Biol Pharm Bull, 2000 Sep, 23(9), 1033 - 5 Bioassay of amoxicillin in rats; Groppo FC et al.; Few reports are available about tissue concentration of amoxicillin . The techniques used to measure tissue concentration usually require rupture and are expensive . The objective of the present study is to assess the utility of an animal model to predict tissue concentration of amoxicillin using induced granulomatous tissue . We used 160 rats with four polyurethane sponges previously implanted in their backs . At 7, 14, 21 and 28 d after sponge introduction, groups of eight animals each received 3.5, 7.0, 40.0 or 80.0 mg/kg of amoxicillin (p.o.) or 1 ml of 0.9% NaCl solution (control group) . One hour after drug administration, 10 microl of serum and granulomatous tissue were obtained . Tissue and serum were placed on different plates containing Mueller Hinton agar inoculated with 10(8) cfu (colony forming unit) of Staphylococcus aureus (ATCC 25923), and the diameters of the inhibition zones were measured after 18 h of incubation . Analysis of variance showed no statistically significant differences (p>0.05) among time periods for the same dose of amoxicillin . These results suggest that the pharmacokinetics of amoxicillin did not change in relation to the development of granulomatous tissue; therefore this method is valid to measure the tissue concentration of amoxicillin. J Vet Med Sci, 2000 Aug, 62(8), 875 - 80 Effects of autogenous toxoid-bacterin in lactating cows with Staphylococcus aureus subclinical mastitis; Hwang CY et al.; To evaluate clinical effects of autogenous toxoid-bacterin treatment for Staphylococcus aureus subclinical mastitis in lactating cows, 22 cows which had at least one S . aureus infected quarter were selected from among cows at a S . aureus prevalent dairy farm . Eleven cows were injected with their own autogenous toxoid-bacterin and the others were maintained as non-injected control . In the toxoid-bacterin injected group, 27% of infected quarters were cured during the 12-week trial, compared to 5% in the control group . New intramammary infections with S . aureus were only detected in 3 quarters of the control group . Mean IgG antibody titer against S . aureus somatic antigens and alpha-toxin in serum and milk were significantly increased in the toxoid-bacterin injected group (p<0.05) and remained higher than those of the control group which showed no significant changes (p<0.05) . In contrast to the control group, from 3 weeks after the second injection of the toxoid-bacterin injected group, mean S . aureus cfu/ml in milk samples from injected quarters with S . aureus was significantly decreased until the end of the study (p<0.05) . In the toxoid-bacterin injected group, significant decreases of mean SCC were detected from milk samples from infected quarters with S . aureus from week 7 to week 10 (p<0.05) . These data show that autogenous toxoid-bacterin treatment against S . aureus subclinical mastitis in lactating cows may increase the cure rate of the infections, reduce the severity of the infections and also prevent occurrence of the new infections. Ned Tijdschr Geneeskd . 2000 Sep 2;144(36):1731. {Diagnostic image (I) . Staphylococcal endocarditis}; Blaauwgeers JL et al.; A 48-year-old man had high fever and paralysis of the left leg, caused by an infectious endocarditis from which Staphylococcus aureus was cultured. Infect Immun, 2000 Oct, 68(10), 6052 - 5 Immunization with alpha-toxin toxoid protects the cornea against tissue damage during experimental Staphylococcus aureus keratitis; Hume EB et al.; Alpha-toxin is a major virulence factor in Staphylococcus aureus keratitis . Active or passive immunization with alpha-toxin toxoid could protect against corneal damage . Results show that either form of immunization did not kill bacteria but did significantly protect against corneal pathology, especially epithelial erosion. Infect Immun, 2000 Oct, 68(10), 5908 - 13 Modulation of neutrophil chemokine receptors by Staphylococcus aureus supernate; Veldkamp KE et al.; In a previous study, we showed that Staphylococcus aureus supernate (SaS) is a potent agonist for both neutrophils and mononuclear cells . To further investigate the immunomodulating effects of SaS, the effect on different neutrophil receptors was studied . Expression of various neutrophil receptors, before and after treatment with SaS, was quantified by flow cytometry . We found that SaS treatment of neutrophils resulted in a specific and total downregulation of the C5a and the fMLP receptor, both serpentine receptors, while other receptors were totally unaffected . Since these two receptors are both involved in chemotaxis, we tested the effect of SaS in calcium flux and chemotaxis assays . We showed that preincubation with SaS abrogated the rise in intracellular calcium concentration upon triggering with fMLP and C5a . We also showed that SaS is a potent inhibitor of neutrophil chemotaxis towards fMLP and C5a, but does not interfere with chemotaxis towards interleukin-8 . These findings indicate that S . aureus produces a virulence factor extracellularly, which impairs chemotaxis towards the infected site. Tissue Eng, 2000 Aug, 6(4), 401 - 11 Surgical irrigation with pooled human immunoglobulin G to reduce post-operative spinal implant infection; Poelstra KA et al.; A multiple-site, nonlethal rabbit surgical model of spinal implant infection was used to assess the efficacy of a spinal wound lavage to reduce post-operative infection from methicillinresistant Staphylococcus aureus (MRSA) . Multiple aqueous lavages of isotonic saline were compared to the same procedure using 1wt% pooled human immunoglobulin G (IgG) applied directly to the surgical implant sites . Visually observed clinically relevant signs of infection (e.g . , swelling, erythema, pus) were supported by bacterial enumeration from multiple biopsied tissue and bone sites post-mortem at 7 and 28 days post-challenge . Clinical signs of infection were significantly reduced in IgG-lavaged infected spinal sites . Bacterial enumeration also exhibited statistically significant reductions in soft tissues, bone and on K-wire spinal implants using IgG lavage compared with saline . Complete healing of all surgical wounds was seen after 28 days, although isolated fibrosed abscesses were observed in autopsied sites treated with both IgG and saline lavages . Local use of IgG wound lavage is proposed as supplementary infection prophylaxis against antibiotic resistant implant-centered or surgical wound infection. Antimicrob Agents Chemother, 2000 Oct, 44(10), 2880 - 2 Bactericidal activity of quinupristin-dalfopristin against Staphylococcus aureus: clindamycin susceptibility as a surrogate indicator; Fuchs PC et al.; Of 516 Staphylococcus aureus strains tested, 97.1% were susceptible to quinupristin-dalfopristin, which was bactericidal for 22 (56%) of the 39 strains tested, comparable to vancomycin . All 17 clindamycin and macrolide-resistant strains were inhibited but not killed by quinupristin-dalfopristin, whereas all 22 clindamycin-susceptible strains (5 were macrolide resistant) were killed. Antimicrob Agents Chemother, 2000 Oct, 44(10), 2845 - 7 The D-alanine residues of Staphylococcus aureus teichoic acids alter the susceptibility to vancomycin and the activity of autolytic enzymes; Peschel A et al.; Recently, Staphylococcus aureus strains with intermediate resistance to vancomycin, the antibiotic of last resort, have been described . Multiple changes in peptidoglycan turnover and structure contribute to the resistance phenotype . Here, we describe that structural changes of teichoic acids in the cell envelope have a considerable influence on the susceptibility to vancomycin and other glycopeptides . S . aureus cells lacking D-alanine esters in teichoic acids exhibited an at least threefold-increased sensitivity to glycopeptide antibiotics . Furthermore, the autolytic activity of the D-alanine mutant was reduced compared to the wild-type, and the mutant was more susceptible to the staphylolytic enzyme lysostaphin . Vancomycin inhibited autolysis at very high concentrations but neither in the wild-type nor in the mutant was the autolytic activity influenced in the range of the MIC . Mutant cells had a considerably higher capacity to bind vancomycin. Oncology (Huntingt), 2000 Aug, 14(8 Suppl 6), 23 - 9 Linezolid--a new option for treating gram-positive infections; Batts DH; The increase in serious gram-positive infections has increased the need for treatment of gram-positive infections in patients with hematologic malignancies . Common gram-positive pathogens exhibit a variety of resistance mechanisms, and this has supported the need for new antibiotics with unique modes of action and no endogenous resistance mechanism(s) directed against them . Linezolid (Zyvox), the first member of the oxazolidinone class of antibiotics to be tested clinically, is such an antibiotic . Linezolid has been shown to be effective against key gram-positive pathogens in vitro, without evidence of resistance development or cross-resistance to other antibiotics . Its efficacy and safety in the treatment of non-immunocompromised patients with hospital- and community-acquired pneumonia and skin and soft-tissue infections have been found to be comparable to commonly used present-day antibiotics . It has also been shown to be effective against vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus . Linezolid has a wide gram-positive spectrum of activity and is amenable to oral or parenteral administration These attributes make it potentially useful for continuing outpatient therapy that was initiated for inpatients. Antibiot Khimioter, 2000, 45(8), 6 - 11 {The study of Staphylococcus aureus strain resistant to actinomycin D}; Bulgakova VG et al.; Staphylococcus aureus strains, resistant to actinomycin D (AMD) and to gramicidin S (GS) were selected by S . aureus 209P passing on the media containing the above mentioned drugs . Strain R80 resistant to AMD and strain R9 resistant to GS and AMD and described before didn't perform enzyme inactivation of AMD . Cells of both strains had diminished ability to bind exogenous AMD . Electron microscopy investigation revealed that cells of R80 strain had thickened cell walls and they are characterized by more electron density then cells of R9 strain and of parent strain . Adaption to AMD and GS influenced also on functions of some staphylococcal surface proteins--the activity of endogenous coagulase (clumping factor) was found only in R9 strain . Exogenous coagulase was present in all the strains, but development of resistant to AMD and GS diminished this enzyme activity . It is concluded that development of resistance to AMD and GS causes substantial changes in staphylococcal cell wall, but the type of these changes differ. Rev Med Interne, 2000 Aug, 21(8), 713 - 6 {Viral superantigens}; Lafon M; Viral superantigens bind several alleles and isotypes belonging to the MHC class II and subsequently activate particular T cell families via the variable portion of the beta chain of TCR . As a result, a superantigen bridges MHC and TCR molecules, leading to activation of T and B cells . The T expansion of various TCR V beta subsets is triggered on the basis of their V beta specificity, but not on their antigenic specificity . The best known superantigens are bacterial endotoxins produced by Staphylococcus aureus . However, viruses such as mouse mammary tumor or rabies viruses encode superantigens too . The ability of superantigens to break the barriers of MHC restriction and to activate large numbers of T and B cells has led to the hypothesis that superantigens may activate autoreactive T and B cells to initiate or worsen autoimmune diseases such as diabetes, multiple sclerosis, or psoriasis. Transfusion, 2000 Sep, 40(9), 1067 - 70 Staphylococcus aureus bacteremia as a cause of early relapse of thrombotic thrombocytopenic purpura; Niv E et al.; BACKGROUND: Thrombotic thrombocytopenic purpura (TTP) is a multisystem disease characterized by the sudden onset of hemolytic anemia, thrombocytopenia, fever, renal failure, and neurologic dysfunction, occurring in various combinations . The most effective treatment of TTP is plasma exchange and the administration of corticosteroids, which reduces mortality from the 90 percent seen in untreated patients to 10 percent . CASE REPORTS: Two patients responded favorably to plasma exchange and corticosteroid therapy, but their TTP relapsed during treatment . In both cases, the early relapse of TTP was associated with Staphylococcus aureus bacteremia secondary to central line infection . Treatment of the infection and intensification of the plasma exchange regimen resulted in a sustained remission . CONCLUSION: Infection should be actively sought and treated in TTP patients who are refractory to treatment or in whom an exacerbation of the disease occurs while they are undergoing plasma exchange. Acta Leprol, 1999, 11(4), 153 - 9 {Nature and sensitivity of bacteria superinfecting plantar ulcers caused by leprosy at the Marchoux Institute, Bamako, Mali}; Tiendrebeogo A et al.; To determine potential usefulness of antimicrobial agents and to guide their prescription in the treatment of leprosy plantar ulcers, we conducted an in vitro study about germs' nature and sensitivity to antibiotics . We took samples of plantar ulcers secretion from 107 patients at Marchoux Institute . 92.5% of those ulcers were infected . These samples revealed 145 strains of micro-organisms among those, Staphylococcus aureus (70 strains) and genus Pseudomonas (41 strains) were the most frequent . These bacteria were resistant to several antibiotics currently used at Marchoux Institute (tetracycline, penicillin, cotrimoxazol and erythromicin) . Antibiotics, efficient at 80% on tested strains, were expensive for patients . They cannot be recommended for the treatment of local infections . These results outline that the main treatment in plantar ulcers is based upon antiseptic solutions and keeping feet at rest . Antibiotherapy in case of extension of local infection would be based on the results of a previous study of sensitivity. J Basic Microbiol, 2000, 40(4), 261 - 7 Antimicrobial activities of secondary metabolites produced by endophytic fungi from Spondias mombin; Rodrigues KF et al.; We performed a search for bioactive compounds produced by fungal endophytes from Spondias mombin (Anacardiaceae) . Culture broth extracts of Guignardia sp., Phomopsis sp . and Pestalotiopsis guepinii were separated by chromatographic methods and tested for biological activities . The crude extracts of these endophytes were tested against fourteen organisms, including actinomycetes, Gram-negative and Gram-positive bacteria, yeast, and filamentous fungi . All fungal extracts inhibited actinomycete growth . Guignardia sp . was also active against Escherichia coli, Staphylococcus aureus, Saccharomyces cerevisiae, Geotrichum sp., and Penicillium canadensis . Culture extracts of P . guepinii were active against S . cerevisae, while strains of Phomopsis sp . showed a pronounced antifungal effect against Cladosporium elatum, Mycotypha sp . and S . cerevisae. J Dairy Sci, 2000 Aug, 83(8), 1758 - 66 Production of antibodies to Staphylococcus aureus serotypes 5, 8, and 336 using poly(DL-lactide-co-glycolide) microspheres; O'Brien CN et al.; Staphylococcus aureus is responsible for a major portion of the economic losses due to mastitis . Attempts to produce a vaccine to prevent S . aureus mastitis have been hampered by the low immunogenicity of the polysaccharide, which forms on the surface of the organism when it enters the mammary gland . The polysaccharide inhibits phagocytosis and destruction of the organism by neutrophils . This study was conducted to determine if S . aureus polysaccharide serotypes 5, 8, and 336 conjugated to a protein and incorporated in poly(DL-lactide-co-glycolide) microspheres would enhance the production of opsonizing antibodies to the polysaccharide . Cows were immunized with either polysaccharide conjugates emulsified in Freund's incomplete adjuvant or polysaccharide conjugates encapsulated in poly (DL-lactide-co-glycolide) microspheres emulsified in Freund's incomplete adjuvant . All cows produced sustained antibody titers to the three polysaccharide serotypes . Cows immunized with microspheres had higher antibody titers . Cows in both groups produced increased concentrations of IgG1 and IgG2 antibodies; neither group produced an increase in IgM . Immune sera from cows immunized with conjugates alone increased phagocytosis, which decreased at the end of the study . Sera from cows immunized with conjugates in microspheres increased phagocytosis, which was sustained at the end of the study . Immune sera from both groups decreased bacterial adherence to bovine mammary epithelial cells . These data showed that a single injection of antigen in microspheres produced higher titers and more sustained enhancement of phagocytosis, which could aid in the defense of the cow against S . aureus infections. J Dairy Sci, 2000 Aug, 83(8), 1750 - 7 Evaluation of 1.6% phenol as a premilking and postmilking teat dip in preventing new bovine intramammary infections; Peters RR et al.; We evaluated the effectiveness of a 1.6% phenol-based teat dip using both a teat skin assay and natural exposure field trial . A teat skin assay was conducted to ascertain the concentration of phenol + phenate to be used in the field study . One percent and 0.5% iodine, and 0.5, 1.1, and 1.6% phenol + phenate were compared using Escherichia coli and Staphylococcus aureus . Logarithmic reductions for S . aureus were 2.2 and 2.8 for 0.5 and 1% iodine, and 1.3, 2.1, and 2.8 for 0.5, 1.1, and 1.6% phenol + phenate, respectively . Logarithmic reductions for E . coli were 3.3 and 3.8 for 0.5 and 1% iodine, and 1.2, 1.9, and 2.6 for 0.5, 1.1, and 1.6% phenol + phenate, respectively . A concentration of 1.6% phenol + phenate was chosen as experimental teat dip, and 0.5% iodine served as control . The field study was conducted at Beltsville (n = 185) and Clarksville (n = 100) dairy herds using a split herd design . Teat dips were used premilking and postmilking for 12 mo . The number of new intramammary infections (IMI) for the Beltsville herd in iodine and phenol + phenate teat dipped cows were: 29 and 35 for major pathogens, and 81 and 72, for minor pathogens . For the Clarksville herd, number of new intramammary infections in iodine and phenol + phenate teat dipped cows was 9 and 10 for major pathogens, and 50 and 60 for minor pathogens . Rates of IMI per quarter day per lactation were not different for either herd or when herd data were combined . The number of clinical mastitis cases per 100 cows per month were similar in both treatments . The incidences of new IMI and clinical mastitis were similar using both dips. J Food Prot, 2000 Sep, 63(9), 1277 - 81 Effects of growth at low water activity on the thermal tolerance of Staphylococcus aureus; Shebuski JR et al.; Staphylococcus aureus is the most osmotolerant foodborne pathogen, and outbreaks of staphylococcal food poisoning are often linked to foods of reduced water activity (a(w)) values . While it is generally known that the thermal tolerance of microorganisms increases as the a(w) of the heating menstruum is decreased, surprisingly little research has examined the influence of growth medium a(w) on microbial thermal tolerance . In the present study, we show that growth of S . aureus at an a(w) value of 0.94 leads to the development of dramatically enhanced thermal tolerance (i.e., less than 1 log reduction after heating for 20 min at 60 degrees C) . We further show that the identity of the accumulated compatible solute within cells grown at low a(w) can also influence the overall level of thermal tolerance of S . aureus . Finally, we provide evidence that the synthesis of general stress and/or osmotic stress proteins is required for the development of enhanced thermal tolerance of S . aureus at low a(w). Clin Experiment Ophthalmol, 2000 Jun, 28(3), 194 - 6 Staphylococcus aureus causes acute inflammatory episodes in the cornea during contact lens wear; Wu PZ et al.; The aim of this investigation was to determine the ability of Staphylococcus aureus to cause keratitis during contact lens wear in the rabbit . Rabbits were fitted with hydrogel lenses and wore them on an extended wear schedule for 7 weeks . At the end of each week of wear, one drop of S . aureus was added to the eyes, and the eyes were monitored using slit lamp bio-microscopy, with subsequent microbial and histological studies of the cornea . In the presence of S . aureus, keratitis occurred after 3 weeks of lens wear, a condition that was characterized by diffuse infiltration of the peripheral cornea and limbal redness . In the absence of bacteria, there was no infiltration until week 6 . Contact lens wear also prolonged the retention of bacteria in the eye . Extended contact lens wear and S . aureus caused non-ulcerative keratitis in a rabbit model, and disturbances in the ability of the eye to remove bacteria. J Exp Zool, 2000 Oct 1, 287(5), 340 - 5 Antibacterial and hemolytic activity of the skin of the terrestrial salamander, Plethodon cinereus; Fredericks LP et al.; As resistance increases against fungal antibiotics, antimicrobial peptides are receiving attention as possible replacements . The dermal glands of frogs secrete, among other things, antimicrobial peptides . As part of the innate immune system, stressors may affect the production of antimicrobial peptides by dermal glands . The dermal secretions of some salamanders have been examined for their toxic secretions, but little attention has been given to salamander antimicrobial peptides . This study examines the skin from the tail region for the production of antimicrobial peptides in the terrestrial salamander, Plethodon cinereus . Fractions of tail extracts were isolated using cation-exchange chromatography and reverse-phase HPLC . An HPLC fraction eluting at 15.75 min (HPLC run: 30 min, 30-80% acetonitrile/water gradient, Aquapore RP-300 C18 column) showed activity against Staphylococcus aureus but not against Escherichia coli . The antibacterial activity gradually increased over a 4-hr incubation time up to about 85% inhibition of bacterial growth . Lysis of guinea pig red blood cells also increased gradually over a 1-hr time period . J . Exp . Zool . 287:340-345, 2000 . J Infect Dis, 2000 Oct, 182(4), 1251 - 4 Epub 2000 Sep 08. In vitro resistance to thrombin-induced platelet microbicidal protein in isolates of Staphylococcus aureus from endocarditis patients correlates with an intravascular device source; Fowler VG Jr et al.; Platelet microbicidal proteins (PMPs) are small antimicrobial peptides secreted by mammalian platelets . In vitro resistance of Staphylococcus aureus strains to PMPs correlates with more extensive disease in experimental infective endocarditis (IE) . To determine whether this same relationship exists in human S . aureus IE, we evaluated the in vitro PMP susceptibility phenotype of isolates from 58 prospectively-identified patients with definite S . aureus IE . On multivariate analyses, patients with S . aureus IE complicating an infected intravascular device were significantly more likely to have IE caused by a PMP-resistant strain (P=.0193) . No correlations were detected between in vitro PMP resistance among S . aureus strains and the severity of human IE . This work supports the concept that in vitro PMP resistance in clinical S . aureus strains is associated with important clinical characteristics of S . aureus endovascular infections in vivo. Neth J Med, 2000 Sep, 57(3), 94 - 7 Right ventricular failure in acute respiratory distress syndrome; Romberg-Camps MJ et al.; Right ventricular failure can be the result of acute respiratory distress syndrome (ARDS) . A patient with eclampsia and sepsis with Staphylococcus aureus developed life-threatening right ventricular failure as a result of ARDS . She finally stabilized after treatment with inhaled nitric oxide (NO) . The pathophysiology of right ventricular failure in ARDS is described. J Nat Prod, 2000 Aug, 63(8), 1146 - 9 5'-Methoxyhydnocarpin-D and pheophorbide A: Berberis species components that potentiate berberine growth inhibition of resistant Staphylococcus aureus; Stermitz FR et al.; A new method of bioactivity-directed fractionation, based on multidrug resistant pump (MDR) inhibition in Staphylococcus aureus, was demonstrated . This resulted in the isolation, from berberine-containing Berberis species, of two compounds that are themselves devoid of S . aureus antibacterial activity, but that form potent synergistic couples with a subinhibitory concentration of berberine . The bacterial MDR pump inhibitors were identified as the flavonolignan 2 and the porphyrin 3 . Another natural flavonolignan, silybin (8) from Silybum marianum, was also shown to be a bacterial MDR pump inhibitor. J Nat Prod, 2000 Aug, 63(8), 1140 - 5 Synthesis and structures of regioisomeric hydnocarpin-type flavonolignans; Guz NR et al.; Flavonolignans represent natural compounds whose biosynthesis presumes a radical coupling of a ring B catecholic flavonoid with a molecule of coniferyl alcohol or an analogue . Many natural flavonolignans can exist as regioisomers, depending on how the coupled coniferyl alcohol moiety orients to the flavonoid . These regioisomers are often difficult to separate and have virtually identical NMR spectra . Structural assignments for some have changed with time or have been given without proof . We here report syntheses of both regioisomers of the flavonolignan hydnocarpin and one isomer of a plant isolate previously known as 5'-methoxyhydnocarpin . This isomer, here renamed 5'-methoxyhydnocarpin-D, was recently shown to be a potent inhibitor of a Staphylococcus aureus multidrug resistant efflux pump. J Nat Prod, 2000 Aug, 63(8), 1082 - 9 New antimicrobial flavanones from Physena madagascariensis; Deng Y et al.; Two new flavanones (1 and 2) with antibacterial activity were isolated from the methanolic extract of the dried leaves of Physena madagascariensis using activity against Staphylococcus aureus to guide the isolation . A third flavonoid, a flavanone dimer linked by a methylene group (3) was also isolated and proved to be inactive . The structures of 1 and 2 were established primarily from NMR studies, while that of 3 required more extensive mass spectrometric analysis . All three flavanones had lavandulyl units in the limonene form . Flavanones 1 and 2 were active against several bacteria at concentrations as low as 4 microM. Ophthalmic Surg Lasers, 2000 Jan-Feb, 31(1), 66 - 8 Preseptal abscess formation following ocular cryotherapy for Behçet's uveitis; Kiratli H et al.; A 42-year-old man with Behcet's disease developed a rapidly growing mass under his right lower eyelid a week after transconjunctival cryotherapy . He underwent surgical drainage of the mass following imaging studies . Magnetic resonance imaging scans demonstrated the abscess, which did not violate the orbital septum . Cultures from drained material yielded Staphylococcus aureus . He recovered completely with systemic antibiotics . Preseptal abscess may occur as a complication of intense transconjunctival cryotherapy for intraocular disorders, and patients should be followed closely within the first few weeks postoperatively. Chang Gung Med J, 2000 Jul, 23(7), 420 - 6 Septic arthritis of the ankle joint; Lee CH et al.; BACKGROUND: Septic arthritis of the ankle joint is a rare but serious disease . Very few reports in the literature have mentioned the method of care and treatment results of septic ankle . This study was designed to retrospectively review the treatment results and to analyze the prognostic factors of septic arthritis of the ankle inpatients at our hospital . We also formulated a protocol for the management of septic arthritis of the ankle joint . METHODS: All records of those patients with a diagnosis of septic ankle from 1985 to 1997 were retrospectively reviewed . There were 29 patients that met the diagnostic criteria of septic arthritis of the ankle joint (21 male and 8 female patients; 6 children and 23 adults) . The average follow-up time was 5.5 years (ranging from 1.5 to 13.7 years) . The patients' ages, associated diseases, single or multiple joint(s) involved, timing of treatment, and the final results of these cases were assessed . The infecting organism and drug sensitivity were discussed to determine the proper antibiotics regimen . RESULTS: Staphylococcus aureus was the most common infecting microorganism in the septic ankles . Combined therapy with oxacillin and gentamicine was effective against 88.1% of the infecting microorganisms . The poor prognostic factors for septic ankle included a positive bacterial culture, involvement of multiple joints simultaneously, a delay in treatment, and an increased number of associated diseases . In addition, a high proportion of patients with septic ankle had gouty arthritis (43.5%) . CONCLUSION: Early treatment (symptom duration of less than 5 days) significantly affected the final results . The early recognition and prompt treatment of this condition may reduce morbidity and mortality . Based on our results, oxacillin and gentamicine are recommended as the first-line antibiotics for the management of septic ankle. J Hosp Infect, 2000 Aug, 45(4), 322 - 9 The prevalence of methicillin-resistant staphylococcus aureus among the residents of six nursing homes for the elderly; O'Sullivan NR et al.; Admissions to Irish hospitals from nursing homes are recognized as a high-risk category for methicillin-resistant Staphylococcus aureus (MRSA) colonization . This study was conducted between August 1994 and May 1995 to determine the prevalence of MRSA within six Eastern Health Board elderly care nursing homes . A point prevalence survey was conducted in each home on two separate occasions at an interval of five to six months . An MRSA prevalence rate of 8.6% (65 of 754 residents) was recorded for the first survey, and an increased prevalence rate 10.1% (75 of 743 residents) for the second . The prevalence rates within individual homes varied from 1-27% . The body site most commonly colonized was the nares (83%), as anticipated . The main unexpected finding was a low wound colonization rate of 12%, which increased to only 20%, among MRSA positive residents . The dynamic state of MRSA colonization within nursing homes was documented among the 587 residents screened in both surveys . The MRSA positive status of 19 residents remained unchanged, but 32 who were initially positive became negative, while 34 residents acquired the organism . Twenty-six of the 56 (46%) residents identified as MRSA positive in the second survey had acquired the organism within the nursing home over the preceding five to six months . These findings suggest that 'infection control' interventions could have a significant impact on MRSA prevalence within nursing homes. Spine, 2000 Sep 1, 25(17), 2258 - 61 Missing anterior cervical plate and screws: a case report; Fujibayashi S et al.; STUDY DESIGN: A case report of an anterior cervical plate and screws that disappeared completely . OBJECTIVES: To present a case of a missing anterior cervical plate and screws, this being quite a rare complication of a cervical implant . SUMMARY OF BACKGROUND DATA: No mention of this complication was found in the literature . METHODS: Methods in the literature and clinical presentation are reviewed . RESULTS: Dislodgment of an anterior cervical plate occurred in association with an methicillin-resistant Staphylococcus aureus infection . Three months later the implants had disappeared, presumably passing without notice through the gastrointestinal tract . Whole body fluoroscopy could not identify any residual plate or screws . No esophageal fistula could be detected by barium meal swallow study . CONCLUSIONS: The plate and screws became dislodged, eroded through the posterior wall of the esophagus, then traversed the limit of the gastrointestinal tract, passing with feces without significant morbidity . Whether the methicillin-resistant Staphylococcus aureus infection contributed to this unique circumstance or is coincidentally related to it remained a matter of speculation. Lett Appl Microbiol, 2000 Sep, 31(3), 213 - 7 Bactericidal activity of catechin-copper (II) complexes against Staphylococcus aureus compared with Escherichia coli; Hoshino N et al.; The bactericidal activity of catechin-copper (II) complexes against Staphylococcus aureus compared with Escherichia coli was investigated in relation to the generation of hydrogen peroxide and the binding of Cu(II) ion onto the bacteria . The bactericidal activity of catechin-Cu(II) complexes against Staph . aureus (Gram-positive) was much lower than that against E . coli (Gram-negative), suggesting that the binding of copper ions to the surface of bacterial cells plays an important role in the bactericidal activity of catechin-Cu(II) complexes. Ned Tijdschr Geneeskd, 2000 Aug 19, 144(34), 1641 - 4 {Primary osteomyelitis of sternum}; Raissadat K et al.; Primary osteomyelitis of the sternum is rare, especially in young adults . A 16-year-old boy was admitted to the orthopaedic department with chest pain and fever . The blood culture was positive for Staphylococcus aureus . MRI revealed a retrosternal abcess; a bone scan showed increased local uptake, suggestive of isolated osteomyelitis . Two weeks after the start of treatment with flucloxacillin 1 g 6 times a day i.v . the patient's condition had significantly improved: the pain had subsided and the fever had disappeared . In sternal osteomyelitis early treatment with antibiotics is successful and avoids complications and surgical intervention. Med J Malaysia, 1998 Dec, 53(4), 372 - 5 A 3 year audit of infected pseudoaneurysms in intravenous drug users managed surgically in the Vascular Unit, Hospital Kuala Lumpur; Zainal AA et al.; This is a study of 54 intravenous drug user's (IVDUs) with infected pseudoaneurysms undergoing ligation and debridement at the Vascular Unit, Hospital Kuala Lumpur (HKL) from February 1993 to February 1996 . The median age was 37 years with a male preponderance (53:1) . Chinese form the largest ethnic group with 57.4% of the cases . Staphylococcus aureus was the most common organism cultured . Human immunodeficiency virus (HIV) positive cases numbered 21 (38.9%) . Four of the patients had to have an above-knee amputation after surgery . Simple ligation and debridement of all necrotic tissue is an acceptable mode of therapy in these patients with low amputation rates. Behav Med, 2000 Spring, 26(1), 14 - 22 An organizational climate intervention associated with increased handwashing and decreased nosocomial infections; Larson EL et al.; Handwashing practices are persistently suboptimal among healthcare professionals and are also stubbornly resistant to change . The purpose of this quasi-experimental intervention trial was to assess the impact of an intervention to change organizational culture on frequency of staff handwashing (as measured by counting devices inserted into soap dispensers on four critical care units) and nosocomial infections associated with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) . All staff in one of two hospitals in the mid-Atlantic region received an intervention with multiple components designed to change organizational culture; the second hospital served as a comparison . Over a period of 8 months, 860,567 soap dispensings were recorded, with significant improvements in the study hospital after 6 months of follow-up . Rates of MRSA were not significantly different between the two hospitals, but rates of VRE were significantly reduced in the intervention hospital during implementation. J Appl Microbiol, 2000 Aug, 89(2), 275 - 9 Susceptibility testing: inoculum size dependency of inhibition using the Colworth MIC technique; Lambert RJ; The minimum inhibitory concentration, MIC, is an accepted and well used criterion for measuring the susceptibility of organisms to inhibitors . Many factors influence the MIC value obtained, including temperature, inoculum size and type of organism . A modification of the method developed in this laboratory to obtain inhibition profiles of antimicrobials was used to examine the effect of inoculum size on the degree of inhibition observed with respect to inhibitor concentration . The data obtained enabled the production of an empirical model of inhibition, based on a Gompertz function, relating the level of growth observed to both the inoculum size and concentration of the inhibitor . The inoculum size dependencies of phenethyl alcohol, phenoxyethanol, p-chloro-m-cresol, trichloro-phenol, thymol and dodecyltrimethylammmonium bromide against Staphylococcus aureus were obtained. Clin Exp Dermatol, 2000 Jun, 25(4), 327 - 30 Observations on high levels of fusidic acid resistant Staphylococcus aureus in Harrogate, North Yorkshire, UK; Ravenscroft JC et al.; A retrospective study was carried out to investigate possible reasons for a marked increase in fusidic acid-resistant Staphylococcus aureus (FusR S . aureus) identified by our routine hospital microbiology service . Information was obtained on a sample of 64 consecutive patients from whom resistant S . aureus had been cultured . The source of isolates was found to be diffuse within the hospital and community . The site of sample was most frequently chronic cutaneous infections (68%) . All the S . aureus isolates were resistant to both fusidic acid and penicillin and many were resistant to multiple antibiotics . Topical fusidic acid had been used by 40% of patients in the preceding 6 months and none had received oral fusidic acid (sodium fusidate) . Most (80%) had received an oral antibiotic in the preceding 2 years . Information from the Prescriptions Pricing Authority revealed that the total number of prescriptions for fusidic acid-containing preparations for the period September 1997 to August 1998 was markedly higher in Harrogate than in five other local areas where increases in (FusR) S . aureus have not been observed. J Clin Microbiol, 2000 Sep, 38(9), 3453 - 6 Use of coagulase gene (coa) repeat region nucleotide sequences for typing of methicillin-resistant Staphylococcus aureus strains; Shopsin B et al.; Coagulase gene (coa) short sequence repeat region sequencing was used to measure relatedness among a collection of temporally and geographically diverse methicillin-resistant Staphylococcus aureus isolates . The results show that coa polymorphism is free of strong selective pressure and has a low index of variation that may be useful for long-term epidemiological investigations . coa typing is a useful addition to spa typing for analysis of S . aureus, including methicillin-resistant strains. J Clin Microbiol, 2000 Sep, 38(9), 3174 - 8 Cutaneous microenvironment of human immunodeficiency virus (HIV)-seropositive and HIV-seronegative individuals, with special reference to Staphylococcus aureus colonization; Shapiro M et al.; A cross-sectional quantitative study of cutaneous bacterial and yeast flora at seven body sites in 99 human immunodeficiency virus-seropositive and 50 seronegative military personnel was performed . Statistically significant differences in carriage rates were only observed for Staphylococcus aureus on the foreheads of seropositive individuals . Seronegative individuals demonstrated staphylococcal carriage rates 1.3 to 2 times as great as those of historical controls (defined as healthy individuals not receiving any medications) at five of six body sites . We conclude that seropositive military personnel do not exhibit statistically significant elevations in densities and carriage rates of the microorganisms examined (except Staphylococcus aureus), relative to seronegative individuals . Seropositive individuals may be predisposed to staphylococcal carriage . The elevated staphylococcal carriage rates of military personnel undergoing basic training warrants a formal evaluation of the impact of training exercises on cutaneous flora . The information gained may serve to limit the spread of infection during training exercises and battlefield conditions. Bioorg Med Chem Lett, 2000 Aug 21, 10(16), 1871 - 4 Aminoalkyl adenylate and aminoacyl sulfamate intermediate analogues differing greatly in affinity for their cognate Staphylococcus aureus aminoacyl tRNA synthetases; Forrest AK et al.; Aminoalkyl adenylates and aminoacyl sulfamates derived from arginine, histidine and threonine, have been prepared and tested as inhibitors of their cognate Staphylococcus aureus aminoacyl tRNA synthetases . The arginyl derivatives were both potent nanomolar inhibitors of the Class I arginyl tRNA synthetase whereas for the Class II histidyl and threonyl tRNA synthetases, the acyl sulfamates were potent inhibitors but the adenylates had very little affinity. Unfallchirurg, 2000 Jul, 103(7), 557 - 63 {Molecular and phenotypic characterization of methicillin-resistant Staphylococcus aureus isolates . Studies at a traumatic surgery clinic, 1994-1997}; Zabel LT et al.; Methicillin resistant Staphylococcus aureus-strains, isolated from 1994 to 1997 from patients of the traumatic surgery hospital Tubingen, were compared using lysotyping and pulsed-field gel electrophoresis . Both typing methods detected two clones causing an outbreak 1994 in 6 patients and a third endemic clone of MRSA, which was isolated from 5 patients (1995), 4 patients (1996), and 6 patients (1997) . Additionally other MRSA-types were found in 6 cases of which transmissions occurred in up to three patients . An epidemiological connection to MRSA isolated from patients of the university hospital of Tubingen was made . Possible consequences for patient management and antibiotic strategies in MRSA-infections were discussed. Pediatrics . 2000 Sep;106(3):E39. Spinal epidural abscess in a young child; Bair-Merritt MH et al.; This is a case report of a spinal epidural abscess, caused by Staphylococcus aureus, in a 3-year-old girl . The child presented with fever and hip pain, but without any neurologic deficit . After normal plain films and a normal bone scan were obtained, the diagnosis was made via magnetic resonance imaging (MRI) . The neurosurgery and pediatric infectious disease teams evaluated the patient, and the decision was made to forego surgical drainage and to treat medically with appropriate intravenous and then oral antibiotics . Several months later, the child was doing well without any signs of neurologic sequelae . Because of the rarity of this disease in children, the treatment guidelines are controversial . Many suggest that a spinal epidural abscess must be drained surgically . Our experience adds to the literature a case of a child successfully treated with antibiotics alone . We believe that this success is related to the fact that the child was diagnosed by MRI early in the course of the disease and that she never displayed any neurologic deficits. Infect Control Hosp Epidemiol, 2000 Aug, 21(8), 505 - 9 Pathogenic organisms associated with artificial fingernails worn by healthcare workers; Hedderwick SA et al.; OBJECTIVE: To determine differences in the identity and quantity of microbial flora from healthcare workers (HCWs) wearing artificial nails compared with control HCWs with native nails . DESIGN: Two separate studies were undertaken . In study 1, 12 HCWs who did not normally wear artificial nails wore polished artificial nails on their nondominant hand for 15 days . Identity and quantity of microflora were compared between the artificial nails and the polished native nails of the other hand . In study 2, the microbial flora of the nails of 30 HCWs who wore permanent acrylic artificial nails were compared with that of control HCWs who had native nails . In both studies, nail surfaces were swabbed and subungual debris was collected to obtain material for culture . Staphylococcus aureus, gram-negative bacilli, enterococci, and yeasts were considered to be potential pathogens . All organisms were identified and quantified . RESULTS: In study 1, potential pathogens were isolated from more samples obtained from artificial nails than native nails (92% vs . 62%; P<.001) . Colonization of artificial nails increased over time; by day 15, 71% of cultures yielded a pathogen compared with 21% on day 1 (P=.004) . A significantly greater quantity of organisms (expressed as mean log10 colony-forming units +/- standard deviation) was isolated from the subungual area than the nail surface; this was noted for both artificial (5.0+/-1.4 vs . 4.1+/-1.0; P<.001) and native nails (4.9+/-1.3 vs . 3.7+/-0.8; P<.001) . More organisms were found on the surface of artificial nails than native nails (P=.008), but there were no differences noted in the quantities of organisms isolated from the subungual areas . In study 2, HCWs wearing artificial nails were more likely to have a pathogen isolated than controls (87% vs . 43%; P=.001) . More HCWs with artificial nails had gram-negative bacilli (47% vs . 17%; P=.03) and yeasts (50% vs . 13%; P=.006) than control HCWs . However, the quantities of organisms isolated from HCWs wearing artificial nails and controls did not differ . CONCLUSIONS: Artificial fingernails were more likely to harbor pathogens, especially gram-negative bacilli and yeasts, than native nails . The longer artificial nails were worn, the more likely that a pathogen was isolated . Current recommendations restricting artificial fingernails in certain healthcare settings appear justified. Clin Nephrol, 2000 Aug, 54(2), 128 - 33 Effects of "isolating hemodialysis" on prevention of methicillin-resistant Staphylococcus aureus cross-infection in a hemodialysis unit; Osono E et al.; AIM: To evaluate the effects of a contact isolation program against methicillin-resistant Staphylococcus aureus (MRSA) cross-infection among patients in a hemodialysis unit . CLINICAL SETTING AND METHODS: In all patients maintaining hemodialysis therapy were tested for MRSA infection and who had MRSA infection, not only inpatients but also outpatients were separated into a designated area (isolating hemodialysis) . Clinically isolated MRSA strains were clonotyped with coagulase typing, staphylococcal enterotoxin typing and restriction enzyme analysis of plasmid DNA . RESULTS: The frequency of patients with MRSA infection was 4.5% before starting this protocol and was reduced to 2.9% two and a half years later . At this time, MRSA was isolated from the 8 patients . These 8 clinical strains were differentiated into 6 clonotypes and 3 strains showed the same patterns . Two of 3 were isolated from inpatients and the other was from a patient with community onset MRSA colitis . In this case, most MRSA infections were independent under prophylaxis control and cross-infection was observed only once between hospitalized patients who stayed in a same ward . CONCLUSION: This "isolating hemodialysis" should be useful to prevent cross-infection among patients in end-stage renal disease in a dialysis unit. Med J Malaysia, 1998 Sep, 53 Suppl A, 86 - 94 An epidemiological study of septic arthritis in Kuala Lumpur Hospital; Razak M et al.; Forty-one patients with 42 joint infections were admitted to the hospital between June 1989 and June 1994 . An overview on the behaviour of septic arthritis in both children and adults, at presentation and after various types of treatment was done . There were 32 knees, 7 hips, 2 elbows and 1 shoulder . Duration of symptoms, type of organism, type of joint drainage, presence of preexisting joint problems and presence of osteomyelitis are among the important factors with prognostic significance . Seventy three percent of patients with less than 7 days duration of symptoms had satisfactory results . Whereas when the duration of symptoms exceeded 7 days, 75% of the patients had unsatisfactory outcome . All cases with poor outcome had positive cultures . Staphylococcus aureus was responsible for 77% of the culture-positive cases . All Staphylococcus aureus in this study were penicillin-resistant but sensitive to cloxacillin . There were 3 instances where Staphylococcus became resistant to cloxacillin following recurrence of septic arthritis . However, they were still sensitive to third generation cephalosporin . Staphylococcus aureus was capable of producing poor results even when the case was treated early . Other organisms were gram-negative bacilli which infect patients with suppressed immune system, that is, intravenous drug abuser, systemic steroid therapy and diabetes mellitus . Open arthrotomy was the method of drainage used in all hip sepsis . This method was also the most reliable method of joint drainage in other joints compared to aspiration method when frank pus was already present . Most immuno-compromised patients recovered badly from septic arthritis . Associated adjacent osteomyelitis, preexisting chronic arthritis and recent intra-articular fractures were also noted to adversely affect the functional outcome. Med J Malaysia, 1996 Mar, 51(1), 23 - 8 Bacterial hand infections: an analysis of cases presenting at the University Hospital, Kuala Lumpur; Omar BM et al.; A significant number of hand infections were found to occur in college students, a group not associated with manual labour . Diabetics did not have a significant delay in recognising the symptoms but have a significant longer period of hospitalisation . The right hand was predominantly involved especially the thumb, index finger and the thenar region . Staphylococcus aureus was the commonest infecting organism. Pneumonol Alergol Pol, 2000, 68(1-2), 57 - 9 {Breast tuberculosis}; Dyla T et al.; A 47-year-old woman, mother of 7 children, was admitted to hospital because of the painful tumour of her left breast . The clinical course was chronic with formation of abscess and then fistula . Chest X-ray was normal . Axillary lymph nodes were not palpable . During mammography tumour was revealed (3.5 cm in diameter) . During tumour resection abscess was found . Staphylococcus aureus was cultured from its pus, but histologic picture of resected tissue suggested caseous tuberculosis of mamma . Bacilli were not found . The patient was treated with antituberculous drugs . At the early stage of treatment the skin fistula of mamma occurred but the long-lasting therapy was successful. FEMS Immunol Med Microbiol, 2000 Sep, 29(1), 39 - 45 Staphylococcus aureus alpha-toxin induces apoptosis in endothelial cells; Menzies BE et al.; The internalization of Staphylococcus aureus by cultured human umbilical vein endothelial cells was recently shown to induce apoptosis . We examined the role of alpha-toxin, a major pore-forming toxin secreted by S . aureus, in causing apoptosis in vitro . Purified alpha-toxin, at sublytic concentrations, induced apoptosis in endothelial cell monolayers . Comparisons of two alpha-toxin (hla)-positive S . aureus strains and their isogenic hla-deficient mutants in the invasion assay of endothelial cells demonstrated that the capacity to produce alpha-toxin was associated with a greater propensity for apoptosis in endothelial cells . These results demonstrate for the first time that expression of alpha-toxin during endothelial cell invasion by S . aureus enhances apoptosis. Appl Environ Microbiol, 2000 Sep, 66(9), 3931 - 8 Variable expressions of Staphylococcus aureus bicomponent leucotoxins semiquantified by competitive reverse transcription-PCR; Bronner S et al.; A competitive reverse transcription-PCR method was developed for the semiquantitation of the expression of genes encoding bicomponent leucotoxins of Staphylococcus aureus, e.g., Panton-Valentine leucocidin (lukPV), gamma-hemolysin (hlgA and hlgCB), and LukE-LukD (lukED) . The optimization procedure included RNA preparation; reverse transcription; the use of various amounts of enzymes, antisense primer, and RNA; and the final amplification chain reaction . Reproducible results were obtained, with sensitivity for detection of cDNA within the range of 1 mRNA/10(4) CFU to 10(2) mRNA/CFU, depending on the gene . Both specific mRNAs were more significantly expressed at the late-exponential phase of growth . Expression was about 100-fold higher in yeast extract-Casamino Acids-pyruvate medium than in heart infusion medium . Expression of the widely distributed gamma-hemolysin locus in the NTCC 8178 strain was around 10-fold diminished compared with that in the ATCC 49775 strain . Because of the lower level of hlgA expression, the corresponding protein, which is generally not abundant in culture supernatant, should be investigated for its contribution to the leucotoxin-associated virulence . The agr, sar, and agr sar mutant strains revealed a great dependence with regard to leucotoxin expression on the global regulatory system in S . aureus, except that expression of hlgA was not affected in the agr mutant. Ann Hematol, 2000 Jul, 79(7), 402 - 4 Specific cutaneous infiltrate caused by Staphylococcus aureus in a patient with chronic myelomonocytic leukemia; Wintzen M et al.; We present a patient with chronic myelomonocytic leukemia who showed disseminated papules and nodules . Arguments in favor of leukemia cutis are the clinical appearance, the cyclic pattern with which the lesions appeared and disappeared, and the histologic features . The lesions reproducibly responded to treatment with antibiotics given for a Staphylococcus aureus infection . We speculate that at least in some patients, leukemic cells are recruited in the skin because of local infection and do not merely reflect autonomous growth but an inflammatory response. Kansenshogaku Zasshi, 2000 Jul, 74(7), 573 - 9 {A new exanthematous disease in newborn infants caused by exotoxins producing methicillin-resistant Staphylococcus aureus; pathology from viewpoints of local and systemic levels of exotoxin and cytokine}; Okada T et al.; Neonatal exanthematous diseases induced by toxic shock syndrome toxin-1 (TSST-1)-producing methicillin-resistant Staphyloccocus aureus (MRSA) is one of emerging infectious diseases in Japan . We experienced 36 patients with this disease in National Kagawa Children's Hospital and in 13 patients of them, investigated the role of both the toxin and cytokines in pathogenesis of it . The results are summarized as follows: 1 . The TSST-1 level was high in the umbilical inflammatory exudate of cases induced by umbilical infection and in the gastric fluid of cases induced by respiratory infection . The blood TSST-1 level was below the detection limit in most of the exathematous++ cases examined, but it was detected in one of the nine cases induced by respiratory infection and a case secondary to severe MRSA infection (phlegmonous abscess in buttock) . 2 . Local cytokine levels were examined in the abscess pus obtained from a case of severe MRSA infection and in the gastric fluid from cases induced by respiratory infection . The local levels of TNF {alpha}, IL-1 {beta}, IL-6 and IL-8 were markedly high, but the local levels of IL-2 and IFN-{gamma} were similar to their blood levels . 3 . The severity of hypercytokinemia (IL-1 {beta}, IL-2, IL-6, IFN-{gamma}) was proportionate to the severity of exanthematous disease . Accompanied by increased levels of inhibitory factors sTNF-R, IL-1 ra, sIL-2R and IL-10, this hypercytokinemia normalized soon within four or five days . 4 . As compared to cases induced by umbilical infection, cases induced by respiratory infection often had higher blood cytokine levels and some of them had cardiorespiratory disorders . Based on the results of this study, we consider that this disease is generally induced by toxemia with a small number of toxins without tissue destructive lesions by MRSA infection and that this is closely related to the course of the disease that shows a tendency to a spontaneous recovery. Pediatr Neurosurg, 2000 May, 32(5), 230 - 3 Neonatal cervical osteomyelitis with paraspinal abscess and Erb's palsy . A case report and brief review of the literature; Sharma RR et al.; An unusual case of pyogenic cervical osteomyelitis is reported in a newborn who immediately after birth had no movements in the left shoulder . There was a fullness in the left cervical region . Left Erb's palsy due to an unrecognized birth trauma was diagnosed in a peripheral hospital . Later, the child developed fever and a significant swelling in the left cervical region . On transfer to our institution, the X-rays of the cervical spine, ultrasound and computed tomography (CT) established the diagnosis of C(6) cervical osteomyelitis and paraspinal abscess which extended to the posterior triangle of the neck . The abscess was drained, and the lamina and lateral mass of the C(6) vertebra were debrided . Staphylococcus aureus was grown from the pus . The patient was put on long-term antibiotics to which he responded very well, and he became asymptomatic . In the immediate post-operative period, some movements at the left shoulder were noted, and at 6-month follow-up in the out-patient clinic, the child was virtually normal with near-complete regeneration of the C(6) lamina and lateral mass . Immunol Lett, 2000 Jul 3, 73(1), 71 - 4 Comparison of IgG preparations by a turbidimetric assay of opsonizing capacity; Nemet K et al.; A convenient turbidimetric phagocytosis assay was applied for the functional comparison of various intravenous IgG preparations . Staphylococcus aureus (Oxford) was opsonized by the immunoglobulin samples in the presence of an IgG deficient serum as a source of complement . The opsonized bacteria were subjected to phagocytosis by neutrophil granulocytes isolated from healthy adults . The time course of phagocytosis was monitored by the decrease of light absorbance at 400 nm . Changes in light absorbance during a 15 min period of opsonophagocytosis (delta E(400)) were expressed as a percentage of delta E(400) obtained by a reference IgG preparation . The opsonizing effect of five commercially available i.v . IgG preparations was compared . Three different preparations containing whole, non-modified IgG molecules had a comparable opsonizing effect while a further one prepared by propiolacton modification displayed a reduced activity (52%) of the reference preparation, taken as 100% . A preparation consisting of IgG molecules without an Fc-region proved to be practically ineffective (8.7%). Acta Biochim Pol, 2000, 47(1), 87 - 94 Synthesis and antimicrobial activity of new adamantane derivatives I; Orzeszko A et al.; A series of fourteen derivatives of adamantane was synthesised . The new compound 4-(adamant-1-ylmethoxycarbonyl)phthalanhydride obtained from 1-adamantane-methanol and trimellitic anhydride chloride appeared very useful for preparation of a number of N-substituted phthalimides . Antimicrobial activity of the newly obtained derivatives such as, for example, 4-(adamant-1-ylmethoxycarbonyl)-N-(5-carboxypentamethylene)p hthalimide or 4-(adamant-1-ylmethoxycarbonyl)-N-(L-alanyl)phthalimide was tested against Staphylococcus aureus, Bacillus sp., Micrococcus flavus and Enterococcus faecium . The minimal inhibitory concentration (MIC) for these compounds against S . aureus were 0.022 and 0.05 microg/ml, respectively. Infection, 2000 Jul-Aug, 28(4), 240 - 2 Mycotic aneurysm of the aortic arch; Aliaga L et al.; A 61-year-old diabetic woman presented with a mycotic aneurysm of the aortic arch, also involving the left subclavian and vertebral arteries, caused by Staphylococcus aureus . Two months before, she had suffered from staphylococcal septic arthritis in her left knee . The patient was treated with antibiotics and an emergency operation was performed involving aneurysm excision and in situ synthetic graft replacement . She died on the fourth postoperative day from hemorrhagic shock. Int J Med Microbiol, 2000 Jul, 290(3), 259 - 67 Interaction of alveolar macrophages with Staphylococcus aureus and induction of microbial L-forms during infection in rats; Michailova L et al.; In vivo cell interactions between Staphylococcus aureus and rat alveolar macrophages were investigated after intranasal inoculation during a 30-days period of examination . Some dynamic characteristics of microorganisms in the macrophages were examined by electron microscopy and acid phosphatase cytochemistry . It was found that at earlier infection intervals (days 3 and 7) the ingested cocci were sequestered in phagosomes and phagolysosomes and later many of the microbial cells were digested . An interesting finding was the intracellular appearance of cell wall-defective forms (L-forms) of S . aureus at later intervals (days 14 and 30 after challenge) . Infection kinetics were evaluated by isolation and enumeration of colony-forming units of S . aureus from bronchoalveolar fluid and by assessment of blood and bronchoalveolar total and differential leukocyte counts . The results indicate that induction and survival of S . aureus L-forms may occur spontaneously in vivo . This phenomenon could explain some of the mechanisms, provoking the latent and relapsing lung infections. Scand J Infect Dis, 2000, 32(4), 423 - 4 Community-acquired methicillin-resistant Staphylococcus aureus brain abscess in an immunocompetent individual; Khan MA et al.; A 52-y-old woman with a community-acquired methicillin-resistant Staphylococcus aureus brain abscess who was successfully treated with surgical drainage and antibiotics is described . The increase in community-acquired methicillin-resistant S . aureus and the impact this will have on empirical treatment of such infections are discussed. Scand J Infect Dis, 2000, 32(4), 411 - 5 Epidemiology of vascular catheter-related bloodstream infections in a large university hospital in Israel; Siegman-Igra Y et al.; Intravascular catheter-related infection and associated bacteraemia constitute a serious and increasing problem among nosocomial infections . As a part of an ongoing survey of positive blood cultures, all catheter-related bloodstream infections (CR-BSI) were reviewed in the authors' Medical Center in 1996, in order to evaluate the magnitude and seriousness of this problem . The largest group (28%) of hospital-acquired bacteraemia by 1 source of infection during 1996 was CR-BSI, identified in 110 patients with 126 episodes . The vascular line was central in 83 (66%), peripheral in 24 (19%), tunnelled in 18 (14%) and arterial in 1 (1%) . Among the 83 central CR-BSI no sign of local inflammation was detected in 65% . Gram-positive and gram-negative bacteria shared equal parts among the 145 blood isolates; Staphylococcus aureus was the most common species (43/145, 30%) followed by Klebsiella pneumoniae (15/145, 10%); 11 (8%) isolates were Candida species . Fungal isolates were more common among tunnelled catheter infections than among others (6/18, 33% vs . 5/108, 5%, p < 0.001) . Crude mortality was 35% (38/110), while attributable mortality was 14% (15/110), mostly associated with central line infection . Catheter-associated bacteraemias cause significant morbidity and mortality, and have become the most common source of hospital-acquired bacteraemia . There is a need to implement more effective infection-control measures and more advanced technologies in an effort to reduce this unacceptably high incidence. J Dermatol Sci, 2000 Aug, 23(3), 155 - 60 Adherence characteristics and susceptibility to antimicrobial agents of Staphylococcus aureus strains isolated from skin infections and atopic dermatitis; Akiyama H et al.; We examined the adherence characteristics and susceptibility to various antimicrobial agents of 130 strains of Staphylococcus aureus isolated from infective skin lesions and 135 strains of S . aureus isolated from non-infective eczematous lesions of atopic dermatitis (AD) patients . The isolation rate of methicillin-resistant S . aureus (MRSA) was 27.7% in strains from clinical sources excluding AD and 31.1% in those from AD . Coagulase type II strains were most frequently observed in MRSA strains isolated from all sources excluding AD, and coagulase type III strains were most frequently observed in those isolated from AD . We proposed that antimicrobial treatment for AD patients should be carefully designed to prevent MRSA infection . Plasma coagulation ability was lowest in S . aureus strains isolated from abscesses, suggesting that the lower production of fibrin observed in abscesses may assist the infiltration of neutrophils into skin tissues and that a decrease in plasma coagulation ability may enable abscess formation . Adherence to polypropylene tubes with slime production was most evident in S . aureus strains isolated from felon and least evident in those isolated from cellulitis and lymphangitis . Tube adherence was characteristic of the S . aureus strains attached to superficial skin tissues, but not necessarily for strains that had infiltrated the deep skin tissues . Fusidic acid demonstrated significant antimicrobial activity against the MRSA strains, but rifampicin was the strongest antimicrobial agent. Sarcoidosis Vasc Diffuse Lung Dis, 2000 Jun, 17(2), 125 - 9 New treatments of ANCA-associated vasculitis; Kallenberg CG et al.; The ANCA-associated systemic vasculides are, in many cases, life-threatening conditions . Combined treatment with corticosteroids and cyclophosphamide has improved their prognosis considerably . Five year survival does, however, still not exceed 75%, due to the occurrence of treatment resistant cases and the severe adverse effects of this treatment regimen . In this review new treatment modalities are discussed . In cases resistant to conventional therapy high dose intravenous immunoglobulin and T-cell directed biologicals, that is anti-thymocyte globulin (ATG) and humanised monoclonal antibodies to CD4 and CDw52, may be effective . Also, TNF-directed treatment is being used . Less severe cases may benefit from methotrexate treatment instead of cyclophosphamide . For maintenance of remission azathioprine has been proven to be as effective as cyclophosphamide so preventing the toxicity of long-term cyclophosphamide treatment . Relapses may also be prevented by treatment based on changes in ANCA-titers or by elimination of Staphylococcus aureus carriage which is associated with relapsing disease in Wegener's Granulomatosis . Several of those new treatment modalities are now being tested in controlled studies by the European Vasculitis Study Group (EUVAS). Microbios, 2000, 102(403), 175 - 81 Activity pattern of natural and synthetic antibacterial agents among hospital isolates; Oloke JK; The antibacterial pattern of tetracycline and bactrim was compared with that of the chloroform extract of two Pseudomonas strains using ten hospital strains each of Staphylococcus aureus and Escherichia coli . There was no perfect correlation between isolate source, antibiotic type and sensitivity . Both the synthetic and natural antibiotic agent exhibited antibacterial activities against resistant hospital isolates at high concentrations. Pediatr Surg Int, 2000, 16(5-6), 408 - 10 Primary pyogenic psoas abscess in children; Kadambari D et al.; Primary pyogenic psoas abscess, although quite a common condition, particularly in the tropics, is often overlooked as a clinical entity, probably because a psoas abscess has been traditionally associated with tuberculous spondylitis . The abscess is easily diagnosed by ultrasonography (US) . Treatment by open drainage and antibiotics effective against Staphylococcus aureus results in complete reversal of symptoms and signs . In our series of 55 cases in the pediatric age group (0-12 years), pain and flexion at the hip were the most frequent clinical features at presentation . US was diagnostic in all cases in which it was performed . All except 1 patient showed complete resolution with extraperitoneal drainage, antibiotics, and skin traction . Although 4% of the cases were associated with suppurative external-iliac lymphadenitis, the remaining ones arose de novo in the psoas sheath, suggesting a primary pyomyositis of the psoas muscle. Jpn J Antibiot, 2000 Jun, 53(6), 422 - 9 {Colony PCR for rapid detection of antibiotic resistance genes in MRSA and enterococci}; Tsuchizaki N et al.; We examined colony PCR that does not use the prepared template DNA but intact cells as the template DNA source for the rapid, simple and reproducible detection of antibiotic resistance genes in strains of methicillin-resistant Staphylococcus aureus (MRSA) and Enterococcus . Two factors turned out to be important; i.e . the transfer size of bacterial cells and the use of DNA Polymerase with high performance . In practice, the tip of a toothpick was lightly touched with a colony on agar plates followed by the PCR mixture (20 microliters) containing KOD-plus-DNA Polymerase and multiplex primers . The cell transfer size ranged from 10(3) to 10(4) cfu and 30 cycles of PCR (95 degrees C, 30 sec.-->50 degrees C, 30 sec.-->72 degrees C, 60 sec.) following the first heating (95 degrees C, 3 min.) resulted in good amplification of the target regions of mecA and aac(6')/aph(2") that are responsible for the resistance to methicillin and arbekacin, respectively. J Bone Joint Surg Am, 2000 Aug, 82-A(8), 1115 - 21 Management of chronic deep infection following rotator cuff repair; Mirzayan R et al.; BACKGROUND: Deep infection of the shoulder following rotator cuff repair is uncommon . There are few reports in the literature regarding the management of such infections . METHODS: We retrospectively reviewed the charts of thirteen patients and recorded the demographic data, clinical and laboratory findings, risk factors, bacteriological findings, and results of surgical management . RESULTS: The average age of the patients was 63.7 years . The interval between the rotator cuff repair and the referral because of infection averaged 9.7 months . An average of 2.4 procedures were performed prior to referral because of infection, and an average of 2.1 procedures were performed at our institution . All patients had pain on presentation, and most had a restricted range of motion . Most patients were afebrile and did not have an elevated white blood-cell count but did have an elevated erythrocyte sedimentation rate . The most common organisms were Staphylococcus epidermidis, Staphylococcus aureus, and Propionibacterium species . At an average of 3.1 years, all patients were free of infection . Using the Simple Shoulder Test, eight patients stated that the shoulder was comfortable with the arm at rest by the side, they could sleep comfortably, and they were able to perform activities below shoulder level . However, most patients had poor overhead function . CONCLUSIONS: Extensive soft-tissue loss or destruction is associated with a worse prognosis . Extensive debridement, often combined with a muscle transfer, and administration of the appropriate antibiotics controlled the infection, although most patients were left with a substantial deficit in overhead function of the shoulder. Ceska Slov Farm, 2000 May, 49(3), 134 - 8 {The effect of ascorbic acid on the antibacterial activity of selected antibiotics and synthetic chemotherapeutic agents in in vitro conditions}; Belicova A et al.; The study was aimed to determine the ability of selected antibiotics and synthetic chemotherapeutic agents to interact with ascorbic acid by means of spectrophotometric measurements and the evaluation of the effect of the presence of ascorbic acid on antimicrobial activity of the substances in which the interaction was detected . Out of 13 chemotherapeutical agents tested, ofloxacine, N-succinimidylofloxacine, fleroxacine, tetracycline, 6-thiatetracycline, and doxycycline reacted with ascorbic acid with the development of the superoxide radical (O2.-) . Heatley's method revealed that in the presence of ascorbic acid the antibacterial effect of substances was decreased by 9.6 to 40.7% and 10.1 to 45.1% in Staphylococcus aureus and Escherichia coli, respectively . The kinetics of the process of the survival of cells within 24 hours demonstrated that a combination of ofloxacine as well as tetracycline with ascorbic acid produced a statistically significant increase in log10 of CFU/ml in S . aureus as well as E . coli. Baillieres Best Pract Res Clin Rheumatol, 1999 Mar, 13(1), 115 - 28 Soft tissues and osteo-articular infections in HIV-infected patients and other immunodeficient states; Espinoza LR et al.; Soft tissue and osteo-articular infections are rarely seen in patients with HIV infection and other immunodeficiency states . When present in HIV-infected patients, they tend to occur in the presence of low CD4(+)cell counts, intravascular indwelling catheters, extra-articular infection and trauma, and in intravenous drug users and haemophiliacs . A wide spectrum of clinical manifestations is seen, ranging from cellulitis and soft tissue abscesses to septic arthritis and pyomyositis . In general, the clinical picture and response to therapy is similar to that of patients without HIV infection . Causal micro-organisms are also similar to those in non-HIV populations, Staphylococcus aureus being the most common aetiological agent . Baillieres Best Pract Res Clin Rheumatol, 1999 Mar, 13(1), 77 - 94 Peculiarities of osteo-articular infections in children; Gavilan MG et al.; Paediatric osteomyelitis is uncommon in the developed world, haematogenous spread of infection being the most prevalent cause in children . The metaphyses of the long bones are the sites involved in most cases, but in neonates the infection may spread to the contiguous epiphysis and joint . Staphylococcus aureus is the main causal organism in all groups . Plain X-rays take at least 7 days to show the first signs of osteomyelitis . Bone scans show change earlier, with a high sensitivity but a lower specificity . Magnetic resonance imaging and computed tomography are useful, if expensive, imaging techniques but usually require sedation in children . The causal micro-organisms may be identified from blood cultures, fine-needle aspiration or surgical drainage . Antimicrobial therapy should be given for 3-4 weeks, initially via the intravenous route and later switching to oral medication . Surgery is indicated for the drainage of acute abscesses or when there has been no improvement with antibiotics; it is essential in the treatment of chronic osteomyelitis . Baillieres Best Pract Res Clin Rheumatol, 1999 Mar, 13(1), 37 - 58 Septic arthritis; Carreno Perez L; Septic arthritis is a direct invasion of the joints by pathogenic micro-organisms . These micro-organisms and their products stimulate the release of pro-inflammatory cytokines and proteolytic enzymes that induce an inflammatory response and degradation of the cartilage . Staphylococcus aureus remains the most prevalent micro-organism, and the most important aetiological change has been the decreased incidence of gonorrhoea, which is related to changes in sexual behaviour as a result of the HIV epidemic . Diagnostic suspicion is based on clinical symptoms, imaging findings and examination of synovial fluid . Scintigraphy and magnetic resonance imaging are useful methods for localizing and defining the extent of infection . The definitive diagnosis is based on the isolation and culture of the pathogen from synovial fluid . Optimal cultures are obtained by inoculating the synovial fluid immediately into blood culture bottles . Treatment includes initial empirical antibiotics, which are modified according to the synovial fluid culture . It is recommended that 3-4 weeks of intravenous antibiotic therapy are followed by 2 or 3 more weeks of an oral regimen . Adequate drainage may be performed by means of repeated needle aspiration, arthroscopy or surgery . Recent studies on the pathogenic mechanisms of septic arthritis have led to the simultaneous use of intra-articular steroids and antibiotics in order to reduce articular damage . Antimicrob Agents Chemother, 2000 Sep, 44(9), 2514 - 7 Antimicrobial evaluation of N-alkyl betaines and N-alkyl-N, N-dimethylamine oxides with variations in chain length; Birnie CR et al.; Alkyl betaines and alkyl dimethylamine oxides have been shown to have pronounced antimicrobial activity when used individually or in combination . Although several studies have been conducted with these compounds in combinations, only equimolar concentrations of the C(12)/C(12) and C(16)/C(14) chain lengths for the betaine and the amine oxide, respectively, have been investigated . This study investigates the antimicrobial activity of a wide range of chain lengths (C(8) to C(18)) for both the betaine and amine oxide and attempts to correlate their micelle-forming capabilities with their biological activity . A broth microdilution method was used to determine the MICs of these compounds singly and in various molar ratio combinations . Activity against both Staphylococcus aureus and Escherichia coli was investigated . Antimicrobial activity was found to increase with increasing chain length for both homologous series up to a point, exhibiting a cutoff effect at chain lengths of approximately 16 for betaine and 14 for amine oxide . Additionally, the C(18) oleyl derivative of both compounds exhibited activity in the same range as the peak alkyl compounds . Critical micelle concentrations were correlated with MICs, inferring that micellar activity may contribute to the cutoff effect in biological activity. Antimicrob Agents Chemother, 2000 Sep, 44(9), 2276 - 85 Contribution of a thickened cell wall and its glutamine nonamidated component to the vancomycin resistance expressed by Staphylococcus aureus Mu50; Cui L et al.; Staphylococcus aureus Mu50, which has reduced susceptibility to vancomycin, has a remarkably thickened cell wall with an increased proportion of glutamine nonamidated muropeptides . In addition, Mu50 had enhanced glutamine synthetase and L-glutamine D-fructose-6-phosphate aminotransferase activities, which are involved in the cell-wall peptidoglycan synthesis pathway . Furthermore, significantly increased levels of incorporation of (14)C-labeled D-glucose into the cell wall was observed in Mu50 . Unlike a femC mutant S . aureus strain, increased levels of production of nonamidated muropeptides in Mu50 was not caused by lower levels of glutamine synthetase activity but was considered to be due to the glutamine depletion caused by increased glucose utilization by the cell to biosynthesize increased amounts of peptidoglycan . After the cells were allowed to synthesize cell wall in the absence or presence of glucose and glutamine, cells with different cell-wall thicknesses and with cell walls with different levels of cross-linking were prepared, and susceptibility testing of these cells demonstrated a strong correlation between the cell-wall thickness and the degree of vancomycin resistance . Affinity trapping of vancomycin molecules by the cell wall and clogging of the outer layers of peptidoglycan by bound vancomycin molecules were considered to be the mechanism of vancomycin resistance of Mu50 . The reduced cross-linking and the increased affinity of binding to vancomycin of the Mu50 cell wall presumably caused by the increased proportion of nonamidated muropeptides may also contribute to the resistance to some extent. Antimicrob Agents Chemother, 2000 Sep, 44(9), 2271 - 5 Characterization of a variant of vga(A) conferring resistance to streptogramin A and related compounds; Haroche J et al.; A variant of the vga(A) gene (1,575 bp), encoding an ATP-binding cassette protein conferring resistance to streptogramin A and related antibiotics, was cloned from the chromosome of a Staphylococcus aureus clinical isolate and sequenced . The sequence of the variant was similar to that of the vga(A) gene (83.2% identity) . However, the G+C content of the variant (35.6%) was higher than that of vga(A) (29%) and there was no cross hybridization between vga(A) and the variant at high stringency (> or =60 degrees C), the highest temperature at which a signal was detected being 55 degrees C . Unlike previous reports for vga(A) and vga(B), the variant of vga(A) may be present in multiple copies in the genome . These copies are chromosomal in some isolates and both chromosomal and plasmid-borne in others . Nucleotide sequences hybridizing at 65 degrees C with the vga(A) variant were found in all the staphylococcal strains harboring plasmids carrying both vga(B) and vat(B), which also encode resistance to streptogramin A. Am J Vet Res, 2000 Aug, 61(8), 951 - 9 Phagocytosis and killing of Staphylococcus aureus by bovine neutrophils after priming by tumor necrosis factor-alpha and the des-arginine derivative of C5a; Rainard P et al.; OBJECTIVES: To evaluate effects of proinflammatory mediators on phagocytosis and killing of Staphylococcus aureus, the oxidative burst (OB), and expression of receptors for opsonins by bovine neutrophils . SAMPLE POPULATION: Neutrophils from 10 cattle . PROCEDURE: Neutrophils were primed with recombinant bovine tumor necrosis factor-alpha (TNF-alpha) or the des-arginine derivative of bovine C5a (C5a(desArg)) and mixed with S aureus . Phagocytosis and OB were measured by use of flow cytometry . Rate of phagocytosis and intracellular killing were evaluated . Expression of receptors for immunoglobulins and the C3bi fragment of complement were estimated by use of flow cytometry . RESULTS: Priming of neutrophils by TNF-alpha improved phagocytosis of S aureus with a concentration-dependent effect . Phagocytosis of preopsonized washed bacteria was increased by activation of neutrophils with C5a(desArg) . Phagocytosis was optimal when neutrophils primed with TNF-alpha were activated with C5a(desArg) . The OB of phagocytizing neutrophils was highest when TNF-alpha and C5a(desArg) were used in combination . Bactericidal activity of neutrophils was stimulated by priming with TNF-alpha or C5a(desArg) . Binding of bovine IgM or IgG2 to bovine neutrophils was not stimulated byTNF-alpha, C5a(desArg), or both, and aggregated IgG1 did not bind to neutrophils regardless of their activation state . Both TNF-alpha and C5a(desArg) increased expression of beta2 integrins (CD18), with the highest expression when they were used in combination . CONCLUSIONS AND CLINICAL RELEVANCE: The mediators TNF-alpha and C5a(desArg) stimulated phagocytic killing by neutrophils and potentiated each other when used at suboptimal concentrations . Bovine neutrophils have enhanced bactericidal activities at inflammatory sites when TNF-alpha, C5a(desArg), or both are produced locally. J Infect Dis, 2000 Sep, 182(3), 888 - 94 Epub 2000 Aug 17. Expression of the chemokine receptors CXCR1 and CXCR2 on granulocytes in human endotoxemia and tuberculosis: involvement of the p38 mitogen-activated protein kinase pathway; Juffermans NP et al.; The chemokine receptors CXCR1 and CXCR2 critically determine the functional properties of granulocytes . To obtain insight in the regulation of these receptors during infection, CXCR expression was determined on blood granulocytes by fluorescence-activated cell sorter analysis in healthy subjects intravenously injected with lipopolysaccharide (LPS) and in patients with active tuberculosis . In healthy subjects, LPS induced a transient decrease in granulocyte CXCR1 and CXCR2 expression, whereas in tuberculosis patients, only CXCR2 showed reduced levels . In whole blood in vitro, LPS, lipoarabinomannan from Mycobacterium tuberculosis, and lipoteichoic acid from Staphylococcus aureus reduced expression of CXCR2 but not of CXCR1 . CXCR2 down-regulation induced by LPS or tumor necrosis factor-alpha in vitro was abrogated by a p38 mitogen-activated protein kinase (MAPK) inhibitor . Granulocytes may down-regulate CXCR2 and, to a lesser extent, CXCR1 at their surface upon their first interaction with mycobacterial or bacterial pathogens by a mechanism that involves activation of p38 MAPK. Infect Immun, 2000 Sep, 68(9), 5443 - 6 Contribution of clumping factor B to pathogenesis of experimental endocarditis due to Staphylococcus aureus; Entenza JM et al.; Staphylococcus aureus Newman with an insertion mutation in clfB, the gene encoding clumping factor B, only marginally decreased infection rate (P>0.05) in rats with experimental endocarditis . In contrast, clfB complementation on a multicopy plasmid significantly increased infectivity (P<0.05) over the deleted mutants . Although clfB could affect endovascular infection, its importance in experimental endocarditis was limited. Infect Immun, 2000 Sep, 68(9), 5385 - 92 Staphylococcus aureus RN6390 replicates and induces apoptosis in a pulmonary epithelial cell line; Kahl BC et al.; Staphylococcus aureus frequently colonizes the airways of patients with compromised airway defenses (e.g., cystic fibrosis {CF} patients) for extended periods . Persistent and relapsing infections may be related to live S . aureus bacteria actively residing inside epithelial cells . In this study, we infected a respiratory epithelial cell line, which was derived from a CF patient, with S . aureus RN6390 . Internalization of S . aureus was found to be time and dose dependent and could be blocked by cytochalasin D . Transmission electron microscopy revealed that internalized bacteria resided within endocytic vacuoles without any evidence of lysosomal fusion in a 24-h period . The results of internalization experiments and time-lapse fluorescence microscopy of epithelial cells infected with green fluorescent S . aureus indicate that, after an initial lag period of 7 to 9 h, intracellular bacteria began to replicate, with three to five divisions in a 24-h period, leading to apoptosis of infected cells . Induction of apoptosis required bacterial internalization and is associated with intracellular replication . The slow and gradual replication of S . aureus inside epithelial cells hints at the role of host factors or signals in bacterial growth and further suggests possible cross talk between host cells and S . aureus. Infect Immun, 2000 Sep, 68(9), 5205 - 9 Production of toxic shock syndrome toxin 1 by Staphylococcus aureus requires both oxygen and carbon dioxide; Ross RA et al.; The effect of O(2) and CO(2) on expression of toxic shock syndrome toxin 1 (TSST-1) by Staphylococcus aureus was investigated under controlled growth conditions with continuous-culture techniques . To stimulate TSST-1 production, air and anaerobic gas were premixed before delivery to the culture vessel . At a growth rate-or mass doubling time (t(d))-of 3 h, production of specific TSST-1 (expressed as micrograms per milligram of cell dry weight) was 5 . 9-fold greater at an O(2) concentration of 4% than under anaerobic conditions . Increasing the O(2) concentration to 11% did not result in a significant increase (P> 0.05) in the rate of toxin production over that during growth in 4% O(2) but did result in a significant increase (4.9-fold; P<0.001) in the rate of toxin production over that during anaerobic growth . At a t(d) of 9 h, addition of 3.5% O(2) resulted in a 7.6-fold increase in specific TSST-1 production . When room air was sparged through a culture growing at a t(d) of 9 h, TSST-1 production increased significantly (by 3.4-fold) over that during anaerobic growth . When a growth environment of 4% O(2)-remainder N(2) was studied, no increase in TSST-1 production was observed; this was also the case with 8% O(2) at gas-flow rates of 0.1, 0.2, and 0.4 liters/min . In all experiments, production of biomass (expressed as milligrams of cell dry weight per milliliter) increased, indicating that O(2) was metabolized by S . aureus . Addition of CO(2) to the gas mix (4% O(2), 10% CO(2), 86% N(2)) resulted in a 5.1- to 6.8-fold increase in TSST-1 production over that during anaerobic growth and a 3.6-fold increase over that during growth in an environment of 4% O(2)-remainder N(2) . The agr mutant strain tested produced 6.1-fold more specific TSST-1 in a growth environment of 4% O(2)-10% CO(2)-86% N(2) than during anaerobic growth . These data suggest that in this system, O(2) alone does not trigger production of TSST-1; rather, both CO(2) and O(2) are required. Infect Immun, 2000 Sep, 68(9), 4865 - 71 Adherence of Staphylococcus aureus to endothelial cells: influence of capsular polysaccharide, global regulator agr, and bacterial growth phase; Pohlmann-Dietze P et al.; The adherence of Staphylococcus aureus to human endothelial cells (EC) is probably an important step in the pathogenesis of systemic staphylococcal infections . We examined the influence of type 5 capsular polysaccharide (CP5) production, the global regulator agr, and the bacterial growth phase on S . aureus adherence to EC . Whereas S . aureus Newman showed maximal adherence to EC in the logarithmic phase of growth, an isogenic agr mutant showed maximal adherence in the stationary growth phase . S . aureus adherence to EC and CP5 expression were negatively correlated: a mutation in the agr locus diminished CP5 production and led to increased adherence . Likewise, induction of CP5 expression by addition of NaCl to the growth medium resulted in reduced staphylococcal adherence to EC . S . aureus Newman cells that adhered to EC did not express CP5 . A Newman cap5O mutant was acapsular and showed significantly greater adherence to EC than the parental strain did (P<0.005) . Complementation of the cap5O mutation in trans restored CP5 expression and reduced EC adherence to a level similar to that of the parental strain . The enhanced adherence shown by the cap5O mutant was similar in magnitude to that of the agr mutant or the cap5O agr double mutant . Cells of the cap5O mutant and cap5O agr double mutant harvested from stationary-phase cultures adhered significantly better than did cells harvested in the exponential growth phase . These data are consistent with the postexponential and agr-independent expression by S . aureus of at least one putative EC adhesin, whose binding domain may be masked by CP5. Vet Microbiol, 2000 Sep 25, 76(2), 153 - 62 Differences between Danish bovine and human Staphylococcus aureus isolates in possession of superantigens; Larsen HD et al.; PCR-assays for the detection of staphylococcal enterotoxins A-E, and H, toxic shock toxin 1, and exfoliative toxins A and B were evaluated against phenotypic methods, and performed well . Four hundred and fourteen isolates of Staphylococcus aureus from Danish cases of bovine mastitis were screened for genes encoding these superantigens . One hundred isolates from Danish human carriers were also included in the study . In contrast to the frequent presence of genes encoding and in vitro expression of superantigens among the human carrier isolates, only one of 414 isolates from bovine mastitis carried the genes encoding enterotoxin C and toxic shock toxin-1 . These results further support the hypothesis that the bovine and human S . aureus reservoirs constitute two separate sub-populations of the species S . aureus . The results also show that these superantigens are generally not present in Danish S . aureus isolates from bovine mastitis, and thus play no essential role in the pathogenesis of bovine S . aureus mastitis. J Mol Microbiol Biotechnol, 1999 Nov, 1(2), 295 - 302 Occurrence of mazEF-like antitoxin/toxin systems in bacteria; Mittenhuber G; The mazEF locus of Escherichia coil located in an operon together with the upstream relA gene (encoding ATP:GTP 3'-pyrophosphotransferase; (p)ppGpp synthetase), encodes an antitoxin/toxin system which might play a role in programmed cell death under stress and starvation conditions at high cell densities . By homology searches, chromosomally encoded orthologous systems were identified in a variety of bacteria, sometimes without the MazE-like antitoxin, and several bacterial species possess multiple MazEF-like systems (paralogs) . In many gram positive bacteria, the mazEF-locus is located directly upstream of the sigB (stress sigma factor sigmaB) operon in a putative operon together with the upstream dal (aIr) gene (encoding D-alanine racemase) . The acidic antitoxins are less conserved than the basic toxins . The differences in genomic organization of the mazEFloci in E . coli versus those in gram positive bacteria might indicate their association with different stress response regulons in these organisms . A study on the sigmaB operon of Staphylococcus aureus showed that the mazF gene of this organism is cotranscribed with the sigmaB operon in response to heat shock, providing the first example that the expression of the mazEFlocus might be indeed associated with stress responses. Thromb Res, 2000 Aug 1, 99(3), 249 - 58 Antiplatelet activity of Staphylococcus aureus lipoteichoic acid is mediated through a cyclic AMP pathway; Sheu JR et al.; In this study, Gram-positive Staphylococcus aureus lipoteichoic acid (LTA) dose dependently (0.1-1.0 microg/mL) and time dependently (10-60 min) inhibited platelet aggregation in human platelets stimulated by agonists (i.e., thrombin and collagen) . LTA also dose dependently inhibited intracellular Ca(2+) mobilization in human platelets stimulated by collagen . In addition, LTA (0.5 and 1.0 microg/mL) dose dependently increased the formation of cyclic AMP but not cyclic GMP in platelets . LTA (0.5 and 1.0 microg/mL) did not significantly increase the production of nitrate within a 10-min incubation period . Rapid phosphorylation of a platelet protein of M(r) 47,000, a marker of protein kinase C activation, was triggered by PDBu (0.03 microM) . This phosphorylation was dose dependently inhibited by LTA (0.5 and 1.0 microg/mL) within a 10-min incubation period . Furthermore, LTA (0.5 and 1.0 microg/mL) also inhibited platelet aggregation induced by PDBu (0.03 microM) in human platelets.These results indicate that the antiplatelet activity of LTA may be involved in the increase of cyclic AMP, leading to inhibition of intracellular Ca(2+) mobilization and protein kinase C activity . Therefore, LTA-mediated alteration of platelet function may contribute to bleeding diathesis in septicemic and endotoxemic patients. J Infect, 2000 Jul, 41(1), 23 - 31 Clinical isolates of Staphylococcus aureus exhibit diversity in fnb genes and adhesion to human fibronectin; Peacock SJ et al.; OBJECTIVES: The fibronectin-binding proteins (FnBPs) of Staphylococcus aureus are involved in the pathogenesis of infection, but their characteristics in clinical isolates are incompletely defined . The aim of this study was to evaluate phenotypic and genotypic characteristics of the FnBPs of a large collection of recent isolates . METHODS: The adherence of 163 S . aureus isolates to immobilized fibronectin was compared with that of S . aureus 8325-4 using a microtitre assay . The presence of the genes encoding the fibronectin-binding proteins FnBPA and FnBPB was evaluated by Southern dot blot using probes specific for region A of fnbA or fnbB . RESULTS: The adherence of clinical isolates to fibronectin (expressed as a percentage of the mean adherence of S . aureus 8325-4) was 56%-125% for 155 isolates (95%), and less than 20% for eight isolates (5%) . Adherence of the bacterial group associated with orthopaedic implant-associated infection was significantly greater than that for isolates associated with nasal carriage, endocarditis, or septic arthritis/osteomyelitis . Southern dot blot demonstrated that 126/163 isolates had two genes (77%) and 37/163 had one detectable gene (23%) . There was no difference in adherence between isolates with one or two fnb, but isolates associated with invasive disease (endocarditis or primary septic arthritis and/or osteomyelitis) were more likely to have two genes . CONCLUSIONS: These data demonstrate diversity in the FnBPs of clinical isolates of S . aureus . The findings suggest that the interplay between pathogenesis and a single virulence determinant is unlikely to be a uniform process across a spectrum of infections . This confirms the need to extend the study of staphylococcal pathogenesis from the laboratory to non-uniform populations of clinically relevant isolates. Microbiol Immunol, 2000, 44(6), 463 - 72 Modification of autolysis by synthetic peptides derived from the presumptive binding domain of Staphylococcus aureus autolysin; Takano M et al.; The autolytic cell wall hydrolase of Staphylococcus aureus, Atl, contains three highly cationic repeats in the central region of the amino acid sequence, and the repeats are presumed to have the role of binding the enzyme to some components on the cell surface . To explain the possible function of the repeats, we synthesized a number of 10- to 30-mer oligopeptides based on the Atl amino acid sequence (Thr432-Lys610) containing repeat 1, and examined their effects on the autolysis of S . aureus cells . When the peptides were added to a cell suspension of S . aureus under low ionic strength conditions, five peptides, A10, A11, A14, A16 and B9, showed immediate increases in optical density (OD) of the cell suspension accompanied by decreases in viable cell counts . After the immediate increases, the ODs for A10 and A14 changed little in the first 2 hr . In contrast, the ODs for A11 and A16 decreased rapidly . When peptide A10 was added to suspensions of heat-killed whole cells, crude cell walls and a crude peptidoglycan preparation, their ODs were increased approximately 2-fold . In contrast, the OD was not increased when the peptide was added to a suspension of pure peptidoglycan from which anionic polymers had been removed . Light microscopic and transmission electron microscopic study showed that A10 and A14 inhibited autolysis and that A11 and A16 induced autolysis earlier than the control . These results suggest strongly that the peptides adsorb to and precipitate on the anionic cell surface polymers such as teichoic acid and lipoteichoic acid via ionic interaction . The effects of peptides on the autolysis may be the results of the modification of S . aureus autolysin activities . These peptides, especially the 10-mer peptide B9 (PGTKLYTVPW) that represents the C-terminal half of A10 and N-terminal half of A11, may be important segments for Atl to bind to the cell surface. Arch Pediatr, 2000 Jul, 7(7), 779 - 83 {Hand infections in children}; Journeau P; Subcuticular whitlow is the most frequent form of hand infections in children, mainly resulting from the penetration of a foreign body such as a thorn bush or onychophagy . Local antispesis, Dakin's fluid baths and eventually antibiotics directed toward Staphylococcus aureus are usually effective therapies . Extension to a subcutaneous whitflow needs surgery . Specific treatment must be used in case of fungal and herpetic whitlows . Paronychia tendinosa is a severe form of infection affecting flexor tendons sheaths with a high risk of sequelae; it requires an emergency surgical excision and i.v . anti-Staphylococcus aureus antibiotics therapy . Hand bites need particular attention and systematic surgical advice. FEBS Lett, 2000 Aug 11, 479(1-2), 6 - 9 Antibacterial activities of temporin A analogs; Wade D et al.; Temporin A (TA) is a small, basic, highly hydrophobic, antimicrobial peptide amide (FLPLIGRVLSGIL-NH2) found in the skin of the European red frog, Rana temporaria . It has variable antibiotic activities against a broad spectrum of microorganisms, including clinically important methicillin-sensitive and -resistant Staphylococcus aureus as well as vancomycin-resistant Enterococcus faecium strains . In this investigation the antimicrobial activity and structural characteristics of TA synthetic analogs were studied . For antibacterial activity against S . aureus and enterococcal strains, the hydrophobicity of the N-terminal amino acid of TA was found to be important as well as a positive charge at amino acid position 7, and bulky hydrophobic side chains at positions 5 and 12 . Replacing isoleucine with leucine at amino acid positions 5 and 12 resulted in the greatest enhancement of antibacterial activity . In addition, there was little difference between the activities of TA and its all-D enantiomer, indicating that the peptide probably exerts its effect on bacteria via non-chiral interactions with membrane lipids. J Bacteriol, 2000 Sep, 182(17), 4995 - 7 The rel gene is essential for in vitro growth of Staphylococcus aureus; Gentry D et al.; The stringent response in Staphylococcus aureus is mediated by the nucleotide guanosine pentaphosphate, whose synthesis is catalyzed by the product of the rel gene . We report here that the rel gene is essential for the in vitro growth of S . aureus, distinguishing it from all other bacteria tested for this requirement. J Bacteriol, 2000 Sep, 182(17), 4822 - 8 Analysis of genetic elements controlling Staphylococcus aureus lrgAB expression: potential role of DNA topology in SarA regulation; Fujimoto DF et al.; Penicillin-induced killing and murein hydrolase activity in Staphylococcus aureus are dependent on a variety of regulatory elements, including the LytSR two-component regulatory system and the virulence factor regulators Agr and Sar . The LytSR effects on these processes can be explained, in part, by the recent finding that a LytSR-regulated operon, designated lrgAB, affects murein hydrolase activity and penicillin tolerance . To examine the regulation of lrgAB expression in greater detail, we performed Northern blot and promoter fusion analyses . Both methods revealed that Agr and Sar, like LytSR, positively regulate lrgAB expression . A mutation in the agr locus reduced lrgAB expression approximately sixfold, while the sar mutation reduced lrgAB expression to undetectable levels . cis-acting regulatory elements involved in lrgAB expression were identified by fusing various fragments of the lrgAB promoter region to the xylE reporter gene and integrating these constructs into the chromosome . Catechol 2,3-dioxygenase assays identified DNA sequences, including an inverted repeat and intrinsic bend sites, that contribute to maximal lrgAB expression . Confirmation of the importance of the inverted repeat was achieved by demonstrating that multiple copies of the inverted repeat reduced lrgAB promoter activity, presumably by titrating out a positive regulatory factor . The results of this study demonstrate that lrgAB expression responds to a variety of positive regulatory factors and suggest that specific DNA topology requirements are important for optimal expression. Br Homeopath J, 2000 Jul, 89(3), 106 - 15 Immunologic changes in healthy probands and HIV infected patients after oral administration of Staphylococcus aureus 12c: a pilot study; Danninger T et al.; The tumoricidal and antiviral effects of Staphylococcal toxins are well documented . In a preliminary study we investigated the immune modulating properties of these toxins by administering single oral doses of a 12c potency of a lysate of Staphylococcus aureus Cowan I, to 4 healthy probands and 12 HIV infected patients with clinical symptoms . We observed a decrease of circulating immune complexes in the healthy probands as well as in the HIV positive patients, accompanied in the latter by a significant increase of CD4 lymphocytes, CD4/CD8-ratio and an improvement of the HIV related symptoms . None of the dose dependent toxic effects commonly found in Staphylococcal sepsis were noticed . Further research on the immune modulating effects of potencies of bacterial superantigens is suggested, especially in view of a possible treatment for HIV infected and other immune compromised patients. Am J Physiol Regul Integr Comp Physiol, 2000 Aug, 279(2), R610 - 6 Fever and motor activity in rats following day and night injections of Staphylococcus aureus cell walls; Luker FI et al.; Body temperature and physical activity are affected by both circadian cycles and pyrogens . We injected intraperitoneally 2.5 x 10(9) cell walls of the gram-positive organism Staphylococcus aureus or sterile saline at three different times in the circadian temperature and activity rhythm of Sprague-Dawley rats . Irrespective of whether pyrogen injections were made when the rats were inactive (injection at 0900), just before the nighttime rise in activity and body temperature (1630), or during high activity (2100), the peak body temperature attained and the time to reach peak temperature were indistinguishable . The fever response, as measured by the thermal-response index, was greatest, however, when body temperature and activity were in the lowest phase . Physical activity was inhibited by night but not day injection of S . aureus . Our results provide the first description of experimental fever resulting from a gram-positive pyrogen in rats and the first time an aspect of sickness behavior (suppressed motor activity) has been associated with fever resulting from simulated gram-positive bacterial infection. Bioorg Med Chem Lett, 2000 Aug 7, 10(15), 1751 - 4 Studies on the novel anti-staphyloccal compound nematophin; Kennedy G et al.; A number of analogues of the recently described compound nematophin were prepared and studied for antibacterial activity . The 2-phenyl derivative was found to exhibit exceptional activity against methicillin resistant Staphylococcus aureus (MRSA) whereas the isosteric benzimidazole analogue was much less active. J Orthop Res, 2000 May, 18(3), 485 - 93 Effects of hydrosyapatite coating on Ti-6A1-4V implant-site infection in a rabbit tibial model; Vogely HC et al.; To investigate the effect of implant type after direct contamination, a hydroxyapatite-coated or noncoated Ti-6A1-4V implant was inserted into both tibiae of 32 New Zealand White rabbits . Prior to implantation, the left tibia was contaminated with increasing concentrations of Staphylococcus aureus (10(2)-10(5) colony-forming units), ranging from very low (10(2)) to relatively high (10(5)) . Four weeks after implantation, half of the tibial bone adjacent to the implant was harvested for bacteriological examination . Bacterial counts were quantified by plating serial dilutions . For the histological evaluation, sections of the implant with the remaining tibia were examined by semiquantitative scoring of infection parameters . The bacteriological data showed the inoculum dose and implant type to have a significant effect on the culture outcome: more bacteria were retrieved from the hydroxyapatite-coated implants than from the noncoated titanium implants . Histological evaluation showed an increased score for the infected left tibiae compared with their contralateral control . In addition, with increasing inoculum dosage, the difference between the two types of implant increased . We demonstrated that infections can occur with biocompatible, noncemented implants and that they are related to the dose of the original inoculum . Bacteria were more likely to grow onto or next to the hydroxyapatite implants than on titanium implants and resulted in a more severe histopathological characterization of infection. Indian J Med Res, 2000 Mar, 111, 77 - 80 Characterization of methicillin resistant Staphylococcus aureus strains by a set of MRSA phages; Mathur MD et al.; A recently developed international set of phages for typing methicillin resistant Staphylococcus aureus (MRSA) was used to characterize 300 strains of MRSA . The results were compared to that of phage typing with conventional phages and reverse phage typing . The use of MRSA phages increased the percentage typability from 17.6 per cent with the conventional set to 45.6 per cent with MRSA set and the strains were recognised as five distinct phage pattern viz., 622, M3/M5, MR8/MR12/MR25, 30/33/38 and mixed group . Phage type 622 was the most prevalent . On reverse phage typing 73 per cent strains could be typed with most strains belonging to one pattern i.e., 83A complex with limited discrimination . These 83A strains were highly resistant to erythromycin (98%) and tetracycline (93%) . Our results show that MRSA phages are more useful in increasing typability and discrimination between the strains as compared to the conventional phages, reverse phage typing, and antibiogramtyping. Am J Med, 2000 Jul, 109(1), 52 - 8 Third-generation thrombolytic drugs; Verstraete M; Several third-generation thrombolytic agents have been developed . They are either conjugates of plasminogen activators with monoclonal antibodies against fibrin, platelets, or thrombomodulin; mutants, variants, and hybrids of alteplase and prourokinase (amediplase); or new molecules of animal (vampire bat) or bacterial (Staphylococcus aureus) origin . These variations may lengthen the drug's half-life, increase resistance to plasma protease inhibitors, or cause more selective binding to fibrin.Compared with the second-generation agent (alteplase), third-generation thrombolytic agents such as monteplase, tenecteplase, reteplase, lanoteplase, pamiteplase, and staphylokinase result in a greater angiographic patency rate in patients with acute myocardial infarction, although, thus far, mortality rates have been similar for those few drugs that have been studied in large-scale trials . Bleeding risk, however, may be greater. J Exp Med, 2000 Aug 7, 192(3), 405 - 12 Human monocyte-derived dendritic cells induce naive T cell differentiation into T helper cell type 2 (Th2) or Th1/Th2 effectors . Role of stimulator/responder ratio; Tanaka H et al.; The subset of dendritic cells (DCs) and the nature of the signal inducing DC maturation determine the capacity of DCs to generate polarized immune responses . In this study, we show that the ability of human monocyte-derived DCs (myeloid DC(1)) to promote T helper type 1 (Th1) or Th2 differentiation was also found to be critically dependent on stimulator/responder ratio . At a low ratio (1:300), mature DCs that have been differentiated after inflammatory (Staphylococcus aureus Cowan 1 or lipopolysaccharide) or T cell-dependent (CD40 ligand) stimulation induced naive T cells to become Th2 (interleukin {IL}-4(+), IL-5(+), interferon gamma) effectors . Th2 differentiation was dependent on B7-CD28 costimulation and enhanced by OX40-OX40 ligand interactions . However, high DC/T cell ratio (1:4) favored a mixed Th1/Th2 cell development . Thus, the fact that the same DC lineage stimulates polarized Th1 or Th2 responses may be relevant since it allows the antigen-presenting cells to initiate an appropriate response for the signal received at the peripheral sites . Controlling the number and the rate of DC migration to the T cell areas in lymphoid tissues may be important for the therapeutic use of DCs. Am J Pathol, 2000 Aug, 157(2), 647 - 58 Proinflammatory cytokine, chemokine, and cellular adhesion molecule expression during the acute phase of experimental brain abscess development; Kielian T et al.; Brain abscess represents the infectious disease sequelae associated with the influx of inflammatory cells and activation of resident parenchymal cells in the central nervous system . However, the immune response leading to the establishment of a brain abscess remains poorly defined . In this study, we have characterized cytokine and chemokine expression in an experimental brain abscess model in the rat during the acute stage of abscess development . RNase protection assay revealed the induction of the proinf