Bacteriological

Arch Neurol, 1995 Nov, 52(11), 1081 - 6
Plasma and red blood cell thiamine deficiency in patients with dementia of the Alzheimer's type; Gold M et al.; OBJECTIVES: To determine the prevalence of plasma thiamine deficiency in patients referred to a memory disorder clinic and to compare plasma thiamine levels with red blood cell (RBC) thiamine levels . To determine if patients with senile dementia of the Alzheimer's type (SDAT) differ from those without SDAT in either plasma or RBC thiamine levels . DESIGN: Case-control study . SETTING: Ambulatory care referral center . PATIENTS: Consecutive sample of 34 patients; 17 patients who met the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria for probable Alzheimer's disease and 17 patients with other forms of dementia . METHODS: Plasma and RBC thiamine levels were determined in all patients with the use of a microbiologic assay known for its specificity to biological forms of thiamine . Vitamin supplementation was determined by chart review . OUTCOME MEASURES: Plasma and RBC thiamine levels . RESULTS: Patients with SDAT were found to have significantly lower plasma thiamine levels than patients without SDAT . Low plasma thiamine levels were detected in a significantly larger proportion of patients with SDAT than in patients without SDAT . Red blood cell thiamine levels did not correlate with the clinical diagnosis of SDAT . Vitamin supplementation did not correlate with diagnosis and plasma or RBC thiamine levels . CONCLUSIONS: A significant proportion of patients with SDAT may have a thiamine deficiency, which may have an impact on cognitive function . Currently used assays may not be adequate to assess thiamine status.

Acta Cytol, 1995 Nov-Dec, 39(6), 1089 - 93
Diagnosis of Pneumocystis carinii pneumonia by bronchoalveolar lavage in AIDS patients . Comparison of Diff-Quik, fungifluor stain, direct immunofluorescence test and polymerase chain reaction; Armbruster C et al.; OBJECTIVE: To assess the sensitivity, specificity and accuracy of Diff-Quik, fungifluor stain, the direct immunofluorescence test (DIFT) and the polymerase chain reaction (PCR) in the diagnosis of Pneumocystis carinii pneumonia (PCP) in human immunodeficiency virus (HIV)-infected patients . STUDY DESIGN: From December 1992 through November 1993, 112 bronchoalveolar lavage fluid (BALF) samples were obtained from 80 HIV-infected patients . BALF samples were processed for cytologic and microbiologic analysis and for PCR . Cytologic examination was carried out on Diff-Quik-stained cytocentrifuge preparations and with May-Grunwald-Giemsa staining and fungifluor staining . For diagnosis of PC infection, DIFT and PCR were used . RESULTS: Thirty-two of 112 acute episodes were caused by P carinii . Diff-Quik had the highest sensitivity (84.8%) as compared to fungifluor stain (60.0%), DIFT (59.4%) and PCR (65.6%) . The specificity was 98.7% with Diff-Quik, 100% with fungifluor stain, and 98.6% and 97.3% with DIFT and PCR, respectively . Accuracy was high with every method (94.4% with Diff-Quik, 88.3% with fungifluor stain, 86.7% with DIFT and 87.6% with PCR) . CONCLUSION: Diff-Quik is a good diagnostic tool in the diagnosis of PCP . The combination of Diff-Quik and fungifluor stain is recommended because of its cost-effectiveness and because of its rapid diagnosis of severe PCP . PCR and DIFT should be used only on patients judged clinically to have PCP with discrepant results in Diff-Quik and fungifluor stain in BALF samples.

Tidsskr Nor Laegeforen, 1995 Oct 20, 115(25), 3141 - 4
{Indications for testing for sexually transmitted Chlamydia trachomatis infections}; Aavitsland P et al.; Laboratory testing for sexually transmitted Chlamydia trachomatis infection is widely used in Norwegian general practice . The yield of this testing is declining, since the prevalence of infection in the community has decreased . Thus, the cost-effectiveness of testing is reduced, and the risk of false positive results using non-culture methods has increased . In cooperation with a panel of medical microbiologists, gynaecologists, venerologists, general practitioners and public health specialists, we have reviewed the literature and drawn up a set of recommendations for the use of laboratory testing for genital C . trachomatis infection . We emphasize clinical testing of men and women, notification of partners in order to reach males, and screening of women under the age of 25 after each change of sexual partner.

MLO Med Lab Obs, 1995 Nov, 27(11), 48 - 53
Molecular infectious disease testing: the hype, the hope, and the hoopla; Wiedbrauk DL; To remain competitive in the next century, microbiologists and virologists must acquire molecular diagnostic skills or they will relinquish molecular infectious disease testing to labs with little experience in handling infectious agents.

Cytopathology, 1995 Oct, 6(5), 331 - 8
The cytologic diagnosis of Mycobacterium kansasi tuberculosis by fluorescence microscopy of Papanicolaou-stained specimens; Kupper T et al.; The sensitivities of (i) Papanicolaou fluorescence, (ii) auramine rhodamine fluorescence, and (iii) Ziehl-Neelsen staining were compared for their ability to detect the atypical mycobacterium Myco . kansasi in cytological samples . Ninety-two cases were investigated, and the sensitivities of the three methods of detection were found to be 36.9%, 12.0%, and 20.7% respectively . The control groups consisted of 30 specimens from cases of bronchial carcinoma and 30 of pneumonia . All cases were proved by microbiology . No false-positive results were recorded using Papanicolaou fluorescence . An important but coincidental finding arising from this study was that infection by the atypical mycobacterium Myco . kansasi causes cytological patterns corresponding to those normally associated with acute pneumonia and not to tuberculosis.

FEMS Immunol Med Microbiol, 1995 Oct, 12(2), 121 - 6
Peritoneal macrophages from C57BL/6 mice orally immunized with Toxoplasma gondii antigens in association with cholera toxin possess an enhanced ability to inhibit parasite multiplication; Bourguin I et al.; Gamma-interferon (IFN-gamma) has been reported to be a major mediator of resistance to toxoplasma infection, mainly through macrophage activation . Cholera toxin used as oral adjuvant induces enhanced protection . Following oral immunization of C57BL/6 mice with a Toxoplasma gondii sonicate (TSo), in association with either cholera toxin (CT) or its B subunit (CTB), the ability of primed sensitized peritoneal macrophages (PM phi) to prevent T . gondii intracellular proliferation in vitro was examined both with and without rIFN-gamma activation . Under these conditions, the inhibition of T . gondii multiplication was greatly enhanced in PM phi from mice immunized with a TSo and CT as an oral adjuvant . In contrast, PM phi from mice immunized with a TSo in association with CTB showed a decrease in their microbiostatic activity towards T . gondii . This negative effect on IFN-gamma-treated PM phi was cancelled out by the addition of a small amount of CT in association with TSo and CTB in the immunization regimen . These data suggest that CT could act as an oral adjuvant in vaccination against toxoplasmosis by increasing the microbiostatic activity of M phi activated with IFN-gamma . Further studies, using intestinal effector cells such as enterocytes, are needed to confirm the value of CT for enhancing this major mechanism of protection against T . gondii infection.

Clin Biochem, 1995 Oct, 28(5), 481 - 97
Postdoctoral training in clinical chemistry: laboratory training aspects; Allen LC et al.; OBJECTIVE: To provide a general outline for a 2-year postdoctoral training program in clinical chemistry, and a detailed outline of the first year laboratory training program . METHODS & RESULTS: Essential elements of the 2-year Postdoctoral Training Program in Clinical Chemistry at the University of Toronto are its didactic courses and a comprehensive, structured laboratory rotation in the first year . Residents rotate in hospital laboratories in both years of the Program . The hospital laboratory rotation in first year includes a 36-week laboratory rotation based on the Laboratory Training Program Manual . In the second year, they consolidate the basic knowledge acquired in first year and gain experience in pediatric testing and other specialty areas . In both years, residents attend teaching and ward rounds on a regular basis, investigate unusual test requests and patient results, and make regular presentations at case presentation and journal club sessions . They undertake research and development projects which lead to presentations at scientific meetings and to publication . Residents attend departmental management meetings, arrange discussions on management topics, and attend a short course on key management topics . Approaches for strengthening the knowledge and skills of residents in the areas of hematology, microbiology and pathology are being developed . CONCLUSION: The program outline described should provide a useful framework for other such programs both nationally and internationally.

Infect Control Hosp Epidemiol, 1995 Oct, 16(10), 600 - 6
Hospital epidemiology in smaller hospitals; Boyce JM; In hospitals with 200 to 300 beds, hospital epidemiologists serve primarily as medical and epidemiology consultants to the infection control practitioners, as advocates for the infection control programs, and as chairpersons of the infection control committees . Because smaller hospitals often have limited resources for infection control, surveillance and control activities must focus on issues that have caused problems for the facility and on compliance with mandates and recommendations made by healthcare agencies . The clinical microbiology laboratory plays an important role in ongoing surveillance activities and often is responsible for performing cultures obtained during point prevalence culture surveys or outbreak investigations . Because laboratory support often is limited, the indications for obtaining a culture from patients, personnel, or the inanimate environment for infection control purposes must be reviewed and discussed carefully with the clinical laboratory in advance.

J Protein Chem, 1995 Oct, 14(7), 521 - 6
An improved method for large-scale purification of recombinant human glucagon; Okamoto H et al.; Glucagon was expressed in Escherichia coli as a fusion protein including the glucagon sequence {Ishizaki et al . (1992), Appl . Microbiol . Biotechnol . 36, 483-486} . The high-level expression of a protein in E . coli often results in an insoluble aggregate called an inclusion body containing a fusion protein . In our previous report {Yoshikawa et al . (1992), J . Protein Chem . 11, 517-525}, we solubilized this inclusion body by using guanidinium chloride . However, the existence of denaturant caused problems such as a low proteolytic activity for transforming the fusion protein into glucagon and complicated purification methods . We tried to improve the method to enable large-scale purification . At alkaline pH, the inclusion body could be solubilized to a high concentration and cleaved by amino acid-specific endopeptidases . By utilizing isoelectric precipitations as a new economical purification method for glucagon from intermediates, the glucagon obtained was shown to be over 99.5% pure by analytical RP-HPLC . The yield was almost equal that of our previous method, and the glucagon produced was chemically and biochemically equivalent to natural glucagon.

Curr Opin Pediatr, 1995 Oct, 7(5), 547 - 52
Inflammatory bowel disease in children; von Allmen D et al.; Inflammatory bowel disease remains a serious chronic illness in children . Recent developments in the care of these patients involves both basic science research into the pathophysiology of ulcerative colitis and Crohn's disease and the development of refinements in the surgical techniques and medical therapies available as treatment options . In Crohn's disease, a new steroid analogue (budesonide) shows some promise as a possible medical treatment that would limit the devastating side effects of steroids in children . In addition, the bowel-sparing technique of strictureplasty has now been reported in children with good results . In ulcerative colitis, the surgical technique of endorectal pull-through continues to evolve with reports of the efficacy of specific pouch designs and surgical techniques . An understanding of pouchitis, the most common complication of endorectal pull-through, has focused on documenting specific alterations in the microbiology and physiology of the pouch, as well as investigating a possible link between autoantibodies and susceptibility to this complication.

J Clin Pathol, 1995 Oct, 48(10), 915 - 8
Perceptions of a medical microbiology service: a survey of laboratory users; Morgan MS; AIM--To ascertain the perception of laboratory users regarding the quality of the medical microbiology services in a district general hospital . METHODS--Detailed questionnaires were circulated to all clinicians in the locality, with headings covering the quality of medical advice provided, the availability of information on specimen collection, format of request forms, specimen transport arrangements, turnaround times, the quality and need for interpretative advice, and the overall impression of the quality of the services provided . RESULTS--Two hundred and thirty five replies were received, giving a response rate of 69% . Transportation of specimens and communication of reports were identified as priority areas for improvement . The overall quality of the service was perceived as satisfactory, although areas were identified where substantial improvements could be made, some at little or no cost to the laboratory . CONCLUSIONS--The survey focused clinicians' attention on the service, raised the profile of the laboratory, and resulted in improved communications and a better understanding of customer needs . Overall, the exercise was felt to be extremely useful, and worthwhile repeating to gauge the effect of the changes instituted as a result.

Tuber Lung Dis, 1995 Oct, 76(5), 387 - 93
The epidemiology of tuberculosis in Gran Canaria, Canary Islands, 1988-92: effectiveness of control measures; Caminero JA et al.; SETTING: Since there is no national programme for tuberculosis control in Spain and the epidemiological situation in this country is unknown, a programme against tuberculosis in Gran Canaria (Canary Islands) was started in 1987 . OBJECTIVE: To analyze the impact of this control programme, particularly the trend of new cases of tuberculosis by age groups and risk factors for 1988-92 . DESIGN: A detailed search of all new cases of tuberculosis was carried out by examining the files of all public and private hospitals and outpatient clinics of the island, the records of the Services of Clinical Microbiology and Pathology of the public hospitals, and the registers of patients with AIDS . RESULTS: The annual rates of new cases of tuberculosis per 100,000 were 32.2 in 1988 (214 cases), 26.2 in 1990 (174 cases), and 29.4 in 1992 (196 cases), and the rates of sputum-positive cases 13.3 (89 cases), 12 (80 cases) and 15 (100 cases), respectively . The distribution of tuberculosis cases by age peaked in the age groups 40-49 and 30-39 years . Between 1988 and 1992, statistically significant differences were found in the percentage of cured patients (21% {45/214} vs 85.7% {168/196}), patients with a delay in diagnosis > 3 months (40.2% {86/214} vs 21.9% {43/196}), and contacts evaluated (45.3% {97/214} vs 90.3% {177/196}) . However, an upward trend in the incidence of tuberculosis for 1990-92 was found in association with an increase of new cases among the homeless, immigrants, and HIV-infected people . When these three population groups were excluded from the analysis, the annual rate for the total population showed a progressive decline from 1988-92 . CONCLUSIONS: The data studied here show that successful priority control measures (cure rate, early diagnosis, study of contacts) have been achieved in this island . It is necessary, however, to develop strategies for combating the tuberculosis problem in specific high risk populations.

Genitourin Med, 1995 Oct, 71(5), 295 - 8
Prevalence of Chlamydia trachomatis in women attending a family planning clinic in Papua New Guinea; Theunissen JJ et al.; OBJECTIVE--To determine the prevalence of Chlamydia trachomatis infection in women attending a family planning clinic in Papua New Guinea, in the period between April and June 1991 . SETTING--The outpatient department of Obstetrics and Gynaecology of Port Moresby General Hospital, Port Moresby, Papua New Guinea, the departments of Dermato-Venereology and Clinical Microbiology of the Erasmus University, Rotterdam, The Netherlands and the National Institute of Public Health and Environmental Protection, Bilthoven, The Netherlands . PATIENTS--A total of 254 consecutive women who attended the family planning clinic at Port Moresby General Hospital, Papua New Guinea were enrolled into this study . METHODS--Cervical infections with C trachomatis were diagnosed using the direct immunofluorescent assay (DFA) and the polymerase chain reaction (PCR) . Serum IgM and IgG antibodies directed against C trachomatis were detected using the enzyme-linked fluorescent assay (ELFA) . RESULTS--The prevalence of C trachomatis was 14.6% using the PCR, 9.1% using the DFA and 17.3% when the results of the PCR and the DFA were combined . An elevated IgM titre was observed in 14.2% of the women, whereas 44.1% had an elevated IgG titre . The titres of IgM or IgG were significantly higher in women who were positive using the PCR or the DFA than in those who were negative in both the PCR and the DFA (p = 0.032 and p = 0.0046, respectively) . CONCLUSION--Cervical infection by C trachomatis can be considered a major health problem in at least the studied population in Papua New Guinea . The prevalence of C trachomatis infection is at least comparable with that in groups with a high prevalence in industrialized countries . Effective screening and treatment programmes are imperative to combat this problem.

Appl Environ Microbiol, 1995 Oct, 61(10), 3741 - 4
Substrate-dependent differential splicing of introns in the regions encoding the cellulose binding domains of two exocellobiohydrolase I-like genes in Phanerochaete chrysosporium; Birch PR et al.; Recently, we have shown differential splicing of an intron in the cbhI.2 gene of Phanerochaete chrysosporium ME446; this intron lies within the region of the gene encoding the cellulose binding domain (P.F.G . Sims, M . S . Soares-Felipe, Q . Wang, M.E . Gent, C . Tempelaars, and P . Broda, Mol . Microbiol . 12:209-216, 1994) . Here, we show that such differential splicing occurs in the cbhI.1 gene of this fungus as well as in the cbhI.2 gene and that this phenomenon is substrate dependent . Avicel elicits the synthesis of both classes of mRNA transcripts from both of these genes . In contrast, carboxymethyl cellulose predominantly elicits the synthesis of fully spliced transcripts from both genes . Such differential splicing might allow this fungus to regulate the specificities of substrate binding for these cellulases.

Presse Med, 1995 Sep 16, 24(26), 1193 - 7
{Preimplantation diagnosis of delta F508 mutation of mucoviscidosis in transgenic mice}; Ji YZ et al.; OBJECTIVE: The aim of our study was to master preimplantation diagnosis in transgenic mice . METHODS: Stage 4 or 8 cells preembryos were collected from C57BL6xCBAF1 mice, three days after mating with transgenic C57BL6xSJLF1 mice homozygous for the human gene delta F508 mutation of cystic fibrosis . A single blastomere was sampled by microbiopsy and the preembryos transferred in Swiss mice foster mothers . Molecular biology for delta F508 mutation on a single blastomere was performed with a double PCR technique on a Perkin Elmer Cetus 9600 . RESULTS: The success rate of biopsy on the 122 preembryos with 4 cells was 90.2%, and 93.8% on the 128 prembryos with 8 cells . The rate of in vitro hatching was 84.6% after biopsy on 52 preembryos with 4 cells (92.2% for controls without biopsy, p > 0.05), and 90.0% for 50 preembryos with 8 cells (94.4% for controls without biopsy, p > 0.05) . The rate of birth after biopsy and transfer of 42 preembryos with 4 cells was 66.7% (72.5% for controls transferred without biopsy, p > 0.05) and 70.3% for 37 preembryos with 8 cells (71.9% for controls, p > 0.05) . No difference was evidenced for births weight or organ weight at 3 weeks between mice born from biopsied embryos and controls . Thirty-two double PCR were performed for the diagnosis of the cystic fibrosis delta F508 mutation, 20 on a single blastomere obtained by microbiopsy and 12 for various negative controls, with 100% specificity and 100% sensitivity . CONCLUSIONS: Microbiopsy of preembryos with 4 cells or 8 cells does not alter their viability or further development . The double PCR technique on a single blastomere for the cystic fibrosis delta F508 mutation is reliable with our current methods of investigation.

Lik Sprava, 1995 Sep-Dec, (9-12), 49 - 51
{The pathogenetic role of dysbacteriosis of the large intestine in the recurrence of peptic ulcer}; Andrusiak OV et al.; Microbiologic investigations were carried out of excrements as were measurements of blood levels of malonic dialdegyde, reduced glutathione and activity of glutathione-dependent enzymes in 36 patients with peptic ulcer when they experienced exacerbation . Gastric and duodenal ulcer in exacerbation was accompanied by dysbacteriosis of the large intestine, uncontrolled augmentation of the processes of free-radical lipid oxidation against the background of impairment of functional systems of antiradical defence, which fact plays its part in relapsing of gastroduodenal ulcer.

Baillieres Clin Obstet Gynaecol, 1995 Sep, 9(3), 529 - 43
Infectious diseases; Gilbert GL; Routine antenatal screening can detect some potentially serious infectious diseases or susceptibility to infection and allow intervention to prevent adverse outcomes . However, screening programmes can only be justified if appropriate criteria are met for the quality of laboratory tests and interventions . For many infections that are associated with adverse maternal or fetal effects, there are no suitable, cost-effective methods of screening or prevention . However, early diagnosis of infection in high-risk women or those with symptoms can allow preventive intervention . Acute febrile illness or other symptoms consistent with infection during pregnancy should be investigated more diligently than in a non-pregnant woman . Early diagnosis of an apparently trivial maternal infection may prevent serious fetal disease . When the diagnosis of maternal infection is made, appropriate action depends on the nature of infection and the stage of pregnancy at which it occurs . The results of serological test should be confirmed, preferably by a reference laboratory, by retesting the original specimen(s) and/or testing further specimens, as appropriate . Management decisions generally should be made in consultation with an infectious disease physician or clinical microbiologist with experience of infectious diseases in pregnancy.

Diagn Microbiol Infect Dis, 1995 Sep-Oct, 23(1-2), 53 - 60
Evaluation of new technology in the clinical microbiology laboratory; Jenkins SG; Technology capable of significantly influencing the practice of clinical microbiology is evolving at an ever-accelerating rate . During their early developmental years, it is difficult to predict which evolving technologies will prove amenable for use in hospital laboratory settings . With the considerable and increasing cost constraints placed on our medical institutions and the resulting budgetary pressures exerted on clinical laboratories, evaluation of developing technology is essential . The Clinical Laboratory Improvement Act of 1988 mandates correlation studies by clinical laboratories as part of the evaluation of all new assays to compare their sensitivities and specificities with those obtained using established methodologies . With shrinking numbers of technologists available for such evaluations, however, the mechanism with which this will be accomplished promises to pose a significant challenge . Factors that demand consideration in any such evaluation include (but are not restricted to) utility, accuracy, prospective time savings, cost of related instrumentation and reagents, and potential for diverse applications . Specific current examples that exemplify the need for such evaluations include the emergence of gene-based techniques such as the polymerase chain reaction as clinical tools, availability of new blood culture systems based on divergent sensor systems, and varying techniques for the the detection of antibodies and antigens for the serodiagnosis of infectious diseases . We as clinical microbiologists have the opportunity to approach the challenges confronting us regarding evaluation of developing technologies with responsible innovation and insight . Only by embracing these responsibilities can we hope to influence the impact of health care reform in the hospital laboratory setting.

Diagn Microbiol Infect Dis, 1995 Sep-Oct, 23(1-2), 45 - 51
The changing role of the clinical microbiology laboratory director: results of a survey; Thomson RB Jr; Health care reform has provided clinical microbiology laboratory directors with new responsibilities and challenges that should highlight and enhance their importance within the health care system . Results of a survey sent to directors suggest that management tasks have increased since 1990, and activities that move the director into the hospital and patient care environment underscore their value to the health care team . These activities include participation on clinical practice guidelines pathway committees and use of consultative and interpretative reports . Survey results also summarize the directors' qualifications, laboratory size, typical daily schedule, job responsibilities, hours worked, time away from the laboratory for professional purposes, and comments about one's most important functions . In summary, failure to recognize new responsibilities could result in the disappearance of the position of director as we know it . Capitalizing on this challenge will secure the microbiology director's role for decades to come.

Diagn Microbiol Infect Dis, 1995 Sep-Oct, 23(1-2), 35 - 43
Impact of CLIA 88 on the clinical microbiology laboratory; Chapin K et al.; The Clinical Laboratory Improvement Amendments (CLIA 88) to the Clinical Laboratory Improvement Act of 1967 continues to undergo transformation since its implementation more than 2 years ago . The law and its subsequent regulatory modifications were intended to promote high quality in and accurate results from laboratory testing procedures, regardless of the site at which testing occurred . A number of federal regulatory agencies and committees such as the Healthcare Financing Administration, the Clinical Improved Amendments Committee, and the Commission on Laboratory Accreditation, as well as numerous new or modified regulations and requirements have gained importance since CLIA 88 was enacted . In this discussion, components of CLIA 88 that have the greatest impact on clinical microbiology laboratories are presented . In addition, the potential future significance of CLIA 88 are outlined.

Diagn Microbiol Infect Dis, 1995 Sep-Oct, 23(1-2), 23 - 34
Quality management and the clinical microbiology laboratory; Baron EJ; Quality management in today's health care environment requires a fresh approach . Laboratories that have traditionally directed their efforts toward meeting the needs of physicians must now also satisfy the needs of society, the greater public health, and the agency's administrators . Technical advances must today be considered in the context of patient care cost-effectiveness or final outcomes . Examples of strategies for improving quality in the laboratory, such as seeking input from all individuals involved in interpreting or using laboratory test results, forming multidisciplinary committees for development of critical pathways, issuing surveys for assessing the level of satisfaction of the laboratory's customers, and providing visual feedback of the results of activities, are described.

Diagn Microbiol Infect Dis, 1995 Sep-Oct, 23(1-2), 17 - 21
Influence of managed care and health maintenance organizations on the clinical microbiology laboratory; Scott DR; This article outlines the main source of the relentless cost squeeze facing health care and clinical microbiology in the 1990s, the explosive growth in services available, services done, and services demanded . The author also explained why he believes some type of rationing is inevitable . Health care professionals must enter the debate on how to ration or face unpleasant consequences . The approach outlined here is one proven way to create testing and treatment guidelines based on health outcomes as well as consumer satisfaction and cost . The long-term best interests of all patients deserve nothing less.

Cancer, 1995 Sep 1, 76(5), 840 - 52
Improved long term survival after intracavitary interleukin-2 and lymphokine-activated killer cells for adults with recurrent malignant glioma; Hayes RL et al.; BACKGROUND . The median survival for adults with glioblastoma multiforme (GBM) is 12 months, despite surgery, radiation, and chemotherapy . Regimens using interleukin-2 (IL-2) plus lymphokine-activated killer (LAK) cells have been beneficial against systemic cancers, albeit with significant toxicity . METHODS . Nineteen adults with recurrent malignant glioma (5 GBMs, and 4 anaplastic astrocytomas (AA)), Karnofsky performance status 60 or greater, were treated with intracavitary autologous LAK cells plus IL-2 after reoperation . Lymphokine-activated killer cells and IL-2 were given on day 1, and IL-2 alone was given 5 times during a 2-week cycle . This cycle was repeated at 2 weeks to constitute one 6-week course of therapy . Each two-cycle course of treatment was repeated at 3-month intervals for patients with stable disease or response to therapy . At the conclusion of immunotherapy, all patients were offered chemotherapy, generally carmustine or procarbazine, including responders . Corticosteroids were strictly limited during immunotherapy . Sequential reservoir aspirates were obtained for microbiologic and cytologic analyses . RESULTS . The maximal tolerated dose for a 12-dose course of therapy was 1.2 million international units (MIU) per dose . Dose-limiting, cumulative IL-2-related central nervous system (CNS) toxicity was observed at 2.4 MIU per dose . Three responses were confirmed by computed tomography scan during therapy: one complete response (CR) (1 AA), and two partial responses (PR) (2 GBM); as well as a significant increase in GBM survival . One additional CR (GBM) was observed at 17 months . The median survival for immunotherapy patients with GBM was 53 weeks after reoperation (N = 15) (mean, 87.9 +/- 21.4 weeks, standard error for the mean), with 8 of 15 surviving more than 1 year (53%) . The median survival for 18 contemporary patients with GBM reoperated and treated with chemotherapy was 25.5 weeks (mean, 27.4 +/- 3.7 weeks), with 1/18 alive at 1 year (> 6%) . Six of the 15 patients with GBM had additional surgery or biopsy, and chemotherapy after immunotherapy . The contribution of subsequent chemotherapy to survival cannot be discounted . CONCLUSIONS . Lymphokine-activated killer cells and IL-2 can be administered safely within the CNS resulting in improved long term survival in patients with recurrent glioblastoma . Increased survival was associated with significant biologic changes characterized by a regional eosinophilia, and extensive lymphocytic infiltration . A prospective randomized clinical trial is warranted.

Mycoses, 1995 Sep-Oct, 38(9-10), 411 - 4
Dermatophytes in northern Finland in 1982-90; Lehenkari E et al.; The epidemiology of human dermatophytes was studied in northern Finland in 1982-90 . The samples were analysed at the Department of Medical Microbiology, University of Oulu . The total number of samples was 17,822, of which 3185 (18%) were positive . The annual number of samples and positive cultures remained relatively constant . Trichophyton rubrum was the most common species being isolated from 2101 samples (66% of all positive cultures), while Trichophyton mentagrophytes was isolated from 815 samples (26%) and Epidermophyton floccosum from 193 samples (6%) . T . verrucosum caused an epidemic among cattle keepers in 1987-90, causing 47 infections . Microsporum canis, T . terrestre and T . violaceum were rare . The same species affected both children and adults . There was a tendency towards a decrease in tinea in the groin and a slight increase in tinea pedis . T . rubrum and T . mentagrophytes occurred most frequently in patients aged 41-45 years and as foot infections . E . floccosum usually affected the toe web and the groin in patients aged 21-25 years, more often infecting men . Fifty-four per cent of all positive samples came from men and 46% from women.

Med Clin North Am, 1995 Sep, 79(5), 1205 - 40
Infective endocarditis; Bansal RC; IE is a fascinating disease that continues to challenge the clinicians . Over the last several decades, there have been marked changes in its presentation . The morbidity and mortality have markedly improved by early diagnosis and prompt treatment using highly effective antibiotic regimens and early valve replacement surgery whenever necessary . Early diagnosis is possible by improvement in blood culture techniques and advances in transthoracic and transesophageal echocardiographic approaches . This article has reviewed the pathogenesis, microbiology, clinical presentation, diagnostic methodology, treatment, and prevention of IE.

J Clin Oncol, 1995 Sep, 13(9), 2394 - 400
Survival of patients with resistant Hodgkin's disease after polyclonal yttrium 90-labeled antiferritin treatment; Herpst JM et al.; PURPOSE: A follow-up study was initiated of patients with Hodgkin's disease who were treated with yttrium 90-labeled antiferritin . Prescription method, pharmacokinetics, acute and late side effects, and survival were evaluated . METHODS: Patients had measurable disease and failed > or = two multiagent chemotherapy regimens previously (N = 44) . All patients received 5-mCi indium 111-labeled antiferritin 2 mg intravenously and were scanned repeatedly by gamma camera . In five patients, polyclonal antiferritin (rabbit, pig, or baboon) failed to target the tumor . Thirty-nine patients were injected intravenously with 10-, 20-, 30-, 40-, or 50-mCi yttrium 90-labeled antiferritin 2 to 5 mg . Patients received between one and five cycles . Some patients were supported with 5 x 10(7) autologous bone marrow cells per kilogram . RESULTS: Yttrium 90-labeled polyclonal antiferritin does not produce immunologic, pharmacologic, or microbiologic complications in vivo . Bone marrow toxicity is the only side effect observed . Overall response rate is 20 of 39, or 51% . Two patients had stable disease . A significant positive correlation is found between blood radioactivity level 1 hour after radioimmunoconjugate administration and subsequent response of Hodgkin's disease . A dosage in millicuries per kilogram provides a higher positive correlation with blood radioactivity levels 1 hour after administration than a dosage in millicuries per square meter of body-surface area or in total millicuries . Fifty percent of patients survive for > or = 6 months . CONCLUSION: The low-dose protein used (2 to 5 mg) indicates that the high response rate is due to radiation and not to immunologic effects of the antibody . High-activity administrations followed by bone marrow transplantation are not required for tumor response . The therapeutic ratio of radiolabeled antiferritin is higher than the therapeutic ratio observed in most phase I studies of chemotherapeutic agents . This analysis does not identify a superior mode of treatment for patients with end-stage Hodgkin's disease . However, in a heavily pretreated patient population, prolonged survival is observed after relatively inexpensive treatment . Preclinical research with yttrium 90-labeled antiferritin indicates that significant increases in tumor dose can be obtained in the future without an increase in normal tissue toxicity.

J Bacteriol, 1995 Sep, 177(17), 4872 - 80
A consensus sequence for binding of Lrp to DNA; Cui Y et al.; Lrp (leucine-responsive regulatory protein) is a major regulatory protein involved in the expression of numerous operons in Escherichia coli . For ilvIH, one of the operons positively regulated by Lrp, Lrp binds to multiple sites upstream of the transcriptional start site and activates transcription . An alignment of 12 Lrp binding sites within ilvIH DNA from two different organisms revealed a tentative consensus sequence AGAAT TTTATTCT (Q . Wang, M . Sacco, E . Ricca, C.T . Lago, M . DeFelice, and J.M . Calvo, Mol . Microbiol . 7:883-891, 1993) . To further characterize the binding specificity of Lrp, we used a variation of the Selex procedure of C . Tuerk and L . Gold (Science 249:505-510, 1990) to identify sequences that bound Lrp out of a pool of 10(12) different DNA molecules . We identified 63 related DNA sequences that bound Lrp and estimated their relative binding affinities for Lrp . A consensus sequence derived from analysis of these sequences, YAGHAWATTWT DCTR, where Y = C or T, H = not G, W = A or T, D = not C, and R = A or G, contains clear dyad symmetry and is very similar to the one defined earlier . To test the idea that Lrp in the presence of leucine might bind to a different subset of DNA sequences, we carried out a second selection experiment with leucine present during the binding reactions . DNA sequences selected in the presence or absence of leucine were similar, and leucine did not stimulate binding to any of the sequences that were selected in the presence of leucine . Therefore, it is unlikely that leucine changes the specificity of Lrp binding.

Invest Ophthalmol Vis Sci, 1995 Sep, 36(10), 1976 - 87
Murine model of ocular infection by a human biovar of Chlamydia trachomatis; Whittum-Hudson JA et al.; PURPOSE . A human biovar of Chlamydia trachomatis was used to develop a murine model of ocular chlamydial infection . The inbred mouse model will allow detailed immunologic studies during ocular infection, and use of a human biovar for infection may aid in identification of appropriate vaccine strategies against chlamydial infections . METHODS . BALB/c, C3H/HeN, and C57B1/6J mice (n = 5 to 10 mice/group) were topically infected in the conjunctiva with C serovar of C . trachomatis . The effects were tested of single and repeated infection with 5000 inclusion-forming units (IFU) in 5 microliters and different inoculum doses . Conjunctival surfaces of both eyes were swabbed for microbiologic signs (isolation culture or direct fluorescent antibody staining) of infection over 4 to 6 weeks . Conjunctivae were removed for histopathologic study, and lymphocytes from draining cervical lymph nodes and spleens were tested for chlamydia-specific proliferative responses . Serum was obtained from all mice and tested for anti-chlamydial antibodies . RESULTS . BALB/c and C3H/HeN mice developed dose-dependent microbiologic, histopathologic, and immunologic evidence of ocular infection . Eyes of mice were culture-positive from day 7 through at least day 21, with the peak of infection at days 10 to 14 after infection . Histopathologically, the development of conjunctival subepithelial mononuclear infiltration, exudate, and loss of goblet cells occurred within 1 week . Dose-dependent lymphoproliferative responses to whole chlamydial elementary bodies were observed; anti-chlamydial antibody was detected by immunoblotting only in infected mice . CONCLUSIONS . Several strains of inbred mice are susceptible to human chlamydial biovars and may provide a useful alternative disease model in which to study the immunopathogenesis of ocular chlamydial infection and test of vaccine candidates derived from clinically relevant human biovars.

J Acquir Immune Defic Syndr Hum Retrovirol, 1995 Sep 1, 10(1), 48 - 53
Treatment with letrazuril of refractory cryptosporidial diarrhea complicating AIDS; Loeb M et al.; Thirty-five AIDS patients (mean CD4 count 44 x 10(6)/L) with chronic cryptosporidiosis were treated with letrazuril at an initial oral daily dose of 50 mg in an open-label Phase I prospective trial . Treatment was continued for > or = 10 days and for as long as there was a response . The majority of subjects (91%), had previously failed paromomycin treatment . At baseline, 74% of patients had moderate (five to nine bowel movements per day) to severe (> 10 bowel movements per day) diarrhea . Twenty-three subjects (66%) had a clinical response within a mean of 1.7 weeks of treatment initiation . Twenty-two patients had a partial response (> 50% reduction in bowel movements per day for > or = 1 week), one patient had a complete response (two or fewer bowel movements per day) . Of the responders, 15 (65%) had a clinical relapse with worsening diarrhea at an average of 1.2 months following initiation of letrazuril . The other eight (35%) had had symptom control for an average of 2.9 months from initiation of letrazuril to the latest follow-up . Microbiologic eradication was demonstrated in 10 (40%) of 25 patients with follow-up stool examinations . Seven patients (20%) experienced a rash, all within 1 week of starting the drug, and resolved in all patients when the drug was discontinued . In conclusion, severely immunocompromised AIDS patients with refractory cryptosporidiosis may show a modest, short-lived response to letrazuril . Microbiologic response is variable and relapse high . Rash is a major limiting side effect of the drug.

Microbiology, 1995 Sep, 141 ( Pt 9), 2111 - 21
Restriction site polymorphism of the genes encoding the major 25 kDa and 36 kDa outer-membrane proteins of Brucella; Cloeckaert A et al.; Seventy-seven Brucella reference and field strains from different geographic origins and hosts representing the six recognized species and their different biovars were analysed for diversity of their genes encoding the major 25 and 36 kDa outer-membrane proteins (OMPs) by PCR-RFLP . The 25 kDa OMP is encoded by a single gene (omp25) whereas two closely related genes (omp2a and omp2b) encode and potentially express the 36 kDa OMP . Analysis of PCR products of the omp25 gene digested with nine restriction enzymes revealed two species-specific markers, i.e . the absence of the EcoRV site in all Brucella melitensis strains and an approximately 50 bp deletion at the 3' terminal end of the gene in all Brucella ovis strains . Analysis of PCR products of the omp2a and omp2b genes digested with 13 restriction enzymes indicated a greater diversity than the omp25 gene among the six Brucella species and within the Brucella abortus, Brucella suis, B . melitensis and B . ovis species . Greater polymorphism was also detected for the omp2b than for the omp2a gene, especially in B . ovis which seemed to carry two similar (but not identical) copies of omp2a instead of one copy each of omp2a and omp2b for the other Brucella species as was previously suggested by Ficht et al . (1990; Mol Microbiol 4, 1135-1142) . Results of PCR-RFLP indicated that distinction can be made between Brucellia species and some of their biovars, except between B . canis and B . suis bv . 3 and 4, on the basis of the size and diversity of their major OMP genes, and that it could be of importance for diagnostic, epidemiological and evolutionary study purposes.

J Clin Microbiol, 1995 Sep, 33(9), 2415 - 20
Outer surface protein C gene sequence analysis of Borrelia burgdorferi sensu lato isolates from Japan; Fukunaga M et al.; The nucleotide sequences of the outer surface protein C gene (ospC) from Borrelia burgdorferi sensu lato isolates representing six different restriction fragment length polymorphism (RFLP) ribotype groups were determined, and the deduced amino acid sequences were aligned in comparison with the previously published OspC protein sequences . The sequence similarity analysis revealed the high sequence variability of OspC protein, and the degree of amino acid similarity ranged from 53.8 to 100% among 25 isolates . It has been reported that the representatives belonging to the three species of B . burgdorferi sensu lato showed a species-specific amino acid sequence motif at positions 23 to 35 (B . Wilske, S . Jauris-Heipke, R . Lobentanzer, I . Pradel, V . Preac-Mursic, D . Rossler, E . Soutschek, and R.C . Johnson, J . Clin . Microbiol . 33:103-109, 1995) . Alignment with the OspC sequences of RFLP ribotype group IV, V, and VI isolates revealed that a sequence motif of all the isolates was quite similar to that of Borrelia garinii . A phylogenetic analysis based on OspC protein sequences also showed that most of the Japanese isolates were closely related to the species B . garinii . THe RFLP ribotype group IV species is predominant among clinical isolates of Lyme disease patients, reservoir rodents, and adult ticks in Japan . Although the isolates differed from type strains of the three delineated genospecies in genetic and immunological characteristics, it is likely that the spirochetes diverged within the species level . Therefore, the representatives of ribotype groups IV, V, and VI appear to have evolved within B . garinii and to have adapted to an Asiatic habitat, and there appeared to be a sufficient ecological pressure to allow bacterial species level development.

J Clin Microbiol, 1995 Sep, 33(9), 2304 - 15
Genotypic and phenotypic characterization of Borrelia burgdorferi isolated from ticks and small animals in Illinois; Picken RN et al.; We have characterized 33 isolates of Borrelia burgdorferi from northern Illinois (32 isolates) and Wisconsin (1 isolate) representing the largest series of midwestern isolates investigated to date . The techniques used for molecular analysis of strains included (i) genospecies typing with species-specific PCR primers, (ii) plasmid profiling by pulsed-field gel electrophoresis of total genomic DNA, (iii) large-restriction-fragment pattern (LRFP) analysis by pulsed-field gel electrophoresis of MluI-digested genomic DNA (J . Belfaiza, D . Postic, E . Bellenger, G . Baranton, and I . Saint Girons, J . Clin . Microbiol . 31:2873-2877, 1993), (iv) sodium dodecyl sulfate-polyacrylamide gel electrophoresis of total proteins, (v) microsequencing of high-performance liquid chromatography-purified peptides derived from proteins showing high levels of expression, (vi) amino acid composition analysis of proteins, and (vii) immunological analysis of proteins with a polyclonal antiserum of human origin . Five reference strains as well as two atypical tick isolates from California (DN127) and New York (25015) were included for comparison . All of the Illinois and Wisconsin isolates were typed as B . burgdorferi sensu stricto with genospecies-specific PCR primers . The isolates were found to be heterogeneous with regard to their plasmid and protein profiles . One isolate from Illinois possessed two large-molecular-size plasmids instead of the usual 49-kb plasmid . Fragment patterns resulting from MluI digestion of genomic DNA from the 33 isolates and strains DN127 and 25015 were separable into six distinct LRFPs, five of which have not previously been described . Strain 25015 and an isolate from Illinois (CT39) shared an unusual LRFP that is not typical of other B . burgdorferi sensu stricto strains, suggesting that they may represent a fifth species of B . burgdorferi sensu lato . Five of the 33 isolates and strains DN127 and 25015 showed high-level expression of proteins with molecular masses of approximately 22 kDa . Investigation of these proteins by microsequencing of individual peptides and total amino acid composition analysis indicated that the 22-kDa proteins expressed by the seven strains were polymorphic OspC proteins . By using a polyclonal serum of human origin, expression of OspC could be detected in all 33 Illinois and Wisconsin isolates.

J Clin Pathol, 1995 Sep, 48(9), 810 - 4
Routine application of the polymerase chain reaction for detection of Mycobacterium tuberculosis in clinical samples; Noordhoek GT et al.; AIM--To investigate the use of the polymerase chain reaction (PCR) in the routine laboratory for the detection of Mycobacterium tuberculosis in clinical samples . METHODS--Samples were divided and processed separately for the detection of M tuberculosis by microscopy, culture and PCR . After DNA extraction, PCR was performed with primers specific for the insertion element IS6110 and the product was analysed by agarose gel electrophoresis, Southern blotting or dot blotting and hybridisation with a digoxigenin labelled internal probe . Each sample was tested for inhibitors of Taq polymerase with the aid of an internal control . Multiple negative and positive controls were used to monitor each step of the procedure . RESULTS--The data from two laboratories, using the same operating procedures, were combined . Of 1957 specimens, 79 (4%) were culture and PCR positive, while 1839 (93.9%) were negative in both tests . Thirty specimens (1.5%) were PCR positive only and nine (0.5%) were culture positive but PCR negative . CONCLUSION--Using culture and clinical history as the gold standard, sensitivity and specificity for PCR were 92.1% and 99.8%, respectively . With elaborate precautions, PCR is a suitable and reliable method for the detection of M tuberculosis in clinical samples in a routine microbiology laboratory.

Ultrasound Obstet Gynecol, 1995 Aug, 6(2), 121 - 5
Sonographic features of tuberculous peritonitis with female genital tract tuberculosis; Yapar EG et al.; Our aim was to illustrate the sonographic features of tuberculous peritonitis with female genital tract tuberculosis in an attempt to facilitate the recognition of the disorder preoperatively . Transabdominal and transvaginal sonographic features and the findings from laparotomy/laparoscopy, endometrial biopsy and microbiology were reviewed and compared in 15 patients with tuberculous peritonitis with female genital tract tuberculosis . Of the 15 patients, 12 had wet tuberculosis and three had dry (adhesive) tuberculosis . Sonographic features of wet tuberculosis were categorized as follows: septated ascites (ten patients), particulate ascites (two patients), loculated fluid (two patients), thickened peritoneum (eight patients), thickened omentum (eight patients), adnexal mass (11 patients), adhesions (seven patients) and endometrial involvement (five patients) . Adnexal masses, adhesions and loculated fluid were found to be present in the dry type . When sonographic findings were compared with those of laparotomy and/or laparoscopy and/or endometrial biopsy, ultrasound was able to identify aspects of tuberculosis infection as follows: ascites/loculated fluid, 13/13 (100%); adnexal mass, 12/13 (93%); peritoneal thickening, 9/13 (69%); omental thickening, 8/13 (61%); and endometrial involvement, 5/6 (83%) . We conclude that awareness of the sonographic changes associated with tuberculosis infection may improve diagnostic accuracy, and avoid clinical mismanagement and surgical explorations in the wet type of tuberculosis.

Med Hypotheses, 1995 Aug, 45(2), 164 - 8
Leukocyte adhesion molecules as a cofactor in AIDS: basic science and pilot study; Allen AD et al.; It is well known that the AIDS pandemic is a consequence of pandemic HIV infection . However, Koch's postulates are not satisfied for two reasons: 1) AIDS cannot be experimentally produced in animals susceptible to HIV infection and 2) some people have AIDS (idiopathic CD4+ T lymphocytopenia) in the absence of HIV infection . It follows that there is a human immunologic cofactor (HIC) that causes AIDS when certain other conditions are satisfied, and the most common of these other conditions (but not the only one) is HIV infection . Results from microbiology make leukocyte adhesion molecules a good candidate for the HIC . We have tested this hypothesis with a pilot study in which a small number of patients with HIV disease were infused with a monoclonal mouse antibody (MmAb) directed against an LFA-1 adhesion epitope, and then with F(ab) and F(ab)2' fragments that bind to the same epitope but are nonimmunogenic . Both agents reduced peripheral viral burden significantly but fragments were more effective in this respect than the MmAb due to the mitogenic properties of the latter . For the same reason, only the MmAb were highly effective in raising circulating levels of single and double-marked CD4+ T lymphocytes, with a correlated resolution of cutaneous anergy.

J Trauma, 1995 Aug, 39(2), 309 - 19
Cultured epithelial autograft: five years of clinical experience with twenty-eight patients; Williamson JS et al.; Cultured epithelial autograft (CEA) has been used as an adjunct in burn wound coverage at the Vancouver Hospital and Health Sciences Centre since 1988, and has been available to all patients admitted with significant burn injuries . During the 5-year period from 1988 to 1992 inclusive, 28 patients treated with CEA survived long enough for assessment . The mean age was 35.3 years with a mean total body surface area burn of 52.2% and a mean total full thickness injury of 42.4% . CEA was applied to wounds covering between 2% and 35% body surface area (BSA; mean 10.4%) after excision to fat or fascia . Most wounds had interim homograft coverage . Preservation of homograft dermis was attempted in three patients at the time of removal without effect . The mean CEA "take" was 26.9% of the grafted area . Eight patients had 50% or greater take and were discharged with between 1 and 19% BSA covered with CEA . Thirteen patients had no take on wounds between 2 and 16% BSA . Overall mortality in burn patients treated at the Vancouver Hospital and Health Sciences Centre from 1988 to 1992 was not significantly different from 1983 to 1987 with the populations being similar in terms of total BSA burns, age, inhalation injury, and homograft availability . When compared to a matched control population from the preceding 5 years, when CEA was not available, there was no significant difference in duration of hospital stay or number of autograft harvests . However, approximately one more debridement without autograft harvest per CEA patient occurred . Timing and depth of wound excision, interim coverage, type of dressing, and wound microbiology were not found to influence good versus poor take . The anterior trunk and thighs were the best recipient sites . Subjective differences between CEA and meshed autograft were noted . The results show that after 5 years of use, CEA engraftment continues to be unpredictable and inconsistent, and hence, it should be used as only a biologic dressing and experimental adjunct to conventional burn wound coverage with split thickness autograft.

Arch Pathol Lab Med, 1995 Aug, 119(8), 706 - 12
User interface reengineering . Innovative applications of bar coding in a clinical microbiology laboratory; Willard KE et al.; Some clinical laboratory departments (such as microbiology) provide extensive reporting of text and other data not generated by instruments that can be interfaced to a laboratory information system . These data are usually entered into the laboratory information system manually by keyboard data entry, which can be cumbersome and time consuming . Bar codes, which are already used in laboratories to facilitate rapid entry of sample-identifying information, have the potential to be used much more broadly as a generalizable data entry technique . We developed a comprehensive system that takes advantage of several applications of bar coding to facilitate the work of our Clinical Microbiology Laboratory . Central to our system is the use of bar code "scripts" to meet many of our complex data entry requirements . Use of these scripts is transparent to the laboratory information system (ie, no special "drivers" are needed) because data are received as if they had been generated by typing the characters on the keyboard . The scripts consist of bar codes that encode the series of keystrokes needed to give the appropriate response at the series of prompts offered by the laboratory information system . Both alphanumeric and other keys, including carriage returns and special characters, can be converted into bar codes and incorporated into scripts . By creating and printing these scripts in the laboratory using standard wordprocessing software and bar code fonts for personal computers, laboratorians without specialized computer training have the tools to substantially improve the data entry efficiency of existing data entry terminals for a variety of laboratory information systems.

J Bacteriol, 1995 Aug, 177(16), 4696 - 702
Modulation of flagellar expression in Escherichia coli by acetyl phosphate and the osmoregulator OmpR; Shin S et al.; During the search for unknown factors involved in motility, we have found that expression of the flagellar master operon flhDC is affected by mutations of the pta and ackA genes, encoding phosphotransacetylase and acetate kinase, respectively (S . Shin, J . Sheen, and C . Park, Korean J . Microbiol . 31:504-511, 1993) . Here we describe results showing that this effect is modulated by externally added acetate, except when both pta and ackA are mutated, suggesting the role of acetyl phosphate, an intermediate of acetate metabolism, as a regulatory effector . Furthermore, the following evidence indicates that the phosphorylation of OmpR, a trans factor for osmoregulation, regulates flagellar expression . First, in a strain lacking ompR, the expression of flhDC is no longer responsive to a change in the level of acetyl phosphate . Second, an increase in medium osmolarity does not decrease flhDC expression in an ompR mutant . It is known that such an increase normally enhances OmpR phosphorylation . Third, OmpR protein binds to the DNA fragment containing the flhDC promoter, and its affinity is increased with phosphorylation by acetyl phosphate . DNase I footprinting revealed the regions of the flhDC promoter protected by OmpR in the presence or absence of phosphorylation . Therefore, we propose that the phosphorylated OmpR, generated by either osmolarity change or the internal level of acetyl phosphate, negatively regulates the expression of flagella.

Am J Med, 1995 Aug, 99(2), 164 - 72
Diagnosis and therapeutic monitoring of invasive candidiasis by rapid enzymatic detection of serum D-arabinitol; Walsh TJ et al.; BACKGROUND: Using a rapid automated enzymatic assay, we prospectively investigated serum D-arabinitol (DA), a biochemical marker of invasive candidiasis, in a large population of high-risk patients to determine its potential diagnostic, therapeutic, and prognostic significance in invasive candidiasis . PATIENTS AND METHODS: A total of 3,223 serum samples were collected from 274 patients with cancer . Serum DA concentrations were determined in coded serum samples analyzed by rapid enzymatic assay . Creatinine also was analyzed in the same system to determine a serum DA and creatinine ratio (DA/Cr) . The sensitivity, specificity, correlation with therapeutic response, and prognostic significance were analyzed for all patient study groups . RESULTS: A DA/Cr of > or = 4.0 mumol/L per mg/dL was detected in 31 (74%) of all 42 cases of fungemia and 25 (83%) of the 30 cases of the subset of persistent fungemia . Elevated DA/Cr was detected in 4 (40%) of 10 patients with tissue-proven, deeply invasive candidiasis and negative blood cultures (eg, hepatosplenic candidiasis or localized abscess) and 7 (44%) of 16 cases of deep mucosal candidiasis (eg, esophageal candidiasis) . Elevated serial DA/Cr levels also were detected in persistently febrile and granulocytopenic patients requiring empirical amphotericin B . Among 26 assessable cases of fungemia, abnormally elevated DA/Cr values were detected in 14 (54%) before, 10 (38%) after, and 2 (8%) simultaneously with the first microbiologic report of fungemia . The trends of serial DA/Cr values correlated with therapeutic response in 29 (85%) of 34 patients with assessable cases of fungemia, decreasing in 8 (89%) of 9 patients with clearance of fungemia and increasing in 21 (84%) of 25 patients with persistence of fungemia . Among the 34 assessable patients with fungemia, mortality was directly related to the trend of serial DA/Cr determinations over time: 71% among fungemic patients who had persistently elevated or increasing DA/Cr, and 18% among the fungemic patients who had resolving DA/Cr or never had elevated DA/Cr (P < 0.01) . CONCLUSIONS: Rapid enzymatic detection of DA in serially collected serum samples from high-risk cancer patients permitted detection of invasive candidiasis, early recognition of fungemia, and therapeutic monitoring in DA-positive cases . Serially collected serum DA determinations complement blood cultures for improving detection and monitoring therapeutic response in patients at risk for invasive candidiasis.

Chirurg, 1995 Aug, 66(8), 818 - 22
{Thoracic actinomycosis}; Mohr VD et al.; Thoracic actinomycosis is a rare disease without characteristic clinical signs . Approximately 90% of patients suffering from thoracic actinomycosis have undergone diagnostic and therapeutic procedures based on a wrong diagnostic hypothesis (malignancies 35-44%, other pulmonary disorders 33-35%) . The opportunities for a timely and adequate diagnosis by the use of clinical examination, laboratory studies, microbiology studies, radiologic imaging or invasive measures are limited . In 85%, thoracic actinomycosis has not been identified prior to thoracotomy, open biopsy and histological examination . Based on a wrong diagnostic hypothesis, resective thoracic surgery according to the principles of oncologic surgery can hardly be avoided . We report on a 43-year-old male suffering from actinomycosis of the left hemithorax . Clinical signs, differential diagnosis, treatment and clinical course are described . The role of surgery in the treatment protocol of thoracic actinomycosis is discussed . In pulmonary and pleural disorders of unknown origin, differential diagnosis should include thoracic actinomycosis as early as possible . Due to the considerably high mortality rate of untreated disease, the outcome of thoracic actinomycosis can only be improved by a timely and combined employment of surgical and antibiotic therapy.

Arzneimittelforschung, 1995 Aug, 45(8), 934 - 9
Intent and coincidence in pharmaceutical discovery . The impact of biotechnology; Drews J; Drug research developed around a purpose: the cure of diseases . This intent to cure, however, offered no clue to the understanding of diseases and to their treatment . Instead such guidance had to come from scientific disciplines which laid the foundations for drug research and offered specific opportunities for the solution of therapeutic problems . In the sequence of their appearance, these scientific disciplines were: chemistry, pharmacology/physiology, microbiology, biochemistry and molecular biology . It can be shown that new therapeutic classes of drugs like muscle relaxants, diuretics, L-dopa, antibiotics, recombinant proteins, monoclonal antibodies and others were generated on the basis of scientific opportunities rather than therapeutic need . All of these drugs were created within the confines of a chemical paradigm of medicine and drug therapy . We are now witnessing the entry of a new informational paradigm into medicine which is most prominently represented by genomic sciences . This paradigm will bring two important changes to the therapy of diseases . First, molecular biology has matured to such a degree that it can now study complex genomes and their functionality in complex organisms such as humans . Therefore, results from these studies no longer have to be translated into the context of medicine: they are already within this context . Secondly, drug therapy which used to be largely symptomatic, will now aim at targets which are closer to the causes of diseases than previously . Therapeutic progress, which used to be indirect, conjectural and coincidental, is about to become more directed, definitive and intentional . At least from the limited and utilitarian perspective of medicine, drug discovery will be more often based on intent rather than coincidence . But industry and, for that matter, society as a whole should not forget that this situation has come about through the evolution of science which was not, and can never be, predictable.

Rev Clin Esp, 1995 Aug, 195(8), 546 - 9
{Extrapulmonary tuberculosis . Experience at a general hospital (1980-1993)}; Ramos JM et al.; In order to know extrapulmonary tuberculosis in our environment the results of all samples submitted for culture of mycobacteria to the Microbiology Department, Fundacion Jimenez Diaz, from 1980 to 1993 were analyzed . During this period 290 cases of extrapulmonary cases were diagnosed, 101 from 1980 to 1985 and 189 from 1986 to 1993 . The most common site of infection before 1985 was in genitourinary tract (42.6%); in contrast, from 1986 onwards the more common sites of infection were pleural (22.8%), genitourinary tract and lymphatic glands (22.2% in both sites) . When EPT was compared in the two periods of time the observations made were a relative decrease of genitourinary infections (p = 0.00004) and increase in disseminated (p = 0.015) and pleural tuberculosis (p = 0.011) from 1986 compared with previous years . From 1986 a greater proportion of disseminated form was observed (p < 0.0001) in positive-HIV patients and of genitourinary (p = 0.011) and pleural (p = 0.076) forms in negative HIV-patients . In conclusion, extrapulmonary tuberculosis has increased in our environment during the period 1980-1993, and this increase is not attributable only to positive-HIV patients . The distribution of clinical forms of this disease was different in the two studied periods and among positive and negative HIV patients.

J Clin Microbiol, 1995 Aug, 33(8), 2048 - 53
Investigation of sheep-associated malignant catarrhal fever virus infection in ruminants by PCR and competitive inhibition enzyme-linked immunosorbent assay; Li H et al.; Development of control measures for the gammaherpesviral disease of cattle known as sheep-associated malignant catarrhal fever (SA-MCF) has been hampered by a lack of accurate diagnostic tests either for the causative virus or for antibody against that virus . A recently developed competitive-inhibition enzyme-linked immunosorbent assay (CI-ELISA) for the detection of antibody to malignant catarrhal fever (MCF) virus (MCFV) in ruminants based on a monoclonal antibody to a widely conserved epitope of MCFV (H . Li, D . T . Shen, D . P . Knowles, J . R . Gorham, and T . B . Crawford, J . Clin . Microbiol . 32:1674-1679, 1994) and a PCR assay based on previously reported primers (S . I . F . Baxter, I . Pow, A . Bridgen, and H . W . Reid, Arch . Virol . 132:145-159, 1993) were used to detect anti-MCFV antibody and SA-MCFV DNA in sheep and other ruminants . The PCR amplified a specific 238-bp SA-MCFV genomic DNA fragment from peripheral blood lymphocytes of adult sheep and other ruminants with clinical MCF . Of 144 samples from randomly selected healthy adult sheep, 143 (99%) were positive by PCR and 136 (94%) were positive by CI-ELISA . The agreement between the two assays exceeded 95% . Of nine samples collected from cattle and deer with clinical MCF of apparent sheep origin, seven were CI-ELISA positive and all 9 were PCR positive . Among 59 serum samples from presuckling lambs, none contained antibody detectable by CI-ELISA . After suckling, maternal anti-MCFV antibody was detectable for about 10 +/- 3 weeks . Although all colostrum and milk samples from infected ewes were strongly PCR positive, the appearance of detectable SA-MCFV DNA in lambs was correlated generally with antibody patterns, which suggests that the natural infection event in sheep may not occur during the perinatal period but occurs sometime later in life.

Med Microbiol Immunol (Berl), 1995 Aug, 184(2), 73 - 80
Sequence analysis of ospA genes shows homogeneity within Borrelia burgdorferi sensu stricto and Borrelia afzelii strains but reveals major subgroups within the Borrelia garinii species; Will G et al.; The genes coding for the outer surface protein A (OspA) of 19 different Borrelia burgdorferi strains belonging to the seven OspA-serotypes 1-7, previously described {Wilske et al . (1993) J Clin Microbiol, 31: 340-350}, have been investigated . B . burgdorferi sensu lato strains were chosen from various biological sources (ticks, human skin and cerebrospinal fluid) as well as different geographical origins (Germany, Slovenia, Austria, United States) . The open reading frames of all ospA genes consist of 819-825 nucleotides corresponding to proteins of approximately 30 kDa . The ospA sequences obtained in this study and previous published studies were compared with the results from OspA serotyping with monoclonal antibodies . The classification into the seven OspA serotypes could be confirmed on a genetic basis (ospA genotypes 1-7) for all strains analyzed so far (n = 29) . In addition, one strain without OspA expression could be assigned to ospA genotype 2 . Genetic stability could be proven for the ospA gene of B . burgdorferi strain PWudI after inocculation and reisolation from a gerbil . However, we found evidence for intragenic recombination by cluster analysis of ospA sequence data . Accordance of ospA genotype 1 strains with B . burgdorferi sensu stricto and ospA genotype 2 strains with B . afzelii, as well as the ospA genotype strains 3-7 with B . garinii was confirmed by pulsed-field gel electrophoresis of MluI-digested genomic DNA . B . garinii is not only more heterogeneous in respect to the OspA-encoding genes, but shows moreover major subgroups formed by genotypes 4, 5 and 6 and genotypes 3 and 7, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Appl Environ Microbiol, 1995 Aug, 61(8), 3014 - 8
Detection of Norwalk virus and hepatitis A virus in shellfish tissues with the PCR; Atmar RL et al.; A method for the detection of Norwalk virus and hepatitis A virus from shellfish tissues by PCR was developed . Virus was added to the stomach and hepatopancreatic tissues of oysters or hard-shell clams, and viral nucleic acids were purified by a modification of a previously described method (R.L . Atmar, T.G . Metcalf, F.H . Neill, and M.K . Estes, Appl . Environ . Microbiol . 59:631-635, 1993) . The new method had the following advantages compared with the previously described method: (i) more rapid sample processing; (ii) increased test sensitivity; (iii) decreased sample-associated interference with reverse transcription-PCR; and (iv) use of chloroform-butanol in place of the chlorofluorocarbon trichlorotrifluoroethane . In addition, internal standards for both Norwalk virus and hepatitis A virus were made which demonstrated when inhibitors to reverse transcription-PCR were present and allowed quantitation of the viral nucleic acids present in samples . This assay can be used to investigate shellfish-associated gastroenteritis outbreaks and to study factors involved in virus persistence in shellfish.

FEMS Microbiol Lett, 1995 Jul 15, 130(1), 75 - 80
Phylogenetic analysis of polycyclic aromatic hydrocarbon degrading mycobacteria by 16S rRNA sequencing; Wang RF et al.; Mycobacterium sp . PYR-1 was previously isolated in our laboratory and was shown to be able to mineralize high molecular mass polycyclic aromatic hydrocarbons (PAHs) {Heitkamp and Cerniglia, (1988) Appl . Environ . Microbiol . 54, 1612-1614} . In this research, the 16S rRNA gene (rDNA) of this strain was amplified by polymerase chain reaction (PCR) and directly sequenced by cycle sequencing method . We compared this sequence with all known mycobacterial 16S rDNA sequences available from GenBank and found that Mycobacterium sp . PYR-1 16S rDNA differs from the other mycobacteria, especially in the region of nucleotides 168-200 (in the Escherichia coli numbering system) . Using the 16S rDNA sequences of the mycobacteria, a phylogenetic tree was constructed . The data from the phylogenetic tree and similarity values suggest that Mycobacterium sp . PYR-1 is closer to M . aurum and M . vaccae . Using the same approach, we also determined the 16S rDNA from an another PAH-degrading Mycobacterium sp . PAH135, isolated by Grosser and colleagues (1991) (Appl . Environ . Microbiol . 57, 3462-3469) . Mycobacterium sp . PAH135 was found to be closer to M . aichiense, and different from our Mycobacterium sp . PYR-1.

Int J Syst Bacteriol, 1995 Jul, 45(3), 549 - 53
Mycobacterium branderi sp . nov., a new potential human pathogen; Koukila-Kahkola P et al.; A number of mycobacterial strains with similar growth characteristics, metabolic properties, and lipid compositions, which were previously placed in the Helsinki group (E . Brander, E . Jantzen, R . Huttunen, A . Juntunen, and M.-L . Katila, J . Clin . Microbiol . 30:1972-1975, 1992), were characterized by performing 16S rRNA gene sequencing . Of the 14 strains studied, 9 had a unique, previously undescribed sequence in the variable region of 16S rRNA . These nine strains, all of which were isolated from respiratory tract specimens, were nonpigmented and grew at 25 degrees C to 45 degrees C, reaching full colony size after 2 to 3 weeks . They produced arylsulfatase, nicotinamidase, and pyrazinamidase and were negative for Tween 80 hydrolysis, catalase, urease, and nitrate reductase activities, and niacin . Their glycolipid patterns were identical . A mycolic acid analysis performed by using thin-layer chromatography showed that these organisms contained alpha-mycolates, ketomycolates, and carboxy mycolates . Gas-liquid chromatography revealed that 2-eicosanol was the major alcohol and hexacosanoic acid was the major mycolic acid cleavage product . On the basis of their growth, biochemical, and lipid characteristics and their unique 16S rRNA sequence, we propose that these organisms should be assigned to a new species, Mycobacterium branderi . Comparative 16S rRNA sequencing revealed that this new species is closely related to Mycobacterium celatum, Mycobacterium cookii, and Mycobacterium xenopi . Strains 52157T (T = type strain) and 43548 have been deposited in the American Type Culture Collection as strains ATCC 51789 and ATCC 51788, respectively.

Pathology, 1995 Jul, 27(3), 260 - 7
Selection and implementation of a laboratory computer system; Moritz VA et al.; The process of selection of a pathology computer system has become increasingly complex as there are an increasing number of facilities that must be provided and stringent performance requirements under heavy computing loads from both human users and machine inputs . Furthermore, the continuing advances in software and hardware technology provide more options and innovative new ways of tackling problems . These factors taken together pose a difficult and complex set of decisions and choices for the system analyst and designer . The selection process followed by the Microbiology Department at Heidelberg Repatriation Hospital included examination of existing systems, development of a functional specification followed by a formal tender process . The successful tenderer was then selected using predefined evaluation criteria . The successful tenderer was a software development company that developed and supplied a system based on a distributed network using a SUN computer as the main processor . The software was written using Informix running on the UNIX operating system . This represents one of the first microbiology systems developed using a commercial relational database and fourth generation language . The advantages of this approach are discussed.

J Clin Microbiol, 1995 Jul, 33(7), 1860 - 6
Molecular analysis of genes encoding outer surface protein C (OspC) of Borrelia burgdorferi sensu lato: relationship to ospA genotype and evidence of lateral gene exchange of ospC; Jauris-Heipke S et al.; It has been shown by analysis with monoclonal and polyclonal antibodies that outer surface protein C (OspC) of Borrelia burgdorferi sensu lato is highly heterogeneous . To determine if the heterogeneity has a genetic basis, the genes of 18 different B . burgdorferi sensu lato strains have been amplified by PCR, cloned, and sequenced . The ospC genes could be amplified from all strains tested, even from two strains which did not express OspC in detectable amounts . Among the 18 strains, 16 significantly different types of ospC sequences have been found . The sequence identities of the deduced amino acid sequences of different ospC genotypes range between 62 and 80% (determined without the leader peptide) . The sequences range between 62 and 80% (determined without the leader peptide) . The sequences correspond to one of the 13 OspC types distinguishable by analysis with monoclonal antibodies (B . Wilske, S . Jauris-Heipke, R . Lobentanzer, I . Pradel, V . Preac-Mursic, D . Roessler, E . Soutschek, and R . C . Johnson, J . Clin . Microbiol . 33:103-109, 1995) or represent additional types . Two completely new types were found, and OspC type 8 (which was found in Borrelia afzelii and Borrelia garinii) could be divided into two groups with different sequences but the same antibody pattern . Thus, strains belonging to different species or OspA serotypes were always significantly different in their ospC sequences . This was also confirmed by ospA sequence analysis . Interestingly, some strains of the same OspA serotype or genotype were very heterogeneous with respect to OspC, while others had nearly identical OspC proteins . Such groups of strains were found among B . burgdorferi sensu stricto, B . afzelii, and B . garinii strains . Cluster analysis of 5'-terminal and 3'-terminal stretches of ospC suggested recent intragenic recombination events in the ospC gene at least one B . afzelii strain . In addition, other recombination events between ancestors of strains belonging to the same or different species were evidenced by this type of analysis.

J Clin Microbiol, 1995 Jul, 33(7), 1716 - 9
Use of amplified fragment length polymorphism in molecular typing of Legionella pneumophila and application to epidemiological studies; Valsangiacomo C et al.; A novel method for molecular typing of organisms, amplified fragment length polymorphism analysis, was tested for its suitability in epidemiological studies in medical microbiology . Amplified fragment length polymorphism analysis, originally developed for typing crop plants, consists of a simple restriction-ligation reaction and a subsequent PCR amplification . In a single-step reaction, the genomic DNA is digested and the restriction fragments are ligated to specially constructed adapters . PCR amplification of such tagged restriction fragments with primers complementary to the adapters allows the detection of restriction fragment length polymorphisms upon resolution on agarose gels . The method is fast, efficient, and reproducible for typing strains of Legionella pneumophila isolated from both humans and the environment . The accuracy of the method was tested by comparison with standard restriction fragment length polymorphism typing performed with both a ribosomal and a genomic probe.

Br J Gen Pract, 1995 Jul, 45(396), 349 - 51
Diagnosis and management of cases of suspected dermatomycosis in The Netherlands: influence of general practice based potassium hydroxide testing; De Kock CA et al.; BACKGROUND . Microscopy of a potassium hydroxide preparation of skin scrapings or nail clippings, although widely advocated as a test for dermatomycosis, is used in only a small proportion of cases . AIM . This study set out to investigate the effect of potassium hydroxide testing on the subjectively assessed probability that a dermatomycosis was present . METHOD . The study was undertaken in 1992 in Limburg, a province in the south of the Netherlands . Ten general practitioners and eight trainees completed a questionnaire and performed a potassium hydroxide preparation for each patient presenting with a skin condition that they thought might be caused by dermatomycosis . Skin or nail material was also sent to a microbiology laboratory where another potassium hydroxide preparation as well as a culture were performed, these two tests serving as a gold standard against which to judge the potassium hydroxide preparation by the general practitioners . Data from a total of 164 cases were analysed . RESULTS . The results of the potassium hydroxide test carried out in the practice had a considerable influence on the subjectively assessed probability that a dermatomycosis was present, especially if the outcome was positive . The indication for antifungal treatment was altered as a result of the test in a quarter of all cases, mostly from negative to positive . Use of the practice potassium hydroxide test could increase the proportion of correct therapeutic decisions from 54% to 69%, with 20% of cases being undertreated . Of cases that gave a positive test result in the practice 83% also had a positive laboratory test result, while of cases that gave a negative practice result 43% were positive in the laboratory . CONCLUSION . The potassium hydroxide test improves the diagnostic process in cases of possible dermatomycosis and may result in a change in management . The test can provide a confirmation of the diagnosis of dermatomycosis but is not useful in the exclusion of this diagnosis.

J Bacteriol, 1995 Jul, 177(13), 3647 - 55
Nitrate repression of the Escherichia coli pfl operon is mediated by the dual sensors NarQ and NarX and the dual regulators NarL and NarP; Kaiser M et al.; The pfl operon is expressed at high levels anaerobically . Growth of Escherichia coli in the presence of nitrate or nitrite led to a 45% decrease in expression when cells were cultivated in rich medium . Nitrate repression, however, was significantly enhanced (sevenfold) when the cells were cultured in minimal medium . Regulation of pfl expression by nitrate was dependent on the NarL, NarP, NarQ, and NarX proteins but independent of FNR, ArcA, and integration host factor, which are additional regulators of pfl expression . Strains unable to synthesize any one of the NarL, NarP, NarQ, or NarX proteins, but retaining the capacity to synthesize the remaining three, exhibited essentially normal nitrate regulation . In contrast, narL narP and narX narQ double null mutants were devoid of nitrate regulation when cultured in rich medium but they retained some nitrate repression (1.3-fold) when grown in minimal medium . By using lacZ fusions, it was possible to localize the DNA sequences required to mediate nitrate repression to the pfl promoter-regulatory region . DNase I footprinting studies identified five potential binding sites for the wild-type NarL protein in the pfl promoter-regulatory region . Specific footprints were obtained only when NarL was phosphorylated with acetyl phosphate before the binding reaction was performed . Each of the protected regions contained at least one heptamer sequence which has been deduced from mutagenesis studies to be essential for NarL binding (K . Tyson, A . Bell, J . Cole, and S . Busby, Mol . Microbiol . 7:151-157, 1993).

Invest Ophthalmol Vis Sci, 1995 Jul, 36(8), 1477 - 91
A chlamydial major outer membrane protein extract as a trachoma vaccine candidate; Campos M et al.; PURPOSE . As shown in infected humans and in animal models of chlamydial infection, the major outer membrane protein (MOMP) of Chlamydia trachomatis is immunogenically potent . The purpose of this investigation was to test in the cynomolgus monkey model of trachoma a new extract of MOMP as a candidate vaccine against ocular chlamydial infection . METHOD . The nonionic detergent octyl-beta-D glucopyranoside (OGP) was used to extract MOMP from purified C . trachomatis (serovar C) elementary bodies . Protective immunization with OGP-MOMP by mucosal and systemic routes was compared in the cynomolgus monkey model of trachoma . All control and immunized monkeys were challenged by topical application of infectious C . trachomatis to the conjunctivae 35 days after the initiation of immunization . RESULTS . Immunization with OGP-extracted MOMP successfully induced chlamydia-specific local and systemic immunity to MOMP and to whole organism before challenge and early clearance of infection by systemically immunized monkeys . Although ocular disease was not significantly reduced in either immunized group compared to control animals, the lowest clinical and microbiologic disease scores developed in two animals in the mucosal group with the highest immunoglobulin A tear antibody titers at day 0 to 14, whereas higher tear and serum immunoglobulin G correlated with reduced disease in the systemically immunized group . CONCLUSIONS . These data demonstrate that despite evidence of vigorous MOMP-specific and other chlamydia-specific serologic and cell-mediated immunity, as well as anamnestic serologic responses to chlamydia, vaccination with OGP-MOMP was only partially protective against chlamydial ocular disease . The partial protection correlated best with tear immunoglobulin A responses after mucosal immunization and with local and systemic immunoglobulin G responses after peripheral immunization, suggesting that alternative chlamydial antigens may have to be considered in future vaccine development to induce more effective protective immunity and that evaluation of efficacy must be appropriate to route of immunization.

J Child Neurol, 1995 Jul, 10(4), 271 - 82
The diagnosis of congenital infections: contemporary strategies; Souza IE et al.; Congenital infections remain an important source of neurologic, ophthalmologic, and audiologic disability for thousands of children throughout the world . This review summarizes the clinical features and describes contemporary approaches to the microbiologic diagnosis of congenital infections . In particular, this review emphasizes the important roles that molecular methods, especially the polymerase chain reaction, have in detecting the many infectious agents capable of damaging the developing nervous system.

Int J Food Microbiol, 1995 Jul, 26(2), 199 - 218
Mathematics of predictive food microbiology; Baranyi J et al.; Commonly encountered problems related to modelling bacterial growth in food are analysed from a mathematical point of view . Modelling techniques and terms, some misused, are discussed and an attempt is made to clarify how, and under what conditions, they may be used . A theoretical framework is given to provide a basis in which mathematical models having been used in predictive microbiology can be embedded . By using several simplifying idealizations as a compromise between the complexity of the biological system and the available data, a practically usable model becomes available.

J Clin Pathol, 1995 Jul, 48(7), 667 - 9
Documentation of blood culture results; Howe RA et al.; AIMS--To evaluate the adequacy of documentation of blood culture results in patients' medical notes . METHODS--A pro-forma was completed following review of medical notes at 24 and 48 hours after a blood culture had been reported as positive . The study was performed on blood cultures received at the Department of Microbiology, Royal Hallamshire Hospital, Sheffield, from two local hospitals . Two periods were studied: (A) May to June 1993 and (B) September to October 1993 . RESULTS--There were 43 results studied in period A and 79 in period B, giving a total of 122 results studied . Overall, 72 (59%) of 122 results were recorded in the medical notes at 24 hours . Of those results deemed highly significant, 40 (63%) of 63 were recorded . There was no significant difference in the documentation of results if the result was given personally or via the telephone . Nor was there any difference in documentation between different medical grades . Throughout the study there were six inaccurate records . The cumulative documentation over 48 hours of positive results was 54 (86%) of 63 of highly significant, 27 (69%) of 39 of uncertain significance, and 11 (55%) of 20 probable contaminant results . CONCLUSIONS--Documentation of blood culture results is currently suboptimal.

Gesundheitswesen, 1995 Jul, 57(7), 411 - 5
{Blind alleys and misconceptions in public health}; Muller HE; The concept of hygiene was created in the 19th century although Hippocrates had already conceived an influence of atmosphere, soil and water on human health . The concept of a public health organisation, however, is a fairly recent one . Environmental and social hygiene were the two poles of the new discipline that focussed on public health . However, the ideologies of capitalism, communism and socialism as well as of social darwinism and "survival of the elite" discredited social hygiene . The decline of totalitarianism was associated with a "loss of face" of state-controlled medicine, including social hygiene . Both the post-World War II German constitution and the previous German statutory health insurance ordinance had blocked it, and hence, no Federal bill on public health was carried . The consequences of this disregard of public health are poor protection by vaccination, a gap in compulsory notification and in epidemics control and high rates of nosocomial infections . Absolutely no development of the science of epidemiology was possible whereas that of medical microbiology is choked by the system now in existence . There is a great misconception within individual hygiene by identifying it merely with cleanliness . Hygiene became a synonym for cleanliness, although that had evolved during a long cultural sociological process centuries before hygiene was established . The modern evolution of the science of hygiene shows the danger that emphasis on healthy lifestyles or on environmental protection may result in regulations and finally in a tyranny that may threaten the liberty of human rights . The so-called "principle of concern" is an example of such irrationality because there is no sensible proportion between risk and expense.

Curr Opin Rheumatol, 1995 Jul, 7(4), 290 - 8
Etiopathogenesis of reactive arthritis and ankylosing spondylitis; Careless DJ et al.; Advances in molecular biology have brought more refined techniques to the study of the structure and function of HLA molecules and the biology of arthritogenic bacteria . Site-directed mutations in HLA and bacterial genes have focused attention on amino acids that are playing a critical role in the dynamic interaction of host and pathogen . The role of HLA-B27 in conferring disease susceptibility is being evaluated in both human disease and in B27 transgenic animal models . The continued interchange between clinical research in the spondyloarthropathies and the in vitro systems analyzing the immunology and microbiology of these diseases has maintained a high level of interest in this field of arthritis research.

Adv Dent Res, 1995 Jul, 9(2), 125 - 6
Saliva stimulants and the oral health of geriatric patients; Makinen KK et al.; Root-surface caries (RSC) has been recognized as a specific and important dental disease . Significant advances have been made in the pathology and microbiology of RSC, and the need to standardize the guidelines for recording RSC data has been recognized . Researchers have emphasized the increasing impact RSC will have on the geriatric population, especially since the methods to treat and prevent this disease are limited . The purpose of this study was to investigate the possibility of limiting RSC in a Veterans Administration (VA) patient population, using polyol-containing saliva stimulants that were voluntarily consumed by residents of a VA Medical Center (VAMC) over a period of from six to 30 months . Another aim was to study the effect of this program on the gingival health of periodontal patients.

Vaccine, 1995 Jul, 13(10), 953 - 60
Isotype profiles induced in Balb/c mice during foot and mouth disease (FMD) virus infection or immunization with different FMD vaccine formulations; Perez Filgueira DM et al.; The IgG isotype response in Balb/c mice infected with FMDV or immunized with different vaccine formulations using inactivated virus particles as antigen was analyzed at various times post-inoculation . For this purpose an ELISA based on polyclonal antibodies for detection and quantification of mouse IgG isotypes with FMD virus (FMDV) specificity was developed . Three immunomodulators, which have been shown to be very effective in inducing strong and long-lasting antibody responses (Bahnemann, Arch . Virol . 1975, 47, 47-56; Polatnik and Bachrach, Appl . Microbiol . 1964, 12, 368-376), were employed to formulate different vaccines using aqueous and oil vehicles: a water-soluble fraction of the cell wall of Mycobacterium sp., a purified extract of lipopolysacharide from Brucella ovis and a synthetic lipoamide, Avridine . Infected animals between 14 and 60 days post-inoculation (d.p.i.) showed responses dominated by IgG2b, followed by IgG1, IgG2a and IgG3, respectively . The IgG3 isotype was the first, together with IgG1, to be elicited during the first 7 days after infection, whereas no IgG3 activity was detected in vaccinated animals at any time . With formulations including immunomodulators, persisting high levels of IgG2b (similar to those of infected animals) were detected until 180 d.p.i., while with conventional vaccines IgG2b responses were detected up to 60 d.p.i . Animals vaccinated with formulations including these immunomodulators presented an augmented resistance to viral challenge at 210 d.p.i . in relation with those immunized with conventional vaccines . The possible relationship of these differences in the isotype response and protection is discussed.

Rev Med Brux, 1995 Jul-Aug, 16(4), 216 - 7
{Fine-needle cytopuncture and/or microbiopsies}; Dagnelie J; When lesions cannot be clearly identified by sonography or mammography and if their images are clinically occult, their cytology or histology confirmation is required . Stereotactic biopsy allows an accurate locating of non palpable lesions, that are also invisible at sonography . The choice between a fine needle aspiration biopsy and core needle micro-biopsy depends upon local and technical possibilities but above all upon mammographic aspect of the lesion . When microcalcifications have to be identified both methods should be used.

Rev Med Brux, 1995 Jul-Aug, 16(4), 214 - 5
{Difficult diagnosis in breast cancer}; Baeyens L; A detailed senologic evaluation with complete clinical examination, (color Doppler) echography, comparative mammography and cytology or microbiopsy can avoid surgery in case of a post-traumatic fat necrosis, a Mondor Syndrome, an infectious mastitis or a ductal ecstasy with nipple discharge . Actually we have still difficulties to interpret non palpable breast lesions and to supervise operated and radiated breasts.

Presse Med, 1995 Jun 17, 24(22), 1021 - 4
{Prognosis of acute tuberculous respiratory distress syndrome . 4 cases}; Roger PM et al.; OBJECTIVES: We examined the characteristics of 4 cases of adult respiratory distress syndrome in patients with tuberculosis in an attempt to improve prognosis . METHODS: Four new cases of adult respiratory distress syndrome were described together with a review of the cases reported in the literature . Inclusion criteria were the presence of the syndrome as defined according to the American-European consensus conference and the criteria described by Murray et al . and identification of the mycobacteria causing tuberculosis . RESULTS: A total of 52 cases were included in the study . The sex ratio was 0.71 and mean age 46 +/- 15 years . Eight patients had a past history of pulmonary tuberculosis . Alcoholism was the primary immunodepression factor observed (35%) followed by human immunodeficiency virus infection (13%) . For 74% of the patients, the disease course lasted 7 days . The initial chest X-ray was suggestive of tuberculosis in 11 . Intradermoreaction to tuberculin was positive in 2 out of 17 patients . Direct examination of non-invasive respiratory samples was positive in 44% for mycobacteria . Disseminated tuberculosis was seen in 64% . Anti-tuberculosis antibiotherapy was started on the first day of intensive care in 68% of the patients; rapid treatment was associated with better prognosis: 1.5 +/- 1.2 days versus 3 +/- 2.7 in fatal cases (p = 0.02) . Adjuvant corticosteroid therapy was used in 46% of the cases and was apparently associated with unfavourable outcome: 74% mortality versus 58% without corticosteroids . Ventilatory assistance was required in 88% and associated with poor prognosis (13% survival versus 100% without assistance) (p < 10(-3)) . Outcome was fatal in 36 cases (70%) with a mean delay of 9.7 +/- 10.8 days . CONCLUSION: The conditions required for improving the prognosis of adult respiratory distress syndrome in tuberculosis patients included suspecting tuberculosis in all cases of acute respiratory failure of unknown origin, particularly in the immunodepressed patient, and to avoid missing this diagnosis in case of a non-suggestive chest X-ray and a negative though exhaustive microbiology search . Adjuvant corticotherapy is uneffective and may be dangerous.

Schweiz Med Wochenschr, 1995 Jun 3, 125(22), 1082 - 8
{Comparative study of preliminary and definitive anatomo-pathological diagnoses in 375 autopsies in adults}; Perren F et al.; For the past 5 years the institute of pathology of the University of Lausanne has been delivering both provisional and final autopsy reports . The provisional reports are based mainly upon macroscopic findings, whereas the final reports include the information provided by supplementary investigations such as microscopy, histochemistry, more rarely electron microscopy, immunohistochemistry and/or microbiology . The reliability and usefulness of the provisional reports were analyzed by systematic comparison between the provisional and final reports of 375 adult post-mortems as well as through an inquiry among requesting physicians . No significant difference was found between the two reports in 77.1% of the cases . In 22.1% the supplementary investigations provided information which had a bearing on the final diagnosis and made it possible to complete or correct the macroscopic diagnosis . In 0.8% the significant difference was due to the omission, in the provisional report, of an obvious macroscopic diagnosis . Finally, 95% of the consulted physicians found the provisional reports useful because of the precise written and particularly rapid information they provided . These results not only demonstrated that the establishment of such provisional reports is fully justified, but further emphasize the fundamental and complementary role played by the final autopsy reports.

Malays J Pathol, 1995 Jun, 17(1), 11 - 5
Comparative study of a non-radiometric BACTEC system and a conventional blood culture system in a clinical microbiology laboratory; Yew OF et al.; The BACTEC NR730 blood culture system is a commercially available system which utilizes infrared spectrophotometry to detect bacterial growth in broth media inoculated with the blood specimen . The objective of this study is to compare this system with the conventional system used in our laboratory . A total of 479 blood samples were collected from adult patients in the Klang TAR Hospital and inoculated simultaneously into the two systems . Clinically significant isolates were recovered from 59 (12.3%) specimens by one or both systems yielding a total of 65 isolates of which 41 isolates were recovered in both systems, 18 in BACTEC only and 6 in the conventional system (P < 0.01) . Of the 40 (8.3%) blood cultures that were judged as contaminated, 2 were found in both systems, 12 in the BACTEC only and 26 in the conventional system . After 48 hours (day 2) the BACTEC system had recovered 93.2% of the total significant isolates while the conventional system recovered 61.7% only . Our results showed that the BACTEC system yielded more significant isolates in a shorter time and with a lower incidence of contamination as compared to the conventional system.

Braz J Med Biol Res, 1995 Jun, 28(6), 693 - 8
The diameter of water pores formed by colicin Ia in planar lipid bilayers; Krasilnikov OV et al.; The effective size of colicin Ia channel was tested by a recently described method (FEMS, Microbiology and Immunology (1992) . 105: 93-100) in which the nonelectrolyte molecules with different hydrodynamic diameters (0.52 to 5.0 nm) were used as molecular tools . We have shown that despite low conductance (55-105 pS at 1.5 M KCl, pH 7.0) the ion channels formed by colicin Ia have a fairly large water pore diameter equal to 1.66-1.88 nm . The results are discussed in terms of an energetic barrier for ions passing into the channel lumen.

Chest, 1995 Jun, 107(6), 1689 - 97
Intravenacaval membrane oxygenation and carbon dioxide removal in severe acute respiratory failure; Conrad SA et al.; STUDY OBJECTIVE: To characterize the physiologic response to, and safety of, intravenacaval membrane oxygenation and carbon dioxide removal . DESIGN: Interventional before-after study . SETTING: University teaching hospital ICU . PATIENTS: Twenty-two patients with severe acute respiratory distress syndrome (ARDS) . INTERVENTIONS: Implantation of a hollow-fiber membrane oxygenator (IVOX; CardioPulmonics; Salt Lake City, Utah) into the superior and inferior venae cavae by venotomy of the right femoral or right internal jugular vein for a duration of up to 20 days . MEASUREMENTS: Hemodynamic measurements using pulmonary artery and systemic artery catheters, ventilator settings (FIO2, minute ventilation, peak inspiratory pressure, and positive end-expiratory pressure), arterial and mixed venous blood gases (pH, PCO2, PO2, and measured saturation), and clinical laboratory determinations (CBC, fibrinogen, plasma hemoglobin, complement C3 and C5) were obtained . Calculations of PaO2/FIO2 ratio and PaCO2-VE product were used to assess gas exchange efficacy . Microbiologic cultures were obtained from the device and wound following explantation . Survival to ICU discharge and hospital discharge were recorded . RESULTS: Implantation was successful in 20 of 22 patients . Gas exchange rates averaged 50.4 +/- 15.8 mL.min-1 for carbon dioxide and 71.1 +/- 20.2 mL.min-1 for oxygen . A reduction in FIO2 from 0.78 +/- 0.16 to 0.63 +/- 0.21 and in VE from 177 +/- 94 mL.kg-1.min-1 to 127 +/- 58 mL.kg-1.min-1 was possible within 4 h post-implantation . By 12 h, FIO2 was reduced to 0.57 +/- 0.18 . Indices of gas exchange improved significantly after implantation, with PaO2/FIO2 ratio increasing from 79 +/- 20 to 112 +/- 47 and PaCO2-VE product decreasing from 7.6 +/- 4.2 to 4.9 +/- 2.5 within 4 h . A significant reduction in peak inspiratory pressure was achieved (45 +/- 10 to 38 +/- 9 cm H2O) . Major complications were blood loss during implantation requiring transfusion in 11 patients, a retroperitoneal bleed in 1 patient, and femoral deep venous thrombosis in 4 patients, but there were no long-term sequelae or IVOX-related deaths . The ICU and hospital survival were 10/20 (50%) and 8/20 (40%), respectively . CONCLUSIONS: Intravenacaval membrane oxygen and carbon dioxide removal can provide partial respiratory support during severe respiratory failure and permit reductions in the level of mechanical ventilator support, with an acceptable safety profile.

J Bacteriol, 1995 Jun, 177(12), 3370 - 8
The proline-rich P65 protein of Mycoplasma pneumoniae is a component of the Triton X-100-insoluble fraction and exhibits size polymorphism in the strains M129 and FH; Proft T et al.; Previously, we described the identification of a novel Mycoplasma pneumoniae M129 protein, named P65 because of its apparent molecular mass of 65 kDa estimated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (T . Proft and R . Herrmann, Mol . Microbiol . 13:337-348, 1994) . DNA sequence analysis of the P65 open reading frame (orfp65), however, revealed an ORF encoding a protein with a molecular weight of 47,034 . This discrepancy can be explained by the unusual amino acid composition of this protein . According to the deduced amino acid sequence, the N-terminal half of P65 contains several penta- and hexapeptides (DPNAY and DPNQAY) forming a proline-rich acidic domain . Secondary-structure predictions indicated beta-sheets and turns within that region, suggesting an extended and rigid conformation . Near the C terminus of P65 the tripeptide Arg-Gly-Asp (RGD) was found . This motif is known to play an important role in binding of extracellular matrix proteins to integrins . P65 could be located exclusively to the Triton X-100-insoluble cell fraction . The results of immunofluorescence microscopy and of immunoadsorption experiments indicated that P65 carries surface-exposed regions . Mild treatment of whole cells with proteases resulted in cleavage of a limited amount of P65 molecules, suggesting either that only a small percentage of P65 molecules are exposed on the surface or that protease cleavage is hampered by a compact protein conformation or by binding of an unknown component to P65 . P65 exhibits size polymorphism in M . pneumoniae M129 and FH . This is caused by an intragenetic duplication of a 54-bp sequence within the FH orfp65 . As a consequence, the number of DPNAY pentapeptides increased from 9 to 12 repeats in the FH strain.

Am J Respir Crit Care Med, 1995 Jun, 151(6), 1878 - 88
Diagnostic tests for pneumonia in ventilated patients: prospective evaluation of diagnostic accuracy using histology as a diagnostic gold standard; Marquette CH et al.; The diagnostic accuracy of protected-specimen brush (PSB), bronchoalveolar lavage (BAL), and endotracheal aspirates (EA) was prospectively evaluated in a series of 28 mechanically ventilated patients (MV patients) who died within 3 d of the bronchoscopic procedure, using postmortem lung examination as the gold standard for establishing the diagnosis of pneumonia . The entire fixed lungs were carefully dissected along the bronchovascular axes and each segment was cut into 5- to 10-mm thick sections, enabling gross examination of the lung parenchyma . Two tissue blocks were taken from each segment, including grossly abnormal areas whenever present . In several cases, two peripheral (subpleural) lung-tissue blocks were also taken from each lobe prior to systematic dissection of the lungs . Quantitative cultures (QC) and direct cytologic and microbiologic examination (DE) was performed on respiratory samples obtained within 72 h before death . Values of 10(3) cfu/ml of Ringer's solution, 10(4) cfu/ml of retrieved fluid, and 10(6) cfu/ml of respiratory secretions were used as cutoff points for quantitative PSB, BAL, and EA cultures, respectively . The main findings in this study were that: (1) Pneumonia was present in 67% of the patients . (2) Histologic lesions of pneumonia were mainly bilateral and predominated in the dependent lung segments . (3) Coexistence of a variety of noninfectious processes was a common finding in patients with pneumonia . (4) In several cases pneumonia was absent from peripheral lung samples while more central areas of the same segment displayed typical foci of pneumonia . (5) The sensitivity of quantitative cultures was 55%, 57%, and 47% for EA, PSB, and BAL, respectively, and the specificity was 85%, 88%, and 100%, respectively . Reducing the diagnostic threshold of EA to 10(5) cfu/ml of respiratory secretions instead of 10(6) cfu/ml resulted in a sensitivity of 63.1% and a specificity of 75% for EA . The sensitivity of direct examination (DE) was 50%, 47%, and 47%, respectively, and the specificity was 75%, 88%, and 87% . (6) The presence of intracellular organisms (ICO) in BAL had a 36.8% sensitivity and 100% specificity in establishing the diagnosis of pneumonia regardless of their percentage . (7) Although 15 patients (53%) were not on antibiotics or were off antibiotics for more than 48 h before testing, no relationship could be established between the patients' antibiotic status and the result of any diagnostic test . By using a recommended methodology for respiratory sampling techniques together with complete postmortem lung examination as a diagnostic "gold standard," this study provides a realistic insight into the diagnostic values of EA, PSB, and BAL in MV patients with suspected pneumonia.

Clin Lab Med, 1995 Jun, 15(2), 437 - 46
Strategies for quality management in clinical microbiology; Schifman RB; Quality assessment and performance improvement are important management functions that add value to information and services produced by the clinical microbiology laboratory . Analytical quality control procedures are well standardized, and in many cases regulated . Whereas preanalytical and postanalytical factors have considerable impact on quality, performance assessment and improvement in this area have received less consideration . This article describes an approach to quality management of the total testing process in clinical microbiology, including interdisciplinary participation, specimen quality, test use, result use, turnaround time, information quality, user perceptions, and benchmarking.

Clin Lab Med, 1995 Jun, 15(2), 407 - 31
The use of molecular techniques in the epidemiology and control of infectious diseases; Sader HS et al.; The ability to identify specific strains within a given species of pathogen is an important aid in the rational development of effective measures to prevent and control nosocomial infections . The efforts of both microbiologist and hospital epidemiologic are facilitated greatly by the availability of the newer molecular epidemiologic typing techniques . Although these methods clearly have limitations, they generally are a significant improvement over the more conventional typing methods, many of which are too cumbersome, insensitive, and time-consuming to be of practical value for epidemiologic evaluations . Based on current experience, the molecular typing methods that appear to be the most practical and useful for both large and small scale epidemiologic studies are the DNA-based methods of REAP and PFGE . Many questions remain concerning the appropriate role of molecular typing methods in the clinical microbiology laboratory . Often, molecular typing may be performed more efficiently in a reference laboratory . In contrast, selected methods such as plasmid analysis are well within the scope of clinical microbiology laboratories and may be an important adjunct to the hospital infection control effort . Given the limitations of the available methods and the complex nature of patients at risk for nosocomial infections, it is imperative that these methods be employed with clear epidemiologic objectives in mind . Typing should always include unrelated as well as epidemiologically related isolates and, whenever possible, all organisms should be typed under identical conditions, preferably within the same test run . In addition, results are most effectively used to supplement rather than to replace hypotheses and questions thoughtfully developed by the clinician or epidemiologist . Ideally, typing is performed independently by the laboratory to avoid bias, but the results are applied collaboratively to ensure that both the potential insights and the unavoidable ambiguities presented by the results are clearly appreciated . Additional studies based upon sound epidemiologic principles will help clarify the role of the various molecular typing methods as epidemiologic markers and advance our understanding of the epidemiology of nosocomial infections.

Clin Lab Med, 1995 Jun, 15(2), 365 - 87
New aspects of emerging fungal pathogens . A multifaceted challenge; Schell WA; This article describes adventitious morphologic forms for species of Fusarium, Paecilomyces, Acremonium, and Scedosporium that can be easily mistaken on histologic, cytologic, and microbiologic examination for Candida species . These forms appear to be correlated with, and may provide explanation for, positive blood cultures in disseminated infections with these species . Adventitious histologic forms also are illustrated for Blastoschizomyces capitatus . Data from culture-proven mycoses for a 15-month period at one medical center are reviewed, and species are listed for which an increase is anticipated . These and other aspects of emerging fungal pathogens are related to the need for strengthened support of mycology training and for federal funding of a mycoses reporting program.

Clin Lab Med, 1995 Jun, 15(2), 251 - 78
Fine-needle aspiration and surgical pathology of infectious lesions . Morphologic features and the role of the clinical microbiology laboratory for rapid diagnosis; Silverman JF et al.; There has been a renewed interest in the use of imprint smears at the time of frozen section in surgical pathology and FNA biopsy for the diagnosis of infectious disease because of the increasing need for rapid diagnosis of opportunistic infections in immunocompromised patients . Moreover, the use of FNA biopsy for the evaluation of superficial and deep masses has become more widespread . The critical step in the FNA biopsy and in evaluation of imprint smears from surgical specimens is immediate interpretation of the slides that have been stained by rapid methods as the Diff-Quik technique . This quick interpretation can identify as infectious case that may need ancillary studies such as a separate pass or more tissue for microbiologic examination and special stains on the aspirated smears, sections, or cell block . An infectious case may be suspected when the basic cytologic inflammatory patterns are identified including acute inflammation, chronic inflammation, granulomatous inflammation, or necrosis . There have been numerous reports describing the cytomorphologic features of several organisms seen in FNA and tissue specimens . The pathologist also needs to be aware of the potential for a false-negative diagnosis of neoplasms in those lesions having a prominent inflammatory component as well as the potential for false-positive diagnosis of malignancy when inflammatory atypia and a repair reaction is present . The interaction of anatomic pathologists and clinical microbiologists is essential for appropriate workup of specimens with an infectious disease etiology . Thus, pathologists need to be well versed in both the anatomic and clinical pathology features of infectious diseases . Finally, those involved with FNA biopsy and handling of surgical pathology specimens should use universal precautions, since all patients are potentially infectious with the HIV virus and other communicable agents.

J Clin Pathol, 1995 Jun, 48(6), 560 - 3
Internal audit in a microbiology laboratory; Mifsud AJ et al.; AIM--To set up a programme of internal laboratory audit in a medical microbiology laboratory . METHODS--A model of laboratory based process audit is described . Laboratory activities were examined in turn by specimen type . Standards were set using laboratory standard operating procedures; practice was observed using a purpose designed questionnaire and the data were analysed by computer; performance was assessed at laboratory audit meetings; and the audit circle was closed by re-auditing topics after an interval . RESULTS--Improvements in performance scores (objective measures) and in staff morale (subjective impression) were observed . CONCLUSIONS--This model of process audit could be applied, with amendments to take local practice into account, in any microbiology laboratory.

Enferm Infecc Microbiol Clin, 1995 Jun-Jul, 13(6), 338 - 44
{10 years of literature on AIDS (1983-1992): bibliometric analysis}; Aleixandre R et al.; BACKGROUND: Reasons for the quantitative study of the Spanish publications on AIDS are both the huge volume attained by the printed material on the subject since the first case was described in 1981 by the Center for Disease Control, and the high incidence of the cases reported on this disease . METHODOLOGY: Searches have been performed on the subject through the database of the Indice Medico Espanol (IME), the Indice Espanol de Ciencia y Technologia (ICYT), the ISBN and Bibliografia Espanola in order to retrieve all possible Spanish journal papers' and books . The references were distributed using criteria of documentary tipology, publication date, institutions involved, autonomous communities, and, finally, after its relation with the confirmed cases of AIDS . RESULTS: A total 2,013 items have been retrieved, 1,821 journal papers' and 192 books . More than 50% of the papers are published only by five journals, being 139 the total number of journals able to carry pertinent information . The most productive journals were Medicina Clinica and Enfermedades Infecciosas y Microbiologia Clinica . CONCLUSIONS: The results confirm exponential growth of the publications from 1983, the first year when a paper was published on AIDS in Spain . The grow is similar to the tend observed in other countries . Parallelism has been detected between growth in the number of publications and in the number of journals publishing on the subject, the growth in the number of journals publishing on the subject, the growth in the number of institutions which collaborate and the growing tend of reported cases in Spain . The results of the bibliometric study, showing an epidemiological growth out of comparison in the history of the scientific literature, could be useful both to information scientists, and to the research inside this scientific field.

J Clin Microbiol, 1995 Jun, 33(6), 1640 - 2
Enhancement of the Brucella AMOS PCR assay for differentiation of Brucella abortus vaccine strains S19 and RB51; Bricker BJ et al.; Because the brucellosis eradication program uses slaughter and quarantine as control measures, it would benefit from faster methods of bacterial identification . Distinguishing vaccine strains from strains that cause infections among vaccinated herds in the field is essential . To accomplish this, our PCR-based, species-specific assay (B . J . Bricker and S . M . Halling, J . Clin . Microbiol . 32:2660-2666, 1994) was updated to identify Brucella abortus vaccine strains S19 and RB51 . Three new oligonucleotide primers were added to the five-primer multiplex Brucella AMOS PCR assay . Identification is based on the number and sizes of six products amplified by PCR.

Radiol Med (Torino), 1995 Jun, 89(6), 831 - 4
{Percutaneous vertebral biopsy . Assessment of results}; Bernardi L et al.; The results were reviewed of 81 percutaneous trephine biopsies performed under fluoroscopic or CT guidance from January, 1989, to August, 1994, in 78 patients with thoracic or lumbar vertebral lesions . All the patients presented abnormal findings at conventional radiography and questionable CT or MR findings . A fine-needle sample was obtained as a complementary tool in 9 patients and material for microbiologic culture in 5 patients . Clinical and pathologic findings were correlated for each patient . Biopsy always permitted to obtain sufficient material for the histologic examination; its overall accuracy was 91% . The technique exhibited the highest diagnostic sensitivity in vertebral tumors (100%) and the lowest sensitivity in vertebral infections (69%) . Complementary fine-needle sampling was useful especially in small osteolytic lesions, while the microbiologic examination was often negative . There was only one pneumothorax due to the maneuver . To conclude, percutaneous trephine biopsy of thoracic and lumbar spine lesions is a valuable tool for tumor diagnosis which usually spares the patients open surgery.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1995 Jun, 79(6), 705 - 9
Helicobacter pylori in the oral cavity . A critical review of the literature; Nguyen AM et al.; Helicobacter pylori is now generally accepted as a key etiologic agent in peptic ulcer disease as well as in gastric cancer . Dental plaque has been implicated as a possible source of H . pylori by studies that used culture, biochemical, nucleic acid, and immunologic analyses . Variation in the sensitivities of detection by these different reported assays may reflect the methods used, technical difficulties, microbiota complexes, geographic distribution, and host response . The finding of H . pylori in dental plaque also suggested that dental workers may be at increased risk of acquiring H . pylori infection from occupational exposure . We review the available data concerning the presence of this important pathogen in the oral cavity and its potential to be acquired by dental workers . Knowledge of this organism's route of transmission may aid in the development of therapeutic procedures to stop its potential spread.

Nippon Hinyokika Gakkai Zasshi, 1995 Jun, 86(6), 1137 - 41
{Clinical study on Fournier's gangrene--value of "through and through drainage"}; Watanabe S et al.; From 1991 to 1994, we experienced 5 patients with Fournier's gangrene . Their age, associated diseases, etiology, area of the disease, microbiologic findings, treatment and prognosis were reviewed . Patient age ranged from 25 to 72 years, with a mean age of 47 years . An associated disease process could be identified in all patients . Two patients had diabetes mellitus, 1 systemic lupus erythematosus, 1 chronic alcoholism and 1 multiple myeloma . The etiology of the infectious process was presumed to be wound infection in 2 patients and indwelling urethral catheter in 2 patients . All patients were treated with broad-spectrum antibiotics . Extensive debridement with later skin graft was done in 2 patients . Multiple Penrose-drains were placed subcutaneously after limited removal of necrotic tissue in 3 patients . In these 3 patients, redness and swelling reduced quickly, the wound was cured without defects of skin except 1 patient who had multiple myeloma and was in a very serious condition . Although inflammation reduced after the placement of drains, the patient with multiple myeloma died of sepsis and DIC . The majority of patients with Fournier's gangrene are immunocompromised . Although extensive debridement is commonly performed as the surgical treatment, defects of the skin seem to have some disadvantages, such as the need for the skin graft and the chance of secondary wound infection . In the narrow excision of necrotic tissue and drainage of involved areas by multiple Penrose-drains, skin defects are minimum, and the effectiveness of the surgical management seems to be competitive with the wide debridement.(ABSTRACT TRUNCATED AT 250 WORDS)

Eur J Clin Microbiol Infect Dis, 1995 Jun, 14(6), 549 - 52
Use of a commercial PCR kit for detection of hepatitis C virus; Seme K et al.; To evaluate the usefulness of a recently developed standardised reverse transcription polymerase chain reaction (PCR) kit for detection of hepatitis C virus RNA (Amplicor HCV Test, Roche Molecular Systems), a total of 322 serum samples were examined and compared to an in-house nested PCR . Seventy-nine samples were found positive and 237 samples negative by both methods . Five sera were reactive by the commercial test only, and one was reactive by the nested PCR only . It was concluded that the commercial HCV test had comparable sensitivity and specificity to the in-house nested PCR . However, the commercial HCV test was more rapid and easier to perform than nested PCR and is thus more appropriate for use in a diagnostic microbiology laboratory.

Antimicrob Agents Chemother, 1995 Jun, 39(6), 1320 - 3
New semisynthetic pneumocandins with improved efficacies against Pneumocystis carinii in the rat; Schmatz DM et al.; A new series of semisynthetic, water-soluble pneumocandin analogs has been found to be extremely potent against Pneumocystis carinii in an immunocompromised-rat model . These compounds are 5 to 10 times more potent than the parent natural product, pneumocandin B0 (L-688,786) (R . E . Schwartz et al., J . Antibiot . 45:1853-1866, 1992), and > 100 times more potent than cilofungin . One compound in particular, L-733,560, had a 90% effective dose against P . carinii cysts of 0.01 mg/kg of body weight when delivered parenterally (subcutaneously, twice daily for 4 days) . This compound was also effective when given orally for the treatment and prevention of P . carinii pneumonia . For treating acute P . carinii pneumonia, oral doses of 2.2 mg/kg twice daily for 4 days were required to eliminate 90% of the cysts . A once-daily oral prophylactic dose of 2.2 mg/kg prevented cyst development, and a dose of 6.2 mg/kg prevented any development of P . carinii organisms (cysts and trophozoites), as determined through the use of a P . carinii-specific DNA probe (P . A . Liberator et al., J . Clin . Microbiol . 30:2968-2974, 1992) . These results demonstrate that the antipneumocystis activities of the pneumocandins can be significantly improved through synthetic modification . Several of these compounds are also extremely effective against candidiasis (K . Bartizal et al., Antimicrob . Agents Chemother . 39:1070-1076, 1995) and aspergillosis (G . K . Abruzzo et al., Antimicrob . Agents Chemother . 39:860-894, 1995) in murine models, making them attractive as broad-spectrum antifungal agents.

J Hosp Infect, 1995 Jun, 30 Suppl, 107 - 15
Staff compliance with infection control practices: application of behavioural sciences; Seto WH; Microbiology and epidemiology have made significant contributions to the field of Infection Control . Most nosocomial infections which can be prevented are related to inappropriate patient care practices . However, it is extremely difficult to implement new infection control policies . To achieve staff compliance, infection control should learn from the behavioural sciences . Three related fields have been shown to be helpful in this respect: social psychology, consumer behaviour and organizational behaviour . Basic concepts from all three fields can be applied to the work of infection control for achieving staff compliance; the use of social power and the reasoned action model from the field of social psychology; the use of participatory decision-making from organizational behaviour; and the opinion leaders from consumer behaviour.

Mol Cell Probes, 1995 Jun, 9(3), 145 - 56
Nucleic acid detection using non-radioactive labelling methods; Mansfield ES et al.; Nucleic acid probe-based assays are now widely used in genetic research, human identification, forensics and in a broad spectrum of clinical assays in the fields of microbiology, haematology/oncology and virology . Labelled probes are used in a variety of assay formats including dot-blots, Southern blots (DNA target), Northern blots (RNA target), Western blots (protein target), in situ hybridization, plaque or colony screening and immobilized arrays on silicon or glass surfaces . Traditionally, the probes used in these assays have a radioactive 32phosphorous label that has a short shelf-life, is dangerous, has high disposal costs and, when labelled to high specific-activity, may be unstable . Extensive efforts to develop alternative labelling techniques have resulted in colorimetric, chemiluminescent and fluorescent assay formats . This review summarizes the properties desired in a probe, describes the advantages and disadvantages of the different non-radioactive labelling strategies, and illustrates examples of probe-based assays in which detection is facilitated by imaging samples using a general purpose fluorescence scanner.

Gene, 1995 May 19, 157(1-2), 97 - 8
Overproduction of His-tagged EcoRII restriction endonuclease and terminally deleted mutant proteins; Kupper D et al.; EcoRII was the first restriction endonuclease (ENase) reported requiring the cooperative interaction with at least two DNA sites for activity . Using two different expression systems the enzyme could be purified and its special substrate requirements were further analyzed . At the present state of knowledge we suggest a model of simultaneous binding of two DNA sites to one dimeric enzyme molecule (see Kruger et al., FEMS Microbiol . Rev . (1995) in press).

Nurs Stand, 1995 May 31-Jun 6, 9(36), 35 - 8
Infection control: a survey to determine knowledge of nurses in a clinical setting; Gould D; This study set out to discover whether nurses with an understanding of the theoretical principles of microbiology know more about the clinical aspects of infection control than those without . Two vignettes were developed depicting typical situations . They were presented to 130 nurses in intensive care, surgical or medical units in two similar hospitals, one with updated guidance and one without . Results showed that most subjects would not perform optimally in the everyday situations depicted, nor would they have sufficient knowledge of microbiology to understand the theoretical principles underpinning infection control.

Compend Contin Educ Dent, 1995 May, 16(5), 448 - 55; quiz 456
Treating periodontal diseases with tetracycline-impregnated fibers: data and controversies; Greenstein G; This article addresses the use of tetracycline-impregnated fibers in the treatment of periodontal diseases . Clinical and microbiologic data are reviewed to provide pragmatic guidelines for fiber use . In addition, controversial issues associated with the labeling of Actisite, the potential of developing antibiotic-resistant strains, and the benefits of systemic vs local drug delivery are discussed . Ultimately, the article concludes that tetracycline-impregnated fibers can be used as an adjunct to scaling and root planing in certain patients at sites that do not respond to conventional therapy.

Vet Med (Praha), 1995 May, 40(5), 151 - 5
{The NEFERM-Test for identification of psychrotrophic bacteria in food}; Urbanova E et al.; Identification of gramnegative nonfermentative bacteria by traditional methods requires much labor and time consumption . Therefore in this study we tested the use of an available commercial diagnostic kit and processing of its results by computerized numerical identification systems . Identification involved 83 gramnegative, psychotrophic, nonfermentative, oxidase-positive bacteria isolated from just slaughtered and deep-frozen chickens . The strains were isolated from primary cultures in Psedomonas F and Endo agar, Violet Red Bile agar (IMUNA, OXOID) and King B agar (King et al., 1954), under two cultivation regimes (room temperature for three days and 7 degrees C for 10 days) . A commercial kit for diagnostics of nonfermentative bacteria in clinical microbiology under the name NEFERM-test (Lachema a.s., Brno) containing 12 biochemical assays was used for strain identification: GLU, AGR, IND, ESL, SCI, PHS, URE, MAN, XYL, MLT, LAC, NIT . All these assays were conducted parallelly by traditional methods . Additional tests involved the use of OXI and ONPG commercial strips (Lachema a.s., Brno), gelatin and Tween 80 hydrolysis (Pacova and Kocur, 1984) and fluorescein production (King et al., 1954) . These identification systems were used to process the results of tests; index and differentiation table (Lachema a.s., Brno) and numerical computerized systems TNW (Czech Collection (Z . Svoboda, Jihlava) . Various shortened procedures, identification keys and systems are used to speed up identification of gramnegative nonfermentative bacteria . Available commercial identification kits (API NE20) in form of microassay have been developed particularly for diagnostics of bacteria from clinica materials, which applies to NEFERM-test of the Czech make.(ABSTRACT TRUNCATED AT 250 WORDS)

Am J Obstet Gynecol, 1995 May, 172(5), 1427 - 35
Assessment of fetal activity and amniotic fluid volume in the prediction of intrauterine infection in preterm prelabor amniorrhexis; Carroll SG et al.; OBJECTIVE: Our purpose was to assess fetal activity, fetal heart rate patterns, and amniotic fluid volume in the prediction of intrauterine infection in pregnancies complicated by preterm prelabor amniorrhexis . STUDY DESIGN: A prospective study was performed on 89 patients with preterm prelabor amniorrhexis undergoing fetal blood and amniotic fluid sampling for microbiologic investigations . Within 2 hours before cordocentesis and amniocentesis, computerized fetal heart rate monitoring was carried out and ultrasonographic examination was performed for assessment of biophysical profile and amniotic fluid volume . RESULTS: In the pregnancies with microbiologic evidence of intrauterine infection compared with those with no infection, there was a tendency for a lower biophysical profile score and amniotic fluid index and an increased fetal heart rate . However, in the majority of pregnancies with positive amniotic fluid or fetal blood cultures the results of the various tests were normal . CONCLUSION: In pregnancies complicated by preterm prelabor amniorrhexis assessment of fetal activity and amniotic fluid volume do not provide useful prediction of intrauterine infection.

J Bacteriol, 1995 May, 177(10), 2870 - 7
Integrative and free Spiroplasma citri oriC plasmids: expression of the Spiroplasma phoeniceum spiralin in Spiroplasma citri; Renaudin J et al.; The replication region (oriC) of the Spiroplasma citri chromosome has been recently sequenced, and a 2-kbp DNA fragment was characterized as an autonomously replicating sequence (F . Ye, J . Renaudin, J . M . Bove, and F . Laigret, Curr . Microbiol . 29:23-29, 1994) . In the present studies, we have combined this DNA fragment, containing the dnaA gene and the flanking dnaA boxes, with a ColE1-derived Escherichia coli replicon and the Tet M determinant, which confers resistance to tetracycline . The recombinant plasmid, named pBOT1, was introduced into S . citri cells, in which it replicated . Plasmid pBOT1 was shuttled from E . coli to S . citri and back to E . coli . In S . citri, replication of pBOT1 did not require the presence of a functional dnaA gene on the plasmid . However, the dnaA box region downstream of the dnaA gene was essential . Upon passaging of the S . citri transformants, the plasmid integrated into the spiroplasmal host chromosome by recombination at the replication origin . The integration process led to duplication of the oriC sequences . In contrast to the integrative pBOT1, plasmid pOT1, which does not contain the E . coli replicon, was stably maintained as a free extrachromosomal element . Plasmid pOT1 was used as a vector to introduce into S . citri the G fragment of the cytadhesin P1 gene of Mycoplasma pneumoniae and the spiralin gene of Spiroplasma phoeniceum . The recombinant plasmids, pOTPG with the G fragment and pOTPS with the spiralin gene, were stably maintained in spiroplasmal transformants . Expression of the heterologous S . phoeniceum spiralin in S . citri was demonstrated by Western immunoblotting.

J Bacteriol, 1995 May, 177(10), 2673 - 8
Isolation of a novel paraquat-inducible (pqi) gene regulated by the soxRS locus in Escherichia coli; Koh YS et al.; We have isolated promoters inducible by paraquat, a superoxide radical-generating agent, from Escherichia coli, using promoter-probing plasmid pJAC4 (Y.S . Koh and J.H . Roe, Korean J . Microbiol . 31:267-273, 1993) . One promoter clone pqi-5 (pqi denotes paraquat-inducible gene) was mapped at 21.8 min on the E . coli chromosome by using the Kohara phage library . We constructed an operon fusion of the lacZ gene with the pqi-5 promoter to monitor the expression of the gene in the single-copy state . LacZ expression was induced about 7- to 13-fold by 77 to 780 microM paraquat . Other known superoxide generators such as menadione, phenazine methosulfate, and plumbagin also induced the expression of beta-galactosidase in this fusion strain . On the other hand, no significant induction was observed with treatment with hydrogen peroxide, ethanol, and heat shock . Induction of beta-galactosidase was significantly reduced by introducing a delta sox-8::cat or soxS3::Tn10 mutation into the fusion strain, indicating that pqi-5 is a member of the soxRS regulon . A DNA fragment containing the pqi-5 promoter was cloned and sequenced from the Kohara phage E2E5 . We identified two pqi-5 open reading frames (ORFs); ORF-A encodes a predicted protein of 342 amino acids, and ORF-B is truncated at the cloning site . The transcription start site from the pqi-5 promoter was determined by primer extension and S1 nuclease protection analyses . Northern (RNA) and S1 analyses indicated that there are two kinds of pqi-5 transcript; one covers ORF-A only and the other covers ORF-A and possibly also ORF-B.

Infect Immun, 1995 May, 63(5), 1933 - 9
Identification and characterization of a surface-exposed, 66-kilodalton protein from Borrelia burgdorferi; Probert WS et al.; The surface-exposed antigens of Borrelia burgdorferi represent important targets for the development of a protective immune response . We have identified a proteinase K-accessible, 66-kDa protein from B . burgdorferi and have demonstrated that at least a portion of this protein is surface exposed . The 66-kDa protein was purified by sequential extraction of spirochetes with butanol and Triton X-114 followed by preparative gel electrophoresis . Polyclonal antibodies developed against the purified 66-kDa protein were Borrelia spp . specific, whereas a monoclonal antibody, Route 66, displayed a genospecies-specific pattern of recognition for the 66-kDa protein . N-terminal amino acid sequence was obtained from an internal fragment, a truncated version, and the full-length form of the 66-kDa protein . A search of protein and gene databases for homologous sequences yielded a match with the predicted amino acid sequence from a segment of B . burgdorferi chromosomal DNA (P . A . Rosa, D . Hogan, and T . G . Schwan, J . Clin . Microbiol . 29:524-532, 1991) . The construction of primers based on this DNA sequence and the N-terminal amino acid sequence allowed the amplification and cloning of the 66-kDa-protein gene . The identity of the cloned gene was verified by the recognition of the expressed gene product by Route 66 . Pulsed-field gel electrophoresis and Southern blot analysis were performed to confirm the chromosomal location of the 66-kDa-protein gene . This study describes the identification and cloning of the first chromosomally encoded, surface-exposed protein from B . burgdoferi.

J Small Anim Pract, 1995 May, 36(5), 201 - 6
Investigating uterine disease in the bitch: uterine cannulation for cytology, microbiology and hysteroscopy; Watts JR et al.; A technique for transcervical cannulation of the uterus of the bitch for the collection of samples for cytology and microbiology was developed . This technique involved passing a cannula into the uterus with the aid of an endoscope . The uterus was cannulated successfully in mature bitches (over 10 kg) 110 times in 144 attempts . Success of cannulation was influenced by the experience of the operator and ease of cannulation by the stage of the reproductive cycle, the size of the bitch and the type of cannula . Complications associated with the procedure were endometritis, vaginitis and vaginal tears . Uterine cannulation was generally possible in all bitches studied at all stages of the reproductive cycle . Techniques for the collection of samples from the uterus for cytology and microbiology and for the processing of samples for uterine cytology are outlined . Hysteroscopy was performed on seven occasions in post partum bitches and was found to be possible at least until day 17 after whelping.

Contracept Fertil Sex, 1995 May, 23(5), 323 - 6
{Adolescents and chlamydia: cervix microbiology among adolescents; the first statistics of the family planning centers according to the Calmat law}; Henry-Suchet J; Infertility due to Chlamydia trachomatis infection can be prevented by systematic screening of low genital tract infection . This screening is to be done systematically in women < 25 years old in Family Planning Centers . In France, according to Calmat's low, screening and treatment are anonymous and free of charges for adolescents and people without National Health care . In a foreseeable future, screening will be done for both sexes, by PCR or LCR, on first void urines.

Biol Rev Camb Philos Soc, 1995 May, 70(2), 277 - 316
The revival of interest in mechanisms of bacterial pathogenicity; Smith H; 1 . After a long barren period, the study of bacterial pathogenicity is now one of the most popular subjects in microbiology . This is because bacterial diseases remain a major problem in public health despite the advent of antibiotics, and the subject is a fertile field for the application of genetics and molecular biology . 2 . Pathogenicity is a multifactorial property . The biological requirements are abilities to: infect mucous surfaces; enter the host through those surfaces; multiply in the environment of the host; interfere with host defences; and damage the host . Each requirement has many facets all of which can be accomplished by a variety of processes . 3 . The molecular determinants of the five requirements for pathogenicity can be identified and the relation between their structure and function obtained by a seven step procedure . Genetic manipulation and observations on organisms grown in vivo play major roles in this procedure . Other vital aspects are the availability of good animal models and the design of biological tests for virulence determinants in vitro that are pertinent to the situation in vivo . 4 . A survey of the state of studies on bacterial pathogenicity has highlighted some areas of immense erudition and exposed others that need more attention in the future . Research is often at the highest level of molecular biology for: adherence to and entry of epithelial cells; interference with humoral and phagocytic defences; toxins; and direct induction of cytokines and inflammation . The major gaps are: the determinants of competition with commensals on mucous surfaces; spread into deeper tissues; the host supplied nutrients and metabolism underlying growth rate in vivo; the determinants of interference with the immune response in important chronic diseases and carrier states; the determinants of immunopathological reactions that cause damage in chronic disease; and the determinants of change from carrier to invasive state . Areas that are receiving some attention but are worthy of more are: moving through mucus to gain access to mucous surfaces; opportunistic infections; the determinants of mixed infections; and the determinants of host and tissue susceptibility to infection . 5 . Current interest in the regulation of production of virulence determinants and the influence on it of environmental factors has raised speculation on the role these factors play in vivo . However, it has not yet provided much information on the host factors specifically involved in particular bacterial infections . The individualistic concept of community, as a relative latecomer to discussions of animal community, is sometimes misconstrued as holding that communities are random assemblages of organisms without biotic interactions among species . Nevertheless, it has increasingly been accepted as supported by studies of diverse taxa and habitats . However, many other ecologists continue to argue for integrated, biotically controlled and evolved communities.(ABSTRACT TRUNCATED AT 400 WORDS)

Kansenshogaku Zasshi, 1995 May, 69(5), 539 - 45
{Comparison of amplified Mycobacterium Tuberculosis Direct Test (MTD), Amplicor Mycobacteria kit (Amplicor) and PCR method for detection Mycobacterium tuberculosis in clinical specimens}; Goto M et al.; Accuracy amplified Mycobacterium Tuberculosis Direct Test (MTD), Amplicor Mycobacteria kit (Amplicor) and PCR method routinely used in the University of Tokyo Hospital (J . Clin . Microbiol . 31: 446-450 1991) were evaluated and compared with the same samples . The detection limits of MTD, Amplicor and PCR method (University of Tokyo) were 0.01-0.1 CFU/tube, 0.625 CFU/tube and 0.2 CFU/tube respectively, which were almost the same . These were shown to be at least as sensitive as the conventional culture techniques . The Tokyo Univ . method using radioisotope, takes up to 3 days, on the other hand 2 kits take 4-5 hours . These kits become useful tools for the early and rapid detection of M . tuberculosis in uncultured clinical specimens . But the risk of laboratory contamination and false-positive results remain . These must be further improved.

J Refract Surg, 1995 May-Jun, 11(3), 210 - 1
Nocardial keratitis following myopic keratomileusis; Nascimento EG et al.; PURPOSE/METHODS: Interface opacities were detected in a patient who underwent uncomplicated myopic keratomileusis . RESULTS AND DISCUSSION: Nocardia asteroides keratitis was confirmed by microbiologic work-up and guided the correct treatment . The eye recovered 20/60 spectacle-corrected visual acuity and had a residual stromal scar.

FEMS Microbiol Lett, 1995 Apr 15, 128(1), 9 - 14
The enhancement of the human immunoglobulin G Fc fragment-binding activity of Mycoplasma salivarium cells by trypsin treatment is ascribed to the binding of trypsin to the Fc fragment; Sawa Y et al.; Human immunoglobulin G Fc fragment-binding activity of Mycoplasma salivarium cells was remarkably enhanced by trypsin treatment of the cells . Sodium dodecyl sulfate-polyacrylamide gel electrophoresis profile of proteins of the cells treated with trypsin was the same as that of the cells treated with pronase, although pronase treatment had been shown to reduce the activity in our previous study (FEMS Microbiol . Lett . 123, 305-310, 1994) . This contradiction was clarified by the finding that trypsin bound the Fc fragment more strongly than the cells, and a small amount of trypsin remained in the cells treated with trypsin and washed well . On the basis of these results, it was concluded that the enhancement of cell activity by trypsin treatment was ascribed to binding of the Fc fragment to trypsin remaining in the trypsin-treated cells.

Emerg Infect Dis, 1995 Apr-Jun, 1(2), 47 - 52
Escherichia coli serotype O157:H7: novel vehicles of infection and emergence of phenotypic variants; Feng P; Escherichia coli serotype O157:H7 was only recognized as a human pathogen a little more than a decade ago, yet it has become a major foodborne pathogen . In the United States, the severity of serotype O157:H7 infections in the young and the elderly has had a tremendous impact on human health, the food industry, and federal regulations regarding food safety . The implication of acidic foods as vehicles of infection has dispelled the concept that low-pH foods are safe . Further, the association of nonbovine products with outbreaks suggests that other vehicles of transmission may exist for this pathogen . In laboratory diagnosis, most microbiologic assays rely on a single phenotype to selectively isolate this pathogen . However, the increasing evidence that phenotypic variations exist among isolates in this serogroup may eventually necessitate modifications in assay procedures to detect them.

Zentralbl Hyg Umweltmed, 1995 Apr, 197(1-3), 134 - 61
{Infectious diseases from the hygienic viewpoint with special reference to environmental infections--a retrospective and prospective view}; Exner M; Infectious diseases showed a considerable change in their epidemiologic significance during this century . Twenty years ago it seemed that infectious diseases would be definity under control . As a result there was a neglect of the efforts for prevention, recognition and controlling of infectious diseases, especially in the administration . Today we have to state that old and new infectious diseases have regained a new and partly dramatic epidemiologic importance, influenced by several factors like overpopulation, wars, hunger, migration in the underdeveloped countries and the increase of the old and the immunosuppressed people of the population in the developed countries . A review is given of the increasing significance of old and new infectious diseases in the last 2 decades . Transmissible diseases from the environment have a special importance because many people are affected hereby . Hygienic aspects of drinking and swimming water, air- and ground caused infectious diseases are treated . The political support is requested . The institutions have had an important role in the prevention and control of infectious diseases in the past like the public health departments, hygiene and medical microbiologic urgently need the support and promotion of the government.

J Bacteriol, 1995 Apr, 177(7), 1766 - 71
Nucleotide sequence, mutational analysis, transcriptional start site, and product analysis of nov, the gene which affects Escherichia coli K-12 resistance to the gyrase inhibitor novobiocin; Ivanisevic R et al.; In a previous study, we demonstrated the existence of a gene locus, nov, which affects resistance of Escherichia coli K-12 to the gyrase inhibitor novobiocin and, to a lesser degree, coumermycin (J . Rakonjac, M . Milic, D . Ajdic, D . Santos, R . Ivanisevic, and D . J . Savic, Mol . Microbiol . 6:1547-1553, 1992) . In the present study, sequencing of the nov gene locus revealed one open reading frame that encodes a protein of 54,574 Da, a value . found to be in correspondence with the size of the Nov protein identified in an in vitro translation system . We also located the 5' end of the nov transcript 8 bp downstream from a classical sigma70 promoter . Transcription of the gene is in the counterclockwise direction on the E . coli chromosome . Transposon mutagenesis of nov followed by complementation analyses and replacement of chromosomal alleles with mutated nov confirmed our previous assumption that the nov gene exists in two allelic forms and that the Novr gene is an active allele while the Novs gene is an inactive form . After comparing nucleotide sequences flanking the nov gene with existing data, we conclude that the gene order in this region of the E . coli K-12 map is att phi 80-open reading frame of unknown function-kch (potassium channel protein)-nov-opp . Finally, the possible identity of the nov gene with cls, the gene that codes for cardiolipin synthase, is also discussed.

Crit Care Clin, 1995 Apr, 11(2), 255 - 72
The abdomen as source of sepsis in critically ill patients; Merrell RC; Among patients with life-threatening sepsis that has no clear site of origin, the abdomen continues to be a probable and tractable possibility . The cavity has the microbiologic and anatomic potential for sudden or indolent sepsis and the cause may be either obvious or obscure . The abdomen or the various structures may be primary sources that are secondary and independent of disease that brought the patient to peril . They also could be secondary and dependent upon an abdominal operation complicated by sepsis . The partnership of intensivist and surgical consultant, addressing possibilities and challenges, must identify the most probable cause and the most timely response for positive intervention in the critically ill patient threatened by sepsis.

Rev Clin Esp, 1995 Apr, 195(4), 220 - 5
{H . pylori infection at the duodenal bulb in different endoscopic diagnoses}; Boixeda D et al.; Biopsy samples obtained by endoscopy to diagnose infection by H . pylori usually come from the antral region . Nevertheless, there are few reports documenting the prevalence of infection at duodenal level . OBJECTIVE . To investigate the prevalence of H . pylori infection in duodenal bulb in different endoscopic diagnosis . METHODS . 331 patients with the following endoscopic diagnosis were studied: normal appearance (n = 55), gastritis (87), gastric ulcer (49), duodenal ulcer (120), and duodenitis (20) . At endoscopy, different samples from duodenal bulb were obtained (apart from gastric fundus, body and antrum), which were processed for microbiology (Gram stain and culture) and histology (hematoxilin-eosin) . RESULTS . Patients with duodenal ulcer or duodenitis had the highest H . pylori infection rate at duodenal bulb (47.7% and 65%, respectively) . Differences were significant when compared with normal appearance (14.5%; p < 0.001) and gastritis (25%; p < 0.05) . In all patients with H . pylori at duodenal bulb this organism was also detected at antral region . CONCLUSIONS . 1) The highest prevalence rates for H . pylori infection in duodenal bulb were found in patients with duodenal ulcer or duodenitis . 2) Diagnosis of H . pylori infection should not be based on the duodenal bulb samples alone, as this sample yields high false-negative results.

Chest, 1995 Apr, 107(4), 973 - 80
Bronchiolitis obliterans in recipients of single, double, and heart-lung transplantation; Keller CA et al.; Thirty-two recipients of single, double, or heart-lung transplantation followed-up for at least 3 months posttransplant were retrospectively reviewed to assess the frequency, predictors, and risk factors associated with the development of bronchiolitis obliterans (BO) . A clinical definition for the diagnosis of BO was made using the following criteria: persistent and progressive decline in FEF25-75, associated with normal results of cytologic and microbiologic studies for significant pathogens in bronchoalveolar lavage fluid, with a normal chest radiograph . This was correlated with histologic diagnosis and patient outcome . Sixteen (50%) of the patients developed BO, and this was associated with a 56% mortality . All but 1 patient with histologic BO had a clinical diagnosis of BO made (often months) prior to diagnostic biopsy . No patients with normal histologic findings had a clinical diagnosis of BO . More than 3 episodes of histologically documented acute rejections in any 12-month period were eventually associated with a 100% incidence of BO . Cytomegalovirus occurred with greater frequency in patients with BO, and in most cases, preceded or occurred concomitantly with the diagnosis of acute rejection or BO.

J Clin Pathol, 1995 Apr, 48(4), 358 - 63
Serological testing in a microbiology laboratory of specimens from patients with suspected infectious disease; Waghorn DJ; AIMS--To determine how the microbiology laboratories of one region process serological requests from patients with suspected infectious illness, referred to as "clinical syndrome" type patients in this study; to consider areas where improvement in the associated serology service could be made . METHODS--A prospective two month collection of data on all serological requests from patients with suspected infectious illness was undertaken . A questionnaire on laboratory policies/procedures was also completed by the 10 departments taking part . RESULTS--Serology specimens from "clinical syndrome" patients accounted for 1-2% of total microbiology samples . There was significant variation in some of the policies/procedures carried out by the 10 laboratories when handling serological requests . Differences were seen in the use of laboratory protocols for test processing, range of tests performed, demand for second (convalescent) serum samples, storage of serum samples, and reporting of results . CONCLUSIONS--The laboratory management of "clinical syndrome" type requests is complex . Individual pathology departments vary in the way they handle serology specimens but this study highlighted areas which may contribute to improving the appropriateness of testing and the more efficient use of serology resources . These include improving (1) clinician education, (2) pathology request forms to encourage better clinical information, (3) appropriate laboratory protocols to aid decision making on test selection, (4) percentage of convalescent serum samples received together with longer serum sample storage, and (5) turnaround times of serology reports.

Commun Dis Rep CDR Rev, 1995 Mar 31, 5(4), R54 - 6
Active surveillance of health and safety in microbiology laboratories; Workman MR et al.; In microbiology laboratories highly infectious material is handled alongside complex and potentially dangerous equipment, and staff are therefore at risk of infections and accidents . Acts of parliament and regulations exist to protect staff in the workplace, including those exposed to biological agents . The current monitoring of health and safety in laboratories seeks to ensure that employers and employees comply with existing regulations, but this form of passive surveillance is of limited value because it does not highlight shortcomings in techniques, equipment, premises, or personnel . We propose a scheme for the surveillance of health and safety in microbiology laboratories that will actively seek information about laboratory incidents and practices, in order to enable appropriate preventive measures to be instituted.

Neurosci Lett, 1995 Mar 16, 188(1), 33 - 6
Carbon fibre micro-electrodes for concomitant in vivo electrophysiological and voltammetric measurements: no reciprocal influences; Crespi F et al.; Differential pulse voltammetry and more recently cyclic voltammetry have been successfully used to monitor basal levels of endogenous chemicals by means of treated carbon fibre microbiosensors inserted in specific brain regions . In this study, feasibility of concomitant in vivo recordings of stable electrophysiological signals and basal ascorbate, catecholaminergic and indolaminergic voltammetric peaks at the same cerebral site by means of a single electrically treated carbon fibre micro electrode (microbiosensor) is presented . The results indicate that these two independent techniques can be combined in vivo at a single electrode, and that voltammetric measurements of unstimulated levels of extracellular compounds do not alter concomitant basal cell firing for a period long enough (more than 6 h) to allow pharmacological manipulations.

Am J Med, 1995 Mar, 98(3), 224 - 31
Feasibility of outpatient management of fever in cancer patients with low-risk neutropenia: results of a prospective randomized trial; Malik IA et al.; PURPOSE: We recently demonstrated the efficacy of single-agent oral ofloxacin in the management of hospitalized neutropenic febrile patients . Ofloxacin was particularly effective in patients with short duration of neutropenia and fever of undetermined origin . These results prompted us to study the feasibility of outpatient management of neutropenic febrile patients who are otherwise at low risk of morbidity and mortality . PATIENTS AND METHODS: This multi-institutional, prospective, randomized trial included 182 low-risk neutropenic febrile episodes . After an initial work-up for fever, patients were randomized to receive oral ofloxacin 400 mg immediately and twice daily thereafter in the hospital or as outpatients . Close monitoring and follow-up were carried out in all patients . Those who failed to respond and remained febrile were given parenteral antibiotics . Nonresponding outpatients were admitted to the hospital for parenteral therapy . RESULTS: One hundred sixty-nine episodes were evaluable . The hospital and outpatient treatment groups had comparable clinical characteristics . Pyrexias of undetermined origin (PUO) comprised 69% of episodes managed in hospital and 73% of episodes treated outside . The success rate with PUO was similar with inpatient and outpatient management . Patients with clinical and microbiologic infections fared less well than those with PUO . Overall, 78% of inpatient and 77% of outpatient fevers resolved with no modification of the initial treatment . Twenty-one percent of patients originally assigned to outside management required hospitalization . Mortality was 2% among inpatients and 4% among outpatients . One early death in a nonhospitalized patient underscores the need for close monitoring and surveillance in these cases . CONCLUSIONS: Outpatient management of low-risk neutropenic febrile patients with ofloxacin is as effective as inpatient management with the same agent . This approach should be limited to the subset of patients with low-risk factors who are not otherwise on quinolone prophylaxis.

Clin Chest Med, 1995 Mar, 16(1), 61 - 93
Diagnosis and differential diagnosis of ventilator-associated pneumonia; Meduri GU; Clinical criteria, radiographic findings, and analysis of a tracheal aspirate are inaccurate for diagnosing ventilator-associated pneumonia (VAP) . This article reviews both invasive and noninvasive diagnostic techniques, discusses microbiologic and microscopic analysis of lower airway secretions, and considers factors influencing the results of these tests . The differential diagnosis of fever and pulmonary densities in ventilated patients is discussed, and a systematic diagnostic approach for the evaluation of patients with suspected VAP is presented.

Clin Chest Med, 1995 Mar, 16(1), 135 - 46
Pneumonia in patients with multiple trauma; McRitchie DI et al.; This article examines the features of nosocomial pneumonia in the subpopulation of patients with multiple trauma . Epidemiology, trauma-associated risk factors, diagnosis, microbiology, therapy, and prevention are reviewed . While some issues may overlap with critically ill patients in general, differences in approach and management will be discussed.

Transfus Med, 1995 Mar, 5(1), 63 - 7
Pilot trials of PDF symbology as a means of transfering data on blood units between transfusion centres; Fisher MM et al.; PDF 417, a two-dimensional barcode, was used as a portable data file to transfer key information on blood units and delivery documentation between two Regional Blood Transfusion Centres . Multiple Codabar messages currently displayed on blood packs, as well as other useful information, i.e . microbiology conformance, were encoded in a 45-character single PDF barcode . The delivery note which accompanied each consignment of blood consisted of a series of PDF barcodes, each representing 20 blood units . Computer validation showed 100% reconciliation of PDF data with Codabar data . Readability of the code was excellent with a greater than 98% first-pass read rate . The delivery note PDF barcode identified eight operator errors which would have been undetected by the present manual system . We conclude that PDF 417 is an effective, secure and space efficient means of transferring data associated with the transfer of blood.

Appl Microbiol Biotechnol, 1995 Mar, 42(6), 853 - 9
Purification and properties of thermostable N-acylamino acid racemase from Amycolatopsis sp . TS-1-60; Tokuyama S et al.; Thermostable N-acylamino acid racemase from Amycolatopsis sp . TS-1-60, a rare actinomycete strain selected for its ability to grow on agar plates incubated at 40 degrees C, was purified to homogeneity and characterized . The relative molecular mass (M(r)) of the native enzyme and the subunit was estimated to be 300,000 and 40,000 on gel filtration chromatography and sodium dodecyl sulfate-polyacrylamide gel electrophoresis respectively . The isoelectric point (pI) of the enzyme was 4.2 . The optimum temperature and pH were 50 degrees C and 7.5 respectively . The enzyme was stable at 55 degrees C for 30 min . The enzyme catalyzed the racemization of optically active N-acylamino acids such as N-acetyl-L- or D-methionine, N-acetyl-L-valine, N-acetyl-L-tyrosine and N-chloroacetyl-L-valine . In addition, the enzyme also catalyzed the racemization of the dipeptide L-alanyl-L-methionine . By contrast, the optically active amino acids, N-alkyl-amino acids and methyl and ethyl ester derivatives of N-acetyl-D- and L-methionine were not racemized . The apparent Km values for N-acetyl-L-methionine and N-acetyl-D-methionine were calculated to be 18.5 mM and 11.3 mM respectively . The enzyme activity was markedly enhanced by the addition of divalent metal ions such as Co2+, Mn2+ and Fe2+ and was inhibited by addition of EDTA and P-chloromercuribenzoic acid . The similarity between the NH2-terminal amino acid sequence of the enzyme and that of Streptomyces atratus Y-53 {Tokuyama et al . (1994) Appl Microbiol Biotechnol 40:835-840} was above 80%.

Rev Esp Enferm Dig, 1995 Mar, 87(3), 193 - 8
{The effect of "triple therapy" on the eradicating of H . pylori and the healing of a duodenal ulcer . The initial study and 6 months later}; Gisbert JP et al.; Helicobacter pylori plays an important role in the pathogenesis of peptic ulcer disease, and many therapy regimens have been used to eradicate it . AIM: To assess the efficacy of triple therapy in duodenal ulcer patients, in ulcer healing and eradication of H . pylori, early after treatment and 6 months later . METHODS: In a prospective study, 32 patients with duodenal ulcer disease and H . pylori infection were studied . Biopsy specimens from the duodenal bulb, antrum, body and gastric fundus were taken and were analyzed by a microbiology (Gram and specific culture) and histology process (hematoxylin and eosin) . All patients were treated with triple therapy (bismuth, tetracyclin and metronidazole) . Patients were investigated endoscopically one month after cessation the triple therapy and 4 months later, with taking of antrum and body biopsy specimens . RESULTS: During the therapy, adverse events were elucidated in 3 patients (9.4%) . Eradication (no evidence on ongoing H . pylori infection 4 wk after cessation treatment) was obtained in 26 patients (81.25%) . Eradication reached 92% when H . pylori was metronidazole sensitive (N:25; 78.13%) and 42.86% (p < 0.05) when it was resistant . Reinfection rate was 3.85% (N = 1) . Healing ulcer was observed in 28 patients (87.5%) 1 month after cessation of treatment . When triple therapy regimen was successful the healing rate was 96.15%, and it was 50% (p < 0.05) when it failed . CONCLUSION: Triple therapy (with low doses of metronidazole, and tetracyclins) has a high efficacy (81.25%) in the eradication of H . pylori (metronidazole sensitivity plays an important role), with few (9.4%) and non-serious adverse events . Healing rate is 96.15% when eradication is obtained and 50% (p < 0.05) when it failed.

J Clin Pathol, 1995 Mar, 48(3), 198 - 202
Internal quality assurance in a clinical virology laboratory . II . Internal quality control; Gray JJ et al.; AIMS--In April 1991 additional quality control procedures were introduced into the virology section of the Clinical Microbiology and Public Health Laboratory, Cambridge . Internal quality control (IQC) samples were gradually included in the serological assays performed in the laboratory and supplemented kit controls and standard sera . METHODS--From April 1991 to December 1993, 2421 IQC procedures were carried out with reference sera . RESULTS--The IQC samples were evaluated according to the Westgard rules . Violations were recorded in 60 of 1808 (3.3%) controls and were highest in the IQC samples of complement fixation tests (25/312 (8%) of controls submitted for complement fixation tests) . CONCLUSIONS--The inclusion of IQC samples in the serological assays performed in the laboratory has highlighted batch to batch variation in commercial assays . The setting of acceptable limits for the IQC samples has increased confidence in the validity of assay results.

Acta Radiol, 1995 Mar, 36(2), 122 - 6
Pleuro-pulmonary aspergillosis . US and US-guided biopsy as an aid to diagnosis; Tikkakoski T et al.; We reviewed the US findings and the diagnostic yield of fine-needle aspiration biopsy (FNAB) for cytologic and microbiologic samples in 4 patients with pulmonary or pleural aspergillosis . All 3 apical Aspergillus abscesses were round, hypoechoic with irregular margins and one contained echo-densities with shadowing consistent with air . One pleural empyema was oval and hypoechoic . Cytology suggested inflammation in all cases and Aspergillus hyphae were detected in 2 of 4 aspirates . Culture of the aspirate was positive for Aspergillus in 3 of 4 cases, while one diagnosis was made after surgery . No complications occurred . Apico-pleural Aspergillus lesions are suitable targets for US-guided FNAB, thus avoiding more invasive methods . Our results suggest wider use of this procedure.

Equine Vet J, 1995 Mar, 27(2), 131 - 4
Evaluation of Directigen Flu A assay for detection of influenza antigen in nasal secretions of horses; Morley PS et al.; The Directigen Flu A assay (Becton Dickinson, Microbiology Systems, Mississauga, Ontario, Canada) is a commercially available immunoassay designed for rapid in vitro recognition of influenza A nucleoprotein . The purpose of this study was to evaluate this assay for detection of influenza virus in nasal secretions of naturally infected horses . The assay was shown to react with representative strains of influenza virus which cause disease in horses and did not react with nasal secretions from uninfected horses kept in isolation . Between 33% and 45% of nasal secretions specimens obtained from clinically diseased horses during influenza epidemics reacted positively in the assay and 95% to 98% of horses not showing signs of disease during influenza epidemics tested negative . In contrast, influenza virus was isolated from only 7% of diseased horses using conventional techniques . Diseased horses which were positive in the Directigen assay had lower pre-exposure influenza antibody concentrations and showed more clinical signs than diseased Directigen-negative horses . This evaluation demonstrates that the Directigen Flu A assay detects influenza virus in nasal secretions of infected horses and is more sensitive than virus isolation.

FEMS Microbiol Lett, 1995 Feb 15, 126(2), 123 - 6
Phylogenetic position of Gluconobacter species as a coherent cluster separated from all Acetobacter species on the basis of 16S ribosomal RNA sequences; Sievers M et al.; The 16S rRNA sequences from the Gluconobacter species G . asaii, G . cerinus and G . frateurii were determined and compared with homologous sequences from published databases and sequences of G . oxydans and Acetobacter species previously described {Sievers, M., Ludwig, W . and Teuber, M . (1994) System . Appl . Microbiol . 17, 189-196} . The Gluconobacter species have unique 16S rRNA sequences and exhibit sequence similarity values of 97.4 to 99.1%, corresponding to 36 to 14 base differences . The phylogenetic tree inferring methods (distance matrix, maximum parsimony and maximum likelihood) show that the species of Gluconobacter form a coherent, closely related cluster . Based on the distance matrix method including Rhodopila globiformis as an outgroup reference organism, Gluconobacter is well separated from Acetobacter.

J Am Vet Med Assoc, 1995 Feb 15, 206(4), 452 - 5
Microbiologic evaluation of carcasses before and after washing in a beef slaughter plant; Jericho KW et al.; The effect of washing on the bacterial contamination of beef carcasses in a modern abattoir was evaluated . Twenty-six carcasses were evaluated at the end of the slaughter process before and after washing, and 13 other carcasses were evaluated only after being washed . An excision sample (5 x 5 x 0.5 cm) was collected from 10 sites on each carcass immediately before washing and at an adjacent site immediately after washing . Aerobic bacterial colonies were enumerated, using hydrophobic grid membrane filter technology . After washing, the log10 of the most probable number of growth units/cm2 decreased (P < 0.01) at the lateral rump site, increased (P < 0.01) at the thorax and neck sites, but was unchanged at the other 7 sites, compared with before washing . The sample size required to estimate, within 0.5 log10 units, the mean log10 most probable number of growth units/cm2 at a site for use in future group-carcass evaluations was determined and compared with a previously used sample size definition . It was concluded that the washing process described did not result in a major change in the bacterial contamination of carcasses.

Health Policy Plan, 1995 Mar, 10(1), 71 - 8
Reducing maternal mortality in Kigoma, Tanzania; Mbaruku G et al.; An intervention programme aiming at a reduction of maternal deaths in the Regional Hospital, Kigoma, Tanzania, is analyzed . A retrospective study was carried out from 1984-86 to constitute a background for an intervention programme in 1987-91 . The retrospective study revealed gross under-registration of data and clarified a number of potentially useful issues regarding avoidable maternal mortality . An intervention programme comprising 22 items was launched and the maternal mortality ratio was carefully followed in 1987-91 . The intervention programme paid attention to professional responsibilities with regular audit-oriented meeting, utilization of local material resources, schedules for regular maintenance of equipment, maintenance of working skills by regular on-the-job training of staff, norms for patient management, provision of blood, norms for referral of severely ill patients, use of antibiotics, regular staff evaluation, public complaints about patient management, travel distance of all essential staff to the hospital, supply of essential drugs, the need of a small infusion production unit, the creation of culture facilities for improved quality of microbiology findings, and to efforts to stimulate local fund-raising . The results indicate that the maternal mortality ratio fell from 933 to 186 per 100,000 live births over the period 1984-91 . Thus it is underscored that the problem of maternal mortality can be successfully approached by a low-cost intervention programme aiming at identifying issues of avoidability and focusing upon locally available problem solutionsPIP: A review of all 1984-1986 hospital records at the Regional Hospital in Kigoma, Tanzania, aimed to determine the maternal mortality rate and contributory/medical causes of death . Underregistration of data was evident . Contributory causes of maternal death were: a lack of most of the basic equipment, outdated existing basic equipment, no reserve water tank, poor staff attitude, absent hospital staff during office hours, prescriptions without physically seeing the patients, low supply of drugs, acute shortage of blood, and no trained anesthetist . A low-cost intervention program implemented 22 items which focused on professional responsibilities with regular audit-oriented meetings, utilization of local material resources, schedules for regular maintenance of equipment, maintenance of working skills by regular on-the-job training of staff, norms for patient management, provision of blood, norms for referral of severely ill patients, use of antibiotics, regular staff evaluation, public complaints about patient management, travel distance of all essential staff to the hospital, supply of essential drugs, the need for a small infusion production unit, the creation of culture facilities for improved quality of microbiology findings, and efforts to encourage local fund-raising . A 1991 prospective study revealed that the average maternal mortality ratio fell significantly between 1984-1986 and 1987-1991 (849-275/100,000 live births; p 0.001) . Specifically, it fell from 933 to 186/100,000 between 1984 and 1991 . Causes of maternal death were difficult to determine because relatives refused to allow autopsies in most cases . Based on the unreliable data available, the most common causes of death during the retrospective study were uterine rupture, sepsis, and anemia . The prevalence of uterine rupture, sepsis, and postpartum/ antepartum hemorrhage, as main causes of admission fell somewhat between 1984 and 1991, while anemia, septic abortion, and pelvic infection increased .

Pediatr Rev, 1995 Feb, 16(2), 62 - 8
Proper use of the clinical microbiology laboratory; Christenson JC et al.; The interaction between clinicians and microbiology laboratory staff has to be one of mutual benefit . The more the laboratory personnel know about your patients, the more meaningful and thorough will be the results . Communication is the key to success . Visit the microbiology laboratory and get to know the staff . The clinician also needs to be familiar with and use the most commonly used diagnostic tests for individual bacterial pathogens appropriately.

Am J Trop Med Hyg, 1995 Feb, 52(2), 117 - 23
Identification of a new North American hantavirus that causes acute pulmonary insufficiency; Ksiazek TG et al.; In May 1993, a pulmonary disease syndrome with novel clinical and epidemiologic features was identified in the southwestern United States . Healthy young adults developed a febrile prodrome followed by the rapid onset of often lethal acute respiratory distress . Although an infectious disease was suspected, intensive investigations initially failed to identify the causative agent . Multiple specialized microbiology laboratories at the National Center for Infectious Diseases (Centers for Disease Control and Prevention) applied classic serologic and culture methods as well as recently developed molecular biological techniques to samples collected from field investigations of the patients . Serologic tests detected the presence of an active immune response to a hantavirus . Reverse transcription and polymerase chain reaction amplification of RNA extracted from human tissues used primers designed from sequences of known hantaviruses to demonstrate genomic sequences of a novel hantavirus . Immunohistochemistry showed the presence of hantavirus antigens in the endothelium of lung tissues from patients and provided the final pathogenetic link to this group of viruses . These methods were concordantly positive in virtually all samples available from 18 patients with compatible clinical histories identified between January and July 1993 . Test results of control subjects and searches for other agents in identified cases were negative . This newly recognized hantavirus causes a novel syndrome of acute pulmonary edema and shock; the pathogenesis is related to the presence of virus antigens in the pulmonary capillaries . The virus may be an important cause of severe and fatal disease presenting as adult respiratory distress syndrome in otherwise healthy persons.

Arch Surg, 1995 Feb, 130(2), 183 - 7
Accuracy of disincorporation for identification of vascular graft infection; Padberg FT Jr et al.; OBJECTIVE: The presence or absence of prosthetic graft incorporation with surrounding tissue was assessed relative to bacterial culture results, using enhanced microbiologic culture techniques . DESIGN: Criterion standard . SETTING: University and Veterans Affairs hospital . PATIENTS: Prosthetic samples were removed from 113 aortofemoral, extra-anatomic, infrainguinal, and hemoaccess sites at the time of vascular reoperative surgery . Harvested grafts were sonicated . Density of organisms was determined by quantitative culture . MAIN OUTCOME MEASURES: The culture result was predicted from the status of prosthetic incorporation or disincorporation as determined at surgery . For purposes of this study, any bacterial growth represented graft infection . RESULTS: Cultures positive for bacteria were obtained from 31 sites; cultures with no growth, from 82 . Thirty-one of the 113 sites were disincorporated, of which 23 yielded cultures positive for bacteria, and eight, no growth . The remaining 82 sites were well incorporated, of which 74 yielded cultures negative for bacteria, and eight, bacterial growth . Sixteen (14%) incorrect predictions were noted . The concurrence of disincorporation and a culture positive for bacteria relative to all culture-positive grafts (sensitivity) was 74% . The concurrence of incorporation and cultures negative for bacteria relative to all culture-negative grafts (specificity) was 90% in prostheses implanted for longer than 2 weeks; in prostheses implanted for longer than 12 weeks, specificity was 97% . CONCLUSIONS: The surgical finding of incorporation or disincorporation accurately predicted the culture result in 89% of the sites . Disincorporation correlated with presence of bacteria in 71%; incorporation reliably excluded the presence of bacteria in 97%.

Otolaryngol Head Neck Surg, 1995 Feb, 112(2), 274 - 8
Treatment of cervical necrotizing fasciitis with hyperbaric oxygen therapy; Langford FP et al.; Hyperbaric oxygen therapy has significantly improved the management of necrotizing fasciitis of the extremities and trunk . Its role in cervical necrotizing fasciitis has not been fully evaluated . Historically, necrotizing fasciitis has been associated with considerable morbidity and mortality . This report discusses our experience with cervical necrotizing fasciitis in six patients treated from 1986 to 1993 who received hyperbaric oxygen therapy . All patients survived . In all cases infection was of probable odontogenic origin . Most patients in whom necrotizing fasciitis develops have identifiable risk factors; however, two patients in this series were previously healthy, and there was no relationship between hospital course and identified risk factors . Clinical presentation and microbiology are reviewed together with the rationale for hyperbaric oxygen therapy as an adjunct to broad-spectrum antibiotics and aggressive early surgical debridement.

J Am Acad Dermatol, 1995 Feb, 32(2 Pt 2), 326 - 33
Normolipemic papular xanthomatosis in erythrodermic atopic dermatitis; Goerdt S et al.; We describe papular xanthomatosis that progressively developed in a patient with long-standing erythrodermic atopic dermatitis and normal lipid metabolism and without an associated systemic disease . Light microscopy showed a lobulated aggregate of sometimes foamy histiocytes . Ultrastructurally, these histiocytes contained lipid inclusions and lacked features of Langerhans or epithelioid cells . Other granulomatous skin diseases such as tuberculosis, sarcoidosis, or foreign body granuloma were excluded by histologic study, polarizing microscopic examination, electron microscopy, and microbiologic investigations . Nevertheless, these xanthomas showed an antigen expression pattern similar to that found in noninfectious granulomas (CD1a-, MS-1-, CD11c+, MRP-8/-14+, 25F9+, RM 3/1+/-, CD36(+), indicating that normolipemic papular xanthomatosis may be reactive process and should not be included among the true cutaneous non-Langerhans cell histiocytoses.

Obstet Gynecol, 1995 Feb, 85(2), 215 - 9
Clinical presentation of gynecologic infections among Indian women; Singh V et al.; OBJECTIVE: To study the clinical presentation of different gynecologic infections among Indian women . METHODS: This was a cross-sectional study of 257 women that included clinical, cytologic, colposcopic, and microbiologic screening for various gynecologic infections . RESULTS: Human papillomavirus (HPV) was the leading infection, affecting 127 (49.4%) women; however, overt warts were only seen in seven (2.7%) patients . Women infected with HPV had a 60.3-fold higher risk of developing a bleeding ectopia compared to those with other infections; women with an unhealthy cervix and cervical ectopias also had an increased risk of HPV infection (7.6- and 2.8-fold, respectively) . Bacterial vaginosis, detected in 33.5% of the women studied, had an increased risk of bleeding ectopia (9.3-fold), cervical ectopia (3.1-fold), cervicitis (2.9-fold), vaginitis (6.9-fold), and cervical hypertrophy (2.1-fold) . Chlamydial infection, detected in 23.3% of the patient population, was associated with an eightfold increase in the risk of an unhealthy cervix and a fourfold increase in risk of a hypertrophied cervix . Immunoglobulin-A antibodies to the herpes simplex virus were detected in 53 (20.6%) women . More than half (55.2%) of the women had two or more infections, and the mean delay of seeking medical treatment was 7-13 months . CONCLUSION: The specific finding of bleeding cervices was associated with HPV and bacterial vaginosis, hypertrophied cervices with chlamydia and bacterial vaginosis, and unhealthy cervices with chlamydia and HPV infections.

Enferm Infecc Microbiol Clin, 1995 Feb, 13(2), 90 - 5
{Intestinal parasitoses in the prison population in the Madrid area (1991-1993)}; Alonso-Sanz M et al.; BACKGROUND: Intestinal parasitoses are frequent in populations in tropical and subtropical areas, HIV infection has favoured an increase in the prevalence of some of these parasitoses . Both conditions concur in innate populations . The aim of this study was to determine the prevalence and clinical characteristics of the intestinal parasitosis in a penitentiary population from the Madrid area . METHODS: On the basis of the data from the Laboratory of Clinical Microbiology in the Hospital General Penitenciario, patients with the diagnosis of intestinal parasitosis were retrospectively reviewed . The study period covered 29 months (from 1/8/91 to 31/12/93) . Samples were taken from patients admitted to, and attended, in the outpatient area of this hospital in addition to those held in dependents prisons . Processing was done by direct macroscopic and microscopic visualization (400x) of the sediment obtained by the formol-ether concentration method (Ritchie) . Modified Ziehl staining was carried out . Demographic, clinical-evolutive and microbiologic data of the patients were analyzed . RESULTS: One thousand two hundred eighty-one samples corresponding to 1,033 patients were studied 131 (10.2%) positives corresponding to 96 (9.3%) patients were observed . 88.5% (n = 85) were males . The mean age was 31.2 years (CI 95%: 29.3-32.9) . The patients were from Europe in 39.7% of the cases (Spain: 94%), Africa 28.9% and Latin America 28.9% . Twenty-five patients were HIV+ (46%) with a mean CD4 count of 160/mm3 (CI 95%: 65-255) and 29 were HIV- . Globally, the most frequently found parasites were uncinaria (22%), Giardia lamblia (21%) and Cryptosporidium parvum (20%) . One case of intestinal capillariasis was diagnosed . Fifteen mixed parasitoses (15.6%) were observed and the most frequent association was Trichuris trichiura and uncinaria in 8 patients (5 HIV+ and 3 unknown HIV) . Clinical manifestations were present in 63.7% (42/66) of the patients with diarrhea being the most frequent (25 cases) . In patients in whom the clinical evolution could be evaluated, it was favorable in most of the cases except in those with Cryptosporidium parasitosis . CONCLUSIONS: Intestinal parasites are of relevance within a prison population, presenting some differences to the intestinal parasites observed in a general population . The most frequently observed parasite was uncinaria in HIV- patients and Cryptosporidium parvum in HIV+ patients . Mixed parasitosis was not infrequent (15.6%) . 25% of the intestinal parasitosis are asymptomatic . When symptomatology does exist, diarrhea is the most common clinical manifestation . The clinical evolution is usually favourable with the exception of some cases of diarrhea by Cryptosporidium in severely immunosuppressed HIV+ patients.

Am J Infect Control, 1995 Feb, 23(1), 27 - 33
Comparison of case-finding methodologies for endometritis after cesarean section; Baker C et al.; BACKGROUND: Endometritis is a possible complication of delivery among patients undergoing cesarean section, resulting in increased costs and patient morbidity . However, traditional case-finding methods for endometritis may not identify most cases . We compared various case-finding methods with a reference method to determine a simple and accurate method for collecting data on endometritis after cesarean section . METHODS: We reviewed charts of all patients undergoing cesarean section (N = 167) during March 1 through July 31, 1991 . These data were compared with study case-finding methods that used microbiology data, infection report forms from nursing, and computerized reports linking patients undergoing cesarean section with intravenous antibiotic use data and admission and discharge diagnoses . RESULTS: Each case-finding method was compared separately with the reference method ("gold standard"), which was designed to capture all cases among the patients in the study population (N = 145) . This review yielded nine cases of endometritis (infection rate of 5.4/100 procedures) . The computerized report method linking patients who underwent cesarean section with antibiotic use had a positive predictive value of 0.53 . Methods that used microbiology data and nursing report forms had lower positive predictive values of 0.18 and 0.20, respectively . CONCLUSIONS: In our institution, case finding for postcesarean endometritis by means of a computerized report linking patients undergoing cesarean section with i.v . antibiotic use data and admission and discharge diagnoses is the most effective method of detecting postcesarean endometritis . It also represents the most efficient use of the infection control department's resources.

Lab Anim Sci, 1995 Feb, 45(1), 27 - 30
Cerebrospinal larva migrans due to Baylisascaris procyonis in a guinea pig colony; Van Andel RA et al.; Four guinea pigs from a colony of approximately 50 animals were examined for progressive neurologic disease of 5 days' duration . Signs of neurologic dysfunction included cachexia, stupor, hyperexcitability, lateral recumbency, and opisthotonos . Results of gross pathologic, microbiologic, and serologic examinations were unremarkable . Histologic examination of cerebral and cerebellar sections revealed multifocal malacia and regions of eosinophilic granulomatous inflammation . Cross-sections of nematode larvae, identified as Baylisascaris sp., most likely B . procyonis, the raccoon ascarid, were seen in the brain of some affected animals . An intact Baylisascaris larva was recovered from a symptomatic animal when cerebral tissue was processed by the Baermann extraction technique . Results of further investigation indicated that wood shavings used for the guinea pigs had been contaminated by raccoon feces, some of which contained numerous B . procyonis eggs . The bedding source for this colony was changed and, to date, no new cases of neurologic disease have been seen . This report emphasizes the potential insidious entrance of B . procyonis into well-managed laboratory animal facilities.

J Clin Pathol, 1995 Feb, 48(2), 168 - 73
Internal quality assurance in a clinical virology laboratory . I . Internal quality assessment; Gray JJ et al.; AIMS--In April 1991 an internal quality assessment scheme (IQAS) was introduced into the virology section of the Clinical Microbiology and Public Health Laboratory, Cambridge . The IQAS was established to identify recurring technical and procedural problems, to check the adequacy of current techniques, and to calculate the frequency of errors . METHODS--Between April 1991 and December 1993, 715 anonymous clinical serum samples were submitted to the laboratory to test 3245 individual procedures of diagnostic viral serology . RESULTS--A total of 485 (14.9%) procedural and 61 (1.9%) technical discrepancies were observed, the technical discrepancies mainly being recorded in complement fixation tests . Twenty two (0.7% of total procedures) of the technical discrepancies were diagnostically significant . CONCLUSIONS--Evaluation criteria developed with the introduction of IQAS to viral serology, and technical and procedural discrepancies are assessed . As yet, IQAS has not been introduced to other sections of the diagnostic virology laboratory (virus isolation, electron microscopy, immunofluorescence, and enzyme linked immunosorbent assays for viral and chlamydial antigens).

Vet Microbiol, 1995 Feb, 43(2-3), 103 - 22
There is nothing permanent except change . The emergence of new virus diseases; Truyen U et al.; The sudden appearance of apparently new viruses with pathogenic potential is of fundamental importance in medical microbiology and a constant threat to humans and animals . The emergence of a "new" pathogen is not an isolated event, as for instance the frequent appearance of new influenza virus strains demonstrates . Often the new virus strains co-circulate with the older strains in a susceptible population, but a replacement of the older strains has been also observed . In rare instances the new viruses can cause dramatic epidemics or pandemics, such as those observed with the human immunodeficiency virus, canine parvovirus, or most recently, with the agent of bovine spongiform encephalopathy in the United Kingdom . The mechanisms of the emergence are not always clearly understood, but an altered host range appears to be a common event . Whether a true change in host range occurs, or whether the virus adapted to the host and replicated more efficiently, is often unknown . This review tries to summarize the facts that are known about a wide variety of "new" viruses of mammals, such as the simian, human and feline lentiviruses, the feline coronaviruses, the feline parvoviruses, the carnivore morbilliviruses, the influenza A viruses, and the transmissible spongiform encephalopathies . A particular emphasis will be put on the genetic mechanisms that might have taken place and that might have been responsible for their sudden appearance.

J Clin Microbiol, 1995 Feb, 33(2), 413 - 5
Evaluation of enzyme immunoassay for hepatitis B virus DNA based on anti-double-stranded DNA; Garcia F Jr et al.; We have evaluated a new enzyme immunoassay technology to detect the products of PCR-based amplification that may be applicable to routine testing of hepatitis B virus (HBV) DNA . Two hundred eight serum samples were studied: 73 were basal samples and 135 were sequential serum samples from patients with chronic hepatitis, some of whom were being treated with alpha interferon . We compared the new detection method (PCR-DNA enzyme immunoassay {DEIA}) with dot blot hybridization performed without prior PCR amplification and with two other methods for detection of PCR products: agarose gel electrophoresis with ethidium bromide staining (PCR-EB) and dot blot (PCR-dot blot) . For hepatitis B-antigen-positive basal samples, HBV DNA was detected in 70.4% by dot blot, 74.1% by PCR-EB, and 100% by PCR-DEIA and PCR-dot blot; for anti-hepatitis B e-antigen basal samples, HBV DNA was found in 10.5% by dot blot and PCR-EB and in 42.1% by PCR-DEIA and PCR-dot blot . Chi-square tests showed a strong association between dot blot and PCR-EB and between PCR-DEIA and PCR dot blot . Using PCR-dot blot as the reference, dot blot shows a 56.9% sensitivity and a 100% specificity, PCR-EB shows a 55.0% sensitivity and a 100% specificity, and PCR-DEIA shows a 95.4% sensitivity and a 97% specificity . We conclude that the technical advantages of the DEIA method and its high sensitivity and specificity may facilitate the use of PCR in routine testing for HBV DNA in clinical microbiology laboratories.

J Clin Microbiol, 1995 Feb, 33(2), 270 - 4
Use of rubella virus E1 fusion proteins for detection of rubella virus antibodies; Starkey WG et al.; Two glutathione S-transferase fusion proteins containing 44 (p1503) and 75 (p1509) amino acid residues of the rubella virus E1 glycoprotein were expressed in Escherichia coli with the aim of producing a recombinant rubella virus antigen for use in serological assays . p1503 contained three neutralizing and hemagglutinating epitopes (G . M . Terry, L . M . Ho-Terry, P . Londesborough, and K . R . Rees, Arch . Virol . 98:189-197, 1988); p1509 contained the putative neutralization domain described by Mitchell et al . (L . A . Mitchell, T . Zhang, M . Ho, D . Decarie, A . Tingle, M . Zrein, and M . Lacroix, J . Clin . Microbiol . 30:1841-1847, 1992) in addition to the three epitopes present in p1503 . Both fusion proteins were soluble and affinity purified on glutathione-Sepharose 4B . In Western blots (immunoblots), p1503 and p1509 reacted with human sera containing rubella virus-specific immunoglobulin G . When used as antigens in indirect enzyme immunoassays to detect rubella virus-specific immunoglobulin G, p1503 correctly identified the rubella virus antibody status of 43 (76.8%) and p1509 correctly identified that of 48 (85.7%) of 56 serum samples received for routine rubella virus antibody screening . The results obtained with p1509 compare well with those obtained with a latex agglutination assay.

Immun Infekt, 1995 Feb, 23(1), 19 - 22
{Models of the cause of spongiform encephalopathies}; Streckert HJ; Transmissible spongiform encephalopathies seem to contradict a dogma in microbiology . There is now increasing evidence that the infectious agents are proteins (prion proteins) . These proteins seem to be able to catalyze conformational conversions of a host-encoded isoform . The altered conformation induces intracellular accumulation and may lead to polymerization into fibrils and amyloid rods . Catalytical interactions of infectious prion proteins and their cellular isoforms are dependent on the primary structure . These considerations may be helpful to evaluate the risk of transmission of BSE to humans.

Proc R Soc Lond B Biol Sci, 1995 Jan 23, 259(1354), 7 - 14
Molecular phylogeny and evolution of marsupial protamine P1 genes; Retief JD et al.; We report the DNA sequences of protamine P1 genes and flanking regions from 21 mammalian species, including representatives of all extant marsupial orders . The protamine P1 locus in marsupials displays highly conserved 5' and 3' flanking sequences, as well as a highly variable intron . Marsupial protamines examined are distinct from those of eutherian mammals in lacking cysteine residues, a feature that may be correlated with lower stability of marsupial sperm nuclei during chromatin condensation . Phylogenetic analysis of protamine sequences leads to the following conclusions: (i) the microbiothere Dromiciops is part of a clade that includes dasyurids, Notoryctes and diprotodontians but not bandicoots; (ii) dasyurids are the closest living relatives of Notoryctes; (iii) macropodids, phalangerids and pseudocheirids form a clade apart from the phascolarctids; and (iv) the closest living relatives of caenolestids are didelphids.

Eur J Biochem, 1995 Jan 15, 227(1-2), 261 - 9
Analysis of the vhoGAC and vhtGAC operons from Methanosarcina mazei strain Gö1, both encoding a membrane-bound hydrogenase and a cytochrome b; Deppenmeier U et al.; DNA encompassing the structural genes of two membrane-bound hydrogenases from Methanosarcina mazei Go1 was cloned and sequenced . The genes, arranged in the order vhoG and vhoA as well as vhtG and vhtA, were identified as those encoding the small and the large subunits of the NiFe hydrogenases {Deppenmeier, U., Blaut, M., Schmidt, B . & Gottschalk, G . (1992) Arch . Microbiol . 157, 505-511} . Northern-blot analysis revealed that the structural genes formed part of two operons, both containing one additional open reading frame (vhoC and vhtC) which codes for a cytochrome b . This conclusion was drawn from the homology of the deduced N-terminal amino acid sequences of vhoC and vhtC and the N-terminus of a 27-kDa cytochrome isolated from Ms . mazei C16 . VhoC and VhtC contain four tentative hydrophobic segments which might span the cytoplasmic membrane . Hydropathy plots suggest that His23 and His50 are involved in heme coordination . The comparison of the sequencing data of vhoG and vhtG with the experimentally determined N-terminus of the small subunit indicate the presence of a 48-amino-acid leader peptide in front of the polypeptides . VhoA and VhtA contained the conserved sequence DPCXXC in the C-terminal region, which excludes the presence of a selenocysteine residue in these hydrogenases . Promoter sequences were found upstream of vhoG and vhtG, respectively . Downstream of vhoC, a putative terminator sequence was identified . Alignments of the deduced amino acid sequences of the gene clusters vhoGAC and vhtGAC showed 92-97% identity . Only the C-termini of VhoC and VhtC were not similar.

Emerg Infect Dis, 1995 Jan-Mar, 1(1), 16 - 21
Unraveling mysteries associated with cat-scratch disease, bacillary angiomatosis, and related syndromes; Regnery R et al.; The search for the infectious agents responsible for cat-scratch disease, bacillary angiomatosis, and related syndromes has a long and often circuitous history . Recognition of the etiologic agents and a new understanding of the fundamental features of the epidemiology and natural history of modern day Bartonella (formerly Rochalimaea)-associated diseases culminate a multipartite story that combines clinical medicine, traditional microbiology, and novel technological approaches to solve a long-standing enigma.

Przegl Epidemiol, 1995, 49(4), 353 - 9
{Correlation of clinical and morphological diagnoses in 55 fatal AIDS cases}; Walewska-Zielecka B; Pathomorphological studies were performed in 60 HIV-infected patients and the accuracy of clinical diagnoses of infections and neoplasms was evaluated . In 5 cases clinical diagnosis of AIDS was not confirmed at autopsy . 114 infections and neoplasms were found in 55 AIDS-patients, of these 80 (70%) were not diagnosed clinically . Clinical diagnosis of the cause of death was consistent with morphological findings in 24 AIDS cases (45.5%) . The results justify a plea for a close co-operation of clinicians, microbiologists and pathologists to improve the accuracy of clinical diagnoses in AIDS patients . In a fatal case of AIDS a post-mortem study should always be performed.

Acta Otolaryngol Suppl, 1995, 520 Pt 2, 395 - 8
Vestibular modulation of the septo-hippocampal cholinergic system of rats; Horii A et al.; Effects of vestibular stimulation on the in vivo release of hypothalamic histamine and hippocampal acetylcholine (ACh) were investigated in urethan-anesthetized rats, using a brain microdialysis method . Changes in glutamate concentration in the medial vestibular nucleus (MVN) were also monitored by a microbiosensor technique using a glutamate oxidase-embodied platinum electrode . Caloric stimulation with hot water increased the glutamate release in the MVN, while that with ice water decreased it . It is evidenced that glutamate is a neurotransmitter between afferent vestibular nerve and the MVN . Electrical stimulation of the round window evoked the release of hypothalamic histamine and hippocampal ACh and these effects were inhibited by the blockade of second-order vestibular neurons by the pre-injection of 6,7-dinitroquinoxaline-2,3-dione (DNQX), an antagonist of non-N-methyl-D-aspartate (non-NMDA) glutamate receptors, into the ipsilateral vestibular nucleus . Caloric stimulation with both hot and ice water increased the release of hypothalamic histamine and hippocampal ACh . It is suggested that both the histaminergic and cholinergic systems were activated by the imbalance of intervestibular activities . Depletion of neuronal histamine by alpha-fluorometylhistidine (FMH), an irreversible inhibitor of histamine synthesis, did not suppress the vestibular evoked release of hippocampal ACh . In contrast, caloric stimulation did not evoke hypothalamic histamine release in rats treated with ethylcholine aziridiniun ion (AF64A), a putative cholinotoxin . All these findings suggest that the vestibular information activated the histaminergic neurons via the activation of the cholinergic neurons and this neuronal circuit was involved in the vestibulo-autonomic response.

Gynakol Geburtshilfliche Rundsch, 1995, 35 Suppl 1, 148 - 51
{Sequence analysis of PCR amplification products of old formalin fixed conisation tissue sections}; Labeit D et al.; OBJECTIVE: Standard analytical techniques (DNA hybridisation methods) require high-quality DNA . In very small samples and in processed tissue (e.g . analysis of DNA in paraffin-embedded archival tissues) these methods fail due to their restricted sensitivity . METHODS: In this study we used the considerably more sensitive PCR for analysis of HPV-16-e6/-e7 DNA in histologic cone biopsy sections . HPV-16-e6 and -e7 ORF were amplified, subcloned into M13mp18 and sequenced . RESULTS: The sequence is identical to the published e6/e7 sequence . CONCLUSIONS: Due to its high sensitivity the PCR is suitable to give answers to questions in cellular microbiology even in formalin-fixed paraffin-embedded tissues.

Crit Rev Oral Biol Med, 1995, 6(4), 319 - 42
Genetic influences in caries and periodontal diseases; Hassell TM et al.; Deciphering the relative roles of heredity and environmental factors ("nature vs . nurture") in the pathogenesis of dental caries and diseases of the periodontium has occupied clinical and basic researchers for decades . Success in the endeavor has come more easily in the case of caries; the complex interactions that occur between host-response mechanisms and putative microbiologic pathogens in periodontal disease have made elucidation of genetic factors in disease susceptibility more difficult . In addition, during the 30-year period between 1958 and 1987, only meager resources were targeted toward the "nature" side of the nature/nurture dipole in periodontology . In this article, we present a brief history of the development of genetic epistemology, then describe the three main research mechanisms by which questions about the hereditary component of diseases in humans can be addressed . A critical discussion of the evidence for a hereditary component in caries susceptibility is next presented, also from a historical perspective . The evolution of knowledge concerning possible genetic ("endogenous", "idiotypic") factors in the pathogenesis of inflammatory periodontal disease is initiated with an analysis of some foreign-language (primarily German) literature that is likely to be unfamiliar to the reader . We identify a turning point at about 1960, when the periodontal research community turned away from genetics in favor of microbiology research . During the past five years, investigators have re-initiated the search for the hereditary component in susceptibility to common adult periodontal disease; this small but growing body of literature is reviewed . Recent applications of in vitro methods for genetic analyses in periodontal research are presented, with an eye toward a future in which persons who are at risk--genetically predisposed--to periodontal disease may be identified and targeted for interventive strategies . Critical is the realization that genes and environment do not act independently of each other; the appearance or magnitude of heritability may differ with various environments.

Med Pregl, 1995, 48(3-4), 123 - 8
{On the 185th anniversary of the birth of David Gruby (1810-1898)}; Kovac T; David Gruby, the founder of Medical Microbiology, is better known abroad than in his homeland . The Yugoslav public has no knowledge of him and only a small number of physicians have heard of David Gruby and his contribution to medicine . At the beginning of his career he was a passionate explorer and later a very well known practitioner . Although he had lived abroad during his active period of life, he had never denied his origin and considering his contribution to science, he and his work deserve to be known about more at least among physicians.

ORL Head Neck Nurs, 1995 Fall, 13(4), 17 - 22
Chronic suppurative otitis media without cholesteatoma management; Preston DY; Chronic suppurative otitis media without cholesteatoma (CSOMWC) is a significant disease process within the pediatric population . The definition, epidemiology, pathogenesis, pathology, and microbiology of CSOMWC are described . Recommendations for the medical management of CSOMWC are supported by the clinical outcomes of three studies.

Medinfo, 1995, 8 Pt 2, 1064 - 7
Improvement in user performance following development and routine use of an expert system; Kahn MG et al.; Hospital-acquired (nosocomial) infections represent a significant cause of prolonged inpatient days and additional hospital charges . In many hospitals, infection control nurses manually review positive microbiology culture results to monitor the incidence and prevalence of potential nosocomial infections . We have developed an expert system called GermWatcherTM, which uses the United States Centers for Disease Control and Prevention National Nosocomial Infection Surveillance criteria to classify microbiology results as potential nosocomial infections . In February 1993, we deployed GermWatcher at a large tertiary-care teaching hospital . In July 1993, we implemented a revised version of GermWatcher . With each version, we performed an evaluation of the program by comparing its electronic classification of positive culture results to the paper-based manual classification performed by three infection control nurses and one Infectious Disease specialist (gold standard) . In the present study, we focus not on changes in the performance of the expert system, but on changes in performance among the infection control nurses . We found significant improvement in agreement and accuracy in the manual classification of cultures by the infection control nurses in the second evaluation compared to the first evaluation . We attribute this improved manual performance to the development of the expert system's rule base throughout the two evaluation phases and to the use of the expert system in the nurses' daily activities.

Medinfo, 1995, 8 Pt 1, 65 - 9
Constructing clinical applications: the GALEN approach; Alpay LL et al.; A common problem for developers of clinical applications is coping with the diversity of medical language . Medical language as it is used all over the world varies widely, while the referents for these words stay essentially the same . Software developers must reconcile this diversity with the practical necessity of producing applications that are usable in a variety of hospitals, while ensuring that information can be shared between applications . Existing approaches center around coding and classification schemes, but these approaches must be supplemented by a range of sophisticated terminological services in order for the language barriers to be overcome . To address this, the GALEN project is developing an application called the Terminology Server to provide such a range of terminological services (e.g., conceptual and multilingual services) . The software is built upon a re-usable core model of medical terminology . This paper reports on the development of a clinical application called the SCUI (Structured Clinical User Interface) which draws on these GALEN technologies and illustrates an innovative approach to the construction of future clinical applications . The SCUI was specifically developed and tested in the context of infectious diseases to satisfy the demands made by the medical intensive care unit on the Geneva Hospital's microbiology laboratory.

Scand J Infect Dis, 1995, 27(5), 489 - 94
Occurrence of pneumococci with resistance or decreased susceptibility to penicillin in southeast Sweden; Kihlstrom E et al.; The minimal inhibitory concentrations (MICs) of 14 beta-lactam and non-beta-lactam antibiotics were determined for all pneumococci with intermediate susceptibility (I), (n = 26) or resistance (R), (n = 15) to penicillin G isolated at the Clinical Microbiology Laboratory, University Hospital, Linkoping, Sweden during 1994 . These isolates accounted for 3% of all pneumococcal isolates . The results were compared with those of 26 penicillin-susceptible isolates . The MICs of all tested beta-lactam antibiotics increased with MICs of penicillin G . The least increase and the lowest MICs of these agents were recorded for cefotaxime and imipenem . 27% of I- and R-strains were multiple-resistant, most often to tetracycline, trimethoprim-sulfametoxazole, erythromycin, chloramphenicol and clindamycin . All strains were susceptible to vancomycin and rifampicin . I-strains belonged to at least 5 different serotypes . However, 12 of the 15 R-strains were serotype 9 and 6 of these were recovered during contact tracing, indicating spread of a single clone within day-care centres.

Proc Annu Symp Comput Appl Med Care . 1995;:771-5.
The deployment of a World Wide Web (W3) based medical information system; Willard KE et al.; The development of Web technologies has revolutionized information dissemination on the Internet . The University of Minnesota Hospital and Clinic's Web Clinical Information System (CIS) demonstrates the use of the Web as an infrastructure for deploying a medical information system at a fraction of the developmental cost of more traditional client server systems . This Web CIS has been deployed since December 1994 . It makes available laboratory results, including a radically improved clinical microbiology reporting system, ad hoc laboratory order entry, and an embedded expert system protocol laboratory ordering system . It provides these services to any physician or patient care area with TCP (or SLIP/PPP) connection to our hospital network backbone, whether the client computer is running MS Windows, the Macintosh OS, or X-Windows . A formal evaluation of one of this systems subcomponents, the display of clinical microbiology information, demonstrated a significant savings in clinician time (43% p < .001) and substantial reduction in interpretive errors (0 vs 15 p < .01).

Crit Rev Clin Lab Sci, 1995, 32(5-6), 469 - 508
Hantaviruses: clinical, microbiologic, and epidemiologic aspects; Hjelle B et al.; Hantaviruses comprise a genus of the family Bunyaviridae . Bunyaviruses are enveloped viruses with a negative-sense, tripartite RNA genome . Hantaviruses are etiologic agents for two acute and severe illnesses of man, hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS) . Each hantavirus is primarily associated with a single rodent host species or genus, and is transmitted to man through accidental inhalation or ingestion of virus-contaminated rodent excreta . The distribution of hantaviruses is worldwide . HFRS is caused by infection with Hantaan, Seoul, Dobrava/Belgrade, and Puumala hantaviruses, all of which are enzootic in murid rodents of Old World origin . HPS is caused by any of several hantavirus species associated with indigenous New World rodents of the subfamily Sigmodontinae, family Muridae . HFRS and HPS have numerous common epidemiologic, clinical, and laboratory characteristics . Common features include fever, myalgia, thrombocytopenia, neutrophilia, and a profound capillary leak syndrome associated with hypotension, decreased cardiac output, and shock . Worldwide, HPS is much less common than HFRS but is associated with a higher mortality rate . Recovery from hantavirus disease is generally complete, although chronic renal insufficiency may be a rare sequel of HFRS.

Can J Infect Control, 1995 Autumn, 10(3), 80 - 2
Surveillance methods for central venous access device-associated infections in Canadian pediatric hospitals; Langley JM et al.; The most common complication of central venous access device (CVAD) use is infection, which occurs in 3 to 48% of hospitalized patients . It is recommended that regular surveillance of adverse events with CVADs be conducted, expressed as a proportion of 1000 device days and reviewed and acted upon by the institution's infection control committee . In the process of developing a CVAD program the authors attempted to determine the standard of practice at other Canadian pediatric hospitals . A telephone survey of infection control practitioners (ICPS) or CVAD nurses in 15 university-affiliated Canadian pediatric hospitals was conducted using a standard questionnaire . Fourteen hospitals (93%) conduct surveillance for infections associated with CVADS . One program, a pilot project, follows mechanical complications of CVAD use . Eleven centres conduct comprehensive surveillance; in three, selected patients are followed . Only three programs have sufficient staff to follow out-patients . Definitions for CVAD infections varied widely . A positive blood culture from the catheter is sufficient for diagnosis in eight of the 14 centres (57%); the rest use Centers for Disease Control and Prevention (CDC) or modified CDC criteria . In the four centres where CVAD line days are collected on most or all patients, multiple personnel other than the ICP assist in data collection . Four hospitals report number of infections per 100 discharges, four report absolute number of infections and two use more than one denominator . Surveillance methods rely largely on paper-based chart and microbiology record review; no hospital had access to computerized patient data for direct data retrieval . Eight centres have CVAD committees for policy development, and all 15 have or are developing hospital-wide protocols for CVAD use . Canadian pediatric hospitals recognize the importance of CVAD infections, but it appears that insufficient resources are available to meet recommended data collection methods . Interhospital comparison of rates is not possible at present because of variation in definitions and denominators and in types of patients surveyed.

Ann Dermatol Venereol, 1995, 122(4), 213 - 5
{Genetic diagnosis of mycobacterium infections by polymerase chain reaction (PCR)}; Perronne C et al.; Diagnosis is often difficult for mycobacteria because of the limitations of both direct microscopy and cell culture . Polymerase chain reaction (PCR), widely developed in microbiology, could provide major progress in the diagnosis of tuberculosis and atypical mycrobacterial diseases . Sensitivity rarely exceeds 80% and can be lower than 60% compared with traditional culture techniques . The specificity of tuberculosis PCR is rarely better than 97% so that the positive predictive value varies from 5 to 75% depending on the incidence of tuberculosis in the tested population (from 0.2 to 10%) . The sensitivity of PCR compared with traditional culture varies from 2 to 90% depending on the laboratory . The proportion of false negative usually varies from 3 to 20% . Reliability should be improved with standardized simplified techniques, but quality control remains essential to validate the method in each laboratory . Current management strategies cannot be developed or changed solely on the grounds of PCR results.

Appl Environ Microbiol, 1995 Jan, 61(1), 260 - 5
Adhesion of germlings of Botrytis cinerea; Doss RP et al.; Adhesion of conidia and germlings of the facultative plant parasite Botrytis cinerea occurs in two distinct stages . The first stage, which occurs immediately upon hydration of conidia and is characterized by relatively weak adhesive forces, appears to involve hydrophobic interactions (R . P . Doss, S . W . Potter, G . A . Chastagner, and J . K . Christian, Appl . Environ . Microbiol . 59:1786-1791, 1993) . The second stage of adhesion, delayed adhesion, occurs after viable conidia have been incubated for several hours under conditions that promote germination . At this time, the germlings attach strongly to either hydrophobic or hydrophilic substrata . Delayed adhesion involves secretion of an ensheating film that remains attached to the substratum upon physical removal of the germlings . This fungal sheath, which can be visualized by using interference-contrast light microscopy, scanning electron microscopy, or atomic force microscopy, is 25 to 60 nm thick in the region immediately adjacent to the germ tubes . Germlings are resistant to removal by boiling or by treatment with a number of hydrolytic enzymes, 2.0 M periodic acid, or 1.0 M sulfuric acid . They are readily removed by brief exposure to 1.25 N NaOH . A base-soluble material that adheres to culture flask walls in short-term liquid cultures of B . cinerea is composed of glucose (about 30%), galactosamine (about 3%), and protein (30 to 44%).

Int J Syst Bacteriol, 1995 Jan, 45(1), 173 - 7
Isoenzyme, restriction fragment length polymorphism, and random amplified polymorphic DNA characterization of Phaffia rhodozyma Miller et al; Varga J et al.; The validity of the species concept was examined with strains of Phaffia rhodozyma by comparing the isoenzyme profiles, ribosomal DNAs, and random amplified polymorphic DNA (RAPD) patterns of the strains . The isoenzyme profiles appeared to be more stable than the RAPD patterns or the electrophoretic karyotypes determined previously (A . Nagy, N . Garamszegi, C . Vagvolgyi, and L . Ferenczy, FEMS Microbiol . Lett., in press) . The ribosomal DNA patterns revealed only a limited degree of variability, while RAPD analysis proved to be the most useful method for differentiating the strains studied . Strain CBS 5905T (T = type strain) produced characteristic RAPD patterns, which were different from those produced by the other strains . However, despite the high degree of variability observed, the isoenzyme data and the slightly variable ribosomal DNA hybridization profiles confirmed that the strains which we examined belong to one species.

Dig Dis Sci, 1995 Jan, 40(1), 114 - 9
Long-term prospective study of Helicobacter pylori in nonulcer dyspepsia; McCarthy C et al.; Helicobacter pylori is present in up to 87% of patients with nonulcer dyspepsia . This study assessed the effect of eradicating Helicobacter pylori infection on the symptoms of nonulcer dyspepsia at four weeks and one year after treatment . Dyspepsia was assessed on the frequency and severity of six symptoms {epigastric pain (night and day), nausea and vomiting, upper abdominal discomfort, and regurgitation} where each symptom was scored from 0 to 4 . Helicobacter pylori status was assessed before treatment and four weeks after treatment with histology and microbiology, and at one year with a carbon-13 urea breath test . Eighty-three patients (23 males, 60 females; mean age 56.3 years; mean symptom duration 3.6 months) with nonulcer dyspepsia and Helicobacter pylori infection entered the study . Seventy-five were available at one year follow-up . Four weeks after treatment, the mean symptom score improved in those with eradication (6.95-2.3, P = 0.01, N = 41) or persistent infection (6.69-3.0, P = 0.015, N = 42) . At one year, those with persistent Helicobacter pylori infection (N = 38, score 5.24) had a higher score than those remaining clear of infection (N = 24, score 1.4, P < 0.0001) and those with reinfection (N = 13, score 2.2, P < 0.0001) . In addition, persistent Helicobacter pylori infection was associated with more additional treatments than those with eradication (34/38 versus 4/37, P < 0.001) . These results suggest that Helicobacter pylori plays an important role in the symptoms of nonulcer dyspepsia.

Obstet Gynecol, 1995 Jan, 85(1), 57 - 9
Developmental potential of microbiopsied murine blastocysts; Gentry WL et al.; OBJECTIVE: To evaluate the frequency of mouse pups born following blastocyst biopsy and embryo transfer compared to nonbiopsied controls . METHODS: ICR Swiss albino and C57B1/6 mice served as embryo donors . Pregnant mare serum gonadotropin treatment was followed 46-52 hours later by hCG, when donors were paired with fertile males . Mating was confirmed the following day and embryos were collected on the afternoon of day 4 . After overnight culture, hatching trophoblast was excised by micromanipulation with a fine-pulled glass pipette . Embryos (206 controls, 206 biopsied) were transferred to 26 pseudopregnant recipients . Alternate mouse strains were used to identify pups born from control or biopsied embryos . RESULTS: The end point was percentage of pups born ((number born/number transferred) x 100), using angular transformation before analysis . There was no significant difference (P > .1) between percent live-born in control (27.7%) or biopsied (34.5%) embryos, nor were there any strain differences . CONCLUSION: These data support the hypothesis that the developmental potential of murine blastocysts is not affected adversely by the biopsy procedure.

Retina, 1995, 15(1), 14 - 20
Progressive outer retinal necrosis secondary to varicella zoster virus in acquired immune deficiency syndrome; Greven CM et al.; BACKGROUND: A syndrome consisting of rapidly progressive outer retinitis in patients with suppressed immune systems has been described . The etiologic agent appears to be a member of the herpes virus family . METHODS: A 41-year-old man with acquired immune deficiency syndrome (AIDS) developed bilateral outer retinitis and choroiditis, which progressed despite antiviral treatment . A transscleral eye wall biopsy specimen and whole globe were submitted for microbiologic and histologic study . RESULTS: Polymerase chain reaction of a transscleral eye wall biopsy specimen and of the enucleated specimen determined the etiologic agent to be varicella zoster virus (VZV) . Histologic studies demonstrated intranuclear inclusions consistent with viral particles in choroidal cells . CONCLUSION: Our study revealed intranuclear inclusions in choroidal cells, a previously undocumented finding in progressive outer retinal necrosis . Polymerase chain reaction was very useful in identifying the causative agent.

ASAIO J, 1995 Jan-Mar, 41(1), 42 - 8
Evaluation of an implantable ventricular assist system for humans with chronic refractory heart failure . Device explant protocol; Borovetz HS et al.; An explant protocol was developed to investigate the effects of implantation of a left ventricular assist system (LVAS) manufactured by Novacor Division, Baxter Healthcare Corporation on the function of end organs (such as the brain, the kidney, the liver), with particular interest in examining possible complications due to LVAS support . Emphasis was placed on an analysis at the time of device removal and/or autopsy of 1) the local LVAS-host interface; 2) remote cardiovascular and end-organ effects; and 3) the impact of chronic circulatory support on the native heart . To accomplish these objectives, tissue and device samples must be obtained in an appropriate fashion to ensure photographic documentation, microscopic examination, microbiologic and biochemical assays, and compliance with regulatory and manufacturer requirements . This article describes the techniques and protocol that were proposed to ensure the quality of device explant and tissue analysis.

Clin Podiatr Med Surg, 1995 Jan, 12(1), 87 - 103
Bone and soft-tissue infections of the lower extremity in diabetics; LeFrock JL et al.; The foot is the most common site of infection in the diabetic individual, and one of every four diabetics eventually seeks medical care for a foot problem . This article examines pathologic conditions of the lower extremity from a variety of views, including pathophysiology, classification, microbiology, infections, osteomyelitis, treatment, and prevention strategies.

Int J Biomed Comput, 1995 Jan, 38(1), 71 - 3
A new method for global optimization in two dimensions; Bendiab O et al.; We propose a new method for solving numerically minimization problems involving any function of two variables . This method uses a reducing transformation, and is inspired by the Alienor method . We have used this reducing transformation for applications to microbiology problems . Identification of models are treated.

Ann Pathol, 1995, 15(3), 221 - 3
{Guidelines for the diagnosis of endocarditis . Pathology of the cardiac valves}; Loire R et al.; This article reports the difficulties of the diagnosis of endocarditis, especially when blood cultures are negative . It emphasizes the respective roles of the microbiology and pathology laboratories for the processing of cardiac valves removed by surgery . It clarifies the morphological characteristics of the endocarditis.

Microbiol Immunol, 1995, 39(8), 563 - 70
Distribution of C22-, C24- and C26-alpha-unit-containing mycolic acid homologues in mycobacteria; Kaneda K et al.; There are three mycolic acid homologues with C22-, C24- and C26-alpha-units in Mycobacterium . In order to reveal the composition and distribution of these homologues in each subclass and molecular species of mycolic acids and to compare them with the composition of constitutive non-polar fatty acids (free and bound forms), we have separated non-polar fatty acids and each subclass of mycolic acids from 21 mycobacterial species by thin-layer chromatography, and analyzed non-polar fatty acid methyl esters by gas chromatography (GC) and the cleavage products of methyl mycolate by pyrolysis GC . We further performed mass chromatographic analysis of trimethylsilyl (TMS) ether derivatives of mycolic acid methyl esters by monitoring {B-29}+ ions (loss of CHO from the alpha-branched-chain structure of mycolic acids) of m/z 426, 454 and 482 which are attributed to C22-, C24- and C26-alpha-units of TMS ether derivatives of methyl mycolates, respectively, (Kaneda, K . et al, J . Clin . Microbiol . 24: 1060-1070, 1986) . By pyrolysis GC, C22:0, C24:0 and C26:0 fatty acid methyl esters generated by the C2-C3 cleavage of C22-, C24- and C26-alpha-unit-containing mycolic acid methyl esters, respectively, were detected . Their proportion was almost the same among subclasses of mycolic acids in every Mycobacterium and also similar to the proportion of constitutive non-polar C22:0, C24:0 and C26:0 fatty acids . By mass chromatography, the composition and distribution of C22- and C24-alpha-unit-containing homologues were revealed to be similar between alpha- and alpha'-mycolic acids in every Mycobacterium.(ABSTRACT TRUNCATED AT 250 WORDS)

Clin Chim Acta, 1994 Dec 31, 232(1-2), 153 - 7
Clinical biochemistry education in Spain; Queralto JM; Clinical biochemistry in Spain was first established in 1978 as an independent specialty . It is one of several clinical laboratory sciences specialties, together with haematology, microbiology, immunology and general laboratory (Clinical analysis, analisis clinicos) . Graduates in Medicine, Pharmacy, Chemistry and Biological Sciences can enter post-graduate training in Clinical Chemistry after a nation-wide examination . Training in an accredited Clinical Chemistry department is 4 years . A national committee for medical and pharmacist specialties advises the government on the number of trainees, program and educational units accreditation criteria . Technical staff includes nurses and specifically trained technologists . Accreditation of laboratories is developed at different regional levels . The Spanish Society for Clinical Biochemistry and Molecular Pathology (SECQ), the national representative in the IFCC, has 1600 members, currently publishes a scientific journal (Quimica Clinica) and a newsletter . It organizes a continuous education program, a quality control program and an annual Congress.

Clin Chim Acta, 1994 Dec 31, 232(1-2), 143 - 52
The impact of clinical biochemistry on university education in France; Masseyeff RF et al.; In France, clinical biochemistry, similar to other disciplines of laboratory medicine, is taught in both the regular medical and pharmacy curricula, but medical teaching is oriented more towards the interpretation of laboratory findings than test performance . At present, there is no compulsory program of lifelong continuing education, but it is planned to introduce such an obligation in the near future . The practice of laboratory medicine is regulated strictly by the national Health Administration . Clinical laboratories are multidisciplinary, covering simultaneously clinical biochemistry, microbiology, parasitology, hematology and immunology . The only officially recognized laboratory profession is that of 'Director of a Laboratory for Medical Analysis' . The practice of this profession is only open to physicians and pharmacists, provided they graduated in 'Medical Biology' after 4 years of specialized training through a particular type of residency called the 'internat' . The 'interns' are selected by competitive examination . After completing their curriculum, specialized physicians or pharmacists can without further examination or certification either enter a career in a hospital, a university, or both, or direct or co-direct a private laboratory . In this scheme, clinical biochemistry exists as a separate academic discipline, but barely as a distinct profession.

Gene, 1994 Dec 30, 151(1-2), 61 - 71
The yeast FKS1 gene encodes a novel membrane protein, mutations in which confer FK506 and cyclosporin A hypersensitivity and calcineurin-dependent growth; Eng WK et al.; FK506 and cyclosporin A (CsA) are potent immunosuppressive agents that display antifungal activity . They act by blocking a Ca(2+)-dependent signal transduction pathway leading to interleukin-2 transcription . Each drug forms a complex with its cognate cytosolic immunophilin receptor (i.e., FKBP12-FK506 and cyclophilin-CsA) which acts to inhibit the Ca2+/calmodulin-dependent protein phosphatase 2B, or calcineurin (CN) . We and others have defined the Saccharomyces cerevisiae FKS1 gene by recessive mutations resulting in 100-1000-fold hypersensitivity to FK506 and CsA (as compared to wild type), but which do not affect sensitivity to a variety of other antifungal drugs . The fks1 mutant also exhibits a slow-growth phenotype that can be partially alleviated by exogenously added Ca2+ {Parent et al., J . Gen . Microbiol . 139 (1993) 2973-2984} . We have cloned FKS1 by complementation of the drug-hypersensitive phenotype . It contains a long open reading frame encoding a novel 1876-amino-acid (215 kDa) protein which shows no similarity to CN or to other protein phosphatases . The FKS1 protein is predicted to contain 10 to 12 transmembrane domains with a structure resembling integral membrane transporter proteins . Genomic disruption experiments indicate that FKS1 encodes a nonessential function; fks1::LEU2 cells exhibit the same growth and recessive drug-hypersensitive phenotypes observed in the original fks1 mutants . Furthermore, the fks1::LEU2 allele is synthetically lethal in combination with disruptions of both of the nonessential genes encoding the alternative forms of the catalytic A subunit of CN (CNA1 and CNA2) . These data suggest that FKS1 provides a unique cellular function which, when absent, increases FK506 and CsA sensitivity by making the CNs (or a CN-dependent function) essential.

Lancet, 1994 Dec 17, 344(8938), 1693 - 4
Renewed UN drive against AIDS; McGregor A; PIP: After a 1-day meeting of agency directors on December 12 in New York, UN Secretary-General Boutros Boutros-Ghali announced the appointment of Dr . Peter Piot as director of a renewed UN program against human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), provisionally entitled "UN Joint and Co-sponsored Programme on AIDS." The 6 UN agencies already involved (UNICEF, UNDP, UNESCO, UN Population Fund, the World Bank, and WHO) will be more tightly coordinated; the World Health Organization (WHO) will remain in charge . Dr . Piot, a 45-year-old Belgian physician and co-discoverer of the Ebola virus (1976), assisted and effectively succeeds Dr . Michael Merson, the director of the World Health Organizations's global program on AIDS . While professor of microbiology at the Institute of Tropical Medicine in Antwerp, Dr . Piot launched a series of collaborative projects in Africa, including "Project SIDA" in Kinshasa in 1984 . The new program will not be fully operational until 1996 . The World Bank is expected to provide additional money . Dr . Merson's predecessor, Dr . Jonathan Mann (now director of the International Center at the Harvard School Of Public Health) expressed hopefulness about the new leadership and concern that what has been learned about AIDS in the last decade will be applied in the new program . A transition team has been working on a provisional program blueprint that provides for a resident coordinator and the full integration of local staff in each country . Additional emphasis will be given to education . An estimated 17 million people are infected with HIV, 3 million more since June of last year . 20-40 million are expected to be infected by 1999 .

Biochem Biophys Res Commun, 1994 Dec 15, 205(2), 1318 - 24
Mechanism of adenovirus-mediated endosome lysis: role of the intact adenovirus capsid structure; Seth P; Adenoviruses have been previously shown to enhance the delivery of many ligands including proteins and plasmid DNAs to the cells . The key biochemical step during this process is the ability of adenovirus to disrupt (lyse) the endosome membrane releasing the co-internalized virus and the other ligands into the cytosol (Seth et al, 1986, In: Adenovirus attachment and entry into cells, pp 191-195, American Society for Microbiology, Washington, D.C.) . To understand the role of the adenovirus proteins involved in the endosome lysis, it is further shown here that empty capsids of adenovirus also possess this membrane vesicle lytic activity; though the activity is about 5-times lower than the adenovirus . Incubation of adenovirus with low concentration of ionic detergent or brief exposure to 45 degrees C destroyed this lytic activity without affecting the adenovirus binding to cell surface receptor, suggesting the lytic activity of adenovirus to be of enzymatic nature . However, exposing adenovirus to conditions that can disrupt adenovirus capsid structure such as heating at 65 degrees C, treating with 0.5% SDS, treating with different proteases, dialyzing against no glycerol buffer, treating with 6 M urea or with 10% pyridine, and sonication destroyed the adenovirus-associated lytic activity . Results suggest the requirement of an intact capsid structure for adenovirus-mediated lysis of the endosome.

J Aerosol Med, 1994 Winter, 7(4), 345 - 50
Nebulizer therapy with antibiotics in chronic suppurative lung disease; el-Din MA et al.; Aerosolized antibiotics have been shown to be a useful modality of treatment in patients with cystic fibrosis . In this investigation we examined the utility of this treatment in patients with other chronic suppurative lung disorders . These included forty patients, thirty men and ten women with chronic airway infection (27 with bronchiectasis, 6 with chronic abscess and 7 with chronic suppurative bronchitis) . Pathogenic organisms were isolated from the affected part of the lung by a fiberoptic bronchoscopy using a sterile disposable bronchial microbiology brush . Cultures from these specimens were used to determine the appropriate antibiotic . A second control group of 20 patients was treated with systemic antibiotics alone . Both systemic and aerosolized antibiotics were administered in 20 patients . A statistically significant improvement in clinical, and ventilatory functions was recorded in the first group compared to the second . Nebulized antibiotics used as adjunctive therapy in association with systemic antibiotics may offer a therapeutic advantage in chronic suppurative lung diseases.

Ann Surg, 1994 Dec, 220(6), 751 - 8
Candida colonization and subsequent infections in critically ill surgical patients; Pittet D et al.; OBJECTIVE . The authors determined the role of Candida colonization in the development of subsequent infection in critically ill patients . DESIGN . A 6-month prospective cohort study was given to patients admitted to the surgical and neonatal intensive care units in a 1600-bed university medical center . METHODS . Patients having predetermined criteria for significant Candida colonization revealed by routine microbiologic surveillance cultures at different body sites were eligible for the study . Risk factors for Candida infection were recorded . A Candida colonization index was determined daily as the ratio of the number of distinct body sites (dbs) colonized with identical strains over the total number of dbs tested; a mean of 5.3 dbs per patient was obtained . All isolates (n = 322) sequentially recovered were characterized by genotyping using contour-clamped homogeneous electrical field gel electrophoresis that allowed strain delineation among Candida species . RESULTS . Twenty-nine patients met the criteria for inclusion; all were at high risk for Candida infection; 11 patients (38%) developed severe infections (8 candidemia); the remaining 18 patients were heavily colonized, but never required intravenous antifungal therapy . Among the potential risk factors for candida infection, three discriminated the colonized from the infected patients--i.e., length of previous antibiotic therapy (p < 0.02), severity of illness assessed by APACHE II score (p < 0.01), and the intensity of Candida spp colonization (p < 0.01) . By logistic regression analysis, the latter two who were the independent factors that predicted subsequent candidal infection . Candida colonization always preceded infection with genotypically identical Candida spp strain . The proposed colonization indexes reached threshold values a mean of 6 days before Candida infection and demonstrated high positive predictive values (66 to 100%) . CONCLUSIONS . The intensity of Candida colonization assessed by systematic screening helps predicting subsequent infections with identical strains in critically ill patients . Accurately identifying high-risk patients with Candida colonization offers opportunity for intervention strategies.

Pediatrics, 1994 Dec, 94(6 Pt 1), 847 - 52
Comparison of cefpodoxime proxetil and cefixime in the treatment of acute otitis media in infants and children . Otitis Study Group; Asmar BI et al.; OBJECTIVE . To compare the use of once-a-day cefpodoxime proxetil to once-a-day cefixime in the treatment of acute suppurative otitis media . DESIGN . Randomized, multicenter, investigator-blinded . SETTING . Outpatient . PATIENTS . A total of 368 patients (age 2 months to 17 years) were randomized to receive either cefpodoxime or cefixime in a 2:1 ratio (245 cefpodoxime, 123 cefixime); 236 patients (155 cefpodoxime, 81 cefixime) were evaluable for drug efficacy . INTERVENTIONS . Patients received either cefpodoxime proxetil oral suspension (10 mg/kg/day, once daily for 10 days) or cefixime oral suspension (8 mg/kg/day, once daily for 10 days) . MAIN OUTCOME MEASURES . Clinical evaluations were performed before treatment (study day 1), at an interim visit (study day 3 through 6), at the end of therapy (study day 12 through 15), and at final follow-up (study day 25 through 38) . Microbiologic evaluations were performed at enrollment and whenever appropriate thereafter . RESULTS . End-of-therapy clinical cure rates in evaluable patients were 56% for the cefpodoxime group and 54% for the cefixime group . Clinical improvement rates were 27% for both groups . Clinical response rates were not significantly different between treatment groups (P = .541; 95% confidence interval = -8.1%, 15.2%) . At long-term follow-up, 17% of patients in the cefpodoxime group and 20% in the cefixime group had a recurrence of infection . Drug-related adverse events (eg, diarrhea, diaper rash, vomiting, rash) occurred in 23.3% of cefpodoxime-treated patients and 17.9% of cefixime-treated patients (P = .282) . CONCLUSIONS . These findings suggest that cefpodoxime proxetil administered once daily is as effective and safe as cefixime given once daily in the treatment of acute suppurative otitis media in pediatric patients.

Clin Infect Dis, 1994 Dec, 19(6), 1155 - 7
Infection due to Mycobacterium haemophilum identified by whole cell lipid analysis and nucleic acid sequencing; Artenstein AW et al.; A patient with indolent, non-Hodgkin's lymphoma developed a pretibial soft tissue abscess caused by a fastidious mycobacterium . Because the organism could not be definitively identified by standard microbiologic testing, whole cell fatty acid analysis and 16S rDNA sequencing were performed . These procedures identified the organism as Mycobacterium haemophilum . We review the diagnostic considerations with regard to this pathogen.

Clin Infect Dis, 1994 Dec, 19(6), 1152 - 4
Mycobacterium genavense infection presenting as a solitary brain mass in a patient with AIDS: case report and review; Berman SM et al.; Patients with AIDS are prone to developing infections with opportunistic pathogens . Recently, a new mycobacterium, Mycobacterium genavense, has been found to cause infection in patients with AIDS . Previously published reports indicate that patients who are infected with this organism present with the same clinical features as do patients with disseminated infection due to organisms of the Mycobacterium avium complex . We describe an unusual case of a patient with AIDS who presented with grand mal seizures and a mass lesion in his brain, which was found to be caused by infection with M . genavense . No evidence of disseminated infection could be found in this patient . We discuss the microbiology of this organism and review the literature on M . genavense infections . Clinicians should be aware of this organism so that efforts at culture and identification will be made.

J Clin Microbiol, 1994 Dec, 32(12), 2962 - 7
PCR identification of four medically important Candida species by using a single primer pair; Jordan JA; A single pair of primers was used in a PCR assay to amplify and identify the DNAs from four medically important Candida species: C . albicans, C . parapsilosis, C . tropicalis, and C . (Torulopsis) glabrata . The report describes the first successful amplification of a chitin synthase-specific fragment from the four Candida species responsible for more than 90% of all cases of neonatal candidemia . The primer pair sequence was based on that from the C . albicans chitin synthase gene, CHS1 (J . Au-Young and P.W . Robbins, Mol . Microbiol . 4:197-207, 1990) . Each of the four amplified products is a single band of a different size . The DNA sequence of each PCR product was determined, and four species-specific probes were synthesized . The DNAs from as few as 10 organisms in 100 microliters of plasma could be detected after amplification and Southern blot analysis . In a retrospective study of 27 paired blood samples from 16 patients with culture-proven candidemia, PCR analysis was successful at detecting and correctly identifying to the species level 26 of the 27 Candida isolates . The speed and accuracy of this PCR-based technology make it a very powerful tool for detecting and diagnosing candidemia . Implementation of this assay for analyzing blood samples should result in the more timely treatment of neonatal candidemia, thereby reducing morbidity and mortality.

Cytopathology, 1994 Dec, 5(6), 359 - 68
Fine needle aspiration of focal liver lesions; Rebello Pinto M et al.; Fourteen percutaneous fine needle aspirates (FNAs) of focal liver lesions performed under ultrasound guidance at the Sultan Qaboos University Hospital (SQUH), Oman, between January 1991 and October 1992, are presented . Ten of these were cytologically diagnosed as hepatocellular carcinomas (HCC) . The patients' ages ranged from 50 to 70 years and eight of these were males . The important diagnostic cytological criteria of HCC were found to be increased nucleocytoplasmic (N/C) ratio, trabecular pattern, atypical naked nuclei, bile production by malignant hepatocytes and absence of bile duct epithelium . Carcinoembryonic antigen (CEA) positivity of bile canaliculi by cross-reaction with biliary glycoprotein I (BGP I) made possible the differentiation of HCC from metastases . We stress the importance of cell blocks as these often constitute microbiopsies . Ultrasound-guided FNA of focal liver lesions is recommended as a simple, easy and quick procedure.

J Periodontol, 1994 Dec, 65(12), 1158 - 68
Comparison of canine and non-human primate animal models for periodontal regenerative therapy: results following a single administration of PDGF/IGF-I; Giannobile WV et al.; Two commonly used animal models for evaluating putative periodontal regenerative therapies are the beagle dog model with natural periodontal disease and the non-human primate with ligature-induced attachment loss . The host response, microbiology, and skeletal rates of remodeling of these two models are summarized . In addition, the results of experiments comparing the healing response to periodontal surgery with and without concurrent use of the combination of platelet-derived growth factor (PDGF) and insulin-like growth factor-I (IGF-I) in these models are presented . At 1 month, PDGF/IGF-I administration resulted in a 64.1% and 51.4% increase in new attachment formation in the non-human primate and canine, respectively, while controls (surgery plus placebo) demonstrated 34.1% and 8.6% increases in new attachment formation in the non-human primate and canine models, respectively . Further, application of PDGF/IGF-I stimulated 21.6% and 65% osseous defect fill in the non-human primate and canine, respectively, while controls demonstrated 8.5% and 14.5% osseous defect fill in the non-human primate and canine, respectively . The osseous response in the canine appears greater than that of the non-human primate, and the new attachment formation was more substantial in the non-human primate than the canine . However, in general these data demonstrate a high degree of consistency in the effects of PDGF/IGF-I in promoting periodontal regeneration . Positive results in these two models--the dog with natural periodontal disease and the non-human primate with ligature-induced attachment loss--justify human clinical trial testing of a putative regenerative therapy.

Int J Food Microbiol, 1994 Dec, 24(1-2), 261 - 71
Application of subtyping by combined allozyme, whole-cell protein and antibiotic resistance analysis in epidemiological investigations of food-borne infections; Thurm V et al.; Allozyme pattern, whole-cell protein pattern and antibiotic resistance were used as markers for epidemiological subtyping (below the species level) of food-relevant bacteria . The results of this study confirm the applicability of these patterns as epidemiological markers also for this special purpose . Electrotyping using also a reduced allozyme set seems to be the method with the highest discriminatory power of the three methods evaluated . Several examples demonstrate that complex typing of bacteria based on a combination of these three methods is useful for the analysis of food-borne infections and establishment of their causes but also for zoonotic studies . We see, beyond this, further applications of molecular subtyping methods in food microbiology and food hygiene such as safety checking in food industry or monitoring in biotechnological processes.

Braz J Med Biol Res, 1994 Dec, 27(12), 2843 - 57
Cell wall deficiency in "slime" strains of Neurospora crassa: osmotic inhibition of cell wall synthesis and beta-D-glucan synthase activity; da-Silva MM et al.; 1 . The RCP-3 S/H mutant of Neurospora crassa was obtained by vegetative selection in medium of high osmolarity of a mycelial form of an fz, sg, os-1 ("slime"-like) segregant . The mutant exhibits spheroplast-hyphal dimorphism conditioned by the osmolarity of the culture medium (Pietro et al . (1990) . Journal of General Microbiology, 136: 121-129) . The carbohydrate composition of the cell wall of the mutant was different from that of the wild type in the absence of an alkali-soluble galactosaminoglycan polymer . Furthermore the mutant cell wall had a somewhat lower content of beta-glucan relative to that of chitin . 2 . Increasing concentrations of sorbitol in the culture medium of the mutant inhibited by 10-fold the formation of cell wall relative to total biomass . The cell wall of the mutant cultured in the presence of sorbitol lacked mannose- and galactose-containing polymers, and also showed progressively lower amounts of beta-glucan relative to chitin . 3 . The activity of membrane-bound (1-3)-beta-D-glucan synthase from the mutant grown in the absence of sorbitol shared several properties with the wild type enzyme (i.e., Km app., Vmax, stability at 30 degrees C, activation by GTP gamma S, and dissociability by treatment with NaCl and Tergitol NP-40 into a membrane-bound catalytic center and a GTP-binding activating protein) . On the other hand, the enzyme from the mutant but not that from the wild type was inactivated by about 15% by treatment with NaCl and detergent . 4 . At high concentrations of sorbitol (1.0 M) the RCP-3 S/H mutant exclusively produced spheroplasts devoid of (1-3)-beta-D-glucan synthase activity . The defect was at the level of the membrane-bound catalytic center . The activity of the GTP-binding activating factor was apparently normal in these cells . 5 . These results suggest that the definitive loss of cell wall in the N . crassa "slime" RCP-3 S/H mutant was due to a defect in (1-3)-beta-D-glucan synthase activity which was exaggerated in the presence of high osmolyte concentrations.

Med Microbiol Immunol (Berl), 1994 Dec, 183(6), 307 - 13
Use of polymerase chain reaction and specific monoclonal antibodies as rapid method to recognize Borrelia burgdorferi sensu stricto, B . garinii and B . afzelii among Italian isolates of B . burgdorferi; Cinco M et al.; We previously classified locally isolated strains of Borrelia burgdorferi by a restriction fragment length polymorphism analysis of total DNA, by DNA/DNA Southern Blot hybridization and by a hybridization with rRNA 16 + 23S from Escherichia coli {Cinco et al . (1993) Microbiologica 16:323-332} into three genetic groups which, according to the reference strains used, should correspond to the three species so far described as B . burgdorferi sensu stricto, B . garinii and B . afzelii . To find a simpler method for strain identification, in this study we analyzed the Italian strains and some strains identification, in this study we analyzed the Italian strains and some strains originating from other European countries, employing the species-specific 16S rRNA primers in the polymerase chain reaction technique (PCR) and some phenotypic markers like the B . afzelii-specific monoclonal antibodies and the battery of OspA-specific monoclonal antibodies which were reported to give a reactivity pattern correlated to the species {Wilske et al . (1993) J Clin Microbiol 31:340-350} . The PCR results confirmed those obtained previously by identifying the three groups as B . burgdorferi sensu stricto, B . garinii and B . afzelii; the reactivity patterns obtained with the monoclonal antibodies (mAb) also corresponded to those described as typical of the three species . We standardized the PCR technique to amplify a sample of crude template DNA obtained from a culture of 10(5) spirochetes.

Virology, 1994 Nov 15, 205(1), 321 - 8
Localization of antigenic sites on human cytomegalovirus virion structural proteins encoded by UL48 and UL56; Bradshaw PA et al.; Two human cytomegalovirus (HCMV) virion structural proteins and their associated reading frames have been identified with two human-derived monoclonal antibodies (HMAbs), X2-16 and X-16 . HMAb X2-16 identified recombinant protein expressing molecular clones that mapped to the open reading frame (ORF) of the UL48 gene of HCMV, between amino acids 584 and 646 (nucleotides 65,084 and 65,272, Chee et al., 1990, "Current Topics in Microbiology and Immunology," Vol . 154, pp . 125-169) . The UL48 gene product has an apparent molecular weight of 216 kDa . HMAb X-16 identified clones derived from the UL56 ORF between amino acids 380 and 425 (nucleotides 84,733 and 84,870) . On immunoblots, HMAb X-16 detected two HCMV proteins of 96 and 60 kDa . Both UL48 and UL56 are highly conserved among the human herpesviruses and their products have been predicted to have essential functions for virus production and maturation . These results confirm that UL48 and UL56 are functional genes encoding essential viral proteins which also generate an immune response in the immunocompetent host.

Acta Eur Fertil, 1994 Nov-Dec, 25(6), 339 - 41
Menopausal hormonal status and vaginal microbiology; Tolino A et al.; The authors have examined endocrine function in women during postmenopausal age . They have also studied polymicrobic vaginal flora related to sexual hormone levels . Have been controllated correlations between vaginal microbic status and cytohormonal response at different hormonal situation present in the same woman . In postmenopausal women have been formed low oestrogen levels related to low presence of Doderlein . Perhaps in postmenopausal women other factors than oestrogen and progesterone levels, could influence vaginal polymicrobic flora.

J Leukoc Biol, 1994 Nov, 56(5), 588 - 92
Multiple functions of nitric oxide in pathophysiology and microbiology: analysis by a new nitric oxide scavenger; Maeda H et al.; A wide range of biological functions of nitric oxide (NO) was analyzed using a newly discovered nitric oxide scavenger, 2-phenyl-4,4,5,5-tetramethylimidazolineoxyl-1-oxyl-3-oxide (PTIO) or its water-soluble derivative carboxy-PTIO . The chemistry is very simple in that NO was oxidized by PTIO, yielding one mole each of NO2 and 2-phenyl-4,4,5,5-tetramethylimidazoline-1-oxyl . Based on the potent NO-scavenging activity of PTIO derivatives, the diverse functions of NO under physiological states as well as various pathological conditions such as endotoxin shock and viral diseases are now explicated . It was found that PTIO and carboxy-PTIO showed significant inhibitory activity against a series of biological actions of NO: (1) endothelium-dependent vascular relaxation in an ex vivo system, (2) pathogenicity of NO produced excessively in endotoxin shock in rats and in influenza virus pneumonitis in mice, and (3) enhanced vascular permeability in solid tumors mediated by NO . PTIO directly extinguishes NO generated by NO synthase (NOS) without affecting NOS activity, which is a clear contrast to NOS inhibitors . Therefore, characterization of this unique mode of action of PTIO appears to be helpful not only in understanding of the pathophysiological role of NO but also in the treatment of various diseases caused by excessive production of NO.

Am J Psychiatry, 1994 Nov, 151(11), 1571 - 83
Lyme disease: a neuropsychiatric illness; Fallon BA et al.; OBJECTIVE: Lyme disease is a multisystemic illness that can affect the central nervous system (CNS), causing neurologic and psychiatric symptoms . The goal of this article is to familiarize psychiatrists with this spirochetal illness . METHOD: Relevant books, articles, and abstracts from academic conferences were perused, and additional articles were located through computerized searches and reference sections from published articles . RESULTS: Up to 40% of patients with Lyme disease develop neurologic involvement of either the peripheral or central nervous system . Dissemination to the CNS can occur within the first few weeks after skin infection . Like syphilis, Lyme disease may have a latency period of months to years before symptoms of late infection emerge . Early signs include meningitis, encephalitis, cranial neuritis, and radiculoneuropathies . Later, encephalomyelitis and encephalopathy may occur . A broad range of psychiatric reactions have been associated with Lyme disease including paranoia, dementia, schizophrenia, bipolar disorder, panic attacks, major depression, anorexia nervosa, and obsessive-compulsive disorder . Depressive states among patients with late Lyme disease are fairly common, ranging across studies from 26% to 66% . The microbiology of Borrelia burgdorferi sheds light on why Lyme disease can be relapsing and remitting and why it can be refractory to normal immune surveillance and standard antibiotic regimens . CONCLUSIONS: Psychiatrists who work in endemic areas need to include Lyme disease in the differential diagnosis of any atypical psychiatric disorder . Further research is needed to identify better laboratory tests and to determine the appropriate manner (intravenous or oral) and length (weeks or months) of treatment among patients with neuropsychiatric involvement.

J Virol, 1994 Nov, 68(11), 7253 - 9
Evidence for a putative second receptor for porcine transmissible gastroenteritis virus on the villous enterocytes of newborn pigs; Weingartl HM et al.; Aminopeptidase-N (APN) has been identified {B . Delmas, J . Gelfi, R . L'Haridon, L . K . Vogel, H . Sjostrom, O . Noren, and H . Laude, Nature (London) 357:417-420, 1992} as a major receptor for porcine transmissible gastroenteritis virus (TGEV) . Binding of TGEV to villous enterocytes from the jejuna of newborn pigs is saturable and at a higher level than that of binding of virus to newborn cryptal enterocytes or to enterocytes from older piglets (H . M . Weingartl and J . B . Derbyshire, Vet . Microbiol . 35:23-32, 1993) . The distribution of APN in enterocytes in the jejuna of neonatal and 3 week-old-piglets, as determined by the measurement of enzymatic activity and by labeling of the cells with an anti-APN monoclonal antibody, did not correspond with the reported distribution of saturable binding sites on enterocytes . Monoclonal antibodies, which were prepared against plasma membranes derived from enterocytes harvested from the upper villi of newborn pigs, blocked the replication of TGEV, but not the porcine respiratory coronavirus, in ST cells and immunoprecipitated a 200-kDa protein in ST cell lysates . This protein was demonstrated by immunohistochemistry and by fluorescence-activated cell scanning to be present on the villous enterocytes of newborn pigs but to be lacking on the cryptal enterocytes of newborn pigs and on the villous and cryptal enterocytes of 3-week-old piglets . Since this distribution of the protein corresponds to the previously demonstrated distribution of saturable binding sites, we conclude that the 200-kDa protein may be an additional receptor for TGEV which is restricted to the villous enterocytes of newborn pigs and which contributes to the age sensitivity of these animals to the virus.

Environ Health Perspect, 1994 Nov, 102 Suppl 7, 5 - 11
An introduction to boron: history, sources, uses, and chemistry; Woods WG; Following a brief overview of the terrestrial distribution of boron in rocks, soil, and water, the history of the discovery, early utilization, and geologic origin of borate minerals is summarized . Modern uses of borate-mineral concentrates, borax, boric acid, and other refined products include glass, fiberglass, washing products, alloys and metals, fertilizers, wood treatments, insecticides, and microbiocides . The chemistry of boron is reviewed from the point of view of its possible health effects . It is concluded that boron probably is complexed with hydroxylated species in biologic systems, and that inhibition and stimulation of enzyme and coenzymes are pivotal in its mode of action.

Int J Food Microbiol, 1994 Nov, 23(3-4), 305 - 15
Predictive modelling: applications in the dairy industry; Griffiths MW; Predictive modelling has been used in the dairy industry for determining the keeping quality of raw milk and pasteurized products . More recently, predictive equations describing growth and toxin production for a number of bacteria of concern to dairy microbiologists have been developed . A more mathematical approach is also being adopted for determining effective pasteurization conditions for organisms present in milk.

Ultrastruct Pathol, 1994 Nov-Dec, 18(6), 549 - 51
Adenovirus infection of the duodenum in an AIDS patient: an ultrastructural study; Yi ES et al.; Intractable diarrhea in a 40-year-old woman with terminal acquired immunodeficiency syndrome resulted from adenovirus infection of the duodenal mucosa . Electron microscopic examination of a duodenal biopsy specimen performed because of clinical suspicion of cryptosporidiosis or microsporidiosis showed pathognomonic viral particles in the nuclei of mucosal epithelium . Extensive sloughing of damaged mucosal cells may have contributed to the diarrhea, for which no other cause was found during either pathologic or microbiologic analysis.

J Clin Periodontol, 1994 Nov, 21(10), 658 - 65
A longitudinal study from prepuberty to puberty of gingivitis . Correlation between the occurrence of Prevotella intermedia and sex hormones; Nakagawa S et al.; A longitudinal study of 24 subjects progressing normally from prepuberty to puberty was undertaken to evaluate the effects of sex hormone levels on clinical and microbiologic parameters and on serum antibodies . During elementary school, at the beginning of the longitudinal monitoring, 2 groups, 12 subjects with gingivitis and 12 gingivitis-free subjects, were selected and observed through puberty . Bone ages and self-assessment of secondary sex characteristics were used to confirm puberty . A statistically significant increase in the proportions of Prevotella intermedia including Prevotella nigrescens and serum antibody levels against P . intermedia was seen in gingivitis group throughout the longitudinal study . Serum levels of testosterone in boys and estradiol and progesterone in girls was positively correlated with levels of P . intermedia and P . nigrescens . In puberty, a slight but significant increase in GI scores over prepuberty has been shown; however, there was no significant change in PlI from prepuberty to puberty . Our study confirmed that there was a statistically significant increase in gingival inflammation and in the proportion of P . intermedia and P . nigrescens in puberty relative to the baseline value, except in the gingivitis-free male group . Our findings suggest that these increases are correlated with elevation in systemic levels of the sex hormones.

J Burn Care Rehabil, 1994 Nov-Dec, 15(6), 519 - 22
Evaluation of traditional African medicine "Compound R" for the treatment of thermal burn wounds in fuzzy rats; Noormohamed SE et al.; The efficacy of an oil-in-water emulsion of a traditional Kenyan medicine, Compound R, on thermal burn wounds in fuzzy rats is reported . The burn wounds were inflicted on the depilated skin of rats with a 2 cm diameter aluminum template heated at 65 degrees C . Mean +/- SD days to healing (complete closure) were 9.9 +/- 2.2 (range 7 to 14 days) and 13.3 +/- 2.4 (range 10 to 16 days) for the treated and control (untreated) wounds, respectively (paired Student's t test, t value -5.667, p = 0.0003) . Preliminary microbiologic results showed no activity of Compound R against some of the commonly encountered pathogens in burn wounds . Compound R appears to decrease the days to burn wound healing in fuzzy rats . This study provides preliminary data for further investigations of Compound R in managing burn wounds.

Oral Surg Oral Med Oral Pathol, 1994 Nov, 78(5), 590 - 3
Lip component of burning mouth syndrome; Lamey PJ et al.; To our knowledge there has been no previous study of factors specifically involved in the pathogenesis of patients who complain of burning sensation of the lips when the lips appear clinically normal . The complaint is akin to patients who complain of a burning sensation of the mouth when it appears clinically normal, a condition known as burning mouth syndrome . This study therefore studied precipitating factors in patients with burning mouth syndrome who reported lip involvement . Previous studies have shown that the lips are the third most common site reported as involved in patients who have burning mouth syndrome . Indeed patients with burning mouth syndrome often report multiple oral site involvement . To investigate the precipitating factors involved in the lip component of burning mouth syndrome, we studied 104 patients who reported the lips as a site affected by the condition from a total population of 312 patients with burning mouth syndrome . Hematologic, biochemical, and microbiologic parameters were studied in these patients . Sialometry, patch testing, psychological testing, and examination of denture status as well as questioning of parafunctional habits were also undertaken . No clear differences were noted in relationship to the frequency of abnormalities in burning mouth syndrome alone or burning mouth syndrome with lip involvement suggesting that similar precipitating factors apply . The precipitating factors in patients with lip involvement were found to be the same as burning mouth syndrome in general . Treatment of patients with lip involvement alone in burning mouth syndrome or lip involvement in burning mouth syndrome in conjunction with other intraoral sites gave an equally good response.(ABSTRACT TRUNCATED AT 250 WORDS)

Med Clin (Barc), 1994 Oct 22, 103(13), 490 - 3
{How many cases of tuberculosis are not reported?}; Garcia Rodriguez JF et al.; BACKGROUND: The aim of this study was to evaluate the degree of registry of tuberculosis and the factors associated to the same . METHODS: A retrospective study of the cases of respiratory tuberculosis diagnosed in the hospital A . Marcide-Novoa Santos (El Ferrol . La Coruna . Spain) from 1990 to 1992 was carried out . Identification was obtained from the registries of microbiology and pathology and the clinical history files . Registered cases were obtained from the nominal notifications to the Epidemiology Department of the local health service department . Sex, age, place of residence, previous history of tuberculosis, HIV, diagnostic method, localization of the tuberculosis, registration and reporting physician were evaluated for each patient . RESULTS: Three hundred ninety-three cases were identified of which 78 (19.8%) had been registered . Age and pulmonary localization were the variable influencing the degree of registration . Reporting was greater in the age group from 0 to 10 years (p < 0.05) . Pulmonary tuberculosis was the most reported type although only 22.4% of the cases were declared . Bacilloscopy was positive in sputum in 190 patients and declared in 46 (24.2%) . The degree of registration increased significantly over three years (p < 0.000001) . Sex, previous history of tuberculosis, infection by the HIV and diagnostic method did not influence the degree of registration . CONCLUSIONS: Seventy-five percent of the cases with positive bacilloscopy in sputum were not declared . The degree of declaration has improved over time, however, remains deficient being 2.7 fold lower than the total number of cases diagnosed in 1992.

Biochim Biophys Acta, 1994 Oct 18, 1219(2), 314 - 20
DNA uptake stimulating protein from Neurospora crassa enhances DNA and oligonucleotide uptake also in mammalian cells; Toth G et al.; The presence of the DNA uptake stimulating protein (designated earlier as DUSF by Schablik and Szabo (1981) FEMS Microbiol . Lett . 10, 395-397) was demonstrated on the surface of Neurospora crassa (FGSC 1118, slime) fungal cells as well as on HEp-2 and K562 human and F4N mouse tumor cells by immunofluorescence microscopy . DUSF markedly enhanced the uptake of both macromolecular {3H}DNA and of {3H}oligonucleotides by K562, HL-60 and also by DD human leukemia cells . Polyclonal anti-DUSF antibodies inhibited both the basal and stimulated {3H}oligonucleotide uptake by K562 cells . DNA-DNA hybridization has shown that the uptake of linearized pBR322 plasmid DNA into N . crassa and K562 cells was stimulated by DUSF, increasing proportionally with the length of incubation time . Unfragmented plasmid molecules were recovered from the cells . It is assumed that DUSF (or related proteins) may play a role in the physiological uptake of oligonucleotides and DNA not only in N . crassa but also in--at least some--mammalian cells.

Ann Emerg Med, 1994 Oct, 24(4), 652 - 6
Incidence of subclinical methemoglobinemia in infants with diarrhea; Pollack ES et al.; STUDY HYPOTHESIS: Infants with diarrhea are at a greater-than-recognized risk of developing methemoglobinemia . DESIGN: Prospective clinical study . SETTING: A university hospital pediatric emergency department . PARTICIPANTS: Consecutive infants under 6 months of age with a history of diarrhea of more than 24 hours' duration not associated with vomiting . INTERVENTIONS: Blood samples were obtained for methemoglobin (MHgb) assay (normal, 0.4% to 1.5%) and electrolytes . Treatment interventions were performed as clinically indicated . Patients with elevated MHgb levels subsequently underwent hemoglobin electrophoresis to exclude congenital methemoglobinemia . RESULTS: Forty-three patients were studied; 27 (64%) had elevated MHgb levels and 13 were cyanotic . Five patients received infusions of methylene blue for methemoglobinemia . All patients recovered without sequelae . There was a strong correlation between weight at or below the tenth percentile for age and the development of methemoglobinemia . Contrary to previous studies, there was no correlation between incidence or severity of methemoglobinemia and acidosis, hyperchloremia, or positive microbiologic studies . CONCLUSION: In ill infants with diarrhea, particularly those who are small for age, consideration should be given to screening for methemoglobinemia.

Obstet Gynecol, 1994 Oct, 84(4), 521 - 4
Association between preterm birth and increased maternal plasma cortisol concentrations; Mazor M et al.; OBJECTIVE: To measure the amniotic fluid (AF) and plasma concentrations of cortisol in women with preterm labor and intact membranes . METHODS: Thirty-eight normal healthy women with singleton gestations, preterm labor, and intact membranes at 32-36 weeks' gestation underwent amniocentesis for evaluation of the microbiologic status of the amniotic cavity . Nineteen women delivered within 1 week of amniocentesis (preterm labor and delivery group), and 19 delivered at term (preterm labor and term delivery group) . Maternal plasma and AF concentrations of cortisol were measured with sensitive and specific, commercially available radioimmunoassay kits . RESULTS: The median plasma cortisol concentration was significantly higher in women who delivered prematurely than in those who delivered at term (260 versus 240 ng/mL; P = .014) . However, no significant differences in median AF cortisol concentrations were detected between the groups (13 versus 14 ng/mL) . CONCLUSIONS: Although maternal plasma cortisol concentrations were significantly higher in women with preterm birth, no similar changes were found in the AF . The rise in maternal plasma cortisol may be related to the stress mechanism of labor.

Enferm Infecc Microbiol Clin, 1994 Oct, 12(8), 378 - 84
{Differential clinical characteristics among pediatric patients with gastroenteritis caused by rotavirus and adenovirus}; Reina J et al.; BACKGROUND: The differential clinical and epidemiological characteristics of pediatric patients (< 14 years) with gastroenteritis caused by rotavirus or adenovirus were studied . MATERIAL AND PATIENTS: A retrospective study was performed in patients with viral gastroenteritis diagnosed from January 1990 to December 1992 . The detection of viral particles was carried out by the agglutination system with latex particles sensitized with antibodies versus rotavirus and adenovirus . Clinical and epidemiological characteristics of the patients were collected reviewing the medical records and emergency charts . RESULTS: Two hundred eighty-nine patients corresponding to 240 cases of infection by rotavirus (83.1%) and 48 (16.9%) by adenovirus, were analyzed . Diarrhea by rotavirus predominated in the winter months (59.7% of the cases from December to March) . Nonetheless, those caused by adenovirus were seen throughout the year with a stable incidence being observed . Statistically significant differences were seen in both groups (p < 0.001) with rotavirus infection having a greater tendency to admission and greater incidence of vomiting, fever (> 39 degrees C) and underlying disease . The presence of leukocytosis was different in the adenovirus group as were the greater length of duration of diarrhea prior to attending the Emergency Department (5.2 days) and the total length of stay (11.2 days) . No other associated enteropathogenic organisms were detected in 86.3% of the infections by rotavirus and in the 89.8% of those caused by adenovirus . In regard to age group distribution prevalence of diarrhea by rotavirus was observed during the first 3 months of life (76.6%) while adenovirus group it went up to 24 months of age with similar percentages . CONCLUSIONS: Diarrhea by rotavirus is mainly presented in the winter, with vomiting and its shorter in length and the symptoms less prolonged than diarrhea caused by adenovirus . Rotavirus diarrhea generally affect patients admitted with some underlying disease . Nonetheless, microbiologic diagnosis is required to establish the definitive etiology of both clinical processes.

Enferm Infecc Microbiol Clin, 1994 Oct, 12(8), 372 - 7
{Microbiologic diagnosis of typhoid fever: report on an outbreak}; Gonzalez A et al.; BACKGROUND: The incidence of typhoid fever has greatly fallen in Spain although sporadic cases and limited outbreaks may be observed . The usefulness of the serum agglutinin studies for the diagnosis of this disease has been questioned by many authors . However, this diagnosis criteria continues to be used in Spain . The usefulness of blood cultures, stool cultures, urinecultures and serological test is herewith compared . METHODS: Three groups were prospectively studied: 18 patients with typhoid fever from one single outbreak, 50 blood donors, and 24 patients with other infections . Blood, stool culture, urinecultures and serology (agglutination) were carried out in the first group and in the other two groups serological test were used to determine the cut-off points and study cross reactions . RESULTS: Blood culture was found to be the most sensitive technique (94%) followed by stool culture (53%) . No positive urineculture of seroconvesrion were observed . The cut off points accepted following the study of the donors were 1/160 or greater for the O antigen and 1/320 or greater for the H antigen . Two false positive for the O antigen and 3 for the H antigen were observed in the 24 patients with other infections . CONCLUSIONS: When suspecting typhoid fever, the combined use of blood culture and stool culture is recommended . The usefulness of serological test in our area lays in the observation of seroconversion associated to a compatible clinical picture . Its performance should not being considered as adequate in unspecific febrile syndromes.

J Pediatr, 1994 Oct, 125(4), 519 - 26
Escherichia coli O 157:H7-associated hemolytic-uremic syndrome after ingestion of contaminated hamburgers; Brandt JR et al.; We conducted a retrospective analysis of 37 children with Escherichia coli O157:H7-associated hemolytic-uremic syndrome . The infection was traced to contaminated hamburgers at a fast-food restaurant chain . Within 5 days of the first confirmed case, the Washington State Department of Health identified the source and interrupted transmission of infection . Ninety-five percent of the children initially had severe hemorrhagic colitis . Nineteen patients (51%) had significant extrarenal abnormalities, including pancreatitis, colonic necrosis, glucose intolerance, coma, stroke, seizures, myocardial dysfunction, pericardial effusions, adult respiratory disease syndrome, and pleural effusions . Three deaths occurred, each in children with severe multisystem disease . At follow-up two children have significant impairment of renal function (glomerular filtration rate < 80 ml/min/per 1.73 Hm2); both of these children have a normal serum creatinine concentration . Hemolytic-uremic syndrome is the most common cause of acute renal failure in children, and this experience emphasizes the systemic nature of this disease . Clinicians should anticipate that multisystem involvement may occur in these patients, necessitating acute intervention or chronic follow-up . This outbreak of Hemolytic-uremic syndrome also highlights the microbiologic hazards of inadequately prepared food and emphasizes the importance of public health intervention in controlling Hemolytic-uremic syndrome.

J Bacteriol, 1994 Oct, 176(20), 6286 - 94
Integrons found in different locations have identical 5' ends but variable 3' ends; Hall RM et al.; The positions of the outer boundaries of the 5'- and 3'-conserved segment sequences of integrons found at several different locations have been determined . The position of the 5' end of the 5'-conserved segment is the same for six independently located integrons, In1 (R46), In2 (Tn21), In3 (R388), In4 (Tn1696), In5 (pSCH884), and In0 (pVS1) . However, the extent of the 3'-conserved segment differs in each integron . The sequences of In2 and In0 diverge first from the conserved sequence, and their divergence point corresponds to the 3'-conserved segment endpoint defined previously (H.W . Stokes and R.M . Hall, Mol . Microbiol . 3:1669-1683, 1989), which now represents the endpoint of a 359-base deletion in In0 and In2 . The sequence identity in In3, In1, In4, and In5 extends beyond this point, but each sequence diverges from the conserved sequence at a different point within a short region . Insertions of IS6100 were identified adjacent to the end of the conserved region in In1 and 123 bases beyond the divergence point of In4 . These 123 bases are identical to the sequence found at the mer end of the 11.2-kb insertion in Tn21 but are inverted . In5 and In0 are bounded by the same 25-base inverted repeat that bounds the 11.2-kb insert in Tn21, and this insert now corresponds to In2 . However, while In0, In2, and In5 have features characteristic of transposable elements, differences in the structures of these three integrons and the absence of evidence of mobility currently preclude the identification of all of the sequences associated with a functional transposon of this type.

J Chemother, 1994 Oct, 6(5), 283 - 318
A review of the microbiology of amoxycillin/clavulanic acid over the 15 year period 1978-1993; Rolinson GN; A review of the published literature over the period 1978-1993 was undertaken to assess any changes in the prevalence of beta-lactamase-producing bacterial pathogens and also any changes in the susceptibility in these pathogens to amoxycillin/clavulanate . The review has involved the examination of over 1500 publications . The review shows that in general there has been an increase in the frequency of beta-lactamase-producing pathogens resistant to ampicillin and amoxycillin but there is no evidence for any significant increase in resistance to amoxycillin/clavulanate over the period of the review.

Acta Paediatr Jpn, 1994 Oct, 36(5), 480 - 4
Tuberculous meningitis in children; Altunbasak S et al.; Between May 1988 and November 1992 the data from 52 patients with tuberculous meningitis (TBM) were noted down for their symptoms and signs, BCG vaccines, PPD tests; clinical, laboratory, radiologic and microbiologic findings . These data were discussed by means of literature knowledge . Cranial computed tomography (CT) demonstrated hydrocephalus (HC) in 98% of the patients . There was a statistically significant difference among the clinical stages on admission in respect to prognosis (P < 0.05) . In addition, there was also a significant relationship between prognosis and HC (P < 0.05) . However, we did not find any significant relationship between parenchymal involvement, basilar meningitis and prognosis (P > 0.05).

Gene, 1994 Sep 15, 147(1), 29 - 40
Sequence of the essential early region of phi C31, a temperate phage of Streptomyces spp . with unusual features in its lytic development; Hartley NM et al.; The temperate phage phi C31 is the most studied bacteriophage infecting Streptomyces spp., and has been used to develop an extensive and widely used series of cloning vectors . The sequence of 10 kb of phi C31 DNA containing most or all of the essential early genes was determined . Among the ORFs, 14 (perhaps 15) appear to be protein-coding, and these have been designated ORF1 to ORF14 and ORFX . Previously mapped transcripts appear to initiate upstream from ORFs 1, 8, 11 and 12, and within ORF3 and ORF12, in each case close to one example of the unusual ('21-mer') sequences that appear to serve as a recognition site for RNA polymerase early in the phi C31 lytic cycle {Ingham et al., Mol . Microbiol . 9 (1993) 1267-1274} . Further copies of the 21-mer are upstream from ORF2 and ORF13 . There are four recognisable examples of a conserved inverted repeat sequence motif (CIR) thought to bind phi C31 repressor {Smith and Owen, Mol . Microbiol . 5 (1991) 2833-2844} . Only one CIR is closely associated with a 21-mer sequence, though three are located between known transcription units . Of all 14 ORFs, only one (ORF11) would encode a protein unmistakably resembling other known proteins; its product appears to be a DNA polymerase . Strikingly, two codons, TTA (Leu) and AGG (Arg), are absent from the 14 ORFs.

Riv Eur Sci Med Farmacol, 1994 Sep-Dec, 16 Suppl 1, 39 - 68
{Intestinal malabsorption, celiac disease and associated lymphoma: from symptoms to diagnosis}; Gasbarrini G et al.; The clinical consequences of intestinal malabsorption are extremely variable and a dissociation between malabsorption, malabsorption syndrome and enteropathy is often noted . Enteropathy does not always results in malabsorption and in an alteration of the tests exploring the absorptive function . The following have particular relevance in clinical practice: coeliac disease, malabsorption induced by microbiologic agent (including Whipple's disease), post-surgical malabsorption and selective carbohydrate malabsorption . In particular, coeliac disease has been analyzed in its various aspects, from studies with organ cultures to immunological hypotheses, from the classical variety to subclinical forms and to serious complications, such as enteropathy-associated T cell lymphoma . Malabsorption syndromes are dramatically underdiagnosed: in the typical case of coeliac disease, enteropathy represents a clinical iceberg, and the discovery of the submerged portion, represented by the polymorphous subclinical varieties, has just started . As far as intestinal malabsorption is concerned, the main clinical problem regards diagnosis.

Acta Cytol, 1994 Sep-Oct, 38(5), 777 - 81
Nodular subcutaneous histoplasmosis . A case report with diagnosis by fine needle aspiration biopsy; Stong GC et al.; Fine needle aspiration biopsy (FNAB) of a solitary subcutaneous nodule in the upper arm of a patient being treated with corticosteroids for chronic obstructive pulmonary disease contained numerous spherical, unstained, refractile particles mixed with necrotic cellular material and rare intact histiocytes with yeastlike inclusions . The morphology of the extracytoplasmic spheroids and cytoplasmic inclusions, as demonstrated with Gomori methenamine silver stain, was characteristic of Histoplasma capsulatum var capsulatum . This organism's identification was confirmed by excisional biopsy and microbiologic testing . If the characteristic intrahistiocytic, yeastlike forms are rare or absent, recognition of this peculiar, uncommonly encountered extracellular pattern is crucial to the diagnosis of infection with H capsulatum . This pattern may become more common with increased numbers of immunosuppressed patients and increased use of FNAB.

Med Clin North Am, 1994 Sep, 78(5), 1081 - 90
Nosocomial pneumonia in the medical and surgical patient . Risk factors and primary management; Dal Nogare AR; Nosocomial pneumonia is a large and growing problem in American hospitals . This article reviews the epidemiology, risk factors, microbiology, natural history, and presentation of nosocomial pneumonia . Pathogenesis is also reviewed, and practical measures for prevention are stressed.

Mol Cell Biol, 1994 Sep, 14(9), 6030 - 8
Hyphal tip extension in Aspergillus nidulans requires the manA gene, which encodes phosphomannose isomerase; Smith DJ et al.; A strain of Aspergillus nidulans carrying a temperature-sensitive mutation in the manA gene produces cell walls depleted of D-mannose and forms hyphal tip balloons at the restrictive temperature (B.P . Valentine and B.W . Bainbridge, J . Gen . Microbiol . 109:155-168, 1978) . We have isolated and characterized the manA gene and physically located it between 3.5 and 5.5 kb centromere distal of the riboB locus on chromosome VIII . The manA gene contains four introns and encodes a 50.6-kDa protein which has significant sequence identity to type I phosphomannose isomerase proteins from other eukaryotes . We have constructed by integrative transformation a null mutation in the manA gene which can only be maintained in a heterokaryotic strain with wild-type manA+ nuclei . Thus, a manA null mutation is lethal in A . nidulans . The phenotype of the mutation was analyzed in germinating conidia . Such conidia are able to commence germination but swell abnormally, sometimes producing a misshapen germ tube, before growth ceases . The reason for the lethality is probably the lack of synthesis of mannose-containing cell wall polymers that must be required for normal cell wall development in growing hyphae.

Obstet Gynecol, 1994 Sep, 84(3), 463 - 9
Potential for bias in studies of the influence of human immunodeficiency virus infection on the recognition, incidence, clinical course, and microbiology of pelvic inflammatory disease; Irwin KL et al.; As the human immunodeficiency virus (HIV) epidemic affects more women, clinicians are increasingly observing pelvic inflammatory disease (PID) in HIV-infected women . The extent to which PID is a factor in the recognition of HIV or HIV is a factor in the recognition of PID is unknown . Even less is known about how HIV infection influences the development, clinical course, and microbiology of PID . The paucity of existing data largely results from difficulties in designing studies that are free of bias . Several biases may distort studies of the effect of HIV on the recognition, incidence, clinical presentation and course, and microbiology of PID . Selection bias, diagnostic bias, and confounding bias are the most likely causes of invalid conclusions in studies of the influence of HIV infection on these aspects of PID, for three major reasons: Factors that determine patients' health care seeking behavior may be related to HIV status; the diagnosis of PID tends to be imprecise; and extraneous factors that cause or prevent PID may be distributed differently in HIV-infected and HIV-uninfected women . Appropriate study design and analytic techniques can eliminate, reduce, or estimate the magnitude and direction of these biases, thereby yielding more valid conclusions . To interpret properly existing and future studies of the influence of HIV infection on PID, clinicians must consider several biases that may distort results.

Pharmacotherapy, 1994 Sep-Oct, 14(5), 509 - 13
Effect of simultaneous didanosine administration on itraconazole absorption in healthy volunteers; May DB et al.; STUDY OBJECTIVE . To investigate the effect of simultaneously administered didanosine (ddI) on the absorption of a single dose of itraconazole . DESIGN . Randomized, crossover, unblinded single-dose pharmacokinetic study in healthy volunteers . Comparisons of itraconazole alone and itraconazole with simultaneous ddI were performed on days 1 and 15 . SETTING . A university medical center . PATIENTS . Seven healthy men and women . Six subjects (86%) completed the study; one was removed due to the development of a rash . INTERVENTIONS . Volunteers received a single 200-mg oral dose of itraconazole or itraconazole with concomitant oral ddI 300 mg (two 150-mg tablets) dispersed in 240 ml water . Each regimen was separated by a 2-week washout period . Serum samples were obtained frequently for 12 hours after the dose . MEASUREMENTS AND MAIN RESULTS . Concentrations of itraconazole were determined using a microbiologic assay . Individual concentrations in serum versus time data were evaluated by linear regression analysis . Peak serum concentration and time to peak were determined by visual inspection of each individual's serum concentration-time curve . A mean +/- SD peak serum itraconazole concentration of 0.90 +/- 0.30 micrograms/ml was observed at 3.0 +/- 0.7 hours when itraconazole was administered alone, compared with undetectable levels in all patients during therapy with ddI . CONCLUSIONS . Simultaneous oral administration of ddI significantly decreases absorption of itraconazole . These drugs should not be administered concurrently.

Respir Med, 1994 Sep, 88(8), 593 - 7
Endobronchial tuberculosis: diagnostic features and therapeutic outcome; Hoheisel G et al.; BACKGROUND: Endobronchial tuberculosis (EBTB) is not seen often in the adult population . In most cases it is associated with pulmonary tuberculosis . During its course significant tracheobronchial stenosis may develop . In this study we report our experience with patients with EBTB . METHODS: The records of 38 patients in whom EBTB had been proved by fibre optic bronchoscopy, microbiology and histology studies were evaluated . RESULTS: Symptoms were non-specific and represented mainly the co-existing pulmonary tuberculosis . Signs characteristic of airway obstruction were rare (localized wheezing in 6%) . Indications for bronchoscopy were radiographic features (87%), microscopy smear negatives (8%), wheezing (3%), and blood stained sputum (3%) . The lesions were more likely to be seen in the main and upper bronchi . In 5% of patients the lower trachea was involved . Most lesions looked inflamed (51%), followed by caseous (19%), granulomatous (17%), ulcerative (12%), and fibrotic appearance (1%) . The degree of stenosis was nil (22%), minor (45%), significant (13%), subtotal (13%), or total (7%) . The patients were treated with a combination of antituberculosis drugs . Four patients underwent surgical procedures . Dilatation techniques were used in two patients for a right and left main bronchus stenosis respectively, with significant improvement in one . Dilatation in combination with laser therapy of a right intermediate bronchus stenosis did not result in re-expansion of the dependent part of the lung due to pleural adhesions . Left pneumonectomy was performed in one patient for destroyed lung . Twenty-two patients agreed to follow up bronchoscopy . The macroscopic appearance of the mucosa had improved in most cases but the degree of stenoses was unchanged in a considerable proportion (58%) . Bronchial stenosis in one patient subsided during therapy but developed again at a later stage . CONCLUSIONS: Patients with pulmonary tuberculosis and radiographic evidence of volume loss are recommended to undergo bronchoscopy to rule out EBTB . Specific symptoms for EBTB are rare . Biopsy of inflamed areas of bronchial mucosa seems to be indicated . Despite adequate antituberculosis therapy tracheobronchial stenosis may develop . Long term follow up including bronchoscopy seems therefore advocated . Dilatational intervention may be indicated in selected cases.

Arch Fam Med, 1994 Sep, 3(9), 828 - 32
Lower respiratory tract infection with Chlamydia pneumoniae; Thom D; Chlamydia pneumoniae, also known as TWAR, is a common respiratory pathogen that can cause pneumonia, bronchitis, sinusitis, and pharyngitis . The clinical similarities between C pneumoniae infection and infection with other respiratory pathogens together with the lack, until recently, of readily available diagnostic tests for C pneumoniae have hindered its recognition and treatment in the outpatient setting . In this report, three patients with acute C pneumoniae infection from the Acute Respiratory Disease Study at the University of Washington are described, and the microbiologic characteristics, epidemiologic characteristics, clinical presentations, diagnosis, and treatment of acute C pneumoniae infection are considered.

Mt Sinai J Med, 1994 Sep, 61(4), 341 - 8
Drug-resistant tuberculosis: factors associated with rise in resistance in an HIV-infected urban population; Salomon N et al.; Our objective was to characterize the population with tuberculosis (TB) and to identify factors predictive of resistance to anti-TB agents in an area of high prevalence of human immunodeficiency virus infection . We reviewed microbiology and clinical records from 1988 to 1991 at Beth Israel Medical Center, New York City, for patients with culture-proved TB and analyzed the frequency of resistance to anti-TB agents with respect to demographic and clinical variables . Of 360 patients with TB, 17.5% had drug-resistant isolates . Of the 333 patients on whom the information was available, 72% reported HIV risk factors, 54% injectable drug use, and nearly one-third homelessness . The majority (56%) had documented HIV infection . Between 1988 and 1991, acquired resistance to isoniazid (INH) alone rose from 5% to 21% and initial resistance to INH alone rose from 0% to 19% . Drug resistance was more likely in previously treated patients; 61% of the previously treated patients admitted noncompliance with therapy . Cavitary lung disease was the strongest predictor of acquired drug resistance . Initial drug resistance was more likely in patients with HIV infection . Among persons with HIV infection, none of the analyzed factors was found to be predictive of drug resistance . Noncompliance with therapy and the HIV epidemic played a major role in the rise of drug resistance in our population . HIV infection confounds the epidemiologic factors that might otherwise allow clinical prediction of resistance.

Epidemiol Mikrobiol Imunol, 1994 Sep, 43(3), 142 - 5
{Fusarium and fusariosis}; Jesenska Z; The submitted review deals with the problem of hyalohyphomycoses caused by the genus Fusarium . Attention is drawn to the fact that members of this genus cannot be considered any longer in medical microbiology as mere saprophytes but that they are able to cause superficial, organ and disseminated infections . The number of patients infected with these fungi is increasing.

Zh Mikrobiol Epidemiol Immunobiol, 1994 Sep-Oct, (5), 45 - 9
{A prognostic model of hepatitis A morbidity}; Asratian AA et al.; The growing interest to the study of the processes of the spread of hepatitis A (HA) in big cities of our country has stimulated the development of a new prognostic model at the Gamaleia Research Institute of Epidemiology and Microbiology . The model specifically takes into account a number of factors linked with the dynamics of the development of the disease in 6 stages and some regularities in the seasonal rises of HA morbidity . Quantitative relations in the mathematical model are determined by a system of nonlinear integral-differential equations with the first order partial derivatives and under the integral type boundary conditions, which increases the strictness of modeling of HA . The use of this new model has made it possible to carry out the prognostic-analytical study of HA morbidity among children in Perm and to evaluate a decrease in HA morbidity due to the hypothetical vaccination of children in spring months.

Trends Microbiol, 1994 Sep, 2(9), 332 - 6
A retroviral implication in multiple sclerosis?
Christensen T, Moller-Larsen A, Haahr S.
The etiology of multiple sclerosis (MS) is still unexplained . Epidemiological studies indicate that environmental agents are involved, and MS shares both clinical and histopathological features with retrovirus-mediated neurological diseases in animals and humans . Thus, combining the fields of microbiology and epidemiology may throw new light on the many unanswered questions posed by MS.

Antimicrob Agents Chemother, 1994 Sep, 38(9), 2024 - 8
Ticarcillin-clavulanic acid pharmacokinetics in preterm neonates with presumed sepsis; Burstein AH et al.; The objective of the reported study was to characterize the pharmacokinetics of ticarcillin and clavulanic acid in premature low-birth-weight (less than 2,200 g) neonates with presumed sepsis . Eleven infants received 12 courses of ticarcillin-clavulanic acid at 75 mg/kg of body weight intravenously every 12 h . Blood samples were collected at 0.5, 1.5, 4, and 8 h following the infusion of the initial dose . The concentrations of ticarcillin and clavulanic acid were determined by a microbiologic assay . Median (interpatient coefficients of variation) values for the volume of the central compartment, total steady-state volume, distributional clearance, total clearance, and terminal elimination half-life for ticarcillin were 0.030 liter/kg (21%), 0.26 liter/kg (48%), 0.41 liter/h/kg (47%), 0.047 liter/h/kg (47%), and 4.2 h (45%), respectively . For clavulanic acid the parameters were 0.28 liter/kg (32%), 0.36 liter/kg (34%), 11 liters/h/kg (36%), 0.12 liters/h/kg (72%), and 1.95 h (40%), respectively . Our results suggest that the current dosing recommendations of 75 mg/kg every 12 h risk subtherapeutic clavulanic acid concentrations and that 50 mg/kg every 6 h is a more rational dosing strategy.

J Heart Lung Transplant, 1994 Sep-Oct, 13(5), 916 - 8
Toxoplasmosis after heart transplantation: diagnosis by endomyocardial biopsy; Wagner FM et al.; Protozoal infections such as toxoplasmosis are known complications in heart transplant recipients . Diagnosis of the disease is often difficult . This article describes the course of a patient who had a febrile illness with leukocytosis and neurologic disorders after heart transplantation; all microbiologic and serologic tests of the peripheral blood and the cerebrospinal fluid failed to identify the responsible pathogen . Infection with Toxoplasma gondii was finally diagnosed by endomyocardial biopsy . We conclude that in heart transplant recipients with infections of unclear origin and neurologic disorders, endomyocardial biopsy may be helpful in the diagnosis, especially in cases of toxoplasmosis.

Antibiot Khimioter, 1994 Sep-Oct, 39(9-10), 49 - 53
{Mechanism of action of the antineoplastic antibiotic asterin on cellular factors of immunogenesis regulation}; Smirnov VV et al.; Asterin is a novel antitumor antibiotic isolated from a medicinal plant of the aster family in the Department of Antibiotics of the Institute of Microbiology and Virology of the National Academy of Sciences of the Ukraine . The mechanisms of its influence on the host antitumor resistance were studied . Asterin was shown to promote the modulation of the specific and nonspecific link of the antitumor resistance . It activated to a definite extent the effector productive phase with the dominating influence on the proliferative phase . The antibiotic immunocorrective action was achieved via the recovery of the suppression mechanism controlling the proliferation and differentiation of all the cell populations . The molecular mechanisms of the asterin action on the lymphocyte transformation characterized by an increase in the metabolism and synthesis of the membrane phospholipids are likely associated with the control of their free radical processes.

Chest, 1994 Sep, 106(3), 952 - 4
Melioidosis in a diabetic sailor; Turner MO et al.; Melioidosis was diagnosed in a diabetic sailor who presented with a history and chest radiograph that suggested tuberculosis . Melioidosis is a tropical disease with protean manifestations: from asymptomatic infection to chronic cavitary lung disease to overwhelming sepsis . The diagnosis is easily made, even in nonendemic areas when duly considered by the clinicians and microbiology laboratory . Ceftazidime has dramatically improved outcomes in hospitalized patients with severe melioidosis.

Biochemistry, 1994 Aug 2, 33(30), 8912 - 20
Association of Hsp90 with cellular Src-family kinases in a cell-free system correlates with altered kinase structure and function; Hartson SD et al.; Following synthesis in the cytoplasm, the transforming proteins encoded by the retroviral oncogenes src, yes, fps, fes, and fgr form complexes with hsp90 and the hsp90 cohort p50 . These cytoplasmic complexes are intermediates in the production of the mature membrane-associated kinase . However, soluble complexes between the nascent cellular homologs of these proteins and hsp90-p50 have not been readily detected {Brugge, J.S . (1986) Curr . Top . Microbiol . Immunol . 123, 1-22 and references therein} . In this paper, we have utilized protein synthesis in reticulocyte lysate to determine whether three cellular members of the src family of tyrosine kinases, myeloid-specific p59fgr, B cell-specific p59fgr, and p56lck, form complexes with hsp90 . Following their synthesis, fast- and slow-sedimenting forms of these proteins can be separated on glycerol gradients . Anti-hsp90 monoclonal antibodies co-immunoadsorb the fast-sedimenting, but not the slow-sedimenting, forms of these kinases from gradient fractions . These hsp90 complexes can be detected in the complete absence of detergent . Conversely, an unrelated protein, firefly luciferase, does not form stable complexes with hsp90 following synthesis in reticulocyte lysate . Anti-p56lck antibodies specifically co-immunoadsorb hsp90 from protein synthesis reactions programmed with lckRNA . The fast-sedimenting, complex-bound form of p56lck is deficient in autophosphorylation activity and phosphorylates an exogenous substrate, acid-treated enolase, less efficiently than does the monomeric form . Fast-sedimenting p56lck is hypersentitive to limited proteolysis by chymotrypsin.(ABSTRACT TRUNCATED AT 250 WORDS)

Thorax, 1994 Aug, 49(8), 808 - 10
Characteristics of patients with drug resistant and drug sensitive tuberculosis in East London between 1984 and 1992; al Jarad N et al.; BACKGROUND--The aim of this study was to investigate retrospectively factors associated with drug resistant tuberculosis at the London Chest Hospital . METHODS--The microbiology results for patients with tuberculosis at the hospital for the period 1984-92 were reviewed, together with case notes and chest radiographs of all patients with drug resistant tuberculosis and of 101 patients with drug sensitive tuberculosis notified during the same period as a control group . RESULTS--Culture positive pulmonary tuberculosis occurred in 292 patients . Drug resistant strains were isolated from 20 patients (6.8%) . Ten of the 292 (3.4%) had strains resistant to a single drug and nine (3.1%) had resistance to more than one first line drug . One patient had strains resistant to isoniazid and capreomycin . Strains resistant to more than one drug were all resistant to isoniazid and rifampicin . In five patients these strains were also resistant to pyrazinamide and in two they were resistant to streptomycin . Single drug resistant strains were resistant to isoniazid (nine patients) or streptomycin (one patient) . Among the risk factors studied previous treatment for tuberculosis was the most significant association with drug resistant tuberculosis (7/9) for patients with resistance to more than one drug; 5/11 for single drug resistance compared with 6/101 patients in the drug sensitive group (odds ratio 22.8) . Other risk factors were bilateral disease at presentation (odds ratio 8.5), and disease at a young age (odds ratio 1.03) . CONCLUSIONS--Previous treatment for tuberculosis and bilateral disease at presentation were found to be more commonly associated with cases of drug resistant than with drug sensitive tuberculosis.

Am J Med, 1994 Aug, 97(2), 135 - 44
NIAID Mycoses Study Group Multicenter Trial of Oral Itraconazole Therapy for Invasive Aspergillosis; Denning DW et al.; BACKGROUND: Invasive aspergillosis is the most common invasive mould infection and a major cause of mortality in immunocompromised patients . Response to amphotericin B, the only antifungal agent licensed in the United States for the treatment of aspergillosis, is suboptimal . METHODS: A multicenter open study with strict entry criteria for invasive aspergillosis evaluated oral itraconazole (600 mg/d for 4 days followed by 400 mg/d) in patients with various underlying conditions . Response was based on clinical and radiologic criteria plus microbiology, histopathology, and autopsy data . Responses were categorized as complete, partial, or stable . Failure was categorized as an itraconazole failure or overall failure . RESULTS: Our study population consisted of 76 evaluable patients . Therapy duration varied from 0.3 to 97 weeks (median 46) . At the end of treatment, 30 (39%) patients had a complete or partial response, and 3 (4%) had a stable response, and in 20 patients (26%), the protocol therapy was discontinued early (at 0.6 to 54.3 weeks) because of a worsening clinical course or death due to aspergillosis (itraconazole failure) . Twenty-three (30%) patients withdrew for other reasons including possible toxicity (7%) and death due to another cause but without resolution of aspergillosis (20%) . Itraconazole failure rates varied widely according to site of disease and underlying disease group: 14% for pulmonary and tracheobronchial disease, 50% for sinus disease, 63% for central nervous system disease, and 44% for other sites; 7% in solid organ transplant, 29% in allogeneic bone marrow transplant patients, and 14% in those with prolonged granulocytopenia (median 19 days), 44% in AIDS patients, and 32% in other host groups . The relapse rates among those who completed therapy and those who discontinued early for possible toxicity were 12% and 40%, respectively; all were still immunosuppressed . CONCLUSION: Oral itraconazole is a useful alternative therapy for invasive aspergillosis with response rates apparently comparable to amphotericin B . Relapse in immunocompromised patients may be a problem . Controlled trials are necessary to fully assess the role of itraconazole in the treatment of invasive aspergillosis.

Acad Med, 1994 Aug, 69(8), 663 - 9
Influence of a highly focused case on the effect of small-group facilitators' content expertise on students' learning and satisfaction; Davis WK et al.; BACKGROUND . There has been considerable debate over the need for content expertise to lead a successful small-group discussion for medical students . Some authors feel process expertise related to the conduct of a small group is of more value than content expertise related to the case . At least one study has presented data that suggest content expertise can lead to teacher domination of the learning environment . In an earlier study, the present authors found that students learned more and were more satisfied with small-group instruction when the instruction was facilitated by a faculty member who was an expert in the content of the case . That study also identified no tendency for content experts to dominate the sessions (e.g., through lecturing or otherwise controlling the learning environment) . The purpose of the present study was to explore the efficacy of a carefully designed and highly focused case problem to remove the influence of group facilitators' content expertise on students' learning outcomes . METHOD . The 211 students in the University of Michigan Medical School class of 1994 were randomly assigned to 28 groups in a microbiology and immunology course in the fall of 1991; each small group was led by a faculty facilitator . Complete data were available from 27 groups: 13 groups led by experts and 14 groups led by non-experts . Data collection included observers' codings of interactions between the students and the facilitators (interactional analysis), test scores, and students' ratings of the experience . RESULTS . Unlike in the previous study, group leaders who were content experts devoted significantly more time to teacher-directed activities than did non-content-expert leaders . However, overall, 62% of the time was devoted to student-initiated activity . The results of the multiple-choice tests that were related specifically to the goals of the case indicated there was no significant difference between the students' performances in the groups led by experts and those led by non-experts . With respect to students' satisfaction, all students gave consistently high ratings to the experience and there was no difference between groups led by expert and non-expert facilitators . CONCLUSION . The data from this study suggest that a facilitator's content expertise alone does not determine the amount of teacher-directed behavior in a group, the amount of students' learning, or students' satisfaction . The focus built into the case and the amount of facilitator's training directly related to the content of the case are also significant variables related to students' learning, teacher's behavior, and students' satisfaction.

Surgery, 1994 Aug, 116(2), 250 - 3; discussion 253-4
Use of artificial intelligence to analyze clinical database reduces workload on surgical house staff; Grossi EA et al.; BACKGROUND . The current quantity and diversity of hospital clinical, laboratory, and pharmacy records have resulted in a glut of information, which can be overwhelming to house staff . This study was performed to measure the impact of artificial intelligence analysis of such data on the junior surgical house staff's workload, time for direct patient care, and quality of life . METHODS . A personal computer was interfaced with the hospital computerized patient data system . Artificial intelligence algorithms were applied to retrieve and condense laboratory values, microbiology reports, and medication orders . Unusual laboratory tests were reported without artificial intelligence filtering . RESULTS . A survey of 23 junior house staff showed a requirement for a total of 30.75 man-hours per day, an average of 184.5 minutes per service twice a day for five surgical services each with an average of 40.7 patients, to manually produce a report in contrast to a total of 3.4 man-hours, an average of 20.5 minutes on the same basis (88.9% reduction, p < 0.001), to computer generate and distribute a similarly useful report . Two thirds of the residents reported an increased ability to perform patient care . CONCLUSIONS . Current medical practice has created an explosion of information, which is a burden for surgical house staff . Artificial intelligence preprocessing of the hospital database information focuses attention, eliminates superfluous data, and significantly reduces surgical house staff clerical work, allowing more time for education, research, and patient care.

J Bacteriol, 1994 Aug, 176(15), 4710 - 7
Inactivation of FhuA at the cell surface of Escherichia coli K-12 by a phage T5 lipoprotein at the periplasmic face of the outer membrane; Braun V et al.; Inactivation of phage T5 by lysed cells after phage multiplication is prevented by a phage-encoded lipoprotein (Llp) that inactivates the FhuA outer membrane receptor protein (K . Decker, V . Krauel, A . Meesmann, and K . Heller, Mol . Microbiol . 12:321-332, 1994) . Using FhuA derivatives carrying insertions of 4 and 16 amino acid residues and point mutations, we determined whether FhuA inactivation is caused by binding of Llp to FhuA and which regions of FhuA are important for inactivation by Llp . Cells expressing Llp were resistant not only to phage T5 but to all FhuA ligands tested, such as phage phi 80, colicin M, and albomycin, and they were strongly reduced in the uptake of ferrichrome . Most of the FhuA derivatives which were not affected by Llp were, according to a previously published FhuA transmembrane topology model, located in periplasmic turns and in the TonB box close to the periplasm . Since the ligands bind to the cell surface, interaction of FhuA with Llp in the periplasm may induce a FhuA conformation which impairs binding of the ligands . This conclusion was supported by the increase rather than decrease of colicin M sensitivity of two mutants in the presence of Llp . The only Llp-resistant FhuA derivatives with mutations at the cell surface contained insertions of 16 residues in the loop that determines the permeability of the FhuA channel and serves as the principal binding site for all FhuA ligands . This region may be inactivated by steric hindrance in that a portion of Llp penetrates into the channel . Outer membranes prepared with 0.25% Triton X-100 from cells expressing Llp contained inactivated FhuA, suggesting Llp to be an outer membrane protein whose interaction with FhuA was not abolished by Triton X-100 . Llp solubilized in 1.1% octylglucoside prevented T5 inactivation by FhuA dissolved in octylglucoside.

Blood, 1994 Aug 1, 84(3), 972 - 84
Increased levels of circulating Epstein-Barr virus (EBV)-infected lymphocytes and decreased EBV nuclear antigen antibody responses are associated with the development of posttransplant lymphoproliferative disease in solid-organ transplant recipients; Riddler SA et al.; Epstein-Barr virus (EBV)-associated posttransplant lymphoproliferative disease (PTLD) is an uncommon but potentially fatal complication of immunosuppression in solid-organ transplant recipients . A semiquantitative DNA polymerase chain reaction assay was developed to amplify a unique 269-bp region of the EBNA-1 gene in peripheral blood lymphocytes (PBL) using the primers described by Telenti et al (J Clin Microbiol 28:2187, 1990) . Serial samples were studied from 23 transplant recipients, 12 of whom were diagnosed with PTLD . The majority of transplant recipients who were EBV seropositive at the time of transplant surgery and who did not develop PTLD (5 of 7, 71%) exhibited less than a 10-fold increase in the levels of EBV-infected PBL over the 0.1 to 5 EBV genomes/10(6) PBL observed in immunocompetent EBV seropositive controls . Transplant recipients who were seronegative at the time of transplantation and who underwent a primary EBV infection but did not develop PTLD exhibited a reduced capacity to control viremia because the levels of EBV-infected PBL were up to 400 times greater than the 1.0 to 50 EBV genomes/10(6) PBL observed in individuals undergoing acute infectious mononucleosis (Rocci et al: N Engl J Med 296:132, 1977) . However, all transplant recipients who developed PTLD exhibited a marked elevation of EBV-infected PBL independent of their serologic state at the time of transplantation . Six of the 10 transplant recipients with PTLD exhibited > or = 300,000 EBV genomes/10(5) PBL, two exhibited 10,000 to 50,000 EBV-infected genomes/10(5) PBL, and one each exhibited 2,500 and 500 EBV genomes/10(5) PBL . However, the latter two samples were obtained 4 to 5 weeks after the diagnosis of PTLD and may reflect a decrease in viral load resulting from immunomodulation . Marked decreases in the levels of EBV nuclear antigen-1 (EBNA-1), EBNA-2, and EBNA-LP antibodies correlated with the increase in EBV-infected PBL . Hence, a quantitative difference in circulating EBV viral load and EBNA antibody levels is evident between transplant recipients with and without PTLD and may be useful as a noninvasive prognostic marker with which to monitor and/or predict the development of PTLD.

Ann Intern Med, 1994 Aug 1, 121(3), 219 - 30
Nonvalvular infections of the cardiovascular system; Kearney RA et al.; PURPOSE: To review the risk factors, clinical presentation, diagnosis, and treatment of nonvalvular infections of the cardiovascular system . DATA SOURCES: A MEDLINE search of English-language articles from 1966 to 1993 relating to myocardial abscesses, mural endocarditis, infective endarteritis and mycotic aneurysms, infection of pacemakers and implantable defibrillators, prosthetic vascular graft infections, and infected atrial myxomas; manual review of article bibliographies . STUDY SELECTION AND DATA EXTRACTION: Case series and single reports, prospective and retrospective clinical studies, autopsy studies, and reviews were selected if they contained sufficient information about the prevalence, clinical manifestations, microbiologic features, management, and outcome of nonvalvular cardiovascular infections . RESULTS: Nonvalvular infections of the cardiovascular system most commonly occur on previously damaged endocardium or vascular intima and are usually associated with intravascular devices such as graft material or pacemakers . Rarely, they can involve primary cardiac tumors such as myxomas . Most patients affected are beyond the fifth decade of life . Risk factors include cardiovascular disease, diabetes mellitus, and malignancy . The sexes are affected equally . The clinical presentations of nonvalvular endovascular infections are subtle and diagnoses are difficult to make, often requiring not only a high index of suspicion but also the use of sophisticated radiologic techniques . Hence, for many of these infections, the diagnosis is made late in the course of the infection, and survival rates are poor . Complications include peripheral embolization, cardiac rupture, vascular aneurysm rupture, and pericarditis . Therapy frequently involves surgical intervention in addition to the use of antibiotics . CONCLUSIONS: Although uncommon, nonvalvular infections of the cardiovascular system will increase in frequency as the use of implantable devices and prosthetic materials increases in the elderly . Studies are needed to determine the most appropriate diagnostic methods, treatment regimens, and methods for prevention of these infections.

J Clin Microbiol, 1994 Aug, 32(8), 2035 - 6
Outbreak of Brucella melitensis among microbiology laboratory workers; Martin-Mazuelos E et al.; We report on an outbreak of laboratory-acquired brucellosis involving four technicians working at a microbiology laboratory . All cases occurred in a period of 4 months . Blood cultures and the Rose Bengal test were positive for Brucella spp . in all cases . Microagglutination was positive for Brucella spp . at titers of between 1/40 and 1/160 . All patients were cured after treatment.

Compendium, 1994 Aug, 15(8), 1052, 1054 - 63; quiz 1064
HIV disease as a risk factor for periodontal disease; Murray PA; A multitude of oral lesions, including unique forms of periodontal disease, have been discovered in individuals infected with the human immunodeficiency virus (HIV) . Although the frequency of HIV-associated periodontal diseases appears to be less than previously thought, many researchers agree that an important factor influencing the prevalence of unique periodontal disease in the HIV population is the degree of immunodeficiency . The pathogenesis of HIV-associated periodontal diseases remains unclear, but may be the result of microbiota and/or alterations in the host . HIV-gingivitis, now called linear gingival erythema, and HIV-periodontitis, now called necrotizing ulcerative periodontitis, have microbiology profiles similar to conventional adult periodontitis, although these lesions are quite different clinically . This article reviews clinical signs and symptoms, treatments, and the pathogenesis of HIV-related periodontal findings . It specifically focuses on the immuno-incompetence of HIV disease as a risk factor for periodontal disease . Because the caseload of acquired immunodeficiency syndrome patients will increase significantly in the future, the dental practitioner must be able to recognize and manage the periodontal lesions associated with HIV infection.

Genitourin Med, 1994 Aug, 70(4), 262 - 4
Evaluation of a microdot immunofluorescent antigen detection test for Chlamydia trachomatis; Thompson C et al.; OBJECTIVE--To evaluate a centrifuge enhanced direct immunofluorescent antigen test (MD test), compared with conventional culture and ELISA testing in the diagnosis of Chlamydia trachomatis infection . SETTING--A District General Hospital situated 30 miles from a University Department of Medical Microbiology . SUBJECT AND METHOD--A prospective study on specimens from 638 patients . Culture was performed on 348 specimens from genitourinary medicine patients and ELISA testing was carried out on 272 specimens from Gynaecology patients . RESULTS--When compared with culture the MD test had a sensitivity of 90.6%, specificity of 96.8%, positive predictive value of 74.3% and a negative predictive value of 99% . When compared with confirmed ELISA results the MD test had a sensitivity of 100%, specificity of 98.8%, positive predictive value of 78.5% and negative predictive value of 100% . CONCLUSION--The MD test compares favourably with other chlamydial diagnostic techniques and in our setting is preferable to sending specimens for chlamydial culture . It is not suitable as the sole diagnostic method for screening large numbers of specimens but is a cost effective confirmatory test for positive ELISA results.

Berl Munch Tierarztl Wochenschr, 1994 Aug, 107(8), 275 - 81
{Mycobacteriosis of ornamental birds--frequency, pathologo-anatomic, histologic and microbiologic data}; Hoop RK et al.; Mycobacteriosis was diagnosed in 146 (3.8%) of 3801 necropsied pet birds between 1986 und 1991 . Gross changes in 62 pet birds with histologically and culturally confirmed mycobacteriosis were predominantly enlargement of liver and spleen and thickening of intestinal walls . Three histological patterns could be observed: granulomas, sheet-like proliferations of mycobacteria-laden epithelioid cells and single scattered macrophages filled with acid-fast bacteria . Mycobacteria grew in 27 (43.6%) of 62 cultures, but the species could only be identified in 13 (21.0%) cases (5 x M . avium-Complex, 3 x M . genavense, 2 x M . fortuitum, 1 x M . gordonae, 1 x M . nonchromogenicum and 1 x M . tuberculosis) . The significance of mycobacteriosis in pet birds as a zoonosis remains to be determined.

Zh Mikrobiol Epidemiol Immunobiol, 1994 Aug-Sep, Suppl 1, 95 - 8
{The lysozyme-antilysozyme functional system in hydrobionts and its role in forming aqueous biocenoses}; Solovykh GN et al.; Lysozyme activity has been evaluated in hydrobionts of different trophic levels: algae, zooplankton and germs . The existence of the functional system "Lysozyme of hydrobionts--antilysozyme of germs", functioning as a regulating element in the formation of aqueous microbiocenosis, has been substantiated on the basis of data provided by laboratory experiments and investigations carried out in natural water pools.

Appl Environ Microbiol, 1994 Aug, 60(8), 2999 - 3005
Development of a method for detection of enteroviruses in shellfish by PCR with poliovirus as a model; Lees DN et al.; The application of the PCR to complex samples is hindered by amplification inhibitors . We describe a reverse transcription-PCR-based method capable of inhibitor removal for the detection of enteroviruses in shellfish . Initial virus extraction stages based on a modified polyethylene glycol precipitation technique (G.D . Lewis and T.G . Metcalf, Appl . Environ . Microbiol . 54:1983-1988, 1988) were followed by virus purification with 1,1,2-trichloro,2,2,1-trifluoroethane and concentration by ultrafiltration . A guanidine isothiocyanate-glass powder extraction system was utilized for sample lysis, RNase protection, and nucleic acid purification . Removal of PCR inhibitors and method sensitivity were quantified in shellfish (oysters and mussels) seeded with poliovirus . PCR sample tolerance exceeded 4 g for depurated shellfish; however, polluted field samples were more inhibitory . Virus recoveries of 31% for oyster extracts and 17% for mussel extracts and nucleic acid extraction reverse transcription-PCR detection limits down to 1 PFU yielded an overall sensitivity limit of < 10 PFU of poliovirus in up to 5 g of shellfish . PCR-positive results were obtained from a variety of polluted field samples naturally contaminated with human enteroviruses . The methods developed for virus recovery and PCR inhibitor removal should be equally applicable to detection of other RNA viruses such as hepatitis A virus, Norwalk virus, and other small round-structured viruses in shellfish.

Infect Immun, 1994 Aug, 62(8), 3172 - 7
Cytokine sensitivity and methylation of lysine in Rickettsia prowazekii EVir and interferon-resistant R . prowazekii strains; Turco J et al.; Modified Rickettsia prowazekii strains have been derived from the avirulent Madrid E strain by passage in the lungs of white mice (strain EVir) or by selection for resistance to gamma interferon (IFN-gamma) (strains 427-19 and 87-17) or alpha/beta interferon (IFN-alpha/beta) (strains 83-2P, 60P, 103-2P, and 110-1P) . Compared with the Madrid E strain, strain EVir has increased virulence (N . M . Balayeva and V . N . Nikolskaya, J . Hyg . Epidemiol . Microbiol . Immunol . 17:11-20, 1973) and a different lysine methylation profile in its surface protein antigen (A . V . Rodionov, M . E . Eremeeva, and N . M . Balayeva, Acta Virol . 35:557-565, 1991) . The other six strains differ from the Madrid E strain in their resistance to IFN and their ability to grow well in untreated macrophagelike RAW264.7 cells . In the present study, to determine which properties are shared by these strains, we examined R . prowazekii EVir for the following: (i) the sensitivity of its growth in L929 cells to the cytokines IFN-alpha/beta, IFN-gamma, tumor necrosis factor alpha (TNF-alpha), and IFN-gamma plus TNF-alpha; (ii) the ability to grow in untreated RAW264.7 cells; and (iii) the ability to induce interferon in L929 cell cultures; we also evaluated strains 83-2P and 87-17 for lysine methylation . Multiplication of strain EVir in growing L929 cells was not markedly inhibited by either IFN-alpha/beta or IFN-gamma . In X-irradiated L929 cells, growth of strain EVir was slightly inhibited (11%) by TNF-alpha alone, somewhat inhibited (38%) by IFN-gamma alone, and markedly inhibited (87%) by IFN-gamma plus TNF-alpha . Nitrite production was induced in X-irradiated, strain EVir-infected L929 cell cultures treated with TNF-alpha alone or IFN-gamma alone; however, more nitrite was produced in infected cultures treated with IFN-gamma plus TNF-alpha . Nitrite production, the dramatic inhibitory effect of IFN-gamma plus TNF-alpha, and the modest inhibitory effect of IFN-gamma on the growth of strain EVir in X-irradiated L929 cells were all alleviated by the addition of the nitric oxide synthase inhibitor NG-methyl-L-arginine . Strain EVir grew very well in untreated macrophagelike RAW264.7 cells and appeared defective in the ability to induce IFN in L929 cell cultures . All strains grown in L929 cells in the presence of radiolabeled lysine had similar percentages of their radioactivity as methylated lysines.(ABSTRACT TRUNCATED AT 400 WORDS)

Oral Microbiol Immunol, 1994 Aug, 9(4), 248 - 50
Mitsuokella dentalis in human periodontitis; Flynn MJ et al.; The occurrence of Mitsuokella dentalis in periodontitis was determined by culture and DNA probe detection . Subgingival paper-point samples from 480 periodontitis patients were transported in VMGA III, plated onto brucella agar with 5% sheep blood and incubated anaerobically for 7 days . Presumptive identification was based on a colony morphology resembling a water drop and biochemical characteristics . DNA probe detection was performed on paper-point samples using a digoxigenin-labeled cellular M . dentalis DNA probe in a dot-blot assay . Culture and DNA probe identified M . dentalis in 18.1% and in 80.7% of the study patients, respectively . M . dentalis isolates produced phosphatases, galactosidase, glucosidase and acetylglucosaminidase and showed high in vitro sensitivity to metronidazole . This study revealed that M . dentalis is a constituent of the pathogenic microbiota in human periodontitis . The periodontopathic potential of the organism is unknown.

N Engl J Med, 1994 Jul 7, 331(1), 16 - 21
The 1993 epidemic of pertussis in Cincinnati . Resurgence of disease in a highly immunized population of children; Christie CD et al.; BACKGROUND . In 1993 there was a resurgence of pertussis in the United States . Altogether, 6335 cases were reported, the most in 26 years . METHODS . Using active microbiologic surveillance, we investigated the epidemic of pertussis in Greater Cincinnati in 1993 . The population of 1.7 million in this area is served by a single children's hospital and pertussis laboratory . We prospectively followed patients given a new diagnosis of pertussis in July through September 1993 to determine the characteristics of the epidemic . RESULTS . From 1979 to 1992, there was a cumulative total of 542 cases of pertussis . In 1993, 352 cases were diagnosed, an increase of 259 percent over the 1992 total . Sixty-three percent of the cases had positive cultures for Bordetella pertussis, 18 percent were positive on direct fluorescent-antibody testing only, and 19 percent were diagnosed clinically . The outbreak began in the suburbs during the summer and spread through Greater Cincinnati . Of 255 total cases diagnosed in July through September (195 excess cases over the maximal base-line level of 20 per month in the previous 14 years), 75 percent were in white patients and 67 percent of the patients had private insurance or paid for care out of pocket . In 1993, as compared with 1979 through 1992, there was a shift in incidence from younger infants to older children; the percentages of cases according to age group were as follows: 0 to 6 months, 53 percent from 1979 through 1992 and 35 percent in 1993 (P < 0.001); 7 months to 5 years, 33 percent and 43 percent (P < 0.002); 6 to 12 years, 5 percent and 11 percent (P < 0.001); and more than 12 years, 5 percent and 11 percent (P < 0.003) . Immunization records revealed that 74 percent (75 of 101) of the children with pertussis who were 19 months to 12 years old had received four or five doses of the combined diphtheria-pertussis-tetanus (DPT) vaccine, and that 82 percent (103 of 126) of those 7 to 71 months old had received at least three doses of DPT vaccine . The whole-cell vaccines used came from both of the major manufacturers (Connaught Laboratories and Lederle Laboratories) . Disease was not severe, but 80 of the 255 children (31 percent) given diagnoses during the three epidemic months were hospitalized . There were no deaths . CONCLUSIONS . Since the 1993 pertussis epidemic in Cincinnati occurred primarily among children who had been appropriately immunized, it is clear that the whole-cell pertussis vaccine failed to give full protection against the disease.

Am J Obstet Gynecol, 1994 Jul, 171(1), 231 - 6
Human preterm birth is associated with systemic and local changes in progesterone/17 beta-estradiol ratios; Mazor M et al.; OBJECTIVE: The purpose of this study was to determine whether human preterm birth is associated with changes in 17 beta-estradiol and progesterone concentrations in maternal plasma and amniotic fluid . STUDY DESIGN: Forty healthy women in preterm labor with singleton pregnancies and intact membranes at 32 to 36 weeks of gestation who underwent amniocentesis for evaluation of the microbiologic status of the amniotic cavity were classified into the following two groups: 20 women who were delivered within 1 week from the amniocentesis (preterm delivery group) and 20 who were delivered at term (term delivery group) . Maternal plasma and amniotic fluid concentrations of progesterone and 17 beta-estradiol were measured with sensitive and specific commercially available radioimmunoassay kits . RESULTS: The median amniotic fluid concentration of 17 beta-estradiol was significantly higher in women delivered prematurely than in those who were delivered at term (1.5 ng/ml vs 0.9 ng/ml, p = 0.0001) . Moreover, the median plasma 17 beta-estradiol concentration was also significantly higher in the preterm delivery group than in the term group (14.1 ng/ml vs 6.9 ng/ml, p = 0.022) . In contrast, no significant difference was found in amniotic fluid and plasma concentrations of progesterone between these two groups (24.5 ng/ml vs 27.5 ng/ml and 132.0 ng/ml vs 107.5 ng/ml, respectively) . The median amniotic fluid progesterone/17 beta-estradiol ratio was significantly lower in the preterm delivery group than in those delivered at term (18.4 vs 33.6, respectively, p = 0.0017) . Moreover, the median plasma progesterone/17 beta-estradiol ratio was also significantly lower in the preterm delivery group than in the term group (9.8 vs 17.0, respectively, p = 0.016) . CONCLUSION: Human preterm birth is associated with significantly lower progesterone/17 beta-estradiol ratios than those of women with preterm labor delivered at term.

J Infect Dis, 1994 Jul, 170(1), 198 - 202
Temporal trends of opportunistic infections and malignancies in homosexual men with AIDS; Katz MH et al.; Temporal changes in the lifetime occurrence of opportunistic infections and malignancies among 1115 homosexual men diagnosed with AIDS were examined . Information from the AIDS surveillance registry, hospital pathology and microbiology logs, patient chart reviews, cancer registries, and death certificates was used to calculate the frequency of specific opportunistic infections and malignancies as lifetime (initial or subsequent) diagnoses . The most common lifetime diagnoses were Pneumocystis carinii pneumonia (PCP; 66.5%), Kaposi's sarcoma (KS; 50.7%), disseminated Mycobacterium avium complex (DMAC) infection (29.6%), and cytomegalovirus (CMV) infection (19.6%) . From 1981 to 1990, there was a significant decrease in the rate of KS (P = .003) and a significant increase in the rate of DMAC infection (P = .03) . PCP decreased during 1985-1990 (P = .009), while CMV infection increased from 1987 through 1990 (P = .03) . Thus, KS and PCP have declined over time, while DMAC and CMV are causing substantial and increasing morbidity among AIDS patients.

J Virol Methods, 1994 Jul, 48(2-3), 223 - 36
Polymerase chain reaction kinetics when using a positive internal control target to quantitatively detect cytomegalovirus target sequences; Chan A et al.; High-performance liquid chromatography (HPLC) was used to detect and quantify cytomegalovirus (CMV) specific polymerase chain reaction (PCR) products generated during PCR co-amplification . PCR of CMV AD 169 or a plasmid which contains the CMV AD 169 native target sequence using the CMV primer set of Hsia et al . (J . Clin . Microbiol . 27, 1802-1809) generates a 152 bp PCR product . A CMV control sequence plasmid which shared the primer sequence of native CMV AD 169 but when amplified produces a larger 362 bp product was constructed . Under co-amplification conditions there was a linear relationship (over 3 logs) between the molar ratio of input CMV native and control target sequence and the molar ratio of the output PCR products as detected by HPLC despite differences between the two PCR target and product sizes . Co-amplifying known amounts of CMV control sequence plasmid as an internal standard allowed accurate quantitation of the amount of CMV native target sequence in a sample when the two PCR targets were present in approximately equimolar amounts +/- 1.5 log (coefficient of variation (CV) < 12%) . By modifying the amount of CMV control target sequence plasmid used for co-amplification, accurate detection of the amount of CMV native sequence in samples could be extended to 5 logs, standard error (S.E.) < or = 16% . Precise quantitation of PCR targets using co-amplification PCR requires multiple sample dilutions to ensure that the CMV native target sequence was in a close equimolar relationship with the CMV control sequence at the time of PCR amplification.

Pediatr Infect Dis J, 1994 Jul, 13(7), 617 - 22
Clinical and microbiologic features of children presenting with pertussis to a Canadian pediatric hospital during an eleven-year period; Gordon M et al.; To characterize the morbidity of pertussis in Canada, we did a retrospective review of all children with laboratory-confirmed pertussis seen at the Hospital for Sick Children, Toronto, between 1980 and 1990 . A total of 975 patients were identified, of which 223 (23%) were admitted to hospital . The peak incidence of disease was observed in the fall . The incidence of disease did not vary with gender . Only 41% of children admitted had the classical symptoms of pertussis (paroxysmal cough and whoop) . Compared with children older than 6 months of age, children younger than 6 months of age were more likely to be hospitalized, tended to be hospitalized longer, were less likely to be age-appropriately vaccinated and were more likely to require intensive care unit monitoring . Seventeen (8%) of 223 children required intensive care unit monitoring, and 12 of these children required mechanical ventilation therapy, for a duration of 3.5 +/- 0.6 days (mean +/- SD) . One (0.1%) patient with secondary bacterial pneumonia died . This hospital-based study indicates that pertussis continues to be a cause of serious illness in children, particularly those younger than 6 months of age.

J Heart Lung Transplant, 1994 Jul-Aug, 13(4), 727 - 30
Single lung transplantation with simultaneous contralateral pneumonectomy for cystic fibrosis; Forty J et al.; A 24-year-old man with cystic fibrosis and marked reduction of volume of the left hemithorax caused by skeletal asymmetry and mediastinal shift underwent successful right single lung transplantation with simultaneous left pneumonectomy . Despite significant preoperative microbiologic contamination, it proved possible to sterilize the pneumonectomy space and no airway complications occurred . Good long-term results have been achieved, and the historic assumption that single lung transplantation is unsuitable for patients with septic lung disease is challenged.

Orthopedics, 1994 Jul, 17(7), 617 - 23
The management of dog bites and dog bite infections to the hand; Wiggins ME et al.; Dog bites account for approximately one of 200 emergency room visits . The majority of bites are from dogs known to the victim . Due to the numerous small compartments and the thin covering of soft tissue over the bones and joints, bite wounds to the hand are more likely to become infected that are bites to the arm, leg, or face . Improper management can result in significant morbidity and prolonged treatment . This article discusses the microbiology of dog bite wounds, antibiotic selection, and proper wound management.

J Clin Microbiol, 1994 Jul, 32(7), 1669 - 73
Quantification of human immunodeficiency virus in plasma by RNA PCR, viral culture, and p24 antigen detection; Van Kerckhoven I et al.; A semiquantitative PCR technique for detecting human immunodeficiency virus type 1 (HIV-1) RNA in plasma was compared with quantitative viral culture and p24 antigen detection in plasma . Ninety-three samples from 20 symptomatic, 10 asymptomatic, and 10 seronegative individuals were tested . For most of the seropositive patients, consecutives samples were examined . Viral RNA was extracted from plasma by the method described by Boom et al . (R . Boom, C.J . A . Sol, M . M . M . Salimans, C.L . Jansen, P . M . E . Wertheim-van Dillen, and J . van der Noordaa, J . Clin . Microbiol . 28:495-503, 1990) . The RNA PCR was the most sensitive method (100 and 74% sensitivity for symptomatic and asymptomatic patients, respectively) and produced less divergent results with the consecutive samples from individual patients compared with the other techniques . All samples positive by viral culture or p24 antigen assay were also positive in the RNA PCR . For each of the three assays, the number of positive results obtained correlated with the disease stage . The estimated mean number of HIV-1 RNA copies was significantly higher in symptomatic patients (22,750 copies per ml) than in asymptomatic patients (1,820 copies per ml) . It was also higher in samples positive for viral culture than in culture-negative samples . No close correlation was found between the amount of HIV-1 RNA and the amount of p24 antigen or the titer of infectious virus in plasma or between this titer and the level of p24 antigen . The plasma RNA PCR may be a useful additional marker of disease progression and may be valuable for monitoring the effects of antiviral therapy.

J Clin Microbiol, 1994 Jul, 32(7), 1634 - 8
Development and evaluation of a rapid and simple procedure for detection of Pneumocystis carinii by PCR; Cartwright CP et al.; We report the development of a simplified PCR-based assay for the detection of Pneumocystis carinii DNA in clinical specimens . The adoption of a rapid DNA extraction procedure and the introduction of a type of enzyme-linked immunosorbent assay for PCR product detection enabled this procedure to be carried out in a single working day in a clinical microbiology laboratory . The PCR assay was prospectively compared with an immunofluorescent-antibody (FA) staining method for the detection of P . carinii in induced sputum and bronchoalveolar lavage (BAL) specimens . The results of the study showed that, for induced sputum specimens, FA staining had a sensitivity of 78% (32 of 41 specimens) and a specificity of 100% (166 of 166 specimens); PCR was 100% (41 of 41 specimens) sensitive and 98% (162 of 166 specimens) specific . For BAL specimens, FA staining was 100% sensitive (21 of 21 specimens) and 100% specific (133 of 133 specimens), and PCR had a sensitivity of 100% (21 of 21 specimens) and a specificity of 99% (132 of 133 specimens) . These results strongly suggest that use of our PCR-based assay could effect clinically useful improvements in the sensitivity of induced sputum specimens for the detection of P . carinii.

Gesundheitswesen, 1994 Jul, 56(7), 377 - 9
{Prevalence of hepatitis A virus antibodies in hospital personnel}; Abb J; We screened 351 employees of a county hospital for the presence of antibodies against hepatitis A virus (anti-HAV) . Hospital staff tested was from the department of paediatrics, infectious diseases unit, institute of microbiology, hospital kitchen, and the day-care centre . 292 donors from the hospital blood bank served as a control group . The prevalence of anti-HAV in indigenous hospital staff less than 30 years of age was extremely low, but showed an age-dependent increase to 69 per cent in personnel more than 50 years of age . The anti-HAV prevalence rate of indigenous health-care workers did not show significant differences from that of volunteer blood donors . The high prevalence of anti-HAV in non-indigenous employees with almost total exposure in persons more than 40 years of age most probably reflects the high risk of childhood infection in endemic regions . We conclude that the risk of occupational exposure to HAV in the hospital setting appears to be small . Active immune prophylaxis with hepatitis A vaccine should be restricted to employees with frequent contact with HAV-contaminated faeces . Pre-vaccination screening for anti-HAV is cost effective in indigenous hospital staff more than 30 years of age and in all non-indigenous employees.

Fortschr Med, 1994 Jun 30, 112(18), 257 - 60
{Viruses and cell therapy . Evaluation of cell therapy from the virologic viewpoint}; Korn K et al.; The risks of cell therapy as seen by the microbiologist and virologist, are not calculable . Numerous viruses with longterm persistence in the host cells, cannot be detected on the basis of an acute disease in the host . This applies, for example to herpesviruses, lentiviruses, retroviruses, hepatitis C virus, Borna disease virus and the so-called unconventional viruses . There are two reasons why testing of the donor animal ist not possible, the first being the great number of potential pathogens, the second being the fact that for some of these agents there are no signs of a diagnostic approach involving isolation or antibody detection . e.g . scrapie (BSE) . Further, so far unknown viruses must be expected.

Arch Intern Med, 1994 Jun 27, 154(12), 1359 - 64
Mycobacterium marinum skin infections . Report of 31 cases and review of the literature; Edelstein H; BACKGROUND: Mycobacterium marinum is a rare cause of skin infections, and its treatment has been based primarily on the personal experience and preferences of individual investigators without the benefit of large studies . METHODS: Thirty-one patients with confirmed M marinum infection were identified at 33 Kaiser Permanente Northern California Region medical centers by microbiologic records, and their charts were reviewed . RESULTS: The upper extremity was affected in 90% of cases, and lymphatic or local spread was seen during the initial examination or during observation in 25 patients (81%) . Granuloma was present in 22 (63%) of 35 biopsy specimens, and staining for acid-fast bacteria yielded positive results in two of 22 specimens . Cure or improvement occurred in 22 (81%) of 27 patients in whom outcome could be evaluated . Treatment with ethambutol plus rifampin appeared more successful (effective in five {100%} of five cases) than minocycline treatment (effective in 10 {71%} of 14 cases), although not significantly so (P = .28) . Adverse reactions, most of which were gastrointestinal, occurred in five patients (18%) . CONCLUSION: Ethambutol plus rifampin appears more useful than minocycline in treating cutaneous M marinum infection . This result remains to be confirmed by larger clinical studies, which may be difficult because this infection is relatively rare.

J Biol Chem, 1994 Jun 10, 269(23), 16029 - 33
Requirement for conformational flexibility in the signal sequence of precursor protein; Nouwen N et al.; According to the "unlooping" model (de Vrije, T., Batenburg, A . M., Killian, J . A., and de Kruijff, B . (1990) Mol . Microbiol . 4, 143-150), proposed to explain how signal sequences serve to target proteins into the secretory pathway, the initial interaction of the signal sequence with the membrane in a helix-turn-helix conformation (spanning half of the bilayer) plays an important role in the initiation of the translocation reaction . To test this model we have introduced 2 cysteines (at positions -5 and -19) in the signal sequence of the Escherichia coli outer membrane protein PhoE . The mutations did not influence the translocation of precursor PhoE in vivo or in vitro . The 2 cysteines were oxidized to form a disulfide bridge . In vitro translocation of the looped precursor into inner membrane vesicles was disturbed . The looped precursor competed with translocation of wild type precursor PhoE, and looped precursor that was first bound to inner membrane vesicles could be translocated after the addition of dithiothreitol . Apparently, the mutant precursor with a disulfide bridge in the signal sequence is arrested as a very early intermediate in the translocation process . All of these results are consistent with the proposed unlooping model and show that, besides the primary structure characteristics of a signal sequence, conformational flexibility is needed to initiate the translocation reaction.

Fertil Steril, 1994 Jun, 61(6), 1034 - 8
The endoscopic localization of endometrial implants in the ovarian chocolate cyst; Brosens IA et al.; OBJECTIVE: To describe the characteristics of the endometrial cyst and to locate the implants for selective biopsy . DESIGN: Prospective study . SUBJECTS: Fifty-one women with one or two ovarian chocolate cysts of 3 cm or more were investigated . INTERVENTIONS: Laparoscopy and random biopsy versus a new technique of ovarioscopy and selective biopsy . MAIN OUTCOME MEASURE: Visual characteristics and histopathology of endometrial cysts . RESULTS: The clinical suspicion of an endometrioma was confirmed in a series of 59 hemorrhagic cysts by histopathology in 89% and 42%, respectively, of typical and atypical cases and in 27% of recurrent chocolate cysts in the presence of postoperative adhesions . The atraumatic technique of ovarioscopy allowed description of the typical characteristics of the inner wall of the endometrioma and location of the active implants for biopsy . Endometrial tissue was obtained by small ovarioscopy-guided biopsies in 82% of the cases versus 42% in large random biopsies . Red lesions were highly significant for a mucosa-type implant and were predominantly located at the site of invagination stigma and adhesions with the pelvic wall . CONCLUSIONS: Endoscopy of ovarian chocolate cysts allows observation of typical features of the wall that differentiates it from other benign cysts of the ovary . Microbiopsies obtained under endo-ovarian endoscopy provided significantly more active, endometrial tissue than random biopsies . The data confirm that in most cases the endometrioma is formed by invagination of the cortex and that active implants are located at the site of invagination . Ovarioscopy is therefore proposed as a useful tool to differentiate in doubtful cases between a hemorrhagic functional and an endometriotic cyst and to select the sites for biopsies.

J Virol, 1994 Jun, 68(6), 4075 - 9
A furin-defective cell line is able to process correctly the gp160 of human immunodeficiency virus type 1; Ohnishi Y et al.; Furin, a subtilisin-like mammalian endoprotease, is thought to be responsible for the processing of many proprotein precursors of cellular and viral origin, including gp160 of human immunodeficiency virus type 1, which share the consensus processing site motif, Arg-X-Lys/Arg-Arg, for protease recognition (for reviews, see P . J . Barr, Cell 66:1-3, 1991, and Y . Nagai, Trends Microbiol . 1:81-87, 1993) . To confirm and extend the concept that gp160 is processed by furin, we used here a cell line, LoVo, which was recently demonstrated to be furin defective . Unexpectedly, LoVo cells were found to process gp160 as efficiently as normal cell lines do, hence being able to fuse with CD4-expressing HeLa cells and to produce fully infectious virions . On the other hand, the same cell line was almost totally incapable of processing Newcastle disease virus fusion glycoprotein with a similar oligobasic cleavage recognition motif, providing a strong case for furin-mediated processing . Our present study thus raises a further need to search for and identify the proteinases involved in human immunodeficiency virus type 1 gp160 processing rather than supporting the notion that furin is responsible.

Enferm Infecc Microbiol Clin, 1994 Jun-Jul, 12(6), 280 - 4
{Pulmonary infection by Mycobacterium kansasii . Presentation of 27 cases (1988-1992)}; Echevarria MP et al.; BACKGROUND: The aim of this study was to know the incidence of pulmonary disease by Mycobacterium kansasii in our medium in the general population with a description of the characteristics as well as the subjects which this disease affects . The incidence was related with the isolation of Mycobacterium tuberculosis on consideration of the hospital studied (practically a monography of thoracic diseases) . METHODS: A retrospective review of the clinical histories of patients with positive cultures of Mycobacterium kansasii in respiratory samples was performed with the criteria of the pulmonary diseases attended in the authors center over the period from January 1988 to December 1992 being defined . A descriptive analysis of the clinical and radiographic variables, treatment and evolution was also carried out . RESULTS: Mycobacteria was isolated in 1,755 respiratory samples processed by the Laboratory of Microbiology with 95% corresponding to Mycobacterium tuberculosis and 4.5% to non tuberculin mycobacteria . Mycobacterium kansasii made up 83% of the latter (3.7% of global significant isolations) . Pulmonary disease by Mycobacterium kansasii was diagnosed in 27 patients (26 males and 1 female) with a mean age of 48 years (range: 24-84 years) . No disseminated forms of disease were observed in this series . The sputum demonstrated high diagnostic profitability (positive in 26/27) . Clinical and radiological variables were unspecific (only 1 normal) with a high percentage of cavitation being observed (74%) . Most were carriers of chronic and/or general pulmonary diseases . The evolution was favorable in 70.3% of the cases with 3 patients dying (11.1%), all with severe subjacent disease and one of a cause not related with the infection . Three recurrences were observed (11.1%) and 2 persistence of positive culture (7.4%) . One of the strains was niacin positive (expectional feature) . CONCLUSIONS: Mycobacterium kansasii is not a rare producer of disease in our medium in the general population being found in 3.7% of the total significant isolations of mycobacteria in respiratory samples in the authors center over the period from 1988 to 1992 . It was found to be associated to pulmonary or general subjacent diseases preferable affecting middle-aged males . The clinical are radiological features were not specific with a high percentage of cavitation being observed . No disseminated disease was found . Conventional combined chemotherapy was effective with persistence and recurrence being seen in 11% and 7%, respectively . The prognosis of the disease was primarily determined by the basal situation of the host.

J Paediatr Child Health, 1994 Jun, 30(3), 210 - 9
Infectious diarrhoea in children: controlling transmission in the child care setting; Thompson SC; An increase in the number of preschool children cared for within groups in child care centres has been associated with increasing numbers of women in the workforce . Children at this age are at high risk for gastrointestinal diseases caused by a large number of enteric pathogens, and the risk is increased by the greater potential for person-to-person transmission within group care . This report considers the pathogens that may cause diarrhoeal illness in children, with particular reference to those that have been reported in formal day care settings . The major risk factors for transmission of these agents and a high rate of diarrhoeal illness in the child care setting include attendance of non-toilet-trained children, staff combining nappy changing and food preparation duties, large enrollment, low staff-to-child ratio, and poor hygiene and child handling practices . Investigations undertaken during an outbreak of diarrhoea have frequently used limited diagnostic testing, often suitable for identifying only bacterial and protozoal agents . Such limited investigations have tended to incriminate agents that have prolonged carriage and are easily identifiable in standard microbiology laboratories . Finding a pathogen in these circumstances needs to be interpreted with caution . Prevention and control measures include training and education in good personal hygiene, emphasis on the need for frequent handwashing, separation of change areas from food handling and eating areas, routine cleaning and disinfection of environmental surfaces and personal items, and exclusion of any child or child care worker with diarrhoea.

Thorax, 1994 Jun, 49(6), 545 - 8
Effect of long term treatment with oxitropium bromide on airway secretion in chronic bronchitis and diffuse panbronchiolitis; Tamaoki J et al.; BACKGROUND--Anticholinergic bronchodilator drugs improve lung function in chronic bronchitis but less is known of their effects on the volume and physical properties of sputum in conditions associated with excessive airway secretions . This study examines the effects of the regular use of oxitropium bromide in such patients . METHODS--The study was conducted in a parallel, double blind, placebo controlled fashion . Patients were divided into two groups: the first group (n = 17) received oxitropium bromide from a metered dose inhaler (two puffs three times daily; 100 micrograms/puff) for eight weeks, and the second group (n = 16) received placebo . Lung function was measured as forced expiratory volume in one second (FEV1) and vital capacity . In evaluating airway secretion, daily amount of expectorated sputum, percentage solid composition, viscoelastic properties including elastic modulus and dynamic viscosity, and sputum microbiology were determined . RESULTS--Oxitropium bromide increased FEV1 and decreased the mean (SE) sputum production from 61(4) to 42(3) g/day after treatment, whereas placebo had no effect . Bacterial density and sputum flora were unchanged, but solid composition and elastic modulus increased from 2.52(0.43)% to 3.12(0.34)%, and 68(12) dyne/cm2, respectively, in the group taking oxitropium bromide . CONCLUSIONS--Regular treatment with oxitropium bromide not only improves airflow limitation but also reduces sputum production, probably through the inhibition of both mucus secretion and water transport, the latter component being predominant.

Biochemistry, 1994 May 24, 33(20), 6043 - 51
1H and 15N NMR assignments of PsaE, a photosystem I subunit from the cyanobacterium Synechococcus sp . strain PCC 7002; Falzone CJ et al.; PsaE is a highly conserved, water-soluble protein of the photosystem I reaction center complexes of cyanobacteria, algae, and green plants . Along with the PsaC and PsaD proteins, the PsaE protein binds to the stromal surface of photosystem I and is required for cyclic electron transport in Synechococcus sp . strain PCC 7002 {Yu, L., Zhao, J., Muhlenhoff, U., Bryant, D.A., & Golbeck, J.H . (1993) Plant Physiol . 103, 171-180} . The psaE gene from this cyanobacterium encodes a mature protein of 69 amino acid residues and has recently been overexpressed in Escherichia coli {Zhao, J., Snyder, W.B., Muhlenhoff, U., Rhiel, E., Warren, P . V., Golbeck, J . H., & Bryant, D . A . (1993) Mol . Microbiol . 9, 183-194} . By using both unlabeled and uniformly 15N-labeled protein in a series of two- and three-dimensional NMR experiments, complete 1H and 15N amide resonance assignments were made . The major secondary structural element of PsaE is a five-stranded antiparallel beta-sheet . The five strands extend as follows: beta A, residues 7-10; beta B, residues 21-26; beta C, residues 36-39; beta D, residues 57-60; and beta E, residues 65-68 . The topology is represented by (+1, +1, +1, -4x); it brings the first and last strands, and consequently the N- and C-termini, together . The protein has an extensive hydrophobic core organized around a conserved phenylalanine residue (Phe-40); another of its distinctive features is a segment extending from residue 42 to residue 56 devoid of dipolar contacts with the beta-sheet . The pK1/2 of the sole histidine residue (His-63) was determined to be 5.4.

Am Fam Physician, 1994 May 15, 49(7), 1627 - 34
Recognizing skin lesions of systemic fungal infections in patients with AIDS; Cohen PR et al.; Mucocutaneous lesions may be the initial feature or a subsequent manifestation of disseminated systemic fungal infections in patients who are seropositive for human immunodeficiency virus (HIV) . These lesions can be classified by their morphologic appearance as macules, nodules, papules, patches, plaques, pustules or ulcers . Some lesions mimic the morphology of conditions such as herpes simplex, Kaposi's sarcoma and molluscum contagiosum, or present as abscesses, fistulas or purpura . Since the morphologic appearance may vary, a biopsy is necessary for microbiologic cultures and histologic evaluation of any new, unusual or unexplained cutaneous or mucosal lesion that appears in any patient who is seropositive for HIVPublication Types:

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