J Trop Pediatr, 2004 Jun, 50(3), 153 - 7 Childhood brucellosis--a microbiological, epidemiological and clinical study; Mantur BG et al.; A total of 5726 blood specimens (from children aged 14 years and younger) were studied for the serological evidence of brucellosis . Ninety-three (1.6 per cent) showed diagnostic agglutinin titres with a geometric mean titre of 403 (SD +/- 547) . Forty-three (59.7 per cent) blood specimens yielded the growth of Brucella melitensis . Thirty-nine patients (41.93 per cent) were shepherds, who constituted the major occupational group affected in the present series . More than 60 per cent of the patients had a history of both consumption of fresh goat's milk and close animal contact . The habit of consuming fresh goat's milk to obtain relief from chronic ailments was noted in nine patients . Seventy-three (78.49 per cent) were males and 20 (21.51 per cent) were females, with a male to female ratio of 3:1 . The disease occurred mainly in the school age group (mean age 10.3 years) . All the patients had an acute history of less than 2 months . Forty-nine (52.68 per cent) patients presented with persistent fever, 19 (20.43 per cent) with joint pain, and the rest with a combination of fever and joint pain with and without low backache, fever being the commonest complaint . One case presented with involuntary movements of limbs alone and the other with burning feet only . Pityriasis alba was the consistent physical finding, with fever in the majority of the patients . The major joint found to be involved was the knee (52.77 per cent) . The synovial fluid obtained from the knee joint of five patients demonstrated Brucella agglutinins and also three grew B . melitensis . Eight patients presented with complications that included skin lesions (3), carditis (2), neurobrucellosis such as chorea (1), peripheral neuritis (1), and meningitis (1) . Brucella melitensis biotype 1 was successfully isolated from the papular eruption of one out of three cases who presented with skin lesions . To our knowledge this is the fourth confirmed isolation of B . melitensis from skin lesions with brucellosis, reported in the literature . The cerebrospinal fluid obtained from the meningitis patient was positive for B . agglutinins . To our knowledge chorea of brucellar origin appears to be the first case reported in the literature . In 15 cases (16.13 per cent) brucellosis was suspected clinically whereas 78 (83.87 per cent) cases, only serological evidence of brucellosis confirmed the diagnosis . None of the cases relapsed . In our experience an initial combination therapy with a three-drug regimen followed by a two-drug regimen for a minimum of 6 weeks has been found to be effective in the prevention of a relapse. Rev Panam Salud Publica, 2004 May, 15(5), 307 - 12 Infectious disease risks from dead bodies following natural disasters; Morgan O; OBJECTIVE: To review existing literature to assess the risks of infection from dead bodies after a natural disaster occurs, including who is most at risk, what precautions should be taken, and how to safely dispose of the bodies . METHODS: Disease transmission requires the presence of an infectious agent, exposure to that agent, and a susceptible host . These elements were considered to characterize the infectious disease risk from dead bodies . Using the PubMed on-line databases of the National Library of Medicine of the United States of America, searching was done for relevant literature on the infection risks for public safety workers and funeral workers as well as for guidelines for the management of the dead and prevention of infection . A small but significant literature was also reviewed regarding the disposal of the dead and the contamination of groundwater by cemeteries . RESULTS: Victims of natural disasters usually die from trauma and are unlikely to have acute or "epidemic-causing" infections . This indicates that the risk that dead bodies pose for the public is extremely small . However, persons who are involved in close contact with the dead-such as military personnel, rescue workers, volunteers, and others-may be exposed to chronic infectious hazards, including hepatitis B virus, hepatitis C virus, HIV, enteric pathogens, and Mycobacterium tuberculosis . Suitable precautions for these persons include training, use of body bags and disposable gloves, good hygiene practice, and vaccination for hepatitis B and tuberculosis . Disposal of bodies should respect local custom and practice where possible . When there are large numbers of victims, burial is likely to be the most appropriate method of disposal . There is little evidence of microbiological contamination of groundwater from burial . CONCLUSIONS: Concern that dead bodies are infectious can be considered a "natural" reaction by persons wanting to protect themselves from disease . However, clear information about the risks is needed so that responsible local authorities ensure that the bodies of disaster victims are handled appropriately and with due respect . This paper provides a source of information for those who are in the unfortunate position of managing those bodies. Pol J Vet Sci, 2004, 7(2), 149 - 51 Effect of the dry feed contaminated with moulds on the prevalence of alimentary tract disorders in cats; Popiel J et al.; The experiment was performed on the group of 8 kittens aged from 7 to 9 weeks . The aim of the studies was to establish the reasons for alimentary tract disorders and lower gains of body weight occurring in these animals . The cats were fed with commercial dry diet . Morphological and biochemical blood tests were carried out in the animals at the onset of the experiment . The tests were re-performed at the end of the studies, together with bacteriological and mycological cultures of faeces, hygienic litter and internal organs of dead cats . The feed samples underwent microbiological and toxicological analyses . An increase in leukocyte count was recorded on morphological blood inspection while the biochemical tests revealed the rise of AIAT and amylase activities and urea concentration . The moulds of Aspergillus flavus and A . fumigatus were isolated on quality feed assessment . Toxicological analyses of feed performed by means of thin layer chromatography revealed zearalenone within the samples . Technology of dry diet production may not be efficient enough to protect the feed against contamination and subsequent growth of moulds . Consumption of Aspergillus-contaminated feed may result in growth inhibition and alimentary tract disorders, including the fatal ones. Probl Tuberk Bolezn Legk, 2004, (5), 3 - 6 {Microbiological aspects of identification of patients with drug-resistant tuberculosis}; Kheifets LB; This review discusses controversial issues, such as definitions of drug resistance, the conditions laboratory drug-susceptibility testing in all new patients is justified, and the requirements for the optimum turnaround time of laboratory reports . It also analyses the advantages and disadvantages of different methods for drug susceptibility testing, including those based on cultivation in the solid and liquid media, as well as molecular phenotypic and genotypic methods . While molecular genotypic methods represent the most promising direction for future development, their application in the clinical laboratory setting today is limited to the initial preliminary screening for rifampicin resistance as a marker for possible MDR and as an indicator for the need for subsequent testing with other drugs . The direct susceptibility test in the solid media (at least that with rifampicin and isoniazid) represents the most affordable method that allows timely adjustment in the treatment regimen if drug resistance is detected . The total turnaround time can be as short as three weeks for 85-90% of smear-positive specimens when the agar plate technique is used for a direct test . Introduction of a liquid media system is the next step to achieving the expected results in all patients. Am J Respir Crit Care Med, 2004 Sep 15, 170(6), 621 - 5 Epub 2004 Jun 30. Invasive aspergillosis in critically ill patients without malignancy; Meersseman W et al.; Using criteria designed for invasive aspergillosis (IA) in patients with cancer, we aimed to determine the impact of IA in patients without malignancy in a medical intensive care unit (ICU) . In this retrospective study, 127 patients out of 1,850 admissions (6.9%) hospitalized between 2000 and 2003 had microbiological or histopathologic evidence of Aspergillus during their ICU stay . There were 89 cases (70%) without hematologic malignancy . These patients were classified as proven IA (n = 30), probable IA (n = 37), possible IA (n = 2), or colonization (n = 20) . In these patients, mean SAPS II score was 52 with a predicted mortality of 48% . The observed mortality was 80% (n = 71) . Mortality of the proven and the probable IA was 97 and 87%, respectively . Postmortem examination was done in 46 out of 71 patients, and 27 autopsies (59%) showed hyphael invasion with Aspergillus . Aspergillus infections occurred in five critically ill patients with proven IA who did not have any predisposing factors according to the currently available definitions . Three of these patients had Child C liver cirrhosis . IA is an emerging and devastating infectious disease in patients in the ICU without malignancy . In those patients, host criteria for probable fungal infections should probably be adapted. Srp Arh Celok Lek, 2004 Jan-Feb, 132(1-2), 44 - 9 {Importance of microbiologic examination of vaginal secretions in the reproductive period}; Arsic-Arsenijevic V et al.; Vaginal infections, during reproductive period are frequent and although not life treating, they can affect their normal functions . They can also affect women's fertility as well as the course of pregnancy . The outcome of pregnancy can be endangered due to the possibility of infection of newborn while passing trough birth canal of the infected mother . As statistically shown, bacterial vaginosis is considerably more often found with the patients having precancerous changes on cervix, or diagnosed cancer of cervix, comparing with women with healthy cervix . It can also cause the appearance of postoperative pelvic cellulitis after hysterectomy . On the other side, the presence of S . agalactiae in vaginal secretion may cause very serious and lethal infections of the newborn such as meningitis, pneumonia and sepsis . As for protozoa T . vaginalis it has been shown that it could cause reduced fertility ability and that during pregnancy it could damage fetal membranes and bring to its premature rupture and premature birth . There is also increased risk of cervix cancer . During reproductive period of women especially if risk factors are existing such as hormone therapy, diabetes mellitus type 1 and applications of wide range antibiotics, vaginal fungal infections caused by Candida can frequently appear . These infection apart from the discomfort like itch and affluent secretion they can also mean diagnostic and therapeutical problem . Regular microbiological test of women are highly recommended during reproductive period as standard for bacterial vaginosis, fungal and trichomonas infections . If those results appear negative, further microbiological tests are necessary . Such tests which are more elaborate, more timely and more expensive are referring to tests on chlamydia, microplasma and some viruses that can also be the cause of vaginal secretion disbalance in women during reproductive period. Srp Arh Celok Lek, 2004 Jan-Feb, 132(1-2), 14 - 7 {Pathologic conditions associated with drug-induced rhinitis}; Milosevic D et al.; Rhinitis medicamentosa ("nose-drop-nose") is a term used for pathological condition of the nasal mucous membrane that results from long-term abuse with intranasal vasoconstrictors . The aim of this work was to examine what lead the patients with nosedropnose rhinitis to the initial usage of intranasal vasoactive drugs . In this prospective study, 92 patients with rhinitis medicamentosa were included . The evaluation of all study subjects comprised the history, ORL, microbiological and radiological examination, skin prick tests with a battery of routine respiratory and nutritive allergens and nasal cytology . The results of this study showed that the pathological conditions for initial use of intranasal vasoactive drugs were: acute upper respiratory infections in 29.3%, vasomotor rhinitis in 21.7%, allergic rhinitis in 16.3%, deviated nasal septum in 13.0%, nasal polyposis in 12%, rhinitis induced by mechanical trauma in 4.4%, and hormonal rhinitis in 3.3% of patients with rhinitis medicamentosa . In conclusion, the most common pathological conditions for developing rhinitis medicamentosa were chronic inflammatory and structural diseases manifested by permanent nasal obstruction as well as acute upper respiratory infections are. Folia Microbiol (Praha), 2004, 49(2), 117 - 22 Microbiological aspects of determination of trichloroacetic acid in soil; Matucha M et al.; Soils have been shown to possess a strong microbial trichloroacetic acid (TCA)-degrading activity . High TCA-degradation rate was also observed during soil extraction with water . For correct measurements of TCA levels in soil all TCA-degrading activities have to be inhibited immediately after sampling before analysis . We used rapid freezing of soil samples (optimally in liquid nitrogen) with subsequent storage and slow thawing before analysis as an efficient technique for suppressing the degradation . Frozen soil samples stored overnight at -20 degrees C and then thawed slowly exhibited very low residual TCA-degrading activity for several hours . Omitting the above procedure could lead to the confusing differences between the TCA levels previously reported in the literature. Yonsei Med J, 2004 Jun 30, 45(3), 453 - 61 Clinical manifestations and diagnosis of extrapulmonary tuberculosis; Yoon HJ et al.; Since the diagnosis of extrapulmonary tuberculosis (EPT) is largely depended on the physician's suspicion in respect of the disease, we believed that it would be worthwhile to scrutinize the clinical characteristics of EPT . Thus, here we present retrospectively evaluated clinical manifestations of patients who were diagnosed as EPT cases in a tertiary referral care hospital . Medical records of 312 patients, diagnosed as having EPT at Yongdong Severance hospital from January 1997 to December 1999, were reviewed retrospectively . In total 312 patients, 149 (47.8%) males and 163 (52.2%) females aged from 13 years to 87 years, were included into this study . The most common site of the involvement was pleura (35.6%) . The patients complained of localized symptoms (72.4%) more frequently than systemic symptoms (52.2%) . The most common symptom was pain at the infected site (48.1%) . Leukocytosis, anemia, and elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were found in 12.8%, 50.3%, 79.3% and 63.1% of the patients, respectively . Twenty-four percent of the patients had underlying medical illnesses such as, diabetes mellitus or liver cirrhosis, or were over 60 years old . In 67.3% of patients, tuberculosis was suspected at the initial visit . However, tuberculosis was microbiologically proven in only 23.7% of the patients . The time interval from the symptom onset to the diagnosis varied, with the mean duration of the period 96 days . Pulmonary parenchymal abnormal lesions were found in 133 patients (42.6%) on chest radiographs . EPT has a wide spectrum of clinical manifestations, so it is difficult to diagnose it . Based on our studies, only 11.2% of the patients were confirmed as EPT . So it is important that the physician who first examines the patient should have a high degree of suspicion based on the chest radiography, localized or systemic symptoms and several laboratory parameters reviewed in this study. Klin Mikrobiol Infekc Lek, 2004 Jun, 10(3), 109 - 113 {Saprophytic microorganisms in food - impact on human health}; Hruby S; The paper discusses issues that research, in both the world and the Czech Republic, has for the most part been resolved . Yet in practice very little attention has been paid to them in this country . And yet non-specific microbial toxicoses produced by the enzymatic activity of various microorganisms in certain substrates, more specifically in food, may cause not only fairly insignificant, but also highly significant threats to human health, in both individuals and large groups of the population . They are thus important not only from a microbiological, but also epidemiological point of view . In this respect the greatest danger represent microbes with a lipolytic or proteolytic activity . Aldehydes, ketones, peroxides, epoxides and various other polymeres may be generated in fats, more particularly in butter, and in foodstuffs containing small or large proportion of fats, while various forms of biogenic amines may be found in foodstuffs containing proteins . The result are non-specific toxicoses - epidemiological examinations clearly point to an alimentary toxicosis, yet bacterial toxins cannot be demonstrated and possible products of enzymatic microbial activity are disregarded . In all such instances we should not only explore the suspicious foodstuffs for the presence of pathogenic or conditionally pathogenic microbes and bacterial toxins, but we should also carry out qualitative and quantitative investigations to detect lipolytic or proteolytic microorganisms (depending on the content of the foodstuff) and their metabolic activity. Int J Antimicrob Agents, 2004 Jul, 24(1), 67 - 71 Mode of action of novel polyamines increasing the permeability of bacterial outer membrane; Yasuda K et al.; We have clarified how the polyamines naphthylacetylspermine and methoctramine (N,N'-bis{6-{{(2-methoxyphenyl)methyl}amino}hexyl}-1,8-octanediamine), originally developed as a synthetic analogue of joro spider toxin and a muscarinic receptor antagonist, respectively, can increase the permeability of the outer membrane of Escherichia coli . These polyamines were recently found to be outer membrane permeabilisers, based on investigations of the structure-activity relationship using ion-selective electrodes . In a standard microbiological assay examining membrane-permeabilising ability, these polyamines enhanced the action of hydrophobic antibiotics such as novobiocin and erythromycin, which ineffectively traverse the outer membrane of E . coli, to inhibit the growth of E . coli . This result substantiated the outer membrane-permeabilising ability of these polyamines demonstrated by using ion-selective electrodes . We observed the release of lipopolysaccharide from the outer membrane in the concentration range causing permeabilisation, showing that the action of the polyamines is attributable to disruption of the outer membrane structure. J Food Prot, 2004 Jun, 67(6), 1303 - 8 Sampling methods for microbiological analysis of red meat and poultry carcasses; Capita R et al.; Microbiological analysis of carcasses at slaughterhouses is required in the European Union for evaluating the hygienic performance of carcass production processes as required for effective hazard analysis critical control point implementation . The European Union microbial performance standards refer exclusively to the excision method, even though swabbing using the wet/dry technique is also permitted when correlation between both destructive and nondestructive methods can be established . For practical and economic reasons, the swab technique is the most extensively used carcass surface-sampling method . The main characteristics, advantages, and limitations of the common excision and swabbing methods are described here. J Food Prot, 2004 Jun, 67(6), 1299 - 302 An outbreak of ammonia poisoning from chicken tenders served in a school lunch; Dworkin MS et al.; Although foodborne outbreaks of illness are relatively common, they are rarely caused by chemical agents . An outbreak of gastrointestinal illness occurred among students at two schools shortly after lunch was served . A cohort study, an environmental investigation, and microbiological and toxicological laboratory testing of food samples were performed . A case was defined as a student or teacher who ate food prepared in the kitchen at school A on 25 November 2002 (and served at schools A and B) and who later developed headache or symptoms of gastrointestinal tract irritation, with onset within 180 min of eating lunch . Among 312 persons interviewed, 157 persons became ill (attack rate = 49%; attack rate 41% for school A, 11% for school B) . Onset of illness occurred within 60 min for 81% of cases; 91% of students reported that their chicken tenders smelled unusual . Eating chicken tenders that smelled unusual was associated with being a case (relative risk 9.2, 95% confidence interval 1.4 to 62.6, P < 0.05) . Ammonia was detected in uncooked chicken tenders at levels as high as 2,468 ppm . The chicken had been contaminated during a warehouse leak of ammonia refrigerant . This outbreak of ammonia poisoning is only the second reported in food, and the first in a solid food . Heated chicken tenders contaminated with ammonia can cause acute illness within a short period of time. Vet Clin Pathol, 1987, 16(4), 102 - 6 A comparison of commercial kit methods for assay of vitamin b(12) in ruminant blood; Schultz WJ; Five commercially available radioisotope dilution (RID) kits for assay of Vitamin B(12) were obtained for evaluation with ovine and bovine serum; also, for comparison with our laboratory's (Lab 1) RID method and the methods of two independent laboratories, one using RID and the other a microbiological method . One commercial kit was found to be suitable for both species because negligible non-specific binding occurred when extraction was performed at 100 degrees C (212 degrees F) . Of the other four kits, two were found to be suitable for ovine and bovine serum provided non-specific binding of the latter was measured . This was also the case with the Lab 1 method . Two of the commercial kits were found to be unsuitable for assay of Vitamin B(12)in ruminant blood. Bioelectrochemistry, 2004 Aug, 64(1), 79 - 84 Oxidative dissolution of chalcopyrite by Acidithiobacillus ferrooxidans analyzed by electrochemical impedance spectroscopy and atomic force microscopy; Bevilaqua D et al.; The microbiological leaching of chalcopyrite (CuFeS(2)) is of great interest because of its potential application to many CuFeS(2)-rich ore materials . However, the efficiency of the microbiological process is very limited because this mineral is one of the most refractory to bacterial attack . Knowledge of bacterial role during chalcopyrite oxidation is very important in order to improve the efficiency of bioleaching operation . The oxidative dissolution of a massive chalcopyrite electrode by Acidithiobacillus ferrooxidans was evaluated by electrochemical impedance spectroscopy (EIS) and atomic force microscopy (AFM) . A massive chalcopyrite electrode was utilized in a Tait-type electrochemical cell in acid medium for different immersion times in the presence or absence of bacterium . The differences observed in the impedance diagrams were correlated with the adhesion process of bacteria on the mineral surface. Int Dent J, 2004 Jun, 54(3), 149 - 53 Relationship between volatile sulphide compounds concentration and oral bacteria species detection in the elderly; Senpuku H et al.; AIM: To evaluate the relationship between oral bacteria species detection and volatile sulphide compounds (VSC) concentration in the elderly . DESIGN: Cross-sectional microbiological and clinical VSC examination of elderly . PARTICIPANTS: Sixty-seven elderly people aged 75, who were functionally independent and dentate . METHODS: VSC (H2S and CH3SH) concentrations in the mouth air of subjects were measured using portable gas chromatography . Oral bacteria samples were taken from dental plaque and identification of bacteria species was accomplished using standard methods . RESULTS: Fewer than 20% of subjects showed more than 10 ng/10 ml of H2S (severe odour level) . The detection rate of P . melaninogenica was significantly higher in elderly people with more than 10 ng/10 ml (p=0.043) levels . Fusobacterium had a tendency to be found in those with more than 10 ng/10 ml, but a significant relation was not found . CONCLUSIONS: The results suggest that Fusobacterium and P . melaninogenica may be involved in the production of H2S in the oral cavity of elderly people. Indoor Air, 2004 Aug, 14(4), 243 - 57 Dampness in buildings as a risk factor for health effects, EUROEXPO: a multidisciplinary review of the literature (1998-2000) on dampness and mite exposure in buildings and health effects; Bornehag CG et al.; The scientific literature on health effects from dampness in buildings, including mite exposure over the period 1998-2000 has been reviewed by an European group (EUROEXPO) of eight scientists in experience from medicine, epidemiology, toxicology and engineering . Forty studies deemed relevant have been the foundation for the conclusions . Dampness in buildings is a risk factor for health effects among atopics and non-atopics both in domestic and in public environments . However, the literature is not conclusive in respect of causative agents, e.g . mites, microbiological agents and organic chemicals from degraded building materials . There is a strong need for more multidisciplinary studies including expertise from all relevant areas . A general conclusion from the work was that there is a strong need for multidisciplinary reviews in scientific journals of articles dealing with associations between indoor environmental factors and health effects . PRACTICAL IMPLICATIONS: There is good evidence for a true association between dampness in buildings and health . As the causative factors behind this association are not known, the main focus in practical investigations should be on finding out and remediate the reasons for the humidity problem. J Chemother, 2004 Apr, 16(2), 156 - 9 Ciprofloxacin as treatment for conjunctivitis; Chisari G et al.; The authors studied the bactericidal action and therapeutic effectiveness of ciprofloxacin in treating external ocular infections (bacterial conjunctivitis and bacterial blepharoconjunctivitis) . 108 ambulatory patients with clinical signs of conjunctivitis and blepharoconjunctivitis were enrolled in the study . All subjects underwent a conjunctival swab before starting therapy and at 10 days, to identify the causative bacteria and their susceptibility to ciprofloxacin, following routine microbiological methods . The reported therapeutic success rate (95%) and bacteriological analysis confirmed the effectiveness of ciprofloxacin in subjects with bacterial conjunctivitis and bacterial blepharoconjunctivitis . In vitro tests conducted 10 days after treatment confirmed the in vivo therapeutic effectiveness, even for those infections characterized by a difficult etiological identification which interferes with specific antibiotic therapy. Surg Endosc, 2004 May, 18(5), 736 - 40 Epub 2004 Apr 06. Endoscopic ultrasound-guided transrectal aspiration of pelvic fluid collections; Sailer M et al.; BACKGROUND: The aim of this study was to evaluate the feasibility, safety, and diagnostic accuracy of endorectal ultrasound-guided aspiration and drainage of pelvic fluid collections . METHODS: All patients who underwent endorectal ultrasound-guided aspiration and/or drainage of pelvic fluid collections were included in this prospective study . Patients were prepared using bowel lavage and a single-dose antibiotic combination . The procedure was carried out in the lithotomy position usually without sedation . All aspirates were examined microbiologically and/or cytologically . RESULTS: Twenty-nine patients {18 females and 11 males; median age, 67 years (range, 18-79)} underwent 33 endosonographic controlled aspirations . No procedure-related complications were encountered . In 22 cases (76%) the lesions were encountered following a surgical procedure . Fluid amounts varied between 5 and 750 ml . Fluids were sterile in 14 cases (42%) . These fluid collections were hematomas, seromas, peritoneal cysts, and a mucocele . Microorganisms were found in the remaining 19 aspirations (58%), i.e., abscesses (n = 16) and infected hematomas (n = 3) . A transrectal (n = 14) or transvaginal (n = 2) drainage catheter was placed in 16 patients under endosonographic guidance . Only two patients required a subsequent laparotomy for definitive treatment of their septic focus, whereas all other patients could be treated successfully by this conservative approach . CONCLUSION: Endoscopic ultrasound-guided transrectal aspiration and drainage of pelvic fluid collections is a safe method with a favorable outcome because it avoids unnecessary operations in selected patients. Ig Sanita Pubbl, 2004 Jan-Apr, 60(1-2), 39 - 50 {A ten-year risk evaluation study in Catania hospital operating rooms}; Ferrante M et al.; Previous studies conducted in Catania hospitals have revealed a high burden of contamination in the air of operating rooms and have recommended measures to improve air quality . In this study we verified the effectiveness of the undertaken measures . Furthermore we evaluated the possibility of using microclimatic parameters as "markers" of operating room contamination . Changes made to ventilation systems and to waste gas scavenging systems in the monitored operating rooms were remarkably effective . Microclimatic conditions and degree of chemical contamination improved over time; nevertheless airflow velocity values were found to be insufficient and nitrous oxide values, in some cases, remained slightly elevated . A significant correlation was observed only between some nitrous oxide values and relative humidity . Monitoring important marker levels is useful for correctly evaluating operating room thermal, chemical and microbiological air quality. Chemosphere, 2004 Aug, 56(5), 449 - 56 Improvement of soil characteristics and growth of Dorycnium pentaphyllum by amendment with agrowastes and inoculation with AM fungi and/or the yeast Yarowia lipolytica; Medina A et al.; The effectiveness of two microbiologically treated agrowastes {dry olive cake (DOC) and/or sugar beet (SB)} on plant growth, soil enzymatic activities and other soil characteristics was determined in a natural soil from a desertified area . Dorycnium pentaphyllum, a legume plant adapted to stress situations, was the test plant to evaluate the effect of inoculation of native arbuscular mycorrhizal (AM) fungi and/or Yarowia lipolytica (a dry soil adapted yeast) on amended and non-amended soils . Plant growth and nutrition, symbiotic developments and soil enzymatic activities were limited in non-amended soil where microbial inoculations did not improve plant development . The lack of nodules formation and AM colonization can explain the limited plant growth in this natural soil . The effectiveness and performance of inocula applied was only evident in amended soils . AM colonization and spores number in natural soil were increased by amendments and the inoculation with Y . lipolytica promoted this value . The effect of the inoculations on plant N-acquisition was only important in AM-inoculated plants growing in SB medium . Enzymatic activities as urease and protease activities were particularly increased in DOC amended soil meanwhile dehydrogenase activity was greatest in treatments inoculated with Y . lipolytica in SB added soil . The biological activities in rhizosphere of agrowaste amended soil, used as indices of changes in soil properties and fertility, were affected not only by the nature of amendments but also by the inoculant applied . All these results show that the lignocellulosic agrowastes treated with a selected microorganism and its further interaction with beneficial microbial groups (native AM fungi and/or Y . lipolytica) is a useful tool to modify soil physico-chemical, biological and fertility properties that enhance the plant performance probably by making nutrients more available to plants. Risk Anal, 2004 Jun, 24(3), 521 - 36 The potential of next-generation microbiological diagnostics to improve bioterrorism detection speed; Casman EA; Emerging, rapid, multivalent, microbial diagnostic technologies can produce results in hours, as contrasted to the standard methods that require at least the better part of a week . Used in bioterrorism surveillance in medical settings, the new biodetectors could significantly reduce the time between a covert attack and its detection . By how much is determined by the intensity of sampling . If used to screen all patients reporting flu-like symptoms to their doctors, this basic level of "front-line" sampling would reduce life-threatening medical floundering and missteps and give responders 3-5 days of warning that they otherwise would not have had . Being miniaturized and amenable to mass production, these devices could reduce the cost of screening to a fraction of current costs and so it is tempting to imagine their use in more intensive bioterrorism screening programs aimed at the apparently healthy population, programs that could detect a covert attack even before the victims felt ill . This article examines the tradeoffs between surveillance effort and probability of detection for such programs . Dual-use deployment, where the biodetector provides some medically useful information in addition to bioterrorism surveillance, is discussed. Bioresour Technol, 2004 Oct, 95(1), 107 - 12 Characteristics of rice straw and sewage sludge as composting materials in Valencia (Spain); Iranzo M et al.; This work supports the idea that composting can be useful for minimizing the rice straw and sewage sludge environmental impact . Several physical, chemical and microbiological properties of these raw materials were analyzed . The characteristics of the rice straw were complementary to those of the sewage sludge for the application of composting . The C/N ratios suitable for a rapid increased in microbial activity were the lowest (17-24) . A temperature of 62 degrees C during 48 h removed pathogenic microorganisms from rice straw and sewage sludge mixture . The results obtained in the present work suggested that these materials could be use in the composting process. Med Clin (Barc), 2004 May 29, 122(20), 786 - 8 {Rickettsia africae infection . Three cases confirmed by PCR}; Oteo JA et al.; BACKGROUND AND OBJECTIVE: African tick bite fever or Rickettsia africae infection has been recognized as an emerging health problem in the last few years . The aim of this study was to describe 3 cases of Spanish tourists who suffered from R . africae infection after visiting South Africa . PATIENTS AND METHOD: Three patients with a suspected rickettsial disease according to epidemiological and clinical manifestations (fever, eschar and exanthema) were studied . Antibodies against Rickettsia conorii were determined by IFI assays . Semi-nested PCR reactions (rOmpA) and subsequent sequence analysis of the amplified products were also carried out . RESULTS: Epidemiological and clinical aspects of this rickettsiosis are described . For diagnosis of this rickettsial disease, conventional serological assays (IFI) were less useful than semi-nested rOmpA PCR reactions, which showed a sensitivity of 100% in our samples . CONCLUSIONS: Three cases of R . africae infection are reported . PCR and subsequent sequencing of the amplicons are useful for the microbiological confirmation of this type of infection . We must think about African tick-bite fever as a possible diagnosis in patients with a febrile rash after returning from endemic areas. Orv Hetil, 2004 May 23, 145(21), 1123 - 6 {Bronchoscopic specimen collection, role of the protected specimen brush in lower respiratory tract infections}; Dulka E et al.; INTRODUCTION: The ineffectiveness of microbiological methods in the lower respiratory tract infections are caused by anachronistic sampling methods . Authors checked the protected specimen brush effectiveness and those of the influencing factors . MATERIALS AND METHODS: 103 patients were involved in the study . The causative agents were identified in 44 cases . These results were compared to last year's classic sampling techniques and they experienced 20.4% improvement of the sensitivity . Further increasing in effectiveness can be reached if we perform bacteriological sampling after the first unsuccessful antibiotic treatment was performed . Out of 103 examined patients only 69 underwent antibiotic treatment . In the case of 13 patients after the course of one type antibiotic treatment 10 positive bacteriological cultures were positive . In the case of 31 patients 2 types of antibiotics were administered sequentially and examined afterwards and the authors found 15 positive bacteriological cultures . In the case of 25 patients the administered sequentially 3 times of antibiotics and examined afterwards, 6 cultures were positive . CONCLUSION: The examinations prove that the protected specimen brush, used in time, raises the sensitivity of microbiological processes. J Invest Surg, 2004 May-Jun, 17(3), 127 - 34 Effects of prostaglandin E1 and E2 analogues on mucosal injury-induced, and on bacterial translocation promoted by, experimental intestinal obstruction; Gurleyik G et al.; The aim of this experimental study was to investigate effects of prostaglandin E1 and E2 analogues on mucosal structure and bacterial translocation during small bowel obstruction . The study was carried out on 40 Wistar rats equally divided into four groups; group 1 = control, group 2 = intestinal obstruction by ligation of distal ileum, and groups 3 and 4 = obstruction and administration of PGE2 and PGE1, respectively . Intestinal bacterial content and translocation to mesenteric lymph nodes and to the blood were determined by microbiological analysis . Mucosal structural changes were assessed by histopathological examination and expressed as a structural damage score and as the thickness of the mucosal layer . Bacterial overgrowth was determined in all obstruction groups . Mucosal thickness was 39.7 microm in group 1 and 26.8 microm in group 2 (p <.001) . The thickness was significantly preserved by administration of PGE1 and PGE2 (p <.001) . Mean structural damage score was 0.4 in group 1 and 6.7 in group 2 (p <.001) . The damage scores were significantly lower in groups treated with PGE1 and PGE2 than obstruction alone group (p <.001) . Better scores were obtained in rats treated with PGE1 than rats treated with PGE2 (p =.0026) . Translocation to the lymph nodes did not occur in group 1, but was 70% in group 2 (p =.0015); significantly lower rates of translocation to lymph nodes were observed in rats treated with PGE1 (p =.035), but not with PGE2 . We conclude that mucosal structure is partly maintained by administration of PGE1 and PGE2 during intestinal obstruction; PGE1 is more effective than PGE2 for ameliorating mucosal injury . PGE1 prevents bacterial translocation by preserving structural integrity of the mucosa . PGE2 partially prevents mucosal damage but not bacterial translocation. Clin Chem Lab Med, 2004 May, 42(5), 533 - 9 An International Standard for whole blood folate: evaluation of a lyophilised haemolysate in an international collaborative study; Thorpe SJ et al.; Folate measurements, particularly for whole blood, show wide inter-laboratory and inter-methodology variability . This variability appears to be due in part to the lack of internationally accepted reference materials . A whole blood haemolysate, lyophilised in ampoules and designated 95/528, was therefore evaluated by 15 laboratories in five countries for its suitability as an International Standard (IS) for whole blood folate . The preparation was assayed using a variety of microbiological and protein-binding methodologies against local standards and calibrators . A consensus folate content was assigned to 95/528 . The inclusion of three whole blood samples in the study with widely differing folate levels demonstrated a considerable reduction in inter-laboratory variability when the folate content of the samples was determined relative to the proposed IS 95/528 rather than to laboratories' local standards and calibrators . Accelerated degradation studies indicated that the folate content of 95/528 is stable when stored at -20 degrees C . On the basis of the results presented here, the World Health Organization Expert Committee on Biological Standardization established 95/528 as an IS for whole blood folate. Can J Neurol Sci, 2004 May, 31(2), 282 - 5 Intramedullary blastomycosis in a child: case report; Parr AM et al.; OBJECTIVE: To report a case of spinal intramedullary blastomycosis causing myelopathy . CLINICAL PRESENTATION: An otherwise healthy 13-year-old patient was diagnosed with respiratory North American blastomycosis . She subsequently received a five-month course of itraconazole with presumed resolution of the infection . The patient presented again at 14 years of age with a lumbar myelopathy . Magnetic resonance imaging revealed an intramedullary lesion of 1 cm diameter at the level of T12-L1 . INTERVENTION: A T12-L1 laminectomy was performed with a gross total resection of the lesion . Pathological examination and microbiological culture of the specimen was consistent with blastomycosis . Postoperatively, the patient was placed on a five week course of amphotericin B . The patient showed substantial improvement in neurological function . CONCLUSION: Blastomycosis can present as an isolated intramedullary lesion causing compromised function . It should be considered in the differential diagnosis of a patient with a myelopathy and previously recognized blastomycosis . The prognosis is good with surgical resection. J Eur Acad Dermatol Venereol, 2004 Jul, 18(4), 467 - 70 HIV seronegative eosinophilic pustular folliculitis successfully treated with doxicycline; Brazzelli V et al.; Eosinophilic pustular folliculitis (EPF) is an unusual disease, first described in adult East Asians in 1970 by Ofuji . It is characterized by follicular papules and pustules tending to coalesce and form plaques involving the trunk, face and extremities . In recent years, it has been often associated with human immunodeficiency virus (HIV) infection or with immunosuppressed and/or oncohaematological patients . EPF has been described in immunocompetent adult caucasian patients only occasionally . The diagnosis requires clinical and microbiological features such as sterile folliculitis and histopathological findings characterized by folliculitis and perifolliculitis with eosinophilic infiltrate . We describe an HIV seronegative caucasian male with EPF, allergic to non-steroidal anti-inflammatory drugs and indomethacin, treated with oral doxicycline . The treatment led to the complete remission of the lesions within 2 months. Otolaryngol Head Neck Surg, 2004 Jun, 130(6), 759 - 66 Tuberculous otitis media: a significant diagnostic challenge; Vaamonde P et al.; OBJECTIVE: This study was undertaken to revise the diagnostic characteristics of tuberculous otitis media (TOM), a disorder that is often diagnosed late, leading to delay in specific treatment . STUDY DESIGN AND SETTING: Retrospective study of a longitudinal series of 10 TOM patients over a 7-year period at an institutional referral center . RESULTS: Most patients showed intractable otorrhea, moderately severe hearing loss, and necrotic eardrums with granulation tissue and single perforations . Multiple perforations, facial palsy, and cervical adenopathies were rare (<10% of patients) . CT generally showed soft tissue involvement of the middle ear without bone erosion . The most effective laboratory test microbiological culture of exudate (diagnostic efficacy 71%) . Specific antibiotic treatment was effective in all cases . CONCLUSION: The diagnosis of TOM remains a significant challenge for otorhinolaryngologists . SIGNIFICANCE: If there are strong clinical grounds for suspicion, standard laboratory tests for tuberculosis should be repeated even if initially negative. Rev Panam Salud Publica, 2004 Apr, 15(4), 249 - 55 {Efficacy and safety of a vaccine against human leptospirosis in Cuba}; Martinez R et al.; OBJECTIVES: To evaluate the efficacy of vax-SPIRAL, a Cuban vaccine against leptospirosis, and to provide additional information concerning the safety of this vaccine (which was developed by Cuba's Finlay Institute) . METHODS: This phase III efficacy trial of vax-SPIRAL was controlled, randomized, and double blind . The control vaccine used for the trial was Heberbiovac-HB (Heber Biotec, Cuba), a recombinant hepatitis B vaccine . The randomization unit for allocating persons to the study group or the control group were 523 family physician offices in the selected municipalities . The study covered the entire population of males and females from 20 to 64 years old who voluntarily agreed to participate, from the municipalities of Ranchuelo, Quemado, Santo Domingo, Encrucijada, Corralillo, Cifuentes, and Camajuani, which are in the province of Villa Clara, in the central region of Cuba . The vaccinations were given in the physicians' offices between February and July 1998, with an interval of 6 weeks between the two doses . The follow-up period was 12 months . A case was considered positive if a person who had received the two doses of the vaccine became ill with leptospirosis more than 21 days after receiving the second dose, with the diagnosis confirmed through serological and microbiological methods . We calculated the efficacy of the vaccine and the relative risk of becoming ill with leptospirosis after the vaccination . For the safety study, two persons were chosen at random from among the individuals vaccinated at the office of each physician participating in the study . Follow-up of local and systemic adverse reactions was carried out by the family physicians during the seven days after the application of each dose . The level of statistical significance was set at 0.05 . RESULTS: A total of 101 832 persons were vaccinated, with 50 354 of them (49.4%) receiving the leptospirosis vaccine and 51 478 of them (50.6%) receiving the control vaccine . The efficacy of the vax-SPIRAL vaccine was 78.1% (95% confidence interval (CI): 59.2% to 88.3%), and the relative risk of becoming ill with leptospirosis after receiving the leptospirosis vaccine was 0.22 (95% CI: 0.12 to 0.41) . General discomfort was the most frequent systemic adverse reaction, and mild spontaneous pain at the injection site was the most frequent local effect . The local and systemic adverse reactions were both more frequent in the study group than in the control group (P = 0.003) . There were no serious adverse events . CONCLUSION: The vax-SPIRAL vaccine proved to be safe and efficacious for leptospirosis control . The vaccine is recommended for use in preventing this disease among groups at risk of contracting it. Crit Care Med, 2004 May, 32(5), 1166 - 9 Diagnostic and prognostic value of procalcitonin in patients with septic shock; Clec'h C et al.; OBJECTIVE: To determine whether procalcitonin is a reliable diagnostic and prognostic marker in septic shock compared with nonseptic shock . DESIGN: Prospective controlled trial . SETTING: Intensive care unit of the Avicenne Teaching Hospital, Bobigny, France . PATIENTS: All patients admitted to our intensive care unit over a 12-month period with clinical evidence of shock . INTERVENTIONS: None . MEASUREMENTS AND MAIN RESULTS: Echocardiography or pulmonary artery flotation catheter measurements were used to assess hemodynamics, and multiple specimens were obtained for microbiological studies . Standard criteria were used to diagnose septic shock . Serum concentrations of procalcitonin, C-reactive protein, and lactate were determined on the day of shock onset (day 1) and on days 3, 7, and 10 . Seventy-five patients were included, 62 in the septic shock group and 13 in the cardiogenic shock group . Serum procalcitonin on day 1 was significantly higher in patients with than without septic shock (median, 14 {0.3-767} ng/mL vs . 1 {0.5-36} ng/mL, p < .01) . A cutoff value of 1 ng/mL had 95% sensitivity and 54% specificity for separating patients with and without sepsis . C-reactive protein failed to discriminate between these two groups . Among patients with sepsis, procalcitonin concentrations were significantly higher in those who died than in the survivors, at all four measurement time points (median, 16 {0.15-767} ng/mL vs . 6 {0.2-123} ng/mL, p = .045 on day 1; 6.5 {0.3-135} ng/mL vs . 1.05 {0.11-53} ng/mL, p = .02 on day 10) . A cutoff value of 6 ng/mL on day 1 separated patients who died from those who survived with 87.5% sensitivity and 45% specificity . C-reactive protein was not helpful for predicting mortality . Serum lactate was a nonspecific prognostic marker . CONCLUSIONS: These data indicate that procalcitonin may be a valuable early diagnostic and prognostic marker in patients with septic shock. Zhonghua Nan Ke Xue, 2004 May, 10(5), 376 - 7, 381 {Diagnosis and treatment of tuberculosis in the male genital system}; Shen Z et al.; OBJECTIVE: To probe into and improve the diagnosis and treatment of tuberculosis (TB) in the male genital system . METHODS: Fifteen patients with the male genital system TB established by microbiological and pathological examinations were retrospectively reviewed . RESULTS: The male genital system TB was diagnosed by history, physical examination, semen analysis, TB culture and biopsy . Treatment consisted of antituberculous chemotherapy for all the patients before and/or after operation, including 5 cases of epididymectomy and 6 cases of orchi-epididymectomy . CONCLUSION: The male genital system TB tends to be atypical and semen polymerase chain reaction of TB (TB-PCR) may provide a new specific means for diagnosis in case of clinical suspicion . Surgical approaches should be cautiously adopted, especially for young patients. Trop Med Int Health, 2004 Jun, 9(6), 718 - 23 Features distinguishing amoebic from pyogenic liver abscess: a review of 577 adult cases; Lodhi S et al.; Distinguishing amoebic from pyogenic liver abscesses is crucial because their treatments and prognoses differ . We retrospectively reviewed the medical records of 577 adults with liver abscess in order to identify clinical, laboratory, and radiographic factors useful in differentiating these microbial aetiologies . Presumptive diagnoses of amoebic (n = 471; 82%) vs . pyogenic (n = 106; 18%) abscess were based upon amoebic serology, microbiological culture results, and response to therapy . Patients with amoebic abscess were more likely to be young males with a tender, solitary, right lobe abscess (P = 0.012) . Univariate analysis found patients with pyogenic abscess more likely to be over 50 years old, with a history of diabetes and jaundice, with pulmonary findings, multiple abscesses, amoebic serology titres <1:256 IU, and lower levels of serum albumin (P < 0.04) . Multivariate logistic regression analysis confirmed that age >50 years, pulmonary findings on examination, multiple abscesses, and amebic serology titres <1:256 IU were predictive of pyogenic infection . Several clinical and laboratory parameters can aid in the differentiation of amebic and pyogenic liver abscess . In our setting, amebic abscess is more prevalent and, in most circumstances, can be identified and managed without percutaneous aspiration. Berl Munch Tierarztl Wochenschr, 2004 May-Jun, 117(5-6), 193 - 200 {Sampling plans and microbiological criteria as risk management options in recently developed food safety concerns}; Dahms S; In connection with the World Trade Organization SPS-Agreement new concepts for ensuring food safety have been discussed for some years now . Main topics have been quantitative risk analyses investigating relationships between microbial concentrations in foods and disease probabilities as well as the concept of food safety objectives developed by ICMSF . So far food safety demands have been defined as microbiological criteria . However, usually it is not transparent, whether sampling plans incorporated in such criteria are based on specific prescriptions with regard to decision reliability and tolerable food qualities . In addition, it is still to be discussed, which parts microbiological criteria can play in connection with new concepts of food risk management, for instance as an option to test whether food safety objectives are met or not . The performance of microbiological sampling plans, as visualized by operation characteristic curves, assumptions made in this context, and relationships between food safety objectives and microbiological criteria as well as implications for food safety issues are investigated in this paper. J Appl Microbiol, 2004, 97(1), 191 - 204 Identification of waterborne bacteria by the analysis of 16S-23S rRNA intergenic spacer region; Perez-Luz S et al.; AIM: In this study, we evaluated, the use of universal primers, specific for the 16S-23S rRNA intergenic region, to detect and identify nine species that are of high interest for the microbiological control of water . METHODS AND RESULTS: The analysis of the fragments was carried out using a High Resolution acrylamide/bisacrylamide gels in a fluorescent automated DNA sequencer . The results showed specific profiles for each of the nine species but this technique failed to detect simultaneously micro-organisms in samples containing a mixed population . CONCLUSION: Nevertheless, the electrophoretic profiles obtained provided a very useful tool for the rapid and specific identification of water isolates . SIGNIFICANCE AND IMPACT OF THE STUDY: A possible new methodology for a rapid identification of pathogens in water. J Appl Microbiol, 2004, 97(1), 78 - 86 Genotypic analysis of Escherichia coli recovered from product and equipment at a beef-packing plant; Aslam M et al.; AIMS: To identify sources of Escherichia coli on beef by characterizing strains of the organism on animals, equipment and product at beef-packing plant . METHODS AND RESULTS: Generic E . coli were recovered from hides, carcasses, beef trimmings, conveyers and ground beef during the summer of 2001 (750 isolates) and winter of 2002 (500 isolates) . The isolates were characterized by Random Amplification of Polymorphic DNA (RAPD) . The numbers of E . coli recovered from dressed carcasses were less than the numbers recovered from hides . The numbers recovered from chilled carcasses were too few for meaningful analysis of the strains present on them but the numbers recovered from trimmings and ground beef were larger . The RAPD patterns showed that the majority of isolates from hides, carcasses, beef trimmings, conveyers and ground beef were of similar RAPD types, but a few unique RAPD types were recovered from only one of those sources . The E . coli populations present on the hides of incoming animals and in the beef-processing environment were highly diverse . Randomly selected E . coli isolates from each of the five sources were further characterized by pulsed-field gel electrophoresis (PFGE) . Most genotypes of E . coli defined by PFGE corresponded to the E . coli types defined by RAPD . CONCLUSIONS: The hides of the incoming animals appeared to be only one of the sources of the E . coli on trimmings and in ground beef, as additional sources were apparently present in equipment used for carcass breaking . SIGNIFICANCE AND IMPACT OF THE STUDY: This study indicates that hazardous microbiological contamination of meat may occur after the dressing of carcasses at commercial beef-packing plants, which suggests that attention should be given to the control of the contamination of meat during carcass breaking as well as during the dressing of carcasses. Rev Prat, 2003 Sep 30, 53(14), 1545 - 53 {What must one know about microbiology for prescribing antibiotics?}; Andreu M et al.; Antibiotics are usually prescribed for serious bacterial infections . The knowledge of ecological niche of each bacterium, mechanisms of action and resistance to antibiotics and the correct interpretation of a direct exam of microbiological samples are essential to improve the use of antibiotics . Finally, the update of the epidemiology of resistance is necessary to interpret the susceptibility tests and for the optimal use of empirical antibiotherapy. Eye, 2004 Jun, 18(6), 580 - 7 Surveillance of endophthalmitis following cataract surgery in the UK; Kamalarajah S et al.; AIMS: To estimate the incidence of acute-onset presumed infectious endophthalmitis (PIE) following cataract surgery in the UK and provide epidemiological data on the presentation, management, microbiology, and outcome of cases of endophthalmitis . METHODS: Cases were identified prospectively by active surveillance through the British Ophthalmological Surveillance Unit reporting card system, for the 12-month period October 1999 to September 2000 inclusive . Questionnaire data were obtained from ophthalmologists throughout the UK at baseline and 6 months after diagnosis . Under-reporting was estimated by independently contacting units with infection databases . RESULTS: Data were available on 213 patients at baseline and 201 patients at follow-up . The minimum estimated incidence of PIE was 0.086 per 100 cataract extractions and the corrected incidence was 0.14 per 100 cataract extractions . For the management of PIE, 96% of patients received intravitreal, 30% subconjunctival, 65% oral, and 17% intravenous antibiotics . In all, 17% of patients received intravitreal steroid . From the intraocular samples taken for microbiological analysis, 56% were culture positive . At follow-up, 48% of patients achieved visual acuity of 6/12 or better and 66% achieved better than 6/60 . 13% of patients were unable to perceive light or had evisceration of the globe . CONCLUSIONS: The incidence of PIE after cataract surgery in the UK is comparable to that of other studies . Approximately 50% of patients achieved a visual acuity close to the driving standard. Ann Readapt Med Phys, 2004 Jun, 47(5), 233 - 8 {Management of infectious risk associated with therapeutic pools}; Chapuis C et al.; There is no specific legislation concerning pools and others medical hydrotherapy equipments relating hygiene and security rules . For this reason, the hydrotherapy pools use the public swimming pools legislation . METHOD: This article is based on literature review (database Medline and Embase--manual research) . RESULTS: This article offers a review of pool associated infections along with the description of the measures designed to minimise the possible transmission of infection during hydrotherapy activities such as: Technical measures: pool and premises conception, water treatments, feed tanks, air quality . Hygiene rules for patients and hospital staff and pathologies which are contra-indications to hydrotherapy activities . Microbiological and physico-chemical monitoring . DISCUSSION: The infectious risk remains low with therapeutic pools . However, the development of specific legislation and surveillance should be enhanced . CONCLUSION: All these measures are part of the quality assurance program that must be implemented to control the safety of these installations. Eur J Haematol, 2004 Jul, 73(1), 67 - 70 Fulminant bronchiolitis obliterans organizing pneumonia following 2 d of treatment with hydroxyurea, interferon-alpha and oral cytarabine ocfosfate for chronic myelogenous leukemia; Kalambokis G et al.; A 65-yr-old man developed increasing dyspnea and fulminant respiratory failure 48 h after introduction of hydroxyurea, oral cytarabine ocfosfate (YNK01) and interferon-alpha for treatment of Philadelphia chromosome-positive chronic myelogenous leukemia . The chest radiograph showed bilateral patchy infiltrates while computed tomography revealed multiple bullas, ground glass opacities, and patchy consolidations with possible cavitation . Bronchoscopic examination was normal and microbiological tests performed on all biologic fluids were negative . The patient did not respond to multiple antibiotic treatment and corticosteroid administration and died of progressive respiratory failure 5 d after chemotherapy introduction . The postmortem lung examination was consistent with the diagnosis of bronchiolitis obliterans organizing pneumonia (BOOP). S Afr J Surg, 2004 Feb, 42(1), 17 - 9 Disseminated nocardiosis masquerading as abdominal tuberculosis; John MA et al.; A 32-year-old patient was admitted with a community-acquired pneumonia . She had clinical evidence of AIDS and chest X-ray features consistent with pulmonary tuberculosis . While in the ward she developed an acute abdomen necessitating laparotomy, at which a diagnosis of abdominal tuberculosis was made . Sputum and intraoperative pus specimens grew a multiresistant Nocardia brasiliensis . Microbiological investigations for tuberculosis were negative . The patient died after a short ICU admission from multiple organ dysfunction syndrome. An Med Interna, 2004 May, 21(5), 215 - 22 {Tuberculosis in Santiago de Compostela from 1999 to 2002 . An epidemiological study}; Salgueiro Rodriguez M et al.; OBJECTIVE: The purpose of this study was to determine the epidemiological characteristics of tuberculosis (TB) in the Public Health System District of Santiago de Compostela (population : 386125) from 1999 to 2002 . METHODS: Inclusion criteria were: 1) . microbiological and/or pathological diagnosis of TB in any specimen, and 2) . patient younger 35 years old with recent medical history of TB . Mantoux test positive, and pleural effusion with linfocitosis and adenosine deaminase >47 IU/ml . RESULTS: 946 patients were included (568 men and 378 women), with ages ranging from 2 months to 96 years . The incidence of TB was 60.9/100000 in 1999, 67.6/100000 in 2000, 61.9/100000 in 2001 and 54.6/100000 in 2002 . The incidence rate of tuberculous meningitis was 1.03/100000 in 1999 and 2000, 0.77/100000 in 2001 and 0.51/100000 in 2002 . The percentage of cases associated with HIV was 3.4% in 1999, 1.9% in 2000, 2.4% in 2001 and 2002 . We found an increase in the rate of males over 55 years of age; with incidence per 100000 inhabitants of 122.4 in 1999, 142.8 in 2000, 115 in 2001 and 119 in 2002, whereas in females the incidence was 40.6 in 1999, 60.9 in 2000, 54.1 in 2001 and 39.1 in 2002 . CONCLUSIONS: In last four years the incidence of tuberculosis has decreased but remains high in males over 55 years old. Org Lett, 2004 Jun 10, 6(12), 1955 - 8 Microbiological transformations 57 . Facile and efficient resin-based in situ SFPR preparative-scale synthesis of an enantiopure "unexpected" lactone regioisomer via a Baeyer-Villiger oxidation process; Hilker I et al.; {reaction: see text} The microbiological Baeyer-Villiger oxidation of (-)-bicyclo{3.2.0}hept-2-en-6-one allowed exclusive formation of the "unexpected" lactone regioisomer in 84% yield, high chemical purity, and enantiopure form . Substrate (25 g) was transformed in a 1 L bubble column reactor, following a in situ substrate feeding/product removal methodology, which afforded high volumetric productivity (1.2 g L(-)(1) h(-)(1)) . This illustrates the high "sustainable chemistry" advantages of such a process, simply conducted in aqueous medium, at room temperature and using atmospheric oxygen. Ann Acad Med Singapore, 2004 May, 33(3), 285 - 8 Routine microbiological screening in septic patients in a cardiac surgical intensive care unit; Meininger D et al.; INTRODUCTION: Patients in a surgical intensive care unit (ICU) have a high incidence of nosocomial infections which often lead to septic shock and death . Since specific antibiotic treatment is often difficult, it is recommended that routine nose/throat swabs be obtained in order to have a better idea of the causative agent when a systemic inflammatory response occurs in a given patient . MATERIALS AND METHODS: In 1435 patients in a cardiac surgical ICU, routine nose/throat swabs were taken thrice a week and tested for microorganisms and systemic inflammation . Blood cultures were also obtained . Antibiotic treatment was given to cover the microbes from the nose/throat swabs . Alternatively, an empirical antibiotic therapy was given to patients whose swabs had tested negative . RESULTS: Of the 86 patients with systemic inflammation, 29 had blood cultures positive for microbes . Of these, 18 received a specific antibiotic therapy based on their positive nose/throat cultures prior to the return of the blood cultures from the laboratory . However, only 11 patients tested positive for the same microbes on routine swabs and blood cultures . While positive routine swabs are quite specific to sepsis when there is a systemic inflammatory response, routine swabs are not a suitable screening tool due to their low sensitivity . CONCLUSION: Routine nose/throat swabs led to earlier specific antibiotic treatment in only 22 % of patients with clinical signs of systemic inflammation . In 36 % of cases, the organisms detected in the routine swabs and blood cultures were not identical . Hence, we believe that routine swabs are of limited value in instituting earlier, specific antibiotic therapy in septic patients. Ann Otol Rhinol Laryngol Suppl, 2004 May, 193, 24 - 6 Biopsy and specimen collection in chronic rhinosinusitis; Orlandi RR; Biopsy, aspiration, swab, and irrigation of the nose and sinuses are methods used in specimen collection and culture when chronic rhinosinusitis is suspected . Biopsy may be indicated to identify the presence of fungal elements in the mucus or tissues, suspected neoplasm, or inflamed bone . Aspiration directly from the maxillary sinus is considered to be the gold standard for culture, but it is painful . Direct endoscopic-guided culture of the middle meatus appears to be a viable substitute, with swab and suction methods having similar rates of microbiological contamination . Topical delivery methods for irrigating sinus cavities may utilize spray bottles, nebulizers, or a bulb syringe; these have various degrees of efficacy in dispersing materials to the sinuses . Use of the bulb syringe appears to offer broad distribution with limited risk of sample contamination . Specimens must be handled carefully to avoid loss of fungal elements . Advantages and indications of various methods are reviewed. Med Clin (Barc), 2004 May 22, 122(19), 741 - 3 {Tuberculosis in health care personnel in a general hospital}; Casas X et al.; BACKGROUND AND OBJECTIVE: Tuberculosis is an occupational disease in health care workers . The objective of our study was to review tuberculosis cases in health care professionals from a general hospital and to determine their incidence in relation to the general population . PATIENTS AND METHOD: This was a retrospective study of tuberculosis cases among health care workers in a university hospital from 1988 to 2002, evaluating the annual cumulative incidence . RESULTS: 21 tuberculosis cases were found in health care workers . Pulmonary disease was the most frequent type (62%) followed by pleural effusion (28%) . The most affected professional category were medical residents (38%) with the emergency service (48%) being the work place with the highest risk . The cumulative incidence in our hospital was higher in relation to the general population although there was a variability between both populations . CONCLUSIONS: There is risk of tuberculosis transmission among health care workers, principally in the emergency service and the pathology and microbiological departments . A concerted effort is needed to maintain prevention measures in the work place where there is a high risk of infection. Pediatr Pulmonol, 2004 Jul, 38(1), 82 - 7 Clinical value of obtaining sputum and cough swab samples following inhaled hypertonic saline in children with cystic fibrosis; Ho SA et al.; Prompt detection and treatment of lower respiratory tract infection are essential in the management of patients with cystic fibrosis (CF), who often have signs or symptoms of respiratory infection without any pathogens being isolated from sputum or cough swab specimens . The aims of this study were to assess the efficacy and clinical value of obtaining sputum and oropharyngeal cough swab samples following induction with hypertonic saline (HS) in this group of patients . Forty-three outpatients with CF, mean age 7.2 years (range, 1.8-12.9 years), were recruited over a 2-year period . Nebulized salbutamol was administered, followed by 6% HS . Sputum was preferentially obtained before and after HS induction if possible . If the patient was not able to expectorate, oropharyngeal cough swabs were taken instead . Four patients were able to expectorate sputum before and 19 after HS induction . The procedure was tolerated in 41 of 43 patients . Pathogens were isolated from 13 patients' HS-induced samples, but not from their corresponding preinduced specimens, and 4 patients' preinduced specimens cultured organisms which were not identified from their HS-induced samples . Significant changes were made in the management of 13 (30.2%) patients directly resulting from the positive culture of pathogens only from HS-induced samples . Cultures from oropharyngeal cough swab or expectorated sputum specimens following inhalation of HS provide additional microbiological information which is of clinical value and may lead to changes in patient management . Dtsch Med Wochenschr, 2004 May 28, 129(22), 1243 - 5 {Unexpected cause of a tarsal destruction in a diabetic patient}; Guttler A et al.; HISTORY: A 56-year-old male patient has suffered from increasing pain in the left foot which limited the ability of walking since 18 months . There was a soft and painful swelling below the left inner ankle . In addition the patient reported back pain, but no neurological symptoms . Insulin dependent diabetes type II was known for 20 years, and a diabetic foot syndrome was suspected . 6 months prior the patient consulted his physician because of repeated acute bronchitis with expectoration and no improvement following antibiotic therapy . INVESTIGATIONS: Osteolytic destruction of the left middle foot and the tarsal with soft tissue infiltration according to MR, a spondylodiscitis of the lumbar vertebra I and II (MR) and mixed interstitial/alveolar infiltrates throughout the lung with a predominance in both upper lobes were found . The microbiological examination of sputum and biopsy of inflamed soft tissue of the left ankle revealed infection with mycobacterium tuberculosis . DIAGNOSIS: Open lung tuberculosis with concomitant bone tuberculosis and tuberculous arthritis of the left middle foot and spondylodiscitis . THERAPY AND CLINICAL COURSE: The antibiotic therapy consisted of a combination of five antibiotic drugs for 2 weeks and of a four drug combination for further 3.5 months . After that there will be a consolidation therapy with a two drug regime for 6 months . An orthopaedist is also involved . Surgical procedures with respect to the left foot will not be considered as long as the antibiotic therapy has not been finished . CONCLUSION: A combination of symptoms resulting from inflammatory bone processes and pulmonary symptoms is always suspicious for a hematogenic dissemination of a pulmonary tuberculosis. Sex Transm Infect, 2004 Jun, 80(3), 219 - 22 Zafirlukast for severe recurrent vulvovaginal candidiasis: an open label pilot study; White DJ et al.; BACKGROUND: Recurrent vulvovaginal candidiasis (VVC) has been linked to allergic disease, particularly allergic rhinitis . OBJECTIVE: A pilot study to assess the possible use of the leukotriene receptor antagonist zafirlukast as a treatment for recurrent VVC . METHODS: 20 women with six or more symptomatic attacks of VVC in the past year (at least four proved microbiologically) . Clinical atopy determined by the International Study for Asthma and Allergies in Childhood (ISAAC) questionnaire assessed blindly . Monitoring by daily symptom diary and self taken vaginal swabs . Treatment with zafirlukast 20 mg twice daily for 24 weeks or until three microbiologically confirmed episodes of VVC . Response assessed by daily symptom diary and self taken vaginal swabs . Subjective response scales for improvement, side effects, and change in other allergic disease completed when stopping treatment . Semistructured telephone interview 1 year after stopping medication . RESULTS: 14 patients (70%) reported a subjective response on the improvement response scale . Six (30%) showed a complete response with no further symptomatic attacks of VVC or negative swabs when symptomatic . Seven (37%) remained symptom free 18 months after entering the study-that is, 12 months after stopping therapy . 11 (58%) remained symptom free for at least 3 months after stopping therapy . This does not include one patient who remained symptom free but continued on zafirlukast because of an improvement in her asthma . There was no clear relation between response and atopic status . Six of nine atopic subjective responders reported improvements in other allergic symptoms . Side effects were minimal; one seemed clearly attributable to the drug . CONCLUSION: Zafirlukast offers a potential new treatment for recurrent VVC that requires confirmation in controlled studies. Inflamm Bowel Dis, 2004 Mar, 10(2), 129 - 34 Pulmonary involvement in Crohn's disease report of a case and review of the literature; Omori H et al.; Crohn's disease (CD) is a granulomatous systemic disorder of unknown etiology . Obvious pulmonary involvement is exceptional in patients with CD . We report a case of a 38-year-old man who suffered from CD for more than 14 years and was treated with oral steroids for more than 10 years . Surgical excision of parts of the ileum was performed for life-threatening ileal bleeding caused by CD . After acute tapering of oral steroids, pulmonary symptoms and radiologic abnormalities were noted . Lung biopsy through thoracoscopy was performed and revealed signs of chronic inflammation with multiple subepithelial noncaseating and epithelioid granulomas on pathologic examination . Intravenous steroids were required in the initial management of life-threatening pulmonary dysfunction after diagnostic thoracoscopy and led to marked improvement . Tuberculocidal therapy was performed until all microbiological cultures were negative . Oral steroid dosage had slowly been tapered over 1 month . He was discharged with clinical and radiologic improvements . After 36 months, the patient's condition is stable on continued treatment with prednisolone and mesalazine. Cancer, 2004 Jun 1, 100(11), 2462 - 9 Assessment of procalcitonin as a diagnostic and prognostic marker in patients with solid tumors and febrile neutropenia; Jimeno A et al.; BACKGROUND: Cancer patients with fever and neutropenia currently are assessed on clinical grounds only . The current study prospectively evaluated the efficacy of baseline procalcitonin (PCT) in the detection of bacteremia and in the prediction of outcome in patients with solid tumors and febrile neutropenia . METHODS: PCT levels were determined at baseline and every 48 hours in 104 patients undergoing chemotherapy who developed fever (axillary temperature > 38 degrees C on 2 occasions or > 38.3 degrees C in a single record) and neutropenia (absolute neutrophil count < 500 cells/microL) . RESULTS: The median baseline PCT values were significantly higher in patients who had microbiologically documented infections (1.24 ng/mL) compared with patients who had clinically documented infections (0.27 ng/mL) or fever of unknown origin (0.21 ng/mL; P < 0.01) . Accordingly, a PCT cut-off value of 0.5 ng/mL was reached more frequently in patients who had microbiologically documented infections compared with patients who had clinically documented infections or fever of unknown origin (66.7% vs . 13.4%, respectively; P < 0.001) . Furthermore, this threshold also was associated with an increased likelihood of treatment failure (70.0% vs . 14.9%; P < 0.001) . All 4 septic patients and all 5 patients who ultimately died presented PCT values 5-fold to 10-fold greater than the median values . Clinical evaluation in combination with baseline PCT assessment appeared to improve clinical risk evaluation alone . CONCLUSIONS: Baseline PCT levels were higher in patients who had febrile neutropenia with bacteremia compared with patients who had clinical infections or fever of unknown origin . PCT helped to identify patients who had microbiologic infections and patients who were at high risk of treatment failure, and PCT may constitute a complementary tool in the initial assessment of such patients . Am J Clin Nutr, 2004 Jun, 79(6), 1006 - 12 Nutrient partitioning during treatment of tuberculosis: gain in body fat mass but not in protein mass; Schwenk A et al.; BACKGROUND: Tuberculosis is an important cause of wasting . The functional consequences of wasting and recovery may depend on the distribution of lost and gained nutrient stores between protein and fat masses . OBJECTIVE: The goal was to study nutrient partitioning, ie, the proportion of weight change attributable to changes in fat mass (FM) versus protein mass (PM), during antimycobacterial treatment . DESIGN: Body-composition measures were made of 21 men and 9 women with pulmonary tuberculosis at baseline and after 1 and 6 mo of treatment . All subjects underwent dual-energy X-ray absorptiometry and deuterium bromide dilution tests, and a four-compartment model of FM, total body water (TBW), bone minerals (BM), and PM was derived . The ratio of PM to FM at any time was expressed as the energy content (p-ratio) . Changes in the p-ratio were related to disease severity as measured by radiologic criteria . RESULTS: Patients gained 10% in body weight (P < 0.001) from baseline to month 6 . This was mainly due to a 44% gain in FM (P < 0.001); PM, BM, and TBW did not change significantly . Results were similar in men and women . The p-ratio decreased from baseline to month 1 and then fell further by month 6 . Radiologic disease severity was not correlated with changes in the p-ratio . CONCLUSIONS: Microbiological cure of tuberculosis does not restore PM within 6 mo, despite a strong anabolic response . Change in the p-ratio is a suitable parameter for use in studying the effect of disease on body composition because it allows transformation of such effects into a normal distribution across a wide range of baseline proportion between fat and protein mass. Environ Manage, 2004 Jul, 34(1), 26 - 37 Epub 2004 May 13. Public water sources in rural watersheds of Nepal's Middle Mountains: issues and constraints; Merz J et al.; Inadequacy and poor quality of water supply for domestic purposes is increasingly becoming a concern in rural catchments of the Middle Mountains of Nepal . Water quantity is an issue in pocket areas of these catchments, while water quality is subject to concern in most of the water sources . Microbiological contamination in particular poses a risk to human health . In addition, sediment pollution during the monsoon season is perceived as an issue by the local residents . Elevated phosphate and nitrate levels in many water sources indicate intensive interaction with surface water hailing from agricultural areas and human settlements . These water quantity and quality concerns in two watersheds of Nepal, the Jhikhu Khola and the Yarsha Khola watersheds, are not isolated cases . Similar problems are reported from other watersheds monitored under the People and Resource Dynamics in Mountain Watersheds of the Hindu Kush-Himalayas (PARDYP) project in China, India, and Pakistan and the literature of this region. Methods Mol Biol, 2004, 268, 303 - 10 Microbiological test for sanitation of equipment in the food factory; Herrera AG; Microbiological sampling of utensils, tableware, and kitchen ware, in addition to equipment, permits objective evaluation of sanitation practices and procedures used for these items from food service operations. Methods Mol Biol, 2004, 268, 235 - 80 The hazard analysis and critical control point system in food safety; Herrera AG; The Hazard Analysis and Critical Control Point (HACCP) system is a preventive method of ensuring food safety . Its objectives are the identification of consumer safety hazards that can occur in the production line and the establishment of a control process to guarantee a safer product for the consumer; it is based on the identification of potential hazards to food safety and on measures aimed at preventing these hazards . HACCP is the system of choice in the management of food safety . The principles of HACCP are applicable to all phases of food production, including basic husbandry practices, food preparation and handling, food processing, food service, distribution systems, and consumer handling and use . The HACCP system is involved in every aspect of food safety production (according to the UN Food and Agriculture Organization {FAO} and the International Commission on Microbiological Specifications for Foods {ICMSF}).The most basic concept underlying the HACCP system is that of prevention rather than inspection . The control of processes and conditions comprises the critical control point (CCP) element . HACCP is simply a methodical, flexible, and systematic application of the appropriate science and technology for planning, controlling, and documenting the safe production of foods.The successful application of HACCP requires the full commitment and involvement of management and the workforce, using a multidisciplinary approach that should include, as appropriate, expertise in agronomy, veterinary health, microbiology, public health, food technology, environmental health, chemistry, engineering, and so on according to the particular situation . Application of the HACCP system is compatible with the implementation of total quality management (TQM) systems such as the ISO 9000 series. Arch Dis Child, 2004 Jun, 89(6), 577 - 9 Cough plate versus cough swab in patients with cystic fibrosis; a pilot study; Maiya S et al.; BACKGROUND: Accurate identification of lower respiratory tract pathogens is important in the management of cystic fibrosis patients . AIM: To evaluate the cough plate as an alternative method of obtaining respiratory samples for microbiological culture . METHODS AND RESULTS: Using sputum culture as the "gold standard", the cough plate method identified significantly more positive cases than either dry or moistened cough swabs . Of 20 patients who had a positive sputum culture, 16 had a positive culture on cough plate compared to seven positive cultures each on moistened swab and on dry swab respectively . CONCLUSIONS: In this study cough plates were more sensitive than cough swabs in isolating respiratory pathogens in sputum producers . As patients prefer it, the cough plate merits further evaluation, particularly in non-sputum producers. Antimicrob Agents Chemother, 2004 Jun, 48(6), 2021 - 4 Phase 2, randomized, dose-ranging study evaluating the safety and efficacy of anidulafungin in invasive candidiasis and candidemia; Krause DS et al.; This study evaluated the safety and efficacy of anidulafungin, a novel echinocandin, in patients with invasive candidiasis, including candidemia . A total of 123 eligible patients were randomized to one of three intravenous regimens, 50, 75, or 100 mg once daily . Treatment continued for 2 weeks beyond resolution or improvement of signs and symptoms . The primary efficacy criterion was a successful global response rate (i.e., clinical and microbiological success) in the evaluable population at the follow-up (FU) visit, 2 weeks after end of therapy (EOT) . One hundred twenty (120) patients received at least one dose of anidulafungin; 68 were evaluable . Review of adverse events and laboratory data indicated no dose response for safety parameters . Non-albicans Candida species accounted for approximately one-half of all isolates . Success rates at EOT were 84, 90, and 89% in the 50-, 75-, and 100-mg groups, respectively . At FU, the success rates were 72, 85, and 83% . Phase 3 studies of anidulafungin for the treatment of invasive candidiasis and candidemia are warranted. J Antimicrob Chemother, 2004 Jun, 53 Suppl 2, ii51 - 7 Treatment of polymicrobial infections: post hoc analysis of three trials comparing ertapenem and piperacillin-tazobactam; Solomkin J et al.; The efficacy of ertapenem 1 g once a day for the treatment of polymicrobial complicated intra-abdominal, complicated skin/skin-structure and acute pelvic infections was compared with piperacillin-tazobactam 3.375 g every 6 h in a post hoc analysis of data from three large randomized double-blind trials . Of the 1,558 treated patients in the three trials, no pathogen was identified in 345 (22.1%), 423 (27.2%) had a monomicrobial infection and 790 (50.7%) had a polymicrobial infection . At the test-of-cure assessment, there were no significant differences in outcome between the two treatment groups for any of the three infections . Cure rates (clinical and microbiological for intra-abdominal infection, clinical for skin/skin-structure and pelvic infections) in microbiologically evaluable patients for ertapenem and piperacillin-tazobactam, respectively, were 85.6% (154/180 evaluable patients) and 82.5% (127/154) for polymicrobial intra-abdominal infection, 80.3% (53/66) and 78.7% (48/61) for polymicrobial skin/skin-structure infection, and 95.7% (88/92) and 92.6% (88/95) for polymicrobial pelvic infection . Respective cure rates for all evaluable patients in the original trials were: 83.6% and 80.4% for intra-abdominal, 83.9% and 85.3% for skin/skin-structure, and 93.9% and 91.5% for pelvic infections . These data show that in the three trials, ertapenem 1 g once a day was highly effective for the treatment of polymicrobial infections and as effective as piperacillin-tazobactam 3.375 g every 6 h. Vaccine, 2004 Jun 2, 22(17-18), 2221 - 5 Burden of hospitalizations attributable to rotavirus infection in children in Spain, period 1999-2000; Gil A et al.; The aim of this study is to provide estimates on the incidence of rotavirus infection requiring hospitalization in children <or=5 years of age during the 1999-2000 period in Spain and the associated direct cost of these hospitalizations . Hospital admissions attributable to rotavirus were estimated by using data on confirmed laboratory reports of rotavirus and hospital admissions due to acute gastroenteritis . During the study period a total of 32541 cases of pathogens responsible for acute gastroenteritis were reported to the microbiological information national system (SIM) and 14.0% were rotavirus . The proportion of laboratory-confirmed rotavirus cases was extrapolated to the total number of hospitalizations for acute gastroenteritis in children <or=5 years of age . An annual incidence of 1.0 hospital admissions attributable to rotavirus per 1000 persons <or=5 years of age was found, although during the winter season it reached 2.5 hospitalizations per 1000 . Overall, the estimated annual number of days of hospitalization attributable to rotavirus was 8742 days that results in a cost of 3.6 million per year. Methods Mol Biol, 2004, 266, 115 - 35 Exploring and exploiting bacterial proteomes; Cordwell SJ; The plethora of data now available from bacterial genome sequencing has opened a wealth of new research opportunities . Many of these have been reviewed in preceding chapters . Genomics alone, however, cannot capture a biological snapshot from an organism at a given point in time . The genome itself is static, and it is the changes in expression of genes, leading to the production of functional proteins, which allows an organism to survive and adapt to a constantly changing environment . Proteomics is the term used to describe the global analysis of proteins involved in a particular biological process . Such processes may be analyzed via comparative studies that examine bacterial strain differences, both phenotypic and genetic, bacteria grown under nutrient limiting conditions, growth phase, temperature, or in the presence of chemical compounds, such as antibiotics . Proteomics also provides the researcher with a tool to begin characterizing the functions of the vast proportion of "hypothetical" or "unknown" proteins elucidated from genome sequencing and database comparisons . For example, study of protein-protein, protein-ligand, protein-substrate, and protein-nucleic acid interactions for a given target protein may all help to define the functions of previously unknown proteins . Furthermore, genetic manipulation combined with proteomics technologies can provide an understanding of how gene expression is regulated . This chapter examines the technologies used in proteome analysis and the applications of proteomics to microbiological research, with an emphasis on clinically-relevant bacteria. Int J Gynaecol Obstet, 2004 Jun, 85 Suppl 1, S52 - 61 Puerperal sepsis and maternal mortality: what role can new technologies play? Hussein J, Fortney JA. OBJECTIVE: To identify new and underutilized technologies to reduce maternal mortality related to puerperal sepsis in developing countries . METHOD: Review of current medical literature . RESULT: The literature indicates that infection-control protocols and evidence-based procedures--including prophylactic antibiotics for cesarean section or preterm rupture of membranes, and updated antibiotic regimens--should be widely adopted . Devices such as hand rubs, needle-disposal systems, and rapid microbiological diagnostic tests can improve compliance and efficiency . Operational research on promising developments like vaginal cleansing with antiseptics, vitamin A supplementation, and prophylactic antibiotics in high-risk women is needed . CONCLUSION: Sepsis management continues to depend on good implementation of established technologies . Program-based approaches are required to improve uptake. Int J Med Microbiol, 2004 Apr, 293 Suppl 37, 93 - 103 Zoonotic Babesia: possibly emerging pathogens to be considered for tick-infested humans in Central Europe; Hunfeld KP et al.; The three host-tick Ixodes (I.) ricinus is regarded as an important vector of tick-borne microorganisms pathogenic for humans in central Europe and is primarily known as the main vector of Borrelia (B.) burgdorferi and the virus causing tick-borne encephalitis (TBE), the most clinically relevant tick transmitted pathogens for humans in European countries . Furthermore, it is now well established that I . ricinus also transmits Ehrlichia (E.) phagocytophila, Babesia (Ba.) divergens, and Ba . microti, all agents of zoonotic infections in dear, sheep, cattle, dogs, and horses . In addition to their known zoonotic potential, recent molecular-epidemiological and seroepidemiological surveys as well as increasingly reported clinical cases of infections caused by these tick-borne organisms other than B . burgdorferi (TOBB) also strongly suggest a possible relevance of Babesia, Ehrlichia and Rickettsia for humans at risk in Europe . However, there are few medical microbiological investigations and epidemiological data on the distribution and relevance of Babesia for humans in our part of the northern hemisphere . There is also very little diagnostic and clinical knowledge on human babesiosis in many regions of Europe . Furthermore, sophisticated diagnostic tools designed for the reliable detection of the underlying pathogens, are not yet generally available to the microbiological laboratory . This review aims to provide basic information on human babesiosis and the most relevant causative pathogens of the disease in Europe and to draw attention to this parasitic infection as a possibly emerging and probably under-diagnosed disease in this part of the northern hemisphere. Int J Food Microbiol, 2004 May 1, 92(3), 297 - 306 Heterotrophic plate count monitoring of treated drinking water in the UK: a useful operational tool; Sartory DP; The count of general or heterotrophic bacterial populations in treated drinking water in the UK has been undertaken since the 1880s . Counts of heterotrophic bacteria at 22 and 37 degrees C are used widely as part of an overall assessment of treated drinking water quality . There were no legislated standards for water quality in the UK until adoption of the first EU Directive in 1989 . The UK has, however, never stipulated numerical standards or guidelines for heterotrophic bacteria, although their enumeration has long been part of the assessment of 'wholesome' water, on which advice regarding microbiological quality was given in a series of documents known as 'Report 71' . The current regulations stipulate only that there should be 'no abnormal change' in numbers normally associated with a given supply . This paper reviews the historical context regarding the enumeration, and interpretation of results, of heterotrophic bacteria from treated drinking water, and information regarding current practices by UK water suppliers . The appropriateness of using heterotrophic bacteria counts as an operational tool or as a health parameter is briefly discussed in the light of the UK experience . Photodermatol Photoimmunol Photomed, 2004 Jun, 20(3), 144 - 7 Photodynamic therapy of interdigital mycoses of the feet with topical application of 5-aminolevulinic acid; Calzavara-Pinton PG et al.; BACKGROUND: Findings of in vitro studies have demonstrated that dermatophytes and yeasts can be effectively photosensitized after topical delivery of 5-aminolevulinic acid (ALA) . This procedure, called photodynamic therapy (PDT), seems to lack mutagenic activity and hazard of selection of drug-resistant strains . METHODS: Twenty percent ALA preparation in Eucerin cream was applied under an occlusive dressing to skin lesions of nine patients with clinical and microbiological evidence of interdigital mycosis of the feet . After 4 h, lesions were irradiated with 75 J/cm(2) of broad-band red light . Interdigital lesions of the other foot served as control (treated with only light or only ALA) . After 7 days from the first treatment, no further treatment was delivered if lesions were not clinically evident and direct microscopic examination was negative . Otherwise, three additional weekly treatments were delivered . Four weeks after the last treatment, patients had a final follow-up clinical and laboratory examination . RESULTS: Clinical and microbiological recovery was seen in six out of nine patients after one (four cases) or four (two cases) treatments . However, after 4 weeks, recurrences were seen in four patients . Overall tolerability was always good . CONCLUSION: Under the conditions employed in the present study, ALA-PDT had good therapeutic effects on interdigital mycosis of the feet . However, recurrences were quick . In vivo environmental conditions, i.e . temperature, humidity and pH of the interdigital skin, could induce a poor cell uptake of ALA and a deficient biosynthesis of photosensitizing protoporphyrin IX . In addition, the irregular tridimensional shape of this peculiar anatomical area could lead to a non-uniform delivery of light and/or ALA cream . However, the present results can stimulate further studies on the PDT of superficial skin mycoses. Tuberk Toraks, 2003, 51(3), 282 - 8 {The evaluation of close contact case of pulmonary tuberculosis patients enrolled to Eskisehir Deliklitas Tuberculosis Control Dispensary}; Kolsuz M et al.; Persons infected with Mycobacterium tuberculosis are at greatest risk for developing active tuberculosis especially in children, adolescents, young adults and persons who have selected risk factors . Persons who were contact with tuberculosis patients and who have positive tuberculin skin test reactions and had high risk for developing active tuberculosis should be use preventive chemotherapy . In this study, we aimed to evaluate retrospectively 1663 close contacts of 486 active tuberculosis patients who registered in Eskisehir Deliklitas Tuberculosis Control Dispensary . The mean age was 25.4 +/- 18.1 years, 961 (57.7%) cases were female and 702 (42.3%) cases were male . Diagnosis was performed 1114 (67%) of close contacts people's patients with microbiological study . The scatrix of BCG has been recorded 901 (54.2%) cases, tuberculin skin test results has been recorded 952 (57.2%) cases . Tuberculin skin test of 612 (64.5%) cases were above 15 mm . 37.8% of cases were used preventive chemotherapy and 2.6% of cases had active tuberculosis disease . The age group was 7-14 years and persons who had close contacts of bacile positive patients, 80.5% of them had used preventive chemotherapy . Persons who's tuberculin skin test positive and younger than 6 years, 98.5% of them had preventive chemotherapy . Only 372 (59.2%) of patients completed preventive chemotherapy . At the results; we established that the preventive chemotherapy programme which recommended to our country is using regularly, but most of the close contact patients didn't completed their therapy. Eur J Clin Microbiol Infect Dis, 2004 Jun, 23(6), 491 - 4 Epub 2004 May 13. Clinical significance of lower respiratory tract Aspergillus culture in elderly hospitalized patients; Soubani AO et al.; In order to evaluate the clinical significance of Aspergillus-positive culture results from the lower respiratory tract specimens of elderly hospitalized patients, and to identify the clinical variables that differentiate between colonization and infection with Aspergillus spp . in this patient population, a retrospective study was conducted . The records of 66 elderly patients whose lower respiratory tract specimens yielded Aspergillus spp . between January 1995 and July 2000 were examined . The majority of the patients ( n=61) were determined to be colonized with Aspergillus spp., and serious lung infection due to Aspergillus spp . was rare . Clinical, radiological, and microbiological data did not help differentiate between infection and colonization. Reg Anesth Pain Med, 2004 May-Jun, 29(3), 237 - 42 Spinal cord compression from intrathecal catheter-tip inflammatory mass: case report and a review of etiology; Peng P et al.; OBJECTIVES: The majority of intrathecal pumps are implanted by anesthesiologists . Despite a recent increase in case reports involving intrathecal catheter-tip inflammatory masses, this complication is rarely reported in the anesthesiology literature . The present case report describes a patient with spinal cord compression as a result of an inflammatory mass and reviews the current literature as to the etiology of inflammatory mass formation . CASE REPORT: A 47-year-old man with intractable neck and arm pain received an intrathecal pump implantation in 2001, at a stable dose of morphine 8 mg and clonidine 40 microg/d . After an injury in late 2001, his dose requirement for intrathecal morphine steadily increased . In May 2002, hydromorphone was substituted for morphine . The concentrations of hydromorphone and clonidine were 12.5 mg/mL and 150 microg/mL, respectively, infusing at 0.3 mL/d . In October 2003, he developed progressive T9 paraparesis . A computed tomography scan with myelogram showed complete blockage of contrast flow at T8-9 . Surgical exploration found an intradural-extramedullary mass compressing the spinal cord anteriorly and to the left . Four weeks after surgical removal of the mass, the patient's neurologic function had improved minimally . All the microbiological analyses were negative . Review of the current literature suggests that the development of an inflammatory mass is related to the delivery of the high dose opioids in the intrathecal space . CONCLUSION: Delivery of high-dose intrathecal opioids can result in the formation of an inflammatory mass, leading to poor pain control and neurologic complications . Anesthesiologists should be vigilant as to these complications when managing patients receiving intrathecal pump therapy. Support Care Cancer, 2004 Oct, 12(10), 720 - 4 Piperacillin-tazobactam and netilmicin as a safe and efficacious empirical treatment of febrile neutropenic children; Le Guyader N et al.; GOALS OF WORK: We evaluated piperacillin-tazobactam in association with netilmicin (TN) in the early empirical treatment of neutropenic children, as data are limited in number . PATIENTS AND METHOD: In 1996, an observational study was initiated to assess the efficacy and safety of this association, with a glycopeptide (TNG) if needed . The impact on the bacterial ecology of our unit was also observed . Children were treated for hematological malignancy or solid tumor between September 1996 and December 1998 and presented a febrile neutropenia . RESULTS: There were 148 evaluable febrile neutropenic episodes in 104 patients . Median age was 7 years, 55% of the episodes were fever of unknown origin, 22% were clinically documented and 23% microbiologically documented (27 bacteriemia) . A glycopeptide was added in 67 episodes . The initial unmodified treatment was successful in 114 episodes (77%): 75/81 episodes in the TN group and 39/67 in the TNG group . For successful episodes, median treatment duration was 6 days . There were 22 febrile recurrences . These patients, as well as initial failures, always responded to a second-line treatment . One child was considered a failure because he developed a skin rash probably due to piperacillin-tazobactam and required another beta-lactamase . CONCLUSION: This study suggests that piperacillin-tazobactam in association with netilmicin presents a satisfactory efficacy and a good tolerance as empirical therapy for febrile neutropenic children . It allowed us to maintain the bacterial ecology of our unit. Probl Tuberk Bolezn Legk, 2004, (1), 36 - 9 {Chronic bronchitis in children}; Rachinskii SV et al.; Current approaches to diagnosing in children a group of chronic lung diseases running with the symptoms of chronic bronchitis . Chronic bronchitis is demonstrated to be a major syndrome underlying the clinical manifestations of a number of chronic lung diseases, such as congenital malformations of the lung, chronic pneumonia, ciliary dyskinesia, immunodeficiencies running with the involvement of the lung, cystic fibrosis, etc . The paper shows it necessary to diagnose these conditions, by using various diagnostic studies (bronchological, immunological, biochemical, microbiological, etc.) . Primary chronic bronchitis in childhood occurs rarely and it is diagnosed after excluding the above diseases. Biol Sci Space, 2003 Dec, 17(4), 310 - 7 {Search for life in deep biospheres}; Naganuma T; The life in deep biospheres bridges conventional biology and future exobiology . This review focuses the microbiological studies from the selected deep biospheres, i.e., deep-sea hydrothermal vents, sub-hydrothermal vents, terrestrial subsurface and a sub-glacier lake . The dark biospheres facilitate the emergence of organisms and communities dependent on chemolitoautotrophy, which are overwhelmed by photoautotrophy (photosynthesis) in the surface biospheres . The life at deep-sea hydrothermal vents owes much to chemolithoautotrophy based on the oxidation of sulfide emitted from the vents . It is likely that similarly active bodies such as the Jovian satellite Europa may have hydrothermal vents and associated biological communities . Anoxic or anaerobic condition is characteristic of deep subsurface biospheres . Subsurface microorganisms exploit available oxidants, or terminal electron acceptors (TEA), for anaerobic respiration . Sulfate, nitrate, iron (III) and CO2 are the representative TEAs in the deep subsurface . Below the 3000-4000 m-thick glacier on Antarctica, there have been >70 lakes with liquid water located . One of such sub-glacial lakes, Lake Vostok, is about to be drill-penetrated for microbiological studies . These deep biosphere 'platforms' provide new knowledge about the diversity and potential of the Earth's life . The expertise obtained from the deep biosphere expeditions will facilitate the capability of exobiologial exploration. Int J Food Microbiol, 2004 May 15, 93(1), 11 - 29 Fine-tuning Food Safety Objectives and risk assessment; Havelaar AH et al.; Food Safety Objectives (FSOs) have been proposed as a practical tool to translate public health targets for food safety into tolerable levels of pathogens in a food product . The FSO concept is subject to intensive debate, and has not been developed in detail . We evaluate the proposed definition of FSOs and their implementation from the perspective of Quantitative Microbiological Risk Assessment (QMRA) . The relationship between QMRA and FSOs is illustrated by a model for the public health risk of Shiga-producing Escherichia coli in steak tartare . We conclude that the proposed definition of FSOs needs to be modified to properly account for variability in and uncertainty about the contamination of food with pathogenic microorganisms and emphasize that both prevalence and concentration of pathogens must be considered . For this purpose, we propose the P-D equivalence curve, a simple graphical tool to separate "tolerable" from "non-tolerable" combinations of prevalence and concentration (dose) . J Clin Microbiol, 2004 May, 42(5), 2255 - 7 Quantitative microbiological study of subgingival plaque by real-time PCR shows correlation between levels of Tannerella forsythensis and Fusobacterium spp; Suzuki N et al.; A TaqMan-based real-time PCR assay was established to quantify the periodontopathic bacteria Tannerella forsythensis and Fusobacterium spp . With this assay, the prevalence and proportion of these bacteria in clinical specimens were evaluated . Our preliminary results suggest a positive colocalization of T . forsythensis and Fusobacterium spp . in periodontal pockets. Eur J Nucl Med Mol Imaging, 2004 Feb, 31(2), 233 - 9 99mTc-ciprofloxacin planar and tomographic imaging for the diagnosis of infection in the postoperative spine: experience in 48 patients; De Winter F et al.; The non-invasive assessment of postoperative spinal infections can pose a substantial diagnostic challenge, especially in the presence of orthopaedic devices . Whereas white blood cell scanning is of limited use in the spine, the low normal bone marrow uptake of technetium-99m ciprofloxacin combined with its claimed bacterial specificity makes it theoretically an ideal candidate for the evaluation of postoperative spinal infections . This study aimed to evaluate 99mTc-ciprofloxacin planar and single-photon emission tomography (SPET) imaging in relation to microbiological and clinical diagnosis in the postoperative spine . Planar imaging was performed at 1, 3 and 24 h and SPET was performed at 3 h post injection of 370 MBq 99mTc-ciprofloxacin . Images were scored by two independent certified nuclear medicine physicians, blinded to the final diagnosis . Within the 48 patients, there were 13 deep infections . Sensitivity, specificity and accuracy at visual scoring were respectively 54%, 71% and 67% (1 h), 62%, 77% and 73% (3 h), 42%, 91% and 77% (24 h) for planar imaging and 100%, 74% and 81% for SPET . When recently operated patients (< 6 months) were excluded, the specificity of the SPET imaging rose to 81% . In conclusion, unlike white blood cell scanning, 99mTc-ciprofloxacin SPET is sensitive in evaluating infections in the postoperative spine . Sensitivity is much higher for SPET than for planar imaging . However, the results presented prove that its specificity is limited, especially in recently operated patients . Taking this limitation into account, we advise planar and SPET imaging at 3 h post injection and an interval of at least 6 months after surgery to minimise the likelihood of false positives. Appl Environ Microbiol, 2004 May, 70(5), 2577 - 87 Impact of soil drying-rewetting stress on microbial communities and activities and on degradation of two crop protection products; Pesaro M et al.; Prior to registration of crop protection products (CPPs) their persistence in soil has to be determined under defined conditions . For this purpose, soils are collected in the field and stored for up to 3 months prior to the tests . During storage, stresses like drying may induce changes in microbiological soil characteristics (MSCs) and thus may influence CPP degradation rates . We investigated the influence of soil storage-related stress on the resistance and resilience of different MSCs by assessing the impact of a single severe drying-rewetting cycle and by monitoring recovery from this event for 34 days . The degradation and mineralization of the fungicide metalaxyl-M and the insecticide lufenuron were delayed by factors of 1.5 to 5.4 in the dried and rewetted soil compared to the degradation and mineralization in an undisturbed reference . The microbial biomass, as estimated by direct cell counting and from the soil DNA content, decreased on average by 51 and 24%, respectively . The bulk microbial activities, as determined by measuring substrate-induced respiration and fluorescein diacetate hydrolysis, increased after rewetting and recovered completely within 6 days after reequilibration . The effects on Bacteria, Archaea, and Pseudomonas were investigated by performing PCR amplification of 16S rRNA genes and reverse-transcribed 16S rRNA, followed by restriction fragment length polymorphism (RFLP) and terminal RFLP (T-RFLP) fingerprinting . Statistical analyses of RFLP and T-RFLP profiles indicated that specific groups in the microbial community were sensitive to the stress . In addition, evaluation of rRNA genes and rRNA as markers for monitoring the stress responses of microbial communities revealed overall similar sensitivities . We concluded that various structural and functional MSCs were not resistant to drying-rewetting stress and that resilience depended strongly on the parameter investigated. Photochem Photobiol Sci, 2004 May, 3(5), 403 - 5 Epub 2004 Apr 29. Photosensitized inactivation of microorganisms; Jori G et al.; Despite major advances in medicine in the last 100 years, microbiologically-based diseases continue to present enormous global health problems . New approaches that are effective, affordable and widely applicable and that are not susceptible to resistance are urgently needed . The photodynamic approach is known to meet at least some of these criteria and, with the creation and testing of new photosensitisers, may develop to meet all of them . The approach, involving the combination of light and a photosensitising drug, is currently being applied to the treatment of diseases caused by bacteria, yeasts, viruses and parasites, as well as to sterilisation of blood and other products. Environ Int, 2004 Aug, 30(6), 841 - 54 Development of coastal recreational water quality standards in the Mediterranean; Kamizoulis G et al.; Concern about adverse health effects arising out of human exposure to polluted seawater through bathing and other forms of aquatic recreation has led to the development of various quality criteria and standards worldwide . Attempts at quantifying health hazards from polluted recreational waters have been made in several Mediterranean countries through the conduction of epidemiological studies aimed at establishing direct correlation between the microbiological quality of the water and health effects on exposed population groups . This article provides an overview on the development of the criteria and standards for coastal recreational waters in the Mediterranean by examining the evolution of the WHO guidelines, the WHO/UNEP interim criteria for bathing waters a