires and was implemented at a 225-bed Midwestern regional referral center hospital . Evaluation of the postdischarge program was accomplished by review of infection control program data for calendar years 1995 through 1997 . RESULTS: Implementation of the postdischarge program resulted in an almost fourfold increase (in both 1995 and 1996) in SSI rates over the reported SSI rates if only traditional surveillance methods had been used . A majority of surgeons (79% in 1995 and 83% in 1996) had individual response rates of 80% or greater . In addition, implementation of the postdischarge program required only 3.5 to 4 additional hours per month . CONCLUSIONS: Results suggest that the postdischarge surveillance program identified SSIs missed by traditional surveillance methods, resulted in higher reported rates of SSI, was moderately to well accepted by surgeons, and was implemented with a minimum of organizational resources.

Am J Infect Control, 1999 Apr, 27(2), 97 - 132; quiz 133-4; discussion 96
Guideline for Prevention of Surgical Site Infection, 1999 . Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee; Mangram AJ et al.; EXECUTIVE SUMMARY The "Guideline for Prevention of Surgical Site Infection, 1999" presents the Centers for Disease Control and Prevention (CDC)'s recommendations for the prevention of surgical site infections (SSIs), formerly called surgical wound infections . This two-part guideline updates and replaces previous guidelines.1,2 Part I, "Surgical Site Infection: An Overview," describes the epidemiology, definitions, microbiology, pathogenesis, and surveillance of SSIs . Included is a detailed discussion of the pre-, intra-, and postoperative issues relevant to SSI genesis.Part II, "Recommendations for Prevention of Surgical Site Infection," represents the consensus of the Hospital Infection Control Practices Advisory Committee (HICPAC) regarding strategies for the prevention of SSIs.3 Whenever possible, the recommendations in Part II are based on data from well-designed scientific studies . However, there are a limited number of studies that clearly validate risk factors and prevention measures for SSI . By necessity, available studies have often been conducted in narrowly defined patient populations or for specific kinds of operations, making generalization of their findings to all specialties and types of operations potentially problematic . This is especially true regarding the implementation of SSI prevention measures . Finally, some of the infection control practices routinely used by surgical teams cannot be rigorously studied for ethical or logistical reasons (e.g., wearing vs not wearing gloves) . Thus, some of the recommendations in Part II are based on a strong theoretical rationale and suggestive evidence in the absence of confirmatory scientific knowledge.It has been estimated that approximately 75% of all operations in the United States will be performed in "ambulatory," "same-day," or "outpatient" operating rooms by the turn of the century.4 In recommending various SSI prevention methods, this document makes no distinction between surgical care delivered in such settings and that provided in conventional inpatient operating rooms . This document is primarily intended for use by surgeons, operating room nurses, postoperative inpatient and clinic nurses, infection control professionals, anesthesiologists, healthcare epidemiologists, and other personnel directly responsible for the prevention of nosocomial infections.This document does not: Specifically address issues unique to burns, trauma, transplant procedures, or transmission of bloodborne pathogens from healthcare worker to patient, nor does it specifically address details of SSI prevention in pediatric surgical practice . It has been recently shown in a multicenter study of pediatric surgical patients that characteristics related to the operations are more important than those related to the physiologic status of the patients.5 In general, all SSI prevention measures effective in adult surgical care are indicated in pediatric surgical care . Specifically address procedures performed outside of the operating room (e.g., endoscopic procedures), nor does it provide guidance for infection prevention for invasive procedures such as cardiac catheterization or interventional radiology . Nonetheless, it is likely that many SSI prevention strategies also could be applied or adapted to reduce infectious complications associated with these procedures . Specifically recommend SSI prevention methods unique to minimally invasive operations (i.e., laparoscopic surgery) . Available SSI surveillance data indicate that laparoscopic operations generally have a lower or comparable SSI risk when contrasted to open operations.6-11 SSI prevention measures applicable in open operations (e.g., open cholecystectomy) are indicated for their laparoscopic counterparts (e.g., laparoscopic cholecystectomy) . Recommend specific antiseptic agents for patient preoperative skin preparations or for healthcare worker hand/forearm antisepsis . Hospitals should choose from products recommended for these activitie

Clin Microbiol Rev, 1999 Apr, 12(2), 183 - 6
Clinical Microbiology Reviews: genesis of a journal; Morello JA; In 1986 planning for a new ASM review journal, Clinical Microbiology Reviews (CMR), began . CMR would publish articles primarily of interest to persons concerned with pathogenesis, laboratory diagnosis, epidemiology, and control of human and veterinary pathogens . The first issue was published in January 1988, with quarterly publication since then . The journal quickly became successful in terms of subscribers and impact on the field, earning a strong national and international reputation . The achievements of CMR are owed to many persons, including the editorial board, the production team, and especially the contributing authors.

Am J Cardiol, 1999 Apr 1, 83(7), 1075 - 9
Clinical course, microbiologic profile, and diagnosis of periannular complications in prosthetic valve endocarditis; San Roman JA et al.; Whether periannular extension of prosthetic valve endocarditis (abscesses, pseudoaneurysms, fistulas) is related to the etiologic agent, the clinical course and the prognosis is still unknown . Likewise, transesophageal echocardiographic accuracy in detecting periannular complications in prosthetic recipients remains unsettled . We retrospectively analyzed data from 87 patients with anatomically proven prosthetic valve endocarditis who underwent a transesophageal echocardiographic examination . Periannular complications (30 abscesses, 18 pseudoaneurysms, 8 fistulas; 8 with >1) were found in 46 patients; results were compared with the remaining 41 without complications . Transesophageal echocardiography correctly identified 27 abscesses (90%) and all pseudoaneurysms and fistulas . One diagnosis of pseudoaneurysm by echocardiography was not found at surgery . No statistical differences were found regarding age, sex, type of prosthesis (mechanical vs biologic), and etiologic agent . Periannular complications were more frequent in aortic location (70% vs 20% in mitral position; p <0.001) and in early (within 6 months after surgery) endocarditis (63% vs 38% in late endocarditis; p = 0.04) . The same percentage of patients from both groups underwent surgery (98% with and 90% without complications) . At discharge, 62% and 67% of patients were alive, respectively . Thus, periannular complications in prosthetic valve endocarditis are more frequent in aortic location and within 6 months after surgery . Neither the type of prosthesis nor the etiologic agent are related to the presence of periannular complications . Short-term prognosis in patients who underwent surgery is not affected by the presence of periannular complications.

Can J Hosp Pharm, 1994 Jun, 47(3), 111 - 6
The impact of formulary reservations on drug utilization: a controlled trial; Mather JL et al.; A controlled trial was conducted in two teaching hospitals (A and B), with similar case mixes to determine the impact of reservations, which were educational in nature, on the utilization of oral ciprofloxacin . Over a two-month period the health records of all the patients who received the drug were reviewed, and information on utilization and demographics of patients receiving the drug was recorded . As well, the number of admissions to the two hospitals over this period were compared . If culture and sensitivity (C & S) results were available, appropriateness was assessed in accordance with criteria for use established at site A; in the absence of C & S information, consensus by two microbiologists was used . Over the two-month period a total of 136 patients received ciprofloxacin at the two institutions . At site A, which had reservations, the number of patients who continued to receive ciprofloxacin upon admission was significantly decreased relative to site B, which did not have reservations (14% vs . 36% respectively, p = .029) . As well, when assessed by total number of admissions to the institutions, the number of patients receiving ciprofloxacin at site A was less than site B (1.5% vs . 2.6% respectively, p = .003)) . While the utilization was decreased at site A vs . site B, the proportion of patients with therapy deemed to be appropriate was not different between the two sites . Educationally based reservations are an effective formulary tool for optimizing drug utilization.

Hosp Formul, 1993 Jan, 28 Suppl 1, 55 - 8
The true cost of monitoring antibiotic levels; Gruneberg RN; Antibiotic assays are most often ordered for the purpose of toxicity monitoring, which usually involves determination of peak and trough antibiotic concentrations in the blood . The cost of monitoring antibiotic levels is probably higher than is commonly appreciated . Factors that contribute to the cost of this service include staffing the microbiology laboratory with appropriate personnel, who are responsible for determining the adequacy of sample collection and related patient information; analyzing the specimens in a timely manner; and taking action to modify drug dosage and dosage intervals in light of the test results . There are also costs related to the reagents, consumables, and equipment used in the assay, as well as to revenue and capital overheads . Additional clinical and laboratory costs can be incurred in the event of litigation pursuant to antibiotic-induced toxicity . With hospital and government policymakers devoting increasing attention to the escalating costs of health care, pressure to move away from the routine use of drugs having dose-related toxicity may increase, the objective being to save on assay costs.

Hosp Pharm, 1992 Jul, 27(7), 596 - 603, 614
Department of pharmacy-initiated program for streamlining empirical antibiotic therapy; Pastel DA et al.; The outcome of a department of pharmacy-initiated "streamlining" study designed to promote cost-conscious modifications of empirically selected antibiotic therapy is described . Two hundred forty-one evaluable adult patients started on restricted-use antibiotics at this university-affiliated community private teaching hospital were enrolled in a 9-week prospective streamlining study . Patients were alternately assigned to a Control (i.e., no pharmacist-initiated streamlining recommendations offered based on culture and susceptibility reports) or a Pharmacist Intervention group (i.e., pharmacist offers recommendations to streamline therapy) . A statistically significant greater number of patients had their empiric antibiotic treatment courses modified to more appropriate antibiotic choices after receipt of culture and susceptibility reports among private prescribers in the Pharmacist Intervention group (83%) than in the Control group (38%) (p = .006) . Additionally, pharmacists were overall successful in gaining prescriber acceptance for 64% of recommended changes of empiric antibiotic treatment courses before the receipt of culture and susceptibility reports (e.g., dose and/or frequency changes) . There was no program effect observed with respect to improved physician response to microbiologic data that would allow streamlining empirical antibiotic choices in the Housestaff (i.e., medical or surgical residents), or infectious disease consultant prescriber groups . Projected overall annual cost savings that would be achieved as a result of continued efforts by pharmacists directed at streamlining empirical "restricted" antibiotic regimens is approximately +40,000.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1999 Mar, 87(3), 357 - 61
Massive osteolysis of the mandible: report of a case with multifocal bone loss; Bouloux GF et al.; Osteolysis of the jaws has been reported in association with infection, cysts, neoplasia, and metabolic, endocrine, or hematologic abnormalities . Rare cases of idiopathic osteolysis have also been recorded . We report the case of a 10-year-old girl with mandibular basal and alveolar bone resorption that has continued over a period of 9 years . The patient has subsequently developed bilateral resorption of the ascending rami and condyles . The maxilla is uninvolved . Investigations included radiology, computerized tomography, scintigraphy, hematology, serum chemistry, endocrinology, histopathology, microbiology, and immunology . Neutrophil chemotaxis, chemiluminescence, and random migration values were low but within the normal range . These findings are interpreted as indicating an unusual variant of massive osteolysis.

Ir J Med Sci, 1999 Jan-Mar, 168(1), 21 - 4
Farmer's lung in Ireland (1983-1996) remains at a constant level; McGrath DS et al.; A prospective study was undertaken by the Departments of Respiratory Medicine and Medical Microbiology at the Cork University Hospital, a . to investigate the epidemiology of Farmer's Lung (F.L.) in the Republic of Ireland (pop . 3.5 million), with special reference to the South Western Region of this country (pop . 536,000) and b . to assess any relationship between the prevalence/incidence of F.L . with climatic factors in South West Ireland, between 1983 and 1996 . F.L . incidence remained constant throughout the 13 yrs studied both on a national and a regional basis . A significant relationship was also found between total rainfall each summer and F.L . incidence and prevalence over the following yr (p < 0.005) in South-West Ireland . The persistence of F.L . in Ireland at a constant level suggests that farmers' working environment and farm practices need to be improved.

Yonsei Med J, 1998 Dec, 39(6), 485 - 7
Surveillance of resistant pathogens and rational use of antibiotics: general remarks; Acar JF; Surveillance of resistant pathogens should lead to improved treatment of patients and to a rational use of antibiotics . The process for decision making between microbiology, general practice and health policy is still to be documented with careful studies.

Int J Tuberc Lung Dis, 1999 Feb, 3(2), 149 - 52
Drug-resistant strains of Mycobacterium tuberculosis isolated in Russia; Stepanshina VN et al.; SETTING: State Research Center for Applied Microbiology, Russian Research Institute of Phthisiopulmonology (Ministry of Health, Moscow) . OBJECTIVE: To analyze drug-resistant clinical isolates of Mycobacterium tuberculosis obtained from patients referred to the institute from different parts of Russia, and to study the mechanisms of their rifampicin resistance . DESIGN: Fifty clinical isolates of M . tuberculosis were analysed . Polymerase chain reaction (PCR) and sequencing were used to study the mechanisms of rifampicin resistance in 25 isolates . RESULTS: Among cultures isolated from 50 patients, drug resistance was detected in 33 . Most of the isolates were resistant to rifampicin (25 isolates), isoniazid (14 isolates), and streptomycin (seven isolates) . Only 6% of the isolates were resistant to one drug, while 14% were resistant to two, 32% to three, 40% to four, and 8% to five drugs . Susceptible isolates were derived from 17 patients . The following point mutations and deletions in the rpoB locus, responsible for high level rifampicin resistance (more than 50 microg/ml in egg-based medium), were detected: G-->A/395 (Arg-->Gln), C-->T/232 (His-->Tyr), C-->T/221 (Ser-->Leu), G-->T/202 (Asp-->Tyr), GA-->TT/202-203 (Asp-->Phe), deltaATGGACCAG/199-207 (Met, Asp, Gin), A-->T/91 (Met-->Leu), TG-->CC/227-228 (Leu-->Ser), GAG-->AGT/349-350-351 (Gln-->Ser), deltaGGG/354(Gly) . CONCLUSION: A number of previously unrecognised genetic modifications in the rpoB region were found in rifampicin-resistant strains isolated from patients from different parts of Russia.

Microb Pathog, 1999 Apr, 26(4), 207 - 19
Cloning, expression and significance of MPT53 for identification of secreted proteins of Mycobacterium tuberculosis; Wiker HG et al.; Based on our N -terminal amino acid sequence of MPT53 and a deduced DNA sequence, we searched for the corresponding gene in the Mycobacterium tuberculosis genomic sequence at the Sanger centre, localizing mpt53 close to mpt70 and mpt83 . The gene was cloned and expressed, followed by purification of MPT53 to homogeneity from recombinant M . smegmatis culture fluid . In MPT53 there is 60 % identity with the active site of thioredoxin of M . tuberculosis (MPT46) with two cysteins in a CXXC motif, but MPT53 could not serve as an alternative substrate for thioredoxin reductase . Testing for IgM and IgG1 anti-MPT53 in cattle sera showed that MPT53 is immunogenic following natural and experimental infection with M . bovis . Cloning of mpt53 represents cloning of the last of the 10 proteins originally defined as "secreted proteins" of M . tuberculosis and M . bovis based on determination of their "Localization index" (LI) (J Gen Microbiol 1991;137 : 875-84) . The need for a precise definition of the term "secreted protein" is discussed . So far we have observed full concordance between occurrence of an LI value indicating secretion of a protein and occurrence of a signal sequence in the corresponding gene . Signal sequence independent protein secretion in mycobacteria may occur for a limited number of proteins and remains to be established .

Lakartidningen, 1999 Feb 10, 96(6), 582 - 4
{Development of resistant Helicobacter pylori in Sweden . Tendency toward increasing resistance to clarithromycin}; Wreiber K et al.; This study was designed to investigate the development of antibiotic resistance in Swedish H pylori isolated 1990-96 . A total of 415 isolates collected from 10 clinical microbiology laboratories were examined . Three different methods of susceptibility testing were compared: agar dilution, the E-test and disc diffusion . None of the isolates was resistant to ampicillin or tetracycline, but approximately 30 per cent were resistant to metronidazole . An increase in resistance to clarithromycin was noted during 1996 (9% resistant strains), though the significance of this finding needs further investigation . The comparison of susceptibility tests suggested disc diffusion to be of doubtful value, but the E-test to be appropriate for testing H pylori . However, the number of isolates resistant to metronidazole was higher with the E-test than with agar dilution . The value of testing susceptibility to metronidazole is discussed.

Extremophiles, 1999 Jan, 3(1), 71 - 7
Taxonomic studies of extremely barophilic bacteria isolated from the Mariana Trench and description of Moritella yayanosii sp . nov., a new barophilic bacterial isolate; Nogi Y et al.; We have isolated two strains of extremely barophilic bacteria from sediment collected from the world's deepest ocean floor in the Mariana Trench, Challenger Deep, at a depth of 10898m {Kato C, Li L, Nogi Y, Nakamura Y, Tamaoka J, Horikoshi K (1998) Appl Environ Microbiol 64:1510-1513} . One strain, DB21MT-2, was identified as a strain of Shewanella benthica, and the other strain, DB21MT-5, is closely affiliated with members of the genus Moritella on the basis of 16S rDNA sequence analysis . The hybridization values for DNA-DNA relatedness between DB21MT-5 and the Moritella reference strains were significantly lower than that accepted as the phylogenetic definition of a species . Based on this and other taxonomic differences, strain DB21MT-5 appears to represent a novel obligately barophilic deep-sea Moritella species . The name Moritella yaynanosii (JCM 10263) is proposed . This is the first proposed species of obligately barophilic bacteria of the genus Moritella.

Mycoses, 1998, 41 Suppl 2, 26 - 30
{Past and present of mycology in German gynecology and obstetrics}; Mendling W; After the detection of yeasts in 1839, German speaking mycology was first performed in obstetrics to find out the source of neonatal thrush . The authors are Berg (1846), Mayer (1862), Martin (1856), Winckel (1866), Haussmann (1870), Kehrer (1883), Epstein (1924), Ruther, Rieth and Koch (1958), Malicke (1963), Blaschke-Hellmessen (1968) and Schnell (1981) and others . In the gynecological field yeasts, vaginal mycoses and therapeutic problems had been investigated by the gynecologists Doderlein (1892), Spitzbart (1960), Lachenicht and Potel (1971), Neumann and Kaben (1971), Muller and Nold (1981) and Mendling (1987, 1995) . Many gynecological papers, however, had also been written by dermatologists and microbiologists.

Ann Pharmacother, 1999 Feb, 33(2), 156 - 62
Cost-minimization analysis of piperacillin/tazobactam versus imipenem/cilastatin for the treatment of serious infections: a Canadian hospital perspective; Marra FO et al.; BACKGROUND: In 1998 we reported the first Canadian double-blind, randomized, clinical trial involving a comparison of piperacillin/tazobactam (P/T) with imipenem/cilastatin (I/C) . The present study was conducted to determine the feasibility of replacing I/C at our institution . OBJECTIVE: To describe the outcome of a pharmacoeconomic analysis of the clinical trial from the perspective of a tertiary acute-care institution . METHODS: A total of 150 consenting adults originally prescribed I/C were randomly assigned to receive either P/T 4.5 g i.v . (n = 75) or I/C 500 mg i.v . (n = 75) every six hours . Actual direct medical resources used in relation to the treatment of bacterial infections were prospectively assessed during a clinical trial; these included cost of study and ancillary antibiotics, hospitalization, diagnostic testing (radiology, laboratory assessments), and labor, as well as treatment of adverse drug reactions, antibiotic failures, and superinfections . RESULTS: While costs for successful treatment courses were similar across treatment arms, hospitalization costs for treatment course failures were higher for P/T recipients . Direct medical costs for treatment courses associated with a superinfection were also higher in the P/T arm . Overall costs for treatment failures with either study drug were at least twofold those observed for successful treatment courses . Mean total management cost per patient in the P/T group was $15,211 ($ CDN throughout) (95% CI $11,429 to $18,993), compared with $14,232 (95% CI $11,421 to $17,043) in the I/C group (p = 0.32), resulting in a mean cost difference of $979 . Sensitivity analyses revealed that the superiority of I/C over P/T for successful treatment of serious infections was sensitive to changes in the cost of hospitalization and drug efficacy for either drug . CONCLUSIONS: Based on the results of the clinical trial, P/T and I/C offer similar clinical, microbiologic, and toxicity outcomes in hospitalized patients with serious infections . Under base-case conditions, our pharmacoeconomic analysis showed that I/C was a cost-effective alternative to P/T at the dosage regimens studied . However, this finding was sensitive to plausible changes in both clinical and economic parameters.

Mol Phylogenet Evol, 1999 Feb, 11(1), 13 - 26
Phylogenetic studies of marsupials based on phosphoglycerate kinase DNA sequences; Colgan DJ; Phosphoglycerate kinase sequences were obtained for 313 aligned bases of 41 individuals from 39 marsupial species . In contrast to previous molecular analyses, the relationships suggested by these data show a high level of congruence with morphologically defined orders and families . Four main monophyletic lineages are recognizable . These are the monogeneric orders Microbiotheria (Dromiciops australis) and Notoryctemorphia (Notoryctes typhlops), a grouping of the American orders Didelphimorphia and Paucituberculata, and the Australasian species other than N . typhlops . Within the Australasian lineage, there are again four main monophyletic groups; the Dasyuridae, two peramelemorph (bandicoot) lineages (one comprised of pseudogene sequences) and the Diprotodontia . This topology is not greatly affected by the exclusion of pseudogenes except that a clade of syndactylous species (Peramelemorphia plus Diprotodontia) is recovered . Two other peramelemorph pseudogenes have inserts of about 1 kb with high levels of similarity to LINE 1 elements . The Diprotodontia is notable for its relative lack of intersequence variation in comparison to the Dasyuromorphia .

J Assist Reprod Genet, 1999 Feb, 16(2), 81 - 6
Retrieval, maturation, and fertilization of immature oocytes obtained from unstimulated patients with polycystic ovary syndrome; Beckers NG et al.; PURPOSE: Our purpose was to determine whether immature oocytes could be retrieved under local anesthesia, whether these oocytes would mature and fertilize in vitro, and whether adequate endometrium development could be obtained after hormonal supplementation . METHODS: Ovum pick-up was performed under local anesthesia . Immature oocytes were cultured and inseminated . To prepare the endometrium, estradiolvalerate was administered in combination with micronized progesterone . RESULTS: Immature oocytes were obtained in all cases . Fifty-six percent (n = 30) of the oocytes developed into metaphase II (MII) after 48 hr of culture, and another 20% reached the MII stage by 72 hr . Normal fertilization was observed in only 10% of oocytes inseminated . No embryonic development occurred, and therefore embryo transfer was not performed in any of the patients . Endometrial microbiopsy was performed in all subjects and endometrial development was considered sufficient in eight patients . CONCLUSIONS: We collected immature oocytes from patients with polycystic ovary syndrome without general anesthesia . In vitro maturation of these oocytes seemed adequate but fertilization rates were poor . Sufficient endometrial quality was obtained after hormonal substitution.

Ital J Gastroenterol Hepatol, 1998 Oct, 30 Suppl 3, S320 - 3
Diagnosis of Helicobacter pylori: invasive methods; Pajares-Garcia JM; The methods which require endoscopy for the examination of the gastric mucosa are called invasive (direct) methods . Several tests can be performed on the gastric mucosa obtained by endoscopy: Rapid urease test, histology, smear (cytology), culture and polymerase chain reaction . A combination of at least two tests with high sensitivity and specificity is recommended for clinical trials, and, when possible, for clinical management of patients . In clinical practice the invasive methods should be carried out only in those patients to be treated with eradication regimes . All invasive methods rely on gastric biopsy samples . Therefore, the specimens should be taken under optimal conditions . Several factors guide the site and the number of biopsy specimens for identification of Helicobacter pylori infection . In pre-treatment diagnosis, the biopsies should be taken from the distal antrum (2 cm from the pylorus) . The number required depends on the diagnostic method used: in Helicobacter pylori eradicated patients the same number of biopsies for histology and culture should be taken from the antrum and corpus . The sensitivity and specificity of the Rapid urease test varies from 80-90% the results are known very quickly and the cost is very low . The maximal accuracy of histology is obtained with: an optimal specimen processing, an adequate staining and an experienced observer . This method of biopsy processing facilitates the identification of Helicobacter pylori which is commonly located on the superficial and foveolar epithelium . Sensitivity depends on the observer's experience and the extent of biopsy sampling . In general, the histological method has a sensitivity and specificity of 90-95% . In patients treated by proton pump inhibitors, antibiotics or bismuth salts two-four weeks prior to biopsy, the bacteria may be restricted to the corpus or fundus . Culture is strictly indicated in patients after failure of two or more eradication regimens to test for susceptibility and resistence . Specificity is 100% and sensitivity depends on the experience and interest of the microbiologist . The indication of polymerase chain reaction is only for research, specially, in molecular epidemiology and for fingerprinting.

Plast Reconstr Surg, 1999 Mar, 103(3), 903 - 14; discussion 915-7
A new classification for the standardization of nomenclature in free flap wound closure; Ninkovic M et al.; A profusion of terms are currently used to describe free flap wound closure . It is important to broadly standardize nomenclature when embarking on a comparison of functional outcomes between institutions . Therefore, a series of 68 "emergency" (within 24 hours) free flaps performed by a single surgeon were reviewed with respect to a total experience of 188 free tissue transfers to formulate a consistent nomenclature applicable to free flap wound closure in general . The nomenclature presented divides free flap closure into three categories: "primary free flap closure" (12 to 24 hours), "delayed primary free flap closure" (2 to 7 days), and "secondary free flap closure" (after 7 days) . This system is analogous to the standard terms "primary," "delayed primary," and "secondary wound closure." It is consistent with known biologic and microbiologic principles of wound closure in general and should provide a simple basis for classifying free flap wound closure . Illustrative examples are presented to highlight the classification scheme.

Am J Obstet Gynecol, 1999 Mar, 180(3 Pt 1), 578 - 80
The microbiologic effect of digital cervical examination; Imseis HM et al.; OBJECTIVE: The purpose of this study was to determine whether digital examination introduces vaginal organisms into the cervix . Study Design: Thirty-five women with reported ruptured membranes at >/=34 weeks' gestation underwent a sterile speculum examination and a standardized semiqualitative, semiquantitative endocervical culture before and immediately after digital cervical examination . RESULTS: Cultures taken before digital examination demonstrated a mean of 2.8 +/- 1.7 different types of organisms, whereas cultures taken after digital examination demonstrated a mean of 4.4 +/- 1.5 different types of organisms (P <.0001) . Twenty-eight patients (80%) had heavier growth or a greater number of different organisms in the postexamination culture than in the pre-examination culture . The state of the fetal membranes (ruptured as opposed to intact) did not alter these relationships . CONCLUSION: An immediate effect of digital examination is the introduction of vaginal organisms into the cervical canal.

J Biol Chem, 1999 Mar 19, 274(12), 7784 - 92
In vivo and in vitro function of the Escherichia coli periplasmic cysteine oxidoreductase DsbG; Bessette PH et al.; We have characterized in vivo and in vitro the recently identified DsbG from Escherichia coli . In addition to sharing sequence homology with the thiol disulfide exchange protein DsbC, DsbG likewise was shown to form a stable periplasmic dimer, and it displays an equilibrium constant with glutathione comparable with DsbA and DsbC . DsbG was found to be expressed at approximately 25% the level of DsbC . In contrast to earlier results (Andersen, C . L., Matthey-Dupraz, A., Missiakas, D., and Raina, S . (1997) Mol . Microbiol . 26, 121-132), we showed that dsbG is not essential for growth and that dsbG null mutants display no defect in folding of multiple disulfide-containing heterologous proteins . Overexpression of DsbG, however, was able to restore the ability of dsbC mutants to express heterologous multidisulfide proteins, namely bovine pancreatic trypsin inhibitor, a protein with three disulfides, and to a lesser extent, mouse urokinase (12 disulfides) . As in DsbC, the putative active site thiols in DsbG are completely reduced in vivo in a dsbD-dependent fashion, as would be expected if DsbG is acting as a disulfide isomerase or reductase . However, the latter is not likely because DsbG could not catalyze insulin reduction in vitro . Overall, our results indicate that DsbG functions primarily as a periplasmic disulfide isomerase with a narrower substrate specificity than DsbC.

J Clin Microbiol, 1999 Apr, 37(4), 1137 - 43
Genetic diversity of the 28-kilodalton outer membrane protein gene in human isolates of Ehrlichia chaffeensis; Yu XJ et al.; The Ehrlichia chaffeensis 28-kDa outer membrane protein (p28) gene was sequenced completely by genomic walking with adapter PCR . The DNA sequence of the p28 gene was nearly identical to the previously reported sequence (N . Ohashi, N . Zhi, Y . Zhang, and Y . Rikihisa, Infect . Immun . 66:132-139, 1998), but analysis of a further 75 bp on the 5' end of the gene revealed DNA that encoded a 25-amino-acid signal sequence . The leader sequence was removed from the N terminus of a 30-kDa precursor to generate the mature p28 protein . A monoclonal antibody (MAb), 1A9, recognizing four outer membrane proteins of E . chaffeensis (Arkansas strain) including the 25-, 26-, 27-, and 29-kDa proteins (X.-J . Yu, P . Brouqui, J . S . Dumler, and D . Raoult, J . Clin . Microbiol . 31:3284-3288, 1993) reacted with the recombinant p28 protein . This result indicated that the four proteins recognized by MAb 1A9 were encoded by the multiple genes of the 28-kDa protein family . DNA sequence alignment analysis revealed divergence of p28 among all five human isolates of E . chaffeensis . The E . chaffeensis strains could be divided into three genetic groups on the basis of the p28 gene . The first group consisted of the Sapulpa and St . Vincent strains . They had predicted amino acid sequences identical to each other . The second group contained strain 91HE17 and strain Jax, which only showed 0.4% divergence from each other . The third group contained the Arkansas strain only . The amino acid sequences of p28 differed by 11% between the first two groups, by 13.3% between the first and third groups, and by 13.1% between the second and third groups . The presence of antigenic variants of p28 among the strains of E . chaffeensis and the presence of multiple copies of heterogeneous genes suggest a possible mechanism by which E . chaffeensis might evade the host immune defenses . Whether or not immunization with the p28 of one strain of E . chaffeensis would confer cross-protection against other strains needs to be investigated.

J Clin Microbiol, 1999 Apr, 37(4), 1057 - 61
Use of PCR and sodium dodecyl sulfate-polyacrylamide gel electrophoresis techniques for differentiation of Prevotella intermedia sensu stricto and Prevotella nigrescens; Premaraj T et al.; Primers were designed from 16S rRNA sequences of Prevotella intermedia sensu stricto and Prevotella nigrescens and were used to discriminate these two species by PCR . The results were compared with those from the PCR technique using primers designed from arbitrarily primed PCR products by Guillot and Mouton (E . Guillot and C . Mouton, J . Clin . Microbiol . 35:1876-1882, 1997) . The specificities of both assays were studied by using P . intermedia ATCC 25611, P . nigrescens ATCC 33563, 174 clinical isolates of P . intermedia sensu lato, and 59 reference strains and 58 clinical isolates of other Prevotella species and/or common oral flora . In addition, the usefulness and reliability of sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) in the differentiation of the two species were examined by comparing the results with those from PCR assays . The controversial lipase test for distinguishing these species was also carried out . Unambiguous differentiation was made by both PCR assays, and the results matched each other . The SDS-PAGE assay was found to misidentify a few strains tested, compared with the results of PCR assays . The lipase test was positive for both species, including the reference strains of P . intermedia and P . nigrescens . We conclude that both PCR assays are simple, rapid, reliable, and specific methods which could be used in clinical studies and that the lipase test is not valuable in the differentiation . The reliable discrimination of the two species by SDS-PAGE is questionable.

J Recept Signal Transduct Res, 1999 Jan-Jul, 19(1-4), 1 - 14
Methodology of receptor research--a philosophical perspective; Janich P; Two examples taken from the philosophy of physics (measurement and experiment) show the dependence of quantitative data and of causal judgements on technical aims that are invested into both laboratory research and the concept formation of a successful science . Accordingly, methodology is defined as the theory of methods, i.e . of the rules governing actions constitutive of research and the phrasing of its results . Judgement on methods is a matter of means-and-ends rationality . The objects and relations under consideration are not natural but technical ones . With respect to analytical chemistry, a problem concerning the application of mathematics to quantitative data is described in order to argue for the irreducibility of measurement of macroscopic quantities (like volume) to the counting of numbers of micro-objects (like molecules): the basic concepts of microbiology, analytic chemistry and toxicology remain related to certain theoretical (and corresponding experimental) contexts . Starting from the perspective that receptor research is dealing with the effects of chemical substances on organisms, a few constraints on receptor research are characterised . The idealisation of causes and effects by describing them in terms of chemistry (on a molecular level) hinges on a problematic presupposition . It is objected that there is neither a way down from levels more complex to simpler ones nor a way up from simple to complex levels in so far as the criteria for medical diagnoses are not causally linked with chemical descriptions . As a result, the significance of the traditional connection between the medical treatment of persons and the manageableness of health effects by pharmaceutical means is stressed . Whether molecular models, theories and explanations are helpful for a phenomenological description has to be tested accordingly but cannot generally be presupposed.

Arch Med Res, 1999 Jan-Feb, 30(1), 64 - 8
Serologic evidences suggesting the presence of Borrelia burgdorferi infection in Mexico; Gordillo G et al.; BACKGROUND: Lyme disease is the most common vector-borne human disease in Europe and the United States . In Mexico, clinical cases suggestive of Lyme borreliosis have been reported; however, infection was not confirmed by serologic or microbiologic tests . METHODS: To study the prevalence of IgG antibodies against Borrelia burgdorferi among Mexican persons, a community-based sero-survey including all states of Mexico was done . A sample of 2,890 sera representing individuals of all ages and all socioeconomic levels was studied . Antibodies anti-B . burgdorferi were determined by enzyme-linked immunosorbent assay (ELISA) using a whole-cell sonicated extract of B . burgdorferi strain B31 . Serum specimens positive for ELISA were further studied by Western blot (WB) . A serum sample was considered positive by WB if at least three of the following protein bands were recognized: 18, 24, 28, 29, 31, 34, 39, 41, 45, 58, 62, 66, and 93 kDa . Some WB positive specimens were further confirmed with an immunodot-blot (IDB) test using recombinant and purified B . burgdorferi proteins . RESULTS: Of the 2,890 specimens, 34 were positive for ELISA; nine of these 34 were confirmed as positive by WB . Four of the nine WB positive sera were tested by IDB and all four were positive . The prevalence of WB confirmed cases in the sample studied was 0.3% . Positive specimens were from residents of the northeastern and central areas of Mexico . CONCLUSIONS: The serological evidences of this study suggest that Borrelia burgdorferi infection is present in the Mexican population . This finding should be confirmed by documenting the infection in clinical cases and in tick vectors.

Scand J Infect Dis, 1998, 30(5), 469 - 72
Pneumococcal endocarditis is not just a disease of the past: an analysis of 16 cases diagnosed in Denmark 1986-1997; Lindberg J et al.; To remind clinicians and clinical microbiologists of the clinical features and therapeutic aspects of pneumococcal endocarditis, patients with pneumococcal endocarditis from 1986 to 1997 were identified via an enquiry to clinical microbiologists across Denmark . For all patients records were reviewed to confirm the diagnosis of pneumococcal endocarditis, and the clinical course, therapy and outcome were analysed . 16 patients with definitive pneumococcal endocarditis were found . All pneumococcal isolates were sensitive to penicillin . 15 patients had no previously known cardiac valvular disease, 10 patients had X-ray-proven pneumonia and 5 had meningitis . The aortic valve was affected in 13 patients, of whom 12 developed aortic insufficiency and 11 cardiac failure . Of 7 patients who underwent surgery, 6 needed immediate cardiac valve replacement . The 30-day case fatality rate was 19% (95% confidence limits 4-46%) . Pneumococcal endocarditis must be considered when treating patients with pneumococcaemia . The most important clue to the diagnosis is a significant murmur and development of heart failure . Evaluation by transoesophageal echocardiography is helpful in determining the diagnosis and assessing the need for surgical intervention . With appropriate antibiotic therapy, close observation and cardiac valve replacement if necessary, the prognosis is better than recorded in earlier studies.

J Zoo Wildl Med, 1998 Dec, 29(4), 451 - 5
Bronchoscopic and serologic diagnosis of Aspergillus fumigatus pulmonary infection in a bottlenose dolphin (Tursiops truncatus); Reidarson TH et al.; A 4-yr-old male bottlenose dolphin (Tursiops truncatus) developed an Aspergillus fumigatus pneumonia . Fungal elements were identified by cytology and microbiology from endoscopic bronchoalveolar lavage and brushings of a raised yellow endobronchial lesion . The results of qualitative immunodiffusion serology, a technique that identifies specific circulating antibodies to Aspergillus fumigatus, were suggestive of an active infection . The dolphin was treated with itraconazole for over 2 yr, which resulted in remission of clinical signs . Pneumonia caused by Aspergillus sp . accounts for the large majority of pulmonary mycoses in marine mammals . Bronchoscopy facilitated an early definitive diagnosis, accurate treatment, and remission.

J Clin Ultrasound, 1999 Mar-Apr, 27(3), 159 - 63
Sonographic appearances and percutaneous management of primary tuberculous liver abscess; Jain R et al.; Primary tuberculous liver abscesses are rare . We report on 3 patients who presented with a nonresolving abscess in the liver . Clinical presentation and sonographic findings in each case were nonspecific . A diagnosis of tuberculosis was established with microbiologic examination of pus in 2 cases and examination of an excised abscess wall in 1 case . Needle aspiration (1 patient) and short-term (72 hours) catheter drainage (1 patient) were unsuccessful, and surgical excision was required in these patients . In the third patient, continuous catheter drainage over 18 days resulted in cure, indicating that long-term catheter drainage with antituberculous chemotherapy may be a viable alternative to surgery in the management of primary tuberculous liver abscess.

J Pediatr, 1999 Mar, 134(3), 338 - 43
Halitosis in children; Amir E et al.; OBJECTIVE: To determine the relationship between oral parameters and halitosis in children whose parents complained of malodorous breath . METHODS: Twenty-four children (ages 5 to 14) were examined at 3 appointments . After the second appointment oral hygiene instructions were given . Malodor-related parameters included odor judge scores (whole mouth, tongue, nose, and interdental areas), sulfide levels, and microbiologic tests (Oratest and BANA) . Dental-related parameters included plaque index, dental index (DMFT), food impaction, bleeding, and tongue coating . Statistical analyses included analysis of variance, paired t tests, Pearson correlations, and multiple regression . RESULTS: Whole mouth odor was significantly associated with plaque index levels (r = 0.64, P =.001) and Oratest (r = -0.57, P =.003) . Whole mouth malodor was significantly associated with tongue dorsum posterior odor (r = 0.641, P =.001) and was higher in subjects with interdental odor (P =.003) . Tongue odor was also significantly associated with nasal malodor (r = 0.57; P =.004) . Sulfide levels were correlated with oral malodor levels only at the second appointment (r = 0.46, P =.02) . CONCLUSIONS: The data suggest that, as in adults, oral malodor in children is related primarily to oral factors . Correlations between nasal and oral malodor were evident, suggesting that postnasal drip plays a major role.

Eur J Clin Microbiol Infect Dis, 1998 Dec, 17(12), 821 - 7
Procurement, interpretation, and value of postmortem cultures; Roberts FJ; The procurement, interpretation, and value of postmortem cultures is reviewed from the microbiologist's perspective . A brief description of the various procurement techniques is included and the factors involved in the contamination of specimens discussed . The interpretation of culture results is discussed by comparing postmortem specimens to routine laboratory samples such as blood cultures and sputum . The value of performing these cultures is discussed relevant to the individual postmortem examination and the research capabilities of the facility.

Biosci Biotechnol Biochem, 1999 Jan, 63(1), 168 - 79
Purification and characterization of serine acetyltransferase from Escherichia coli partially truncated at the C-terminal region; Mino K et al.; Incubation of serine acetyltransferase (SAT) from Escherichia coli at 25 degrees C in the absence of protease inhibitors yielded a truncated SAT . The truncated SAT was much less sensitive to feedback inhibition than the wild-type SAT . Analyses of the N- and C-terminal amino acid sequences found that the truncated SAT designated as SAT delta C20 was a resultant form of the wild-type SAT cleaved between Ser 253 and Met 254, deleting 20 amino acid residues from the C-terminus . Based on these findings, we constructed a plasmid containing an altered cysE gene encoding the truncated SAT . SAT delta C20 was produced using the cells of E . coli JM70 transformed with the plasmid and purified to be homogeneous on an SDS-polyacrylamide gel . Properties of the purified SAT delta C20 were investigated in comparison with those of the wild-type SAT and Met-256-Ile mutant SAT, which was isolated by Denk and Bock but not purified (J . Gen . Microbiol., 133, 515-525 (1987)) . SAT delta C20 was composed of four identical subunits like the wild-type SAT and Met-256-Ile mutant SAT . Specific activity, optimum pH for reaction, thermal stability, and stability to reagents for SAT delta C20 were similar those for the wild-type SAT and Met-256-Ile mutant SAT . However, SAT delta C20 did not form a complex with O-acetylserine sulfhydrylase-A (OASS-A), a counterpart of the cysteine synthetase and did not reduce OASS activity in contrast to the wild-type SAT and Met-256-Ile mutant SAT.

Bioessays, 1998 Dec, 20(12), 972 - 6
How do yeast cells sense glucose?
Kruckeberg AL, Walsh MC, Van Dam K.
A glucose-sensing mechanism has been described in Saccharomyces cerevisiae that regulates expression of glucose transporter genes . The sensor proteins Snf3 and Rgt2 are homologous to the transporters they regulate . Snf3 and Rgt2 are integral plasma membrane proteins with unique carboxy-terminal domains that are predicted to be localized in the cytoplasm . In a recent paper Ozcan and colleagues {Ozcan S, et al . EMBO J 1998; 17:2556-2773 (Ref . 1)} present evidence that the cytoplasmic domains of Snf3 and Rgt2 are required to transmit a glucose signal . They provide additional evidence to support their earlier assertion {Ozcan S, et al . Proc Natl Acad Sci USA 1996;93:12428-12432 (Ref . 2)} that glucose transport via Snf3 and Rgt2 is not involved in glucose sensing but, rather, that these proteins behave like glucose receptors . Other examples of transporter homologs with regulatory functions have recently been described in fungi as well {Madi L, et al . Genetics 1997; 146:499-508 (Ref . 3) . and Didion T, et al . Mol Microbiol 1998;27:643-650 (Ref . 4)} . The identification of this class of nutrient sensors is an important step in elucidating the complex of regulatory mechanisms that leads to adaptation of fungi to different environments.

Retina, 1999, 19(1), 45 - 50
Primary ocular Epstein-Barr virus-associated non-Hodgkin's lymphoma in a patient with AIDS: a clinicopathologic report; Mittra RA et al.; OBJECTIVE: To report an unusual case of chronic multifocal chorioretinitis with vitritis in a patient with acquired immunodeficiency syndrome (AIDS) that was resistant to antiviral and antitoxoplasmic medication and required a retinal biopsy for definitive diagnosis . METHODS: Vitreous biopsy, pars plana vitrectomy, and retinal biopsy were performed . The vitreous biopsy material was sent for bacterial, fungal, and viral culture, and the vitreous cassette was sent for cytology . The retinal biopsy material was divided and sent for polymerase chain reaction testing for toxoplasmosis and virology and pathologic tissue analysis . RESULTS: Vitreous cytology showed a mixed population of lymphocytes and histiocytes, but all other microbiologic and virologic studies were negative . Tissue analysis revealed an infiltrate of atypical mononuclear cells extending from the inner limiting membrane through the outer plexiform layer characteristic of a B cell, non-Hodgkin's lymphoma of the central nervous system (NHL-CNS) . In situ hybridization for the Epstein-Barr virus (EBV) was positive . An extensive systemic evaluation did not show evidence of extraocular tumor . CONCLUSION: Although rare, primary ocular NHL-CNS can be seen in patients with AIDS, and its clinical presentation often closely resembles other disorders . To our knowledge, this case represents the first ocular NHL in which EBV is shown to be associated.

Rinsho Biseibutshu Jinsoku Shindan Kenkyukai Shi, 1998 Nov 25, 9(1), 3 - 13
New Pathogens and Rapid Diagnostic Methods -Clinical Microbiology in the 21st Century-
Koontz F.
This presentation is actually a predictive opinion piece from the author's experience . No one really knows what new pathogens are awaiting us around the year of 2000 corner but, in 1985, the author was asked by the NCCLS (USA) to predict the emerging pathogens for the 1990's in the U.S . and hit on 80% of them . Thus, using the experience of this decade, we can predict what will happen in the U.S . in the first decade of the new century with 80-90% accuracy of those we predict . In the next millennium we will see a marked increase in the infection rate of the atypical (non-TB) mycobacteria, the environmental fungi, and even greater problems with the "water organisms" . All of this will be described in detail with the preliminary data that indicates these trends for the years "2000 and beyond" . In the area of what will be new in rapid testing, whether manual or automated, the future is even more cloudy . Manufacturers will not discuss with consumers what their long-range plans are for new products . Even long-time associations with Becton-Dickinson, Gen-Probe, Vitek, etc., has yielded little if any indication of their company's plans for the years "2000 and beyond" . One can, however, conceive and get into their minds to some degree based on their previous track records . We think these companies are working very hard on current tests or instruments to upgrade and improve their products yielding tests with greater sensitivity and specificity, while decreasing the technicians "hands-on time" . We anticipate the increased utilization of chromogenic detectors rather than nucleotides due to the inherent problem of disposal of radioactive compounds regardless of how few actual "micro-curies" involved . The use of ligand assay technology to supplement or replace currently employed PCR technology is totally predictable and will occur . One must remember that industry faces the same problems as we do with the "new pathogens" of the future . They will need to develop detection and identification systems for organisms that at this time don't even have names because we haven't encountered them yet . Additionally there are all those organisms out there that environmental microbiologists may be familiar with, but not clinical microbiologists . Industry will respond to need, they always have, they always will, but it is hard to respond to the unknown organism at this time . That problem relates to the philosophical nature and brevity of this abstract, that is "the unknown" . If we knew for sure what the future was, it would be the past.

Rinsho Biseibutshu Jinsoku Shindan Kenkyukai Shi, 1998, 9(2), 89 - 95
Bacterial toxins and detection methods; Asari S; The diagnosis of infectious disease has been carried out by detecting causative organisms from patient's clinical materials using culture methods so far . However, the method for rapid analysis and diagnosis has been changed by development of advanced methods such as immunological, molecular biological and genetic method . Especially, as a mass outbreak of entrohaemorrhagic E . coli (O157), which is reguired to detect toxins as well as bacteria itself, microbiologists and clinicians recognized the significance of rapid analysis of bacterial toxins . On the diagnosis for the state of disease and decision for the way of the therapy, the rapid detection of bacterial toxin is a significant indispensable tests . From these point of view, introduction of rapid analysis into a laboratory, not using cell culture or experimental animals, is strongly required . Here I describe a various kind of bacterial toxins and their detection methods.

Transplantation, 1999 Feb 15, 67(3), 482 - 4
Microsporidia infection in transplant patients; Gumbo T et al.; BACKGROUND: Microsporidia are the most common cause of chronic diarrhea in patients infected with human immunodeficiency virus . Patients who have undergone organ transplantation may also be infected . The precise immune defect and the clinical picture in transplant patients have not been studied . METHODS: We report a case of microsporidia infection in a heart transplant patient and review three other cases reported in the literature . RESULTS: Infection in three solid organ transplant patients occurred when the patients were receiving immunosuppressive therapy for rejection 1.5-3 years after transplantation . Patients had chronic diarrhea, vomiting, dyspepsia, and weight loss for 1 month to 3 years . CONCLUSIONS: Microsporidia may be the cause of chronic unexplained diarrhea and gastrointestinal disturbances in transplant patients . Defects in cell-mediated immunity probably play a role in maintaining the chronicity of this infection . Specific screening requests should be made to the microbiology laboratory when microsporidia infection is suspected.

J Biol Chem, 1999 Feb 26, 274(9), 5348 - 56
Inhibition of cellular growth by increased guanine nucleotide pools . Characterization of an Escherichia coli mutant with a guanosine kinase that is insensitive to feedback inhibition by GTP; Petersen C; In Escherichia coli the enzyme guanosine kinase phosphorylates guanosine to GMP, which is further phosphorylated to GDP and GTP by other enzymes . Here I report that guanosine kinase is subject to efficient feedback inhibition by the end product of the pathway, GTP, and that this regulation is abolished by a previously described mutation, gsk-3, in the structural gene for guanosine kinase (Hove-Jensen, B., and Nygaard, P . (1989) J . Gen . Microbiol . 135, 1263-1273) . Consequently, the gsk-3 mutant strain was extremely sensitive to guanosine, which caused the guanine nucleotide pools to increase dramatically, thereby initiating a cascade of metabolic changes that eventually led to growth arrest . By isolation and characterization of guanosine-resistant derivatives of the gsk-3 mutant, some of the crucial steps in this deleterious cascade of events were found to include the following: first, conversion of GMP to adenine nucleotides via GMP reductase, encoded by the guaC gene; second, inhibition of phosphoribosylpyrophosphate synthetase by an adenine nucleotide, presumably ADP, causing starvation for histidine, tryptophan, and pyrimidines, all of which require PRPP for their synthesis; third, accumulation of the regulatory nucleotide guanosine 5',3'-bispyrophosphate (ppGpp), a general transcriptional inhibitor synthesized by the relA gene product in response to amino acid starvation.

J Am Acad Dermatol, 1999 Feb, 40(2 Pt 2), 350 - 5
Disseminated sporotrichosis with extensive cutaneous involvement in a patient with AIDS; Ware AJ et al.; Sporotrichosis most commonly presents as a localized, lymphocutaneous infection that follows trauma, such as an injury from a rose thorn . In patients infected with HIV, it may be widespread and disseminated . We describe a patient with AIDS who developed disseminated sporotrichosis, a rare opportunistic fungal infection that may affect these patients . The condition remained undiagnosed because of failure to recognize characteristic histopathologic findings and failure of clinicians to interface closely with the microbiology laboratory . The condition was difficult to treat, requiring systemic administration of amphotericin . While localized sporotrichosis is an innocuous disorder that responds well to therapy, in immunocompromised hosts, it is potentially life-threatening and may require prolonged therapy with potentially toxic medications such as amphotericin B . It is important that clinicians be aware of the presentation of this unusual opportunistic infection and that they maintain close communication with pathology and clinical microbiology laboratories to ensure that proper stains and cultures are performed to avoid potential misdiagnosis.

Infect Immun, 1999 Mar, 67(3), 1526 - 32
Molecular and evolutionary analysis of Borrelia burgdorferi 297 circular plasmid-encoded lipoproteins with OspE- and OspF-like leader peptides; Akins DR et al.; We previously described two OspE and three OspF homologs in Borrelia burgdorferi 297 (D . R . Akins, S . F . Porcella, T . G . Popova, D . Shevchenko, S . I . Baker, M . Li, M . V . Norgard, and J . D . Radolf, Mol . Microbiol . 18:507-520, 1995; D . R . Akins, K . W . Bourell, M . J . Caimano, M . V . Norgard, and J . D . Radolf, J . Clin . Investig . 101:2240-2250, 1998) . In this study, we characterized four additional lipoproteins with OspE/F-like leader peptides (Elps) and demonstrated that all are encoded on plasmids homologous to cp32 and cp18 from the B31 and N40 strains, respectively . Statistical analysis of sequence similarities using the binary comparison algorithm revealed that the nine lipoproteins from strain 297, as well as the OspE, OspF, and Erp proteins from the N40 and B31 strains, fall into three distinct families . Based upon the observation that these lipoproteins all contain highly conserved leader peptides, we now propose that the ancestors of each of the three families arose from gene fusion events which joined a common N terminus to unrelated proteins . Additionally, further sequence analysis of the strain 297 circular plasmids revealed that rearrangements appear to have played an important role in generating sequence diversity among the members of these three families and that recombinational events in the downstream flanking regions appear to have occurred independently of those within the lipoprotein-encoding genes . The association of hypervariable regions with genes which are differentially expressed and/or subject to immunological pressures suggests that the Lyme disease spirochete has exploited recombinatorial processes to foster its parasitic strategy and enhance its immunoevasiveness.

Eur J Obstet Gynecol Reprod Biol, 1998 Dec, 81(2), 197 - 206
A decade of salpingoscopy; Puttemans PJ et al.; With the introduction of the salpingoscopy of the tubal ampullary mucosa in the 1980s, this diagnostic endoscopic examination not only disclosed an exciting world of sharp and detailed in vivo images of the actual site of human fertilization . Its systematic use in the assessment of the tubal factor in subfertile couples also provides specific, clinically relevant and prognostically valuable information, since it clearly demonstrates the presence or absence of anatomical distortions, especially adhesions between and destruction of mucosal folds, on a micro-endoscopic, i.e., mucosal level . The routine salpingoscopy of a free, patent tube is easy to perform and the procedure then takes about 10 min for both sides . In contrast with hysterosalpingography, a proximal (e.g., tubocornual or isthmic) block does not prevent us from examining the ampullary mucosa with the salpingoscope, whereas a small incision at the site of the occlusion with one of the techniques of operative laparoscopy, enables the inspection of the mucosa of a hydrosalpinx . With salpingoscopy, and using a simple classification system, a trained endoscopist can evaluate the sequelae of tubal inflammatory disease and their impact on fertility nearly as efficiently as with mucosal microbiopsies and they can direct their patients accordingly, either towards reconstructive (micro)surgery or towards medically assisted reproduction . In case of a tubal pregnancy, the effort to salpingoscopically evaluate both the affected and unaffected side may help to understand the underlying ethiology of the ectopic . Since patency and a normal appearance of the fimbriated end surely do not imply the absence of endoluminal pathology, it is advisable to select only salpingoscopically normal tubes to perform tubal transfers of gametes, zygotes or embryos . In the still ongoing discussion regarding preventive salpingectomy prior to IVF-ET in case of a uni- or bilateral hydrosalpinx, blind victimization of the Fallopian tube can in our opinion be avoided by a proper endoscopic selection of cases.

Med Mycol, 1998, 36 Suppl 1, 106 - 8
Teaching medical mycology in the year 2000; Negroni R et al.; Medical mycology is of increasing interest to the basic scientist, pathologist, microbiologist and clinician . This interest has been prompted by the rising number of immunosuppressed patients with opportunistic fungal infections, the expanding boundaries of the so-called endemic mycoses, the recognition of several major new endemic mycoses and a variety of other emerging fungal infections, and the development of potent, non-toxic antifungal drugs to treat these infections . The world of mycology is changing dramatically, especially in developing countries which have only limited resources to cope with the impact of the compromised host and the introduction of costly new antifungal drugs . Consequently, there is an urgent need to increase our effectiveness as teachers of medical mycology at all levels and in all regions of the world.

J Clin Microbiol, 1999 Mar, 37(3), 852 - 7
hsp65 sequencing for identification of rapidly growing mycobacteria; Ringuet H et al.; Partial sequencing of the hsp65 gene was used for the identification of rapidly growing mycobacteria (RGM) . A 441-bp fragment (A . Telenti, F . Marchesi, M . Balz, F . Bally, E . Bottger, and T . Bodmer, J . Clin . Microbiol . 31:175-178, 1993) was amplified and sequenced by an automated fluorescence-based method involving capillary electrophoresis . Type strains of 10 RGM species were first studied . Each species had a unique nucleotide sequence, distinguishing it clearly from the other species . A panel of strains from the four main RGM species responsible for human infections, Mycobacterium abscessus, Mycobacterium chelonae, Mycobacterium fortuitum, and Mycobacterium peregrinum, was also studied . There were few sequence differences within each of these species (<2% of bases were different from the type strain sequence), and they had no effect on species assignment . hsp65 sequencing unambiguously differentiated M . chelonae and M . abscessus, two species difficult to identify by classical methods and 16S rRNA gene sequencing . The devised procedure is a rapid and reliable tool for the identification of RGM species.

J Pediatr Gastroenterol Nutr, 1999 Feb, 28(2), 157 - 61
Evaluation of enzyme-linked immunosorbent assay for the diagnosis of Helicobacter pylori infection in children from different age groups with and without duodenal ulcer; de Oliveira AM et al.; BACKGROUND: Although enzyme-linked immunosorbent assay (ELISA) is highly sensitive and specific for the diagnosis of Helicobacter pylori infection in adults, their performance in children is still controversial . METHODS: A second-generation ELISA was used to evaluate the IgG response to H . pylori in the serum of 130 consecutive children who underwent upper gastrointestinal endoscopy . The presence of H . pylori was determined in antral biopsy specimens by culture, urease test, and histologic analysis . RESULTS: Sixty-eight children (all of the 20 who had duodenal ulcer) were H . pylori positive by microbiologic test . Immunoglobulin G antibodies to H . pylori were detected in 79.4% of the infected children and in 8.1% of the noninfected ones . The sensitivity of the test was higher in patients with duodenal ulcer (100%) than in those without (70.8%) . When used in children of different ages the test also presented differences in sensitivity: 44.4% in children 2 to 6 years old; 76.7% in children 7 to 11 years old, and 93.1% in children 12 to 16 years old (p = 0.006) . The serum immunoglobulin G concentration was significantly higher (p = 0.0003) in children with duodenal ulcer than in those without and was higher in older children than in younger ones without duodenal ulcer (p = 0.05) . CONCLUSIONS: The accuracy of the test in children with duodenal ulcer and in children more than 12 years old was good; however, in children up to 12 years of age without duodenal ulcer, the sensitivity of the test was too low to be used for screening purposes or to rule out the presence of infection.

Ann N Y Acad Sci, 1998 Dec 30, 862, 111 - 20
Defining appropriate health status and management programs for specific-pathogen-free swine for xenotransplantation; Swindle MM; Swine are expected to be utilized as xenograft donors for both whole-organ and cellular transplantation . In order to meet the criteria for regulatory guidelines, donor animals are going to have to be free of potential zoonoses and other complicating diseases . Screening of animals will have to include tests for viruses, bacteria, parasites, congenital defects, and other inapparent diseases such as neoplasia or metabolic dysfunctions . The term Specific-Pathogen-Free (SPF) swine is a proprietary designation in the U.S . that does not include screening for all appropriate organisms for xenotransplantation . A program for breeding animals as xenograft donors will have to be conducted in a biomedical research facility rather than a conventional farm setting . The research programs at such a facility should include serology, microbiology, necropsy, histology and parasitology . The use of sentinel animal monitoring in a research facility is one method to ensure compliance . It will be impossible to provide complete individual animal screening in a timely fashion prior to performing a xenograft transplant . Quality control measures need to ensure that there is a reasonable confidence that the donor tissue is appropriate for the procedure to be performed . It is suggested that a term such as xenograft-defined flora be used to designate the appropriate health status of donor animals rather than SPF in order to avoid confusion with existing standards.

Ann N Y Acad Sci, 1998 Dec 30, 862, 52 - 66
Infection and xenotransplantation . Developing strategies to minimize risk; Fishman JA; Infection in transplantation results from interaction between the level of immune suppression and the epidemiologic exposures of the recipient . "Xenosis," infection in xenotransplantation, may be increased beyond that of allotransplantation because: (1) the xenograft may serve as a permissive focus of infection for donor-derived organisms; (2) these organisms may be unknown or xenotropic; (3) microbiologic assays may be unavailable; (4) clinical syndromes due to such novel pathogens may not be recognized; (5) the necessary level of immune suppression may be greater than for allotransplantation; (6) donor-derived organisms may acquire new (e.g., genetic) characteristics in the human host; (7) the presence of immune suppression and the high, intrinsic rate of infection may mask the presence of xenosis; and (8) MHC-incompatibility may reduce the efficacy of the immune response within the xenograft . Because immunocompromised individuals are sentinels for infection by many types of novel infectious agents, and because there is some unknown level of risk that such pathogens will spread to the general population, microbiologic studies must be initiated in tandem with preclinical and clinical studies of xenotransplantation.

Med Clin North Am, 1999 Jan, 83(1), 179 - 95, x
The facial nerve . Current trends in diagnosis, treatment, and rehabilitation; Jackson CG et al.; Facial paralysis is a potentially devastating disorder with numerous implications . Multiple entities must be considered in its etiology, and recent advances in microbiology, radiographic imaging, electrodiagnostic testing, and microsurgery have provided great insight into the pathophysiology, diagnosis, treatment, and rehabilitation of the facial nerve . Recent DNA PCR testing has shed new insight into the potential cause for Bell's palsy . This article focuses on the evaluation, differential diagnosis, medical treatment, and rehabilitation of facial nerve pathology with primary emphasis on facial paralysis . Surgical management is also discussed, including reanimation of the paralyzed face.

Appl Environ Microbiol, 1999 Feb, 65(2), 404 - 8
Composition and enzymatic activity of the extracellular matrix secreted by germlings of botrytis cinerea; Doss RP; Germlings of Botrytis cinerea, an important fungal pathogen of plants, produce an extracellular matrix (ECM), or ensheathing film, that serves, in part, in their attachment (R . P . Doss, et al., Appl . Environ . Microbiol . 61:260-265, 1995) . The composition of this film has been ascertained by using samples obtained by growing germlings on a glass surface, removing the fungal mycelium by vigorous washing, and collecting the tightly attached film by scraping the substratum with a razor blade . Slightly over half of the dry weight of the ECM was found to be carbohydrates (about 20%), proteins (about 28%), and lipids (about 6%) . Hydrolysis of the carbohydrate portion of the ECM revealed that glucose was the most prominent monosaccharide present, comprising about 60% of the total monosaccharides . Also present were mannose (about 35%) and myo-inositol (about 5%) . The proteinaceous fraction of the ECM was made up of a number of polypeptides separable by polyacrylamide gel electrophoresis . The lipid fraction of the ECM, analyzed by thin-layer chromatography, was made up of several simple lipid components, including free fatty acid, mono- and triacylglycerol, wax ester, fatty alcohol, and several unidentified components . No complex lipids were detected . Isolated ECM exhibited polygalacturonase and laccase activity and was able to catalyze the hydrolysis of p-nitrophenyl butyrate, a model substrate for assessing cutinase activity . Cellulase, pectin lyase, and pectin methyl esterase activities were noted with both heated and unheated ECM preparations . Proteinase activity was not detected.

Appl Environ Microbiol, 1999 Feb, 65(2), 514 - 22
Diversity of free-living and attached bacteria in offshore Western Mediterranean waters as depicted by analysis of genes encoding 16S rRNA; Acinas SG et al.; In a previous study (S . G . Acinas, F . Rodriguez-Valera, and C . Pedros-Alio, FEMS Microbiol . Ecol . 24:27-40, 1997), community fingerprinting by 16S rDNA restriction analysis applied to Mediterranean offshore waters showed that the free-living pelagic bacterial community was very different from the bacterial cells aggregated or attached to particles of more than about 8 micrometer . Here we have studied both assemblages at three depths (5, 50, and 400 m) by cloning and sequencing the 16S rDNA obtained from the same samples, and we have also studied the samples by scanning electron microscopy to detect morphology patterns . As expected, the sequences retrieved from the assemblages were very different . The subsample of attached bacteria contained very little diversity, with close relatives of a well-known species of marine bacteria, Alteromonas macleodii, representing the vast majority of the clones at every depth . On the other hand, the free-living assemblage was highly diverse and varied with depth . At 400 m, close relatives of cultivated gamma Proteobacteria predominated, but as shown by other authors, near the surface most clones were related to phylotypes described only by sequence, in which the alpha Proteobacteria of the SAR11 cluster predominated . The new technique of rDNA internal spacer analysis has been utilized, confirming these results . Clones representative of the A . macleodii cluster have been completely sequenced, producing a picture that fits well with the idea that they could represent a genus with at least two species and with a characteristic depth distribution.

Chest, 1999 Jan, 115(1), 218 - 23
Development of housing programs to aid in the treatment of tuberculosis in homeless individuals: a pilot study; LoBue PA et al.; STUDY OBJECTIVES: To describe our experience with novel supervised housing programs developed to aid in the treatment of tuberculosis (TB) in homeless individuals, including a preliminary analysis of their effectiveness and estimate of potential cost savings . DESIGN: Retrospective chart review . SETTING: A county TB control program . METHODS: The San Diego County TB Control Program's computer database was used to identify homeless individuals placed in one of two supervised housing programs for treatment of TB {Young Men's Christian Association (YMCA), for noninfectious patients, or Bissell House, for infectious patients} . Charts for all these patients were reviewed and information regarding their demographics, underlying medical conditions, therapy, microbiologic markers of response to therapy, hospitalizations, and participation in supervised housing programs was recorded . MEASUREMENTS AND RESULTS: The sputum culture conversion and treatment completion rates for those housed in the YMCA were 100 and 84.6%, respectively . Of the patients in the Bissell House program, 100% had converted their smear and culture . In addition, all patients in this program completed an adequate course of supervised therapy . These rates of microbiologic conversion and treatment completion compare favorably with historical data from San Diego County and other locations . Estimated cost savings for placing medically stable infectious patients in the Bissell House for respiratory isolation and supervised treatment were estimated to be $27,034 per patient . CONCLUSIONS: Use of supervised housing to aid in treatment of TB in the homeless appears to be effective and results in substantial cost savings . A larger multicenter study should be considered to confirm these findings and better quantify the cost-effectiveness of such programs.

Biochimie, 1998 Dec, 80(12), 1043 - 6
Increased expression of a hemimethylated oriC binding protein, SeqA, in an aphA mutant; Kohiyama M et al.; In Escherichia coli, the origin of DNA replication, oriC, becomes transiently hemimethylated at the GATC sequences immediately after initiation of replication and this hemimethylated state is prolonged because of its sequestration by a fraction of outer membrane . This sequestration is dependent on a hemimethylated oriC binding protein such as SeqA . We previously isolated a clone of phage lambda gt11 called hobH, producing a LacZ fusion protein which recognizes hemimethylated oriC DNA . Very recently, Thaller et al . (FEMS Microbiol . Lett . 146 (1997) 191-198) found that the same DNA segment encodes a non-specific acid phosphatase, and named the gene aphA . We show here that the interruption of the aphA reading frame by kanamycin resistance gene insertion, abolishes acid phosphatase (NAP) activity . Interestingly, in the membrane of the null mutant, the amount of SeqA protein is about six times higher than that in the parental strain, suggesting the existence of a regulatory mechanism between SeqA and NAP expression.

Int J Food Microbiol, 1998 Nov 24, 45(1), 59 - 63
A formal system of approval for monographs in the pharmacopoeia of culture media--statement from the IUMS-ICFMH working party on culture media; Curtis GD et al.; A categorization system for monographs on culture media is outlined which will lead to more rapid publication and a formal division into three classifications; draft, proposed and approved . This should assist the quality assurance and accreditation processes in food microbiology laboratories.

Int J Food Microbiol, 1998 Nov 24, 45(1), 35 - 41
The use of reference materials in quality assurance programmes in food microbiology laboratories; In't Veld PH; Nine different reference materials (RMs) for use in food and water microbiology have been developed with the support of the European Commission (EC) . The production process of RMs is based on spray drying bacteria suspended in milk . The highly contaminated milk powder (HCMP) obtained is mixed with sterile milk powder to achieve the desired level of contamination and is subsequently filled into gelatine capsules . The HCMP may need to be stabilised by storage for more than a year before a stable RM can be prepared . The HCMP are mixed with sterile milk powder using a pestle and mortar in order to produce homogeneous RMs . For routine use of RMs Shewhart control charts can be produced . Based on log10 transformed counts, control limits are calculated . Rules for the interpretation of results facilitate the detection of out of control situations . Besides RMs there are also CRMs (Certified Reference Materials) that are certified by the EC Community Bureau of Reference (BCR) and are intended for occasional use . Based on the BCR certificate, user tables are produced presenting the 95% confidence limits for the number of capsules likely to be examined in practice . Also power analysis is made to indicate the minimum difference between the certified value and the observed geometric mean value in relation to the number of capsules examined.

Int J Food Microbiol, 1998 Nov 24, 45(1), 29 - 34
Strategies in the development of media for the detection of food-borne pathogens; Bolton FJ; Successful medium development is dependent on using a systematic approach and also by giving due consideration to the factors which can influence the performance of the medium at the various stages of assessment . The most important factors to be considered are: (i) the properties of the target organisms, (ii) the selection of test strains, (iii) the methods of evaluation, (iv) the basal medium and growth supplements, (v) the properties of the medium, and (vi) the intended use of the medium . If these are investigated fully then culture media can be optimised to fulfil the demands of modem microbiology techniques used for detection and confirmation of bacteria.

Int J Food Microbiol, 1998 Nov 24, 45(1), 7 - 11
Quality assurance in food microbiology--a novel approach; Bolton FJ; The introduction of quality systems as a requirement of laboratory accreditation is causing microbiologists to review current practices . The need for Quality Assurance (QA) in food microbiology is of growing importance and this paper presents a novel approach to implementing QA based on a system which is analogous to the Hazard Analysis Critical Control Point approach adopted by the food industry . The basis of the QA system is the recognition of Quality Assessment Points (QAPs) . Several Quality Control and monitoring practices are suggested for each of the QAPs with the overall aim of developing a Total Quality Assurance system for food microbiology laboratories.

J Microsc, 1998 Dec, 192 ( Pt 3), 236 - 47
On optimizing high-pressure freezing: from heat transfer theory to a new microbiopsy device; Shimoni E et al.; High-pressure freezing (HPF) is currently the only method which enables adequate cryoimmobilization of biological samples thick enough to describe the bulk of the sample . In the current state of HPF instrumentation and preparation methods, the technique has not yet reached its full potential . While suspensions can be prepared easily for HPF, tissue preparation is restricted by the need to compromise between different requirements and difficulties . (i) In order to achieve optimal freezing quality, very thin samples are required . (ii) There is mechanical difficulty in cutting such thin samples without distorting the organization of the tissue . (iii) The cutting and the succeeding preparation steps of small samples require long handling times (minutes), which may result in physiological and hence structural alterations . Computerized heat transfer simulations are presented which confirm that the efficiency of heat extraction from cylindrical samples contained within thin-walled metal tubes is higher than from standard flat discoid samples sandwiched between relatively thick aluminium platelets . Based on this fact, we developed a prototype of a new microbiopsy device which enables the quick excision of such cylinders of soft tissues . The device utilizes sharp gold needles of an inner diameter of 200 microm and wall thickness of 50 microm . The frozen sample contained in the soft gold needle permits all the manipulations needed for conventional cryo-preparation techniques for electron microscopy (e.g . cryo-sectioning, freeze-fracturing, freeze-substitution).

Cancer, 1999 Jan 1, 85(1), 213 - 9
Outpatient therapy with oral ofloxacin for patients with low risk neutropenia and fever: a prospective, randomized clinical trial; Hidalgo M et al.; BACKGROUND: Hospitalization and treatment with broad-spectrum intravenous antibiotics is the standard care for patients with neutropenia and fever . This randomized clinical trial evaluated the feasibility and efficacy of ambulatory care with oral ofloxacin for patients with low risk, chemotherapy-induced neutropenia and fever . METHODS: Patients with solid tumors who were treated with conventional dose chemotherapy, presented with fever (axillary temperature >38 degrees C on 2 occasions or >38.5 degrees C on a single occasion) and neutropenia (absolute neutrophil count, <500 cells/microL), and met low risk criteria were eligible for this study . They were randomized either to hospitalization and treatment with broad-spectrum intravenous antibiotics, which consisted of a combination of cefazidime and amikacin, or to outpatient treatment with oral ofloxacin . The definitions of fever of unknown origin, clinical and microbiologic infection, success, success with modification, and failure were the usual ones for this type of study . RESULTS: One hundred episodes were randomized, and 95 were evaluable (47 were randomized to ceftazidime/amikacin and 48 to ofloxacin) . Baseline characteristics, as well as the proportion of patients with microbiologic and clinical infections, were similar in the two groups . In 91% of episodes in the inpatient group and 89% in the ofloxacin group, patients recovered uneventfully (P=1; 95% CI for the difference, -0.09 to 0.13), with 2 and 5 patients requiring modification of the antibiotics, respectively . Eight percent of episodes in the control group and 10.4% in the experimental group resulted in treatment failure . Eight patients (16%) in the outpatient group experienced failure with ambulatory care and were admitted to the hospital . CONCLUSIONS: Outpatient oral antibiotic therapy with oral ofloxacin for patients with low risk neutropenia and fever is safe and similar in efficacy to hospitalization and treatment with broad-spectrum parenteral antibiotics.

J Bacteriol, 1999 Feb, 181(3), 772 - 80
Assembly of the K40 antigen in Escherichia coli: identification of a novel enzyme responsible for addition of L-serine residues to the glycan backbone and its requirement for K40 polymerization; Amor PA et al.; Escherichia coli O8:K40 coexpresses two distinct lipopolysaccharide (LPS) structures on its surface . The O8 polysaccharide is a mannose homopolymer with a trisaccharide repeat unit and is synthesized by an ABC-2 transport-dependent pathway . The K40LPS backbone structure is composed of a trisaccharide repeating unit of N-acetylglucosamine (GlcNAc) and glucuronic acid (GlcA) and has an uncommon substitution, an L-serine moiety attached to glucuronic acid . The gene cluster responsible for synthesis of the K40 polysaccharide has previously been cloned and sequenced and was found to contain six open reading frames (ORFs) (P . A . Amor and C . Whitfield, Mol . Microbiol . 26:145-161, 1997) . Here, we demonstrate that insertional inactivation of orf1 results in the accumulation of a semirough (SR)-K40LPS form which retains reactivity with specific polyclonal serum in Western immunoblots . Structural and compositional analysis of the SR-K40LPS reveals that it comprises a single K40 repeat unit attached to lipid A core . The lack of polymerization of the K40 polysaccharide indicates that orf1 encodes the K40 polymerase (Wzy) and that assembly of the K40 polysaccharide occurs via a Wzy-dependent pathway (in contrast to that of the O8 polysaccharide) . Inactivation of orf3 also results in the accumulation of an SR-LPS form which fails to react with specific polyclonal K40 serum in Western immunoblots . Methylation linkage analysis and fast atom bombardment-mass spectrometry of this SR-LPS reveals that the biological repeat unit of the K40 polysaccharide is GlcNAc-GlcA-GlcNAc . Additionally, this structure lacks the L-serine substitution of GlcA . These results show that (i) orf3 encodes the enzyme responsible for the addition of the L-serine residue to the K40 backbone and (ii) substitution of individual K40 repeats with L-serine is essential for their recognition and polymerization into the K40 polysaccharide by Wzy.

Proc R Soc Lond B Biol Sci, 1998 Dec 22, 265(1413), 2381 - 6
The origin of the Australasian marsupial fauna and the phylogenetic affinities of the enigmatic monito del monte and marsupial mole; Springer MS et al.; Alternative hypotheses in higher-level marsupial systematics have different implications for marsupial origins, character evolution, and biogeography . Resolving the position of the South American monito del monte (Order Microbiotheria) is of particular importance in that alternate hypotheses posit sister-group relationships between microbiotheres and taxa with disparate temporal and geographic distributions: pediomyids; didelphids; dasyuromorphians; diprotodontians; all other australidelphians; and all other marsupials . Among Australasian marsupials, the placement of bandicoots is critical; competing views associate bandicoots with particular Australasian taxa (diprotodontians, dasyuromorphians) or outside of a clade that includes all other Australasian forms and microbiotheres . Affinities of the marsupial mole are also unclear . The mole is placed in its own order (Notoryctemorphia) and sister-group relationships have been postulated between it and each of the other Australasian orders . We investigated relationships among marsupial orders by using a data set that included mitochondrial and nuclear genes . Phylogenetic analyses provide support for the association of microbiotheres with Australasian marsupials and an association of the marsupial mole with dasyuromorphs . Statistical tests reject the association of diprotodontians and bandicoots together as well as the monophyly of Australasian marsupials . The origin of the paraphyletic Australasian marsupial fauna may be accounted for by (i) multiple entries of australidelphians into Australia or (ii) bidirectional dispersal of australidelphians between Antarctica and Australia.

Bratisl Lek Listy, 1998 Nov, 99(11), 563 - 6
{Epidemiologic and microbiologic aspects of mycobacteriosis in Slovakia--M . xenopi}; Badalik L et al.; The first mycobacterioses caused by M . xenopi in Slovakia were discovered in the year 1979 . Gradually they became the most often occurring mycobacterioses caused by facultative pathogenic mycobacteria . The purpose of investigation is to describe epidemiological situation of diseases caused by M . xenopi in Slovakia and to confront it with the situation in chosen developed countries . The methodology of this paper is based upon surveillance of tuberculosis as applied on mycobacterioses . During the period of last 10 years 960 isolations of M . xenopi from 622 persons were registered in Slovakia . Pulmonary mycobacterioses caused by M . xenopi was discovered in 58 persons until the end of the year 1966, 48 of them are men and 10 are women . The most often transmission factor is water in water supply mainly in city-habitation and hospital environment . The occurrence has endemic character . (Ref . 31.)

Anal Biochem, 1999 Feb 1, 267(1), 30 - 6
Detection of cell and tissue surface antigens using up-converting phosphors: a new reporter technology; Zijlmans HJ et al.; A novel luminescent reporter for the sensitive detection of antigens in tissue sections or on cell membranes is described . It consists of submicron-size phosphor crystals (0.2-0.4 microm), which are surface labeled with avidin or antibodies and capable of binding specifically to antigens on intact cells or in tissue sections . These phosphor reporters exhibit two-photon, anti-Stokes luminescence by up-converting infrared to visible light and are named Up-converting Phosphor Technology (UPT) . They typically consist of yttriumoxysulfides doped with two different lanthanides exhibiting photostable, strong emission in the visible (blue, green, and red) upon excitation in the infrared . This report describes the conjugation of phosphor particles to NeutrAvidin with the subsequent use of this conjugate in a model system consisting of prostate-specific antigen in tissue sections and the CD4 membrane antigen on human lymphocytes . An epi-illumination fluorescence microscope was adapted to provide near-IR excitation using a xenon lamp for visualization of the visible emission . Advantages of UPT are (i) permanent, strong, anti-Stokes emission of discrete wavelengths; (ii) unmatched contrast in biological specimens due to the absence of autofluorescence upon excitation with IR light; (iii) simultaneous detection of multiple target analytes; and (iv) low-cost microscope modifications . The new methodology has not only high potential value in diagnostic pathology as described here, but may offer advantages for the detection of proteins or nucleic acids when applied to molecular biology, genomic research, virology, and microbiology .

Infect Dis Obstet Gynecol, 1998, 6(5), 204 - 8
Gram stain method shows better sensitivity than clinical criteria for detection of bacterial vaginosis in surveillance of pregnant, low-income women in a clinical setting; Tam MT et al.; OBJECTIVE: The purpose of the study is to determine whether the Gram stain method is superior to the clinical criteria for the diagnosis of bacterial vaginosis in low-income pregnant women seen in a resident clinic setting . The clinical criteria is the current diagnostic method employed to diagnose bacterial vaginosis . STUDY DESIGN: In this study, 51 pregnant women with vaginal discharge were prospectively evaluated . All were screened using the clinical criteria, Gram stain method, and culture of the discharge . The modified scoring system instituted by Nugent et al . (J Clin Microbiol 29:297-301, 1991) was employed in reading the Gram stain smears . The clinical criteria were then compared with the Gram stain method . Isolation of moderate to many Gardnerella vaginalis growth by culture was used as the confirmatory finding . RESULTS: Sensitivity of the Gram stain method (91%) was significantly higher than that of the clinical criteria (46%), (sign test P = 0.0023, < 0.01) . The Gram stain method also has both a low false-negative (4%) and high negative predictive value (96%), making it an ideal diagnostic test . CONCLUSION: The Gram stain method is a rapid and cost-effective test that is also highly reproducible and readily available in many laboratories . These features make the Gram stain method a more desirable screening procedure for bacterial vaginosis in a clinic population.

Otolaryngol Head Neck Surg, 1999 Jan, 120(1), 57 - 61
Selection of antibiotics after incision and drainage of peritonsillar abscesses; Kieff DA et al.; Despite the fact that peritonsillar abscess is the most common complication of acute tonsillitis, the treatment of peritonsillar abscess remains controversial . One element of controversy is the choice of antibiotics after drainage of the abscess . In an attempt to assess the effect of antibiotic choice on the treatment of peritonsillar abscess, we conducted a retrospective review of records from patients with peritonsillar abscess treated with incision and drainage . Our review identified 103 patients, comprising two groups: 58 patients treated with broad-spectrum intravenous antibiotics and 45 patients treated with intravenous penicillin alone . These patients were hospitalized after incision and drainage, and therefore their clinical courses and responses to therapy could be rigorously assessed . Characterization of illness based on patient age, temperature, and white blood cell count revealed similar severity of illness between the two groups . Comparison of clinical outcomes with respect to hours hospitalized (mean 44.3 +/- 6.6 and 38.3 +/- 7.1 hours, 95% confidence interval, for broad-spectrum and penicillin groups, respectively) and mean hours febrile (16.9 +/- 5.0 and 13.3 +/- 4.2 hours, 95% confidence interval) were not statistically significantly different (p = 0.222 and 0.269, respectively) between groups, indicating that broad-spectrum antibiotics failed to show greater efficacy than penicillin in the treatment of these patients . The microbiologic characteristics of these infections, failures of therapy, and complication rates were similar to those reported in the literature . These results suggest that intravenous penicillin remains an excellent choice for therapy in cases of peritonsillar abscess requiring parenteral antibiotics after drainage.

Dermatol Clin, 1998 Oct, 16(4), 691 - 8
Syphilis . Serology; Young H; Microbiologic tests are essential in the diagnosis and management of patients with syphilis . Apart from the very early stage of disease (when T . pallidum may be detected in the lesions of primary syphilis before an antibody response is detectable) serology is the mainstay of laboratory testing . The performance of cardiolipin antigen ("reagin") and treponemal antigen (native and recombinant) tests is discussed in relation to the stage of syphilis, treatment status, and interactions between syphilis and HIV infection . Screening with cardiolipin antigen tests detects early stage disease, but treponemal antigen tests are required for the reliable detection of late-stage infection and the exclusion of syphilis in HIV-infected patients . EIA tests using treponemal antigen are sensitive and specific and fit well into current laboratory practices . Although the FTA-abs test is often considered the "gold standard" confirmatory test, its sensitivity is slightly lower than that of certain other treponemal antigen tests . A reactive antitreponemal IgM test correlates well with untreated or recently treated early infection, but specific IgM tests are often negative in untreated late-stage disease . Serial quantitative cardiolipin antigen tests remain the method of choice for monitoring the efficacy of treatment . The role of the laboratory in aiding a diagnosis of neurosyphilis and congenital infection is discussed briefly, as is the current status of newer technologies, such as PCR and immunoblotting.

Dermatol Clin, 1998 Oct, 16(4), 663 - 7
Screening for sexually transmitted infections; Kinghorn GR; The high prevalence of STI in many developed countries; their costly physical, psychological, and relationship sequelae; and their association with the acquisition and transmission of HIV necessitate the introduction of screening programs, especially those that encourage opportunistic screening in diverse health care and community settings . This requirement is accompanied by the need for better awareness and education of health care professionals, especially those working in primary care or in sexual health disciplines, and knowledge of local prevalence and other epidemiologic factors to allow cost-effective targeting of high-risk groups . Such programs should be accompanied by the development of effective clinical alliances between those undertaking screening, the diagnostic microbiology laboratories, and clinicians with local responsibility for case management and public health control . The development of new molecular methods of diagnosis for the common bacterial STI permits screening in the community to be extended . This will help detect those asymptomatic persons who would not otherwise access health services but who may act as important vectors in STI spread and who continue to maintain local reservoirs.

Med Clin (Barc), 1998 Nov 28, 111(18), 687 - 91
{Septicemia associated with central venous catheterization in a children's hospital . A multivariate study}; Herruzo Cabrera R et al.; BACKGROUND: The blood stream infections (BSI) are the principal nosocomial infection in the child hospitals . In this study we estimate the incidence of BSI associated with central venous catheterization, and estimate different risk and protective factors, through a multivariate study . MATERIAL AND METHODS: The study have followed in a prospective way during 6 months all the children with central venous catheterization (489 catheters), from the moment of insertion until withdrawal, collecting various data previous to the development of the infection: place of insert, type of catheter, duration, clinic information, microbiology, and the treatments administered through the catheter . In was accomplished an multivariate analysis with logistic regression, for two principal effect variables, the catheter colonization and the catheter related BSI . RESULTS: The incidence of catheter related BSI was 5.5% and for local infection 11.2% . The density of incidence was 3.15 and 6.42 for each 1,000 catheters-day, respectively . The logistic regression model included: colonization of the skin in the insertion point > 15 colonies, days with antibiotics through catheter, use of lipidic parenteral solutions and fever, previous to the infection . The area under the ROC curve was 0.72 . CONCLUSIONS: In children with septicemias associated with central catheterization the predictors or sentry criterion for the decision on when to withdraw a catheter are colonization (> 15 colonies) of the insert point, together with the use of lipidic parenteral solutions or extended antibiotic treatment.

Hand Clin, 1998 Nov, 14(4), 511 - 8, vii
The history of hand infections; Kono M et al.; The current approach to hand infections is a culmination of information gained from centuries of medical teaching by the ancient Greeks, nineteenth-century anatomists, and twentieth-century microbiologists and surgeons . Although many individuals have contributed to our knowledge through their teachings and writings, the contemporary treatment of hand infections has evolved quite rapidly . Several landmark scientific discoveries have drastically changed not only the manner in which hand infections are treated, but the ultimate clinical results obtained . This brief review of the history of hand infections highlights the major contributions that have influenced the contemporary medical and surgical approach to infections of the hand.

Diagn Microbiol Infect Dis, 1998 Nov, 32(3), 217 - 21
Evaluation of the new API Candida system for identification of the most clinically important yeast species; Bernal S et al.; The API Candida system (bioMerieux) a new yeast identification system, was evaluated for its reliability in identifying 198 clinical yeast isolates in comparison with the API 20C system (bioMerieux) that was used as reference standard . The API Candida system correctly identified 91.4% and 71.7% of the isolates, with and without additional tests, respectively . The API Candida system identified 96.3% of common isolates studied, and 66.6% of uncommon isolates . We think that API Candida system is an easy and good yeast identification system and it could be used in a routine clinical microbiology laboratory.

Biosens Bioelectron, 1998 Dec 1, 13(12), 1271 - 8
Novel system for real-time ex vivo lactate monitoring in human whole blood; Gfrerer RJ et al.; The objective of the study was to evaluate the performance of an amperometric enzyme based lactate sensor and to investigate the possibility of replacing a double lumen catheter based blood withdrawal system with a heparin coated single lumen system . The inner lumen of a double lumen catheter which was placed in a peripheral vein was perfused with heparin solution . The outer lumen was used to collect heparinized blood samples at a defined flow rate . The single lumen system was attached to a heparinized catheter which was also placed in a peripheral vein . The undiluted blood samples were collected at a specified flow rate . A sensor flow chamber incorporating an amperometric thin-film lactate microbiosensor was placed in the sampling line for real-time lactate monitoring . Plasma lactate concentrations were measured during frequently performed hyperlactatemia bicycle ergometer experiments in six healthy volunteers (age 25.8 +/- 2.8 years, BMI 22.7 +/- 1 kg/m2) . Additionally, plasma lactate was measured in real-time using the lactate sensors . The first three experiments were performed with a double lumen based catheter system whereas the following three experiments were performed with a heparin coated catheter system . The correlation coefficients of sensor readings and laboratory analyzer results in all six experiments were between 0.93 and 0.99, respectively (P < 0.001) . The miniaturized lactate sensors showed a linear range up to 25 mmol/l lactate concentration and 95% response times < 30 s in undiluted serum . During the experiments maximum lactate concentrations of 14 mmol/l were achieved . Improvements of system performance using heparin coated catheter systems could be shown . The overall SD of the sensor readings compared to laboratory results using three double lumen catheter based systems was 0.91 mmol/l whereas the SD using three heparin coated systems was 0.65 mmol/l . In summary, real-time monitoring of lactate in human whole blood is feasible with such a device and can be improved by using heparin coated catheter systems.

Aliment Pharmacol Ther, 1998 Dec, 12(12), 1273 - 8
Eradication of Helicobacter pylori with lansoprazole, roxithromycin and metronidazole--an open pilot study; Pohle T et al.; BACKGROUND: The most extensively studied Helicobacter pylori eradication regimen comprises omeprazole, clarithromycin and metronidazole . Macrolide antibiotics other than clarithromycin should achieve similar efficacy, but they have not yet been thoroughly tested . AIM: To determine the efficacy and safety of a triple therapy regimen using lansoprazole, roxithromycin, and metronidazole on the basis of multicentre outpatient care in an open pilot study . METHODS: 163 patients with duodenal ulcer and proven H . pylori infection received lansoprazole 30 mg b.d., roxithromycin 300 mg b.d . and metronidazole 500 mg b.d . for 7 days followed by another 7 days of lansoprazole 30 mg once daily . H . pylori status was determined by urease quick test, histology, microbiology and 13C-urea breath test before starting and at least 4 weeks after completing treatment . RESULTS: 150 patients were available for evaluation; H . pylori was successfully eradicated in 84.7% (127/ 150) as determined by urease quick test, 78.0% (117/150) by histology, 81.3% (109/134) by 13C-urea breath test; and in 75.3% (113/150), at least two tests were negative . Side-effects were reported in 34 patients (most commonly diarrhoea and changes in liver function tests), in two cases the study medication was interrupted . Prior to treatment, 23% of the H . pylori isolates were resistant against metronidazole and 3.4% against roxithromycin . After unsuccessful treatment, 84% of the isolates were resistant against metronidazole and 21% against roxithromycin . Primary resistance to metronidazole increased the chance of treatment failure approximately sevenfold (7% vs . 53%) . CONCLUSIONS: For H . pylori eradication, the combination of lansoprazole, roxithromycin and metronidazole proved to be as safe as other current triple therapy regimens, while a comparison of efficacy rates yet remains to be assessed in prospective controlled trials . The metronidazole-resistant H . pylori is not rare in Germany and, in the present study, has strongly influenced treatment success.

Pediatr Infect Dis J, 1998 Dec, 17(12), 1159 - 62
Colonization with enteroadherent, enterotoxigenic and enterohemorrhagic Escherichia coli among day-care center attendees in New Orleans, Louisiana; Oberhelman RA et al.; BACKGROUND: E . coli strains producing specific virulence factors are frequently cited as causes of pediatric diarrhea in developing areas, although many well children from the same areas are colonized with these organisms . The role of these Escherichia coli in day-care center (DCC)-associated diarrhea in the United States has not been evaluated . METHODS: A cohort of 112 DCC attendees from 5 DCC in urban New Orleans were followed longitudinally with demographic data, biweekly routine stool samples and additional stool samples with episodes of diarrhea . E . coli isolates were routinely saved; diarrhea stool samples were tested to detect enterotoxigenic, enterohemorrhagic and enteroadherent strains; and the prevalence of these E . coli in children with and without diarrhea was investigated . RESULTS: During 225 child months of observation 21 episodes of diarrhea were documented and microbiologic data were available for 18 . HEp-2 cell enteroadherent E . coli {mostly enteroaggregative (EAggEC) pattern} were identified in 6 of 18 (33.3%) diarrhea cases vs . 6 of 36 (16.6%) age-matched controls . However, the prevalence of EAggEC was very DCC-specific, with EAggEC found in 12 of 22 routine specimens from a DCC with recent EAggEC-related diarrhea vs . 0 of 11 routine specimens from age-matched children in another DCC without EAggEC-related diarrhea (P=0.002) . Enterotoxigenic E . coli were uncommon in both ill and well children, and no enterohemorrhagic E . coli were detected . CONCLUSION: EAggEC were commonly isolated from children with and without diarrhea in certain DCC settings, although we cannot determine whether these strains caused diarrhea . Diarrhea-producing E . coli were not associated with diarrhea in this DCC population.

Infect Control Hosp Epidemiol, 1998 Dec, 19(12), 898 - 904
More than 10 years of unrecognized nosocomial transmission of legionnaires' disease among transplant patients; Kool JL et al.; OBJECTIVE: To investigate a cluster of cases of legionnaires' disease among patients at a hospital . SETTING: A university hospital that is a regional transplant center . DESIGN: Retrospective review of microbiology and serology data from the hospital laboratories and prospective surveillance via the radiology department; a case-control study and environmental sampling within the hospital and from nearby cooling towers . RESULTS: Diagnosis of seven cases of legionnaires' disease in the first 9 months of 1996 led to recognition of a nosocomial outbreak that may have begun as early as 1979 . Review of charts from 1987 through September 1996 identified 25 culture-confirmed cases of nosocomial or possibly nosocomial legionnaires' disease, including 18 in bone marrow and heart transplant patients . Twelve patients (48%) died . During the first 9 months of 1996, the attack rate was 6% among cardiac and bone marrow transplant patients . For cases that occurred before 1996, intubation was associated with increased risk for disease . High-dose corticosteroid medication was strongly associated with the risk for disease, but other immunosuppressive therapy or cancer chemotherapy was not . Several species and serogroups of Legionella were isolated from numerous sites in the hospital's potable water system . Six of seven available clinical isolates were identical and were indistinguishable from environmental isolates by pulsed-field gel electrophoresis . Initial infection control measures failed to interrupt nosocomial acquisition of infection . After extensive modifications to the water system, closely monitored repeated hyperchlorinations, and reduction of patient exposures to aerosols, transmission was interrupted . No cases have been identified since September 1996 . CONCLUSIONS: Legionella can colonize hospital potable water systems for long periods of time, resulting in an ongoing risk for patients, especially those who are immunocompromised . In this hospital, nosocomial transmission possibly occurred for more than 17 years and was interrupted in 1996, after a sudden increase in incidence led to its recognition . Hospitals specializing in the care of immunocompromised patients (eg, transplant centers) should prioritize surveillance for cases of legionnaires' disease . Aggressive control measures can interrupt transmission of this disease successfully.

Chest, 1998 Dec, 114(6), 1774 - 6
Homograft repair of a tuberculous pseudoaneurysm of the ascending aorta; Bojar RM et al.; A 34-year-old HIV-positive black man with pulmonary tuberculosis developed progressive widening of the mediastinum . Evaluation by CT and two-dimensional echocardiography demonstrated a large saccular aneurysm of the ascending aorta . This was repaired with a 26-mm aortic homograft using deep hypothermic circulatory arrest . The microbiology of the aneurysm contents showed this to be a tuberculous pseudoaneurysm.

Curr Microbiol, 1999 Feb, 38(2), 132 - 4
Comparison of methods to enumerate bacteria in dental unit water lines; Karpay RI et al.; Millipore HPC samplers are simple, self-contained test devices that can be used by personnel in dental offices who do not have microbiologic training to easily and economically monitor dental unit water quality without laboratory support . This study evaluated the correlation of HPC samplers to R2A agar for enumerating planktonic bacteria in dental unit treatment water . Eight different dental units were sampled . Five replicates were performed for each media at each dilution . The Pearson correlation coefficient between the R2A agar and HPC sampler is 0.89 . These data suggest HPC samplers correlate with conventional laboratory-based R2A culture techniques for determining dental unit water line contamination.

Indian J Pathol Microbiol, 1998 Oct, 41(4), 427 - 9
Comparison of darkground microscopy with serological tests in the diagnosis of leptospirosis with hepatorenal involvement--A preliminary study; Rao PS et al.; Darkground Microscopy (DGM) was initially done on Plasma in the Department of Microbiology, Kasturba Medical College, Manipal for 44 cases of suspected Leptospiral hepatorenal involvement . A total of 60 sera were collected from these patients and stored at -70 degrees C . Passiive haemagglutination test (PHA) was performed on 25 sera and latex agglutination test on 35 sera (Leptospira antigen Seiken) Leptospira was detected by Darkground Microscopy in 12 patients (27.27%) . Serology was positive in 16 samples (36.36%) of which 7 (15.90%) by PHA and 9 by Latex agglutination (20.45%) . Serological tests confirmed the findings of Darkground Microscopy . DGM was found to be simple and rapid and could be performed on all suspected patients.

Int J Oral Maxillofac Implants, 1998 Nov-Dec, 13(6), 845 - 50
Clinical and microbiologic effects of chemical versus mechanical cleansing in professional supportive implant therapy; Strooker H et al.; The aim of the present study was to compare the cleansing properties of mechanical supportive care for dental implants with the use of an etching gel . Sixteen patients underwent a 5-month clinical trial with monthly recalls . These patients, wearing maxillary complete dentures and mandibular overdentures supported by a bar device on 4 implants, were treated in a split-mouth study design . Test and control therapy were randomly assigned to left and right sides of the mandible . At the test side, 35% phosphoric etching gel (pH 1) was applied in the peri-implant sulcus . After 1 minute, the sulcus was thoroughly rinsed with a water spray for approximately 15 seconds per implants . Control therapy consisted of supra- and subgingival debridement using carbon fiber curettes and a rubber cup . Plaque, calculus, probing pocket depth, and modified Gingival Index were determined before each treatment . Microbiologic evaluation was performed at baseline, 1 month later, and 5 months later, just before and immediately after each treatment . Per treatment and per assessment, the mean scores of all clinical parameters were calculated for each patient . The number of colony-forming units was used as the primary efficacy variable in the analysis of microbiologic data . At baseline, no differences between test and control sites were observed for any of the clinical parameters . The mean Gingival Index and the mean probing pocket depth were reduced over the 5-month period . The mean reduction in Gingival Index at the test sites proved to be significantly larger at the control sites (P = .03) . Both treatment modalities resulted in an instant reduction of the number of colony-forming units, where the reduction by chemical cleaning was larger (P < .05) . This short-term study employing a high recall frequency indicates that local application of 35% phosphoric acid gel can be as effective as conventional mechanical supportive therapy.

Am J Obstet Gynecol, 1998 Dec, 179(6 Pt 1), 1430 - 4; discussion 1434-5
Synthetic graft placement in the treatment of fascial dehiscence with necrosis and infection; McNeeley SG Jr et al.; OBJECTIVE: The objective of this study was to describe the use of synthetic grafts in repairing fascial dehiscence complicated by fascial necrosis and infection after obstetric and gynecologic operations . STUDY DESIGN: A retrospective review of the operating room records at Hutzel Hospital (Detroit, Mich) was performed to find all cases of fascial dehiscence repaired during a 6-year period between January 1, 1991, and December 31, 1996 . Patients with partial or complete disruption of the fascia with evidence of fascial necrosis and infection were included in this study . Demographic information; the initial surgical procedure, including type of incision; suture material; use of synthetic graft and closure technique for repair of dehiscence; postoperative complications, microbiologic results; antibiotic therapy; subsequent operations; length of hospital stay; and late complications were recorded . RESULTS: During the study period 52 patients underwent repair of fascial dehiscence; 36 of these had concurrent fascial necrosis and infection, including 4 women with necrotizing fasciitis . Eighteen patients were from the obstetric service and 18 were from the benign or cancer gynecology service . Ninety-one bacterial isolates were recovered from the infected wounds . Extensive fascial resection precluded closure without tension in 18 cases and necessitated synthetic graft placement to prevent evisceration . Graft materials included polypropylene (11 cases) and polyglactin (7 cases) . Late complications of graft placement included extrusion of the graft in 3 patients and incisional hernia in 1 . CONCLUSIONS: Extensive fascial debridement with resection prevents primary closure of wound dehiscence . Synthetic grafts permit primary closure of large fascial defects and can be used with extensive debridement in the presence of infection.

Am J Med, 1997 May 19, 102(5B), 32 - 8
Principles of clinical pharmacology in postexposure prophylaxis; Flexner CW; Deciding on postexposure prophylaxis for any infection requires that the patient and healthcare provider understand the magnitude of infection risk and the adverse consequences of therapeutic intervention or nonintervention . Principles of epidemiology and microbiology allow us to estimate the risk of infection . Principles of clinical pharmacology allow us to estimate the risk and benefit of therapy . The dose-response-time relationships for antiviral activity and toxicity of a drug can be used to develop regimens that maximize benefit and minimize risk . Other important pharmacologic considerations include the role of active and toxic drug metabolites, combination chemotherapy, drug interactions, and medication compliance.

Acta Histochem, 1998 Nov, 100(4), 344 - 54
Proteases and protease inhibitors in cancer; Van Noorden CJ; The second conference on 'Proteases and protease inhibitors in cancer' was organized by the American Association for Cancer Research (AACR) and Acta Pathologica Microbiologica et Immunologica Scandinavica (APMIS) . To understand the role of proteinases and to develop relevant synthetic inhibitors to stop or slow the progression of cancer, an integrated view on the role of proteinases and proteinase inhibitors in required . This is the main goal of this series of conferences . Approximately 300 people attended this conference, including many highly regarded scientists in the field . In total, 40 invited lectures were presented and 120 posters were displayed during two well-attended sessions.

Am J Otolaryngol, 1998 Nov-Dec, 19(6), 351 - 6
The role of endoscopic sinus surgery in patients with acquired immune deficiency syndrome; Sabini P et al.; PURPOSE: Increasingly, otolaryngologists are treating patients with acquired immunodeficiency syndrome (AIDS) who suffer from associated sinusitis refractory to medical therapy . Despite this trend, few reports in the literature detail the mode of surgical therapy, pathogens, and outcome in this patient population . Our aim in this study was to describe our experience in treating these patients, with particular attention to surgical outcome and pathogens . PATIENTS AND METHODS: We reviewed our experience with performing sinus surgery in 33 AIDS patients . Endoscopic sinus procedures were performed in 24 patients, while the remaining nine patients underwent nasal antral windows and/or Caldwell-Luc operations . Follow-up information was obtained in 16 of the 24 patients who underwent endoscopic sinus surgery . RESULTS: At an average follow-up time of 16 months, 14 of the endoscopic sinus surgery patients reported improvement from their preoperative condition . Thirty-seven pathogens were identified in 23 patients . A larger percentage of nontraditional pathogens was found in these patients, which suggests a larger role for microbiologic diagnosis and treatment versus empiric therapy . CONCLUSION: Patients with AIDS and chronic sinusitis may benefit from endoscopic sinus procedures.

Chemosphere, 1998 Dec, 37(14-15), 2949 - 55
Use of new microbiotests with Daphnia magna and Selenastrum capricornutum immobilized forms; Cerejeira MJ et al.; A preliminary assessment of toxicity to aquatic life of water from rice fields treated with pesticides, and particularly with the herbicides molinate and quinclorac, was performed from June to August 1996 in a rice paddy area integrated in a Natural Reserve . New rapid-screening microbiotests with Daphnia magna and Selenastrum capricornutum were used . Water samples were collected from: a water source for irrigating the rice fields, two rice plots, a drainage channel and the river in which the water is discharged . The results showed that while the water for irrigation was not toxic to D . magna, the samples collected from the river were very toxic causing 100% immobility in D . magna and substantial inhibition of Selenastrum growth . This, however, is due to the brackish nature of the river water . Water collected in the drainage channel of the rice fields were also found to be quite toxic . A greater effect was detected in samples from the rice plot treated with molinate than from that treated with quinclorac, suggesting that molinate treatment was more toxic to both species . The results indicate that the rapidity, simplicity and relatively low cost of the new microbiotests make them very practical for initial acute toxicity screening and offer an alternative to provide evidence for changes needed in agriculture practices for a better protection of the aquatic environment.

J Reprod Med, 1998 Nov, 43(11), 925 - 8
Diagnosing candidiasis . A new, cost-effective technique; Cibley LJ et al.; OBJECTIVE: To demonstrate the efficacy of normal saline as a culture medium for the rapid growth and detection of Candida . STUDY DESIGN: During a six-month period in 1995, the authors examined 302 patients with vulvovaginal complaints . A wet smear diagnosis was accomplished in 271 patients; 31 had symptoms suggestive of a Candida infection, which was not confirmed by microscopy . Two patients were excluded, leaving 29 in the study group . Two samples of the vaginal discharge were collected from the vaginal fornices, with one sample placed in a tube of liquid Sabouraud medium and the second placed in a sterile, red-topped tube containing 5 mL of normal saline . Each saline culture was placed in a test tube rack and left to incubate at room temperature . The samples containing the Sabouraud medium were incubated in the hospital microbiology laboratory . Both samples were evaluated microscopically within 24-72 hours to detect the presence or absence of Candida organisms . RESULTS: Of the 29 patients who had symptoms suggestive of Candida, 16 had a confirmed diagnosis of Candida employing both the saline method and Sabouraud medium . Eleven patients were negative for Candida with both the saline and Sabouraud; there was one false positive and one false negative in each group . The positive predictive value of the normal saline culture technique was 94.1%, with a negative predictive value of 91.7% . Sensitivity and specificity were 94.1% and 91.7%, respectively . CONCLUSION: Using normal saline instead of Sabouraud's medium to culture Candida proved inexpensive, cost-effective and highly accurate for rapid diagnosis.

Transfusion, 1998 Nov-Dec, 38(11-12), 1090 - 6
Saponin, an inhibitory agent of carbon dioxide production by white cells: its use in the microbiologic examination of blood components in an automated bacterial culture system; van Doorne H et al.; BACKGROUND: Blood components with a white cell count > 100 x 10(9) per L may cause false-positive results when the BacT/Alert system is used for the microbiologic examination . The effects of different concentrations of saponin on bacterial growth and on carbon dioxide production by blood fractions with a high white cell count, in particular peripheral blood progenitor cells and buffy coats, were investigated . STUDY DESIGN AND METHODS: The effect of saponin on carbon dioxide production was studied by adding different fractions of white cell-rich material (buffy coat or leukapheresis material) to BacT/Alert culture bottles with or without saponin and incubating these bottles . Five bacterial strains were used to inoculate the culture bottles at four levels ranging from about 1 colony-forming unit per mL to about 10(3) colony-forming units per mL . Aerobic and anaerobic bottles with and without saponin were used . RESULTS: It was demonstrated that the addition of 0.5 percent saponin to BacT/Alert culture bottles effectively inhibited carbon dioxide production, without affecting bacterial growth . CONCLUSION: Saponin at a concentration of 0.5 percent is a valuable additive to BacT/Alert culture media because it prevents false-positive results in the examination of white cell-rich blood components.

Enferm Infecc Microbiol Clin, 1998 Oct, 16(8), 356 - 8
{Incidence of Cryptosporidium in Zaragoza: an 8-year study (1989-1996)}; Moles B et al.; BACKGROUND: To study the incidence of Cryptosporidium infections over an eight year period in an urban area, together with the patients background and the season of the year . MATERIALS AND METHODS: From January 1989 to December 1996, all 32,733 stool samples from 13,639 patients: children and immunocompromised adults, with presumed infective diarrhoea, were investigated for Cryptosporidium oocysts by the Department of Microbiology, Miguel Servet Hospital, Zaragoza (Spain) . RESULTS: Cryptosporidial infection was identified in a 3% of the total children, been the positivity rate highest in the 2-year old group . We visualized oocysts in the 8% of the immunocompromised patients, all of them HIV-positive . The prevalence was higher in winter (February-March) . CONCLUSIONS: According to these findings we conclude that Cryptosporidium should be systematically searched by clinical laboratories, specially in children and in immunocompromised patients suffering from infectious diarrhoea.

J Appl Microbiol, 1998 Nov, 85(5), 913 - 7
Lenticules for the control of quantitative methods in food microbiology; Codd AA et al.; Control dried organisms as lenticules are a dependable and convenient alternative to wet cultures for quality assurance and process controls in routine food microbiology . Lenticules are designed to give a fixed, reproducible inoculum over an extended period of time without loss of cultural characteristics or viability . During a period of 23 months, 596 paired counts were performed by both Miles and Misra and spiral plating techniques on lenticule controls . Correlation between the two methods and within batches was excellent . Only 14 counts (2.5%) fell outside the standard operating limit of 0.5 log10 . All were within 1.0 log10 . On two separate occasions, replicate runs were performed on five reconstituted lenticules from a batch . The counts obtained showed variation within and between lenticules only slightly in excess of what is expected by chance . Lenticule replicates performed by three other laboratories also produced satisfactory results . It is thought that lenticules could improve the accuracy of total plate counts and lead to a better standardization of quantitative methods in food microbiology within and between laboratories.

J Nucl Med, 1998 Nov, 39(11), 1980 - 3
Ectopic hematopoietic bone marrow in the appendicular skeleton after trauma; Kaim A et al.; METHODS: Combined bone scanning and immunoscintigraphy (IS) with 99mTc-monoclonal antigranulocyte antibodies were performed in two patients with suspected reactivation of chronic osteomyelitis of the lower extremity . Because bone scanning and IS were strongly positive, both patients underwent surgical intervention . RESULTS: Macroscopic findings did not show purulent infection and microbiologic results remained negative, but histology revealed unexpected ectopic bone marrow, explaining the strong uptake on IS . One patient exhibited active hematopoietic bone marrow at the former fracture site of the tibial bone . The second patient presented with interspersed bone marrow in the cortical bone of the femoral diaphysis after several intramedullary surgical procedures . CONCLUSION: Unexpected ectopic hematopoietic marrow may occur in the appendicular skeleton after trauma and repeated surgical interventions . The bone marrow shows a physiologic uptake with IS and may be misinterpreted as granulocyte accumulation due to infection . This may lead to false-positive diagnosis in cases of suspected osteomyelitis.

Ann Pharmacother, 1998 Nov, 32(11), 1181 - 92
Cidofovir in the treatment of cytomegaloviral disease; Kendle JB et al.; OBJECTIVE: To review the clinical pharmacology and microbiology of cidofovir in the therapy of cytomegalovirus (CMV) disease . DATA SOURCES: Pertinent literature was identified via a MEDLINE search (October 1986-February 1997), and data from abstracts presented at recent scientific meetings were also included; unpublished information was provided by the manufacturer . STUDY SELECTION: Antiviral activity data were included if widely accepted methodology was used . All clinical data currently available from human studies were also included . DATA SYNTHESIS: Cidofovir is similar to ganciclovir in mechanism of action; however, cidofovir does not require viral enzymes for activation . Although the half-life of cidofovir in plasma is only 2.6 hours, the intracellular half-life may be much longer, allowing efficacy with biweekly maintenance dosing . In vitro, cidofovir appears to be equally or more effective than the other agents currently available for the treatment of CMV . In vivo, cidofovir appears to be effective in delaying the progression of CMV retinitis, although no clinical trials to date have directly compared cidofovir with either ganciclovir or foscarnet . Current intravenous dose recommendations are 5 mg/kg once weekly for two doses (induction), and then 5 mg/kg once every other week (maintenance) . Since cidofovir is cleared almost entirely by the kidneys, dosage adjustments must be made in patients with impaired renal function . Disadvantages of cidofovir primarily include its risks of adverse drug reactions, such as nephrotoxicity, which is likely to occur in up to 50% of patients if appropriate preventative measures are not taken . Neutropenia and constitutional reactions to probenecid are also commonly encountered during the course of cidofovir therapy . CONCLUSIONS: Cidofovir is the first acyclic phosphonate nucleoside antiviral agent to be approved for general use in the US . In addition to delaying the progression of CMV retinitis, cidofovir may provide some protective benefits to patients at risk for developing the disease and may be active against certain strains of virus resistant to other currently available therapies . Another advantage of cidofovir is its infrequent dosage schedule, which may prove beneficial in patients who are not compliant with daily intravenous dosing regimens . When determining the appropriate treatment for a patient with CMV retinitis, the benefits of using cidofovir must be weighed carefully against the risk of potentially serious adverse effects.

J Virol Methods, 1998 Nov, 75(1), 39 - 46
Rapid screening of embryonated chicken eggs for bluetongue virus infection with an antigen capture enzyme linked immunosorbent assay; Hosseini M et al.; The sensitivity and specificity of an antigen capture ELISA have been compared with virus isolation in cell culture . Bluetongue virus (BLU) (serotype 23) from the blood of a sheep was titrated by inoculating embryonated chicken eggs (ECEs) and detecting viral antigen in chicken embryo livers using an antigen capture enzyme linked immunosorbent assay (ELISA) (Stanislawek et al., 1996 . Detection by ELISA of bluetongue antigen directly in the blood of experimentally infected sheep . Vet . Microbiol . 52, 1-12) . Five days after inoculation of ECEs with lysed red blood cells from the infected sheep the embryo livers were harvested and homogenised . The supernatant from the homogenate was used in the antigen capture ELISA to determine which livers were infected and the virus titre calculated as CEID50/ml packed red blood cells . These results were compared with a standard cell culture isolation protocol which passaged the liver homogenate supernatant through Aedes albopictus cells and up to three passages in BHK21 cells . The antigen capture ELISA showed 100% sensitivity and specificity with no false negatives or false positives when compared to cell culture isolation of the virus . The major advantage of the combination of ECE inoculation and antigen capture ELISA is the reduction in the time to less than 7 days from a maximum of 35 days for the ECE/cell culture system . The procedure is easy to undertake, cost effective and does not require expensive specialist cell culture facilities.

J Infect, 1998 Jul, 37 Suppl 1, 55 - 9
Implementation of sequential therapy programmes--a pharmacist's view; Cairns C; Sequential antibiotic therapy has a number of advantages in terms of patient benefit and value for money in drug use . Introduction and maintenance of a process to ensure sequential therapy is multidisciplinary, involving clinicians, pharmacists, microbiologists and possibly nurses . The contribution of pharmacists is multi-faceted and involves senior and junior pharmacists working in a number of areas . Pharmacy managers will be involved at policy setting level through the Drug and Therapeutics committee and similar bodies . Purchasing and formulary pharmacists will be involved in negotiating purchasing agreements while clinical pharmacists provide data on the costs and outcomes of treatment . The drug information pharmacist is a valuable resource in searching and interpreting the available literature . Whatever system is used, clinical pharmacists have an important role in identifying patients and monitoring prescribing . In many schemes described in the literature, pharmacists have had an important role in auditing the effectiveness of sequential therapy . There may be scope for developing the clinical pharmacist's role further by devolving, under protocol, increased decision making and medicines management responsibilities.

J Infect, 1998 Jul, 37 Suppl 1, 24 - 9
Assessment criteria in identifying the sick sepsis patient; Jones GR; Standard definitions of sepsis have been proposed and have been widely adopted . Recognition of the systemic inflammatory response syndrome (SIRS) and assessment of its severity can easily be achieved at the bedside using basic observations and simple laboratory tests . Fulfillment of standardized criteria defining increasing severity of sepsis or manifestation of two, three and four SIRS criteria directly correlates with risk of mortality and progression to organ failure . However, manifestation of only two SIRS criteria identifies patients who may have relatively mild disease . Furthermore, sepsis definitions take no account of pre-existing illness, source of infection or causative agent, all of which have a significant influence on outcome . Despite these limitations, manifestation of four SIRS criteria or the persistence of markers of severe sepsis identifies individuals on general wards who are at particularly high risk of death, who should be closely monitored for deterioration and discussed with an intensive-care physician at an early stage . If the source of sepsis is not clear, empirical antibiotic therapy for such individuals should be discussed with a medical microbiologist or infectious diseases physician.

J Clin Microbiol, 1998 Dec, 36(12), 3558 - 66
In vitro comparison of NALC-NaOH, tween 80, and C18-carboxypropylbetaine for processing of specimens for recovery of mycobacteria; Thornton CG et al.; A recent article (C . G . Thornton et al., J . Clin . Microbiol . 36:1996-2003, 1998) reported a new specimen-processing method for improved recovery of mycobacteria . This method used C18-carboxypropylbetaine (CB-18) and increased both smear and culture sensitivity . The companion article (C . G . Thornton et al., J . Clin . Microbiol . 36:2004-2013, 1998) described initial improvements to this method . Additional significant parameters of the CB-18 processing method are identified herein . First, eliminating the incubation step was shown to further improve culture sensitivity . Subsequently, recovery of several mycobacterial isolates by the CB-18 method was compared to a contemporary processing method that combines NALC and NaOH (NALC-NaOH) and a Tween 80-based method . Recovery of the tuberculous isolates following NALC-NaOH processing averaged 20% and ranged from 1.6 to 45%, whereas recovery of the nontuberculous isolates averaged 11% and ranged from 0.1 to 55% . Recovery of the tuberculous and nontuberculous isolates by the Tween 80-based method ranged from 22 to 92% and 27 to 93%, respectively, with averages of 58 and 65%, respectively . Recovery of the tuberculous and nontuberculous mycobacteria following CB-18 processing averaged 86 and 73%, respectively, with ranges from 61 to over 100% and from 43 to over 100%, respectively . Other parameters of the CB-18 method were also examined, including recovery versus CB-18 concentration and the relationship between CB-18 concentration and the tuberculocidal effect . The tuberculocidal effect was time dependent but independent of concentration, whereas recovery was directly proportional to concentration . Increasing the CB-18 concentration to 4 mM provided quantitative recovery on solid medium; however, higher concentrations of CB-18 were not compatible with liquid culture . Examination of the relationship between increasing CB-18 and lecithin concentrations suggested that lecithin could not overcome the deleterious effects of CB-18 in liquid culture at these higher concentrations.

Berl Munch Tierarztl Wochenschr, 1998 Oct, 111(10), 362 - 7
{History of control measures against bovine tuberculosis--contributions from the Institute of Microbiology and Contagious Diseases of the Tierärztlichen Hochschule Hannover}; Bisping W; A review of history and development of research and control of bovine tuberculosis is given on the occasion of Kurt Wagener's 100th birthday with special reference to his and his co-workers contributions to this subject . The topics as well concern the critical discussion of Ostertag's control measures and their replacement by Bang's methods as the importance of bovine tuberclebacilli as origin of human infections.

J Travel Med, 1996 Mar 1, 3(1), 11 - 13
Effect of Heat on the Sterilization of Artificially Contaminated Water; Groh CD et al.; Background: The objective of the study was to evaluate indirect methods commonly used in the field to decontaminate water as follows: boiling for 5-10 minutes and heating until "too hot to touch." Water perceived to be "too hot to touch" is defined as water in which a subject is unable to bear having the right index finger fully immersed for 5 seconds . Methods: Five flasks of water at 25 degreesC, 50 degreesC, 60 degreesC, 70 degreesC, and 100 degreesC were inoculated with 1.82 3 106 Escherichia coli bacteria . At the time of inoculation, and at 1 minute, 5 minutes, and 10 minutes, samples were withdrawn from each flask . The samples were plated and incubated for 18 to 24 hours . The numbers of colonies were then counted . Finally, subjects attempted to immerse, fully, their right index fingers into water at 50 degreesC, 55 degreesC, 60 degreesC, and 65 degreesC for 5 seconds . Subjects were normal, healthy individuals who worked at a microbiology laboratory . The main outcome measures were the number of colonies and the subjects' intolerance to heat . Results: Results showed that water at 50 degreesC has no effect on the number of bacteria, whereas water maintained at 60 degreesC for 5 minutes and at 70 degreesC and 100 degreesC for any time period effectively kills E . coli bacteria . The majority of subjects found 60 degreesC or cooler to be "too hot to touch." Conclusions: For travelers or campers, water is safe to drink if heated to boiling, but heating water until it is "too hot to touch" is inadequate for safe drinking purposes.

J Travel Med, 1994 Sep 1, 1(3), 152 - 155
Ten-year Experience with Imported Malaria in Bergamo, Italy; Raglio A et al.; Malaria infections have become an increasing public health problem in Europe, especially those imported into nonendemic areas . The transmission and diffusion of malaria has increased, especially over the last decade, due to changes in agricultural practices, vector resistance to insecticides, and most relevantly, increasing international travel and the resistance of these parasites to chemophrophylaxis . This study investigates the epidemiologic factors if imported malaria in an area of Italy, as related to international travel and prophylaxis by Italian immigrants who have revisited their country of origin . All cases (175) of imported malaria detected at the Laboratory of Microbiology of Ospedali Riuniti in Bergamo, Italy, between 1984 and 1993 were studied epidemiologically for the following variables: age, sex, and nationality; travel destination, length of stay, and date of return; and pathogen(s) detected, chemoprophylaxis used, and clinical symptoms exhibited . A high prevalence of Plasmodium falciparum was detected in more than three quarters of the cases with 91.4% of these travelers having visited African countries . Only two subjects had received adequate, correct prophylaxis . Fever, headache, and fatigue were experienced most often; however, in a few cases, blood, exchange transfusion, or treatment for splenomegaly were required . The results indicate that there is an emerging public health problem with immigrants who have resided in Italy for some time, revisited their country of origin, and consequently become infected with malaria, with specific prophylaxis not having been provided . This study emphasizes the importance of local epidemiologic studies, effective prophylaxis, and the need for those involved in the travel industry to promote specialized pretravel advice on a routine basis.

J Travel Med, 1994 Sep 1, 1(3), 147 - 151
West African Immigrants and New Patterns of Malaria Imported to North Eastern Italy; Di Perri G et al.; With the settlement of increasing numbers of immigrants from tropical African countries into Italy over the last decade, the epidemiologic pattern of imported malaria underwent significant change . Italian immigrants originating from endemic areas who revisit their country of origin have exhibited an increasing incidence of malaria: the Italian Ministry of Health recorded an increase of from 14% in 1986 to 40.4% in 1991 . This retrospective study reviews the epidemiology of all malaria cases recorded from 1988 to 1991 in a regional reference center in North Eastern Italy . Epidemiologic factors, including the details of their travel experience, were examined for all cases, and the relation of immigrants to Italian-born citizens were compared . Of the 100 cases recorded during this period, 36 were diagnosed in 1988-1989 and 64 in 1990-1991 . Immigrants accounted for six times more cases during the latter than during the former time period . Compared to nonimmune short-term travelers, immigrants experienced significantly milder forms of the disease and lower levels of parasitemia (Plasmodium falciparum) on admission . Notably, 10 cases of malaria in immigrants were not recognized at first observation on microbiology . With the advent of this new risk group of immigrants that originate from endemic countries, especially those making occasional short visits to their native countries, this new epidemiologic profile of malaria imported into Italy shows the need for improvement in the areas of prophylaxis, pretravel education, and diagnostic services.

Cent Afr J Med, 1998 Jun, 44(6), 145 - 8
TB infection: an exploratory study of BCG protective properties and the possible role of environmental mycobacteria; Chihota VN et al.; OBJECTIVE: To evaluate the presence of environmental mycobacterial strains and explore the implications for BCG vaccination against TB . DESIGN: Multimethod approach which included structured interviews and medical records examination . Soil and water samples were analysed using standard microbiology methods . SETTING: Beatrice Infectious Diseases Hospital, Public Health laboratories, University of Zimbabwe Medical School and several residential areas in Harare . SUBJECTS: 129 tuberculosis inpatients at Beatrice Infectious Diseases Hospital, 26 Public Health Laboratory technicians handling TB specimens and 51 fourth year medical students . MAIN OUTCOME MEASURES: Vaccination status of TB inpatients, medical students and laboratory technicians, protective efficacy of BCG in all subjects, presence of environmental mycobacterium in the environment . RESULTS: The type of tuberculosis did not differ significantly between vaccinated and non-vaccinated TB patients x2(df = 1) = 0.171 p > 0.05 . There was no apparent difference between the revaccinated and non-vaccinated laboratory technicians . One respondent out of each of the revaccinated and non-vaccinated laboratory technicians had developed pulmonary tuberculosis . Among the fourth year medical students, four had positive tuberculin test results, even though they had not been vaccinated at the University clinic . Environmental mycobacteria presumptively identified as Mycobacterium scrofulaceum and Mycobacterium intracellulare were isolated from both the water and soil samples taken from a few selected areas in Harare . Of the 129 TB in-patients, 88 (68.2%) had previously been vaccinated against TB . Similarly among the 51 medical students 44(86.3%) had been vaccinated . Laboratory technicians re-vaccinated on the job were nine out of 26 . CONCLUSION: The results obtained seemed to indicate that BCG protective efficacy did wane with time and revaccination appeared not to be useful . Environmental mycobacterium that could influence the BCG efficacy do exist in our environment.

J Pediatr Surg, 1998 Oct, 33(10), 1463 - 7
Spontaneous intestinal perforation in premature infants: a distinct clinical entity associated with systemic candidiasis; Adderson EE et al.; PURPOSE: The aim of this study was to define patient characteristics, risk factors, microbiology, and outcome of spontaneous intestinal perforations (SIP) in premature infants . METHODS: To identify the characteristics and frequency of SIP, the medical records of 94 premature infants were reviewed retrospectively . RESULTS: Eleven infants experienced 12 episodes of SIP and 53 infants had 55 episodes of confirmed necrotizing enterocolitis (NEC) . Compared with infants who had NEC, the infants with SIP were smaller and born more prematurely . The onset of illness was earlier and was associated with antecedent hypotension, leukocytosis, and a gasless appearance on abdominal radiograph . Blue abdominal discoloration was present in 11 of 12 babies with SIP, but in only one of the babies with NEC . Infants with SIP were significantly more likely to have systemic candidiasis . When controlling for birth weight and age, early onset, blue abdomen, and a gasless abdominal radiograph continued to be statistically significant markers of SIP . CONCLUSIONS: SIP occurs about 12-fold less frequently than NEC in preterm infants . A combination of clinical, laboratory, and radiological features distinguish very low birthweight infants with SIP from those with NEC . Obvious signs of bowel perforation are infrequent with SIP . SIP is frequently associated with systemic candidiasis.

Pediatr Infect Dis J, 1998 Oct, 17(10), 865 - 71
Safety and efficacy of azithromycin in the treatment of community-acquired pneumonia in children; Harris JA et al.; OBJECTIVE: To compare the safety and efficacy of azithromycin with amoxicillin/clavulanate or erythromycin for the treatment of community-acquired pneumonia, including atypical pneumonia caused by Mycoplasma pneumoniae and Chlamydia pneumoniae . METHODS: Multicenter, parallel group, double blind trial in which patients 6 months to 16 years of age with community-acquired pneumonia were randomized 2:1 to receive either azithromycin for 5 days or conventional therapy for 10 days (amoxicillin/clavulanate if < or =5 years of age or erythromycin estolate if >5 years of age) . Patients from 23 geographically diverse sites were evaluated for clinical outcomes and/or adverse events at Days 3 to 5, Days 15 to 19 and 4 to 6 weeks posttherapy . Microbiology (culture or polymerase chain reaction) was done at baseline and Days 15 to 19 for bacteria, Chlamydia pneumoniae and Mycoplasma pneumoniae . Serology for C . pneumoniae and M . pneumoniae was done at baseline and 4 to 6 weeks posttherapy . RESULTS: Of 456 patients enrolled during 17 consecutive months, 420 were evaluable . Clinical success at Study Days 15 to 19 was 94.6% in the azithromycin group and 96.2% in the comparative treatment group (P = 0.735) and at 4 to 6 weeks posttherapy 90.6 and 87.1%, respectively (P = 0.330) . Evidence of infection was identified in 46% of 420 evaluable patients (1.9% bacteria, 29.5% M . pneumoniae and 15% C . pneumoniae) . Microbiologic eradication was 81% for C . pneumoniae and 100% for M . pneumoniae in the azithromycin group vs . 100 and 57%, respectively, in the comparator group . Treatment-related adverse events occurred in 11.3% of the azithromycin group and 31% in the comparator group (P < 0.05) . CONCLUSION: Azithromycin used once daily for 5 days produced a satisfactory therapeutic outcome similar to those of amoxicillin/clavulanate or erythromycin given three times a day for 10 days for treatment of community-acquired pneumonia . Azithromycin had significantly fewer side effects than comparator drugs.

Ecotoxicol Environ Saf, 1998 Nov, 41(3), 231 - 44
A new low-cost microbiotest with the Protozoan spirostomum teres: culture conditions and assessment of sensitivity of the ciliate to 14 pure chemicals; Twagilimana L et al.; This paper defines the culture conditions of the ciliate Spirostomum teres and assesses its sensitivity to some xenobiotics for the development of a new low-cost microbiotest . The model was selected for its ubiquitous distribution, large size for a unicellular species, easy culture in holoxenic medium, moderate generation time, and high sensitivity to pure toxicants . The influence of different culture waters, inocula of ciliates, food, temperature, light, and darkness on the growth of the ciliate population was tested . The shortest generation time (average 39 h) was obtained for cultures incubated at 25 degreesC in the dark with an inoculum of 4 ciliates per ml in 25 ml of Volvic mineral water containing 8 boiled wheat grains, when preincubated without ciliates for the previous week . Under these conditions, it was possible to obtain about 3000 ciliates/ml 3 weeks later . Acute toxicity tests (24-h LC50) were carried out for CuSO4, HgCl2, CdCl2, K2Cr2O7, ZnSO4, Pb(NO3)2, thiram, carbaryl, lindane, parathion, parathion methyl, paraoxon, 2, 4,6-trichlorophenol, and sodium pentachlorophenolate (Na-PCP) . Very high sensitivity of the model to Hg2+, Cu2+, Cd2+, thiram, and Na-PCP was established . Comparison of its sensitivity with that of Microtox (current results), Daphnia Magna, Tetrahymena pyriformis, Colpidium campylum, and murine fibroblasts (data from literature) confirms the high sensitivity of the model, especially to heavy metals . Easy-to-perform, cost-effective, and sensitive bioassays using S . teres are suitable for risk assessment and early detection of toxicity in fresh water .

Appl Environ Microbiol, 1998 Nov, 64(11), 4614 - 7
Evidence for the interplay between trehalose metabolism and Hsp104 in yeast; Iwahashi H et al.; Disruption of the HSP104 gene in a mutant which cannot accumulate trehalose during heat shock treatment caused trehalose accumulation (H . Iwahashi, K . Obuchi, S . Fujii, and Y . Komatsu, Lett . Appl . Microbiol 25:43-47, 1997) . This implies that Hsp104 affects trehalose metabolism . Thus, we measured the activities of enzymes involved in trehalose metabolism . The activities of trehalose-synthesizing and -hydrolyzing enzymes are low in the HSP104 disruption mutant during heat shock . This data is correlated with intracellular trehalose and glucose levels observed in the HSP104 disruption mutant . These results suggest that during heat shock, Hsp104 contributes to the simultaneous increase in both accumulation and degradation of trehalose.

ASDC J Dent Child, 1998 Sep-Oct, 65(5), 318 - 24, 355
Saliva collection technique for cytologic, microbiologic and viral evaluation in pediatric HIV infection; Flaitz CM et al.; Acquisition of saliva for biologic, immunologic and chemical analyses has been extremely difficult in infants and young children due to lack of cooperation and motor skills necessary for expectorating adequately . The purpose of this study was to investigate a technique for obtaining satisfactory quantities of whole, unstimulated saliva in the typical dental operatory setting for cytologic, microbiologic and viral evaluation, while requiring minimal cooperation and motor skills from pediatric patients . A low vacuum-assisted aspiration device was utilized to obtain samples from infants and children who were at risk for vertically acquired HIV-infection (age-range 6 mos to 8 yrs) . Adequate saliva samples were collected in 175 of 196 (89 percent) attempts in 88 of 89 (99 percent) children (2.3 samples/child) . Saliva was not obtained in twenty-one attempts primarily due to xerostomia (62.5 percent) . Saliva sample volume obtained was variable, ranging from 1.2 to 3.6 mls with a collection time of approximately three to five minutes . Cell block preparations were made from the saliva, which allowed for cytologic evaluation of sloughed superficial squamous cells, evaluation of oral flora, and detection of yeast and hyphal fungal forms . Adequate volumes of supernate were also available for microbiologic and viral cultures, immunologic studies and PCR study for various viral agents shed in the saliva . Use of a vacuum-assisted collection device for whole unstimulated saliva in infants and young children in the dental operatory setting provides adequate saliva for multiple analyses, which may provide information regarding HIV disease status and early diagnosis of opportunistic infections.

Circulation, 1998 Oct 27, 98(17), 1742 - 9
Improved exercise tolerance after losartan and enalapril in heart failure: correlation with changes in skeletal muscle myosin heavy chain composition; Vescovo G et al.; BACKGROUND: In congestive heart failure, fatigue-resistant, oxidative, slow type I fibers are decreased in leg skeletal muscle, contributing to exercise capacity (EC) limitation . The mechanisms by which ACE inhibitors and AII antagonists improve EC is still unclear . We tested the hypothesis that improvement in EC is related to changes in skeletal muscle composition toward type I fibers . METHODS AND RESULTS: Eight patients with congestive heart failure, NYHA classes I through IV, were treated for 6 months with enalapril (E) 20 mg/d, and another 8 with losartan (L) 50 mg/d . EC was assessed with maximal cardiopulmonary exercise testing at baseline and after treatment . Myosin heavy chain (MHC) composition of the gastrocnemius was studied after electrophoretic separation of slow MHC1, fast oxidative MHC2a, and fast glycolytic MHC2b isoforms from needle microbiopsies obtained at baseline and after 6 months . EC improved in both groups . Peak V(O2) increased from 21.0+/-4.7 to 27.6+/-4.3 mL . kg-1 . min -1 (P=0.011) in the L group and from 17.5+/-5.0 to 25.0+/-5.5 mL . kg-1 . min -1 (P=0.014) in the E group . Similarly, ventilatory threshold changed from 15.0+/-4.0 to 19.9+/-4.9 mL (P=0 . 049) with L and from 12.0+/-1.9 to 15.4+/-3.5 mL (P=0.039) with E . MCH1 increased from 61.2+/-11.2% to 75.4+/-7.6% with L (P=0.012) and from 60.6+/-13.1% to 80.1+/-10.9% (P=0.006) with E . Similarly, MHC2a decreased from 21.20+/-9.5% to 12.9+/-4.4% (P=0.05) with L and from 19.9+/-7.8% to 11.8+/-7.9% (P=0.06) with E . MHC2b changed from 17 . 5+/-6.5% to 11.7+/-5.2% (P=0.07) with L and from 19.5+/-6.4% to 8 . 1+/-4.6% (P=0.0015) with E . There was a significant correlation between net changes in MHC1 and absolute changes in peak V(O2) (r2=0.29, P=0.029) and a trend to significance for MHC2a and 2b . CONCLUSIONS: Six months' treatment with L and with E produces an improvement in EC of similar magnitude . These changes are accompanied by a reshift of MHCs of leg skeletal muscle toward the slow, more fatigue-resistant isoforms . Magnitude of MHC1 changes correlates with the net peak V(O2) gain, which suggests that improved EC may be caused by favorable biochemical changes occurring in the skeletal muscle.

Infect Dis Obstet Gynecol, 1998, 6(3), 109 - 15
Daily oral grepafloxacin vs . twice daily oral doxycycline in the treatment of Chlamydia trachomatis endocervical infection; McCormack WM et al.; OBJECTIVE: To compare the efficacy and safety of a 7-day course of treatment with oral grepafloxacin, 400 mg once daily, and oral doxycycline, 100 mg twice daily, in patients with chlamydial cervicitis . METHODS: Women aged 18 years or older attending 17 sexually transmitted disease clinics in the United States who had clinical signs of mucopurulent cervicitis or who had a recent positive culture or nonculture test for Chlamydia trachomatis or who had contact with a male partner with a positive culture for C . trachomatis were enrolled into this randomized, double-blind, active-controlled clinical study . The diagnosis of chlamydial cervicitis was based on culture for C . trachomatis . Patients were randomized to receive a 7-day course of treatment with either oral grepafloxacin, 400 mg once daily, or oral doxycycline, 100 mg twice daily . Response to therapy was assessed 3-8 days and 21-28 days after completion of treatment . The primary measure of efficacy was eradication of C . trachomatis at the 21-28 day follow-up visit . Clinical success, defined as improvement or complete resolution of the signs and symptoms of cervicitis, was a secondary measure of efficacy . RESULTS: Of the 451 female patients enrolled, 228 received grepafloxacin and 223 received doxycycline . In all, 154/451 (35%) patients were evaluable at the 21-28 day follow-up (81 who received grepafloxacin and 73 who received doxycycline) . Microbiologic and clinical success rates demonstrated the equivalence of the two treatments . The C . trachomatis eradication rates were 96.3% (78/81) and 98.6% (72/73) for patients receiving grepafloxacin or doxycycline, respectively . The two study drugs were also equivalent in resolving clinical signs and symptoms, with clinical success rates of 88.9% (64/72) and 89.5% (51/57) for patients treated with grepafloxacin and doxycycline, respectively . Both drugs were well tolerated, with 47% of patients receiving grepafloxacin and 46% of patients receiving doxycycline experiencing drug-related adverse events, none of which was serious . CONCLUSIONS: Seven days of treatment with oral grepafloxacin, 400 mg once daily, was as effective as 7 days of treatment with oral doxycycline, 100 mg twice daily, in patients with cervicitis caused by C . trachomatis . Both agents were well tolerated and had comparable safety profiles . Grepafloxacin's once-daily dosing regimen may offer advantages in terms of patient compliance.

Eur J Oral Sci, 1998 Oct, 106(5), 945 - 52
A statistical approach to the ecology of Actinobacillus actinomycetemcomitans in subgingival plaque; Muller HP et al.; Structured complexity may be a key feature of the microbiota residing in periodontal ecosystems . Recently, several attempts have been made to analyse the mutual interdependence of certain organisms in subgingival plaque and/or to identify clinical conditions which might influence presence or absence of these bacteria in subgingival plaque . The aim of the present analysis was to compare the results of different models derived from logistic regression of several clinical factors on the presence of Actinobacillus actinomycetemcomitans in subgingival plaque of adult periodontitis patients all harbouring this organism . Models assuming independence of observations or assuming independent observations with the level of response depending on the individual subject were compared to models considering the correlated structure of the acquired data by employing Generalized Estimating Equation (GEE) methods . Significant associations found when neglecting the correlated observations within a given subject as, e.g., between A . actinomycetemcomitans and amount of supragingival plaque, bleeding on probing, or attachment loss, became generally spurious in the GEE approach . Thus, presence of A . actinomycetemcomitans only depended on periodontal probing depth . It was concluded that the correlated structure of observations in an oral cavity should be carefully considered when associations between clinical factors are calculated.

Ann Clin Lab Sci, 1998 Sep-Oct, 28(5), 261 - 71
Critical limits (alert values) for physician notification: universal or medical center specific limits?
Lum G.
The concept of critical limits (alert values), defined as an imminent life threatening laboratory result requiring immediate physician notification, has been widely adopted as a standard of good laboratory practice . Although virtually all laboratories have tests with critical limits, surveys have shown that there is no universal alert value list . Recently, nine VA medical centers in the New England region, which now constitute one consolidated entity, were surveyed with the objective of summarizing critical limits . Universal (100 percent) critical limit tests for clinical chemistry were: Calcium; mean low/high, 6.5/12.4 mg/dL: Glucose 48/432 mg/dL: Potassium 2.8/6.1 mmol/L: Sodium 121/159 mmol/L . Universal hematology tests included: Hematocrit 22.2/59.7 percent: Platelet count 61K/983K: white blood count 1.9K/29K . Although there was universal agreement that abnormal coagulation tests (PT, PTT) should be included on the hematology critical limit list, there was wide variation in the reporting of coagulation tests (seconds and INR) and patient therapeutic status (anticoagulant or no-anticoagulant) . Universal alert values for microbiology were: Positive blood culture: Positive cerebral spinal fluid (CSF) culture: Positive CSF Gram stain . There was no universal agreement regarding critically high (potentially toxic) therapeutic drugs, with two medical centers declining to notify physicians of any abnormally high therapeutic drug level . No other qualitative critical limits for other laboratory sections, such as physician notification of an unexpected malignancy (surgical pathology) were universal . Medical center specific critical limits, designed to meet the clinical needs of each facility, are the norm in the nine medical centers . Laboratories do need periodically to review their critical limit lists with appropriate clinical input to avoid including critical limits for laboratory tests not required for urgent physician notification and patient evaluation and treatment.

Wien Klin Wochenschr, 1998 Aug 21, 110(15), 521 - 30
The search for the uremic toxin: the case for carbamoylation of amino acids and proteins; Kraus LM et al.; Urea and cyanate, spontaneously transformed from urea, are increased with decreased renal function becoming potential toxins . Isocyanic acid, the active form of cyanate, carbamoylates proteins, amino acids and other molecules, changing molecular structure and function in vivo . Carbamoylation can occur at multiple sites with a cumulative effect over the the life-span of the molecule . Carbamoylation converts free amino acids to carbamoyl-amino acids (C-AA) . C-AA interfere with protein synthesis and transamination reactions and contribute, in part, to protein-malnutrition . Insulin-sensitive glucose uptake is decreased by carbamoyl-asparagine . Cyanate inhibits superoxide release from neutrophils to an extent that interferes with microbiocidal activity . Antihomocitrulline antibodies identified homocitrulline (epsilon-amino-carbamoyl lysine) in situ in proteins in neutrophils in end stage renal disease . Also in uremic patients, homocitrulline was located in proteins in renal tissue but was not found in normal transplanted kidneys . Carbamoylated human low density lipoprotein interferes with human receptor binding, has decreased clearance, and is auto-immunogenic in animals . Carbamoylated insulin has decreased biological activity and changed immunological reactivity . Carbamoylation at a site of molecular activity can affect molecular function of enzymes, co-enzymes, antibodies, hormones and receptors . Carbamoyl-molecules can block, enhance, or be excluded from metabolic pathways, and can affect binding and trafficking, thereby influencing the fate of non-carbamoylated molecules . Normal renal function removes C-AA . In uremia, C-AA are removed by residual renal function or dialysis . Toxicity of cyanate is not an "all or none" phenomenon, but the actions of cyanate are a contributing factor in uremia . Removal of urea, cyanate and carbamoyl-molecules partially alleviates the morbidity and mortality of renal disease.

Int J Tuberc Lung Dis, 1998 Oct, 2(10), 831 - 5
Isoenzymes of adenosine deaminase in pleural effusions: a diagnostic tool?
Carstens ME, Burgess LJ, Maritz FJ, Taljaard JJ.
SETTING: Tygerberg Hospital, an academic teaching hospital, Republic of South Africa . OBJECTIVE: To identify the adenosine deaminase (ADA) isoenzymes as a diagnostic tool for tuberculosis in pleural effusions with increased ADA activity . DESIGN: Patients (n = 157) with exudative effusions and ADA activities >20 U/l, due to causes which satisfied predetermined diagnostic criteria, participated in the study . They consisted of 87 tuberculous effusions, 27 infective effusions (12 empyematous and 15 non-empyematous), 37 malignant effusions and six other exudative effusions (systemic lupus erythematosus, pancreatitis and lung embolus) . In each case the ADA isoenzymes in the pleural fluid were identified using polyacrylamide gel electrophoresis . In addition, microbiology and cytology (including differential cell counts) were also carried out . RESULTS: Although ADA1c and ADA2 were the predominant isoenzymes observed in tuberculous effusions, while ADA1c and ADA1m were predominant in infective non-empyematous effusions, no additional diagnostic value was obtained . In the case of neoplastic effusions and other exudates, determination of ADA isoenzyme patterns also did not assist in diagnosing these conditions . CONCLUSION: Determination of patterns of ADA isoenzymes does not enhance the overall diagnostic value of ADA activity in pleural effusions.

J Infect Dis, 1998 Nov, 178(5), 1446 - 9
Eradication of AIDS-related disseminated mycobacterium avium complex infection after 12 months of antimycobacterial therapy combined with highly active antiretroviral therapy; Aberg JA et al.; To determine if microbiologic cure of AIDS-related disseminated Mycobacterium avium complex (MAC) is possible in patients receiving highly active antiretroviral therapy (HAART), 4 patients with a history of disseminated MAC received >/=12 months of macrolide-based antimycobacterial therapy . All were asymptomatic and had absolute CD4 cell count >100/microL (range, 137-301) and <10,000 copies/mL of human immunodeficiency virus RNA (range, <500-1250) . A bone marrow aspirate and peripheral blood were obtained for mycobacterial culture . Follow-up blood cultures were obtained routinely at 4 weeks and every 8 weeks thereafter . All 4 patients had negative bone marrow and blood cultures and then discontinued antimycobacterial therapy . All patients' subsequent cultures remain sterile and all are clinically asymptomatic (range, 8-13 months follow-up) . It appears that disseminated MAC infection can be cured by prolonged antimycobacterial therapy in some persons who experience sustained CD4 lymphocyte increases while receiving HAART.

Arthritis Rheum, 1998 Oct, 41(10), 1884 - 8
Poncet's disease and papulonecrotic tuberculid in a patient infected with the human immunodeficiency virus; Cuende E et al.; We report the case of a 27-year-old patient with the human immunodeficiency virus (HIV) infection who presented with a 2-week history of crops of painful, red papules over the trunk and extremities, together with a sterile, symmetric polyarthritis involving the small and large joints . Histologic study of a skin biopsy specimen demonstrated features of papulonecrotic tuberculid . Analytical and microbiologic studies ruled out tuberculous infection . Both the synovial and the skin processes were considered to be an immune response secondary to Mycobacterium tuberculosis infection . Specific treatment was established, and there was marked improvement in both the skin and joint symptoms . This case illustrates the complex relationship between the host and the HIV, suggesting an immune dysregulation cause for both the synovial and the skin lesions.

Zhonghua Min Guo Wei Sheng Wu Ji Mian Yi Xue Za Zhi, 1995 May, 28(2), 95 - 108
Clinical microbiology quality assurance program: a Taiwan experience; Tsai WC et al.; Quality assurance programs have been established during the last two decades in developed countries to promote high quality performance in clinical laboratories . In Taiwan, such a program for clinical microbiology laboratories has been in place since July 1987 . It has been supported by the Department of Health, Executive Yuan, R.O.C . and was set up by the authors . The manpower status, facilities and equipment, and performance of clinical laboratories were investigated during the first year and standards of laboratory quality were recommended . Since then, under a continuing education program, we have conducted seminars, symposia, workshops, short-courses or panel discussions approximately 4 times a year . There have been about 150 participants per session and they have come from local hospitals (primary care hospitals), regional hospitals (secondary care hospitals) and medical centers (tertiary care hospitals) . Proficiency test specimens or external unknown specimens were sent to all the laboratories twice a year and approximately 3 specimens were used each time for the evaluation of each laboratory's diagnostic capability and quality of service . Results indicated that there were tremendous improvements in the quality of laboratory performance . At the same time, several laboratory manuals describing the methods of quality control of clinical specimens, test procedures, media and reagents, personnel management and a compilation of reports etc . were published as guidelines of basic requirements for each level of the laboratories . For local hospital laboratories in remote areas, several regional hospitals or medical centers with high quality laboratories were selected to serve as back-ups . Our evaluation has shown that the performance and quality of service provided by most clinical microbiology laboratories in Taiwan have now reached nearly the level of those found in the so-called "developed countries".

J Clin Microbiol, 1998 Nov, 36(11), 3429 - 32
Fluconazole disk diffusion susceptibility testing of Candida species; Kirkpatrick WR et al.; We describe a simple procedure for detecting fluconazole-resistant yeasts by a disk diffusion method . Forty clinical Candida sp . isolates were tested on RPMI-glucose agar with either 25- or 50-microgram fluconazole disks . With 25-microgram disks, zones of inhibition of >/=20 mm at 24 h accurately identified 29 of 29 isolates for which MICs were </=8 microgram/ml, and with 50-microgram disks, zones of >/=27 mm identified 28 of 29 such isolates . All 11 isolates for which MICs were >8 microgram/ml were identified by using either disk . Disk diffusion may be a useful screening method for clinical microbiology laboratories.

J Clin Microbiol, 1998 Nov, 36(11), 3317 - 22
Identification of new verocytotoxin type 2 variant B-subunit genes in human and animal Escherichia coli isolates; Pierard D et al.; The sequence of a verocytotoxin 2 (VT2) variant gene that was untypeable by the B subunit PCR and restriction fragment length polymorphism analysis (PCR-RFLP) method described by Tyler et al . (S . D . Tyler, W . M . Johnson, H . Lior, G . Wang, and K . R . Rozee, J . Clin . Microbiol . 29:1339-1343, 1991) was determined and compared with published sequences . It was highly homologous to two recently reported VT2 variant sequences . The PCR-RFLP method described by Tyler et al . was extended to include these new sequences . New VT2 variants were identified in 65 of 359 VT-producing Escherichia coli (VTEC) with newly designed primers (VT2-cm and VT2-f) and were characterized as well by restriction analysis of the amplification products obtained with another VT2-specific primer pair (VT2-e and VT2-f) . The VT genes harbored by 64 of these isolates proved to be untypeable by Tyler's PCR-RFLP method because no amplification was obtained with the primers used with this method (VT2-c and VT2-d) . The last isolate harbored the new variant gene in addition to VT2vh-a . None of the isolates harboring these new toxin genes belonged to serogroups O157, O26, O103, O111, and O145 . All 65 isolates were negative for the eaeA gene and were significantly less frequently enterohemolytic or positive for the enterohemorrhagic E . coli (EHEC) virulence plasmid than non-O157 VTEC isolates harboring other VT2 genes . They were also less frequently isolated from patients with EHEC-associated symptoms . The extended PCR-RFLP typing method is a useful tool to identify less-virulent VTEC isolates and for VT genotyping in epidemiological studies with non-O157 strains.

Rev Laryngol Otol Rhinol (Bord), 1998, 119(1), 13 - 7
{Maxillary actinomycosis and maxillary candidiasis in the immunocompetent patient}; Rombaux P et al.; Two distinct cases of maxillary actinomycosis and maxillary candidosis in immunocompetent hosts are reported; These infections are rare and similar to mycotic extramucosal non allergic sinusitis . Microbiology and microscopic examination are mandatory to prompt and successful management . Endoscopic endonasal surgery by middle meatotomy seems to be an adequate treatment for these particular entities.

Presse Med, 1998 Apr 11, 27(14), 658 - 60
{Hypercalcemia associated with hyperleukocytosis, a new paraneoplastic syndrome}; Peyrade F et al.; BACKGROUND: The association of hypercalcemia and leukocytosis constitutes a novel paraneoplastic syndrome rarely reported in the course of head and neck and lung squamous cell carcinoma . We report 7 new cases . CASE REPORTS: In 5 cases the diagnosis was well-differentiated squamous cell carcinoma, in 1 differentiated non-small-cell carcinoma and in 1 adenocarcinoma of unknown origin . There was no argument favoring hyperparathyroidism in any of the cases . Microbiology tests were negative and large spectrum antibiotics were unsuccessful, eliminating an associated infection as cause of the leukocytosis . DISCUSSION: This association probably involves the secretion of hematopoietic growth factors such as G-CSF or GM-CSF by the tumor, acting simultaneously on osteoclasts and granulomonocytic cells which have common precursers.

Neurosurgery, 1998 Oct, 43(4), 949 - 52
Nocardia abscess of the choroid plexus: clinical and pathological case report; Mogilner A et al.; OBJECTIVE: Cerebral Nocardia abscesses are rare, accounting for approximately 1 to 2% of all cerebral abscesses . Prompt aggressive surgical treatment involving craniotomy and excision of these lesions has been advocated by many authors, because these lesions have significantly higher morbidity and mortality rates than do most other cerebral abscesses . We report an atypical presentation of cerebral nocardiosis localized to the choroid plexus of the lateral ventricle . CLINICAL PRESENTATION: A 56-year-old man presented with a 3-week history of fever, cough, and progressive headache and an ensuing 3-day history of progressive lethargy, confusion, and gait ataxia . Radiographic studies demonstrated a loculated contrast-enhancing left lateral ventricular lesion with significant perilesional parenchymal edema that was thought preoperatively to be a neoplasm . INTERVENTION: The patient underwent a craniotomy for resection of the lesion . Intraoperatively, a reddish gray lesion with purulent exudate was encountered within the left lateral ventricle intimately adherent to the choroid plexus as well as to the ependyma and subependymal veins . A frozen section demonstrated an organizing abscess wall . The lesion was resected in its entirety, and multiple cultures were sent for analysis . CONCLUSION: Microbiology cultures grew Nocardia asteroides . A course of intravenous antibiotics was started, which included trimethoprim-sulfamethoxazole, amikacin, and ceftriaxone . Two weeks after surgery, at the time of discharge, the patient's neurological status had improved considerably . Although Nocardia abscesses have been documented to occur throughout the central nervous system, the presentation of a lesion confined to the choroid plexus of the lateral ventricle with significant parenchymal edema is unusual and demonstrates that Nocardia abscesses must be considered in the differential diagnosis of a contrast-enhancing intraventricular mass lesion involving the choroid plexus.

Cell Mol Biol (Noisy-le-grand), 1998 Jul, 44(5), 673 - 88
Scanning near-field optical microscopy in cell biology and microbiology; Meixner AJ et al.; Scanning a point light source in close proximity over a sample and recording the scattered or transmitted light intensity point by point allows one to record optical images with a resolution not limited by diffraction . An overview of this technique called scanning near-field optical microscopy (SNOM or NSOM) is given with emphasis on cell- and microbiology . After an introduction, where the basic features of the technique are explained, illustrative examples are presented, such as a HeLa cell, fluorescence labelled human chromosomes, super resolution fluorescence imaging, single molecule imaging and fluorescence resonance energy transfer between a single pair of dye molecules.

Eur J Clin Microbiol Infect Dis, 1998 Jul, 17(7), 479 - 88
Evaluation of six commercial systems for identification of medically important yeasts; Buchaille L et al.; Six commercially available systems for the identification of yeasts were evaluated using 133 clinical isolates and four reference strains that had been previously identified by conventional methods and 19 recent clinical isolates that had been identified by the ID32C system (bioMerieux, France) . The total identification rates (TIR) established for the total number of strains tested and the database identification rates (DBIR) established for the strains included in the respective manufacturer databases were both determined . After incubation for 4 h, the TIR and DBIR were 78% and 84%, respectively, for the RapID Yeast Plus system (Innovative Diagnostic Systems, USA) . After incubation for 24 h, the TIR and DBIR were 32% and 32%, respectively, for the ID32C, 65% and 67% for the Auxacolor system (Sanofi Diagnostics Pasteur, France), 62% and 65% for the Fungichrom I system (International Microbio, France), 52% and 65% for the Fungifast I twin system (International Microbio), and 62% and 68% for the API Candida system (bioMerieux) . The maximum TIR and DBIR (+/- 1%) obtained after incubation for 48 h were 86% and 88% for the Auxacolor, 85% and 89% for the Fungichrom I, 78% and 98% for the Fungifast I twin, and 82% and 91% for the API Candida . For the ID32C, the maximum TIR and DBIR were 98% and 98%, respectively, but these values were obtained only after 72 h of incubation . In addition, the six systems varied in their ease of use and readings . In conclusion, based on results obtained with 156 strains, the Auxacolor and Fungichrom systems seem the most appropriate for use in a clinical microbiology laboratory, due to their ease of use and reading, their rapidity, their cost per test, and their relatively high TIR results, which indicated acceptable performance with strains frequently isolated in our hospital . For a reference identification, the ID32C remains the sole system usable.

Histopathology, 1998 Aug, 33(2), 174 - 82
Applications of the microbiopsy technique in non-cervical cytology: where cytology and histology meet; Mravunac M et al.; AIM: To evaluate a recently developed technique allowing the removal and processing for histology of thick tissue fragments, called microbiopsies, from noncervical cytology specimens . METHODS AND RESULTS: Forty-five non-cervical smears from malignant tumours which contained microbiopsies were selected and processed . Sufficient sections could be cut in most cases for haematoxylin and eosin and an extensive panel of immunostaining . Seventy-one per cent of histological slides from the microbiopsies were representative of the tumour and confirmed the diagnosis . In 29% of the cases they were too small, contained non-representative tissue or showed extensive necrosis . Surprisingly, immunostaining results were at least the same and often better than those observed in routine formalin-fixed, paraffin-embedded tissue . Immunostaining profiles allowed distinction of tumour subtypes . Antigen retrieval techniques could be avoided in all cases . CONCLUSIONS: Application of the microbiopsy technique in routine cytology smears containing microbiopsies is helpful, particularly in those cases in which the diagnosis is not clear on the basis of the cytology smear and in cases in which there are not enough cytology slides for immunohistochemical examination.

Laryngorhinootologie, 1998 Aug, 77(8), 444 - 53
{Chronic mycoses of the paranasal sinuses--value of endonasal paranasal sinus surgery}; Simmen D et al.; BACKGROUND: Many host factors even in immunocompetent patients may have an influence on development of a fungal diseases within the paranasal sinuses . Fungal sinusitis can occur in an acute form or more often to a chronic type of the disease . These mainly relatively asymptomatic chronic forms and further divided into a chronic noninvasive, chronic allergic, and chronic invasive disease . Endonasal microsurgery has significantly changed the management of chronic fungal sinusitis and allows adequate removal of pathologic tissue even in advanced situations . The aim of this study was to analyze the efficacy of endonasal surgery in chronic fungal sinusitis . MATERIAL AND METHODS: In a retrospective study we assessed a group of 40 patients who had endonasal surgery for chronic fungal sinusitis . Patient records, CT and MRI scans, microbiology and histology as well as the postoperative clinical follow-up including endoscopic photo documentation were evaluated over a period of 5 years . All patients underwent endonasal surgery using endoscopic techniques . The microscopic was of additional help in a few cases with extended disease and multiple dehiscences of the skull base . RESULTS: Twenty-four patients had a chronic noninvasive of fungal sinusitis and 16 patients had a chronic invasive form . All these patients underwent endonasal surgery without external incision . The fungal disease was erradicated in 39 cases, and revision surgery was required in only one case in which involvement of the contralateral side was not initially detected . in two cases scar tissue in the middle meatus was later excised but without evidence of residual fungal disease . Only in 6 cases was antifungal chemotherapy required, where the disease had spread into surrounding tissue or the patient had severe symptoms . CONCLUSIONS: Endonasal microsurgical techniques are today the appropriate approach for managing chronic fungal sinus disease even in severe cases with radiologic evidence of expansion or invasion of surrounding tissue . Additional antifungal chemotherapy is only rarely indicated, specifically when the fungal disease invades surrounding tissue.

Appl Environ Microbiol, 1998 Oct, 64(10), 3570 - 5
Leaching of zinc sulfide by thiobacillus ferrooxidans: experiments with a controlled redox potential indicate No direct bacterial mechanism
Fowler TA, Crundwell FK.
The role of Thiobacillus ferrooxidans in bacterial leaching of mineral sulfides is controversial . Much of the controversy is due to the fact that the solution conditions, especially the concentrations of ferric and ferrous ions, change during experiments . The role of the bacteria would be more easily discernible if the concentrations of ferric and ferrous ions were maintained at set values throughout the experimental period . In this paper we report results obtained by using the constant redox potential apparatus described previously (P . I . Harvey and F . K . Crundwell, Appl . Environ . Microbiol . 63:2586-2592, 1997) . This apparatus is designed to control the redox potential in the leaching compartment of an electrolytic cell by reduction or oxidation of dissolved iron . By controlling the redox potential the apparatus maintains the concentrations of ferrous and ferric ions at their initial values . Experiments were conducted in the presence of T . ferrooxidans and under sterile conditions . Analysis of the conversion of zinc sulfide in the absence of the bacteria and analysis of the conversion of zinc sulfate in the presence of the bacteria produced the same results . This indicates that the only role of the bacteria under the conditions used is regeneration of ferric ions in solution . In this work we found no evidence that there is a direct mechanism for bacterial leaching.

Arch Anat Cytol Pathol, 1998, 46(4), 257 - 60
{Diagnostic difficulties and limits in breast histopathology in core biopsies (breast microbiopsies)}; Bellocq JP et al.; Core biopsy is increasingly used for the diagnosis and management of breast lesions . As a result, pathologists are being confronted with new difficulties pertaining to (1) the histological diagnosis on micro specimens (2) the correlation between core biopsy histological findings and mammographic findings, (3) the diagnostic significance of atypical hyperplasia on core biopsies, (4) the impact of tissue displacement on surgical specimens after needling procedures, and (5) the disagreement that can appear between the diagnostic on surgical specimen and on core biopsy.

Arch Anat Cytol Pathol, 1998, 46(4), 223 - 5
{Indications for diagnosing nonpalpable breast lesions}; Clough KB et al.; The increasingly widespread use of mammographic screening for breast cancer has induced a considerable increase in the number of surgical biopsies . Fine-needle aspiration and microbiopsies can allow to reduce this number . 1) In patients with nodular densities of benign or indeterminate appearance, a negative fine-needle aspiration indicates that no further investigations are needed . In contrast, complete surgical excision is indicated in cases of stellate images . 2) In patients with potentially malignant microcalcifications, fine-needle aspiration is to little value, and microbiopsies should be performed . Indeterminate (type II or III) calcifications are the best indication, since negative microbiopsies may obviate the need for lumpectomy, if the negative predictive value of microbiopsies is sufficiently high in this indication . Focal suspicious microcalcifications (type IV or V) should be removed surgically for both diagnostic and therapeutic purposes . Type IV or V microcalcifications involving a large area of the breast can be investigated by initial microbiopsy; a positive result allows to recommend immediate mastectomy without prior lumpectomy . Fine-needle aspiration and microbiopsies should be performed as part of a multidisciplinary diagnostic strategy involving radiologists, surgeons, cytopathologists, and pathologists . This approach is the only means of improving the management of non palpable mammographic lesions and of reducing the number of unnecessary operation.

Am J Med, 1998 Sep, 105(3), 182 - 91
A randomized comparison of the safety and efficacy of once-daily gentamicin or thrice-daily gentamicin in combination with ticarcillin-clavulanate; Gilbert DN et al.; PURPOSE: The primary purpose of the clinical trial was to assess the safety and efficacy of once-a-day compared with three-times-a-day gentamicin in patients with serious infections who had protocol-determined peak serum aminoglycoside concentrations . PATIENTS AND METHODS: A total of 249 hospitalized patients with suspected or proven serious infections were randomized in a 2:2:1 ratio to gentamicin given three times a day with ticarcillin-clavulanate (TC), gentamicin once a day with TC, or ticarcillin-clavulanate (TC) alone . The gentamicin once-a-day dosage for patients with estimated creatinine clearance values of > or =80 mL/min was 5.1 mg/kg . With lower creatinine clearance estimates, the mg/kg dosage of gentamicin was decreased, and the dosage intervals (once daily or three times a day) were maintained . Evaluability required documentation of achievement of protocol-defined peak serum gentamicin levels . RESULTS: Of the total 175 evaluable patients, there were no significant differences found between treatment regimens with respect to clinical or microbiologic efficacy . Bedside audiometry proved impractical due to the frequency of altered mental state in ill patients . Based on the traditional increase in serum creatinine values from baseline values, no differences in renal toxicity between the treatment groups was identified . When changes in renal function were reanalyzed based on maintaining, as opposed to worsening, of renal function, preservation of renal function was better in the gentamicin once-a-day patients as opposed to the gentamicin three-times-a-day patients, P <0.01 . CONCLUSIONS: Gentamicin once a day plus TC, gentamicin three times a day plus TC, and TC alone had similar effects in seriously ill hospitalized patients . The incidence of nephrotoxicity was similar in the three treatment groups . Using a nonvalidated post-hoc analysis, renal function was better preserved in gentamicin once-a-day + TC and TC-only patients as opposed to gentamicin three-times-a-day + TC.

Infect Immun, 1998 Oct, 66(10), 4884 - 94
Antigenic analysis of Bordetella pertussis filamentous hemagglutinin with phage display libraries and rabbit anti-filamentous hemagglutinin polyclonal antibodies; Wilson DR et al.; Although substantial advancements have been made in the development of efficacious acellular vaccines against Bordetella pertussis, continued progress requires better understanding of the antigenic makeup of B . pertussis virulence factors, including filamentous hemagglutinin (FHA) . To identify antigenic regions of FHA, phage display libraries constructed by using random fragments of the 10-kbp EcoRI fragment of B . pertussis fhaB were affinity selected with rabbit anti-FHA polyclonal antibodies . Characterization of antibody-reactive clones displaying FHA-derived peptides identified 14 antigenic regions, each containing one or more epitopes . A number of clones mapped within regions containing known or putative FHA adhesin domains and may be relevant for the generation of protective antibodies . The immunogenic potential of the phage-displayed peptides was assessed indirectly by comparing their recognition by antibodies elicited by sodium dodecyl sulfate (SDS)-denatured and native FHA and by measuring the inhibition of this recognition by purified FHA . FHA residues 1929 to 2019 may contain the most dominant linear epitope of FHA . Clones mapping to this region accounted for ca . 20% of clones recovered from the initial library selection and screening procedures . They are strongly recognized by sera against both SDS-denatured and native FHA, and this recognition is readily inhibited by purified FHA . Given also that this region includes a factor X homolog (J . Sandros and E . Tuomanen, Trends Microbiol . 1:192-196, 1993) and that the single FHA epitope (residues 2001 to 2015) was unequivocally defined in a comparable study by E . Leininger et al . (J . Infect . Dis . 175:1423-1431, 1997), peptides derived from residues of 1929 to 2019 of FHA are strong candidates for future protection studies.

Contraception, 1998 Jul, 58(1), 51 - 60
Contraceptive testing of vaginal agents in rabbits; Castle PE et al.; Development of new vaginal products, such as microbiocides and contraceptives, requires in vivo testing of their effect on fertility . Rabbits, unlike smaller laboratory animals such as rats and mice, which inseminate in the uterus, inseminate vaginally and thus are valuable as animal models for testing vaginal agents for contraceptive effects . Rabbits are inexpensive and easy to handle compared to nonhuman primates, and have frequently been used for testing the effects of vaginal agents on fertility . We review the pertinent literature and report findings that provide guidance for effectively using and improving the rabbit contraceptive model in testing new vaginal products.

FEMS Microbiol Lett, 1998 Aug 15, 165(2), 369 - 72
Co-detection of Helicobacter pylori and of its resistance to clarithromycin by PCR; Sevin E et al.; Our aim was to develop a rapid molecular test based on polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and making it possible to detect Helicobacter pylori directly from gastric biopsy samples, and to test its susceptibility to clarithromycin . A 629-bp fragment of the 23S rRNA gene of H . pylori was amplified by PCR and the mutations responsible for clarithromycin resistance were detected with Bsa1 and Bbs1 restriction endonucleases . Thirty-five gastric samples were tested in parallel by standard microbiologic methods (culture and clarithromycin susceptibility testing with E-test strips) and by PCR-RFLP . The 10 culture-negative samples were also PCR-negative . Sixteen out of the 25 culture-positive samples (64%) were PCR-positive . RFLP analysis could be done in 12 cases and the results were in agreement with those of the E-test: susceptibility in five cases, resistance in seven (six A2144G mutations and one A2143G mutation).

Lancet . 1998 Mar 28;351(9107):964.
Easing the way to safer sex; Larkin M; PIP: Clinical studies of nonoxynol-9 (N-9) products such as vaginal sponges link the spermicide to vaginal and vulval irritation, even at low doses . Since such irritation may facilitate infection with sexually transmitted diseases (STDs), the chief of the US National Institute of Allergy and Infectious Diseases' STD branch does not recommend that women use the product in their vaginas . Existing products containing N-9 continue to be tested against STDs and HIV, while new ways to prevent STDs and HIV infection are progressing to early clinical trials . New topical, nonirritating microbicides for preventing STDs are promising and will be featured at the May meeting of the American Society of Microbiology as products which could offer women safe, convenient, and almost undetectable protection . Examples include PRO 2000, a naphthalene sulphonate polymer; the "invisible condom," a gel; GEDA Plus, a gel; protegrins; and a "vaginal vitamin," a gelatin suppository . While condom use must continue to be encouraged and STDs treated, placing something into the vagina to either prevent or cure infection is within the realm of existing medical science .

Int J Syst Bacteriol, 1998 Jul, 48 Pt 3, 723 - 30
Species identification of Legionella via intergenic 16S-23S ribosomal spacer PCR analysis; Riffard S et al.; Species identification of Legionella in routine laboratory testing is hampered by the lack of highly discriminatory phenotypic tests . Amplification polymorphism of the intergenic 16S-23S spacer regions (ISR) has been previously developed for identification of species within the Legionellaceae {Hookey, J.V., Birtles, R.J . & Saunders, N.A . (1995) . J Clin Microbiol 33, 2377-2381}, but it did not provide enough resolution to distinguish all members of the bluish-white autofluorescent species and the red autofluorescent group of the Legionellaceae . By choosing new primers that target regions 4 (positions 1521-1541 of Escherichia coli 16S rRNA gene) and 6 (positions 114-132 of E.coli 23S rRNA gene) within the rDNA operon close to the 16S-23S intergenic spacer, 34 profiles were determined among the 79 type and reference strains representing 42 species that were tested . Analysis of the RFLP generated after Hinfl restriction digestion of the PCR products further improved the method, allowing complete discrimination among the species and subspecies of Legionella tested . Twenty-three well-identified strains from unrelated origins belonging to seven species gave amplification patterns identical to that of their type strain . The technique was also tested on 80 field isolates that could not be unequivocally assigned to groups by phenotypic methods . Seventy-two per cent (58/80) of these isolates had a profile identical to that of a type strain, while 27% (22/80) may correspond to new taxa since their ISR-PCR profiles did not match any of the known profiles.

J Zoo Wildl Med, 1998 Jun, 29(2), 228 - 32
Actinomycotic splenitis and intestinal volvulus in an alpaca (Lama pacos); Ramos-Vara JA et al.; Morphologic, microbiologic, and polymerase chain reaction amplification techniques were used to evaluate an alpaca (Lama pacos) with splenitis and intestinal volvulus . The intestinal volvulus produced a severe necrosuppurative typhlocolitis associated with vascular thrombosis and was most likely the cause of death of this animal . In addition, this animal had multiple coalescing abscesses affecting most of the splenic tissue . The isolation of Actinomyces spp . from the spleen and the morphology of the colonies when stained with Gram and Steiner stains support a diagnosis of splenic actinomycosis.

J Am Soc Nephrol, 1998 Sep, 9(9), 1697 - 708
Clinical practice guidelines: prevention of cytomegalovirus disease after renal transplantation; Jassal SV et al.; OBJECTIVE: To develop a set of comprehensive, standardized, evidence-based guidelines for the use of antiviral therapy to prevent cytomegalovirus disease in adult patients having undergone renal transplantation . OPTIONS: The use of medication, at the time of induction therapy or at the earliest sign of viremia . Treatments were evaluated by patient and donor serologic groups and the induction regimen used . OUTCOMES: The control of symptoms and features of cytomegalovirus disease over the first 6 mo to 1 yr after transplantation . EVIDENCE: Articles, compiled using a MEDLINE search from 1976 to July 1997, were reviewed by representatives of nephrology, microbiology, pharmacy, and epidemiology . Additional information was obtained from recent review articles and conference abstracts, and from experts in the field . VALUES: The evidence-based methods and values of the Canadian Task Force on the Periodic Health Examinations were used . High value was placed on studies with a randomized controlled design and blinded outcome observers . Study quality was classified as poor when cointervention was present (especially with regard to immunosuppressive regimens), when more than 20% of patients were lost to follow-up, and when intention to treat analysis was not performed . Recommendations were made with a graded system (grades A and B: Use of the intervention advised, based on high or fair quality evidence, respectively; grades D and E: Use of the intervention not advised, based on high or fair quality evidence, respectively: grade C: No recommendation made because of insufficient or conflicting evidence) . RECOMMENDATIONS: (1) Seropositive recipient; donor seropositive or seronegative; immunosuppression with antilymphocyte products . Prophylaxis with antiviral therapy recommended (grade A recommendation) . (2) Seronegative recipient; seropositive donor; immunosuppression with antilymphocyte products . Prophylaxis with antiviral therapy recommended (grade A recommendation) (3) Seronegative recipient; seropositive donor; conventional immunosuppression . Prophylaxis with antiviral therapy recommended (grade B recommendation) . (4) Seronegative recipient; seronegative donor; any immunosuppressive regimen . No prophylaxis with antiviral therapy required (grade D/E recommendation) . (5) Seropositive recipient: donor seropositive or seronegative; conventional immunosuppression . Prophylaxis left to the discrimination of the physician in charge (grade C recommendation).

FEMS Immunol Med Microbiol, 1998 Jul, 21(3), 231 - 9
Influence of the host and parasite strain in a mouse model of visceral Leishmania infantum infection; Honore S et al.; We investigated the respective roles of the host and parasite strain in a murine model of visceral leishmaniasis . Balb/c and C57Bl/6 mice were selected for their respective 'non cure' and 'cure' haplotypes vis-a-vis Leishmania major . Mice were infected with 10(7) stationary-phase promastigotes of four strains of Leishmania infantum with different infection profiles in mice: visceralization or regulation, as established by Sulahian et al . (Sulahian et al . (1998) FEMS Immunol . Med . Microbiol . 17, 131-138) . The infection was monitored by measuring parasite load in the liver and spleen on days 9, 22, 44 and 87 post-infection, using a sensitive microtitration technique . Similar profiles (visceralizing or regulating) were observed in the two mouse strains, suggesting a predominant role of the Leishmania strain in the visceralization process . The host response was assessed by analyzing the granulomatous response in the liver and by quantifying specific IgG, IgG1 and IgG2a as a marker of the Th1/Th2 immune response . A granulomatous response was observed in both strains of mice but was more pronounced with visceralizing strains of L . infantum and in C57Bl/6 mice compared to Balb/c mice . The kinetics of anti-Leishmania IgG antibody production was similar in all the groups, but the distribution of IgG1 and IgG2a isotypes was different between the two mouse strains: Balb/c mice had a predominantly Th2-like response whereas C57Bl/6 had a mixed Th1/Th2-like response . This study demonstrates the determining role of both the parasite and mouse strain in the outcome of L . infantum infection . The Th1/Th2 concept does not seem to explain susceptibility and resistance to infection in our model of visceral L . infantum infection, contrary to the L . major model.

Antonie Van Leeuwenhoek, 1998 Feb, 73(2), 169 - 87
Viability and activity in readily culturable bacteria: a review and discussion of the practical issues; Kell DB et al.; In microbiology the terms 'viability' and 'culturability' are often equated . However, in recent years the apparently self-contradictory expression 'viable-but-nonculturable' ('VBNC') has been applied to cells with various and often poorly defined physiological attributes but which, nonetheless, could not be cultured by methods normally appropriate to the organism concerned . These attributes include apparent cell integrity, the possession of some form of measurable cellular activity and the apparent capacity to regain culturability . We review the evidence relating to putative VBNC cells and stress our view that most of the reports claiming a return to culturability have failed to exclude the regrowth of a limited number of cells which had never lost culturability . We argue that failure to differentiate clearly between use of the terms 'viability' and 'culturability' in an operational versus a conceptual sense is fuelling the current debate, and conclude with a number of proposals that are designed to help clarify the major issues involved . In particular, we suggest an alternative operational terminology that replaces 'VBNC' with expressions that are internally consistent.

Trends Microbiol, 1998 Jul, 6(7), 253 - 5
How is the intracellular fate of the Legionella pneumophila phagosome determined?
Segal G, Shuman HA.
The following pair of articles, the first by Gil Segal and Howard Shuman, and the second by James Kirby and Ralph Isberg (Trends Microbiol . 6, 256-258), explore the genetics and function of the icm/dot genes of Legionella pneumophila . This gene family is implicated in several aspects of virulence and appears to constitute components of a conjugal transfer system that has been adopted to prevent phagosome-lysosome fusion in the host cell and to mediate host cytotoxicity by pore formation . Whether these functions are natural consequences or operate in parallel remains to be discovered.

Vet Radiol Ultrasound, 1998 Jul-Aug, 39(4), 357 - 65
Hepatic abscesses in 13 dogs: a review of the ultrasonographic findings, clinical data and therapeutic options; Schwarz LA et al.; Historical, physical examination, clinicopathologic, radiographic and ultrasonographic findings of 13 dogs with hepatic abscesses were reviewed . Liver abscessation was characterized by number, size, shape, echogenicity and location . Solitary lesions greater than 3 cm were more common than multiple ones . The abscesses were mainly poorly echogenic lesions, often with central cavitation . The shape of the lesion ranged from round to oval or irregular . Enhancement artifact, abdominal effusion, regional lymphadenopathy and hyperechoic perihepatic fat, were identified in several dogs . Ultrasound-guided aspiration was performed in 10 of 13 dogs, and confirmed abscessation with cytologic and microbiologic evaluation . Ultrasound-guided percutaneous drainage of abscesses was performed as an adjunct to medical management in four dogs.

Thorax, 1998 May, 53(5), 377 - 80
Detection of IgG and IgA against the mycobacterial antigen A60 in patients with extrapulmonary tuberculosis; Alifano M et al.; BACKGROUND: Diagnosis of extrapulmonary tuberculosis is often difficult to establish using standard methods . Serological techniques based on detection of antibodies against mycobacterial antigen A60 have shown good sensitivity and specificity in pulmonary tuberculosis . The present study was undertaken to define the diagnostic accuracy of testing for IgG and IgA against A60 in extrapulmonary tuberculosis . METHODS: One hundred and ninety eight subjects were studied: 42 patients with extrapulmonary tuberculosis confirmed by microbiology and/or histology, 24 subjects with healed pulmonary or extrapulmonary tuberculosis, 44 patients with a defined non-tuberculous disease, and 88 healthy volunteers (44 PPD negative and 44 PPD positive) . Detection of IgG and IgA against A60 antigen was carried out by enzyme-linked immunosorbent assay . Cut off values were determined by receiver operating characteristic curves . RESULTS: Sensitivity of the IgG test was 73.8% in extrapulmonary tuberculosis, while the specificity was 96.1% . The IgA test showed a sensitivity of 69.0% with a specificity of 93.6% . Combination of the IgG and IgA tests showed a sensitivity of 80.9% and a specificity of 92.3% . Patients with extrapulmonary tuberculosis showed significantly higher titres of both IgG and IgA against A60 than other groups . CONCLUSIONS: Anti-A60 IgG or IgA tests are characterised by good sensitivity and specificity . The combined use of both tests allows an increase in diagnostic accuracy of extrapulmonary tuberculosis.

J Clin Pathol, 1998 May, 51(5), 378 - 81
Audit of the histopathological diagnosis of non-neoplastic colorectal biopsies: achievable standards for the diagnosis of inflammatory bowel disease; Dube AK et al.; AIM: To assess the performance of a histopathology department in diagnosing inflammatory bowel diseases with comparison of reports from other centres . STUDY POPULATION: 1067 sets of endoscopic biopsies received in the department of histopathology, Royal Hallamshire Hospital, 1990-1995 . METHODS: The histopathological diagnosis of non-neoplastic endoscopic colorectal biopsies was audited using data from histopathology reports . The biopsy diagnosis by the initial reporting pathologist and final diagnosis after additional investigations (endoscopy, radiology, microbiology) or surgery were used to derive sensitivity, specificity, and positive predictive values for categories of disease . RESULTS: Diagnosis was validated for 1067 biopsy sets (43% of those initially assessed) . For all biopsies (with or without active inflammation) reports highly suggestive or suggestive of Crohn's disease had a sensitivity of 50%; for ulcerative colitis the comparable figure was 62% . Sensitivity was the same for both diagnoses (74%) in those biopsies with active inflammation . Positive predictive values for highly suggestive diagnoses of ulcerative colitis or Crohn's disease were 100% . In all biopsies the specificity of a histopathological diagnosis of normality was 96% . CONCLUSIONS: These results compare favourably with the other published audits and present an achievable level of performance for non-specialist hospitals with non-specialist histopathology services.

J Clin Microbiol, 1998 Sep, 36(9), 2786 - 8
Houseflies are an unlikely reservoir or vector for Helicobacter pylori; Osato MS et al.; The route of transmission of Helicobacter pylori from individual to individual remains undefined . It has recently been reported that the domestic housefly, Musca domestica, when fed pure cultures of H . pylori, was able to harbor the organism in its midgut for up to 30 h (P . Grubel, S . Hoffman, F . K . Chong, N . A . Barstein, C . Mepani, and D . R . Cave, J . Clin . Microbiol . 35:1300-1303, 1997) . Our investigation examined whether houseflies could acquire H . pylori from fresh human feces . Domestic houseflies (40 flies/group) were exposed for 24 h to feces from an H . pylori-positive volunteer, feces from an H . pylori-negative volunteer, or feces from an H . pylori-negative volunteer to which a known amount of viable H . pylori had been added . At various intervals, flies were sacrificed and the midguts were excised, homogenized, and plated in duplicate onto selective horse blood agar plates . All plates were incubated under microaerobic conditions at 37 degreesC for 14 days . Emergent colonies presumptive of H . pylori were picked and tested biochemically to confirm the identity as H . pylori . H . pylori was not recovered from houseflies fed human feces either naturally infected or artificially infected with H . pylori . These results suggest that the domestic housefly is not a vector for transmission or a reservoir for H . pylori infection.

J Clin Microbiol, 1998 Sep, 36(9), 2714 - 7
Comparative evaluation of colorimetric microtiter plate systems for detection of herpes simplex virus in cerebrospinal fluid; Tang YW et al.; In the past few years, application of the PCR to the detection of herpes simplex virus (HSV) DNA in the cerebrospinal fluid (CSF) from patients with encephalitis and meningitis has become standard laboratory practice . However, from an operational perspective, the true diagnostic value of PCR in this setting is yet to be realized because most laboratories subject the amplification products to lengthy probe hybridization procedures by Southern blotting . As alternatives to Southern blotting, we evaluated colorimetric microtiter plate (MTP) systems from ViroMed Laboratories, Inc . (PrimeCapture), CPG, Inc . (Quanti-PATH), and Incstar Corp . (GEN-ETI-K), in addition to a system developed at the Mayo Clinic with the PCR ELISA system (Boehringer Mannheim Corp.) . We tested PCR products from 86 clinical CSF specimens submitted to our Molecular Microbiology Laboratory . The CSF specimens used had to have sufficient volume for comparative analysis . By conventional Southern blotting methods, 54 were positive and 32 were negative for HSV DNA . Compared with Southern blotting, the sensitivity and specificity were 63.0 and 100.0%, respectively, for the PrimeCapture system, 98 . 2 and 96.9%, respectively, for the Quanti-PATH system, 98.2 and 100 . 0%, respectively, for the GEN-ETI-K system, and 100.0 and 96.9%, respectively, for the Mayo system . All four MTP systems had turnaround times 12 to 24 h less than that for Southern blotting . There were no significant differences in costs or technologist time between the Mayo system and Southern blotting . Other features of the Mayo system include type-specific genotypic identification of HSV and the potential for determination of drug resistance by DNA sequencing . Overall, we found that colorimetric MTP systems were likely to improve test turnaround times and patient care at no additional cost.

Anticancer Res, 1998 May-Jun, 18(3C), 2145 - 6
Ultrasonic guided microbiopsy in mammary diagnosis: indications, technique and results; Schulz-Wendtland R et al.; Between 1992 and 1993, 307 ultrasonic guided highspeed core cut biopsies were performed . In 119 of the 307 women, we dispensed with further surgical and histological procedures when the tentative diagnosis from complementary mammary diagnostic procedures revealed no pathological findings and concurred with the histological results of the core cut biopsy . In 188 women, the biopsy was followed by surgical intervention and correlation of the histological findings . This group of patients showed a sensitivity of 98%, a specificity and positive predictive value of 100%, and a negative predictive value of 91% . If we combine the results of the complementary mammary diagnosis (including the core cut biopsy), then the sensitivity, specificity, and positive and negative predictive values for this surgically and histologically confirmed group of patients reach 100% . In trained hands, the ultrasonic-guided high-speed core cut biopsy is a reliable means for determining the histological nature of lesions detected in ultrasonic scans . This technique has been perfected in our facility . Along with preoperative carcinoma detection, it permits us to avoid unnecessary operations when, under defined conditions, there are no pathological findings.

Zh Mikrobiol Epidemiol Immunobiol, 1998 May-Jun, (3), 69 - 73
{Intestinal microbiocensosis and immune status in young children with severe forms of acute pneumonia after the use of different therapy regimens}; Dolgushin II et al.; As revealed in this study, the inclusion of bifidumbacterin and carbolen into the complex therapy of severe forms of acute pneumonia in young children leads to the most complete correction of shifts with respect to immune status and intestinal microbiocenosis, thus reducing the duration of the disease.

J Antimicrob Chemother, 1998 Jul, 42(1), 5 - 12
The 1997 Garrod Lecture . The subtleties of antibiotic resistance; Phillips I; Although the qualitative aspects of antibiotic resistance are increasingly well understood, our understanding of the quantitative aspects has always lagged . Deficiency of understanding or of investigation affects the methods used to characterize the phenotypes of organisms from clinical sources, delays acquisition of knowledge of the importance of quantitative diversity in patient management, and introduces error into epidemiological studies of the prevalence of resistance . This, in turn, gives rise to a devaluation of the work done in diagnostic laboratories in relation to the technology of sensitivity testing, to the interpretation of their results for clinicians, including those used in clinical trials, and to the statistical analyses of resistance trends used inter alia as a guide to empirical antibiotic therapy and to test the efficacy of methods of control . There is a need to bring about a shift of opinion of those who provide funds, in relation to the role of clinical microbiologists and infectious diseases clinicians in defining and solving these problems.

Clin Lab Sci, 1998 Sep-Oct, 11(5), 298 - 304
Emerging foodborne pathogens: enterohemorrhagic Escherichia coli; Nauschuetz W; In 1982, a new pathogen caused an outbreak of hemorrhagic colitis in this country . This new pathogen, Escherichia coli O157:H7, was not a known enteropathogen prior to this time . Since 1982, this organism has become the most commonly isolated pathogen from patients with bloody stools . Health officials estimate that E . coli O157:H7 causes 20,000 cases of hemorrhagic colitis annually in the U.S . Approximately 5% of all hemorrhagic colitis patients experience serious sequelae involving hemolytic anemia, thrombocytopenia, and kidney failure, and about 250 patients die each year with E . coli O157:H7 hemorrhagic colitis and sequelae . Even as many clinical laboratories become more efficient at detecting E . coli O157:H7 using simple media, other strains of enterohemorrhagic E . coli are appearing as causes of hemorrhagic colitis and hemolytic uremic syndrome . These non-O157:H7 are more difficult to detect and identify, and present a challenge to clinical microbiologists.

Acta Odontol Scand, 1998 Jun, 56(3), 135 - 42
72-kDa and 92-kDa gelatinases in saliva of patients with human immunodeficiency virus infection; Mellanen L et al.; Human immunodeficiency virus (HIV) infection has been associated with periodontal diseases in HIV-seropositive patients . In periodontal diseases, matrix metalloproteinases (MMPs) may play key roles in the extracellular matrix, basement membrane, serpin degradation, and modification of cytokine action . We characterized the 72 kDa type IV collagenase (gelatinase A, MMP-2) and 92 kDa type IV collagenase (gelatinase B, MMP-9) in the saliva of HIV-seropositive patients and seronegative healthy controls by activity measurements and quantitative immunoblotting . Immunoblot analysis with specific antibodies against MMP-2 and MMP-9 and their tissue inhibitors (TIMP-1, TIMP-2) disclosed that, independent of the phase of the patients' HIV infection, their salivary samples contained higher amounts of MMP-2 and MMP-9 immunoreactivities in pro- and active forms and the TIMP-1 and TIMP-2 inhibitors than did the control samples . Healthy control saliva contained only slight immunoreactivities for gelatinases and TIMPs . However, as judged by the studied clinical and microbiologic indicators, HIV-seropositive patients showed only a slight tendency to develop periodontitis . Overall, an increased amount of gelatinases in saliva may reflect increased host response and defense activities in HIV infection.

Neoplasma, 1998, 45(2), 96 - 101
Early changes in flow cytometric DNA profiles induced by californium-252 neutron brachytherapy in squamocellular carcinomas of the uterine cervix; Tacev T et al.; Ninety-five squamocellular carcinomas of the uterine cervix, clinical Stages II and III, were treated by either four schedules combining 252-californium neutron-gamma-radiotherapy with different proportions of a neutron component (9, 6 and 3 Gy) or gamma-irradiation alone . Flow cytometric DNA profiles were obtainable in 72 cases before treatment and 56 cases were monitored for DNA content by flow cytometry (FCM) in weekly intervals by analysis of sequential microbiopsies for one month during and after radiotherapy . DNA aneuploidy was reduced from 40% (25/63) to 19% (9/47) one week within therapy in neutron-treated groups, but not after initial gamma-radiotherapy alone . Extinction of DNA aneuploid subpopulations occurred after neutron therapy in all remaining aneuploid tumors (9/9) during further monitoring, but only in 40% (2/5) of tumors after sole gamma-irradiation . In contrast, proliferation index by more than 50% was more often achieved in groups with a higher gamma-radiation component than after neutrons only . When all therapy-induced DNA flow cytometric events are taken together for evaluation of the effects of various radiotherapy schedules, it appears that the regimen with the maximal neutron dose may not be optimal for all tumors . It is hypothesized that the differences in the early flow cytometric DNA profiles may select the DNA aneuploid squamous cell uterine cervical carcinomas as candidates for combined neutron-brachytherapy, while highly proliferating DNA near-diploid tumors may profit more from treatment with a higher gamma-radiotherapy component . However, these early DNA flow cytometric findings need to be correlated with clinical course of the disease to validate this hypothesis, a process which will be completed at the end of the expected five-year clinical outcome in 2000.

J Bacteriol, 1998 Aug, 180(15), 3923 - 32
Structural and biochemical analysis of the sheath of Phormidium uncinatum; Hoiczyk E; The sheath of the filamentous, gliding cyanobacterium Phormidium uncinatum was studied by using light and electron microscopy . In thin sections and freeze fractures the sheath was found to be composed of helically arranged carbohydrate fibrils, 4 to 7 nm in diameter, which showed a substantial degree of crystallinity . As in all other examined motile cyanobacteria, the arrangement of the sheath fibrils correlates with the motion of the filaments during gliding motility; i.e., the fibrils formed a right-handed helix in clockwise-rotating species and a left-handed helix in counterclockwise-rotating species and were radially arranged in nonrotating cyanobacteria . Since sheaths could only be found in old immotile cultures, the arrangement seems to depend on the process of formation and attachment of sheath fibrils to the cell surface rather than on shear forces created by the locomotion of the filaments . As the sheath in P . uncinatum directly contacts the cell surface via the previously identified surface fibril forming glycoprotein oscillin (E . Hoiczyk and W . Baumeister, Mol . Microbiol . 26:699-708, 1997), it seems reasonable that similar surface glycoproteins act as platforms for the assembly and attachment of the sheaths in cyanobacteria . In P . uncinatum the sheath makes up approximately 21% of the total dry weight of old cultures and consists only of neutral sugars . Staining reactions and X-ray diffraction analysis suggested that the fibrillar component is a homoglucan that is very similar but not identical to cellulose which is cross-linked by the other detected monosaccharides . Both the chemical composition and the rigid highly ordered structure clearly distinguish the sheaths from the slime secreted by the filaments during gliding motility.

Am J Ophthalmol, 1998 Jul, 126(1), 132 - 4
Chest computed tomography and mediastinoscopy in the diagnosis of sarcoidosis-associated uveitis; Kosmorsky GS et al.; PURPOSE: To report the usefulness of chest computed tomography and mediastinoscopy in diagnosing sarcoidosis in elderly patients with uveitis . METHODS: Case reports . Two Caucasian women, aged 73 and 70 years, underwent evaluations for uveitis, which included chest computed tomography and mediastinoscopy . RESULTS: A chest computed tomographic scan of each woman disclosed mediastinal lymphadenopathy and warranted mediastinal lymph node biopsy by mediastinoscopy . In both patients, histopathologic and microbiologic studies demonstrated sterile noncaseating granulomas consistent with the diagnosis of sarcoidosis . CONCLUSIONS: The diagnosis of sarcoid-associated uveitis in the elderly may be facilitated by chest computed tomography, which may be more sensitive than conventional chest roentgenography . Laboratory studies of biopsied mediastinal nodes obtained by mediastinoscopy can confirm the diagnosis.

ASAIO J, 1998 Jul-Aug, 44(4), 303 - 8
Surface treated large bore catheters with silver based coatings versus untreated catheters for extracorporeal detoxification methods; Bambauer R et al.; Infection, thrombosis, and stenosis are among the most frequent complications associated with blood contacting catheters . Because these problems are usually related to surface properties of the base catheter material, surface treatment processes, such as ion implantation and ion beam assisted deposition (silver based coatings), can be used to mitigate such complications . Because these ion beam based processes affect only the near-surface region (approximately the outer 1 microm), there is little effect on bulk material properties . This study evaluated silver coated large bore catheters used for extracorporeal detoxification . In a 122 patient prospective study, 156 large bore catheters were inserted into the internal jugular or subclavian veins . Seventy-eight surface treated catheters (SPI-ARGENT, Spire Corporation, Bedford, MA; n = 32 acute catheters, n = 45 long-term catheters) were Bambauer inserted in 55 patients . Seventy-eight untreated catheters placed in 67 patients served as controls (n = 35 acute catheters, n = 43 long-term catheters) . After removal, the catheters were cultured for bacterial colonization using standard microbiologic assays . They were also examined using a scanning electron microscope (SEM) . Bacterial colonization was observed in 15.4% of the treated catheters compared with 44.9% of untreated catheters . The SEM investigations showed all treated catheters to possess low thrombogenicity . Results of the study indicate that ion beam based processes can be used to improve thrombus and infection resistance of blood contacting catheters.

Ann Pharmacother, 1998 Jul-Aug, 32(7-8), 785 - 93
Pharmacokinetics and pharmacodynamics of intravenous and oral azithromycin: enhanced tissue activity and minimal drug interactions; Rapp RP; OBJECTIVE: To review the pharmacokinetics and pharmacodynamics of oral and intravenous azithromycin compared with other macrolide antibiotics, and to evaluate these differences and their relation to clinical effectiveness . DATA SOURCE: A MEDLINE search (1966-May 1998) was performed to identify applicable English-language clinical, animal, and microbiologic studies pertaining to pharmacokinetic and pharmacodynamic parameters . STUDY SELECTION: Relevant studies concerning microbiology, pharmacokinetics, tissue concentrations, pharmacodynamics, and the clinical effects of these parameters were selected . DATA SYNTHESIS: The structural modification that distinguishes the azalide antibiotics from the macrolide antibiotics is responsible for the pharmacokinetic and pharmacodynamic behavior of azithromycin, resulting in the high and sustained tissue and intracellular concentrations seen with this agent . Drug delivery to the site of infection by phagocytes and fibroblasts is the hallmark of azithromycin's tissue-directed pharmacodynamics, allowing for convenient once-daily, 5-day regimens for most infections that respond to oral therapy and 7-10 days for more serious infections requiring initial intravenous therapy . Metabolism is via hepatic pathways other than cytochrome P450, thus minimizing the risk of drug interactions . CONCLUSIONS: Compared with other macrolide antibiotics, the unique pharmacokinetic and pharmacodynamic features of azithromycin offer the potential for improved efficacy and safety from drug interactions . These attributes, combined with its once-daily dosing schedule, make azithromycin suitable for the treatment of many types of bacterial infection.

Transplantation, 1998 Jul 15, 66(1), 120 - 3
Microbiologic study of organ-cultured donor corneas; Borderie VM et al.; BACKGROUND: Our purpose was to evaluate the sterility of organ-cultured human donor corneas at the time of surgery . METHODS: We studied 603 organ-cultured corneas . Of these 603 corneas, 409 (68%) were grafted and 69 (11%) were contaminated during storage . RESULTS: Contamination during preservation was either bacterial (65%) or fungal (35%) . None of the tested antibiotics were effective against all of the 45 isolated bacteria . The risk of contamination decreased with death-to-organ culture time (P=0.008) and was higher for corneas excised in situ than for those enucleated (P=0.02) . Corneoscleral rims were sterile in 99.3% of the grafted corneas . Deswelling media were sterile in 100% of cases . A 19- to 53-fold decrease in the percentage of rim contamination was assessed with organ culture as compared with hypothermic storage (previous studies, P < 0.0001) . CONCLUSIONS: These results demonstrate the benefit of organ culture over hypothermic storage, because it allows contaminated tissue to be discarded.

Cleve Clin J Med, 1998 Jul-Aug, 65(7), 369 - 76
Pelvic inflammatory disease: the importance of aggressive treatment in adolescents; Rome ES; Pelvic inflammatory disease (PID), an infection of the female genital tract, presents a number of difficult challenges in diagnosis and management . Adolescents in particular require aggressive care of PID to prevent the long-term sequelae of chronic pelvic pain and infertility . This article reviews the etiology, microbiology, diagnosis, and management of PID, with an emphasis on treating adolescents with PID.

Turk J Pediatr, 1998 Apr-Jun, 40(2), 151 - 8
Persistent diffuse peritonitis in children; Karaguzel G et al.; In adults, persistent diffuse peritonitis (PDP) having a special microbiologic spectrum is now defined as a distinct intraabdominal infection because of its aggressive clinical course . Considering also other types of peritonitis, this study was performed to determine characteristics of childhood PDP in regard to clinical picture, microbiologic features, treatment and outcome . Classification of 175 patients with peritonitis showed that nine patients had primary peritonitis and 121, 37 and eight patients had secondary peritonitis, PDP, and intraabdominal abscess, respectively . Rates of host defense affecting disease, extra-appendicular origin, and mortality were markedly higher in the PDP group . However, polymicrobic and anaerobic infection rates were lower in the PDP group than those of the secondary peritonitis group . While 26 of 37 patients with PDP underwent surgical intervention, the remaining 11 patients were managed by conservative measures . In the PDP group, mortality was 18 percent for conservatively and 23 percent for surgically treated patients . Being of young age, presence of an accompanying disease and fungal growth increased the mortality . The results indicate that PDP is a distinct type of peritonitis in children as well as in adults . In addition, accurate identification of these patients may prevent some unnecessary operations and improve survival by the choice of more conservative treatment plans.

Clin Infect Dis, 1998 Jul, 27(1), 169 - 75
Long-term laboratory contamination by Mycobacterium abscessus resulting in two pseudo-outbreaks: recognition with use of random amplified polymorphic DNA (RAPD) polymerase chain reaction; Lai KK et al.; Beginning in 1993, an increase in clinical isolates of Mycobacterium abscessus was observed in a single hospital microbiology laboratory . This involved a cluster of four patients in June 1993 and five patients and a quality-control culture of distilled water in May 1994 . Twenty-three M . abscessus isolates recovered between 1991 and 1996 were compared by random amplified polymorphic DNA polymerase chain reaction (RAPD-PCR) . Sixteen of 21 clinical isolates recovered over a 6-year period and the distilled water isolate had identical RAPD-PCR patterns consistent with a single strain or clone . Only six of 15 patients had findings suggestive of clinical disease . Since the use of in-house-prepared distilled water was discontinued, no further laboratory contamination of clinical specimens has been observed . Molecular typing was the key to defining distilled water as the source of this pseudo-outbreak . Recognition of such outbreaks is important for prevention of unnecessary therapeutic and diagnostic interventions.

Minerva Med, 1998 Apr, 89(4), 99 - 103
{Mycoplasma pneumoniae pulmonitis: delayed diagnosis and empirical therapy}; Rizzo S; MYCOPLASMA PNEUMONIAE: Delayed diagnosis and empiric therapy . BACKGROUND: To evaluate the consistency of IHA test to the initial diagnosis and therapy in suspected cases of Mycoplasma pneumoniae pneumonia (MP) . METHODS: Design: retrospective-descriptive . Environment: Division of Pneumology, IRCCS Policlinico S . Matteo, Pavia from November 1991 to October 1993 . Patients: 235 pts inpatients . Variables: age, sex, clinical diagnosis, microbiology, serological investigations for MP by indirect hemagglutination test (IHA); therapy, monitoring and evaluation; considered as positive IHA titres > or = 1:40 . RESULTS: Clinical presentation not different from other "atypical" pneumonia . Macrolides, aminoglycosides, quinolones or cephalosporins were the usual treatment; patients recovered within 1 to 2 weeks consistently to the severity of disease . Sixty-five cases were IHA-positive (28%) . Serological outcomes were usually known after 7 to 10 days or more, when most of patients resulted discharged . Mean age in IHA-positive pts was younger than in IHA-negative (31.3 vs 51.6 yrs; p < 0.0001) . IHA test was repeated after 3 weeks in 23/235: 2 (9%) remained negative and 15 (65%) positive; 5 (22%) turned from positive to negative; 1 (4%) from negative to positive . CONCLUSIONS: Clinical and roentgenological presentation similar to other "atypical" pneumonia; late etiological diagnosis and only in 28%, including those monitored distally; significantly young age among IHA-positives; empiric therapy, effective even on the remaining 72% IHA-negative . IHA, commonly used test with good specificity and sensitivity, is of late support to the clinician in short course and uncomplicated disease.

Curr Opin Pulm Med, 1998 May, 4(3), 148 - 53
Nontuberculous mycobacterial pulmonary disease; Olivier KN; The prevalence of the nontuberculous mycobacteria (NTM) among clinical mycobacterial isolates is increasing . Reports of human pulmonary disease ascribed to these isolates, particularly the Mycobacterium avium complex, have involved hosts who did not possess the traditional risk factors of structural airways disease or apparent conditions that alter local or systemic immune function . More definitive evidence supporting a causal relationship between recovery of M . avium complex and the presence of small peripheral nodules with or without focal bronchiectasis now exists from biopsy studies as well as longitudinal evaluations . The concept of airway colonization, the nonpathogenic presence of NTM in the lower airways, is less viable . However, given the very slowly progressive nature of noncavitary disease, the remaining question is whether to aggressively treat patients with a multidrug regimen or to diligently follow them with frequent microbiologic and radiologic evaluations . The advent of the newer macrolide-azide antibiotics with demonstrated effectiveness against M . avium complex has significantly improved the management outcome of multidrug chemotherapeutic regimens . The potential for prevention of significant bronchiectatic lung disease merits an aggressive diagnostic approach to identify NTM in the appropriate clinical presentation . Recognizing the changing presentations of NTM pulmonary disease is requisite for suspecting NTM as potential etiologic agents.

World J Surg, 1998 Aug, 22(8), 778 - 82
Infective complications after abdominal surgery in patients infected with human immunodeficiency virus: role of CD4+ lymphocytes in prognosis; Emparan C et al.; Risk factors associated with surgical infections are related to many events that modulate the immune system and affect the surgical procedure . The aim of this study was to determine the influence of low CD4+ lymphocyte counts in 24 patients with human immunodeficiency virus (HIV) undergoing abdominal surgery . Blood samples were obtained, and the lymphocyte population was evaluated perioperatively, as was the nutritional status of the patient . All the patients received selective antibiotic prophylaxis depending on the surgical procedure performed: (1) clean surgery: splenectomies (n = 8); (2) clean-contaminated: cholecystectomy and biliary tract surgery (n = 8); and (3) contaminated: appendectomy (n = 8) . Depending on their CD4 count, two groups were formed: one with 200 to 500 cells/ml (n = 11) and the other with < 200 cells/ml (n = 13) . When surgical infection was suspected, surgical drainage and microbiologic cultures were undertaken . For statistical evaluation of the groups ANOVA and the chi-square test were used; p < 0.05 was considered significant . Altogether 14 patients (58.3%) had a wound infection, and the mean (+/- SD) CD4 count in those patients was decreased (221.7 +/- 75.1) compared with that of the 10 patients in the uneventful group (386 +/- 81.2) . Surgical infection rates were 50% for clean procedures, 62.5% for clean-contaminated procedures, and 62.5% for contaminated surgery . The group of patients with CD4 counts of < 200 cell/ml had an increased incidence of surgical infection, regardless of the type of surgery (p = 0.002) . Thus the surgical infection rates with HIV patients undergoing abdominal surgery are dramatically increased . The CD4 and subsequently depressed neutrophil populations increase the risk of surgical infection during major procedures regardless of the type of surgery performed.

Community Dent Oral Epidemiol, 1998, 26(1 Suppl), 45 - 8
Response to Reisine & Douglass: psychosocial and behavioral issues in early childhood caries; Milgrom P; The behaviors that are fundamental in early childhood caries are those that initiate and maintain the conditions for transmission of the cariogenic bacteria and block prevention of the disease in the presence of an unfavorable diet . These behaviors have not been the focus of interdisciplinary research involving clinicians, microbiologists, pharmacologists, and behavioral scientists . The current "health promotion product" is not selling . The problem is the "product", not the potential buyer . Evidence suggests that positive interactions with the dental care system do lead to mothers taking preventive steps . However, dentist's attitudes, knowledge, skills and experience with babies and toddlers are deficient . Primary prevention of early childhood caries will fail unless it begins in the prenatal period and addresses the health of both mother and child.

Indian J Med Res, 1998 May, 107, 204 - 7
Diagnosis of typhoid fever by the detection of anti-LPS & anti-flagellin antibodies by ELISA; Jesudason MV et al.; In a developing country like ours where typhoid fever is endemic and there are very few microbiology laboratories to provide diagnosis by culture, a search for non culture techniques for rapid and reliable diagnosis continues . The Widal test has a low sensitivity . We have attempted to adapt the well established enzyme linked immunosorbent assay (ELISA) technique to provide a serological test of better sensitivity and specificity . The ELISA described here to detect anti-LPS antibodies was found to have a sensitivity of 89.4 per cent and a specificity of 94.9 per cent . The sensitivity for the antiflagellin ELISA was 68.1 per cent and specificity was 97.4 per cent . The likelihood ratio was 17.5 for anti-LPS ELISA and 26.2 for the anti-flagellin ELISA . Considering the positivity of either one ELISA as diagnostic, the sensitivity was 93.6 per cent and specificity was 94.9 per cent.

Curr Opin Chem Biol, 1998 Feb, 2(1), 133 - 7
New directions in metabolic engineering; Jacobsen JR et al.; Metabolic engineering is a rapidly evolving field . The term typically refers to the genetic modification of cellular biochemistry to introduce new properties or modify existing ones . Recent progress in genetics, molecular biology, microbiology and chemistry are driving advances in this field . Many well-studied areas continue to yield exciting results and new problems and technologies are constantly being developed.

Hear Res, 1998 Jun, 120(1-2), 62 - 8
Isolation of overexpressed yeast genes which prevent aminoglycoside toxicity; Johnson DF et al.; Aminoglycoside antibiotics at non-toxic levels can cause sensorineural hearing loss in genetically predisposed individuals . The major aminoglycoside hypersensitivity mutation that has been described in humans is at position 1555 in the mitochondrial 12S ribosomal RNA gene . In order to identify additional candidate genes for genetic susceptibility mutations in humans and possibly develop therapeutic interventions, we are using yeast as a model organism to identify genes whose products interact with aminoglycosides or bypass the effects of aminoglycoside poisoning . We have selected yeast genomic DNAs that, when cloned into a high copy number plasmid, confer neomycin resistance . We have previously described the first gene identified through this approach {Prezant, Chaltraw and Fischel-Ghodsian, Microbiology 142 (1996) 3407 3414} and have now completed this search by the exhaustive screening of 35 yeast genome equivalents . This has resulted in the identification of seven additional chromosomal regions . All seven chromosomal regions have been characterized and the most likely gene responsible for aminoglycoside resistance has been identified for each of them . While the mechanism of aminoglycoside resistance can be inferred for some of the gene products, it remains to be determined for others.

Clin Diagn Lab Immunol, 1998 Jul, 5(4), 456 - 62
Diagnostic value of proteins of three Borrelia species (Borrelia burgdorferi sensu lato) and implications for development and use of recombinant antigens for serodiagnosis of Lyme borreliosis in Europe; Hauser U et al.; More and more assays for the serodiagnosis of Lyme borreliosis (LB) are based on recombinant antigens . However, so far, there is no consensus as to which are the most specific and sensitive proteins and how they should be used in combination to obtain tests with the best discrimination abilities . The present study was preceded by a detailed analysis of Western blots (WB) using whole-cell lysates of Borrelia burgdorferi sensu stricto strain PKa2, B . afzelii PKo, and B . garinii PBi (U . Hauser, G . Lehnert, R . Lobentanzer, and B . Wilske, J . Clin . Microbiol . 35:1433-1444, 1997) . For the present work, the data bank from that study, containing information about the reactivities of 330 sera (from patients at different stages of LB {n = 189}; control group, n = 141), was reused . The specificities and sensitivities of various combinations of proteins from different strains were calculated for different interpretation criteria . For immunoglobulin G (IgG) WB, the recommended combination of antigens available to date as recombinant proteins included p83/100 of PKa2, p83/100 of PKo, p39 of PKo, p39 of PBi, and OspC of PBi (interpretation criterion, at least one reactive band required for a positive WB; specificity, 96.5%; sensitivity, 56.1%) . The further addition of p58 of PKo, p17 of PKo, or p14 of PKo was most favorable in terms of both a considerable gain of sensitivity and little loss of specificity . IgG Western blotting with a whole-cell lysate of strain PKo might be improved by the addition of OspC of PBi . For IgG WB, the best combination, out of all bands, was p83/100, p58, p39, p30, and p21 of all three strains and OspC of PBi, p17b of PBi, p56 of PKa2, p43 of PKo, p17 of PKo, and p14 of PKo (interpretation criterion, at least two reactive bands required for a positive WB; specificity, 97.2%; sensitivity, 61.4%) . An interpretation criterion of at least two reactive bands is more reliable than one of only one reactive band . For IgM WB, the best combination was OspC of PKo, OspC of PBi, p39 of all three strains, p17 of PKo, and strong reactions with p41 of all three strains (interpretation criterion, at least one reactive band required; specificity, 97.9%; sensitivity, 47.0%).

Clin Diagn Lab Immunol, 1998 Jul, 5(4), 446 - 51
Detection of Mycobacterium avium subsp . paratuberculosis in infected tissues by new species-specific immunohistological procedures; Coetsier C et al.; We have previously described the cloning and sequencing of a gene portion coding for the terminal part of a 34-kDa protein of Mycobacterium avium subsp . paratuberculosis, the etiological agent of Johne's disease (P . Gilot, M . De Kesel, L . Machtelinckx, M . Coene, and C . Cocito, J . Bacteriol . 175:4930-4935, 1993) . The recombinant polypeptide (a362) carries species-specific B-cell epitopes which do not cross-react with other mycobacterial pathogens (M . De Kesel, P . Gilot, M.-C . Misonne, M . Coene, and C . Cocito, J . Clin . Microbiol . 31:947-954, 1993) . The present work describes the preparation of polyclonal and monoclonal antibodies directed against a362 and the use of these immunoglobulins for histopathological diagnosis of Johne's disease . The new immunohistological procedures herewith detailed proved to be able to identify M . avium subsp . paratuberculosis antigens in the intestinal tissues and lymph nodes of cattle affected by either the paucibacillary or pluribacillary form of the disease . They yielded negative responses not only with healthy animals but also with those affected by tuberculosis (Mycobacterium bovis) . Both immunohistological procedures proved to be as sensitive as or more sensitive than Ziehl-Neelsen staining and, in addition, to be endowed with species specificity.

J Clin Pathol, 1998 Apr, 51(4), 316 - 23
The Vitek analyser for routine bacterial identification and susceptibility testing: protocols, problems, and pitfalls; Shetty N et al.; Automated and semiautomated technology in microbiology has seen great advances in recent years . The choice of automated equipment for the identification and susceptibility testing of bacteria in a routine diagnostic laboratory depends on speed, accuracy, ease of use, and cost factors . The Vitek analyser (bioMerieux, UK) was installed in a busy diagnostic teaching hospital laboratory in London . This report describes one year's experience . Changes to work practice as a result of incorporating the equipment into the laboratory, and the advantages and disadvantages of automation in key areas are described in detail, together with possible solutions to problems . The Vitek analyser was found to be valuable for the speed and accuracy with which results were available for the common bacterial pathogens . Results of susceptibility testing were standardised according to NCCLS guidelines and used breakpoint MICs to ascertain susceptibility and resistance; they were an improvement on disc testing . This equipment is not a reference facility for difficult to identify organisms and many manual techniques, including some disc susceptibility testing, will have to be retained by the laboratory.

J Bacteriol, 1998 Jul, 180(14), 3606 - 13
Copper-binding compounds from Methylosinus trichosporium OB3b; DiSpirito AA et al.; Two copper-binding compounds/cofactors (CBCs) were isolated from the spent media of both the wild type and a constitutive soluble methane monooxygenase (sMMOC) mutant, PP319 (P . A . Phelps et al., Appl . Environ . Microbiol . 58:3701-3708, 1992), of Methylosinus trichosporium OB3b . Both CBCs are small polypeptides with molecular masses of 1,218 and 779 Da for CBC-L1 and CBC-L2, respectively . The amino acid sequence of CBC-L1 is S?MYPGS?M, and that of CBC-L2 is SPMP?S . Copper-free CBCs showed absorption maxima at 204, 275, 333, and 356 with shoulders at 222 and 400 nm . Copper-containing CBCs showed a broad absorption maximum at 245 nm . The low-temperature electron paramagnetic resonance (EPR) spectra of copper-containing CBC-L1 showed the presence of a copper center with an EPR splitting constant between those of type 1 and type 2 copper centers (g = 2.087, g = 2.42 G, A = 128 G) . The EPR spectrum of CBC-L2 was more complex and showed two spectrally distinct copper centers . One signal can be attributed to a type 2 Cu2+ center (g = 2.073, g = 2.324 G, A = 144 G) which could be saturated at higher powers, while the second shows a broad, nearly isotropic signal near g = 2.063 . In wild-type strains, the concentrations of CBCs in the spent media were highest in cells expressing the pMMO and stressed for copper . In contrast to wild-type strains, high concentrations of CBCs were observed in the extracellular fraction of the sMMOC mutants PP319 and PP359 regardless of the copper concentration in the culture medium.

Phytochemistry, 1998 Jun, 48(3), 461 - 6
Biotransformation of shiromodiol diacetate, myli-4(15)-en-9-one and myliol by Aspergillus niger; Hayashi K et al.; Microbiol biotransformation of shiromodiol diacetate from Neolitsea serisea koids, and of myli-4(15)-en-9-one and myliol from the liverwort Mylia taylorii, were carried out with Aspergillus niger IFO 4407 . A . niger hydroxylated the allyl position (C-2) of shiromodiol diacetate, and one of the geminal dimethyl groups of myli-4(15)-en-9-one and myliol regioselectively . The structures of these transformants were elucidated by spectral analysis and confirmed by X-ray analysis.

Microbiol Immunol, 1998, 42(5), 371 - 6
Detection of verotoxin-producing Escherichia coli O157:H7 by multiplex polymerase chain reaction; Nagano I et al.; We constructed primers for multiplex polymerase chain reaction (PCR) to detect verotoxin-producing Escherichia coli (VTEC) O157:H7 . The multiplex PCR primers were designed from the sequence of the flagellin structural gene of Escherichia coli flagellar type H7 (GenBank under accession number L07388), and from the sequence of the rfbE gene of Escherichia coli O157:H7 (GenBank under accession number S83460) . In addition to these primers, we used a primer pair reported by Karch and Meyer (J . Clin . Microbiol . 27: 2751-2757, 1989) to amplify various VT genes from VTEC . All of the examined specimens (18 isolates) of VT-producing E . coli O157:H7 showed a positive result by the multiplex PCR test with the three sets of primers . The sensitivity of detection for VT-producing E . coli O157:H7 was shown to be at least 3,000 cells per PCR tube.

Am J Rhinol, 1998 May-Jun, 12(3), 173 - 8
Intracranial complications of sinusitis: a pediatric series; Giannoni C et al.; Intracranial complications of sinusitis (ICS) (cerebral, epidural, and subdural abscesses, meningitis, and dural sinus thrombophlebitis) remain a challenging and contemporary topic . The progressive pneumatization and continued development of the sinuses after birth and the late appearance of the frontal and sphenoid sinuses imply that some infections would not appear until later childhood . We reviewed the records at a large pediatric hospital between 1986 and 1995 and found 10 children with 13 ICS (cerebral abscess, 5; extra-axial empyema, 5; and meningitis, 3) . Of 43 children with cerebral abscess and 16 with extra-axial abscesses treated in this period, 12% of cerebral and 63% of extra axial abscesses were due to a sinogenic source . Multiple intracranial and extracranial complications of sinusitis in a single patient were common . The average age of children with ICS was 12.2 years old . We present these 10 cases and discuss their presentation, microbiology, and clinical course . Although the majority presented with a classic picture of headache, altered mental status, and fever, a few had symptoms that were more subtle . One child had recurrent meningitis, believed to be due to skull base dehiscence after endoscopic sinus surgery (ESS) . He has required multiple otolaryngologic and neurosurgical procedures in an effort to prevent further episodes of meningitis . Ultimately, nine of 10 patients survived with an average hospital stay of 27.8 days (median of 17 days) . The diagnosis of ICS requires a high index of suspicion, imaging of the brain and paranasal sinuses, and aggressive intervention.

Appl Environ Microbiol, 1998 Jul, 64(7), 2676 - 80
Increased carotenoid production by the food yeast Candida utilis through metabolic engineering of the isoprenoid pathway; Shimada H et al.; The yeast Candida utilis does not possess an endogenous biochemical pathway for the synthesis of carotenoids . The central isoprenoid pathway concerned with the synthesis of prenyl lipids is present in C . utilis and active in the biosynthesis of ergosterol . In our previous study, we showed that the introduction of exogenous carotenoid genes, crtE, crtB, and crtI, responsible for the formation of lycopene from the precursor farnesyl pyrophosphate, results in the C . utilis strain that yields lycopene at 1.1 mg per g (dry weight) of cells (Y . Miura, K . Kondo, T . Saito, H . Shimada, P . D . Fraser, and N . Misawa, Appl . Environ . Microbiol . 64:1226-1229, 1998) . Through metabolic engineering of the isoprenoid pathway, a sevenfold increase in the yield of lycopene has been achieved . The influential steps in the pathway that were manipulated were 3-hydroxy methylglutaryl coenzyme A (HMG-CoA) reductase, encoded by the HMG gene, and squalene synthase, encoded by the ERG9 gene . Strains overexpressing the C . utilis HMG-CoA reductase yielded lycopene at 2.1 mg/g (dry weight) of cells . Expression of the HMG-CoA catalytic domain alone gave 4.3 mg/g (dry weight) of cells; disruption of the ERG9 gene had no significant effect, but a combination of ERG9 gene disruption and the overexpression of the HMG catalytic domain yielded lycopene at 7.8 mg/g (dry weight) of cells . The findings of this study illustrate how modifications in related biochemical pathways can be utilized to enhance the production of commercially desirable compounds such as carotenoids.

Enferm Infecc Microbiol Clin, 1998 Apr, 16(4), 179 - 84
{Methods for evaluating diagnostic tests in Enfermedades Infecciosas y Microbiología Clínica}; Ramos JM et al.; BACKGROUND: In the field of infectious diseases and clinical microbiology, the evaluation of diagnostic tests (DT) is an important research area . The specific difficulties of this type of research has motivated that have not caught the severity methodological of others areas of clinical research . This article try to asses and characterize the methodology of articles about DT published in Enfermedades Infecciosas y Microbiologia Clinica (EIMC) journal . METHODS: Forty-five articles was selected in the EIMC journal during the 1990-1996 period, because of determinate the sensitivity and specificity of different DT . Methodological standards, extensively accepted was used . RESULTS: In all of articles, except one (98%) the gold standard was specified yours use, however in 4 studies (9%) include the DT in the gold standard (incorporation bias) . The correct description of DT was reported in 75% of cases, but only in 11% cases the reproducibility of test was evaluated . The description of source of reference population, standard of inclusion and spectrum of composition was described in 58, 33 and 40% of articles, respectively . In 33% of studies presented workup bias, only 6% commented blind-analysis of results, and 11% presented indeterminate test results . Half of the studies reported test indexes for clinical subgroups, only one article (2%) provided numerical precision for test indexes, and only 7% reported receiver operating characteristics curves . CONCLUSIONS: The methodological quality of DT research in the EIMC journal may improve in different aspects of design and presentation of results.

Avian Dis, 1998 Apr-Jun, 42(2), 239 - 47
Inhibition of Eimeria tenella development in vitro mediated by chicken macrophages and fibroblasts treated with chicken cell supernatants with IFN-gamma activity; Dimier IH et al.; Pretreatment of chicken macrophages or fibroblasts with supernatants from concanavalin A-stimulated spleen cells or from the virus-transformed cell line reticuloendotheliovirus as source of interferon gamma (IFN-gamma) slows down subsequent sporozoite replication in the cells . To identify the presence of IFN-gamma, we combined four typical activities of IFN-gamma: inhibition of cytopathic effect of vesicular stomatitis virus on IFN-gamma-treated fibroblasts, cytostatic activity of IFN-gamma-activated macrophages, induction of major histocompatibility complex II antigen expression on IFN-gamma-activated fibroblasts and macrophages, and induction of nitrite production in macrophages . We have shown that chicken fibroblasts and macrophages possess a microbiostatic capacity once they are able to prevent the otherwise unchecked intracellular replication of Eimeria tenella following activation with culture supernatants identified as containing a strong IFN-gamma activity.

Anal Quant Cytol Histol, 1998 Jun, 20(3), 221 - 4
DNA quantification as a prognostic factor in gastric adenocarcinoma; Azua J et al.; OBJECTIVE: To determine if DNA quantification, studied in cytologic samples obtained by fiberendoscopy, has predictive value in gastric adenocarcinoma . The survival times of patients in whom the tumor was the cause of death were considered variables of interest . STUDY DESIGN: Twenty-nine patients with gastric cancer, diagnosed by cytology, endoscopy and microbiopsy, were selected . The study was done over more than 10 years . Smears were stained with progressive hematoxylin and processed by computer for DNA evaluation by image cytometry . RESULTS: Four different types of histograms that directly relate to tumoral malignancy were obtained . These histograms were characterized by the value of entropy . We established four grades of aggressiveness . Then we obtained two large groups: high and low grade of malignancy . We studied the survival times in both groups and constructed a Kaplan-Meier survival curve for the high grade of malignancy group . We confirmed the results statistically and found that there was a significant relationship, with P < .05 . CONCLUSION: The use of DNA quantification by image cytometry is strongly advised in daily surgery as a prognostic indicator of survival time in gastric adenocarcinoma patients.

Semin Respir Infect, 1998 Jun, 13(2), 132 - 9
Legionella: a major opportunistic pathogen in transplant recipients; Chow JW et al.; Legionella have a predilection for infecting immunocompromised patients, and transplant recipients have the highest risk . Legionella spp have been the most common cause of nosocomial pneumonia among transplant recipients at selected medical centers . Diagnosis is dependent on the ability of the clinical microbiology laboratory to isolate the organism by culture; therefore, the disease is easily overlooked . The mode of transmission of Legionella pneumophila is likely aspiration in transplant recipients . Clinical manifestations are similar to that of other bacterial pneumonias, although diarrhea is often prominent . The quinolone antibiotics (especially ciprofloxacin) are the antibiotics of choice because, unlike the macrolides or rifampin, they do not interact with the immunosuppressive agents used to counter rejection . Prevention of nosocomial legionellosis involves disinfection of the hospital's potable water system . Effective disinfection methods include superheat and flush or copper-silver ionization; hyperchlorination is no longer recommended . Routine culture surveillance directed at the hospital water supply for Legionella is mandatory in hospitals caring for transplant patients.

J Chromatogr A, 1998 May 8, 806(1), 97 - 112
Analysis of clinically relevant, diagnostic DNA by capillary zone and double-gradient gel slab electrophoresis; Righetti PG et al.; A number of applications of capillary zone electrophoresis (CZE) in sieving liquid polymers (notably linear polyacrylamides and cellulose) for the analysis of polymerase chain reaction products of clinically relevant, diagnostic DNA, are reviewed here . The fields covered are human genetics, quantitative gene dosage, microbiology and virology, forensic medicine and therapeutic DNA (notably antisense nucleotides) . Some unique, novel developments are highlighted, such as (a) non-isocratic CZE, i.e., temperature-programmed CZE for detection of DNA point mutations and (b) the synthesis of novel N-substituted acrylamides, offering extreme resistance to alkaline hydrolysis, coupled with high hydrophilicity . In the field of denaturing gradient gel electrophoresis (DGGE), as routinely performed in gel slabs, a novel methodology is described, i.e., double-gradient DGGE . In this technique, two gradients are simultaneously applied along the migration direction; a chemical denaturing gradient, for partially unwinding homo- and hetero-duplexes of DNA and a porosity gradient, for re-compacting diffuse bands melting over a broader range of denaturing conditions . Both the CZE and the slab gel methodologies, with the latest developments described in this review, appear to be promising tools for screening diagnostic DNA.

Hepatogastroenterology, 1998 Mar-Apr, 45(20), 496 - 9
Treatment of benign hepatic cysts by instillation of tetracycline hydrochloride; Lopes HM et al.; BACKGROUND/AIMS: Despite the high frequency of benign hepatic cysts, they rarely cause symptoms . Large cysts, however, may produce clinical manifestations . In these cases, ultrasonography-guided therapy has been proposed . We report the results of this therapy in patients with symptomatic benign hepatic cysts . METHODOLOGY: Seven patients with non-parasitic, non-neoplastic benign hepatic cysts were submitted to fine-needle ultrasonography-guided aspiration, followed by injection of diluted tetracycline hydrochloride (1 g) . In all cases, cytology, tumour markers and microbiology analysis of aspirates were performed . One patient required two sessions . The grade of patient satisfaction and ultrasonography changes were assessed 1, 3 and 6 months after the procedure . RESULTS: Cyst size decreased in all patient, with total collapse in three . No major complications occurred . Cytology, alpha fetoprotein, CA19.9, CEA and microbiology of the cyst fluid confirmed the initial ultrasonographic diagnosis of simple biliary cysts . Clinical complaints improved in 2 cases, and 5 patients became asymptomatic . Ultrasonography evaluation 3 months after the procedure was more reliable in predicting successful treatment . CONCLUSION: Intracystic instillation of tetracycline hydrochloride is an effective and safe technique and may become the first choice therapy for benign hepatic cysts.

Diagn Microbiol Infect Dis, 1998 Jun, 31(2), 405 - 10
Selecting therapy for serious infections in children: maximizing safety and efficacy; Bradley JS; Serious infections in children represent unique challenges for the treating physician . For the pediatric patient, considerations of drug toxicity are especially critical to avoid potential long-term complications of therapy . There are several advantages associated with using single, broad-spectrum, empiric antibiotic therapy, including reduced potential for drug-mediated toxicity or drug interactions and facilitation of home therapy . Of the antibiotics available for monotherapy, the carbapenems have the broadest spectrum of activity . However, a major obstacle toward the use of the carbapenems in pediatrics has been the risk of seizures occurring during therapy with imipenem/cilastatin . In clinical studies of meningitis and other infections in children, no drug-related seizures were reported when treated with the carbapenem meropenem . Meropenem monotherapy has been shown to be similar to ceftriaxone- and cefotaxime-based single or multiple antibiotic regimens, in terms of clinical and microbiologic efficacy and tolerability . Thus, meropenem represents a favorable treatment choice for the seriously ill child, either as empiric monotherapy or as definitive therapy of polymicrobial or nosocomial infections.

J Biol Chem, 1998 May 15, 273(20), 12466 - 75
Function of Escherichia coli MsbA, an essential ABC family transporter, in lipid A and phospholipid biosynthesis; Zhou Z et al.; The Escherichia coli msbA gene, first identified as a multicopy suppressor of htrB mutations, has been proposed to transport nascent core-lipid A molecules across the inner membrane (Polissi, A., and Georgopoulos, C . (1996) Mol . Microbiol . 20, 1221-1233) . msbA is an essential E . coli gene with high sequence similarity to mammalian Mdr proteins and certain types of bacterial ABC transporters . htrB is required for growth above 32 degreesC and encodes the lauroyltransferase that acts after Kdo addition during lipid A biosynthesis (Clementz, T., Bednarski, J., and Raetz, C . R . H . (1996) J . Biol . Chem . 271, 12095-12102) . By using a quantitative new 32Pi labeling technique, we demonstrate that hexa-acylated species of lipid A predominate in the outer membranes of wild type E . coli labeled for several generations at 42 degreesC . In contrast, in htrB mutants shifted to 42 degreesC for 3 h, tetra-acylated lipid A species and glycerophospholipids accumulate in the inner membrane . Extra copies of the cloned msbA gene restore the ability of htrB mutants to grow at 42 degreesC, but they do not increase the extent of lipid A acylation . However, a significant fraction of the tetra-acylated lipid A species that accumulate in htrB mutants are transported to the outer membrane in the presence of extra copies of msbA . E . coli strains in which msbA synthesis is selectively shut off at 42 degreesC accumulate hexa-acylated lipid A and glycerophospholipids in their inner membranes . Our results support the view that MsbA plays a role in lipid A and possibly glycerophospholipid transport . The tetra-acylated lipid A precursors that accumulate in htrB mutants may not be transported as efficiently by MsbA as are penta- or hexa-acylated lipid A species.

Helicobacter, 1998 Jun, 3(2), 120 - 4
Miconazole gel increases the cure rate of Helicobacter pylori infection when added to lansoprazole and amoxicillin in a randomized trial; Ikezawa K et al.; BACKGROUND: Miconazole is an antimycotic agent with bacteriocidal activity against Helicobacter pylori in vitro . Its role in the clinical eradication of H . pylori has not been studied . The objective of this study was to investigate the efficacy and side effect profile of miconazole for the treatment of H . pylori . MATERIALS AND METHODS: We studied 65 patients with gastritis or peptic ulcer disease in whom H . pylori infection was confirmed by a rapid urease test and microbiologic assessment . In vitro miconazole sensitivity was assessed for the H . pylori strains isolated from the enrolled patients . All patients were randomized to receive either dual therapy consisting of lansoprazole 30 mg daily and amoxicillin 500 mg three times a day for 14 days (LA, n = 33) or triple therapy using the LA regimen plus miconazole gel 100 mg three times a day for 14 days (LAM, n = 32) . At least 8 weeks after the treatment, successful therapy was validated by the histological and microbiologic assessment . Adverse effects and drug adherence were monitored by direct questioning . RESULTS: The minimum inhibitory concentrations of miconazole ranged from 3.13 to 6.25 mg/L . H . pylori was eradicated in 16 of 33 patients (48%, 95% CI = 31% to 67%) after LA therapy, and 24 of 32 patients (75%, 95% CI = 59% to 91%) after LAM therapy (p < .03) . There was no significant difference in the occurrence of adverse events between the two groups . CONCLUSIONS: The addition of miconazole gel to the LA regimen significantly improved the cure rate of H . pylori without an increase in adverse effects.

Andrologia, 1998, 30 Suppl 1, 7 - 13
Microbiology of male urethroadnexitis: diagnostic procedures and criteria for aetiologic classification; Schiefer HG; Common pathogens and unconventional, fastidious bacteria, viruses, parasites, and fungi are causative agents in male urethroadnexitis . Uropathogens and sexually transmitted organisms must be considered . Diagnostic procedures and criteria for aetiologic classification in cases of balanitis, urethritis, prostatitis, epididymitis, and orchitis are described and evaluated.

Diagn Cytopathol, 1998 Jun, 18(6), 441 - 4
Fine-needle aspiration cytology of a subareolar abscess of the male breast; Silverman JF et al.; We report on the fine-needle aspiration (FNA) cytology of a subareolar abscess of the breast in a 45-yr-old man . The patient presented with a 1.5-cm mass in the subareolar region . FNA cytology demonstrated the presence of numerous anucleated squamous cells and a few small nucleated squamous cells as well as numerous neutrophils and some lymphocytes in the background . Histiocytes were also present, including some multinucleated foreign-body-type giant cells . No organisms were identified either with special stains or microbiologic cultures . The differential diagnosis of FNA of the male breast is presented, along with other lesions that can potentially contain either benign or malignant squamous cells in the aspirate . The correct FNA diagnosis of this unusual benign lesion involving the male breast should lead to the appropriate treatment . To the best of our knowledge, this is the first published report of FNA cytology of a subareolar abscess of the male breast.

Ecotoxicol Environ Saf, 1998 May-Jun, 40(1-2), 115 - 9
Microbiotesting: an expanding field in aquatic toxicology; Blaise C; In terms of bioanalytical development and application, environmental evolution in this century can be perceived as having gone from the "dark ages" (time period preceding the 1960s and essentially characterized by nonuse of bioassays), to the "beginning of enlightenment" (use of fish bioassays during the 1960s as screening tools for effluents and specific chemicals), to the "regulatory 1970s," when newly created environment departments in developed countries began to sanction bioassays for regulatory purposes, to the "ecotoxicological 1980s," when suites of (micro) bioassays were incorporated in various hazard assessment schemes, right up to the present "microbiotesting 1990s," when an unprecedented upsurge in development and demand for cost-effective multilevel small-scale assays is manifest . This paper offers the view that microscale aquatic toxicology is a rapidly expanding field of ecotoxicology involving numerous bioanalytical techniques developed and applied at various levels of biological organization . This is demonstrated by recalling some of the major highlights that triggered the way for increased use of microbiotesting over the past decades . It is expected that the field of microbiotesting will sustain continuing growth in the future and contribute significant diagnostic power to environmental programs requiring ecotoxicology.

Biotechnol Prog, 1998 May-Jun, 14(3), 420 - 4
Increased phenylalanine production by growing and nongrowing Escherichia coli strain CWML2; Weikert C et al.; Chemostat selection at low dilution rate in glycerol-limited minimal medium was previously employed to isolate the mutant Escherichia coli strain CWML2 which exhibits shorter lag phases, decreased acetate production, and higher specific growth rates and biomass yields in batch culture (Weikert, C.; Sauer, U.; Bailey, J . E . Microbiology 1997, 143, 1567-1574) . In this study, CWML2 was analyzed for its biochemical production capabilities in batch culture and under nongrowing conditions . Both CWML2 and MG1655 were transformed with plasmid pSY130-14, which encodes feedback resistant mutants of the enzymes chorismate mutase P-prephenate synthase and 3-hydroxy-d-arabinoheptulosonate-7-phosphate dehydratase, to enable phenylalanine production . In batch culture, transformed CWML2 produced twice as much phenylalanine as did MG1655:pSY130-14 . In contrast to the reference strain, substantial growth-independent production of phenylalanine was calculated for CWML2:pSY130-14 by using Luedeking-Piret kinetic analysis . Over a period of 30 h, nongrowing cells of CWML2:pSY130-14 exhibited a 2.5-fold higher specific phenylalanine production rate . The apparent capability of E . coli CWML2 to partly uncouple metabolic activity from growth suggests a potentially general advantage of this class of modified hosts for production of biochemicals.

J Virol, 1998 Jul, 72(7), 5579 - 88
Members of the GATA family of transcription factors bind to the U3 region of Cas-Br-E and graffi retroviruses and transactivate their expression; Barat C et al.; Cas-Br-E and Graffi are two murine viruses that induce myeloid leukemia in mice: while Cas-Br-E induces mostly non-T, non-B leukemia composed of very immature cells, Graffi causes exclusively a granulocytic leukemia (E . Rassart, J . Houde, C . Denicourt, M . Ru, C . Barat, E . Edouard, L . Poliquin, and D . Bergeron, Curr . Top . Microbiol . Immunol . 211:201-210, 1995) . In an attempt to understand the basis of the myeloid specificity of these two retroviruses, we used DNase I footprinting analysis and gel mobility shift assays to identify a number of protein binding sites within the Cas-Br-E and Graffi U3 regions . Two protected regions include potential GATA binding sites . Methylation interference analysis with different hematopoietic nuclear extracts showed the importance of the G residues in these GATA sites, and supershift assays clearly identified the binding factors as GATA-1, GATA-2, and GATA-3 . Transient assays with long terminal repeat (LTR)-chloramphenicol acetyltransferase constructs showed that these three GATA family members are indeed able to transactivate Cas-Br-E and Graffi LTRs . Thus, the availability and relative abundance of the various members of the GATA family of transcription factors in a given cell type could influence the transcriptional tissue specificity of murine leukemia viruses and hence their disease specificity.

Ned Tijdschr Geneeskd, 1998 Apr 25, 142(17), 949 - 51
{Optimizing antibiotics use policy in the Netherlands . I . The Netherlands Antibiotics Policy Foundation (SWAB)}; van Kasteren ME et al.; The worldwide problem of antibiotic resistance of bacteria is a point of concern in the Netherlands as well . Responsible use of existing antibiotics was the incentive to establish a foundation, with the acronym SWAB, the primary goal of which is to optimize the use of antibiotics in the Netherlands in order to diminish the development of antibiotic resistance . One of the SWAB projects is the development of national guidelines for the use of antibiotics in hospitals . These guidelines are prepared by a committee of experts and reviewed by external consultants: infectious disease specialists, medical microbiologists and pharmacists . The revised version of the guidelines is submitted for publication in this journal . The SWAB hopes that these guidelines will make the prevention of antibiotic resistance a major factor in the choice of the antibiotic . Streamlining antibiotic therapy is an important tool in this respect.

What Is Activated Sludge?, What Is Biotechnology?, What Is Botulism?, What Is Growth Medium?, What Is Bioengineering?, i, Bacteriology, c, Microorganisms, r, Microorganism, r, Microbes, c, Microbiology, a, Cryptococci, o, Erythromycin, i, Amikacin, r, Yeasts, o, Antibiotics, s, Escherichia coli, c, Erythromycin, r, Bactericidal, s, Candida tropicalis, n, Microorganism, s, Enterobacteriacea, s, Bacteriophages, s, Antibiotics, r, Gram positive, c, Streptococci, c, Pseudomonas, e, Bacteria, s, Staphylococcus aureus, i, Staphylococcus, c, Salmonella, r, Streptococci

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